A Weary Road : Shell Shock in the Canadian Expeditionary Force, 1914-1918 9781442644717

Table of contents :
Cover
Copyright
Contents
List of Tables and Figures
Acknowledgments
List of Abbreviations
Introduction
1 Framing Shell Shock: Nervous Illness before the Great War
2 Purely Shattered Nerves: British and Canadian Approaches to Treatment, 1914–1915
3 Baptism of Fire: The Ypres Salient, 1915
4 The CEF’s Shell Shock Crisis, Spring 1916
5 Treatment of Evacuated Cases, 1915–1916
6 The BEF’s Shell Shock Crisis on the Somme, June–November 1916
7 Managing Shell Shock at the Front, October 1916-June 1917
8 Illusions of Success: The NYDN Centres, June–December 1917
9 Failure and Retrenchment, 1917–1918
Conclusion
Appendix A: Special Shell Shock Hospitals and NYDN Centres in Army Areas
Appendix B: A Note on First World War Medical Sources
Notes
Bibliography
Index

Citation preview

A WEARY ROAD Shell Shock in the Canadian Expeditionary Force, 1914–1918

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A Weary Road Shell Shock in the Canadian Expeditionary Force, 1914–1918

MARK OSBORNE HUMPHRIES

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

© University of Toronto Press 2018 Toronto Buffalo London utorontopress.com Printed in Canada ISBN 978-1-4426-4471-7

Printed on acid-free paper.

Library and Archives Canada Cataloguing in Publication Humphries, Mark Osborne, 1981−, author A weary road : shell shock in the Canadian Expeditionary Force, 1914−1918 / Mark Osborne Humphries. Includes bibliographical references. ISBN 978-1-4426-4471-7 (cloth) 1. Canada. Canadian Army. Canadian Expeditionary Force.  2. War neuroses − Diagnosis – Canada – History − 20th century.  3. War neuroses – Treatment – Canada − History − 20th century.  4. Soldiers − Mental health services – Canada – History − 20th century.  5. Human body in mass media.  6. World War, 1914−1918 − Medical care − Canada. I. Title. RC550.H86 2018   616.85'212   C2018-902583-2

This book has been published with the help of a grant from the Federation for the Humanities and Social Sciences, through the Awards to Scholarly Publication Program, using funds provided by the Social Sciences and Humanities Research Council of Canada. University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council, an agency of the Government of Ontario.

Funded by the Financé par le Government gouvernement du Canada of Canada

Contents

List of Tables and Figures  vii Acknowledgments  ix List of Abbreviations  xiii Introduction 3 1  Framing Shell Shock: Nervous Illness before the Great War  14 2  Purely Shattered Nerves: British and Canadian Approaches to Treatment, 1914–1915  35 3  Baptism of Fire: The Ypres Salient, 1915  48 4  The CEF’s Shell Shock Crisis, Spring 1916  87 5  Treatment of Evacuated Cases, 1915–1916  120 6  The BEF’s Shell Shock Crisis on the Somme, June–November 1916  157 7  Managing Shell Shock at the Front, October 1916-June 1917  198 8  Illusions of Success: The NYDN Centres, June–December 1917  236 9  Failure and Retrenchment, 1917–1918  268 Conclusion 311 Appendix A: Special Shell Shock Hospitals and NYDN Centres in Army Areas  329 Appendix B: A Note on First World War Medical Sources  333 Notes  339 Bibliography  415 Index  443 Illustration section follows page 178.

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Tables and Figures

Tables Table 1.1 Hospital admissions and evacuation rates, categories associated with nervous disease, South African War, 1899−1902 30 Table 2.1 Hospital admissions and evacuation rates, categories associated with nervous disease, August to December 1914  47 Table 3.1 Disposition of patients admitted to Field Ambulance Dressing Stations for nervous and mental illness, 1915  76 Table 3.2 Disposition of primary admissions for nervous and mentally ill patients, Nos. 4 and 5 Field Ambulances, 1915  78 Table 3.3 Disposition of patients admitted to Divisional Rest Stations for nervous and mental illness, 1915  79 Table 4.1 Evacuations to Nos. 10 and 17 CCSs from 2nd Canadian Division Units, April 1916  103 Table 4.2 Evacuations from the Canadian Corps to Nos. 10, 17, and 3rd Canadian CCSs, June 1916  114 Table 6.1 Shell shock admissions to No. 14 (British) Field Ambulance, July 1916  175 Table 9.1 Weekly summary of NYDN and other patients in BEF hospitals, March−June 1918  294 Table 9.2 Weekly summary of NYDN and other patients in BEF hospitals, July−November 1918  296 Table 9.3 NYDN cases and other casualties as reported by First Army, August−November 1918  302 Table 9.4 NYDN cases by diagnosis and outcomes as reported by the Canadian Corps, 1918  303–4

viii

Tables and Figures

Figures Figure 3.1 Diagnoses on admission to Nos. 1, 2, and 3 Field Ambulances by months, 1915  60 Figure 5.1 Outcome of cases by month of admission, Canadian Special Hospital, Granville, 1915−1917  154 Figure 6.1 Daily shell shock admissions, No. 34 Casualty Clearing Station, June−November 1916  173 Figure 9.1 Canadian patient outcomes at No. 4 Stationary Hospital, 1916−1917 274

Acknowledgments

This project began in 2005 when I was a student working with Terry Copp and Roger Sarty at Wilfrid Laurier University. In the subsequent thirteen years, it has grown into the present work and although it may have a single author listed on the cover, it was written with the assistance, mentorship, and expertise of many. I am in debt to many people, and have tried to list them all here, but any errors remain mine alone. Wilfrid Laurier University was where I began my career as a historian, first as an undergraduate and later as a master’s student. I was taught the craft by Hilary Earl, Leonard Friesen, John Laband, Doug and Joyce Lorimer, Michael Sibalis, and Cynthia Comacchio. As a graduate student at the Laurier Centre for Military Strategic and Disarmament Studies (LCMSDS), this project was helped by the friendship and assistance of Mike Bechthold, Sarah Cozzi, Geoff Hayes, Andrew Iarocci, Geoff Keelan, Marc Kilgour, Kellen Kurschinski, David Livingstone, Vanessa McMackin, Katie Rose, Matt Symes, Jane Whalen, and Jim Wood. At the University of Western Ontario, where I completed my PhD, I am indebted to friends and mentors including Adrian Ciani, Dorotea Gucciardo, Luz Maria Hernández-Sáenz, Shelly McKellar, Francine McKenzie, Thomas F. Sea, and Robert Wardhaugh. Most of all, though, I must thank Jonathan Vance, who supervised my PhD dissertation and read several of the articles on shell shock that I published along the road to this book. Thank you all for your support. My first university teaching position was at Mount Royal University in Calgary, Alberta, a place I still have many friends. Amongst those, I would like to thank Peter Morton, Scott Murray, Carmen Neilson, and Jennifer Pettit. Joe Anderson and Jenn each joined me for two field schools on the First World War and so endured endless discussions

x Acknowledgments

about shell shocked soldiers and the difficulties of this type of research. Thomas E. Brown has been a special friend and mentor to me over the years. In addition to being a remarkable scholar and teacher as well as a wonderfully generous and thoughtful person, he was one of the few people to write about shell shock in the CEF. He and I spent many hours at Mount Royal discussing how to tackle the historiography and sources and I am very much in debt to him in so many ways. Tom: I hope this book lives up to your expectations. The bulk of this book was written after returning to Wilfrid Laurier from Memorial University in 2014 and I have to thank all my colleagues in the  Department of History for providing such a collegial and supportive working environment. It is truly a pleasure to work with you all and to be able to draw on such a diverse range of expertise. Let me single out Tarah Brookfield and Peter Farrugia at Laurier’s Brantford Campus and in Waterloo Mary Chaktsiris, Blaine Chiasson, Adam Crerar, Cynthia Comacchio, Darryl Dee, Amy Milne-Smith, David Monod, Darren Mulloy, Chris Nighman, Susan Neylan, Eva Plach, Roger Sarty, Michael Sibalis, and Kevin Spooner. Cindi Wieg, Heather Vogel, and Tamara Hunt also helped me navigate the paperwork involved in paying research assistants and processing expense claims. In the Tri-University graduate program I would also like to thank Geoff Hayes, Whitney Lackenbauer, Linda Mahood, and Heather MacDougall. As a research chair and director of the Laurier Centre for Military Strategic and Disarmament Studies (LCMSDS), I have the privilege of working with some of the best students in the field who do double duty running our various programs and doing their own work on the First World War. Their diligence and expertise have given me the time necessary to research and write and this book would not have been possible without them. I want to thank my PhD students Brittany Dunn, Trevor Ford, Eliza Richardson, Katrina Pasierbek, Kyle Pritchard, Lyndsay Rosenthal, and Eric Story as well my MA students Heather Ellis, Sara Karn, Alec Maavara, Anastasia Pivnicki, and Ben Toews. I have also had the privilege to work with an outstanding post-doctoral research fellow, Kandace Bogaert, who has been conducting research on returned shell shocked soldiers. Matt Baker, the LCMSDS research manager, has helped in innumerable ways: listening to me rant about history some days and paperwork on others, all the while quietly making sure that everything runs smoothly and that nothing falls through the cracks.

Acknowledgments xi

This project would also not have been realized without the financial support of many people and organizations, including a Stan­ dard Research Grant and Insight Grant (with Terry Copp and Cynthia Comacchio) from the Social Sciences and Humanities Research Council (SSHRC), research funding from Mount Royal University, start-up funding from the Faculty of Arts and Social Sciences at Memorial University, direct financial support from the Vice President of Research at Memorial University, and grants from the Vice President of Research at Wilfrid Laurier University. Thank you to Lynne Phillips, Sean Cadigan, Carrie Dyck, and Robert Gordon for your support. I was able to finish writing and editing the book thanks to a teaching release in the fall of 2016 provided by Dr Deborah MacLatchy, then Vice-President Academic and now President at Wilfrid Laurier University. At LCMSDS, John and Pattie Cleghorn have supported our work through many generous gifts over the years which has allowed us to train our excellent group of graduate students. Finally, my position as the Dunkley Chair in War and the Canadian Experience is generously funded by Brad and Sara Dunkley. This book would not have been possible without your support: thank you. Most importantly, I need to thank all the students whose ideas have contributed to this volume in some way, through discussions in undergraduate lectures, graduate seminars, on battlefield tours, and around the lunch table at LCMSDS. I am fortunate to be able to say that my student research assistants have been some of the brightest people in the field. This book would not have been possible without the work of Stephen Collins, Brittany Dunn, Brook Durham, Kyle Falcon, Trevor Ford, Sara Karn, Alex Large, Paula Larsson, Sarah McGarry, Alec Mavaara, Heather Randall, Eliza Richardson, Eric Story, Ben Toews, Mike Westcott, and Fay Wilson. I must especially single out Lyndsay Rosenthal for her exceptional work on this project over the years. Lyndsay has not only helped me collect documents on numerous trips to the archives in Ottawa and Australia, she has also edited parts of the manuscript and assisted in the compilation of statistics from a seemingly endless stream of admission and discharge books. Her attention to detail and willingness to take on these thankless tasks was indispensible. Professional research assistance was provided by Simon Fowler in the United Kingdom, who copied war diaries and operational files on short notice. Joan Beaumont and Ashley Ekins were kind enough to

xii Acknowledgments

fund a trip to present at a conference at the Australian War Memorial in 2015 which also allowed me to access the impressive archival holdings of the Australian War Memorial. In terms of accessing records, I also need to thank Wilhelm Kisselbach, who has translated much of the German official history of the First World War, for his expertise in working through the German sources. John, Tam, and Imogen Maker are great friends who have opened their home to me on trips to Ottawa many more times that I can count. Thank you. I must also thank my colleagues for all the conversations and exchanges over the years, including Pat Brennan, Nic Clarke, Doug Delaney, Pat Dennis, Serge Durflinger, Jack Granatstein, Bill Stewart, Gary Sheffield, and Hew Strachan. Tim Cook and Terry Copp were kind enough to read drafts of a very long manuscript. Tim’s expertise in the social and military history of the Great War helped me work through some difficult problems and his suggestions on questions of length and argument made this a better book. Terry has always been a mentor to me and more than any other shaped the way I do history. Finally, I would like to thank my friends and family for their support and for tolerating endless discussions of shell shock. This includes my parents, Hal and Judy, and my sister Gillian. Lianne Leddy is the best partner I could ask for. Her support, both emotional and academic, makes all things possible and her comments on my ideas and keen editing skills have helped me avoid many potential problems. Thanks too to our daughter Paige, who loyally woke up at 5:00 a.m. and then promptly fell back asleep once she made sure her Dad was up and ready to edit the final draft of the manuscript.

Abbreviations

A&D Books Admission and Discharge Books ADGMS Assistant Director General, Medical Services, British Expeditionary Force ADMS Assistant Director, Medical Services (Divisional Level) AEF Australian Expeditionary Force AG Adjutant General ANZAC Australia and New Zealand Expeditionary Force BEF British Expeditionary Force CAMC Canadian Army Medical Corps CCAC Canadian Casualty Assembly Centre CCS Casualty Clearing Station CEF Canadian Expeditionary Force DAH Disordered Action of the Heart DDMS Deputy Director, Medical Services (Corps Level) DGAMS Director General, Army Medical Services DGMS Director General, Medical Services, British Expeditionary Force DMS Director, Medical Services (Army Level) DRS Divisional Rest Station GHQ General Headquarters, British Expeditionary Force LOC Lines of Communication NYDN Not Yet Diagnosed (Nervous) RAMC Royal Army Medical Corps RMO Regimental Medical Officer SMB Standing Medical Board SMO Senior Medical Officer SSW Shell Shock (Wound)

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A WEARY ROAD Shell Shock in the Canadian Expeditionary Force, 1914–1918

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Introduction

Lieutenant George F., a twenty-five-year-old Anglican minister’s son from Hamilton, Ontario, joined the First Contingent of the Canadian Expeditionary Force in August 1914. Assigned to the 10th (Calgary) Battalion, F.’s unit was one of the first Canadian units to go into the trenches on 22 February 1915, attached to the Royal Irish Fusiliers for training purposes.1 Like most, F. was frightened but he dwelt on terrifying thoughts until he became overwhelmed. “I was told that I had to get my platoon into single file and to march very slowly and quietly,” F. recalled. No one was to smoke or speak or allow anything to rattle, and we were to go along at slight intervals and not lose touch with each other … Presently we came towards a brick wall and were told that this was a target for German machine guns; that “they get the range in the day time and spray it with bullets at night.” I asked the [Irish] sergeant how long it was since the last spray. He replied that they had not done it for some time so it was about due. Honestly, I had a very creepy feeling walking along that road about fifty yards from the wall. I asked what would happen if they began to spray just as we were there. The sergeant said “Everyone into the ditch.” As I went along I wished they would start and get the thing over. It is astonishing what human sensations you have under those circumstances. You don’t feel particularly soldierly. I have just as much antipathy to a man shooting me in uniform as in mufti.

As he marched at the head of his men, the young lieutenant had to fight to keep his feet moving forward, working against his natural instinct to turn and run. “My sensations in walking past that brick wall,”

4

A Weary Road

he recalled, “with one eye on the wall, one eye on the ditch and one eye on the road, were very much the sensations one has in playing musical chairs – only, in this instance, we were waiting for the music to start instead of stop.” But nothing happened and the feeling of impending doom lingered. Death was all around him. Over there a man with a blanket pulled up to his chin on a stretcher, there another motionless figure with a sheet covering his head. In a bay further on lay a distraught kilted highlander who had been hit by a shell fragment and was being treated by his comrades. “It was very upsetting,” F. said “I don’t mind admitting that the first time we went over that flat country I was jolly well afraid. I wanted to squat down behind something. I wanted to go home – anywhere where those haphazard bullets weren’t.”2 F.’s platoon returned to the trenches two nights later, and then again two nights after that. It was the silence, eerie calm, and feelings of impending doom that were most unbearable.3 At the beginning of March, the Calgarians took over their own portion of the line north of Neuve Chappelle and took their first casualties from heavy shellfire.4 F. was certain that he too would be killed; as he later confessed, he was obsessed with the thought.5 On the night of 12–13 March, a particularly severe barrage of high explosive shells began to rain down around the Calgarians. As F. huddled against the trench wall for protection, one of the shells burst above the parapet and the concussive force slammed him to the ground.6 Everything went black. When he came to a few hours later, he was surprised to find that he was alive but elation soon gave way to a general feeling that all was not right. Soon he found that he had difficulty walking, he was dizzy, and felt sick to his stomach. How had he survived, he asked himself again and again? The sense of panic which gripped him the moment the shell burst above his head became all consuming. Although he tried to “stick it out” for two more days, he could no longer hold himself together.7 After dark on 14 March, the 10th Battalion was relieved, and the next morning, F. went to see the battalion’s medical officer, who evaluated him and sent him out on the sick list to No. 2 Canadian Field Ambulance, where he was diagnosed with neurasthenia.8 After two days under observation in a field ambulance rest station, he was evacuated to No. 6 Stationary Hospital and then to the Queen’s Canadian Military Hospi­ tal, Shorncliffe.9 Doctors recorded that the lieutenant “resembles a drunken man. His complaint is a peculiar dizziness. While standing or walking the earth appears to be moving underneath [although there are] no physical signs and [his] symptoms appear exaggerated.”10

Introduction 5

Eventually F. was sent home to Canada, the first returning soldier with what was quickly becoming known as shell shock. The stories of men like F. capture the horrors of the Great War, conveying the human costs of modern warfare while allowing us to connect emotionally to an otherwise distant conflict. It is one of the most studied but least understood aspects of Britain and the Empire’s war.11 In the English-speaking world, shell shock has been an important topic of discussion since the first cases were reported in 1914, fed during the war by doctor’s descriptions of these new forms of suffering and by larger debates about its aetiology, treatment, and prognosis that played out in newspapers and medical journals. Psychologists like Charles S. Myers, Thomas Pear, M.D. Eder, and W.H.R. Rivers became household names, sparring with neurologists like Gordon Holmes, Frederick Mott, and Canadian Colin Russel during the war and after.12 In the much simplified but well-known version of the debate, psychologists held that the condition was a legitimate wound of war, deserved sympathy, and was treatable with talk therapy, while neurologists were less humane, sceptical about its legitimacy, and more prone to advocating harsh disciplinary treatments. During the interwar period, it was the psychologists who won popular sympathy, ultimately helping the emerging profession to displace neurologists from the private clinics of the English-speaking world.13 The narrative on which their claim to expertise was based was one of progress.14 When war began, they argued, the medical profession had been both ignorant about the true nature of emotional distress and so somatically oriented that doctors proved ill-equipped to help suffering soldiers.15 Only when psychologists and psychiatrists were allowed to treat mind and body at the front did understanding and patient outcomes improve.16 This progressive narrative continues to influence discussions of operational stress injuries today.17 This clash between the Victorian military-medical establishment and outsider psychologists captured the imagination of poets, novelists, artists, and film-makers.18 In their work, shell shock became a metaphor for the struggle between the stoic, emotionless world of Victorian high diction which, as Paul Fussel argued, was rendered meaningless by the horrors of trench warfare.19 In the post-Vietnam age, as memories of the Great War faded, images of traumatized soldiers continued to resonate with a generation that was naturally sceptical about war, military service, and political authority. More than any other author, Pat Barker, in her Regeneration trilogy, has shaped popular conceptions of shell shock

6

A Weary Road

at the turn of the century, reinforcing the view that shell shock was a modern disease born of a horrific war, misunderstood by backwards doctors and military officers.20 In this narrative, which continues to dominate popular portrayals of shell shock in literature, film, and on television, psychologists and emotionally expressive men are the heroes to which modern readers can relate, while the unfeeling neurologists and officers are their foils, stuck in a backward age defined by privilege and empty masculine ideals. Historical approaches to shell shock have been shaped by forces similar to those that moulded popular perceptions. In large part, this is because shell shock’s first historians were the medical professionals and military officers who confronted the problem during the war. The various threads of the fractious wartime debate on aetiology, diagnosis, and treatment were brought together in the 1922 report of the War Office Committee of Inquiry into shell shock led by Lord Southborough, which concluded that the condition was usually emotional in origin but could usually be traced to some underlying defect of personality. Treat­ ment would be most effective, the committee found, if it began quickly near the front lines and was overseen by an expert. The real solution to the problem, though, was to be found in better training and screening of soldiers before they were sent overseas. Official histories written by British, Canadian, and Australian doctors emphasized similar themes, focusing on the specific innovations in forward psychiatry that were supposed to have returned 70–90 per cent of soldiers to duty. The first historians of shell shock thus wrote with a specific goal in mind: to justify the approaches they had taken during the war and to demonstrate that psychiatric knowledge might help prevent another shell shock crisis in future.21 Although doctors returned to the experience of the First World War during the Second, little more was said by historians until the 1970s, when the Vietnam War sparked new interest in the subject of war-­ related mental illness. During the previous decade, social historians had begun to broadly question the power and influence of the medical profession, especially psychiatry, criticizing the ways in which various forms of subversive and so-called deviant behaviours had been medicalized by psychiatrists.22 This intersected with the new social history’s emphasis on the lived experiences of ordinary people and the ways in which the stories of the working class had been marginalized by conventional political and military histories. Shell shock naturally became an aspect of both medical and class struggles. In a seminal work by Eric

Introduction 7

Leed, discipline “therapies” proscribed for working-class soldiers were juxtaposed with the more humane forms of talk therapy afforded to officers in order to analyse shell shock as an aspect of a larger struggle for power in the trenches.23 In this sense, soldiers were portrayed as victims, an approach that paradoxically afforded them a new degree of agency, suggesting that by expressing suffering and seeking treatment they had been able to flee the trenches, even if it meant giving into madness. This paralleled the struggles of traumatized Vietnam veterans who, in mid-1970s, were anxious to have their own mental suffering recognized as legitimate by the American military, veterans groups, and the psychiatric profession.24 The development of what would eventually become the diagnosis of Post-Traumatic Stress Disorder (PTSD) was based in part on the recognition that war-related mental illness had a long and consistent history stretching back to the dawn of the modern psychiatric profession; in turn, this recognition sparked renewed interest from the more traditional branches of medical history, which portrayed the First World War as a watershed moment in the history of psychiatry and psychology.25 Histories tracing the evolution of diagnosis and treatment throughout the twentieth century have created the impression that unbroken lines of suffering and learning stretch across time from Great War shell shock to the Combat Stress Reaction (CSR) diagnosed in Iraq and Afghanistan.26 Although progressive narratives dominate much of the professional medical discourse on PTSD and Operational Stress Injuries (OSIs), the consensus within the historical community is that progress was fleeting at best and perhaps a mirage. In the first instance, if there has been progress in the treatment of wartime stress injuries and emotional suffering during the twentieth century, historians have persuasively shown that it has not been as even as is often suggested, with a conservative medical-military establishment constantly forgetting and relearning the lessons that might have been taken from earlier conflicts.27 In the Canadian context, Terry Copp showed that a lack of institutional memory within the Canadian Army doomed the medical services to relearning many of the lessons of the Great War during the 1939–45 conflict –although he also dismisses the effectiveness of both psychological testing and battlefield psychiatric interventions in Normandy and Italy.28 Explaining the intransigence of the psychiatric profession and Western armies is difficult now that it is also clear that nervous illness among soldiers had been observed since at least the early nineteenth century and was well documented by medical science at the outbreak of war in 1914.29

8

A Weary Road

In recent years, discussions of shell shock as a practical military and medical problem have given way to social and cultural approaches.30 Influenced by studies of morale, leadership, and soldiers’ culture which suggest that the power of both senior and junior officers was more limited than once imagined, social military historians have followed Leed’s argument to the home front, painting shell shock as a form of war-­ resistance within larger debates about the nature of British and Dominion participation in the war effort.31 Gender historians, by contrast, see shell shock as part of a wider struggle to define, protect, and control masculine identities in an uncertain and changing world.32 Focusing on the experience of returned soldiers in their home countries, these critiques suggest that expressions of emotional suffering were as much challenges to the prevailing masculine order as they were assertions of power by ordinary people, forcing us to reconsider the nature of military service and the forces that kept men fighting and dying in the trenches.33 Fiona Reid, Marina Larsson, and Peter Barham, among others, remind us that the struggle continued into the post-war world of pensioning and veterans rehabilitation when financial constraints and gender politics ­favoured the interests of the state over those of returned soldiers.34 When the recent trend has been to view shell shock through the lens of cultural history – an approach that naturally focuses on the home front and post-war world – why should we return to basics with a study of shell shock on the front lines? First, almost nothing has been written on the Canadian experience of shell shock during the Great War, which, in itself, justifies such an approach.35 More importantly, though, despite the significant body of literature devoted to shell shock in Britain and Australia, important questions remain unanswered, especially in relation to what actually happened in the trenches among soldiers, how shell shock was diagnosed and treated by doctors (and not just specialists), and how it was managed by the British Army.36 Indeed, much of what we know today about what happened at the front still comes from those early reports, memoirs, and official histories written by shell shock doctors. This is because the archival records for overseas units were almost entirely purged after the writing of the official histories in the 1930s and most patient records from front-line hospitals were also destroyed.37 Gone are most of the British admission and discharge books, official battlefield reports, statistical returns, memoranda, and routine correspondence that has proved so invaluable to historians working on the home front and post-war period. What we do know, though, thanks to the work of Ben Shephard, Edgar Jones, and Simon

Introduction 9

Wessely, among others, is that much of what was written in the 1920s and 1930s cannot be wholly trusted: doctors wrote about what was new and unusual, not routine; they tended to emphasize their successes and minimize failures; and their views on shell shock were coloured as much by the mores and ideals of the day as those of any other historical actor. It is possible, though, to reconstruct much that was once thought lost and thus to re-examine shell shock in the front lines with fresh eyes. Because Canadian and Australian units were part of the British Expedi­ tionary Force (BEF), as operational historians have discovered, copies of many lost British orders, memoranda, and reports are preserved in Ottawa and Canberra.38 In combination with private manuscript sources, these flesh out the more-or-less complete official war diaries preserved at the National Archives in London along with manuscript sources from a variety of other repositories. The Canadian records in particular are remarkably complete and include detailed hospital files, medical reports, orders, and administrative records describing the management of shell shock in the trenches down to the battalion level – basically the official administrative documents lost long ago in Britain.39 Most important, the hospital admission and discharge registers for Canadian patients survive from hundreds of Canadian, British, New Zealand, Australian, and South African hospitals. These include the registers for front line field ambulances, casualty clearing stations, stationary and general hospitals, convalescent camps, as well as many special armylevel shell shock centres. Such records allow us not only to develop a clearer statistical picture of the prevalence of nervous illness at the front, but also to reconstruct the movement of casualties through the medical services from front to rear and back again. Patient names from admission and discharge books can be cross-referenced with the complete Canadian personnel files, which contain full medical records and demographic information, to paint a better picture of patient populations, treatment, and how they evolved over time. In light of this new evidence, much of what we thought we knew about shock at the front needs to be reconsidered. This book presents a history of shell shock as it was experienced, treated, and managed on the front lines within the Canadian Corps, focusing on the lived experience of ordinary soldiers, sufferers, and doctors in the trenches as well as the policies and decisions made by more senior officers in the rear.40 As such, it must also be an imperial history of shell shock in the BEF because although the Canadian Corps was a national formation, it always fought as part of a British army and

10

A Weary Road

its medical services operated under the aegis of the Royal Army Medical Corps (RAMC).41 It was thus British officers rather than Canadians (or Australians or New Zealanders) who were responsible for setting military and medical policies and operating the network of imperial casualty clearing stations and hospitals that treated the wounded.42 The book’s focus is thus on the BEF as a whole, using the Canadians as a case study. The Canadian medical services operated in the same way as those of any British corps because they had to exist as part of that much larger hospital network. When it comes to both the experience of war and the way cases of shell shock were managed at the front, there is no reason to believe that the Canadians functioned any differently than comparable British units. The primary purpose of this work, then, is to provide a clearer understanding of the role that nervous illness played in the life of soldiers at the front and the strategies that the BEF and doctors used to manage what was widely perceived as a threat to military discipline and morale. It argues that there was more continuity than change, both in terms of the ways in which soldiers expressed suffering and the methods used to treat and regulate nervous illness. While other authors emphasize the “discovery” of nervous illness at the start of the war, the important role played by psychiatric specialists, divisions between psychologists and more biologically oriented doctors, and the successful development of forward psychiatry late in the conflict, this work challenges these arguments with new evidence. As we will see, neither the army nor the medical services were unprepared to manage nervous illness in 1914–15 and many of the strategies that they employed at the beginning of the war remained largely unchanged at its end. Although specialists played an important role in policy formation – and sometimes in providing therapy at the front – the majority of shell shocked soldiers were treated by generalists and surgeons in field ambulances and casualty clearing stations following a rest-cure approach typical of civilian private clinics. Disagreement among specialists was also less dichotomous than has sometimes been supposed, with most adopting positions somewhere along a common bio-psychological continuum – even allowing for the fact that there were always rigid adherents at both ends of the spectrum. During the war, the army never “solved” the shell shock problem through psychiatric, medical, or disciplinary interventions – and those that were implemented consistently failed. Ulti­ mately, the military authorities had to negotiate with the men at the front, reaching accommodations that balanced military effectiveness

Introduction 11

against the need to recognize that even brave men had a limited ability to persevere. The text is organized chronologically, beginning with an overview of Edwardian conceptions of nervous illness before turning to the question of how imperial armies traditionally managed such cases in peace and wartime. It then looks at the ways in which nervous illness was managed at the start of the Great War and the front-line strategies developed to control losses and keep men fighting and dying in the trenches. As soldiers learned to use the concept of shell shock to moderate their participation in battle, the army became increasingly concerned about its ability to maintain morale and discipline. The 1916 shell shock “epidemic,” which began that winter in the Canadian Corps, spread across the BEF during the summer of 1916 and forced the army to reconsider its approach. As a result, specialists were given the opportunity to deploy their expertise to the front with promises that their interventions would reduce casualties by 70–90 per cent using methods based in a bio-psychological approach to nervous illness and its treatment. But the BEF’s experiment with special treatment ended in failure soon after, not because old-fashioned medical officers failed to see the promise of psychological approaches and ended these attempts before they might bear fruit, but because when they were tried, they failed to live up to expectations. Forward special treatment centres continued to operate until war’s end, but most were staffed by neurologists and generalists who diverted shell shocked soldiers into non-­combatant forms of service that still had value to the military, such as construction and labour duties as well as agricultural work in France and Belgium. Despite the failure of the psychiatric experiment, after 1916 nervous illness never posed a serious threat to the military efficiency of the CEF or to the BEF as a whole – although some corps and divisions continued to experience localized crises in 1917 and 1918. By war’s end, shell shock and the concept of nervous suffering in general had been systematically delegitimized, ascribed to hereditary and morale defects rather than the traumas of war, a pattern that lay the groundwork for later approaches to pensioning. Although men continued to suffer in 1918, they had fewer ways to express emotional distress in culturally acceptable ways than their counterparts did in 1914. If there was a psychological turn after the war, the ordinary Canadian and British soldiers of 1914– 18 were not its beneficiaries. As a work of social, medical and military history, a secondary concern here is to examine how rates of nervous illness fluctuated over

12

A Weary Road

time and to evaluate whether or not shell shock had any effect on the military operations carried out by either the Canadian Corps or BEF. Although it is clear that official statistics significantly underestimate total casualties, it would be wrong to suggest that shell shock was as widespread as some revisionist accounts suggest – in many ways, what is most remarkable is that more men did not break down given that at the height of the crisis in 1916, there were few disincentives or barriers to reporting. One important conclusion of this study is that shock was clearly a pervasive part of life at the front, but it ebbed and flowed with the tide of battle, so that reporting frequency became linked to the intensity of the fighting, the morale of men and officers, and evolving conceptions of acceptable masculine behaviour. This helps to explain why nervous illness was almost never mentioned by the military authorities until the summer of 1916. Readers will find this ebb and flow reflected in the way in which the shell shock problem is presented throughout the book. While soldier, martial, and medical cultures are important to the analysis, this book is not a work of cultural history nor is it concerned with the legacy of wartime trauma for veterans, their families, and post-war society – although it does lay the groundwork for studies of pensioning in the future. Historians in these fields are necessarily concerned with the memory of the war, that is, the processes and outcomes associated with the construction of meaning through memorialization and other forms of cultural production.43 Historical memory is ever-changing, reflecting a living process of emphasis and suppression through which people and whole societies endow the past with meaning. Historians of memory are less concerned with what happened and why than how groups of people came to agree that certain aspects of the past were important while others were not. Although this book may help to frame those discussions, it is not concerned with the ways soldiers, families, poets, filmmakers, or novelists found meaning in trauma. It also steers clear of debates that tend to historicize shell shock by attempting to connect the suffering of Edwardian soldiers to contemporary concerns about OSIs and PTSD. It is impossible to retroactively diagnosis patients using modern terminology and conceptions of disease without divorcing suffering and its emotional reality from their historical context. The officers, men, and doctors who served in the front lines of the Great War held fundamentally different beliefs about the world and their place in it, what it meant to be “real men,” and the nature of legitimate and illegitimate mental suffering. Although there

Introduction 13

may indeed be a physiological, genetic, or pathological reality to trauma and stress that bridges time and place, the expression of emotional suffering and its interpretation reflects a cultural basis that exists in­ dependent of the body. Instead, this book draws on Charles Rosenberg’s approach to framing disease and Edward Shorter’s work on the history of psychosomatic illness to analyse shell shock within a specific historical and cultural context, not as an objective syndrome but as a series of ideas, beliefs, attitudes, practices, and taboos surrounding suffering.44 The story of shell shock at the front is that of a negotiation, a messy struggle between sufferers and comrades; doctors and patients; officers and men. Lessons were learned and then unlearned, and some were ultimately forgotten altogether. Among the officers and doctors there were neither heroes nor great visionaries, although there were many that at times showed strong leadership and provided insight into an intractable problem. It is clear that many doctors genuinely tried to help patients as best they could; they sympathized with sufferers and found ways to resist policies that they felt were unfair to the soldiers under their care. The same was true of front-line officers. However, there were also many doctors and brass hats that felt shell shock was a sham and its claimants unworthy of sympathy. At different times and in different contexts, most probably exhibited both points of view. Sol­ diers were clearly not passive victims of an efficient military bureaucracy – the medical services were never sufficiently organized to be as oppressive as has sometimes been claimed. However, they were never fully in control of their own destinies either.

Chapter One

Framing Shell Shock: Nervous Illness before the Great War

The soldiers, doctors, and officers who went to war in 1914 carried a whole host of attitudes, ideas, and expectations about the nature of emotional and psychological suffering – what they called nervous illness – that shaped reactions to combat and the treatment of those who could not cope with its horrors. The history of shell shock thus begins in the late nineteenth century with the emergence of a new popular culture of nervous illness that shaped the ideas, attitudes, and practices of soldiers, the medical profession and military. As a disease concept, shell shock existed as part of this larger culture of suffering which was, in turn, reflected in its symptoms, diagnosis, and treatment. It might sound odd to suggest that symptoms reflect culture rather than physical pathology, but this is true of many forms of emotional and mental suffering. The symptoms of nervous illness are not universal but constitute a changing language that we learn in childhood when we start to recognize the signs of illness in others. By watching how people react, we learn to judge whether a given set of symptoms is regarded as “serious” or not. Unconsciously, we construct models of so-called legitimate illness that evolve and change throughout our lifetimes as we gain more knowledge of disease and through our interactions with medical professionals, friends, and family. Because sufferers want to be treated with respect, they draw on these same shared models of disease as they look to win sympathy, assistance, or relief.1 The term nervous illness entered the popular lexicon in the eighteenth century to capture these forms of suffering and to distinguish them from insanity. Because of the vague, changeable nature of nervous symptoms, the medical profession and ordinary people have often been sceptical of the psychological and somatic complaints reported by



Framing Shell Shock 15

sufferers. On the one hand, nervous symptoms are libel to be dismissed as figments of the patient’s imagination – in popular parlance hypochondria. On the other, they may be suggestive of “real” insanity. This makes any expression of emotional or physical suffering risky business, potentially exposing patients to ridicule, stigmatization, and even loss of liberty. These concerns interact with the prevailing culture to unconsciously guide sufferers towards exhibiting and expressing their pain in ways that are most likely to be regarded as legitimate. Since the beginning of the nineteenth century, the main arbiters of legitimacy have been professionally trained physicians. An expert medical diagnosis can confer respectability on illness or it can dismiss it; medical experts can encourage sympathy or make patients appear undeserving. Perhaps it is not surprising then that contacts between doctors and patients are also instrumental in shaping expressions of nervous illness. Research tells us that in their quest to be heard and have suffering taken seriously, patients intuitively and unconsciously exhibit the symptoms that they anticipate physicians will perceive as “real” illness. And in their struggle to understand and relieve patients’ suffering, doctors evolve diagnostic theories and mechanisms of treatment that can, in turn, encourage or discourage various types of illness presentation. The dance between patient and doctor, one acting and the other interpreting, changes over time as expectations, attitudes, and knowledge shifts. Another important factor, of course, are the friends, families, colleagues, and acquaintances of sufferers. They also play a role in arbitrating the rules of the dance, subtly encouraging and discouraging certain behaviours by granting or denying sympathy.2 The rules as they existed in 1914 had been established within the medical profession and popular culture during the three decades before the Great War.3 One of the most important factors was the medical profession’s belief that all legitimate forms of illness – including mental illness – had to correspond to morbid changes in the structures or functions of the body, that is, to anatomical, physiological, or chemical lesions.4 But unlike with physical illness, it almost always proved impossible in cases of nervous or mental illness to find specific lesions, and so physicians adopted the term “functional” to refer to diseases which had an assumed but unknown organic basis.5 The symptoms most commonly reported by patients thus tended to emphasize somatic suffering and included fits, paralysis, stomach complaints, headaches, and exhaustion. So-called emotional symptoms, that is, physical displays of the feelings derived from what would be called anxiety or depression, were

16

A Weary Road

discouraged by a British culture that expected people – but especially men – to maintain a stiff upper lip in the face of adversity. Nineteenthcentury physicians had a variety of diagnoses with which to categorize symptoms, each of which ascribed a slightly different meaning or value to the illness. Although the terms hysteria, neurasthenia, and traumatic neurosis were employed as if they represented distinct diseases, their use was wholly subjective and in fact described overlapping conditions. The original nervous diagnosis was hysteria, an old term stemming from an ancient Greek belief that “wandering wombs” were responsible for a host of varied and vague physical and emotional complaints, including crying, fits, imagined illness, and fainting, primarily in female patients.6 But by the late nineteenthth century, in the absence of a clear organic cause, an intense debate had developed among some of the most important Continental neurologists of the day, including Charcot, Janet, Babinski, and Oppenheim, about what exactly the disease was – and whether it was even a legitimate diagnosis.7 Some argued that it was a distinct organic form of illness due to some defect of the nervous system itself, others said it was a product of a hereditary personality problem, and still others that it was not an illness at all but merely a form of attention seeking.8 The well-known work of Sigmund Freud and Josef Breuer appeared at the same time, but fell outside the parameters of the debate because it ignored the consensus view that all mental phenomena had to have a biological basis. Instead, they argued that hysteria was essentially emotional in nature, caused by a phenomenon termed “repression.”9 While Freud would later gain a significant following, especially in the United States and Canada, before the Great War his ideas had only had a modest impact on neurology and psychiatry – less so in the English-speaking world than on the Continent. The indifference and hostility which many neurologists displayed towards him only underscores the difficult challenge that hysteria posed to orthodox interpretations of disease. While there was little consensus as to its precise aetiology, hysteria was generally conceived as an emotional affliction usually affecting women (although sometimes men), traceable to some as yet unknown hereditary defect in the chemistry or structures of the central nervous system which shaped the personality of the patient.10 Hysteria was thus a doubly stigmatized word: not only was it essentially feminine in a world where that equalled weakness, but it also suggested that the bearer was somehow biologically defective. Most importantly for male



Framing Shell Shock 17

patients, it implied a lack of the sort of emotional control that had become an essential feature of Edwardian masculinity.11 Although the threat of being labelled “hysterical” did much to discourage open discussion of emotional suffering, especially among men, these conversations could be successfully cloaked in the concept of neurasthenia. In comparison with hysteria, neurasthenia was newly constructed as a blameless disease and it caught the public’s imagination throughout the English-speaking world at the turn of the century.12 American neurologist George M. Beard, who first coined the term, described it as a general condition affecting the whole body which he explained using a simple financial metaphor. In two widely read popular books, he argued that everyone was endowed at birth with different levels of nervous energy, just as they came from different financial circumstances.13 While a millionaire could withdraw a hundred dollars without overdrawing his account, so too some people were capable of working endless hours without ever depleting their reservoirs of nervous energy. Overdrawing one’s nerve force might result in nervous collapse just as surely as spending beyond one’s means would cause bankruptcy. In the physically and emotionally taxing modern world, argued Beard, people had to learn to live within their nervous means just as they had to exercise fiscal prudence.14 If they failed to do so, he warned, a deficiency in nervous energy might do physical damage to the nerves themselves, causing symptoms that would mimic those of more serious somatic and mental diseases. The idea that emotional suffering was rooted in a lack of energy and injury to nervous fibres aligned well with the organic emphasis of medical thinking.15 The idea that vague pains, tingling hands, or gurgling stomachs were caused by injury to the nerves from overwork resonated with the middle-class, periodical reading public which learned about the concept in home advice pamphlets, newspaper advertisements, and directly from physicians.16 These made analogies between the technological world of electric wires, combustion, and telephonic communication and the functions of the nervous system. In everyday speech, nerves became lines of communication and under the unnatural stresses of a chaotic world they were said to “shake,” “spark,” and “hum.” Prolonged strain might leave them “frayed” or they could “weaken” and become “tired.” They could also “act up” or “break down.” These were not abstractions or empty metaphors – as they are in today’s vernacular – but concrete representations of the physicality of nervous

18

A Weary Road

illness.17 Constructing neurasthenia as an acquired form of somatic illness freed sufferers from potential shame and stigmatization; it even carried a certain cachet: in order to get the disease in the first place, one had to be thoroughly modern. In this context it also became possible to understand and talk about the psychological effects of physical and emotional trauma, most often associated in the Victorian era with railway and industrial accidents. Cases of “railway spine,” which include paralysis and other hysterical symptoms observed in accident victims, combined with neurasthenia to give life to the general concept of “nervous shock,” in which a sudden and dramatic event was said to produce seemingly hysterical symptoms by causing functional organic lesions in the central nervous system which mimicked the hereditary defects observed in hysterical patients. In other words, nervous shock could be thought of as an acute form of neurasthenia, brought on by sudden trauma rather than a gradual wasting process. Its victims could thus be equally blameless. 18 The differentiation between hereditary, or constitutional, and acquired forms of nervous illness may appear arbitrary but is of key importance to understanding how suffering was conceived, conveyed, and consumed in the Victorian and Edwardian worlds. Whereas hysteria was understood as a permanent, a priori disease state that would always prevent a man from living up to masculine ideals, neurasthenia and shock could describe temporary lapses or breakdowns, making it possible for the sufferer to get well again. More than this, neurasthenia and shock could even be indicative of masculine behaviour, as they required a certain willingness to take risks and engage with the world; hysteria was, in contrast, constructed as an essential failing of the whole organism. Hysterical men and women might be pitied and deserving of empathy, but they could never be wholly trusted nor could they be cured. In this sense, the distinction between acquired (neurasthenia and traumatic neurosis) and constitutional (hysteria) illness was based on a subjective judgment about whether an individual was deserving or undeserving of sympathy. British neurologists were largely content to observe the acrimonious debate about the aetiology of hysteria from afar.19 At the turn of the century, the hub of imperial neurology was the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, where a small, conservative, professional elite became known primarily for their skill in clinical description and teaching rather than the type of clinical research being done in Paris, Berlin, or Vienna.20



Framing Shell Shock 19

Predominantly monolingual, British neurologists tended to take what has been called a “magpie” approach, adapting and changing a variety of often incompatible and sometimes misunderstood theories to fit their own pre-existing beliefs.21 In large measure, this was a consequence of the fact that in Britain and in its colonies, alienists worked at numerous public lunatic asylums which took in growing numbers of the urban poor.22 Unlike in France or Germany, where public asylums were often attached to or affiliated with university research centres (or medical faculties) that also included nervous clinics, the British and colonial systems were decentralized and focused almost exclusively on managing cases rather than clinical study.23 The psychiatric profession, such as it existed in Canada in the late nineteenth and early twentieth century, was centred on the major centres of Ontario and Quebec.24 The result was a more general and less theoretical approach to the diagnosis and treatment of nervous illness which catered to paying patients eager to avoid the stigma of mental illness.25 In Britain and Canada, it was general practitioners and surgeons that were most likely to diagnose and treat nervous illness, even though most received very little instruction or training on the subject in medical school.26 At McGill, for example, mental illness was covered only as part of the general curriculum on jurisprudence and mental diseases.27 The neuroses were afforded slightly more space, but only as part of the curriculum on clinical practice.28 Students were taught that the standard treatment regimen was the rest cure pioneered by American neurologist Silas Weir Mitchell during the American Civil War.29 His strict program sought to renew the “vitality of feeble people by a combination of entire rest and of excessive feeding, made possible by passive exercise obtained through the steady use of massage and electricity.”30 In “taking the cure,” patients were to be deprived of any form of mental or physical exercise and isolated completely from the outside world.31 The rest cure was popular with patients because it offered an opportunity for both physical and psychological escape, at least for those who could visit one of the numerous specialized spas and resort hotels which sprang up across Europe and the United States at the end of the nineteenth century. By the first decade of the twentieth century, Anglo-Canadian physicians were increasingly supplementing the rest cure with a new form of practical talk therapy developed from the work of French and Swiss neurologists Joseph Jules Dejerine and Paul Dubois.32 Their approach used the physician’s power of personality and was based on the idea

20

A Weary Road

that the neuroses arose from a negative idea or suggestion that had been implanted in the sufferer’s mind.33 In this context, the physician’s task was to get to know the patients in order to help uncover the offending idea and thus restore them to rationality. “In short,” wrote Dubois, “in the course of treatment, one must study the mentality of the subject, detect his lack of logic, his exaggerated susceptibility, and, in the daily conversations, modify his natural mentality; for it is to this mentality that one must look for the first cause of the trouble.”34 It was then necessary to change his mental state, “to explain to him how and why he has fallen ill, and how and why, once cured, he cannot slip back again because he will have regained mastery over himself.”35 This practical form of talk therapy proved especially appealing to patients eager to be taken seriously and it was quickly adopted by physicians because it required no specialist training. War and Nerves In many respects, the military’s approach to nervous illness drew from and paralleled developments in the civilian world. During the Revolu­ tionary and Napoleonic Wars, French surgeon Jean Larrey treated soldiers suffering from depression, exhaustion, and a variety of vague physical ailments which he called “nostalgia.”36 In Larrey’s view, nostalgic patients had been overcome by a desire to see their home which, given the impossibility of their wartime situation, resulted in physical pain that intensified as the longing for family increased.37 To provide apparently psychological symptoms with an organic basis, Larrey theorized that psychic impulses produced “a sort of expansion in the substance of the brain, engorgement and torpor of the vessels of this organ, and successively, of the membrane which envelopes it,” producing a characteristic weakness and cognitive difficulties which gradually progressed “towards the deep seated parts of the brain, which furnish the nerves of the organs of sense and locomotion; so that the functions of these organs also become weakened, or undergo changes which have their particular symptoms.”38 This conceptualization allowed doctors to see the symptoms of nostalgia as objectively “real,” attributing them to conditions of service while avoiding the possibility that soldiers were feigning, exaggerating, or self-generating illness.39 For military units to function effectively, soldiers had to be trusted to carry out orders and those who refused to go up the line or who intentionally avoided duty by faking illness or wounding themselves were liable to



Framing Shell Shock 21

punishment. The question of legitimacy thus had tangible consequences for the soldier-patient. As in the civilian world, somaticity was equated with legitimacy, helping to address the murky question of whether an illness should be treated as a medical or disciplinary problem. In the military, though, scepticism remained the key question in diagnosis and treatment as there was a long and even proud tradition of shirking among the rank and file. Military doctors had the opposite goal of their civilian counterparts: to keep as many men out of hospital as possible. In this sense, the idea that nervous illness resulted from exhaustion or shock posed an ongoing challenge. What soldier was not tired or scared? During the American Civil War, more than 5200 Union soldiers were diagnosed with nostalgia and it remained an important condition until the end of that decade – how many more went undiagnosed cannot be known. In 1863, Silas Weir Mitchell, then a thirty-four-year-old Phila­ delphia physician trained in the new specialty of neurology, opened the first special military centre for nervous diseases at Turner’s Lane Hospital, Philadelphia, with fellow neurologists William W. Keen and George Morehouse.40 There Mitchell had the opportunity to treat and study hundreds of cases, many of which not only showed signs of physical exhaustion but also exhibited unexplained symptoms reminiscent of hysteria. “One man walked sideways,” he wrote; “there was one who could not smell; another was dumb from an explosion. In fact, everyone had his own grotesquely painful peculiarity … [There] were also the cases of fits … Upon any great change in the weather it was common to have a dozen convulsions in view at once … On one occasion a hundred and fifty fits took place within thirty-six hours.”41 Weir Mitchell was unsatisfied with Larrey’s vague hypothesis and although he too used the term nostalgia, he gradually came to the view that physical exhaustion, or neurasthenia, offered a more satisfying aetiology.42 The strain and privations of a long campaign, he reasoned, might push some men beyond the limits of physical endurance as poor nutrition and wasting caused organs and nerves to malfunction and fail, perhaps even to the point of death.43 In searching for an effective treatment, Weir Mitchell experimented with various approaches before settling on the rest cure.44 Many of the issues that later dominated debates about the legitimacy of shell shock during the Great War were first encountered by army doctors during the Civil War. The mobilization of hundreds of thousands of conscripted civilian soldiers during the Civil War made the

22

A Weary Road

question of legitimacy pressing as it was thought that many men might try to avoid duty at the front by feigning illness.45 At Turner’s Lane, Weir Mitchell tried to detect such cases through trickery, anesthetization with ether, or by using painful electrical stimuli – none of which proved entirely reliable. “Many a man will suffer dry galvanism, the actual cautery, setons, and blisters, and yet persist in his deception,” he reported.46 Symptoms of blindness, lameness, deafness, aphonia, paralysis, gastro-intestinal disturbance, pain, and, above all, epilepsy were all prime candidates for fakery because of their subjective nature and the lack of objective signs to demonstrate the underlying pathology.47 To complicate matters, it also seemed that some soldiers may have been unintentionally exaggerating real chronic diseases incurred before their military service, while others were so wedded to clearly imaginary symptoms that it was often difficult to determine whether the patient believed his own deception. Although such men were supposed to be dealt with by court martial, Weir Mitchell admitted that it was nearly impossible to definitively prove that disease did not exist, no matter how clear the subjective indications to the contrary. Instead, he recommended that suspected malingerers be sent back to camp, because “if he be really a well man, no harm is thus done. If he be suffering from diseases which we have failed to detect, he is pretty sure to find his way into a hospital again.”48 In the absence of pathological clarity, this “wait and see” approach served the military’s purpose by maintaining a veneer of suspicion while quietly allowing sick soldiers to receive treatment.49 The British Army faced similar problems in the Crimea, among soldiers serving in India, and on campaign in Africa and the Middle East. On the Russian peninsula, men were known to have frequently reported ill with vague pains, heart palpitations, headache, dizziness, shortness of breath, gastrointestinal complaints, confusion, and physical weakness or fatigue.50 Heart complaints and sunstroke were most common on imperial service. Military surgeon W.C. Maclean, who taught military medicine at the Army Medical School, noticed that many of the soldiers he treated were “old sweats” and suspected that an unknown heart ailment related to their long and arduous service might explain their symptoms.51 He studied more than 5000 cases at the army’s new military hospital, the Royal Victoria Hospital, Netley, and found that fully 10 per cent of patients had been invalided out of the army for heart disease although the usual organic signs and symptoms were absent.52 Maclean’s work prompted the army to appoint a commission to



Framing Shell Shock 23

investigate the problem of heart disease in soldiers which concluded that tight uniforms, heavy packs, and arduous drill instruction created physical obstructions or abnormalities in the valves of the heart which might restrict or alter the flow of blood to the brain.53 Palpitations, chest pain, and headache became symptoms of organic heart problems, while other symptoms were thought to result from complications in the central nervous system. As medical thinking evolved, some began to question the legitimacy of a diagnosis confined exclusively to soldiers and the notion that dress alone might cause sickness, and so the diagnosis of soldier’s heart was gradually replaced by a new functional category: Disordered Action of the Heart (DAH). Such patients typically had a long period of service in the army (or another physically demanding occupation) and exhibited breathlessness, high blood pressure, and pulse reactions to exercise, often accompanied by neurotic behaviours or tendencies.54 Both military forms of neurasthenia and soldier’s heart (or DAH) were conceived as chronic conditions that developed gradually and could be correlated to a soldier’s length of service. However, it was clear by the early 1870s that in wartime soldiers might also suffer a similar but acute form of breakdown identical to that observed among civilian victims of railway accidents. For example, a study by German neurologist Ewald Stier suggested that fully 13 per cent of combatants in the Franco-Prussian War of 1870–1 suffered from some form of traumatic neurosis caused by “cranial and other injuries caused by shot or shell, accidents, and shocks sustained in moments of intense cerebral excitement.”55 The effects of somatic injury and cerebral excitement were thought to be indistinguishable from those of exhaustion. By the end of the nineteenth century, military doctors had several somatic pathologies at their disposal to describe nervous illness in soldiers. While the military’s conception of nervous disease was influenced by civilian concepts, ideas developed in parallel rather than in concert so that by the Boer War, military and civilian epistemologies had begun to diverge. By 1900, as civilian doctors were beginning to recognize that nervous illness had a significant psychological component even if they continued to employ somatic language and seek out anatomical explanations for mental phenomena, British army doctors remained attached to older, mechanistic concepts. As late as 1904, an official British Army report suggested that carrying heavy gear in the heat of the South African veldt put pressure put on the “heart, stomach,

24

A Weary Road

transverse colon, and liver” which not only physically exhausted the men but caused “early morning diarrhoea” as well.56 The stubborn persistence of a purely somatic interpretation of nervous illness within the British Army reflected the conservative tendencies of those who tended to become army doctors.57 By the beginning of the twentieth century, the civilian medical profession in Britain and the Empire was becoming increasingly specialized while military medicine remained firmly the purview of the generalist. In the late nineteenth and early twentieth centuries, few members of the RAMC or the medical services of the Dominion forces could claim expertise in nervous diseases. Military doctors were attached to military units to prevent sickness and to treat the ill and wounded in order to safeguard the army’s fighting efficiency.58 They had to be prepared to diagnose and treat any type of disease or injury which might take a soldier off duty; depending on a unit’s posting these might include snakebites, plague, malaria, yellow fever, or any other number of tropical diseases. While this meant that officers required a general knowledge of medicine, sanitation, and the principles of public health, they also had to be trained surgeons capable of repairing the wounds seen in combat. For that reason, all British officers who took commissions in the RAMC between 1887 and 1898 were general surgeons.59 Even in times of war, the army favoured generalists rather than specialists. As late as the Boer War, only two of the civilian doctors who joined the British Army were neurologists, although neither was employed in that capacity in South Africa.60 Service in the RAMC was far from prestigious, and it was common for civilians to quip that army doctors were the “dregs of the medical schools.”61 Most, though, were probably perfectly capable doctors who, for socio-economic reasons, chose not to compete in the uncertain arena of private medicine.62 Army doctors also had neither the time nor the means to keep up with developments outside their main areas of concern in hygiene, sanitation, tropical medicine, and surgery. Yet somatic pathologies played an important cultural role too, which made them difficult to supplant. As members of a professional army, doctors readily identified with its shared culture and masculine ideals. To accept that seemingly brave men might be capable of a range of psychological responses under stress would require that they turn the medical gaze inwards, to reveal elements of the feminine in themselves.63 Somatic pathologies protected and affirmed the masculine identities of doctor and patient.64



Framing Shell Shock 25

The South African War The South African War presented the first serious test of the British Army’s ability to manage battlefield casualties since the Crimean War and established a treatment model that was followed through until at least the end of 1916. Writing about their experiences after the war, army doctors noted that nervous casualties were common in South Africa and differed little from the types of cases seen in civilian practice.65 The staff of the Portland Field Hospital in Bloemfontein captured the majority view when they said in a jointly authored work that the conditions of active service were “eminently favourable to the development of all sorts of functional disorders of the nervous system.”66 The hospital staff noted that military life was mentally and physically taxing with soldiers forced to endure significant dangers while also being starved of food, water, and sleep. In this context, it was believed that avoiding large numbers of “nerve” cases would be impossible.67 Often diagnosed as neurasthenia, these were characterized by typical symptoms of “pain, in the form of headache, generally posterior, pains in the neck, pains in the back and limbs so that cases are sometimes sent back as cases of rheumatism; general feebleness of the muscular system amounting often to paralysis more or less pronounced.”68 Doctors at Pretoria Yeomanry Hospital believed that memory problems were common in soldiers, going so far as to refer to these as a distinct symptom: “The so-called South African memory.”69 This was usually said to be accompanied by insomnia, depression, fatigue, anxiety, and mental confusion.70 DAH cases were characterized by the usual palpitations and irregularity of heart beat and were linked to the “debilitated and sometimes anaemic condition of some men after hard service.”71 Gen­ eral debility served as a catch-all for any case of “men obviously unfit for duty, by reason of loss of flesh and general weakness.”72 It could thus include cases of neurasthenia as well as suspected malingerers who received the diagnosis on the “charity” of their physician.73 The most perplexing cases were soldiers suffering from acute forms of nervous illness with overtly emotional or pseudo-hysterical symptoms. A typical case was that of a private from the 2nd Royal West Surry Regiment who was knocked senseless by the explosion of a nine-inch shell at the Battle of Colenso on 15 December 1899. Although physically uninjured from the explosion, the soldier later exhibited “a distinct loss of power on both sides of the body.” He was said to be “very nervous

26

A Weary Road

and shaky, suffering from twitching and especially over the right side, giddiness, noises in the head, dimness of sight and some deafness … The reflexes are exaggerated with tremors of the hands and tongue. A general condition of neurasthenia is noted.”74 Another, treated in theatre at Portland Hospital, was a private in the Gordon Highlanders whose helmet was knocked off his head by a shell which failed to explode. Although unwounded, he lay on the ground for two hours unable to rise. When finally removed from the veldt to the brigade field hospital, he complained of constant headache, physical and mental exhaustion, and showed “marked double ptosis,” an involuntary drooping of the eyelids. Soon he was invalided back to the base, where he gave a history of sunstroke in India which doctors believed left him susceptible to nervous exhaustion or shock. Eventually he was sent back to England.75 Another was that of an officer who tripped while trying to climb a kopje under fire. Although unwounded and only slightly bruised, over the next few weeks he developed complete paraplegia from the waist down; curiously his bladder and rectum were said to be unaffected.76 Still another was knocked senseless by a shell explosion and although he sustained no visible injuries, he “became quite deaf and dumb forthwith.” After weeks in a clearing hospital he was sent to England and as soon as he boarded the ship, began to recover.77 Doctors were divided on the prevalence of acute nervous illness in South Africa. Dr Morgan L. Finucane, a civilian poor-laws doctor attached to the Connaught Hospital at Aldershot who treated the Colenso case in England, reported seeing a large number of cases of traumatic neurosis among South African soldiers invalided to England.78 In contrast, J.W. Washbourn and H.D. Rolleston of the Pretoria Yeomanry Hospital, felt that “well-marked hysteria was very rare.”79 Sir Anthony Bowlby, who was house surgeon at St Bartholomew’s Hospital and later King Edward VII’s personal physician, served in South Africa at the Portland Hospital and obliquely reported that hysterical disorders occurred “in a certain number of cases.”80 This suggests that doctors saw in their patients what they wanted to see and most did not wish to admit (or discuss) the prevalence of conditions that looked uncomfortably like hysteria. Acute nervous illness was conceived in terms similar to those for the traumatic neuroses of civilian life, ascribed to sudden emotional or physical shocks sustained on the battlefield by individuals with long histories of military service, supposed hereditary predisposition, or



Framing Shell Shock 27

physical weakness. The War Office Committee appointed to investigate medical arrangements in South Africa, led by Lieutenant Colonel R.W. Ford, reported in 1904 that “a considerable number of men reporting sick in the field are suffering from general nervous exhaustion, consequent on hard and continual marching, frequent outpost duty, want of sleep, and constant anxiety, with insufficient and badly cooked food.”81 Similar opinions were expressed by Bowlby: “A highly neurotic, emotional, or even hysterical condition resulted from injuries inflicted on men whose nervous systems were highly strung by the strain of campaigning, the anxieties of outpost duties, and the want of proper sleep, often for many nights in succession.”82 In this way, the military concept of battlefield shock differed little from civilian concepts of the traumatic neuroses which continued to emphasize the essential physicality of suspected injuries to the nerves. Finucane drew the link most clearly, noting that cases of “functional impairment of nerve sense and motor power, associated with psychical symptoms [are] akin to nervous shock or those observed after railway accidents” – these cases he called “purely shattered nerves.”83 While most cases had an important psychological component, British army doctors consistently argued that their root cause would not be found in the mind, but in the body. Of the nine cases Finucane described in detail, all were counted among the physically wounded – indeed, most had suffered trivial or minor gunshot or shell wounds. It is telling that even after the official training manual for the RAMC was revised in 1904, its authors made no distinction between forms of shock produced by blood loss and “emotional disturbance” – they were assumed to be one and the same thing.84 Nevertheless, it was clearly understood that nervous illness occupied a no man’s land between psyche and soma. It was simply easier and more professionally satisfying to provide medical explanations based on somatic principles than it was to wade into the uncertain arena of psychology. In the civilian world doctors accepted that the relationship between mind and body was tangled and developed practical therapies that administered to both while emphasizing physicality to satisfy their patients.85 In the military context, though, the question of malingering and feigned illness always lurked beneath any diagnosis of nervous illness because medical treatment meant the loss of effective soldiers who otherwise appeared to be healthy. At the Imperial Yeomanry Hospitals in South Africa, malingering was thought to be common, especially among the “new drafts” of Yeomanry arriving in theatre after April 1901. There doctors heard the “the usual complaints made by soldiers

28

A Weary Road

anxious to avoid service,” namely, vague pains, back aches, headache, deafness, and “heart disease, without any physical signs or modified action.” But while physicians might have their suspicions, it was almost impossible to prove a case of malingering, for it involved demonstrating that the patient was intentionally lying. “The question of whether a given case of pain in the back or other part of the body is entirely malingering, genuine, or an intentional exaggeration of slight rheumatic pain, is a difficult one to decide,” wrote Washbourn and Rolleston. “In some instances it was almost impossible to exclude the existence of some underlying rheumatic myalgia.”86 Physicians had to rely on patients to describe their pain and suffering, which, in a sense, robbed doctors of their usual power. There were no objective signs to indicate whether someone was lying, exaggerating, or telling the truth, which cast a cloud of suspicion over all cases. “The indefinite nature of the symptoms gives the malingerer the opportunity for deception that he needs,” wrote Sir Anthony Bowlby, “or, to put it less strongly and perhaps more justly, the unwilling soldier may take advantage of a real but slight basis of disease, and, as this presents symptoms mostly of a subjective kind, he may exaggerate these symptoms to his own benefit and to the confusion of the Medical Officer. The effect of such possibilities on the mind of the Medical Officer is, in turn, to make him regard with suspicion all subjective symptoms which are not supported by more definite signs, and so to run the risk of doing an injustice to his patient.”87 In another sense, though, this was a process of legitimization through somatic explanations that also served to protect the physician’s claim to a professional monopoly on health matters: to admit that medicine had no objective means of answering the question of whether a given symptom was legitimate or not would have undermined that claim to an exclusive form of knowledge. Suspected malingerers were thus treated alongside chronic and acute cases of nervous illness with a conventional treatment of diet and rest, sometimes accompanied by massage, hydrotherapy, and electricity. Sol­ diers who left the front on their own power were quickly funnelled to field hospitals behind the lines which offered beef tea and stimulants to exhausted troops in the belief that fatigue and malnourishment might precipitate nervous breakdown.88 Chronic nervous patients were generally given “rest and a good feeding, iron and strychnine tonic” in order to stimulate “digestion, and the result was usually a rapid gain in weight and bodily power.”89 Most were said to have recovered quickly, returning to their units.90 Doctors in South Africa also recommended



Framing Shell Shock 29

the rest cure in cases of malingering in the belief that sooner or later the soldier would either recover or tire of the treatment.91 The treatment of acute cases was often supplemented by drugs as well as more heroic measures, including the use of electric shocks. At the Portland Hospital, a soldier suffering from functional paralysis and who was said to be “much depressed [believing] himself to be permanently paralyzed” was given a combination of massage and galvanic electricity. It was said that “improvement was so rapid that in a fortnight he could walk about the ward, and was improving daily.” In many cases, morphine was administered in liberal doses, both to aid in sleeping and to alleviate pain.92 While many cases appear to have resolved in hospitals in France or Belgium after a few days or weeks in treatment, those that failed to progress or that were accompanied by a loss of physical strength were invalided back to England, where they were sent to military hospitals throughout the country.93 At the Aldershot Barracks hospital, Finucane reported that most of the cases he saw required three to six months of complete rest and nursing care and rarely recovered. He concluded that “there is nothing for it but to invalid them out of the service as permanently unfit.”94 The danger of nervous illness was clear and Finucane had a strong warning for his contemporaries. “The effects [of nervous shock] are of sufficient importance to the military authorities and to the profession generally by reason of the necessity there is at present, and probably will be in the future,” he wrote, “of invaliding a large body of our best and most seasoned and experienced soldiers out of the service as unfitted for future service as soldiers, thus denuding our army of these experienced and gallant men.”95 Indeed, he felt that “badly conceived projects by generals and commanding officers causing panic and disaster” would inevitably lead to a dramatic increase in cases of nervous shock in the future.96 It is impossible now to do more than guess at the total number of cases of nervous illness treated in South Africa. As shown by table 1.1, official medical statistics (for other ranks, meaning enlisted men as opposed to officers, only) recorded 4327 admissions to hospital for diseases of the nervous system, 20,767 for debility, 781 for mental diseases, and 3631 for DAH.97 In addition, cases that might otherwise have been termed neurasthenia and hysteria appear to have been included under rheumatism, which, together with rheumatic fever, accounted for another 24,460 admissions.98 Although these categories would have all included cases that might today be described as operational stress

30

A Weary Road

Table 1.1 Hospital admissions and evacuation rates, categories associated with nervous disease, South African War, 1899−1902 Diagnosis Diseases of the nervous system Debility DAH Rheumatic fever Mental Valvular disease of the heart Total

Admissions to hospital

Evacuations to England

Evacuation rate

4327

1366

32%

20,767

5365

26%

3631

1470

40%

24,460

4305

17%

781

620

79%

2613

1895

72%

56,579

15,021

26%

Source: Major T.J. Mitchell, History of the Great War Based on Official Documents: Medical Services, Casualties and Medical Statistics (London: HMSO, 1931), 273.

injuries, it is impossible to say what proportion these “actually” represented. Some indication that the numbers may have been quite large, though, is provided by an examination of evacuation rates. Within the categories “diseases of the nervous system” and “debility,” the vast majority of patients were treated and released to duty in theatre, suggesting that their illnesses were transitory or minor in nature. In comparison, the majority of those diagnosed with mental disease or organic heart disease had to be invalided to England.99 The lesson of the South African War was that nervous casualties would occur, sometimes in large numbers, but that they could be effectively treated alongside cases of somatic illness and injury. Following the war, the army faced tough scrutiny for its handling of disease and wound infection during the war, and this tended to dwarf any concerns raised about the management of nervous illness. A soldier who made it to field hospital had a 93 per cent chance of survival, which demonstrated the technical prowess of military surgeons and the high hygienic standard that had been achieved since the army’s last major engagement in the Crimea. Disease management, in comparison, was a disaster: a staggering 404,126 soldiers were admitted to field hospitals with injuries and disease, chiefly enteric fever, gastrointestinal disorders, various fevers, and malaria. On an annualized basis, these accounted for 379 hospital admissions per 1000 healthy soldiers, meaning that from a statistical perspective, each soldier could be expected to be



Framing Shell Shock 31

admitted to hospital at least once with one of these conditions while on service. The army’s mismanagement of disease and the evacuation of wounded soldiers was a major public scandal in Britain that cast a long shadow over military medicine through the first years of the Great War, helping create a culture of obfuscation that sought to minimize any ­appearance of “wastage” from preventable illness.100 Nervous Illness and the Canadian Military Although Canada’s military medical services trace their history back to the earliest British units to serve in North America, the national army medical service has a relatively short history.101 Until 1898, the only doctors in the Canadian militia were the regimental medical officers (RMOs), who were attached to local battalions and given the rank of surgeon-officers. During the 1885 Rebellion, field ambulances and hospitals had to be improvised, and although effective at treating surgical and medical cases, they were quickly dissolved following the Battle of Batoche.102 If there were any cases of nervous illness during the campaign, they were classified in euphemistic terms as exhaustion, rheumatism, indigestion, or homesickness and treated in the lines using a combination of rest and cajoling.103 At the field hospital in Winnipeg, Surgeon-Major James Kerr reported treating one case each of concussion and exhaustion and two of debility and rheumatism, representing about 7.5 per cent of the seventy-nine patients who were admitted to his wards.104 But these were unremarkable cases. As in civilian life, nervous illness was a fact of life for military surgeons who regularly treated depressed or anxious soldiers both in garrison and on duty. During the 1898 police action in the Yukon, for example, Halifax-born Yukon Field Force Surgeon G.L. Foster, who would later lead the Canadian overseas medical services during the Great War, reported trekking 70 kilometres south from Fort Selkirk through the snowy wilderness to tend to an attempted suicide at a Royal Northwest Mounted Police outpost known as Five Fingers Rapids.105 Insanity and military service had long been linked, probably because of the prevalence of alcoholism and syphilis in the ranks. Before the First World War, insane members of the Canadian Permanent Force were discharged from the army to public asylums located in the province of their birth. In 1906 there were apparently only three such individuals in Canada and their care was paid for and administered by the local authorities rather than the federal Department of Militia and

32

A Weary Road

Defence.106 Similarly, until the Great War the Canadian government denied responsibility for the care of Canadian veterans, and if they received pensions or medical attention it was paid for by the British government. By the early part of the twentieth century, though, the War Office began to urge the Canadian government to make arrangements to take over care of Dominion soldiers, some of whom had been committed to the mental wards at Chelsea Hospital in London. The governments of neither Sir Wilfrid Laurier nor Sir Robert Borden were eager to take on the expense.107 At the turn of the century, neither Canadian military medicine nor veterans’ care were priorities of the Canadian government, which was reflected in the structure of the Dominion’s defensive force, the Militia. The first attempt to create permanent militia medical units in fact began only in 1898 with the raising of regional field hospitals to coincide with the local nature of militia structure in which regiments, associated with communities, were spread out across the country.108 In this respect, Canada lagged behind the other white settler colonies. New South Wales, for example, sent formed medical units on the Suakin Campaign of 1885 and, together with the other Australian colonies, dispatched more than 350 medical personnel organized into several bearer companies, field ambulances, and hospitals to South Africa.109 Although over 6000 Canadians served in South Africa, only one Canadian medical unit, No. 10 Canadian Field Hospital, went to the Boer War, and then only during the final phase of fighting in 1902.110 Following the Boer War, the British Amy began a series of reforms which aimed to standardize organization, equipment, and drill instruction across the Empire to support the creation of a truly imperial army. Although there was significant debate in Canada about the burdens of imperial defence, the eldest Dominion followed the British scheme and in 1906 formed the Canadian Army Medical Corps (CAMC), with permanent headquarters staff, field ambulance units, casualty clearing hospitals (later stations), and general hospitals. A similar reorganization took place in the new Dominion of Australia, although the Com­monwealth chose not to establish clearing or general hospitals.111 By the outbreak of the First World War the CAMC had a permanent establishment of 25 officers, including 5 nursing sisters, and 102  other ranks.112 Most of these officers served at army headquarters in Ottawa, at barracks hospitals or on the staff of Canada’s nine military districts, and with the few infantry and artillery regiments. The bulk of the men of the CAMC were part of the active



Framing Shell Shock 33

militia, part-time soldiers who staffed the six cavalry field am­bulances, fifteen regular field ambulances, and two clearing hospitals distributed from Halifax to Winnipeg. Most of these were severely under-strength and lacked proper equipment, and so the militia medical units were little more than skeletons around which a proper service might be organized in wartime.113 Conclusion In the years between the Boer War and the outbreak of the First World War, there was general acknowledgment that a large-scale European war would produce more nervous casualties due to both the scale of the conflict and the introduction of new weaponry. During the RussoJapanese war of 1904–5, medical observers attached to the Russian armies noted that “neurasthenic and hysterical conditions were numerous and severe” among both officers and men exposed to rapid artillery fire and heavy fighting.114 Some cases were clearly due to cerebral concussion while others seemed to mimic the traumatic neuroses.115 While cases of major mental illness were treated in specialized hospitals under the care of a psychiatrist close behind the front, neurasthenic or hysterical soldiers were initially sent to general field hospital wards where they were prescribed rest and a modified diet, often recovering within a few days. However, it was soon discovered that when they returned to their units, most quickly relapsed.116 This could only be explained by the fact that the quick mobilization of large numbers of soldiers had drawn individuals to the army who were inherently “neuropathic” and thus unsuited to military life, so that the trauma of battle had merely triggered an innate defect.117 This view was echoed in 1912 by British doctor A.G. Kay, who argued that in future longer conflicts, physical exhaustion, lack of sleep, hunger, and thirst would all inevitably lead to nervous collapse among the professional soldiers, while many other cases of a more severe nature would result from the mobilization of large numbers of unfit reservists and civilians.118 Although in hindsight these warnings appear prescient, the military authorities concluded that nervous illness had been a relatively insignificant source of wastage in South Africa and that cases had generally been managed effectively within the existing casualty treatment and evacuation systems. These were staffed by generalists who administered a field version of the rest cure, supplemented with drugs, massage, and electricity where necessary, evacuating patients to England

34

A Weary Road

only in extreme cases. Most cases were understood to be treatable which was supported by the observation that 75 per cent of patients admitted to hospital under categories consistent with nervous illness were returned to duty in theatre. Because no definite official statistics were kept, though, it is impossible now to say whether this was an accurate assessment. However, from the army’s point of view, enteric fever, wound infection, dysentery, and malaria remained far more serious problems, so that sanitation and hygiene became the army’s focus for research and training in the decade before the Great War.

Chapter Two

Purely Shattered Nerves: British and Canadian Approaches to Treatment, 1914–1915

Sergeant W.J.W. of the 3rd East Yorkshire Regiment was admitted to Beckett’s Park Hospital in Leeds on 25 September 1914. A regular who had been on duty steadily since the outbreak of war earlier that summer, when he went to hospital he was so tired that he “couldn’t think at all.” As he told his doctors, in early September he started to lose his memory and then developed unexplained tremors in his hands and legs. Despite a prolonged period of rest in hospital following a diagnosis of neurasthenia, his symptoms refused to disappear. “I should be glad of an opinion on this case,” wrote an exasperated physician. “There is very little improvement: I scarcely think this man is malingering (he realizes he is interfering with his promotion) and yet I cannot feel he is making his best effort.”1 British and Canadian doctors were confronted by nervous illness as soon as war began in 1914 and approached the problems of diagnosis and treatment using the lessons they had learned from the war in South Africa. This meant that nervous illness was conceived within a bio-psychological framework and treated in the same way as other “minor” wounds, somatic illness, or injuries. While this approach worked well initially, as more and more men were evacuated to England the army had to develop new strategies and systems to keep soldiers closer to the front. As a result, two very different approaches developed within the home and overseas arms of the British medical service that would shape British shell shock treatment for the remainder of the war. Organization and Management The British Army Medical Services on the Continent and in England operated as parallel organizations, which had important consequences

36

A Weary Road

for the ways in which nervous illness was understood and managed both overseas and at home. The medical services were not, in fact, a separate arm of the British army, but part of the Adjutant General’s (AG) branch, which had responsibility for manpower and discipline. At the beginning of the war, the medical services were centrally managed from a sub-department of the AG’s branch at the War Office in London, overseen by a Director General of the Army Medical Services (DGAMS), in August 1914 Surgeon General Arthur Sloggett. However, heavy fighting soon made it clear that it would be impossible to effectively oversee the expansion of the medical services in France and Belgium from London.2 Following the harried retreat from Mons and subsequent advance to the Aisne, in late October Sloggett relinquished his post at the War Office to take command of the BEF’s force in France, creating a separate overseas post: Director General, Medical Services, BEF (DGMS). This left his old office vacant in London, and Alfred Keogh, who served as DGAMS, from 1905 to 1910, was asked to come out of retirement and take over at the War Office.3 The relationship between home and overseas was never clearly defined and remained murky throughout the war.4 Indeed, the two directors rarely communicated with one another and their relationship quickly became passive aggressive so that information and ideas crossed the Channel only with great difficulty.5 The home and overseas services were essentially two different worlds linked by the fact that the casualty management system comprised a chain of medical units stretching from the front to the rear and back to England, and later the Dominions.6 The first link in that chain was termed the “collecting zone” where RMOs, attached to the fighting units, worked with stretcher-bearers to remove the sick and wounded from the battlefield to aid posts, dressing stations, and then field ambulances immediately behind the lines. In the collecting zone, RAMC medical officers were embedded with the fighting forces and played an essential role in maintaining the health of the troops and the battlefield effectiveness of these units. Every British and Dominion battalion had an RMO who commanded four sections of four stretcher-bearers, each of which was (in turn) attached to one of the battalion’s four infantry companies (each of roughly 120–160 men). When an infantry company went into battle, the stretcher-bearers would normally remain behind at the start-line until the RMO instructed them to advance and begin the process of collecting wounded from the field. In peacetime they were trained to make their way forward to the wounded using natural cover,



Purely Shattered Nerves 37

apply field dressings, and then remove the soldier via a hand-carried stretcher to a Regimental Aid Post, established in such a location as to “be under cover or out of the line of fire, but sufficiently near the firing line as to be readily accessible.” 7 At the aid post, the RMO would prepare the wounded for further evacuation to the rear or send a lightly wounded soldier back into battle.8 It was the RMO who mediated access to the field ambulance, determining who was sick enough to be sent back for treatment and who should tough it out in the line. “The regimental medical officer may be likened to the general practitioner or family physician,” wrote the official historian of the CAMC, Sir Andrew Macphail. “In many cases he remained for years with his battalion, refusing change and even promotion … In time he became the friend of every man, knew their names and faces, and the ultimate history of their lives. He knew the hardy soldier who suffered in silence as well as the man who made the most of his ailment. He had his office or aid post to which all might come, formally upon sick parade or privately as occasion required.”9 As such, the RMO controlled the soldier’s access to medical treatment; it was he who was initially triaged cases of illness serious enough to warrant evacuation or required others to tough it out at the front. From a military perspective, the RMO was to protect his unit’s efficiency by providing access to treatment only when it would serve the greater good.10 Cases of infectious disease and soldiers incapable of doing their duty were a liability; others would most likely have to remain at the front until they recovered or their condition worsened sufficiently to warrant evacuation.11 The wounded and severely ill were carried by bearers to field ambulances stationed just in rear of the front lines. Despite the name, a field ambulance was actually a hospital – not a physical vehicle.12 Three field ambulances were allotted to an infantry division, one being theoretically assigned to each of the division’s three infantry brigades.13 Its purpose was to evacuate a division’s wounded from the immediate threat of shell fire, to stabilize them, and eventually remove them to hospitals in the rear.14 Field ambulances would typically establish an advanced dressing station just in rear of the regimental aid posts, along a serviceable road where the wounded could be collected from battalion stretcher-bearers, loaded onto wheeled stretchers, carts, or lorries, and sent back to a main dressing station a few miles back in a town or other sheltered area.15 It was essential that dressing stations be located at the terminus of the main nodes in the transportation infrastructure so that

38

A Weary Road

patients could be easily moved from the collecting zone to the evacuation zone (which contained the hospitals in the rear area). The evacuation zone was much deeper than the collecting zone and was comprised of clearing hospitals, ambulance trains, evacuation barges, and both general and stationary hospitals overlapping both the front-line army area and lines of communication.16 The first stop in rear of the field ambulance was the Casualty Clearing Station (CCS), attached to a specific army and usually housed in buildings commandeered for war purposes, rather than in fixed tents or huts like the field ambulances.17 These makeshift but semi-permanent hospitals evolved through the course of the war from temporary 200-bed receiving stations to more permanent, fully functioning surgical hospitals with accommodation for up to 1200 cases at a time.18 Ambulance or hospital trains then carried soldiers from the CCS to base hospitals, which included both stationary and general hospitals on the French coast in major centres like Boulogne, Étaples, Le Tréport, Rouen, Le Havre, and Trouville.19 Typically, it took as few as twelve hours and as many as forty-eight to move from a regimental aid post at the front, through the field ambulance, to the casualty clearing station, and then to a base hospital on the coast.20 Soldiers requiring an extended period of treatment were evacuated to England, where a network of military receiving centres, converted civilian war hospitals, and convalescent homes constituted the treatment zone. DGMS Sloggett discouraged the transfer of patients to England, preferring to retain as many men as possible at hospitals in France where they could be more easily and quickly returned to the front.21 Experience in South Africa had shown that the further a man got from the battle, the less likely he was to make it back to his unit. Even though the distances were much smaller in 1914, a transfer to England still virtually guaranteed that a soldier would not return to the front for several months. But while evacuations across the Channel were officially discouraged, heavy fighting and a scarcity of beds made them inevitable, and until 1916, most seriously ill or wounded patients were routinely evacuated to “Blighty” to create bed space at the front.22 First Cases The first wartime cases of nervous illness appeared away from the battlefield among reservists mobilizing in England. One of those was Private Michael H., a thirty-five-year-old veteran of the British regulars



Purely Shattered Nerves 39

and Territorial Army of sixteen years, who reported sick on 25 August 1914 soon after being called up. He had pain in the left part of his chest; a physical exam revealed a slight heart murmur. In civilian life he was a “motor man” and reported that he was under familial distress when his unit was activated. His RMO sent him to a military hospital, where he was diagnosed with neurasthenia and treated with the rest cure, remaining in hospital for a little under two weeks. When his symptoms subsided, he was discharged to duty.23 Likewise, Joseph Albert M., a Boer War veteran, then a national reservist, was called up to service on 1 August 1914. Soon after, he experienced difficulty walking. On 30 August, a physical exam revealed exaggerated reflexes and involuntary movements of the legs. He too was diagnosed with neurasthenia and, after a short period of rest, was released to duty with the 6th West Yorkshire Regiment.24 His symptoms resolved in only three days.25 Still another was twenty-three-year old Trooper James B., an electrical engineer in civilian life, who was called up on the outbreak of war to act as a motor-car driver. In early August he suffered a “fit,” having “to be held down. To the horror of his comrades, he was said to have gone “very wild” while driving a lorry. His physician suspected epilepsy, but this was quickly discarded as he had “never bitten his tongue or injured himself” and had never involuntarily passed urine. He complained of fatigue, tremulous hands, and headache – all of which suggested neurasthenia. On his case sheet, his military doctor noted that “with excitement he gets palpitations,” concluding that “he is a nervous man” requiring observation. By 26 September, his case had resolved itself and he was able to return to duty.26 In general, breakdowns like these were attributed to the mental and physical strain inherent in the sudden shift from civilian life to active operations. Most men were sent back to their regular duties after a short stay in hospital, although it is impossible to know how many subsequently relapsed. Official statistics show 416 cases (20 officers, 396 from the other ranks) admitted to hospital in England diagnosed with neurasthenia, traumatic neurasthenia, hysteria, and shock during the first five months of war.27 These diagnoses account for only a small portion of the 2583 soldiers admitted to hospitals in England with diseases of the nervous system in 1914, of whom 1876 or 72 per cent returned to duty; they do not include the 609 men treated for mental illness – of which 200 or 33 per cent went back to duty – nor the 548 soldiers admitted with DAH (of which 71 per cent went back to duty). Not including cases of debility, myalgia, or other somatic diagnoses related to exhaustion and lack

40

A Weary Road

of physical or mental fitness, these figures suggest that as many as 3740 men were admitted to hospital with diagnoses that had historically been used to capture nervous illness, more than two-thirds of whom returned to duty. Using this figure as an upper estimate of total cases (and it is certainly much too high), nervous illness accounted for only about 4 per cent of the 101,078 hospital admissions in Great Britain during 1914.28 In other words, despite their limitations, these figures allow us to establish that nervous illness was not a significant source of sickness during the first months of war. Turning to the situation in France, an anonymous correspondent writing to the British Medical Journal in late November 1914 reported seeing his first case during the fighting on the Aisne. It was “a man who had distinguished himself by his bravery. He was brought to the dressing station by two men and was then oblivious of the nature of his surroundings, mildly agitated and speaking or muttering continuously. He called to mind the appearance of those who suffer from auditory hallucinations.”29 Another, Dr. Arthur Edmonds, reported to the Medi­ cal Society of London the same month that he had seen several patients break down with strange symptoms during the British landings at Antwerp in September. One marine who came under his care had been in the trenches at Lierre when a barrage of high explosive shells “blew a comrade standing close to him to pieces” and knocked him unconscious for several days.30 When he came to, he was deaf and dumb.31 During the first months of fighting in 1914, nervous illness accounted for only about 4.3 per cent of the 56,304 non-fatal wounds in the BEF, representing 1810 admissions for nervous disease, 96 for mental disease, and 508 for DAH.32 Although small in number, cases like these fascinated doctors and the periodical reading public because they sounded so unusual.33 At the front, RMOs played the primary role in diagnosing and treating nervous and mental illness. Corporal John W.G. of the Leicestershire Yeomanry had suffered from periodic bouts of gastro-intestinal trouble long before he went to war. He broke down in May 1914 and again during mobilization. After six weeks in the trenches his RMO approached him, expressing concern about his deteriorating condition, and sent him to hospital at Hazebrouk, ostensibly to have his teeth checked. Once there, he was diagnosed with “early neurasthenia” and sent to hospital in England.34 In other cases, a soldier might carry on until he felt he could endure no longer and reported to the RMO himself, asking to be sent to the rear. This is what happened to Sgt. George C. of the



Purely Shattered Nerves 41

1st  Seaforth Highlanders, a forty-two-year-old veteran with fifteen years’ service. At Neuve Chapelle on 10 March he was “blown over by bursting of a shell, portions of which went through his equipment.” Although he recovered and remained on duty at the front, he said that he continued to feel “ill and nervous.” Four days after his “close-call” he reported sick to his RMO, who sent him to the field ambulance. From there he was evacuated to Boulogne and on to England.35 During active operations, a nervous soldier might also be evacuated from the front by his comrades, bypassing the RMO altogether. Pte. John H. of the 1st Northumberland Fusiliers was thirty-eight when he went to war. At about 8:30 on the morning of 4 March 1915 he was standing in the trenches at the front when a high explosive shell blew in the trench wall, knocking him unconscious and burying him. It took his friends just over half an hour to dig him out. They then brushed him off and carried him into a dugout, where he remained until dark, when they took him to a field ambulance outside Ypres at Poperinghe. There he was diagnosed with shock and neurasthenia and eventually sent to hospital in England.36 At the front, doctors had to treat large numbers of men horribly wounded by shot and shell but even larger numbers of soldiers who became sick, tired, and unwell due to a variety of causes not directly attributable to enemy weaponry. The challenge facing front-line physicians was to ensure that units holding the line remained effective military forces, unencumbered by the sick and injured, while also protecting the strength of those forces by guarding against unnecessary evacuations. Early in the war, though, the problem was that minor cases of legitimate illness and injury could be as damaging to military effectiveness as bullets and shells. Without any dedicated bed space at the front, soldiers requiring care had to be evacuated to the rear, which left those remaining at the front short of strength. Treatment Overseas Initially, all cases of nervous illness were evacuated to the base, which included general and stationary hospitals along the coast clustered at the Channel Ports, especially Boulogne.37 It often took several days for casualties to make their way from the front to the coast. Lance Corporal William Thomas A. of the 1st Middlesex Regiment, for example, arrived in France at Le Havre in early October 1914 where he spent three weeks in a reserve camp before arriving at the front. For several weeks

42

A Weary Road

he was in the trenches, where he “saw a great deal of the ‘fighting,’ and often large ‘shells’ were bursting close to him and he became ‘nervous’ and irritable.” On 17 January 1915 he was buried in a dugout when a high explosive shell landed on the roof. Although he tried to carry on, he soon broke down with “giddiness” and vague pains. The regimental medical officer sent him to a field ambulance and from there he was sent to hospital in Rouen, then to No. 11 General Hospital in Boulogne, where he spent three weeks undergoing rest and treatment.38 There were no special accommodations at the base and in one case, patients were ware-housed “along an attic floor at the top of a large building which had been recently constructed as a hotel” before being converted to war purposes.39 As the number of shell shock patients evacuated from the front grew in the fall of 1914, Sir Alfred Keogh, the director general of the Army Medical Service at the War Office, dispatched Captain Aldren Turner, a prominent Edinburgh trained neurologist, to France as special neurological consultant to the BEF.40 Turner was an important figure in London’s medical establishment. He had been head of the neurology department at King’s College from 1908 and served on the staffs of both the West London Hospital and the National Hospital for the Paralysed and Epileptic, Queen Square, as an expert in epilepsy.41 He had a reputation for organization, thoroughness, and a careful scientific approach to the diagnosis and treatment of mental illness.42 The employment of civilian experts, first in advisory and later in managerial roles, allowed specific personalities and professional agendas to influence the development of casualty management and treatment networks. As a researcher and clinician, Turner spent his career searching for specific anatomical lesions and definitive clinical signs in the neuroses by examining hundreds of case histories and compiling statistics based on careful observation.43 As he recounted in his popular textbook on nervous illness, he was fascinated by epilepsy in particular because it produced symptoms similar to those seen in hysteria and other forms of so-called “incipient insanity,” but unlike those conditions, certain forms of epilepsy had already been definitively traced to pathological changes in the brain that were visible on autopsy.44 If, as most suspected at the time, epilepsy was indeed related to the neuroses – at least on the same aetiological spectrum – it might also be possible to one day use epilepsy to trace hysteria and neurasthenia to similar lesions. This optimism hid a growing sense of professional desperation: by 1914 Turner was middle aged and had spent twenty-five years



Purely Shattered Nerves 43

synthesizing and expanding on the work of others, but had failed to make any definitive contributions of his own.45 Shell shock, it seemed, might provide that opportunity. Keogh asked Turner to observe cases of nervous and mental illness in the base hospitals along the French coast and to make a report as to how they might be best handled upon their return to England.46 In late 1914 and early 1915, Turner spent three months at Boulogne, Étaples, and Le Tréport, where he identified three basic types of war related nervous and mental illness generally corresponding to the types of hysteria, neurasthenia, and traumatic neurosis seen in civilian hos­ pitals.47 The shock cases, he felt, were the most numerous and seri­ ous, noting that they exhibited widely varied symptoms “distributed throughout the nervous system.”48 In his report to the War Office, submitted in late February 1915, he suggested that nervous patients could only be successfully treated and returned to service (or discharged from the army without need of pensioning) if they were placed in the care of civilian specialists in England.49 To triage patients in theatre, Turner recruited Cambridge psychologist Charles S. Myers, whom he had met at No. 11 General Hospital in Boulogne.50 Myers was an unlikely choice for the job. Before the war, he had been a prodigious researcher at Cambridge, producing the first English-language textbook on experimental psychology in 1911 and publishing in the varied fields of statistics, the archaeology and hieroglyphics of ancient Egypt, Aus­ tralian Aboriginal music, and Borneo’s indigenous cultures (before the war he lived among the islanders for twelve months with fellow shell shock doctors W.H.R. Rivers and William McDougall).51 But Myers was no clinical psychologist and although he had a medical degree, he had never practised medicine.52 Turner probably chose him because he was an unattached civilian physician with an interest in nervous illness and was thus available at a time when military surgeons were at a premium. It was, admitted Myers, a posting based equally in ignorance and desperation.53 In March 1915, Myers was attached to the Director Medical Services (DMS), Boulogne, as a special consultant on nervous and mental cases, where he was single-handedly to supervise and provide advice on the treatment and care of nervous soldiers at more than a dozen hospitals; to detect malingering and give evidence in prosecutions for a variety of offences; to sit as an expert on a slate of medical boards; and, when necessary, to act as a consultant, distinguishing organic from psychogenic cases at every hospital on the coast. Unlike regular army doctors,

44

A Weary Road

who tended to see shock as either a form of physical exhaustion – such as DAH or neurasthenia – or cowardice, Myers believed it had a psychological origin. He argued that these patients were men whose primitive fear instincts had left them in a highly suggestible state in which the baser impulses manifested themselves as psychosomatic symptoms, temporarily submerging the higher reasoning processes. In his view, while rest and diet were important, some form of talk therapy also had to be employed to restore the patient’s “self-knowledge, selfconfidence, and self-control. For these a judicious admixture of explanation, persuasion, and sometimes scolding, is required, as in the education of children, and, where necessary, as in amnesiac cases, in the restoration of a completely normal, from a dissociated, personality.” Myers’s talk therapy was practical, following from the work of Dubois and Dejerine, allowing him to suggest that no specialist training was necessary; a medical officer or nurse need only have “enthusiasm, confidence, cheerfulness and tact,” he later wrote, combined with a perceptive and intuitive personality.54 Only a handful of early medical case sheets with Myers’s signature were preserved by the Medical Research Council in the 1920s.55 They suggest that in terms of treatment, he believed that as a consulting expert, his primary role was to initiate therapy, not to see cases through to conclusion. Once he successfully got patients talking, local attending physicians and nurses would keep them engaged in both official and unofficial interactions on the hospital ward. For example, H.B., a twenty-­ six-year-old private in the 2nd King’s Royal Rifles was admitted to No.  11 General Hospital, Boulogne, in August 1915. Unable to speak and without any memory of his war service, he was diagnosed as melancholic and shell shocked. On 12 August, Myers interviewed H.B. and was able to get him to laugh and later convinced the soldier to write a letter to his wife about his troubles. From it, Myers determined that his condition may have originated at the front, but was “enmeshed with her.” After Myers left, H.B. fully recovered his speech and kept up the dialogue with his physician at No. 11 General Hospital and could soon remember everything that had happened to him. He told his doctor that a shell had burst close by him near Bailleul when he “lost control.” While this was the precipitating factor, he soon confirmed Myers’s suspicions: at the time of the shock he was already distraught worrying that his wife did not have enough money to live on – they had only been married in August 1914 and she did not work. By the 16th he was almost fully recovered and was discharged to light duty.56



Purely Shattered Nerves 45

The Divisional Stopping or Rest System In late 1914 and early 1915, the army’s chief concern was that like other men admitted “sick” to hospital, most of Myers patients were eventually evacuated to England, where treatment was usually followed by lengthy leave, convalescence, and reconditioning. A trip to England virtually guaranteed that a soldier could not return to the front for several months.57 For this reason the DGMS officially discouraged transfers to England and began to look for ways to keep more men in hospitals closer to the front.58 The main problem, though, was that the King’s Regulation’s did not provide for the treatment of minor conditions like trench foot in the collecting zone. At the end of November 1914, Lieuten­ ant Colonel M.W. O’Keefe, deputy director, Medical Services, III Corps, devised an experiment, establishing two divisional convalescent depots among its six field ambulances at Steenwerck and Croix du Bac that were intended to treat minor cases thought likely to recover in a short period of time.59 O’Keefe had found that as major operations ceased, the third field ambulance in each division became superfluous, as those cases which did arise at the front could easily be handled by the other two. This approach also helped address concerns about mounting sick evacuations. Sick soldiers who were kept at a field ambulance as opposed to being evacuated to a CCS, were never struck-off their unit’s strength, meaning they were not counted as casualties. Because they remained on-strength of front-line units, they could also return to duty directly from the rest station, instead of meandering their way through the casualty system on the lines of communication. On paper, at least, wastage plummeted. When news of the experiment’s success reached DGMS Sloggett in early January 1915, both First and Second Armies were ordered to convert one field ambulance per division into a convalescent depot, which soon became known as a Divisional Rest Station (DRS).60 Field Ambu­ lances assigned to establish a rest station typically did so for a period of eight to ten weeks before rotating to the front lines, replaced by one of the other two field ambulances attached to a division. According to instructions issued in early 1915, they were not to have direct communication with front line RMOs and were not to receive wounded directly – although in practice they sometimes did.61 Patients were instead supposed to be admitted via the dressing stations of the other two field ambulances, where divisional medical staffs could triage them and determine which soldiers were most likely to recover within a week.62 At

46

A Weary Road

a rest station, treatment consisted of bed rest, an improved diet, a warm bath, and a change of clean clothes.63 They also operated bathing stations and laundry facilities – although in some cases these duties were performed by one of the sections of another field ambulance within the same division.64 Rest stations thus constituted a new diversion along the normal path of evacuation, creating a temporary hospital within the collecting zone, where patients could be sent for assessment and observation. If they improved as anticipated, they returned directly to their units. If their condition worsened, they were evacuated to base hospitals via the CCS.65 On 5 January, No. 14 Field Ambulance sent its first patients to the new divisional station and by the end of the next month, around 13 per cent of all sick admissions were being diverted there and away from the casualty clearing stations.66 By mid-month, this new policy of “divisional stopping” had been implemented in all the medical units in both First and Second Armies.67 Although the DRS system was not created specifically to manage cases of nervous illness, soldiers with shock, neurasthenia, and DAH were soon being diverted to DRSs along with other minor cases of sickness and wounds. There they were typically observed for a short period and given rest, a modified diet, and exercise. As in South Africa, those that improved might be returned to duty, others were evacuated. The result was a significant reduction in primary evacuation rates for nervous illness in the collecting zone. In No. 14 Field Ambulance nearly every nervous patient treated at the hospital had been evacuated between August 1914 and February 1915. With the adoption of the divisional rest system, more patients were kept on divisional strength. In March 1915, for example, 20 per cent of nervous patients admitted to the field ambulance were diverted to the DRS rather than sent to the CCS, and in April that figure climbed to 50 per cent.68 Conclusion From the perspective of the military authorities, in 1914 and early 1915 nervous illness was never perceived as a serious problem in comparison to diseases like trench foot, dysentery, and various fevers. As indicated by table 2.1, between August and December 1914, there were 1810 admissions to hospital for diseases of the nervous system, 508 for DAH, and 96 for mental disease – a total of 2414.69 As in South Africa, these figures would have included a variety of illnesses, only some of which might have been categorized as nervous, and so this represents an



Purely Shattered Nerves 47

Table 2.1 Hospital admissions and evacuation rates, categories associated with nervous disease, August to December 1914 Diagnosis

Admissions to hospital

Returned to duty

Return-to-duty rate

Diseases of the nervous system

1810

1681

92.8%

Debility

1080

1076

99.6%

508

485

95.4%

96

52

54.2%

3494

3294

94.3%

DAH Mental disease Total

Source: Major T.J. Mitchell, History of the Great War Based on Official Documents: Medical Services, Casualties and Medical Statistics (London: HMSO, 1931), 130–2.

upper limit on the total number of cases, not a definitive estimate. Given that during the first four months of fighting, there were 56,301 admissions for battlefield wounds to units in France and Belgium and 74,615 for sickness or injury, these three categories accounted for only 4.3 per cent of wounds and 1.8 per cent of all admissions.70 In comparison, trench foot was responsible for 6455 hospital admissions (4.9 per cent), influenza and pneumonia 1856 (1.4 per cent), malaria 1147 (1 per cent), and various fevers a further 8225 admissions (6.3 per cent).71 There was thus little reason for the military authorities or senior members of the medical services to single out nervous illness for special management, as on its own it did not pose a serious threat to military efficiency. Rather, it was understood to be part of the general wastage problem on the Western Front.

Chapter Three

Baptism of Fire: The Ypres Salient, 1915

When war broke out in 1914, Canada agreed to send an expeditionary force to serve as part of the BEF.1 Although Canadian infantry and artillery units usually fought as a single entity during the war, becoming something akin to a national army, this was not the case with most overseas medical units. Outside of the immediate front lines, hospitals in the rear area were part of an integrated imperial network through which patients moved freely regardless of nationality. Once soldiers left the front-line area, or collecting zone, they also left Canadian jurisdiction.2 Canadian medical units thus had to follow British rules, regulations, and orders and operate within a British chain of command. This required a period of acclimatization, as in contrast with the Canadian infantry, which was two-thirds British-born, most CAMC doctors had been born in the Dominion, and unlike their professional RAMC counterparts, they were also civilians with little experience of military matters.3 Although the surgical and medical tasks were the same as those of the civilian world, the priorities and mindset of military doctors was necessarily different. “Not only must the Military Side do these things but it must do them in a military way,” reflected G.L. Foster, the Assistant Director, Medical Services (ADMS), 1st Canadian Division, one of the few Permanent Force doctors attached to the Canadian Expeditionary Force in 1914, “as, unlike the work of the Professional Side which is internal to the Medical Service itself, almost every aspect of this work interlocks with the work and machinery of the other Arms, and requires for its proper conduct a knowledge and experience of Army machinery, regulations, methods and usages in general.”4 One of the most important differences was that the medical services’ primary concern was military efficiency rather than altruism: casualties were to



Baptism of Fire 49

be treated so as to protect the ability of the army to keep fighting.5 At each stage in the treatment process, medical officers had to decide whether it was in the best interest of the army to evacuate a soldier to the rear, retain him for treatment, or send him back to duty. As the Canadians soon discovered, this was no easy task. This chapter examines the management of nervous illness within the CEF during its first year on the Western Front. Although the total number of nervous casualties remained relatively small, diagnosis became gradually more standardized and by summer shell shock became an accepted part of life at the front for both doctors and soldiers. The stopping system allowed most cases to be treated close to the front within the divisional area, with many returning to duty, which minimized evacuations and ensured that nervous illness was not yet perceived as a serious threat to discipline or military efficiency. As the number of cases grew and men became more familiar with the routine of “holding the line,” doctors, officers, and men came to see the DRS as a place where the nervous might earn a brief “holiday” from the horrors and anxiety of life at the front. Over time this normalized nervous responses to intolerable or traumatic situations and the number of men admitted to field ambulances grew. The Second Battle of Ypres After training in England during the wettest winter on record, 1st Cana­ dian Division arrived at St. Nazaire, France, in mid-February 1915, continuing their training with British units over the next weeks.6 The Canadians’ baptism of fire came unexpectedly in late April during the German gas attack at Ypres. On the 6th, the Canadian division had moved north from its first posting at Neuve Chapelle to the Ypres salient, where it would spend the next seventeen months, joining Second Army’s V Corps.7 There No. 2 Field Ambulance established an advanced dressing station at Wieltje, with their main station just northeast of Ypres on the rail line. The next night, on the 15th, ADMS Foster heard a disturbing story which he recorded in his diary: “Rumour that this evening the enemy will attack our lines using an asphyxiating gas to overcome our men in the trenches. Arrangements made for the handling of 1,000 wounded tonight.”8 But the attack failed to materialize, and over the next two days, No. 1 Canadian Field Ambulance established a DRS at Watou, while No. 3 was billeted north of Ypres in “isolated farms which [had] been occupied by the French troops throughout

50

A Weary Road

the winter and are in a filthy condition.”9 By the 19th, they had opened a main dressing station in a girls’ school at Vlamertinghe and an advanced dressing station in another farm to the north.10 The Canadians were ill prepared for the surprise German attack which came only a few days later. At 4:30 pm on 22 April 1915, the Germans opened up a heavy barrage all along the French and Canadian fronts north and northeast of Ypres.11 “A violent artillery duel began in the region occupied by the French and gradually spread along the sector occupied by the Canadians,” wrote the commander of the Canadian ­mobile field laboratory stationed just outside Ypres. “We watched shells dropping within 200 yards of us. At least 25 “Jack Johnsons” fell in one field, evidently in search of some battery. Shells screamed overhead into Ypres; each one being followed by a great clout of black dust and smoke.”12 This was followed by a yellowish-green cloud of chlorine gas released from hoses in No Man’s Land attached to cylinders in the German trenches.13 ADMS Foster described what happened next. “The French Territorial troops and Belgium [sic] Troops occupying the line of trenches on out left gave way, the enemy using heavy asphyxiating gases. A number of these gas cases flocked into the village of Brielen and although a few of them seemed to suffer and be in great distress, their condition did not appear to be alarming or at all serious. These cases were treated and removed at once by the French Field Ambulance at Elverdinghe and No 3 Canadian Field Ambulance at Vlamertinghe.”14 Many of those suffering from the gas were in a full-fledged panic and were in more distress from the fear unleashed by this new weapon of war than the effects of the gas itself.15 While No. 3 Canadian Field Ambulance was patching up and calming down the French wounded, a second assault on the Canadian left began. Chaos ensued. “Heavy firing continued throughout the night,” Foster reported after the battle, “and many casualties began to arrive at the advanced dressing stations which were evacuated to the main dressing stations of the 3rd Field Ambulance in girls school at Vlamert­ inghe, and from there they were evacuated by motor ambulance convoys to the Casualty Clearing Station in Poperinghe.”16 As the casualties mounted, the German infantry advanced deep into the Canadian rear areas and it became necessary to redeploy the field ambulances to prevent them from being overrun.17 It was a desperate situation.18 That night and the next morning, hurried counter-attacks were made at Kitcheners Wood and from the direction of the Yser Canal which stalled the German advance. By mid-day on the 23rd, most men had gone



Baptism of Fire 51

more than twenty-four hours without sleep and little food or water.19 Nevertheless, they continued to dig new trenches to defend against a renewed German offensive that was expected to begin at any moment. By that evening, the DMS, V Corps learned that there were still more than 1,000 casualties being held in the ruins of St. Julien alone, most waiting to be evacuated under the cover of darkness.20 Medical units continued to function as best they could. When Ypres was severely shelled, British field ambulances were withdrawn to the south, leaving No. 1 Canadian at Vlamertinghe the only advanced dressing station in the salient. Frank Walker, a stretcher bearer with that unit, recorded in his diary for 23 April: “The wounded are pouring in by the hundreds. Those who could walk have limped as best they could, from the trenches. Others crawl in, helped along by comrades. The roads are blocked with ambulance cars. Wounded men are lying on stretchers, outside the Dressing Station, along the high-road, in fields, and on the doorsteps of houses. Doctors and Orderlies are working as quickly as possible, but the queues of waiting wounded are steadily growing longer and more unmanageable.”21 Doctors became overwhelmed in the chaos. “The whole training of a medical man tends to inure him to unpleasant sights and smells,” wrote William Boyd, a professor of pathology at the University of Manitoba and a physician at No. 3 Field Ambulance who was sent up to assist his comrades at Vlamertinghe, “but I must confess that we need all our training this morning. The dressing-station was formerly a school, and every room was so packed with wounded, lying on stretchers on the floor, that it was with the greatest difficulty that we could move about. It was literally almost impossible to put your foot down without treading on a wounded man.”22 At 4:00 am on 24 April, the German Fourth Army released a second cloud of chlorine gas, this time from the north end of the salient, directly towards the Canadian 2nd Brigade and the men of the 8th and 15th Battalions. An officer in the latter noted that morning that the “Germans appear over parapet wearing helmets somewhat like divers with hose in their hands from which they projected a heavy green gas. Rapid fire was brought to bear, but the gas soon rose to about ten feet and struck our trenches in a very short time. We therefore retired to trench in rear.”23 Watching from the rear, field artillery units saw the Canadians retreat to secondary positions and then stop firing their ­rifles.24 To the Canadian right, the British 13th Brigade watched in horror Canadians “wounded and unwounded of 13th, 14th, and 15th

52

A Weary Road

streaming across rear of 7th Bn. Line in disorder. Gassed.”25 By 6:30 am, Brigadier General Arthur Currie, in command of 2nd Brigade, reported that the Germans had “broken through Highlanders trenches … I regard situation … as critical.”26 By late morning, although 2nd Brigade units had been decimated by casualties and small gaps had opened in the line in some places, they still managed to repel repeated German breakthrough attempts. But to the south along 3rd Brigade’s front, with communications largely severed between the front and rear areas, Brigadier General Richard Turner panicked, ordering a precipitous retreat to prepared positions a few hundred metres to the south which opened up a 3-kilometre gap between the two front-line Canadian brigades.27 Fortunately for the Canadians, the German army lacked the men to exploit the situation and Currie’s units were able to strain to their left, plugging the hole. On the 25th British reinforcements began to arrive, saving the serious situation from further deterioration and the Canadians were withdrawn the next day. Nervous Illness during Second Ypres During times of relative quiet, soldiers tried to cope with the horrors of life at the front in a variety of ways: they sang, drank to excess, and made trench art from spent shell casings.28 But the type of heavy shell barrages that preceded an infantry attack were probably the most terrifying aspect of trench life. “A big High explosive came near me and the flash and powder kind of got my goat,” wrote Pte. Herbert Laurier Irwin, a twenty-year-old farmer to his parents in Weston, Ontario. “I thought I saw a big hole. I floundered into it on my head and it was only about a foot deep. I was like an ostrich then trying to bury my head in the mud. Just as I hit the bottom a big ‘dud’ unexploded shell came over my shoulder half burying me. When I got back down the line to the old position it was all torn up but one dug out and two fellows were wounded and one shell shocked. I thought I was due for that but I didn’t get it. I don’t make any bones about saying I’m darn scared of shells and anyone who says differently hasn’t been there.”29 Harry Howland of the 7th Battalion recalled his first experience being caught in a shell barrage while lying in the middle of a turnip patch, large German shells passing low overhead. “In very little time the turnip patch is churned beyond recognition,” he recalled years later. “Clouds of black smoke are belched from the monsters and the ear-splitting explosions of these coal-boxes and ‘Jack Johnson’s’ is nerve-racking. After



Baptism of Fire 53

the third or fourth men brace their bodies to the bangs.”30 As a gunner serving with 1st Canadian Division wrote to a friend back home in the spring of 1916, constant shelling “got on our nerves. We couldn’t work off our pent up feelings by charging the enemy! We couldn’t even see him! All we could do was to smoke, play cards when not actually firing.”31 To the Edwardian mind, real men remained in control, carrying on in the face of adversity. To consciously give in to a churning stomach, shaking knees, and the instinct to run was an abandonment of one’s duty as a man. But give in some did. According to soldiers’ own accounts, chlorine gas clouds drove many men to the brink of madness. “It is impossible for me to give a real idea of the terror and horror spread among us all by this filthy loathsome pestilence,” wrote Major H.H. Mathews of the 8th Battalion, which experienced some of the worst fighting at Ypres. “Not, I think, the fear of death or anything supernatural but the great dread that we could not stand the fearful suffocation sufficiently to be each in our proper places and able to resist to the uttermost the attack which we felt sure must follow, and so hang on at all costs to the trench that we had been ordered to hold.”32 The gas was rarely lethal but caused men to choke, vomit, and become temporarily blind. It is little wonder that some turned and ran in the chaos that ensued. One Cana­ dian highlander was spotted by the commander of the Canadian mobile laboratory on the road to Ypres “on foot and black with powder and grease,” saying that “they had been left up in the corner when the French retreated, that they had been surrounded by Germans and was told [it was] ‘every many for himself.’”33 Gas was one of the first “terror” weapons, intended to sow panic and disorder rather than to kill. As a new weapon of war, in 1915 most soldiers could neither imagine what gas was nor conceive how it would affect them because it was beyond the scope of their experience. In this respect, gas was a highly effective weapon. Even in small quantities, it caused men to gasp for air and hyperventilate as their lungs were unable to pull sufficient oxygen from the air. This lack of oxygen would have heightened the severity of the “normal” fear response associated with combat, inducing an anxiety state similar to a panic attack. Even with crude respirators, it was difficult to remain calm, as the experience of 4th British Division showed a month later. At 2:45 on the morning of 24 May, the Germans opened the valves on several chlorine gas cylinders in the front lines, producing a steady cloud of gas for over threequarters of an hour. As the cloud drifted towards the British trenches,

54

A Weary Road

orders were given for the men to don makeshift respirators consisting of gauze pads dipped in a counteractive solution. “At first men used respirators correctly,” 4th Division reported, but as respirators became choked with gas men re-dipped them in solution. As gassing continued men became excited, but could not be prevented from putting respirators to their mouths after each dip without squeezing them dry, the result was the men could not breathe through saturated respirators, and thinking they were being suffocated by gas dipped them at shorter intervals, breathing hard between the dips instead of holding their breath, with inevitable result that they were rendered unconscious by gas.34

As the men panicked, their officers tried to move between them, giving orders to control their breathing through the gauze pads. When German shells began to rain down on the front lines, killing or wounding the officers, men broke and ran. “In face of severe German attack, trenches had to be evacuated by the few who were not hit or gassed,” continued the report. “There was no chance of checking which of the men left in the trenches were dead or wounded. One officer, the medical officer and 43 men of [his] battalion came out in a formed body. These had noted the casualties which had occurred to officers, but could only report that the remainder of the battalion were missing.” Later, eighty-four of the “missing” were found in a field ambulance, admitted as walking wounded.35 In the chaos of a gas attack, it was impossible for doctors and men to distinguish those who panicked from those who broke down with “shock” or “neurasthenia.” Indeed, any attempt to do so was largely semantic. Captain G.W. Northwood, in command of No. 4 Company of the 8th Canadian Infantry Battalion, reported that “at daybreak on the morning of Saturday 24th April 1915 the gas came over in heavy clouds … The extreme right of my trenches was only slightly affected, but the other portion received the full blast and were soon filled with coughing and choking men.” Although he maintained that most tried to carry on, giving the attacking Germans a “warm welcome” as they came across no man’s land, he acknowledged that “a few men went out of their minds from the gas and most were considerably weakened.”36 Private Frank F. of the 2nd Lancashire Fusiliers, who relieved the Canadians in the trenches at St. Julien on 2 May, was subjected to the third German use of gas. “He noticed a greenish yellow smoke approaching their



Baptism of Fire 55

position,” wrote his doctor. “The smoke rose to about 8 or 10 feet in the air and came slowly on them. He felt a choking sensation and as though his head would burst. He had a desire to lie down and then after a drink of water he vomited a green and yellow fluid. He had a greenish expectoration with a hard and irritating cough.”37 When he reached hospital, F. was described as being in a “highly neurotic condition” characterized by “a shaky condition of [the] hands.”38 He was diagnosed with neurasthenia, and “effects of poison gas” was written in beside. Andrew Iarocci found that roughly 8.5 per cent of the officer casualties in the 7th Battalion, to use one example, left the front due to some form of nervous breakdown – although most were recorded as admissions to hospital for different conditions.39 Enlisted men too were said to have been “driven mad” by gas. One of those was Pte. Ambrose C., a thirty-four-year-old steam engineer from Prince Edward Island. C. was in the trenches at Ypres on the night of 24 August with the 7th Battalion to the rear of the 8th and 13th Battalions. When the German bombardment opened up on the Canadian rear areas he was “knocked silly” and remained unconscious for ten hours.40 When he came to he woke up coughing and choking from the gas. As chlorine gas is heavier than air, it tended to settle along the ground, where it affected wounded soldiers like C., who were unable to move, more than others. Somehow he managed to make it back to a regimental aid post and was sent to hospital suffering from “gas and shock.” A month later he still had pains in his chest, a persistent headache, and a poor memory. At night he could still hear the voices of his officers barking orders in the trenches.41 Gas could have the same psychological effect as shell fire. “At least the horror of shell fire and machine-gun bullets could be partly defended against,” writes Tim Cook, “and the use of deep trenches and shell holes helped psychologically as well as physically. Not so for those caught amidst a gas cloud seeping ever closer into their hiding places, threatening their lives with an agonizing death if they stayed hidden and exposing them to sniper and machinegun fire if they stood up. This was the stuff of mythical fears.”42 Another case was that of Lieutenant Colonel Creelman, the unit’s commanding officer, who reported ill with gas poisoning and a high fever to a dressing station on 29 April. From there he was evacuated to a CCS and then on to hospital in England. In “Blighty” he wrote: “I am ticketed as an ‘influenza’ patient, technically it is called ‘shock.’ A Board sat on me at Rouen and decided that a rest would be beneficial.”43 His medical records indicate that it was difficult to determine at the front whether he was suffering more from the

56

A Weary Road

effects of gas or more from nervous breakdown.44 General Turner’s erratic behaviour too may have partly resulted from nervous exhaustion. His headquarters had been shelled continuously that day and part of it destroyed. As he later told his wife, he felt dazed for weeks afterwards, his head hurt, and his memory frequently failed him.45 He was not the only one in his headquarters. “About 4pm [the Germans] dropped 70 high explosive shells about, and on our, buildings within a radius of 30 yards,” he wrote. “It was most nerve racking, and it drove 4 of the officers with us silly; in the end when we had to get out, we had to swim across the moat which was full of dirty water.”46 Other soldiers were known to have been treated for gas poisoning at Ypres, only to be readmitted to hospital a few weeks later with the same symptoms when they were rediagnosed as nervous or mentally ill. For example, Private Cyril F., a twenty-four-year-old soldier from Indiana, was admitted to hospital in late May 1915 suffering from shock.47 “This patient was through the second battle of Ypres,” wrote his physician. “States he suffered to some extent from gas and was sent to a hospital in Belgium on that account. There, he states, that he, with another, broke away and returned to the lines. He states that he was not feeling quite himself but would rather be with his comrades.”48 When his symptoms returned in the absence of gas, they were construed as nervous.49 The primary effect of gas, of course, was not death, but incapacitation through a combination of temporary asphyxiation and fear. Thomas F., a brass finisher from Quebec, was a corporal in the 1st Battalion when the second gas attack swept across his trenches.50 F. was sent to a field ambulance and kept there for three days, apparently due to gas poisoning before returning to duty. Later that summer his symptoms returned after a close call with a German trench mortar.51 This time he was diagnosed with shell shock. There was little medical officers at the front could do to treat gassed, exhausted, and shocked soldiers except provide a respite from the firing line, a hot meal, and rest. Although the situation was precarious, Colonel Foster allowed a soup kitchen to be opened up alongside No. 3 Field Ambulance at Vlamertinghe. The unit had originally been organized by the British Red Cross and was operated by three English women, a Mrs. Massey, Mrs. Shillington, and Ms. Perry.52 Soup kitchens had been assigned to hospitals on the lines of communication at a rate of one per division, but a few days before the battle Foster specially petitioned to have the one allotted to the Canadians moved forward.53 It proved a wise decision. According to Major Garnet Greer, a



Baptism of Fire 57

field ambulance officer, “These three ladies worked steadily day and night during the battle, and, I am told, in one day fed with hot soup and cocoa over two thousand weary soldiers.”54 The experiment proved successful and soon after the battle ended, a kitchen was opened at each field ambulance in Second Army to provide every wounded or sick man with a hot meal as he left the front.55 George Adami, a serving medical officer and early historian of the CAMC wrote: “It is difficult [to overestimate] what help and comfort these have brought to our men.”56 Battlefield rest stations provided an opportunity for soldiers to regroup and became collecting points close behind the lines for the wounded and panicked alike. It is impossible to accurately gauge the prevalence of nervous and mental illness during a chaotic engagement like the Second Battle of Ypres, in large measure because the line between nervousness and normal behaviour under fire was unclear.57 But because of the confused nature of the fighting, which required hospitals to shift positions while continuing to care for casualties, the Canadian field ambulances also did not keep any Admission and Discharge (A&D) books. Other official records list only total admissions, the number of wounded, and the number of sick, but causes for admission are largely absent and where present often contradictory.58 Official figures tabulated in the 1930s suggest a total of between forty and sixty soldiers with nervous illness at Second Ypres, but this seems far too small given the anecdotal evidence cited above.59 At first glance, this would imply that of the 2616 wounded (all causes) suffered that month, only about 1.5 to 2.3 per cent were nervous casualties. Many of the cases described above may instead have been “hidden” among the 1556 sick who were evacuated during the battle, some misdiagnosed as suffering from gas poisoning and vice versa.60 Yet we must also be cautious in assuming that official figures represented a significant underestimate of nervous casualties. No. 14 Brit­ ish Field Ambulance, which moved to Ypres just a few days before the gas attack, kept full admission and discharge books during the battle which suggest that nervous illness accounted for a relatively small proportion of casualties. At its dressing station at Renilghelst (where it was forced to move on the 23rd after Ypres was shelled), about three kilometres south of the city, the hospital admitted just over 2400 patients, mostly British but some Canadian, between 22 April and 19 May. Of these, the vast majority were for shell, bullet, and bomb wounds, with 285 admissions for “effects of gas” between 1 and 19 May. There were

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A Weary Road

also 50 admissions for shock – sometimes written as shock (shell), 5 for “nerves,” 1 for DAH, 1 for neurasthenia, and 1 for mental illness. These 58 admissions represented only 2.4 per cent of all admissions, and there were only a handful of soldiers written in under diagnoses that might otherwise reasonably include cases of nervous illness: 5 for myalgia, 3 for debility, and 1 for rheumatism. Some – perhaps many – may also have been included under “effects of gas,” but undoubtedly many of these men, none of whom had respirators, would have actually been suffering from gas poisoning. There were also dozens of cases of abrasions and contusions treated in the field ambulance and then evacuated to the base, which is strange given that such injuries are, by definition, minor. All these cases were sent to the base via the CCS. In the end, though, we must admit that we simply do not know how many men broke down during the fighting. Shell Shock Shell shock was not a new term in the spring of 1915, but it was just coming into common usage. Some authors have attributed it to C.S. Myers, who first used it in the medical literature, but as he noted in his memoirs, it was already much in use at the front by the winter of 1915 and appears to have come into use organically.61 As front-line doctors read the medical journals, newspapers, and talked to one another about the growing number of shock cases they treated, the diagnoses they employed became more standardized.62 It was an organic process. The DGMS first noted that there were “men suffering from shock due to shell explosions” in February 1915, suggesting that measures be taken to ensure that these cases were treated as battle casualties and afforded the same rights and privileges as men physically wounded by shot and shell.63 This, in turn, reflected the fact that by that time the language of “nerve shattering” shell barrages had already begun to creep into reports and lower-level correspondence. For example, in the fall and winter of 1914–15, No. 14 Field Ambulance admitted 87 patients under a variety of diagnoses describing nervous and mental illness. The most common diagnosis remained DAH (52 per cent), reflecting old prewar ideas about the mechanism of breakdown and disease within the peacetime army. The remaining cases were admitted under shock (25 per cent), epilepsy (14 per cent), hysteria (8 per cent), and neurasthenia (4 per cent), with the remainder split among insomnia, concussion, and various “mental” diagnoses.



Baptism of Fire 59

But during the late winter and early spring, diagnosis began to shift. In April 1915, not only did the number of admissions spike to 138 in a single month, but now 88 per cent of admissions were for “shock” or “shock (shell).” Admissions for DAH plummeted to only 3 per cent. Whereas DAH, epilepsy, hysteria, neurasthenia, or concussion identified specific disease processes, “shock” or “shock (shell)” indicated only a general group of symptoms clustered around the combat experience, and specifically a traumatic event.64 A similar, although less dramatic, pattern is evident in the diagnosis of nervous and mental illness in the CEF. As indicated by figure 3.1, the prevalence of “shock” or similar so-called commotional diagnoses grew from only about 13 per cent in March to peak at almost 90 per cent in June, averaging out at nearly 60 per cent for the remainder of the year. The specific diagnosis of “shell shock” was first used by No. 1 Field Ambulance on 18 June 1915, and its usage rose steadily but slowly thereafter. It did not fully displace “shock” as the primary diagnosis until the spring of 1916.65 As Peter Leese argues, the concept of “shell shock” was powerful because it encapsulated the notion that the war had unleashed terrible new forces upon the world capable of destroying not only flesh and bone, but also the very fabric of the mind itself.66 It therefore appealed to harried doctors at the front who needed a means of quickly labelling patients in a chaotic environment where a thorough examination was impossible, while also building on popular ideas about the nature of nervous disease. The diagnosis acted like a mirror that reflected back people’s fears about the war and its effect on a generation of young men – those at home knew nothing of the horrors of war and the unknowable and inexplicable elements of the typical shell shock patient’s symptoms came to embody that gap in experience. As civilians became soldiers, this knowledge informed their own expressions of mental anguish on the battlefield, providing a malleable template of legitimate illness with an infinite number of symptom combinations. It is remarkable how rapidly the concept was integrated into popular discourse and the everyday imagery of war in Canada. During the first winter of 1914–15 – long before most Canadian troops had reached the Continent – a coherent militarized disease concept, based on the civilian idea of traumatic neurosis, was already beginning to take shape. An examination of a cross-section of urban and rural Alberta newspapers shows how the popular understanding of war-related nervous and mental illness evolved.67 The first stories appeared in December 1914 as the initial Canadian contingent was training in England. On the 19th, a

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100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

ch ar M

ril Ap

ay M

ne Ju

ly Ju

st gu u A

Mental Illness or Insanity

Epilepsy

Neurasthenia, Nervous, and Exhaustion

Hysteria

r r r er be be be ob t m m m c e ce ve O pt De No Se Shock, Shell Shock, and Concussion

Figure 3.1 Diagnoses on admission to Nos. 1, 2, and 3 Field Ambulances by months, 1915



Baptism of Fire 61

wire service correspondent for the Canadian Press reported that British doctors had observed “the extraordinary effects of shell-fire upon those who are forced to undergo it.” The paper recounted the case of two British men who were “struck deaf and dumb by shell explosions” although “neither of them has anything wrong with his organs of speech or hearing, but is suffering simply from shock.” There were others too, said the reporter. “A third cannot see, caused by nervous shock,” he wrote. “There is nothing the matter with his eyes and complete recovery is promised after a period of quiet and rest. The fourth man’s experiences left his mind blank.”68 Such stories must have seemed fantastical, ominous, and confusing. The power of a bursting shell was something that few civilians had experienced, and so the idea that men might be struck deaf, dumb, and blind was not implausible. At the same time, such reactions must have aroused some suspicions of hysteria, fakery, or mental illness. Any question of character weakness was quickly dismissed, though, by experts in subsequent wire stories who explained that this form of breakdown was a normal reaction to the inexplicable, technological horror of modern warfare. “Normal persons,” a French professor was quoted saying in the Crossfield Chronicle in February 1915, “had adapted themselves courageously to the agonies and uncertainties which suddenly had broken up all their customary habits of thought, action, and feeling, but in the case of certain exceptional subjects the emotional shock had resulted in mental confusion and excitement or in depression, and these, attacking the nervous instability, had produced grave disorders.”69 Such breakdowns, though, were to be expected, as they were the natural result of witnessing the horrors and strains of war, not because the sufferer was cowardly or weak. Such men were to be counted among the brave and wounded as they still chose to play the game despite the risk of being driven mad – a courageous act in itself. The effect of shell fire was understood to excuse men from all sorts of behaviours that might otherwise be construed as cowardly or feminine. “The powerful effect which modern warfare has on the mind is shown by the dreams and nightmares which disturb soldiers’ sleep in dangerous positions,” recounted another wire-service piece printed in the Calgary Eye-Opener in March 1915. Nervous subjects react in a most striking way to the shock of explosions in their immediate vicinity. Some develop a tendency to sleep walking and are found wandering about the premises with faces expressing the utmost

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terror and anxiety … The soldiers dream that they are wandering through endless trenches as complicated as an artificial maze or are picking their way through lonesome forests. The slightest noise during sleep calls up visions of exploding shells or the tramp of armed men, throwing them into a frenzy of shouting terror to the indignation of their rest fellows … Yet these nightmare ridden men are as brave as the rest in the face of ­actual danger.70

Stories of war-shocked soldiers affirmed the idea that the war had unleashed terrible new forces on the world and played on prevailing fears that husbands, sons, brothers, and fathers were undergoing terrible experiences which no one at home could hope to understand. War, it seemed, was destined to transform both the minds and bodies of those who fought. “Under fire he may lose every preconceived notion he ever cherished or shunned,” read another widely reproduced article printed during early May 1915 in the Red Deer News and modified from an earlier story in the London Times, “but it is at least in the highest degree probable that [the soldier] will find himself.”71 In this analysis, the process of individual breakdown could even be regenerative – a painful but necessary part of a larger transformative journey. Such analogies drew heavily on archetypal tropes, casting traumatized soldiers as heroes in the making, forced to overcome the horrors of war in order to achieve redemption. Soon after the Second Battle of Ypres, this emerging language of “concussion” and “shock” was integrated into the daily official casualty lists sent out by telegraph from Ottawa which printed the name, rank, regimental number, and unit of wounded soldiers under broad categories like ill, wounded, seriously wounded, missing in action, and killed.72 The reporting of casualties changed during the war to accommodate new types of injury created by new technologies and the newspaper reading public’s desire for more specific information about the condition of serving soldiers. Following the gas attack at Ypres, soldiers began to be classified as “gassed” or “mildly gassed” after newspaper reports on the battle revealed that Germany had used chemical weapons for the first time. This distinguished victims of this new form of barbarity, elevating them to a separate status among all the others who remained physically wounded, sick, killed in action, or missing. Simi­ larly, the first reports of casualties under distinct categories like “concussion” were first printed in the official lists of mid-May 1915, following the fighting at Festubert when large numbers of war shock



Baptism of Fire 63

cases appeared in the CEF.73 A separate category for shock was added soon after. Lieutenant Lionel Hugh Major, a thirty-year-old financial agent from Victoria serving with the 7th Battalion, was one of the first Canadian soldiers to be officially reported as “suffering from shock” in a list released by the Department of Militia and Defence on the evening of 29 May 1915.74 On 2 June two Canadian soldiers were listed as suffering from concussion, two with shock, and one with “severe shock and weak eyes”; on 5 June eleven soldiers were listed as “shocked”; and the phrase became commonplace in the casualty reports issued thereafter.75 The adoption of new terminology suggests that officials at the Depart­ ment of Militia and Defence expected Canadians to understand what those terms meant.76 The idea of shell shock was powerful precisely because it seemed to capture the idea that men were being physically broken by war. On the home front, medical experts quickly mobilized to explain how the horrors and shock of war produced nervous illness. “High explosives, long-range accuracy, and quickness of fire have made the artillery arm the most effective of the Service,” explained Sir William Osler in a popular 1915 pamphlet, Science and War. “Every device of science has been pressed into use, and the aeroplanes with their observers and cameras have plotted the entrenched lines to checker boards, on to any square of which a rain of shell and shrapnel may be poured. The high explosive shells, the ‘Jack Johnsons,’ and the ‘Black Marias’ have played a great role in the present war, and not only do they kill and maim, but the shell shock from commotion puts a large number of men out of action.”77 Campbell Myers, the chief neurologist at the Toronto General and St Michael’s Hospitals, connected prewar popular and medical discourses of nerves to that battlefield. Like civilian neurasthenia, he said, shell shock was an honourable and natural disease brought on by the individual’s engagement with the unsettling modern world of industrial warfare. “In this terrible war the Army Medical Corps has had no more distressing class of patients to treat than those suffering from nervous disorders, due to shell shock and general nervous strain,” he wrote in a popular pamphlet that was later distributed by the Department of Militia and Defence to doctors treating nervous patients. To those accustomed to the horrors of active campaigns, the sight of an able-bodied soldier, whose bravery and courage are undoubted, suddenly bursting into tears on being asked for a match or some other simple

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question, is more appalling than the physical wounds produced by the mechanical action of the shells. In no previous war have the functional nervous disturbances compared in frequency or intensity with those of the present war in Europe, the difference being chiefly due to the increased calibre of shells fired … In the present war the intense anxiety has been continuous – often for weeks or months, and even after the final lesion the anxiety is still greater before safe surroundings in the rear are reached.78

There was no doubt in Myers’s mind that shell shocked soldiers should be included among the honourably wounded. Much has been written on the medical profession’s use of the term to explain shell shock as a somatic disorder resulting from the concussive force of exploding shells, but as Myers noted, doctors adopted it from soldiers who were already using it in the trenches and at home. The meaning they ascribed to the term and the concept of nervousness in general was not necessarily the same as the medical profession’s. In­ deed, the concept of shell shock developed organically and reciprocally as people at the front and at home tried make sense of nervous suffering in wartime, adapting popular notions of nervous disease to fit a new context. It is sometimes assumed that the home front and battlefield were separate spheres with only limited points of contact between them, but research has shown that this was not the case even for the British Dominions which were separated from Europe by thousands of kilometres of ocean. Letters, telegrams, and newspapers certainly connected both worlds, but people also moved frequently between them. Development of Shell Shock Culture In the late fall of 1914, the Canadian government began raising a second Canadian division for overseas service which arrived in France on 13 September 1915 to form the Canadian Corps. Many of the soldiers who joined the units of 2nd Canadian Division did so after nervous casualties already began to reach England. Living and training in a civilian world, they brought these attitudes and ideas with them when they came to the front. The same was true of the replacements that streamed into 1st Canadian Division from March onwards. Canadian units were not static entities, but constantly evolving and changing as men were killed, wounded, or evacuated sick. The 1st and 2nd Canadian Divisions had a combined average officer strength of 882 men between October 1915 and March 1916.79 During that period, an average of



Baptism of Fire 65

507 officers were evacuated as casualties (either killed, sick, or wounded) and 612 replacements taken on strength. This means that both divisions sustained nearly 60 per cent casualties to their officer corps during a period of the war when there was very little fighting and no major engagements. The men absorbed into these units meant that after a sixmonth period, 70 per cent of officers in both divisions were replacements. The same was true of the men. The average monthly strength of both divisions for the six months from October 1915 to March 1916 was 12,682 men. During that period both divisions evacuated 8112 as casualties and took on 8649 replacements. This again represented a nearly 70 per cent turnover rate in personnel. Of course, many of the replacements, in both officers and men, would have been wounded and sick men returning to their units – how many, though, is unclear. But what is clear is that the battalions that went into the line in October 1915 were very different units six months later.80 When looking at the life of a battalion over time, it is useful to think in terms of generations. Roughly every six months – sometimes less – the personnel of the battalion changed over so that a new group of soldiers with a new set of experiences and ideas made up the core of the unit. As replacements arrived at the front, either as new recruits or returned veterans, they brought new ideas and experiences from the civilian world, just as soldiers stuck off strength took the culture of the trenches back with them to the rear. As Tim Cook has shown, trench culture was vibrant, quickly evolving, and was passed on from one generation to the next by old sweats.81 “Yea they’d tip me off the first time in the line and told me to keep my head down and keep my eyes peeled all the time,” recalled Wallace Carroll of the 14th Battalion of his experience as a new soldier going into the trenches. “It was quite an education you know it was all together different in France than it was in England, training and that sort of thing.”82 New men were also not readily accepted at the front. “The battalions would be reinforced with green men like I was,” recalled W.E. Turner of the 27th Battalion, “and I think the average individual was not much use as a soldier till he had had a little bit of experience.”83 As new men arrived in the trenches, veterans would have to teach them how to react to shell fire, how to behave in an attack, and how to interpret the various feelings and emotions that came over scared soldiers under fire. “New men were always getting killed within a week and we always said that if they could go through the first ten days, they were alright,” said G.U. Francoeur of the 22nd Battalion, “[A man gets himself killed because] he’s nervous,

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they didn’t know where they were going to and they didn’t know how to walk, how to grab things. The first noise, the first thing they could hear, they wanted to see it. Instead it was the opposite thing, they had to head down first and wait after and that’s where our great casualties were coming from and that’s what we had to prevent and that was the training that we did for young soldiers.”84 One of the things that scared soldiers would have learned soon after arriving at the front was how other men expected them to behave under fire for there were acceptable and unacceptable responses to combat. For outsiders, the rules delineating bravery and cowardice, legitimate and illegitimate wounds would have seemed complex, arbitrary, and contradictory. But for those at the front, the key distinction was relatively simple because it was referential. Everyone at the front was tired, miserable, had witnessed death, and experienced the terror of a high explosive barrage. In a very twisted way, these were, in fact, all aspects of normal experience and served to provide a clear but changing yardstick by which soldiers could measure expected levels of endurance. If a soldier broke down after enduring normal levels of trauma, he often risked being stigmatized as a hysteric, coward, or misfit. But when a soldier’s experience exceeded that threshold – either by the accumulation of trauma over a long period of service or during an acute event – his comrades could accept psychological breakdown as a legitimate outcome, but this usually required that they knew and respected the soldier in question. The distinction between legitimate and illegitimate was necessarily subtle. For example, in the winter of 1915–16, Private Donald Fraser of the 31st Battalion recorded in his diary the details of two incidents in which a soldier-comrade broke down ten days apart – in his view one was a case deserving of sympathy, the other not. The former was a friend who underwent the distinct trauma of being buried alive by a shell blast. “Loucks of our Company had a remarkable escape,” he wrote on 30 December 1915. “We thought he was blown to atoms as there was not a vestige of him to be seen [after a particularly heavy bombardment]; about three hours later as I was passing the place I heard a groan. Several who had been digging, but were resting, also heard it. Immediately they buckled to their work and in twenty minutes they had him out. Outside of bruises he was uninjured and at that moment appeared alright. But he was shell shocked and no longer of use as a fighting man. He had a miraculous escape.”85 Years later, Kirke



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Loucks recalled the same incident in an oral history he gave of his experiences overseas. “I had been wounded on the 29th of December 1915 for the first time,” he said. “I was buried alive for a little better than nine hours under a concrete machine gun emplacement which was blown up … As far as they knew, the machine gun emplacement had been blown up by a Minenwerfer, and then 2½ hours later they dug us out. Of the eight that were in there, four of us were wounded and the other four were dead.”86 Although every man in the unit had been subjected to the intense barrage, Loucks was blown up and buried by a high explosive shell for more than three hours before he was dug out by his comrades. Burial was not an unheard-of experience at the front, but it certainly transcended the ordinary.87 Despite his near-death experience, Loucks appears to have tried to remain in control (as he was both uninjured and appeared to be “alright”) and though he ultimately proved to be “no longer of use,” it was understood that he had done his bit and made a lucky escape. However, ten days later, when Fraser witnessed another man break down, his reaction was markedly different. “When Fritz was particularly active with his trench mortars, one of our fellows, Butson, lost his nerve and went semi-insane,” he wrote in his diary. “After the fireworks quietened down a bit Butson was found crawling around the trench on his hands and knees quite demented.”88 Butson was evacuated, treated, and a few months later returned to the battalion. But on 14 March, Fraser noted that when “word was announced that the Company was leaving Scottish Wood for the line, Butson became unnerved again and threatened to shoot himself. He said he could not face the music. To keep him from going into hysterics, he was taken out and returned to the base.”89 The difference between Loucks and Butson was that from Fraser’s perspective, the latter had clearly lost control of his fear in a situation of shared rather than individual trauma. Every man in the trench on 11 January would have been scared, but Butson became “demented” when the others seemingly remained in control of their emotions. When Fraser used the word “hysterics” he was alluding to a complete loss of emotional control, feminizing his comrade’s reaction.90 For soldiers, the distinction between legitimate and illegitimate illness came down to an assessment of motivations and comparative endurance rather than the actions themselves. “You know – you never criticise the action of a man,” said George Bell of the 58th Battalion. “[We had] a very fine NCO, he was a lance-seargent … This man beat it,

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A Weary Road

he just left, he didn’t go far, but he turned around and went back.” Behind the lines the sergeant turned himself in, was arrested, and tried for desertion. According to Bell, the NCO’s only defence was to say: “All I knew was that if I went in I was going to be killed, and I got my wind up and I beat it.” Although initially sentenced to death, his sentence was soon commuted and he reverted to the ranks, sent back to the battalion, where he died in the trenches a few months later. But for Bell, the NCO remained an excellent soldier, despite an act that had the outward appearance of cowardice. “He had a tremendous record, he was a very fine man,” he recalled. As a proven member of the battalion, the NCO’s decision to flee the battlefield was beyond criticism and he was even welcomed back. A conscious decision to flee the field when one felt close to losing control (“getting the wind up”) was itself an act of self-control which served to prevent loss of control and breakdown in combat, which, as an NCO, could have had disastrous consequences for those around him. In turning himself in and offering no defence for his actions, the NCO failed to transgress the masculine code of the trenches and remained a “real man” in the eyes of his comrades. For Bell and others, the difference between bravery and cowardice was subtle and, sometimes contradictory. They knew a brave soldier when they saw one just as they could identify a coward. There was no objective test for either. Shell Shock and the Divisional Stopping System Field ambulances and field medical care played an important role in shaping early attitudes to nervous illness at the front. In this ambiguous world, DRSs became an important middle ground or release valve which allowed men to seek assistance for emotional trauma and physical exhaustion without drawing the ire of their comrades. DRSs were generally established in a single physical location and each field ambulance then rotated through every few months. This made them, in effect, permanent hospitals with temporary administrative and treatment staffs. According to regulations, each DRS was to have space with which to accommodate up to 200 patients, usually in buildings rather than under canvas. They were also to have facilities for washing, bathing, and cooking. In early July, No. 3 Canadian Field Ambulance took over a rest station from a British unit at Bailleul. That unit’s war diary provides a good description of the physical layout of a DRS:



Baptism of Fire 69 One Section took over a large private house in Bailleul, which gave sufficient accommodation to provide a Dressing room, an Orderly room, a Medical Inspection room, and wards sufficient to accommodate 100 NCOs and Men, and in addition, six officers. The kitchen arrangements were good. A small greenhouse was converted into a Bath house. In addition another Section of the Field Ambulance opened up under canvas, in a large field near the Asylum, with tentage accommodation for 100 patients. The third Section remained closed in reserve. The milder cases were kept under canvas. The severer cases in Hospital building. Patients came in direct from troops stationed nearby and as transfers from Nos 1 and 2 Canadian Field Ambulances. In addition there was a large outdoor clinic, principally dental cases, who were attended to by Acting QMS Rotsey, who has had seven years dental experience.”91

The DMS, Second Army, felt that the ideal location for a DRS was in a grassy field with shady grounds or woods nearby, with the men housed in tents or existing buildings, to provide both recreational opportunities and shelter from the elements.92 Patient medical records reveal little about the specifics of treatment in a DRS, as field ambulance doctors did not fill out either a medical history sheet or a medical case sheet for each patient. Orders and published accounts though suggest that treatment was of a general nature, in keeping with its purpose as a sick hospital for mild cases. Routine appears to have consisted of rest, relaxation, and a nourishing diet – little else. Orders stipulated that “the comfort of the men [was] to be studied in every way.” Soon after admission, a soldier would be given a warm bath and issued a change of clothes while his old clothes were deloused. Snacks of soup and cocoa with bread, biscuits, cheese and jam were made available while the men were given an opportunity to relax by playing games, reading books and magazines, writing, or talking. Some rest stations even ran a wet or dry canteen.93 The DRS thus provided a welcome escape from life at the front. As Pte. Bernard Trotter told his family: “I am having a fine holiday at the Rest Station. They don’t worry us at all – the idea apparently is to let us forget the war as much as possible – at least to forget our part in it. So we read and eat and go for walks into the country and otherwise amuse ourselves according to our tastes and inclinations.”94 The rest station indeed provided a break of sorts as patients were relieved of most of the day-to-day anxieties of life at the front and could find time to simply

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relax. Often this meant nothing more than finding time to sleep and daydream the war away. “Another warm, sunny day,” Captain D.E. Macintyre of the 28th Battalion wrote in his personal diary while recuperating from exhaustion in the spring of 1916. “Feasted on the view most of the day while stretched out on the grass. At intervals I fell asleep in the sun. It is no trouble to go to sleep anytime, anywhere … In the far distance we can see the shells breaking on our lines but can hear no sound. I like to pretend that I am on holiday here and there is no war and the aeroplanes are big birds and the shell bursts are fleecy white clouds. I wish it were true.”95 Although rest stations officially accommodated somatically ill soldiers as well as those who were exhausted and nervous, the surviving letters and diaries of former patients indicate that few patients were bedridden. At night, it was typical for both the officers and men to throw concert parties while sports and exercise occupied daylight hours. “Men who are under the weather or have minor wounds which heal in a short time are sent here,” wrote Private John William Law of the 19th Battalion to his parents in mid-February 1916, “so there is no need for speaking in a whisper or anything like that, which accounts for all the liveliness and hilarity that is the continual order of the day. Lots to eat, lots of time to sleep and nothing else to do, so that a week of it is indeed a good rest.”96 This respite from the firing line was meant to restore the patient’s strength and provide an opportunity to regroup. As the trench newspaper for No. 2 Field Ambulance explained, these treatments were as much about restoring the confidence of soldiers as alleviating symptoms: “The wet dirty clothing is removed and the man made as comfortable as his condition permits,” read one account. “With a drink of hot beef-tea or cocoa, a cigarette between his lips, and a cheery word from the Padre, the wounded man regains in a large measure his selfconfidence and happiness.”97 DRSs were liminal spaces as all soldiers admitted were informed that their stay would be limited to a few days at most.98 Indeed, the average stay at 1st Canadian Division rest stations was four days (median three), with the longest being twenty-two days.99 As the DRS was meant to be a temporary respite from the firing line, it was important that military discipline be maintained. According to orders issued by DMS, Second Army, the men were to be given regular exercise “so as not to get stale” and be drilled daily on the parade ground.100 “The bonds of discipline must not be relaxed,” he wrote, “and men, as soon as their health allows, must dress as tidily as



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circumstances permit, and keep themselves clean and shaved.”101 Al­ though designed as hospitals, they were very much centred on boosting morale and restoring physical strength while continuing to prepare the soldier for an imminent return to duty. The creation of DRSs also allowed doctors to have an opportunity to observe nervous patients for a longer period than was possible at a dressing station.102 The intention was to create a space that would assist both RMOs and field ambulance personnel in arriving at a precise diagnosis in vague and difficult cases.103 As Harold McGill, the medical officer for the 31st Battalion, recorded in his war diary, an overworked physician at the front could send a patient to a rest station before ordering a full evacuation to see if the soldier would improve. For example, on 12 October 1915 he wrote that he had seen his “first case of nerves [and that] Pte. [F.W.B.] shows signs of Hysteria. I send him to DRS for week.”104 McGill hoped that a short stay in the rest station would allow him to regain his composure, thus avoiding the need for a full evacuation. But a week after returning to his unit, Butson broke down again. “Pte. [F.W.B.] returns from trenches in a state of nervous collapse,” McGill wrote. “Confesses that he cannot stand shell fire. Will advise that he be employed behind firing line.”105 The rest station thus provided RMOs with a diagnostic space. As George Henry Swindell, an orderly at the 77th (British) Field Ambulance recalled, soldiers with milder symptoms could be observed and given a chance to recuperate to alleviate fears about evacuating malingerers.106 Indeed, one of the great dangers of evacuation, from the view of senior officers, was the possibility that men might manipulate the system through cunning and deception – the well-known traditions of malingering and shirking that were the bane of every medical officer’s existence. Major George Stewart Strathy, who treated Canadian patients at the front as an RMO, noted that although some patients tried to “make the worst of their symptoms,” most were more likely to say they were healthy when they were not. However, he recalled: Every battalion had three classes, who report sick frequently without much cause. They are (1) the neurasthenic or nervous man who reports sick on slight provocation for fear that it may be serious. He is the same as in civil practice. (2) the lazy one who hope to avoid work, and who either make up a trivial excuse or else exaggerate their symptoms … (3) the cowards and nervous … are to be pitied, but must not be shown much

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sympathy. They report sick the day the battalion is to go into the line or the day of an attack. They malinger and exaggerate. If they are not excused on sick parade, they often desert or shoot themselves.107

The DRS thus provided an opportunity to test diagnoses and to determine whether soldiers were “swinging the lead” or in the midst of a breakdown. For example, Private Alphonse H. of the 3rd Battalion, a twenty-nine year-old factory foreman studying law at the University of Toronto, arrived in France as a reinforcement on 21 October 1915. He was in a front-line trench on 1 November when a high explosive shell landed on the parapet killing two of his friends and knocking him unconscious for several hours. When he was dug out of the collapsed earth and came too, he insisted on “sticking it out” for the remainder of the day. That night, he marched 13 km to the rear with his unit “through the mud and water although he felt terribly ill, twitching all over and [with] a terrible headache.”108 A doctor later recorded that “he fainted on arriving in camp and remembers nothing more until the next day when he was taken to [a] dressing station.”109 At No. 2 Field Ambulance H. exhibited a tic of the “muscles of the limbs and head” and was diagnosed with hysteria, then sent on to No. 1 Field Ambulance operating the DRS. There he developed difficulties walking while his headache persisted. He has had “no good sleep since [his] injury,” a physician later scribbled in his chart. “Every time he doses off he dreams of shells and rifle grenades. Wakes frequently and is glad to waken.”110 As his condition deteriorated, it became clear that evacuation was necessary. On 4 November he was sent to the CCS, from there to No. 13 General Hospital at Boulogne and on to England by the 9th.111 If soldiers like H. worsened in the DRS they could still be evacuated without taking away a bed from a soldier severely wounded by a shell or bullet in the main dressing station. For the medical services, rest stations addressed this paradox: despite a lack of time and expertise, physicians and surgeons were supposed to accurately diagnose soldiers with vague symptoms, safeguarding the hospital against cowards, malingerers, and scrimshankers. But where did nervous illness end and mental exhaustion begin? What was the difference between cowardice, physical fear, and exhaustion? In the civilian world, such unanswerable questions could be more easily avoided, and paying patients, at least, were given the benefit of the doubt. On the front lines, though, doctors did not have that luxury. Major General John Taylor Fotheringham, the fifty-four-year-old Assistant Director of



Baptism of Fire 73

Medical Services, 2nd Canadian Division, was one of the founding members of the non-permanent Canadian Army Medical Corps and also a much-loved professor of therapeutics and clinical medicine at the University of Toronto.112 During a visit to Mont Noir rest station in February 1916, he summed up the nature of the problem: It is a most difficult matter in most such cases to do justice between the Officer, the Unit, and the public interest. Psychic trauma is as definite a medical or surgical result [from war] as Physical trauma, but who is able accurately to appraise the moral element in any given case, or say how far the man who is sensitive to psychic trauma is responsible for his own condition by reason of ill habits or mind or of body long indulged, or to what degree his sensitiveness is due to faulty endowment and faulty training from his childhood up? The medical service must be severely judicial and decline to play the game of either a designing Commanding Officer or a malingering subordinate, and withal avoid injustice to the deserving sufferer. [But] this judicial attitude of mind requires facts rather than imponderabilities to sustain it, and I find adequate data often very difficult to secure.113

In absence of the time and expertise necessary to gather and assess the evidence, Fotheringham and his contemporaries adopted a live-andlet-live attitude, giving soldiers the benefit of the doubt with a brief rest at a rest station, thus avoiding (or at least delaying) the need to answer impossible questions. Soldiers also benefited from the institutionalization of the rest station system because it provided an opportunity to seek relief from mental anguish and physical exhaustion without risking the stigmatization of being labelled a coward or mentally ill. By the winter of 1916, soldiers like Private John William Law, a twenty-four-year-old clerk from Toronto who enlisted with the 19th Battalion in November 1914, understood that if he felt his nerves beginning to “go,” his RMO could send him to a rest station. “This last trip in I was played out completely and went to see the doctor to-day,” he wrote to his parents on 12 December 1915. “After examining me carefully he said I was not sick and as I was feeling a lot better I came back on duty again. It was just an attack of what is called out here in [Belgium] tired out, pain in the stomach or a bad headache perhaps. The continual rain and mud together with the strain you are under at times plays a man out for a short while but a rest soon puts him on his feet again.”114 When the RMO evaluated Law, he

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A Weary Road

determined that he was not “sick” – by which he meant that he was not suffering from a specific illness requiring evacuation and hospital treatment. The key point, though, is that both Law and the RMO still recognized that he was tired out from the strain of life at the front and needed a rest. He was thus sent to a DRS, returning to duty after a few days. There was no shame in seeking admission to the rest station because Law was perceived as being “played out” and, in fact, it protected against a more serious breakdown. Two months later, on 12 February 1916, Law returned to his RMO with similar complaints and was again sent to a DRS until he felt well enough to return to the line.115 Law did not see the DRS as a hospital, but a place where he could temporarily go to regain his will to carry on in the trenches.116 Because rest stations provided a middle ground between endurance and evacuation, they served to legitimize and de-stigmatize shell shock, even encouraging men to report to the RMO when they felt close to collapse. For example, Frank Maheux, a French-Canadian lumberman and veteran of the Boer War who enlisted in the 21st Battalion at Maniwaki, Quebec, in late 1914, found the winter of 1915–16 a demoralizing experience. “I think I sooner be dead,” he told his wife Angelique in a letter from February 1916; “it snow a good deal here and the nights are very cold some time the bolt on your rifle get froze so you see how cold it is now. It is a freight here, you see all kinds of killed and wounded. I saw this morning a fine young fellow a shell exploded near him when they gathered [his] body all over the place you had been able to put him in a tea box. How glad I’ll be when it is going to be finish, I am sick of it I’ll tell you.”117 In the third week of April, he was slightly wounded by a shell which left two small cuts on his arm. Although he maintained that he did not need to go to the hospital, he began to notice those around him were breaking down. “They must had throw about 50 big shells were I was but soon as I came to my sense I run and I throw myself in a big shell hole so I had better chance for my life,” he told his wife before abruptly changing the subject. “The nights are very cold 2 fellows in my battalion they lost their nerves do you know what they do? both of them shot each other in the legs so they got off from the army for awhile but they will be punish … Thank god only a few loose their nerves, the same like crazy man you can’t do nothing with them.”118 But Maheux also seemed to fear that he would soon be one of them. Five days later he told his wife, “My head bothered me yet all sore on one side but it is feeling better … I am just going to see the Brigade doctor; I might go to the Hospital for a few days don’t be uneasy if you happened to see



Baptism of Fire 75

my name on the papers as long as you don’t go to Hospital you are not on the casualties list.”119 A couple of days later, the private reported sick to his battalion medical officer and was sent to a DRS for five and a half days. When he returned to the line he wrote his wife to reassure her that although he had been to hospital, he was alright. “I am the same it was only shock,” he wrote. “I am more nervous now I always maked a jumped every time theres a shell land near so I am like a monkey allways on the go.”120 Although Maheux was told that he could ask to be reassigned to the relative safety of the transport lines behind the front, he was afraid his friends would think he had developed “cold feet” and so he opted to remain in the trenches despite growing anxiety.121 A trip to the rest station, though, was a legitimate, acceptable response to feelings of nervousness and fatigue because many soldiers were still able to return to their units ready to carry on. Only when a man was evacuated for shell shock or reassigned from front-line duty did he risk stigmatization. Front-line Outcomes Between 1 March and 31 December 1915, the admission and discharge books for the three field ambulances attached to 1st Canadian Division identify 223 soldiers admitted to main dressing stations with nervous or mental diagnoses. As indicated by table 3.1, only 74 soldiers (33 per cent) were evacuated directly to a CCS for further treatment from a main dressing station. Such patients usually spent only a few hours in a field ambulance awaiting transfer to the rear under the cover of darkness. The majority of soldiers who arrived at the dressing station were actually sent for treatment within the division, rather than being immediately evacuated. In total, 19 (9 per cent) returned directly to duty with their original units from main dressing stations. Another 11 soldiers (5 per cent) were sent elsewhere within the divisional or corps structure for light duty and convalescence, while 119 (53 per cent) were transferred to a field ambulance running the DRS. In sum, nervous or mentally ill soldiers were admitted to a main dressing station, most were sent to the DRS for further treatment, a third were evacuated to the CCS, and about a sixth returned directly to some form of duty.122 A similar pattern is evident in the cases admitted to 2nd Canadian Division during the fall of 1915. Only the A&D books for Nos. 4 and 5 Field Ambulances have survived from 1915 but, between September and December 1915, both admitted a total of 3785 patients: 702 (19 per

Table 3.1 Disposition of patients admitted to Field Ambulance Dressing Stations for nervous and mental illness, 1915 Mar

Apr

May

Evacuated to CCS or base

4 (50%) 3 (27%) 5 (45%)

To Divisional Rest Stations

6 (55%)

To Corps/Army rest camps

Jul

8 (26%) 7 (41%)

Aug 3 (19%)

15 (48%) 5 (29%) 12 (75%)

1 (12%)

To Divisional Sanitary Sections for light duty Returned to duty with original unit

3 (38%) 2 (18%)

6 (55%)

Total

8

11

11

Jun

1 (3%)

1 (6%)

3 (10%)

2 (12%)

4 (13%) 2 (12%) 31

17

Sep

Oct

3 (15%) 22 (41%)

Nov

Dec

5 (17%) 14 (56%)

17 (85%) 31 (57%) 25 (83%)

1(2%)

1 (4%) 54

5 (2%) 6 (3%)

1(6%) 20

74 (33%)

8 (32%) 119 (53%) 2 (8%)

16

Total

30

25

19 (9%) 223

Source: No. 1 Field Ambulance, A&D Books 1–6b, RG 150, Volume 652, LAC; No. 2 Field Ambulance, Admission and Discharge Books 36–9, RG 150, Volume 512, LAC.; No. 3 Field Ambulance, Admission and Discharge Books 73–5, RG 150, Volume 514, LAC.



Baptism of Fire 77

cent) wounded, 2989 (79 per cent) sick, and 94 (2.4 per cent) nervous or mentally ill. This was a ratio of 1 nervous patient to every 7.5 wounded men and 31.8 sick.123 As shown by table 3.2, of the nervous and mentally ill patients admitted to the dressing stations of 2nd Canadian Division, 21.2 per cent were returned directly to duty, 34 per cent were sent to the DRS, and 44.6 per cent were evacuated. In comparison, among the rest of the patients, 26.6 per cent were returned to duty, 28.9 per cent were sent to the DRS and 44.4 per cent were evacuated. This would indicate that in 2nd Division too, shell shocked soldiers were somewhat less likely to return directly to duty, more likely to be sent to a rest station, and about equally likely to be evacuated as other patients.124 No. 5 Field Ambulance, which ran the primary dressing station for much of the fall, sent the majority of its nervous and mentally ill patients to the DRS or returned them directly to duty. Of 43 admissions to the dressing station, 28 per cent returned directly to duty with their original units, while 53 per cent were sent to the DRS for further rest and observation. Only 19 per cent were evacuated to the rear via the CCS.125 The surviving admission and discharge books show 169 admissions to 1st Canadian Division DRSs in 1915.126 Of these, outcomes can be determined in 108 cases. Again, although the figures are incomplete due to gaps in the record, they provide an indication as to the typical outcome of treatment in the DRS. As indicated by table 3.3, of those with known outcomes, forty (37 per cent) returned directly to duty with their original units, twenty-two (20 per cent) were sent for a further period of rest at a corps or army rest camp, while fourteen (13 per cent) were transferred for light duty to the divisional sanitary section. Thirtytwo (30 per cent) were evacuated for further treatment via the CCS. Overall, this means that of the cases with a known outcome, 70 per cent either returned to duty or were sent for further treatment within the division, remaining on the strength of their front-line units. The remaining sixty-one, which cannot be traced, were transferred to a DRS for which no admission and discharge book has survived.127 An outcome of “return to duty” would be largely meaningless if the soldier only broke down again within a matter of weeks. Out of 273 unique admissions to 1st Canadian Division Field Ambulances in 1915 for nervous and mental illness, sixteen or 5.8 per cent could be identified as relapses, meaning that the soldier had previously been admitted to hospital for a nervous or mental illness. Of the seventy-two soldiers (27 per cent) who are known to have returned to duty at the front, at least six eventually relapsed. On average, the time between

Table 3.2  Disposition of primary admissions for nervous and mentally ill patients, Nos. 4 and 5 Field Ambulances, 1915 Sep No. 4 Field Ambulance

No. 5 Field Ambulance

Nov

Returned to duty with original unit

3 (43%)

Treated on-strength of the division

8 (33%)

1 (11%)

Evacuated and struck off strength of division

4 (57%)

16 (66%)

5 (56%)

Total

7

24

9

Returned to duty with original unit Treated on-strength of the division

1 (100%)

Evacuated and struck off strength of division 2nd Division Total

Oct

3 (33%)

4 (20%)

7 (64%)

15 (75%)

3 (27%)

1 (5%)

Total

1

Returned to duty with original unit

3 (38%)

1 (3%)

7 (24%)

Treated on-strength of division

1 (12%)

15 (43%)

16 (55%)

Evacuated and struck off strength of division

4 (50%)

19 (54%)

6 (21%)

Total

8

35

2 (18%)

Total 8 (16%)

9 (18%)

1 (9%)

11

Dec

20

29

9 (82%) 11 7 (63%)

34 (67%) 51 12 (28%) 23 (53%)

4 (36%) 11 9 (41%)

8 (19%) 43 20 (21%) 32 (34%)

13 (59%)

42 (45%)

22

94

Source: Compiled from No. 4 Field Ambulance, A&D Books 100, 101, 102, 103, 103A, RG 150, Volume 516, LAC; No. 5 Field Ambulance, A&D Books 135A, 135B, 135C, RG 150, Volume 518, LAC.

Table 3.3  Disposition of patients admitted to Divisional Rest Stations for nervous and mental illness, 1915 Apr

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total

1

11

2

1

5

11

1

32

To Corps/ Army rest camps

1

1

8

6

6

22

To Divisional Sanitary Sections for light duty

1

4

5

4

3

2

3

15

11

6

40

Evacuated to CCS or base

Returned to duty with original unit

May

14

Unknown

6

10

4

8

16

10

5

2

61

Total

6

14

19

18

17

43

37

15

169

Source: No. 1 Field Ambulance, A&D Books 1–6b, RG 150, Volume 652; No. 2 Field Ambulance, A&D Books 36–9, RG 150, volume 512; No. 3 Field Ambulance, A&D Books 73–5, RG 150, volume 514, LAC.

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A Weary Road

admissions was approximately fifty-five days, with the longest period being 252 days and the shortest only nine days. About half relapsed in thirty days or less. Many more probably relapsed later in the war – perhaps even years later – while others may have relapsed and been listed in admission and discharge books that have not survived. Divisional and Corps Rest Units As the DRS was intended for patients thought likely to recover in less than ten days, during the course of 1915, the British Army also opened corps and army rest stations that were meant to treat patients who were still thought likely to recover without evacuation to England, but who required a longer period of convalescence.128 These were a combination of rest and convalescent camps, usually run by stationary hospitals, casualty clearing stations, or divisional field ambulances operating in reserve.129 Soldiers might spend a few days in a DRS before being sent to a corps rest station, and after a stay in a rest camp, soldiers could still go directly from hospital back to their units at the front and were thus not to be shown as evacuations on divisional returns.130 Convalescent camps had been in operation since the fall of 1914, such as the one run for First Army by No. 4 Stationary Hospital at St. Omer in February 1915. It treated more than 4055 soldiers alone between 16 January and 9 June.131 Second Army created its first rest station in early April 1915, just before the arrival of the Canadians, when DRSs began to overflow with patients. But it was not until May that a suitable permanent location was found, albeit accidentally, to house patients. That month, 3rd Division’s DRS was forced to evacuate from its position as the ground was required for use by the infantry. The nearest accommodations were atop Mont des Cats, a 250-metre rise in the ground, crowned by a Cistercian monastery.132 Patients were impressed with the idyllic setting and the splendid view from atop the hill. “There is a pretty little garden for officers’ use and in it we have a marquee and easy chairs and magazines,” wrote one patient. “In front of this on the slope of the hill is a fruit orchard all in blossom. The view extends for miles and miles and it is a great sight.”133 The location proved difficult to access for a divisional field ambulance, but seemed useful as a rest camp; by 15 June, the North Midland CCS had been moved forward to take over the running of Second Army’s rest station.134 Half the monastery was then used by the British, while the monks continued to live in the other.135



Baptism of Fire 81

From the soldier’s point of view, rest camps provided a further respite from the firing line.136 For example, Private William George B. of the 15th Battalion, twenty-two and a clerk from Toronto, arrived at the front as a replacement on 31 July 1915. His tour in the trenches was generally uneventful, except for occasional casualties due to enemy fire. On 26 September, his battalion went into the trenches at Pleogsteert. It was a routine period at the front with little enemy activity, except for a few “whiz bangs” lobbed at support trenches. At 9:00 in the morning on 29 September the Germans launched a short barrage on his unit’s reserve trenches, killing one and wounding another. B. was terrified by the experience and reported sick to the battalion medical officer, who sent him to the dressing station of No. 2 Field Ambulance. There he was diagnosed with shock and transferred to the DRS operated by No. 1 Field Ambulance. B. spent a total of eleven days at the DRS before he was re-evaluated and sent to Mont des Cats rest camp on the 11th.137 In another case, Private James H., a thirty-nine-year-old labourer who had emigrated from Scotland and settled in Ottawa, was admitted to No. 2 Canadian Field Ambulance on 6 December 1915 diagnosed as “shell shock (buried).”138 H. was in the support trenches on the night of 4/5 December when the German artillery lobbed nearly eighty high explosive shells into the positions occupied by the 2nd Battalion. One shell buried him in earth. He was dug out, and was taken to the dressing station. There he was assessed and sent to the DRS operated by No. 1 Field Ambulance, where he spent eight days. He was then sent to Mont des Cats on the 14th.139 Unlike field ambulances, which treated officers and men alike, rest camps were segregated by rank. The officers’ counterpart to Mont des Cats was atop Mont Noir in an old chateau. Mont Noir was a forested hill behind the lines, and as Frederick Noyes of No. 5 Canadian Field Ambulance recalled, “‘resting’ officers were quartered in the best rooms of the chateau, and the duties of our unit orderlies mostly consisted of serving food and liquid refreshments … In the basement of the chateau there was a well-stocked wine cellar into which some of the lads more than once forced entrance.”140 When one senior officer arrived to inspect the hospital at the end of September 1915, he was disturbed by the fact that its patients were still consuming “the large supplies of champagne and other medical comforts.”141 In these rest or convalescent camps, treatment was geared towards re-establishing military routine and physical conditioning, preparatory to a return to the front line. It was assumed that most men would stay

82

A Weary Road

in these camps no longer than ten days, although some remained longer and others less.142 Typical standing orders specified: “During the first three days as much rest as possible will be given. During the second three days the men will be employed on light duty only. During the second week men should be given physical exercises. Outdoor games such as cricket and football should be organized. At least three route marches should be performed. The first two of these will be in drill order without arms, the last in full marching order. Puttees need not be worn when resting off duty.”143 On the whole, most soldiers spent between ten days and two weeks at a rest camp. In the case of Private B., after eleven days of rest and conditioning he was discharged and returned to the 15th Battalion.144 H. returned to the 2nd Battalion after only three days.145 Sanitary and convalescent companies served a similar purpose within each division, providing the manpower necessary to perform fatigue duties behind the lines and an opportunity for temporary light duty.146 Sanitary sections had been established within each division in the fall of 1914. These were staffed by officers who were considered temporarily unfit for the front because of either their physical or mental condition. It was hoped that physical labour would improve the physique of men transferred to companies, “thus releasing the more physically fit for trench duty.”147 Like rest stations, sanitary sections were occasionally inspected and, when soldiers were discovered who appeared unlikely ever to be fit to return to the trenches, they were evacuated to the base for permanent reassignment in the rear or discharge to Canada.148 They also provided an opportunity to test difficult soldiers, forcing them to choose between the unpleasant physical labour involved in shovelling out latrines and a return to duty at the front. For example, Private James D. of the 4th Battalion was sent to No. 3 Field Ambu­ lance on 4 August 1915 when the battalion was in reserve. There he was diagnosed with neurasthenia and sent to the Divisional Convales­ cent Company, where he remained until 30 September. D. had been a problematic soldier, going absent without leave during the Second Battle of Ypres and not returning until 28 April when his unit left the trenches – a crime for which he received ten days of field punishment number 1. Six weeks of fatigue duty convinced him to return to the front. On 20 October, he volunteered to go over the top with Company Sergeant Major Benton to rescue a friend who had been severely wounded during a raid and was calling for help from near the enemy’s lines. D. crawled nearly 300 yards across No Man’s Land, located the



Baptism of Fire 83

soldier, patched him up and then crawled back with the wounded man on his back. For this remarkable action he was later awarded the Distin­ guished Conduct Medal. D. remained at the front until the summer of 1916, when he was evacuated a second time with shock.149 The first convalescent companies were not established until late March 1915 and provided an intermediate destination between a rest camp and a labour unit for soldiers unable to return to their units. “The convalescent companies are to be considered as units of men who are temporarily medically unfit for duty with their own unit,” read a First Army memorandum, but not in need of special hospital treatment. They will be accommodated in billets and not in medical units, and under control of officers and noncommissioned officers. Although arrangements for treatment and for determining when a man is fit to return to duty with his unit, or requires admission to a medical unit for special treatment or evacuation, will be made by the medical services, it is not desirable that these services should be employed in managing these companies, but it is suggested that they should be commanded by officers who are suffering from disabilities which prevent them performing active duties in the fighting-line. In the event of the medical units being called upon to deal with large numbers of wounded, men suffering from minor ailments, or not sufficiently convalescent to be able to return to duty, will be discharged from the medical units, provided they are not in need of hospital treatment, to join one or other of the convalescent companies in billets, in order to avoid their being evacuated to L of C [Lines of Communication].150

Convalescent companies thus formed a reserve of manpower within the division and corps that could be used during a crisis. Beginning in May, each CCS began to provide billets for up to fifty of these convalescents at a time who would work as orderlies in the hospital or help load and unload ambulance vehicles and train cars.151 Between the middle of June 1915 and the beginning of April 1916, the Canadians were not engaged in any major offensive or defensive operations. But the daily routine of trench warfare continued to take its toll. Official statistics show that the incidence of nervous and mental illness ranged between a low of 16.5 per 10,000 in September 1915 and a high of 36.6 in March 1916, with the average being 26.8 per month.152 This works out to an annualized rate of 321.6 cases per 10,000 healthy soldiers, meaning that during a year of static trench warfare a division

84

A Weary Road

of roughly 21,000 men could expect to lose approximately 675 soldiers to nervous and mental illness. On the one hand, because shell shock cases were disproportionately drawn from the infantry, this suggests that a division would lose the equivalent of one of its twelve infantry battalions, even if it were not engaged in heavy fighting.153 But on the other, this figure represents only about 3 per cent of the total strength of a division, indicating that nervous and mental illness remained a comparatively minor problem that could be accommodated within the somatic treatment framework of front-line DRSs and convalescent units. Conclusion There is no evidence to suggest that senior officers in either the BEF or the medical services harboured significant concerns about shell shock during the first two years of war. In general, the feeling seems to have been that it was a minor problem in comparison to other forms of wastage and that it was being well managed by doctors at the front.154 When concerns did arise they tended to relate to the classification of nervous illness as sickness or a battle casualty and in this regard senior officers tended to agree that “Regimental and Field Ambulance Officers are far better placed for obtaining a true diagnosis” than those at CCSs or on the Lines of Communication.155 Officially, the policy was to treat any case that developed as a result of contact with the enemy as a battle wound, which entitled men to wear the casualty stripe and apply for a pension.156 Yet there was clearly a feeling among some front-line officers that the concept of “battle wound” was being stretched too far. On 19 May 1915, for example, Lt. Colonel Balmfield, commanding the Lahore Indian General Hospital, wrote the DDMS, Bolougne, General R.M. Sawyer, to complain that a large number of “very trivial cases” were being evacuated from the front with suspect wounds. Between 11 and 13 May, he wrote, his hospital had taken in 678 patients from the front, of whom 237 (35 per cent) “complained of having been bruised by trenches falling on them, but in the great majority of cases had no bruising of any kind.” The next day, eighty of these patients were sent directly to an Advance Base Depot for return to their units. “I and my officers,” he concluded, “are convinced [that most] really had nothing the matter with them.”157 Sawyer, in turn, wrote to the DMS, Lines of Communica­ tion, T.J. O’Donnel, who was in charge of all evacuations from the front,



Baptism of Fire 85

suggesting that “it might be an advantage to make it a little more difficult for trivial cases to get evacuated by train from the Field Army.”158 But although perplexing, these cases were not seen as a true disciplinary problem, but rather the type of non-malicious malingering common to the army – the type of “trivial” complaint that front-line doctors were supposed to guard against. Although nervous and mental illness were relatively minor problems compared to the larger issues presented by physical wounds, gas, trench foot, dysentery, accidents, and injuries, they did contribute to the steady drain on front-line manpower. In the winter of 1914–15, a standard divisional and corps treatment structure developed in response to these problems. A series of treatment centres were created to stage evacuations from the front and minimize the length of time required between admission to hospital and return to duty. While DRSs, rest camps, sanitary sections, and convalescent companies were primarily created to manage physical wounds, in 1915 nervous and mentally ill soldiers also fell into this category. So long as “shell shock” was situated in the nerves themselves, a somatic, generalist approach to treatment seemed logical. Indeed, little evidence appeared during the course of 1915 to challenge these underlying assumptions. As DRSs proved useful in not only minimizing wastage but also assisting in diagnosis, they began to serve as collection points for nervous and mentally ill soldiers. As many soldiers returned to duty with their original units or went elsewhere in the corps or army structures, the DRS became a useful tool. But both front-line doctors and senior medical officers remained sceptical. Were malingerers sneaking though? Were RMOs and field ambulance personnel doing their duty? In this sense, the DRS also created a space in which medical personnel could manage difficult diagnoses and prevent unwanted scrutiny from the higher-ups. The creation of these collecting points and the somatic nature of the treatment helped to standardize diagnosis and popularize the concept of “shell shock” at the front. By the end of the year, most soldiers suffering from nervous or mental illness were labelled as “shock” cases and sent to the DRS for initial treatment. In this ambiguous world, the rest station became an important middle ground which allowed men to seek assistance for emotional trauma and physical exhaustion without drawing the ire of their comrades. Medical officers and soldiers at the front had thus reached a tacit understanding that served the interests of both. While this rapprochement served the interests of those at the front, it had the potential to seriously

86

A Weary Road

undermine strategic efforts to maximize manpower in the trenches. Soldiers were effectively being given the power to choose when to participate in the fighting. While fear of stigmatization helped self-regulate evacuations, rest stations had also normalized temporary “holidays” from the front. It was a delicate balancing act, but so long as divisional and corps medical units remained capable of accommodating large numbers of rest station patients without driving up evacuations, the system prevailed. These developments went largely unnoticed by the military authorities, not because they were done in secret or unreported, but because on paper the divisional stopping system accomplished exactly what it was meant to do: reduce wastage and evacuations. There was no need for concern as the growing number of nervous men being treated in rest stations was never reported up the chain of command. While the army’s disciplinary and operational arms would have bristled at the thought that men were being allowed to choose the terms of their participation in the fighting or to set limits on those terms, in the absence of any sense of crisis, there was no reason to question the morale or will of most soldiers – especially when shell shock cases continued to comprise only a small number of evacuations.

Chapter Four

The CEF’s Shell Shock Crisis, Spring 1916

On the night of 10–11 April 1916, Private John C., a thirty-four-year old Irish machinist who crossed the American border to enlist at Windsor in October 1914, was one of about eighty men of the 18th Battalion detailed to attack a large mine crater south of the town of St. Eloi in southern Belgium. C. was no stranger to war, having served in South Africa with the 21st Regiment for three years, but Flanders was nothing like the veldt. First British then Canadian forces had been fighting for the same small patch of mud for two weeks with little to show for their efforts. Constant shelling had churned up the soil down to the water table, obliterating the trenches while hundreds of bodies – both German and British – lay about unburied in the wreckage. In the pitch black of a midnight attack, the men of A company made a mad dash for the crater, but ran into heavy fire from German machine guns, sending them diving for cover into old sodden trenches. Although protected from bullets, a long, heavy barrage of high explosive shells crashed down around them; several shells burst a second, throwing up a churning cloud of dirt, smoke, flame, and debris. Trapped by shell fire without any cover, C. began to panic. As his squad of fifteen men tried in vain to dig to safety, two-thirds were killed or wounded; the South African veteran was twice blown up and temporarily buried alive. When the 18th was relieved the next day, C. emerged from the trenches a dazed wreck of a soldier. Although he tried to carry on, he found he was unable to sleep (despite being physically exhausted), kept awake by intense nightmares of the shelling in no man’s land. On 22 April he reported sick to his battalion medical officer, who sent him to a DRS diagnosed with shell neurasthenia. After two days in the DRS with little sign of improvement, he was evacuated to England with shell

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A Weary Road

shock.1 He was not the only one. In the 18th Battalion alone, 10 per cent of the casualties evacuated from St. Eloi were recorded as being due to shell shock or neurasthenia. In some battalions, casualty rates exceeded 20 per cent, and of the 1501 soldiers of 2nd Canadian Division evacuated from the crater line, 202 were diagnosed with a neuropsychiatric illness. C.’s case was part of a wave of breakdowns that swept across the BEF during the spring and summer of 1916 as rates of nervous and mental illness suddenly rose more than 300 per cent. The so-called shell shock epidemic peaked on the Somme among British and Australia and New Zealand Army Corps (ANZAC) troops, but it began in the Canadian Corps between April and June 1916 during the fighting at St. Eloi and Mount Sorrel. The rise in cases is partly explained by the intensification of artillery barrages and the static nature of the fighting, but it also reflects the changing nature of trench culture which, in certain contexts, de-stigmatized nervous breakdowns. In times of relative quiet, the divisional and corps rest system continued to provide an effective middle ground that served the diagnostic purposes of doctors as well as the needs of exhausted and scared soldiers. But when the fighting intensified, the DRS system collapsed under the weight of admissions, necessitating the evacuation of large numbers of nervous soldiers who might otherwise have carried on at the front. As they were sent to casualty clearing stations (CCSs) en masse to make way for the physically wounded, evacuation rates soared. The resulting shell shock epidemic effectively destroyed the rapprochement between doctors and soldiers as evacuations soared. The St. Eloi Craters Nineteen-sixteen was a miserable year from the start.2 As part of British Second Army, the Canadian Corps spent the winter of 1915–16 enduring constant rain, cold temperatures, and endless mud in exposed positions south of Ypres between Ploegsteert and Kemmel. Their lines were situated on ground well below the water table so that any excavations quickly filled in, turning the trenches to a sodden mess.3 Given the squalid living conditions, mounting casualties, and constant rotation of personnel, it is not surprising that rates of nervous illness also began to rise. During the winter of 1915–16, the ratio of neuropsychiatric evacuations to physically wounded in the Canadian Corps more than dou­ bled. From March to November 1915, shell shock, neurasthenia, and



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hysteria accounted for no more than 6 per cent of the 7882 non-fatal casualties evacuated by the Canadians in France and Belgium. But between December 1915 and the end of March 1916, official figures show that 287 Canadians were evacuated from the front and admitted to ­hospital with those same diagnoses, representing 13 per cent of the 2152 non-fatal battlefield casualties sustained during the same period.4 Yet these figures are also incomplete, as they only represent evacuations from the collecting zone. As we saw in the previous chapter, at the beginning of 1916, it was standard practice for cases of nervous illness to receive a primary course of treatment at a field ambulance rest station, so that many soldiers returned to duty directly from those hospitals. The DRS system had a significant effect on how casualties were reported and so must be factored into any evaluation of official statistics. In the winter of 1915–16, both Canadian divisions assigned one field ambulance to run a DRS, but most main dressing stations also began to dedicate bed space to manage wastage, further staggering and extending the treatment process. For example, No. 3 Field Ambulance ran one of 1st Canadian Division’s two main dressing stations, but also assigned one bearer company to run a small rest station at Bailleul. Be­ tween 20 December 1915 and 3 April 1916 it admitted fifty-one cases of nervous or mental illness and, of these, 29.4 per cent were retained in the field ambulance for a couple of nights before being returned directly to duty at the front. Those requiring a longer period of rest were sent to the larger DRS run by No. 1 Field Ambulance (23.5 per cent) or directly to the corps rest station at Mont des Cats (17.6 per cent). The remaining 29.4 per cent were evacuated through a Casualty Clearing Station.5 On average, most patients spent 3.12 days at the main dressing station before being discharged, transferred, or evacuated, the longest stay being eleven days. The situation was similar in 2nd Canadian Division’s No. 4 Field Ambulance, which ran a main dressing station as well as two smaller rest stations. In the winter of 1916, 72 per cent of patients admitted for various nervous conditions were transferred to another rest station, while only 22 per cent were evacuated to the CCS; 6  per cent were returned directly to duty.6 Unfortunately, the admission  and discharge books for both DRSs have not survived, so while evacuation rates may have been similar to those observed in 1915, we cannot be certain. What is clear, though, is that the treatment and evacuation process for cases of nervous and mental illness was becoming more elaborate as evacuations were being deliberately staged with triage stops at every stage in the process. This had the effect of managing

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the flow of cases to the rear, first by delaying evacuations and then by concentrating them in divisional and corps-level convalescent and sanitary units. When soldiers were invalided from these ancillary units they were classified as “convalescents for transfer” rather than primary evacuations, which meant that they were not included in official divisional wastage figures.7 Because the loss of so-called convalescents was not scrutinized with the same intensity as wastage from front-line units, the growth in evacuations was largely hidden from the prying eyes of senior officers at the army and GHQ levels of command. When divisional stopping is factored in, the combined total of cases treated in the divisional or corps area as well as those evacuated to the base may have approached 900 between December 1915 and March 1916. The first indication that nervous illness was becoming a more significant source of wastage came during the fighting for the St. Eloi Craters in late March and early April 1916. As far as operations on the Western Front went, it was a minor affair, but it represents the beginning of the so-called shell shock epidemic of 1916, which was associated with a new type of trench fighting dominated by massive barrages of high explosive shells, a decline in morale, and a loss of command and control. In an effort to improve observation and retaliate for earlier Ger­ man raids, at the beginning of March Second Army placed six large explosive mines under the German trenches at an area known as “the mound,” a small rise in the otherwise flat landscape which provided the Germans with a view down into the town of Ypres. Here the German trenches bulged into the British lines to a depth of about 90 metres on a 550-metre front.8 Fifth Corps’s 3rd Division was selected to make an assault because its commander, Major General James Aylmer Haldane, had gained experience in the tricky business of “crater fighting” at Hooge the previous July.9 When mines exploded, they blew up huge holes in the ground above that were sometimes more than a hundred metres across and a couple dozen metres deep. High lips formed around the edges from the falling spoil. While the explosion itself would kill enemy combatants, destroy defensive positions, and leave survivors too dazed to resist an infantry assault, paradoxically the new craters also created a literal bull’s-eye on the landscape which enemy artillery could then use to target the attackers. At Hooge, Haldane learned that if his troops tried to hold the actual craters, the Germans would simply train all their guns on the target and blast them out of the newly gained line with high explosive shells. At St. Eloi, he thus proposed to pass over them and establish a new line of trenches several



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hundred metres beyond, close enough to the German second line that the enemy artillery would be reluctant to respond in full force.10 Haldane’s tactics were not well suited to the muddy, waterlogged, wintertime terrain of the Ypres Salient. At St. Eloi, British and German troops occupied two parallel lines of trenches running east–west with several hundred metres of no man’s land between them. The British trenches consisted of three main horizontal lines and several vertical communication trenches stretching back from the ground south of the ruins of the town of St. Eloi towards Voormezeele to the north. The German defensive network was a honeycomb of interlaced excavations, criss-crossing the landscape southwards up to the northernmost spur of the Wytschaete-Messines Ridge. As on the British side, German trenches tended to quickly fill in with water and were only kept relatively dry through an elaborate system of pumps and drains. The ground between the lines was a shattered, muddy mess. No man’s land was already pockmarked by shell holes and contained seven sizable mine craters left over from earlier fighting, as well as dozens of smaller blast-holes, all of which were filled with murky water.11 It would be difficult terrain to cross at night – especially after the explosion of the new mines created an entirely different but parallel line of craters under the German trenches.12 On the snowy night of 26/27 March, the two British assaulting battalions from 9th Brigade crawled silently out into no man’s land, the guns behind them remaining quiet to ensure surprise. On the left the 4/  Royal Fusiliers would advance diagonally towards the southwest while on the right the 1/Northumberland Fusiliers were to move southeast, the two battalions meeting in the middle beyond the new line of craters on the second German line while two reserve battalions held the old British line. At 4:15 am, the mines exploded just as British heavy batteries opened-up on the enemy trenches; a few seconds later the infantry used scaling ladders to climb over the parapet. On the right, the Nor­thumberlands made it over quickly, passed by the old craters, around the new ones, and reached the second line of German trenches with little difficulty, capturing 200 prisoners from a reserve Jäger regiment while taking only one casualty in the process.13 Although the Ger­ man wire had not been cut by the short artillery barrage, the intensity of the mine explosions so dazed the surviving defenders that the assaulting troops only had to “mop up” the remaining stragglers.14 But on the left, things did not go nearly as well. On the far eastern edge of the advance, the sixth mine turned out to be a dud. When it failed to fully

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explode it left the advancing Royal Fusiliers exposed to sweeping enfilading machine gun fire.15 As soon as they climbed over their own parapet, the fusiliers were mowed down almost to a man.16 In the first seconds, 40 per cent of the two lead companies fell and 70 per cent of the battalion’s officers were killed or wounded.17 The survivors staggered forward, but in the confusion of heavy shrapnel shelling and machine gun fire they became disoriented, mistaking the old line of craters closer to their start line for the new ones further on. Desperate for cover, they took to ground only a few dozen yards from their own front line, on the north side of the old crater line.18 Later that morning, the commander of the 4/Royal Fusiliers, Lieutenant Colonel G.G. Ottley, erroneously reported that his men had reached and consolidated the German first line, which was still a few hundred metres away on the other side of the new craters.19 In the confusion of the moment the mistake was understandable, but it meant that a significant gap now existed between the Royal Fusiliers and the Northumberlands who were further to the front on their right.20 Over the next weeks, twelve battalions were rotated in and out of a 600-metre stretch of line as casualties mounted. Haldane knew that it was risky to undertake constant reliefs in the dark over unfamiliar and profoundly changed terrain, but he felt that he had no choice. The German response to his attempts to occupy the new positions had been exactly as predicted: every gun in the Ypres salient was trained on the crater line and British troops were subjected to an unceasing barrage of high explosive shells that fell day and night while the men stood in muck and mire up to their waists.21 The Germans coined a word for this type of barrage on the Champagne front in 1915: trommelfeuer or drumfire – a bombardment so intense that the sound of one shell-burst could not be distinguished from another, similar to the ceaseless sound made by a drum roll.22 Until 1916, such sustained high explosive barrages had been comparatively rare, and they only intensified the horror of trench warfare as men went out of their minds from the seemingly endless fire. The 3rd Division’s failure to take its objectives and to correctly identify its position over several days became the subject of an inquiry after the battle. Eventually, at the end of April, Sir Douglas Haig sacked Haldane, taking issue not only with his plan of attack, but also with his decision to relieve exhausted troops and commanders in the middle of a desperate situation.23 For his part, Haldane blamed a lack of morale  and élan. “Both infantry and engineers … were the reverse of ‘fresh,’” he explained to V Corps after the attack. “When therefore the



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operations began …I had no troops left but those who were by no means at their best and had little if any of that ‘drive’ which was undoubtedly very desirable … Had the Division been fresh I am convinced, judging from their work in trenches in the past, that far more would have been achieved towards carrying out my orders.”24 Morale in his division had, he believed, been eroding steadily and for some time. Since November 1914, officer casualties had exceeded 800, leaving men in command who were, in Haldane’s words, youthful, ignorant, and lacking in military experience. All winter, casualties had been high from trench foot, minor skirmishes in no man’s land, and the daily wastage of static warfare. While replacements had been quick to arrive, Haldane also doubted the advisability of asking new recruits to go straight into battle. “The moral effect of the early arrival of fresh drafts to fill gaps before the troops have become accustomed to the depletion,” he wrote in April 1916, “exerts a powerful influence on the naturally resilient spirits of our men; and an early amalgamation of the old and new elements is essential if it is desired to prevent a feeling of gradual enfeeblement, and enable units to maintain their moral strength in spite of the wastage of war.”25 Command and control indeed appears to have been at the breaking point in 3rd Division in March 1916. Just before the operations at the mound began, Brigadier General MacLachlan, in command of 8th Bri­ gade, started to show signs of nervous breakdown: Haldane observed that he was “very much upset by the losses through ‘trench feet’” and was in an “excited state.”26 On the 10th, MacLachlan was evacuated to hospital following a “cerebral seizure” which later was proven to be “a fainting fit” that left him unresponsive for a full hour, and had to be sent home. General Potter, of 9th Brigade, was thus given command of the operation, but on the night of 27–28 March he too began to breakdown. The next day, Brigadier General Potter (9th Brigade) was removed from command of the St. Eloi operation and replaced with the new commander of 8th Brigade, General E.C. Williams. In explaining his decision, Haldane later recorded that “there was no question in my mind as to the advisability” of removing Potter, as “he looked thoroughly tired out and during 72 hours of strenuous work had had only one hour’s sleep in a crowded dugout.”27 Yet Haldane soon lost faith in 8th Brigade’s staff as well. When the extent of the gap at the front was finally discovered on 29 March, 3rd Division’s commander ordered 8th  Brigade to take the original objectives, consolidating a new line forward of the craters with forces cobbled together from several

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battalions which had earlier been taken out of the line. Twice, though, 8th Brigade’s commander failed to order the attack, apparently because new German wire had been spotted around the target craters indicating that they had been occupied by German defenders in the days following the initial assault. Again, Haldane removed the brigadier in charge of the operation, permanently sacking his brigade major in the process (whom he felt was “unsuited for that appointment”) and firing at least one battalion commander on the spot. By 28 March, the Royal Fusiliers had lost ten of the eleven officers who went into the attack.28 Several other senior officers in various battalions were evacuated for shell shock.29 On 31 March, Lieutenant Colonel S.G. Crawford, who was temporarily in command of 76th Brigade after its regular brigadier had been evacuated sick, took charge of the St. Eloi sector while his four battalions rotated into the line. The men of 76th Brigade found that almost nothing had been done between 27 and 31 March to improve defensive positions. “For the most part [the trenches] were deep in mud and water,” wrote Crawford, “so deep that the men’s long gum boots were of no use. In no places had the trenches been consolidated and many yards were impossible to hold at all … The whole area was terribly broken by shell fire, which made it difficult to carry out reconnaissance at night, as  all the trenches presented the same broken appearance and the craters themselves were difficult to recognise. The nights were also very dark.”30 Nevertheless, on the morning of 3 April, after a brief period of preparation, 76th Brigade finally mounted a successful attack on the two craters which the 4/Royal Fusiliers had failed to capture on the first night of operations. Although guarded by a small party of Ger­ man  soldiers, the defenders quickly surrendered – no more willing than their British counterparts to continue to slog it out in the mire. The Canadians at the St. Eloi Craters When the St. Eloi operation was first conceived in early March, the intention had been for the Canadian Corps to replace V Corps once a new line had been consolidated. But when 3rd Division began to run into trouble, Hubert Plumer, Second Army’s commander, decided to extract the tired British troops and replace them with 2nd Canadian Division a few days earlier than planned. After a final attack on the Germanoccupied craters on the night of 2–3 April succeeded in gaining the division’s original objective, Canadian troops were sent in to consolidate



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the new line.31 Although 2nd Canadian Division was indeed composed of fresh troops, they were also less experienced than their British coun­ terparts. Aside from a large-scale trench raid at La Petite Douve in midNovember and a few minor trench raids, the Canadian Corps as a whole had avoided the fighting which occupied the bulk of the British and French armies to the south in September and October 1915.32 The calamity at St. Eloi would be their baptism of fire. General H.D.B. Ketchen’s 6th Canadian Infantry Brigade was tasked with taking over the positions gained by 76th Brigade, occupying the old trenches and new crater line with the 27th and 31st Battalions.33 On the evening of 2–3 April, the Winnipeg-raised 27th Battalion took up supporting positions on the right, adjacent to the British, and the next night moved to take over the right portion of the front line as the men from the 31st Battalion (Calgary) made the long and difficult march south from Voormezeele to relieve British troops on the left. “A few hundred yards overland and then we stepped down into the communication trench and slowly moved forward,” recalled Pte. Fraser of the 31st Battalion. Soon shell holes appeared in our path; many direct hits had been made on the trench, and walking became difficult. British Tommies, in the throes of exhaustion, were slowly and laboriously bringing down their human freight of suffering. Still figures in stretchers commanded the passage and we have to make way. Anon a wounded man in agony writhed and moaned. At various intervals along the trench our dead lay waiting for an opportune time to be taken out for interment. Onwards we go through Shelley Lane, down into shell holes, clambering up on the other side, into the trenches again, down once more into a hollow, slipping, falling, we curse our way forward, whither we know not, and neither do we care. Striving to keep up we struggle desperately in the mire. At last, when nearly exhausted, we reach the front line.34

There the Canadians met the exhausted, demoralized men of the 1/ Gordon Highlanders and 8/King’s Own Royal Liverpool Regiment, who were anxious to get out of the line.35 Thanks to constant troop rotations and unending shellfire, little work had been done by British troops to construct new defensive positions. In all fairness, little could be ac­ complished in the muck of no man’s land. Like the British, the Canadians now found themselves in exposed, vulnerable positions, surrounded by corpses and standing water. “This new line was more a line on a

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map than an actual line of defence,” wrote Lieutenant Colonel Charles Arthur Ker, a general staff officer in Turner’s division. From the right for 290 yards it consisted of a deep narrow wet untraversed trench, with fire steps facing north in various short stretches; thence for 120 yards it consisted of a straight deep unstrutted drain; thence for 110 yards where it joined up with the old British front line, it consisted of a very narrow and wet communication trench. The whole system when the 2nd Canadian division took it over was very wet, for long stretches the trenches were from two to three feet deep in water, as all drains had been blocked by shell fire, and the explosion of the mines had apparently upset the drainage of the area. There was no wire. There were a large number of bodies, both German and British lying about. The actual position of the enemy had not been definitely ascertained.36

At 10:30 am on 4 April, German artillery and minenwerfer opened up on the Canadian front-line positions; they did not stop firing for nearly five days.37 Lieutenant Colonel Snider, the commanding officer of the 27th Battalion, reported that at the height of the bombardment, nearly 3000 shells dropped into an area roughly 180 by 45 metres in a span of just 45 minutes – a rate of fire in excess of more than one shell per second.38 The RMO of the 31st Battalion, Captain Harold McGill, gave a similar account of the German artillery attack. He wrote: “A most terrific concentrated enemy bombardment is taking place on our position in front of and about St. Eloi, using trench torpedoes and shells of all kinds and sizes. Hundreds of shells must be bursting per minute.”39 Looking up from the support lines, the front would have appeared to be a roiling wall of dirt and debris as the constant explosion of shells brought the front-line trenches to a bursting boil. “Talk about a shell never hitting twice in the same place!” wrote Duncan Eberts Macintyre, the intelligence officer for the 28th Battalion, who was observing from the support trenches behind the front line. “Why the dirt wouldn’t settle from one explosion before another shell would land in the hole … It is a terrible place; all holes and craters and water, and dead and wounded men.”40 St. Eloi was the first time that Canadian soldiers had experienced trommelfeuer. “[It] was the original place where our battalion really got its first casualties,” recalled Lieutenant Alfred Tomkins, a twenty-twoyear-old bank clerk from Lydiard, Saskatchewan … The bay I was in … was blown up. Of course we had quite a lot of casualties … It was such



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a shock that I, personally, didn’t know what it was. I though the end of the world had come.”41 Private Fraser was caught in the barrage to the front and right of Tomkins. Writing in his dairy soon after the experience, he wrote: Shrapnel came pouring over the lines in a ceaseless whine, interrupted only by the crumps of 4.3s and 5.9s. From every direction this fire storm was turned upon us. Every gun within range seemed to have cut loose and the very gates of hell let open. Overhead bursts then deadly sprays of shrapnel were showered into our midst. Heavy shells rocked the earthworks and buried their occupants. The artillery concentration was tremendous and the range was painfully accurate. Imperials who had been at Loos and previous battles never experienced such a concentrated fire on so small a frontage … Men were digging in feverishly to escape this blast of iron, but of no avail … The company was gradually being wiped out as shell after shell burst [and it] was impossible to live under it. It was a miracle that anyone emerged alive.42

Another soldier in the 31st remarked: “I didn’t think a rat could come through alive after the bombardment [and that was] the first really heavy bombardment we had had!”43 When the troops in the front line were relieved, the shelling proved so severe that no trace of the old trenches could be found – they had been completely filled in by the spoil from the heavy shelling.44 On the night of 5–6 April, the 27th Battalion was withdrawn from the line due to heavy casualties, replaced at the front by the 29th Battalion. Just as the relief took place, the German infantry mounted an attack by “trickling” men through the seams in the barrage and the confused Canadians gave way.45 German troops from the 214th and 216th Re­ serve Infantry Regiments pushed forward, occupying four craters in the centre of the Canadian line (numbered from right to left two, three, four, and five) as the exhausted Dominion troops retired northwards.46 The retreat and subsequent failure of the Canadian counterattacks that followed sowed confusion at the front as officers and men struggled to confirm their positions under a constant, unrelenting fire. More than a week later it was discovered that in the aftermath of the retreat, Cana­ dian troops became confused about their positions – just as the British had been at the end of March. When a detachment from the 28th Bat­ talion reported on the 8th that it had successfully pushed the Germans out of craters four and five and had begun the work of consolidation,

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it was assumed that the Germans only held craters two and three. In reality, the 28th Battalion had mistakenly occupied craters 6 and 7 on the far left of the line, leaving the Germans in control of craters four and five. More importantly, this created a large gap between the 28th and 31st Battalions in the centre of the Canadian line which, as with 3rd Di­ vision, no one seemed to notice, this time for more than eight days. When the error was finally discovered from aerial photographs on 16 April, it was deeply damaging to Turner’s reputation. Had the Germans known about the gap, they may well have been able to exploit it to force a more general retreat on Ypres. In the event, Duke Albrecht’s Fourth Army did not have the resources to do much more than hold the line, mounting minor raids to regain the ground they lost on 27 March – confusion reigned on both sides as bad weather grounded most aerial observation. The final of these actions was launched on 19 April when the Canadians were pushed back to the British start line, negating the minor advances of the previous three weeks.47 The debacle at the craters became the subject of an intense investigation precipitated by the commander-in-chief, Sir Douglas Haig. Ulti­ mately, Plumer sacked Alymer Haldane and V Corps’s commander, Hew Fanshawe, for their part in the disaster – despite the fact that both moved quickly to correct errors and eventually succeeded in capturing their objectives. Dealing with the serious lapses in judgment and perceived incompetence of the Canadian Corps was more difficult. Unlike in the British case, the Canadians’ gap in the line went undetected for eight days and they ultimately lost all the ground which had been handed over to them. Lieutenant General Edwin Alderson, the Canadi­ ans’ British commander, placed blame squarely on the shoulders of H.D.B. Ketchen and his handling of 6th Canadian Infantry Brigade and, to a lesser degree, Richard Turner, 2nd Division’s commander. Turner had displayed a similar lack of judgment and situational awareness at Ypres the previous spring and when he defended his brigadier, Alder­ son demanded that Haig dismiss both of them. For political reasons, though, the corps commander’s request was refused. As Haig wrote in his diary, he preferred to retain “a couple of incompetent officers” rather than risk injuring relations with the government of Sir Robert Borden, which was in the process of training a fourth infantry division for the front at a time when the British needed all the men they could get. Haig sacked Alderson instead, but within a few months, both Ketchen and Turner had been “promoted” to new, non-combat commands in Alberta and England respectively. While neither officer could have changed the



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terrible weather or awful state of the ground, their management of a bad situation left something to be desired.48 Shell Shock as an Operational Issue As in case of Haldane’s 3rd Division, the confusion and disorder at St. Eloi was the result of a breakdown in command and control, exhaustion, and declining morale which manifested in a growing number of nervous casualties. The surviving evidence for the Canadians, though, allows a more thorough examination. One of the worst affected battalions was the 27th. An examination of the admission and discharge books for the two British CCSs handling the evacuation of wounded from 2nd Canadian Division reveals that during the month of April, a total of 230 men from the 27th Battalion were sent back to hospital with wounds, injuries, or various illnesses. Of these, forty-eight were admitted for shell shock, neurasthenia, exhaustion, or a similar condition – representing about 21 per cent of the battalion’s total evacuations – with some being included among the wounded and others listed as sick evacuations.49 Put another way, nervous casualties totalled roughly 6 per cent of the unit’s strength in April, which equated to an annualized rate of 720 per 1000. The prevalence of psychological casualties among evacuated wounded suggests that the 27th Battalion had ceased to be a functional combat unit. In Colonel Snider’s assessment, exhaustion and shock were the most significant factors in the inability of the 27th to resist the German counterattack or retake the lost craters. “What was left of the 27th Battalion [on the morning of 6 April] were so utterly exhausted as to be incapable of resistance,” he remarked after the battle. “The Officers of the 27th Battalion immediately concerned were all done in and quite incapable of giving a clear account of what had happened, most of them had not had sleep for over 100 hours, including myself.”50 Although he was reluctant to say so, Snider knew that many of those under his command had broken under the strain.51 In a report filed in May 1916, Snider singled out eleven officers and NCOs whom he believed deserved special mention for their actions at St. Eloi – three of them were said to have been severely shell shocked or “badly shaken,” including the battalion’s second in command, Major Kitson.52 As junior officers collapsed or were killed, the men under their command understandably began to panic in the chaos of a nearly continuous shell barrage. Company Sergeant Major Herbert Snape of the 27th Battalion recalled that many men, including himself, refused to follow orders to

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occupy front-line trenches as the situation deteriorated. When he was told to go forward with a bombing party to reinforce the crater line during the German attack on 6 April he recalled, “I said, ‘To hell with this.’ You was just committing suicide going in there, you see. So we beat it.”53 With the knowledge that it was possible, even acceptable, to ask for a rest behind the lines when soldiers felt their nerves beginning to give way, some units simply melted away until casualties necessitated withdrawal. In the 19th, 21st, 27th, and 31st Battalions, evacuations for shell shock all exceeded 15 per cent of non-fatal injuries – the highest proportion was in the 21st Battalion, where a quarter of evacuation cases were listed as shell shocked.54 Yet evacuation cases were only the tip of the iceberg. As Harold McGill, the 31st Battalion’s RMO noted, given the severity of the situation at the front, only a small percentage of the men who appeared at his regimental aid post with shell shock were ever sent to the field ambulance, which was itself the gateway to the CCS. “Cases of shattered nerves are coming in,” he recorded in his official war diary on the early morning of 6 April. “The worst of these I send to Field Ambulance, but the majority I allow to lie down in an adjoining dugout.”55 Although there were only a half-dozen evacuations for shell shock that day in his battalion, the numbers continued to climb even after the battalion left the trenches on the 8th. From 9 to 30 April, McGill held a daily sick parade and some days as many as 51 men reported ill. The RMO, though, was judicious in selecting cases for the field ambulance and often returned 80–90 of the men back to duty after a short rest at the aid station. He noted that many of these soldiers had been badly shaken by their experience and were reporting general aches, pain, and rapid pulse, which McGill attributed to fatigue.56 Cases that did not resolve with a rest at the regimental aid post were sent back to the DRS for further evaluation, an unusual situation during a period of active fighting. According to regulations, the DRS was supposed to close down during major operations as all casualties streamed to the rear as each field ambulance switched to operating main dressing stations.57 Under normal circumstances, this meant that exhausted soldiers only in need of a rest would not have been allowed to return to the field ambulances, which were only supposed to process evacuation cases destined for the CCS. But when 2nd Division entered the line, it was taking over static positions gained by British troops and was not planning to mount offensive action.58 As a result, the DRS remained open and casualties continued to be evacuated according to the normal routine laid out for a field ambulance in a quiet sector of the front.



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During the fighting at St. Eloi, 2nd Division’s DRS was run by No. 4 Field Ambulance at Boeschepe, where it also continued to run Second Army’s hospital for self-inflicted wound cases; No. 6 Field Ambulance handled evacuations from the crater line.59 Sir Andrew Macphail, a prominent Montreal physician and later official historian of the Cana­ dian Army Medical Corps, was in charge of No. 6 Field Ambu­lance’s main dressing station just behind the 31st Battalion at Ouderdon, located in an 80 by 30 foot thatched-roof barn.60 His diary reveals that while evacuations went smoothly, the field ambulance staff – who had never been in a combat situation either – were nearly overwhelmed, steadied only by the presence of the Corps’s Director of Medical Ser­ vices, Colonel G.L. Foster, who had endured a similar experience at Ypres the previous year. Although Macphail noted that many of the wounded brought to his station faced their injuries stoically, many others had clearly reached their breaking point. “Some were maniacal and had to be bound to their stretchers,” he confided to his diary. “Others are hysterical. Many were dazed and though wounded did not appear to suffer.”61 When cases of shell shock reached the station, Macphail often prescribed morphine to calm them down rather than send them to the rest station or directly to the CCS. Most, he found, slept it off and after ten hours would wake up “quite calm” and ready to be sent back to the line to join their comrades.62 Those who did not were taken in  batches each evening to Boeschepe by horsed-ambulance wagon. Macphail was confident that many of these men were just “utterly exhausted” and would be ready to return after a few days’ rest.63 The Montreal doctor, who observed the wounded streaming through day after day, felt that for many at the front, the situation had become one of hopelessness. Only those who could not see the inevitability of their own demise remained cheerful and focused. “Our men did wonderfully,” he wrote, “especially the more stupid ones [while] our officers are worn, old, gaunt from loss of sleep and horror.”64 To Macphail the hopelessness and meaninglessness of the situation should have been readily apparent to all; by implication, the intelligent response would have been to “perform badly.” As at the Second Battle of Ypres, none of the field ambulances attached to 2nd Canadian Division kept an admission and discharge book during the chaotic days of 3–19 April 1916. This means that we will never know how many men were temporarily treated for exhaustion or shell shock at regimental aid posts or field ambulances. However, the admission and discharge records for Canadian soldiers

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admitted to Nos. 10 and 17 CCSs have survived. These two British units were responsible for evacuating all the cases sent to hospital from the 2nd  Division front, and the records show that 1501 officers and men from the infantry and engineering units of 2nd Canadian Division were evacuated for wounds or illness during April 1916.65 Of these, 202 (13 per cent) were sent to hospital with nervous illness. Yet if we only look at the ratio of neuropsychiatric casualties to somatic injuries from shot and shell the numbers are even more striking. Only 841 of the evacuations were for battlefield wounds, the rest being for sickness or non-combat injuries.66 This would suggest that for every four men sent to the CCS with shrapnel, bomb, or gunshot wounds, one also left with a neuropsychiatric diagnosis. As indicated by table 4.1, of the twelve battalions of infantry and one battalion of pioneers attached to 2nd Division, nine reported neuropsychiatric casualties in excess of 10 per cent of admissions.67 Given that many other men appear to have been treated in battalion aid posts or field ambulances and released, the number of men who actually left the front was likely much higher. Enduring trommelfeuer was already difficult, but as men began to melt away to aid posts, it became even harder for others to remain. It was well understood at the front that if one man gave in to fear, it could quickly spread to those around him. “The greatest fear or all was the fear of being afraid,” recalled Gordon Hamilton of the 58th Battalion, “because the last thing in the world one would want to do would be to show fear … [The men around you would] probably understand because you knew that they probably felt the same way as you did so what’s here to talk about. You had to go ahead and do the job and that’s all.”68 Soldiers provided each other with both physical protection and emotional reassurance. What kept soldiers fighting at the front was the tacit reciprocal obligation each had to the other members of the group. A soldier could endure a barrage or an infantry attack only if he trusted those around him. Not only did he need to believe that the others would help him fight, but he also had to believe that if he was buried by a shell, hit with shrapnel, or knocked down by a bullet, his comrades would work to find him and get him back to the field ambulance. But as soldiers in a unit began to break down, the trust which was integral to coping with the trauma of war disintegrated. The experience at St. Eloi was, quite simply, beyond the limits of anything that Canadian troops had yet experienced.69 In interviews, diaries, and letters, many firmly recorded their belief that the scale of bombardment was unprecedented to that point in the fighting – not



The CEF’s Shell Shock Crisis 103

Table 4.1 Evacuations to Nos. 10 and 17 CCSs from 2nd Canadian Division Units, April 1916 Unit

Total casualties

Nervous diagnoses

Per cent of total

18th Battalion

135

14

10%

19th Battalion

128

23

18%

20th Battalion

122

7

6%

21st Battalion

118

28

24%

22nd Battalion

72

7

10%

24th Battalion

102

5

5%

25th Battalion

86

12

14%

26th Battalion

39

3

8%

27th Battalion

230

48

21%

28th Battalion

118

6

5%

29th Battalion

108

13

12%

31st Battalion

182

27

15%

2nd Pioneers

61

8

13%

1501

201

Total

13.4%

Source: A&D Books 968, 969, 970, 977, 987, 993, and 997, compiled from entries for April 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC.

only in the experience of the Canadians, but in the whole war.70 Of course this was a rationalization which served to legitimize reactions to terrifying conditions. Similar “back and forth fighting,” as the Germans called it, had taken place along the Franco-German line at Arras and in the Champagne the previous year where artillery was also used to blast men from recently gained positions. It had also been experienced by British units at Loos. But for Canadian soldiers yet to experience their baptism of fire, the type of fighting experienced at St. Eloi was beyond anything they had anticipated. In April 1916, the soldiers of 2nd Canadian Division suddenly and simultaneously crossed an experiential threshold. Henry Botel, a labourer from Portage la Prairie wrote to his mother and brother: “No­ body unless they have been there can begin to imagine what an intense ­bombardment is like, and after it is all over, the effect on the nerves lasts for  days with some for weeks, while others never get over it.”71 One of the most traumatic experiences was live burial. High explosive shell

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blasts literally had the power to pick up a man and throw him a dozen feet or more before the earth fell back down on top, burying the soldier alive. Others were buried when they took shelter in a trench or shell hole and the earth thrown up by shellfire fell on top of them.72 At dawn on 4 April, Lieutenant Archibald McEtheran, a twenty-eight-year-old clerk from northwestern Ontario, found himself in a narrow trench at the front of the 27th Battalion’s lines just as the German barrage opened up.73 “We were stretched out along, nicely spaced but the shell fire was gradually breaking this down,” he recalled. People who might be here or there might get a little more shell fire than people a little further on. I realized the fellow who had been sitting over there wasn’t there, the parapet had blown in. So I tried to dig him out with my hand so I wouldn’t hit his face or anything, when another shell came and buried me more or less beside him … At first I dragged myself out, I jerked myself out. As I remember it the steel strap on my helmet broke and let me out … which was a miracle … From the top of my head to my waist was pretty well covered as near as I can make out … The rest of me was at the bottom of the trench because I had been stooping down to dig this man … I really had the wind knocked out of me too, I was suffocating see, that was a super human effort that got me out of there.74

Thomas D., a twenty-two-year-old university student from Brampton, was with the 18th Battalion in the trenches at St. Eloi where he was buried and then “blown up” on the same day. D. reported that he “did not feel effects for about an hour and then collapsed.” His comrades brought him to the RMO, who sent him to the DRS run by No. 4 Field Ambulance. But after two days there he was still in a “dazed semiconscious state” with a poor memory, headache, general pains, and fatigue and had to be evacuated to No. 17 CCS.75 We might now say that burial cases may well have been suffering from mild traumatic brain injuries (mTBI) rather than emotional distress. At the time they tended to be classified as “wounded” rather than sick. At St. Eloi, a growing number of soldiers also presented with what might be called emotional and physical exhaustion brought on by lack of food, no sleep, and constant anxiety. In such cases, most had not been blown up or buried by shells, but self-reported before they became completely ineffective. For example, after the 28th Battalion failed to retake the trenches lost by the 27th in the German counterattack on the night of 6 April, Captain Duncan Macintyre recalled that two officers



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broke down and wept like “children” from “exhaustion and nerve shock.”76 A number of others, he said, had to be evacuated for shell shock, while some who waited too long “went temporarily insane.”77 One of those was Private Richard E., a twenty-two-year-old grocer from London, England, who enlisted at Niagara, arrived at the front in early March. St. Eloi was his first real experience in the front line. Although he was calm going up the line, he later told one of his doctors that “when he entered the trenches under heavy shell fire he became very nervous and his MO sent him down [to the field ambulance].” E. described himself as being “out of his head” and “not knowing what he was doing.” When he first arrived at the dressing station he was shaking badly, dizzy, exhausted, and had a bad headache. He soon developed insomnia and heart palpitations and had to be evacuated.78 Although the condition may have been commonly called shell shock, soldiers like Gregory Clark thought it was often incorrectly applied. “It wasn’t anything of the kind,” he recalled, referring to the stigma which senior officers later applied to the condition, “it was just fatigue, not so much in battle as in these long intervals of living under these conditions.”79 No attempt was made to distinguish cases of physical exhaustion from nervous illness. Indeed, most of those who were admitted to the field ambulances and CCSs in April were suffering from some combination of the two conditions. Only rest and time separated soldiers who could recover quickly from those who needed further treatment behind the line. One of the later was Lieutenant Colonel Snider, commanding officer of the 27th Battalion. Some of his men recalled that he appeared quite shaken in the days after St. Eloi; his friends said that the events at the Craters had been “too much” for him.80 The battalion’s commanding officer would later recall that he had been on duty without sleep for six days and nights and took the loss of his men very personally. But it was only once he reached a safe billet behind the line on 14 April and saw his empty bed that he broke down and began to cry.81 The next day, Snider requested and was granted fifteen days’ leave to England; there he soon checked himself into Granville Special Hospital at Ramsgate for nervous exhaustion.82 At Granville, Snider complained of general weakness, being easily fatigued, suffering from insomnia, severe nightmares, and headache; he also complained of having a poor appetite and a bad memory.83 The colonel spent nearly a month at Granville before being sent for a medical board which determined that he was no longer fit for the field. Officially, Snider was relieved of duty because he was

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A Weary Road

considered too old to return to the front lines. But at fifty-two he was the age of many battalion commanders on the Western Front. The board concluded, though, that as a result of severe nervous strain, Snider had “become very emotional and … unable to sleep well except for a short time each night,” which left him exhausted and “unfit for any mental or physical exertion.”84 Others were luckier. By the end of the third week in April, Captain Macintyre, who was then serving on the staff of 2nd Division as an intelligence officer, was beginning to feel run-down. After going without sleep for more than three days he began to feel tired and seemed to be developing the flu.85 But although he felt sick, he did not have the usual symptoms of a head cold. “I can’t say I’ve very sick, but have no energy to do anything,” he wrote in his diary. On 25 April he visited the DRS run by No. 5 Field Ambulance and was admitted with bronchitis – although he did not have a cough or a fever.86 The real problem was that he was depressed, tired, and anxious. “I feel ashamed when a Doctor asks me how I am,” he wrote, “for I don’t feel sick enough to go to bed and at the same time don’t feel well enough to work.”87 Despite his misgivings, Macintyre was promptly sent to the corps rest station at Mont des Cats for a few days’ rest. There he met other officers from the Canadian Corps, many of whom were convalescing from various forms of nervous strain. At the monastery, Macintyre was treated by the hospital’s commanding officer, who appears to have ordered him to rest and relax while providing an opportunity to talk over his war experiences. Macintyre’s days were spent tramping around the French countryside, sleeping on grassy hilltops or shopping in the villages behind the lines.88 Nights were consumed with concert parties and “smokers.” The captain made fast friends with the other patients, including Billy Bothwell, 9th Brigade’s Machine Gun Officer who was being treated for severe nervous headaches. One day while the two of them were out driving in a motor ambulance they “borrowed” from the hospital, Bothwell rounded a corner and abruptly pulled into a CCS. As the two men sat in an ambulance in the middle of the courtyard, Bothwell looked at Macintyre and said he was not going back to the rest station at Mont des Cats and would instead be admitting himself to the CCS. “I expect they’ll send me back to the base and then on to England,” he told the surprised captain.89 For Macintyre, Mont des Cats provided a welcome “holiday” from life at the front, but that was all. Bothwell wanted to escape permanently. Leaving his friend at the field hospital, Macintyre caught a train back to the rest station and walked the final mile to the



The CEF’s Shell Shock Crisis 107

monastery on the hill.90 Within a couple of days, the intelligence officer was feeling better, determined to return to the lines, which he did on 2 May.91 The problem with exhaustion cases was that regardless of the mild nature of the symptoms, in most instances soldiers genuinely did require a rest in order to again become effective. The crisis was not just about the growth in shell shock casualties, but more so the fact that the entire fighting force required a rest; and most “intelligent” men, to borrow Macphail’s phrase, felt they deserved one. Although it was difficult to argue the point, how was the army to manage as such terrible conditions became the norm? While DRSs and smaller front-line rest stations provided some bed space, as casualties mounted there was simply no place to house them. When somatic casualties began to stream in from the front, many had to be evacuated to the CCS simply because they were not yet ready to return to their units but could no longer be accommodated by the overflowing divisional system. Shell shock began to resemble an epidemic once evacuations routinely neared 20 per cent of  non-fatal casualties. In April 1916, the Canadian Corps reported 2385 non-fatal casualties, of which 470 (20 per cent) were evacuated for neurasthenia, hysteria, or shell shock. Although the fighting died down by the third week in April, neuropsychiatric casualties remained inexplicably high the next month too. During May, 291 Canadians were evacuated for nervous or mental illness representing 18 per cent of the 1665 non-fatal casualties recorded in the Canadian Corps.92 While it is impossible to determine the degree to which the prevalence of the term might have encouraged soldiers to self-report, it is clear that as the idea of shell shock became an accepted part of trench culture, soldiers were more likely to identify a variety of sensory complaints with that specific condition. For example, two months after Private Lawrence Earl Johns arrived in France, he and a group of soldiers from the 58th battalion were sleeping in tents a ways behind the front line. As a replacement, Johns had yet to see actual combat or spend any real time in the trenches, but concepts like shell shock were already part of the immersive culture of the front and shaped his expectations when he finally reached the line. “We arrived here about 5:30 yesterday after noon [and] found our tent lying flat on the ground,” wrote the twenty-three-year-old farmer from Elmville, Ontario, in a letter to his sister. “So we got some sandbags, filled them up, built a wall, and fixed her up before we could go to bed. One end of the tent is open so we could see the fireworks from the front line but that did not keep

108

A Weary Road

us awake long … It started to rain [and then] there was a bolt of lightning struck right near us, all of a sudden, every body thought it was a shell and said they were shell shocked. It made a big cloud of smoke [and] I thought some one hit me on the top of the head with a mallet it run down my legs. Every body felt the same; it sure was close.”93 Before Johns and those around him could process what had actually happened, they instinctually connected the shock and sound of the thunder and lightning with the strange sensations produced by the discharge of static electricity, concluding they had been shell shocked. They were, in essence, following a script that had clearly been internalized long before they experienced the actual hardships of battle. The shell shock script reflected the cultural life of the trenches, which emphasized the importance of “doing one’s bit” to the point of physical exhaustion or exceptional exposure to the physical fire of shells. But these same scripts also connected feelings of fear, the startle response, and general nervous complaints to a specific, seemingly legitimate medical condition called shell shock. This allowed soldiers to easily categorize and describe a variety of common feelings and sensations, but it also suggested medical illness and a possible escape from negative stimuli. Although soldiers engaged in self-regulation, there was little to de-incentivize self-reporting once one felt a certain experiential threshold had been breached. The very existence of rest stations and the willingness of RMOs to send soldiers there when they appeared tired or close to the breaking point reinforced the apparent medical legitimacy of the condition, further shaping and encouraging the ideas of those who watched and observed others leaving and then returning to the line. Whether individual doctors accepted every case of shell shock as a genuine breakdown or, like many, used the rest station as a form of middle ground where serious cases of nervous or mental illness could be triaged from those who just needed a break, the pattern of self-­ reporting, rest, and return became an accepted part of life at the front. Mount Sorrel The admission and discharge books of No. 3 Field Ambulance, which cover the period December 1915 to early May 1916 show how in the wake of the heavy fighting at St. Eloi, diagnosis became more homogenized across the Canadian Corps, as did the process of treatment and release. From December 1915 to the end of March 1916, soldiers were admitted to the hospital under a variety of diagnoses. Although shell



The CEF’s Shell Shock Crisis 109

shock had become the most common label, representing 33 per cent of admissions, various diagnoses suggestive of mental illness still accounted for 27 per cent of admissions, while nervous conditions accounted for 24 per cent and epilepsy (or suspected epilepsy) for 12 per cent. But during April and early May 1916, shell shock came to account for 69 per cent of the 166 admissions to the hospital with other nervous diagnoses accounting for 17 per cent. Most of these shell shock cases were, in fact, exhaustion-type cases which spent, on average, four days in the rest section of No. 3 Field Ambulance’s main dressing station before being transferred elsewhere in the division for treatment; only 5 per cent of primary admissions were sent to the CCS. The examination of a random sample of 10 per cent of the April and May cases (sixteen soldiers) shows that 60 per cent eventually returned to duty after being treated within the divisional rest system, while the other 40 per cent were evacuated. Nevertheless, most spent a total of fourteen days or more in treatment – one remained in a convalescent company for nearly four months before returning to his unit. Even while these men remained part of their own divisions and thus avoided evacuation, they nevertheless represented an ever greater loss to front-line units. Senior Canadian medical officers first noticed the growing effect of nervous illness during the heated fighting for Mount Sorrel – the largest and most costly battle yet fought by the Canadian Corps. After the end of the crater battles in the third week of April, the front quieted down considerably. The 2nd Canadian Division continued to hold the line south of St. Eloi while 1st Canadian Division, to the northwest, held the centre of the corps’s position around Mount Sorrel (Hill 60) to  Zwarteleen. Further to the north, the newly arrived 3rd Canadian Division occupied the wooded forward slope of the Messines ridge, a round salient projecting eastwards into the German lines. The 3rd Cana­ dian Division’s positions were centred on two imperceptible hilltops marked Hill 61 and Hill 62 on British trench maps for their heights. A spur known as Observatory Ridge stuck through the centre of the line, flanked on the south by Armagh Wood and to the north by the much larger Sanctuary Wood. Green Canadian troops faced the 26th and 27th Württemberg Divisions of the German XIII Corps, which had been planning to mount an assault to pin down troops in the Ypres Salient before the anticipated British offensive began in the summer. Mount Sorrel, as the entire Canadian position was known, was an obvious target as it would have provided the Württembergers with clear lines of sight northeast into Ypres. In late May, German troops began stockpiling

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A Weary Road

ammunition and food in the front lines while additional light and ­medium artillery batteries, including corps artillery from XXIII, XXVI Reserve, and the Marine Corps, along with German minenwerfer detachments, were brought up to support the attack.94 The 27th Division alone had ninety-five guns at its direct disposal – including 21-cm mortars – while the front-line soldiers of the 127th Regiment themselves had two heavy, eight medium, ten light, and two Ehrhard Minenwerfer for direct fire support. A total of 200,000 shells had been provided for the artillery preparation; these were to be fired into an area a little more than 500 by 1500 yards over the course of five hours.95 Like St. Eloi, Mount Sorrel was a battle dominated by artillery in which the infantry were attacked and then asked to counterattack across the same ground several times. The hand-to-hand fighting for front-line trenches was brutal, but it was the use of high explosive shells which defined the battle. On the afternoon of 2 June, German artillery opened up without warning on the Canadian lines.96 The German historian of the 27th Division described the terrible scene across no man’s land: “At 1430 hours our fire had increased to a trommelfeuer of indescribable intensity. The bursting of mortars, the flight and explosion of shrapnel and shells was horrifying as the vapour of the hot afternoon air mixed with the fumes of detonating projectiles. Black-grey smoke, dust clouds and spurting columns of earth enveloped the enemy position in impenetrable darkness.”97 After five hours of continuous firing the barrage lifted to the Canadian support trenches to create a curtain of fire preventing reinforcements from reaching the front; the German infantry went forward but only met sporadic resistance. The brunt of the German attack fell on the 4th and 1st Canadian Mounted Rifles (CMRs) and a company of the Princess Patricia’s Canadian Light Infantry (PPCLI) which were holding the front line across the centre of Observatory Ridge along the edge of the two woods. Coincidently, 3rd  Division’s commander, Major General Malcolm Mercer, was inspecting the 4th CMRs trenches with the commander of 8th Brigade, General Arthur V.S. Williams, when the German attack began. Mercer was killed in the barrage; the badly injured Williams was captured when the Germans took the trenches later that afternoon.98 For the green troops of 3rd Division, the intense fire was a new experience and many later insisted that it had to have been the strongest barrage to that point in the war, which explained why front-line units seemed to evaporate. “A lot of fellows later on said those fellows [in the forward trenches] didn’t fight,” recalled Stanley Bowe of



The CEF’s Shell Shock Crisis 111

the 2nd Canadian Mounted Rifles (CMRs), who watched the barrage from the support lines. “[But] they had no chance to fight because they were completely smothered with artillery fire … It was the heaviest concentration of artillery that was ever known in warfare.”99 The assault troops of the 120th Infantry Regiment watched the barrage from their trenches and saw that “isolated groups of men who had lost their officers tried to withdraw, fleeing to the rear from the devastating effect of the fire.”100 German troops later reported that after they made it across no man’s land without a shot being fired and reached their objective they found that the Cana­dian front line had been “literally obliterat[ed] in several places and most of the enemy machineguns were buried in the debris.”101 The few men who had survived the bombardment tried to take shelter in dugouts and tunnels, some of which collapsed under the rain of shells.102 In the sector held by the 4th CMR, just after midday, most of the garrison had already been killed or wounded. The entire front line was also cut off from the rear and the survivors were incapable of anything but sporadic resistance. The 4th CMR lost a total of 625 men and 21 officers killed or captured in the space of only a few hours – only one officer and 45 other ranks survived to answer the roll call next day at brigade headquarters.103 The 125th German Infantry Regiment recorded capturing four field guns, one trench mortar, three machine guns, one general, one colonel, one major, several captains and lieutenants, and around 200 other ranks.104 That evening, the 2nd CMR were sent forward to re-establish a front line while German troops dug in on top of the old Canadian trenches in the remains of the woods. Many of those who went up to the front were fresh reinforcements with little or no combat experience. “We had forty-six fellows in the platoon I was in and I remember walking in and there were a dozen or fourteen new men who had never been in the line before … I stayed with them,” recalled Private Bowe of the 2nd CMRs. “We had no line to occupy, there were no trenches left when we got there.”105 Despite the chaotic situation, and perhaps because of it, the 2nd CMRs were ordered to mount a counterattack that night, which failed miserably. Just after 8:30 p.m., B Company advanced on Rudkin House, a position in the centre of Observatory Ridge which had been captured by the Germans. Although the Canadians reached their target, the Germans laid on a heavy fire with machine guns and rifles as their artillery began to blast B Company out of the line. Private Bowe recalled that the terror of the fight brought most men, including himself, to the breaking point. Some actually cracked:

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A Weary Road

This is hard to believe but when the Germans are attacking and I’m firing, there was a guy at my waist with three or four dead men on top of him, clawing at me and praying to God to take him out. The shells were exploding among those dead and wounded all the time. When we came out you would have sworn that we had been in a slaughter house in a butcher shop. Out clothes were completely saturated and stiff with blood. That night I saw men completely break and cry at the top of their lungs, big, strong men gone completely out. In the morning I started to crack a bit, you see, began to whimper, and this fellow came alongside me and he pats me on the back and he said, “Come on, buck up, you’re no damn use to us like that.” He brought me out of it.106

The next day, Canadian troops cobbled together from 1st and 3rd Di­ visions mounted an ill-prepared counterattack in an attempt to regain their old lines. As Tim Cook notes, this was the first large-scale Canadian offensive action of the war as six infantry battalions lined up to simultaneously charge the German positions.107 But the attack was a disaster from the start. The Germans began to shell the Dominion troops as they moved up to the front with high explosive, shrapnel, and gas shells. This delayed some battalions from reaching the line and the start-time had to be pushed back. Meanwhile, the Canadian artillery had been unable to properly establish the range to their targets, and as a result the barrage proved to be largely ineffective – worse still friendly fire from “short” shells killed or wounded Canadians as they waited in their trenches for the signal to go “over the top.” When the order to advance finally came, few managed to make it much further than their own trenches; those who reached the German line were quickly killed or captured.108 The counterattack of 3 June failed for several reasons. As the battalions advanced to their start positions, the 60th and 52nd were caught in an intense shell barrage and the men immediately took to ground.109 With heavy officer casualties in both battalions, Lieutenant Colonel Griesbach, who had been seconded to lead the attack, was unable to convince the remaining men to go forward. The 49th Battalion was thus left to attack the German trenches alone. Major Agar Adamson, second in command of the PPCLI, acted as Griesbach’s chief of staff during the attack, and although Adamson was usually sympathetic towards his men, in the aftermath of the failed assault he blamed them for a lack of will. “Some of the troops were not satisfactory and for reasons which cannot be entirely put down to funk,” he wrote to his wife Mabel on



The CEF’s Shell Shock Crisis 113

4 June, “[they] failed to push with the vigour that is required to do the job properly, stopped to attend to wounded men, only themselves being wounded and reducing the force and members of the assault.”110 Historians have attributed the loss of Sanctuary Wood and the failure of the counterattack on poor preparation and the inexperience of both front-line soldiers and the staff officers tasked with planning the 3 June assault.111 But an analysis of casualty figures suggests that ­psychological breakdowns also played a role. Nos. 10, 17, and 3 Cana­ dian CCSs were assigned to evacuate wounded from the Canadian Corps at the beginning of June, and as indicated by table 4.2, an analysis of their admission and discharge books reveals that shell shock evacuations were now averaging above 11 per cent in the corps as a whole. This translated into an annualized rate of 1792 evacuations per 10,000 healthy troops. During the initial period of fighting at Mount Sorrel between 2 and 5 June, 365 Canadians were evacuated for shell shock.112 In 3rd Divi­ sion, which bore the brunt of the assault, 15 per cent of those who were eva­cuated to hospitals on the lines of communication were sent back for shell shock. The numbers were lower in 1st Division, which only contributed men to the counterattack: 5 per cent (51) of the Division’s 1127 evacuated casualties were labelled as shell shocked.113 These figures only account for evacuation cases and do not include soldiers treated in DRSs and released back to their units, so the number of soldiers who left their battalions during or immediately after the fighting was much higher. The admission and discharge books for 3rd Division DRSs have not survived, but they do exist for No. 2 Field Ambulance, which ran the primary DRS for 1st Canadian Division which also participated in the counterattack. Its records show a total of eighty-five admissions for shell shock between 2 and 5 June, but only sixteen evacuations. The vast majority, 76 per cent, of patients admitted to the DRS were returned to duty after a day or two and never reached a CCS; the other 5 per cent were sent to a convalescent company or the army rest station at Mont des Cats. This suggests that the evacuation cases seen at the CCS may have again only represented between 20 and 40 per cent of the total number of soldiers incapacitated by shell shock.114 The hardest hit battalion was the 60th from Quebec. Of the 330 men who were evacuated wounded between 2 and 8 June when the last of its casualties came in from the scarred front-line trenches, ninety-four or 28 per cent were sent out for shell shock. The 60th Battalion was supposed to lead the attack, but when the battalion proved sluggish, it was

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A Weary Road

Table 4.2 Evacuations from the Canadian Corps to Nos. 10, 17, and 3rd Canadian CCSs, June 1916 Unit

Sick

Wounded

Shell Shock

Per cent of wounded classified as shell shocked

1st Canadian Division

234

3483

345

10%

2nd Canadian Division

507

1381

138

10%

328

2879

413

14%

1069

7743

896

11.6%

3rd Canadian Division Total

Source: A&D Books 968, 971, 972, 975, 976, 986, 988, 989, 990, 992, compiled from entries for June 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC and A&D Books 324–8, compiled from entries for June 1916, No. 3 Canadian Casualty Clearing Station, RG 150, Volume 529, LAC.

assigned a follow-up role behind the 49th and 52nd Battalions, supporting the counterattack on the left side of the line.115 However the men of the 60th never left their trenches.116 As the barrage fell down on the men as they marched to the trenches then sat still waiting for the signal to go forward, 236 soldiers were physically wounded or killed. Many others appear to have simply had enough. The first forty-three reached the CCS on the evening of 3 June, meaning that they must have reported sick late that same afternoon. If we conservatively estimate that these evacuation cases represented only 40 per cent of the total number of men who went to the field ambulance (the others sent for a rest), it suggests that the battalion lost around 100 men as it was still forming up for the attack. The next batch of evacuations came early the following morning, when thirty-four men were sent to the CCS. Again, this would suggest total losses for shell shock on 4 June were closer to ninety men. In total, then, the battalion may have lost close to a third of its strength when soldiers self-reported with shell shock. When neuropsychiatric casualties and somatic injuries are combined, totalling around 500 men based on the above estimates, it explains why Lieutenant Colonel Gas­ coigne felt that his men had been “hammered to pieces” and were unable to advance as ordered.117 While these figures may appear high, they are supported by an analysis of the second phase of the battle on 12/13 June. From 9 to 12 June



The CEF’s Shell Shock Crisis 115

Canadian artillery pounded the new German trenches across Obser­ vatory Ridge with intermittent barrages ranging in intensity to confuse the defenders about the hour of attack. According to an officer of the 127th Regiment, who was in the support trenches during the bombardment, the German artillery remained largely silent “[in] order that the English may be able to dig themselves in [in] peace.” Once the required assault had been made, the Würtembergers appeared content to return to a live and let live approach. “We hoped that they would creep up close to us,” he continued. “In reality they are about 500 yards off, so that they can bombard us very heavily, of course without danger to themselves.”118 After a final bombardment, at 1:30 am on 13 June, the 3rd, 16th, 13th, and 58th Battalions went over the top. On the right and in the centre, the 3rd, 16th, and 13th Battalions met little resistance from the 125th and 119th Infantry Regiments, going straight through to their final objectives.119 The Canadian troops found a similar situation atop Observatory Ridge, as the Germans discovered on 2 June. The German trenches, it seems, were defended only by a few handfuls of dazed soldiers, who quickly surrendered; only on the left flank was the advance temporarily held up for 20 minutes by machine-gun and tenacious rifle fire.120 During the Canadian trommelfeuer, many German officers and men went “out of their minds” and had to be evacuated or fled the front.121 Some of the remaining German soldiers, exhausted by the heavy artillery fire, refused to fight. “I heard a whole squad of the 125th said they would not go forward anymore,” a German lieutenant recorded in his diary. “The artillery fire is, indeed, absolutely fearful … Some of the 119th are doing the same.”122 When German prisoners from the 119th Regiment were later interrogated, they confirmed that many officers and NCOs fled the trenches during the intense preparatory bombardment.123 The German artillery responded as it had at St. Eloi: with a massive barrage intended to blast the attacking troops out of their newly won positions. After making a midnight attack, Canadian troops were already exhausted. To make matters worse, it was raining heavily and the men had no shelter and little food or water. “The enemy maintained a heavy fire all day, cutting all communication, which was then undertaken by runners,” reported the 2nd Battalion. “Rain fell continuously during the whole period, and as there was no drainage, the damaged trenches soon filled with water, and the men suffered terribly from exposure. In addition to these conditions the soldiers had to subsist on

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A Weary Road

cold food and were in a state of exhaustion when relieved on the night of 14/15.”124 It was also difficult to extract the wounded from the sodden, shell-torn front line, which meant that many men had to lie where they fell for several days. Those that did make it to the dressing stations were sometimes left outside, exposed to the rain until room opened up inside.125 Fortunately, the equally exhausted German infantry was only able to mount two feeble counterattacks, both of which were broken up soon after they began with artillery fire.126 Between 12 and 16 June, 1st Canadian Division evacuated 1674 wounded from the front line.127 Of these, 235 soldiers, or 14 per cent, were listed as shell shocked.128 It is clear from the records of No. 2 Field Ambulance, which continued to run a DRS during the fighting, that these figures represent only about half of the actual totals. Between 12 and 16 June, No. 2 Field Ambulance admitted 381 cases of nervous and mental illness; around 87 per cent were diagnosed with shell shock. At first, most cases were retained in the field ambulance, but as casualties mounted, many rest patients had to be evacuated. In the end, the DRS returned 49 per cent of admissions to duty (188), evacuated 49 per cent to the CCS (185), and sent the remaining 2 per cent to a corps rest station or convalescent company.129 The most affected battalions were those on the left, which experienced the heaviest fighting. The 3rd Battalion reported 218 officers and men wounded in the attack; there were also fifty-four cases of shell shock admitted to No. 2 Field Ambulance between 12 and 15 June, suggesting that as many as 25 per cent of the wounded were sent back shell shocked. Some of these men may also have come from the ninety-two missing reported on 14 June.130 Only fifteen of the 3rd Battalion shell shock cases were actually evacuated. The highest number of cases was reported in the 1st Battalion, which supported the advance of the 3rd. Between 12 and 15 June sixtyseven soldiers were admitted to No. 2 Field Ambulance with shell shock.131 No specific figures are available for the 1st Battalion during the same period, but a total of 304 soldiers were treated in field ambulances during the month of June for wounds and sickness.132 Neuro­ psychiatric admissions from the counterattack alone thus accounted for 21 per cent of total casualties for the month of June.133 According to A.E. Ross, the Assistant Director of Medical Services for 1st Canadian Division, although large numbers of shell shock patients were admitted to the field ambulance, most were considered mild. “Numbers of troops, suffering to a slight extent from shell shock, but to a much greater extent from exhaustion and from the hardships they



The CEF’s Shell Shock Crisis 117

had undergone were sent … to the Divisional Rest Station,” he reported after the battle. Most of these men were kept for twenty-four hours, given warm baths, hot food, and fresh clothing, and after a period of sleep were sent back to their units. In total, Ross reported that 294 shell shocked men from all three divisions were treated and released to their units between 12 and 15 June; 285 were evacuated, suggesting that the total neuropsychiatric casualties were about 570 men.134 Rest and evacuation cases from all causes totalled 1816, which means that shell shock diagnoses accounted for nearly one third of all casualties.135 In response to soaring shell shock admission rates in front-line units, on 14 June Second Army ordered Canadian DRSs to immediately reduce their capacities to 100 beds.136 On that day, there was an average of 367 patients in each of the three DRSs of the Canadians Corps. The Director of Medical Services feared what might happen if so many men had to be simultaneously evacuated either because the Canadian Corps was transferred or in the event of a German breakthrough, as happened at Ypres in April 1915 when field ambulances had to be withdrawn in order to avoid being overrun.137 Although the Assistant Director, Medical Services, 2nd Canadian Division, John Fotheringham, felt that the DRSs had “abundantly justified their existence” by avoiding unnecessary evacuations, he also understood that they now posed a military danger.138 The word “epidemic” was first applied to the explosion of shell shock cases by the Department of Pensions and National Health in an internal study completed during the fall of 1939 as Canada faced another war.139 While it is a problematic term, it is hard to escape the conclusion that the wave of cases which swept across the Canadian Corps during the winter and spring of 1916 represented the beginning of a new phase in the psychological history of the war. When the divisional rest system was created in 1915, it created a middle ground where doctors and soldiers negotiated a rapprochement in the treatment of nervous and mental illness. For doctors the DRS provided a diagnostic space where borderline cases could be evaluated; those that recovered with rest and hot food went back to their units, the rest were evacuated. This also provided soldiers with an opportunity to temporarily escape the privations and horrors of the front without being stigmatized as cowards or “quitters.” The rest system effectively managed cases of nervous and mental illness until both the nature of the cases began to change and the number of patients increased dramatically. After all, no DRS was supposed to have more than 200 patients in residence at a time. Casualties

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A Weary Road

from Mount Sorrel, more than 9000 from shot and shell alone, had simply overwhelmed the system. Conclusion By the winter of 1916, more and more soldiers were reporting to rest stations with the symptoms of physical exhaustion and mild nervous complaints. Such cases often responded well to rest treatment with around two thirds of admissions returning to duty without evacuation. The reasons for the increase in admissions are complex. During the course of 1915 and early 1916, soldiers came to see shell shock as a legitimate condition which could usually be treated by a short rest. The widespread dissemination and popularization of the concept was itself a reflection of the intolerable conditions at the front. Men needed to find a legitimate way to seek relief without risking sanction by their peers. Those who endured exceptional level of trauma – beyond the normalized suffering of the front – came to be seen as legitimate casualties of war, deserving of medical treatment.140 That many were able to return quickly to their friends helped to make the rest station an acceptable site for recuperation. By early 1916, men could come and go from rest stations with the blessing of their doctors who wanted to keep them at the front as well as their peers who understood the need for a temporary holiday from the front. The very success of the system, both in de-stigmatizing shell shock and returning soldiers to duty after a short rest, proved to be its undoing. At St. Eloi and again at Mount Sorrel, evacuations for neuropsychiatric casualties exceeded one fifth of non-fatal injuries – reaching a third or more in some battalions. These only represented a fraction of the real number of cases as most soldiers continued to be treated in front-line rest stations without ever being sent to the CCS. As men endured unheard of levels of shelling and unspeakable horrors, the Canadian Corps collectively and simultaneously exceeded thresholds that had self-regulated reporting to that point in the war. The normalization of shell shock and severe trauma combined to allow whole battalions to melt away from the front. While the chaos of St. Eloi hid many of the casualties, they became more evident and undeniable at Mount Sorrel. Although the counterattack at Mount Sorrel on 13 June was a success, as many as 800 soldiers left the front with shell shock – 300 alone were evacuated. As rest stations became overcrowded, evacuation was the only option. Most cases, though, were suffering from physical and



The CEF’s Shell Shock Crisis 119

mental exhaustion rather than acute symptoms of nervous collapse. In the aftermath of Mount Sorrel, senior British officers began to question the efficacy of the divisional rest system and the wisdom of forward rest treatment. The epidemic which first appeared in the Canadian Corps would spread to the remainder of the BEF during the Battle of the Somme in the summer of 1916. There Australian, New Zealand, and British units would report equally high levels of casualties that resulted in a similar collapse of the divisional rest system. As evacuations soared during the spring and summer of 1916, shell shock ceased to be a marginal aspect of the larger wastage problem and became a significant issue in its own right.

Chapter Five

Treatment of Evacuated Cases, 1915–1916

Until late 1916, most Canadian soldiers evacuated from the front could expect to spend several weeks – sometimes several months – in a variety of hospitals along the lines of communication, eventually winding up on the coast, where they boarded an ambulance transport for Eng­ land. Nervous illness was viewed and experienced in a different context in the evacuation zone than in the front lines. Away from their friends and comrades, shell shock patients became strangers, which robbed them of the legitimacy they often enjoyed at the front. In a CCS or at the base, they were treated with ambivalence and sometimes outright hostility by hospital staff and other patients: some viewed these broken men with pity, others with scorn, and others with keen interest. In this complex environment, many of the milder cases recovered without specialist interventions, often with the assistance of hospital nursing sisters who became their main caregivers. But for many others, as they moved further from the front, symptoms became “fixed” or even worsened. In general, the further a patient moved from the front, the more likely it was that he would eventually be evacuated to England for further treatment. Diagnosis According to official statistics compiled after the war, from February 1915 to June 1916, 2739 Canadian soldiers with shell shock, shock, neurasthenia, or hysteria were treated along the lines of communication in France.1 As we have already seen, this figure captures only a small portion of the overall total, as it does not include the majority of soldiers who were treated and released to duty from a medical unit in the



Treatment of Evacuated Cases 121

divisional or corps area. The decision to evacuate a case of shell shock – or any other non-life-threatening injury – was never taken lightly for it invariably meant that a soldier would be “lost” to his unit for a significant period of time, if not forever. But if a patient’s symptoms did not improve with rest and treatment at a divisional or corps rest station in the collecting zone, medical officers had no other choice. Although there was a tendency to allow some patients to stay in rest stations, convalescence camps, and sanitary sections longer than the official regulations allowed, eventually patients had to be “cleared out” en masse in preparation for offensive action or during German attacks. While this opened up bed space for the more severely wounded at the front, it meant that “problem” or “special” cases had to be sent to medical units in the rear areas along with the rest of the sick and wounded.2 As at the field ambulance, the rhythm of work in the next step in the evacuation chain, the Casualty Clearing Station (CCS), followed the ebb and flow of battle. In times of relative quiet, it might receive only a few dozen patients each day – sometimes none. But during a battle, the unit might process more than 1500 soldiers in a single evening, as British CCSs did in the fighting at Ypres in the late autumn of 1914.3 In times of relative quiet, wounded or ill soldiers who appeared likely to recover and be able to return to duty in a short period of time would be held in the hospital for up to three days before being returned to duty.4 When operations were planned or senior officers suspected an enemy attack, all casualties would be sent almost immediately to the rear in order to make way for new cases.5 When a “rush was on,” physical wounds were naturally prioritized and nervous patients, as well as those with minor ailments or illnesses, were set aside until the more serious cases were dealt with. “Picture a large open space surrounded by buildings,” wrote Sir Anthony Bowlby of the CCS, who during the Great War served as Consulting Surgeon to the BEF. Into this there drives a motor ambulance. The tail curtains are opened and reveal four “lying-down cases” on stretchers. These latter [cases] are swiftly and carefully slid out, and carried into a large receiving room 30 or 40 ft. long. Another ambulance draws up with six or eight men who are “sitting-up” cases, and these are helped out and walk into the receiving room. The clothes of the patients are all thick with mud. Ambulance follows ambulance, for the field ambulances at the front have been filled up during the night, and there has been heavy fighting again at daybreak – a common hour for attacks – and thus it has happened that on many days

122

A Weary Road

from 500 to 1,000 or more wounded have arrived at a single clearing hospital in a single twenty-four hours. And now look inside the receiving room. Here are half a dozen or more surgeons, often some dressers who are medical students, and a score or two of well-trained and very efficient orderlies. Men with simple flesh wounds are sitting on the benches round the room while the surgeons look at their wounds, and perhaps decide that a simple dressing is all that is required; the skin is painted with iodine, the wound is washed with an antiseptic, a dressing is put on by the orderly and the patient goes off to another room for rest and food.6

While Bowlby emphasized efficiency, this often came at the price of precision. On first admission, all patients were sorted according to whether their needs were “medical” or surgical and then assigned to the different sides of the hospital.7 The priority at the CCS was wound treatment and stabilization, and in this respect it did work remarkably well. But this necessarily meant that during a rush, less attention was paid to the medical side, where cases were usually more stable and in less need of urgent, lifesaving interventions. Although on the medical side the initial diagnosis was officially made by an attending doctor, in practice it was sometimes (if not often) an orderly who described superficial wounds on the patient’s medical card, “indiscriminately” applying descriptors such as “gastritis,” “neuritis,” “neuralgia,” and “myalgia” in the absence of a busy surgeon.8 When confronted with hundreds of casualties, it was impossible for a handful of doctors to both diagnose every patient and perform the operations necessary to stabilize them for transport to the rear. But with a little on-the-job training, a competent orderly or nurse could usually determine the severity of a patient’s wounds. Whether completed by an orderly or a doctor, cards for each patient were filled out and attached as tags to the soldier’s stretcher. When the patient was evacuated or returned to duty, the card was collected and the information used to compile the unit’s admission and discharge books.9 Shock patients went to the medical side, where they and other somatically ill patients were again triaged, assigned to either a “retention” or “evacuation” ward depending on whether it appeared likely that they would be able to return to duty in a few days or require further specialized treatment at the rear.10 Unlike the initial assessment, this always required an attending physician to evaluate the nature of the symptoms, usually by a combination of verbal questioning and a brief physical exam. These could be involved interactions or cursory,



Treatment of Evacuated Cases 123

and during peak times both might be “accomplished” with a glance at a chart filled in by a nurse or orderly and another at the patient.11 The admitting rooms and wards were open rooms where men were packed close together. There were no private examination tents and shell shocked soldiers were questioned beside their peers. As the doctor made his way along a long line of medical patients, followed closely by an orderly, he would ask each patient why he was there. Nervous soldiers fumbled awkwardly for answers. “On being asked what was wrong with him, one patient replied that he didn’t know,” recalled Thomas Brenton Smith, a twenty-year-old bank clerk from Liverpool, Nova Scotia, who volunteered to serve with No. 1 Canadian CCS in August 1914 as an orderly. “‘Haven’t you any symptoms at all?’ [asked the doctor] ‘Well,’ he said, ‘I was with three others when a shell burst. It killed them and blew me through the parapet. I guess I feel pretty well shook up.”’12 Although unintended, it was a shaming ritual that initiated nervous soldiers into a different, less understanding world. In the absence of a satisfactory answer to such a simple question, emotionally distraught soldiers were made to feel as if they had done something wrong by leaving the field and seeking help without being able to precisely define what was wrong with them.13 As the physician quickly turned his attention to those with visible wounds, the orderly might scribble a diagnosis of shock, hysteria, or neurasthenia on the soldier’s card, indicating a referral to the retention or evacuation wards depending on the severity of the symptoms. Treatment Shell shock patients were treated alongside other “retention” cases until medical staff decided to evacuate them to the base, send them to a convalescent depot or camp, or return them to full duty at the front.14 At No. 1 Canadian CCS, for example, the average stay for most patients was less than twenty-four hours, whereas shell shock patients were retained for an average of forty hours; of the 278 nervous soldiers admitted to that hospital in 1915, three stayed more than two weeks and one ten days. Evacuation was the normal outcome and during the course of the year 237 nervous soldiers (86 per cent) were sent to the base, while twenty (7.2 per cent) were returned directly to duty and another twenty were sent to an army or corps convalescent station like Mont des Cats. Soldiers who were evacuated or sent to a convalescent hospital spent only about thirty-two hours in hospital, while those sent back to duty

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A Weary Road

doubled that at sixty-five hours.15 This would suggest that doctors determined relatively quickly whether a patient needed further treatment, evaluating the severity of the symptoms and deciding within thirty-six hours whether to evacuate the patient or attempt to return him to the front. Those with more pronounced hysterical symptoms were slotted for immediate evacuation, while soldiers with pronounced fatigue, mild tremors, or weight issues were sent to convalescent hospitals. Men that spent only a few days at the CCS before returning to duty tended to exhibit the mildest of symptoms consistent with fatigue and emotional exhaustion.16 Nervous cases were often viewed with a mixture of annoyance and suspicion, as they occupied precious bed space and, given the vague nature of their symptoms, often had to be kept in hospital for several days for observation or until the rush of physically wounded soldiers came to an end, freeing up space on ambulance transports to the rear. While front-line doctors said that malingering and fakery were relatively uncommon, it was more often suspected along the lines of communication.17 Arthur Harold Walton, a thirty-year-old druggist from Toronto and another orderly at No. 1 CCS, recounted the story of “one of his patients [who] was shamming his illness,” he recalled. This patient continually complained of a pain in his back and not being able to eat. Art decided to have a look at this patient when the latter was unaware that he was being observed. So, all other patients having gone from the ward, Art walked out, leaving the man alone with his groanings. A couple of minutes later Art crept quietly back. The patient was sitting up in bed, had opened up a parcel, and was making great inroads on a loaf of cake. Art crept quietly away and a little later paid the patient another visit, this time announcing his coming with the usual noise. He found the patient on his back, groaning. “How are you feeling?” “Bad.” “Can you eat anything?” “No I can’t keep anything down.”18

While this patient may indeed have been “swinging the lead,” it was also possible that he was telling the truth as vomiting despite a desire to eat was not an uncommon symptom of shell shock and was often the result of gastritis or an elevated gag reflex.19 At one Canadian CCS, nervous patients were sometimes the subject of practical jokes. One of the orderlies at the hospital recalled that when a new comrade was checking over his ward patients for the first time,



Treatment of Evacuated Cases 125

he came across a diagnosis which he had not heard before: neurasthenia. Puzzled, he walked to the other end of the ward to ask Dr William MacKinnon, a physician from Amherst, Nova Scotia, what it was. MacKinnon saw an opportunity to play a trick on his new NCO. “It’s a kind of rash,” said Major MacKinnon. “Strip your patient, and rub the rash with liniment.” A short time later [the orderly] advised Major MacKinnon that the patient in question “couldn’t be suffering from neurasthenia for he had stripped him and could not find the slightest signs of a rash.” The author of the anecdote wryly concluded that “comedy and humour, as well as tragedy and suffering, came with the patients.”20 The tension between shock patients and the somatic patients and staff of military hospitals reflected the fact that shell shocked soldiers challenged medical authority as well as dominant conceptions of masculinity, honour, and bravery. Many physicians or surgeons working in CCSs were fresh out of medical school or had spent many years in the surgical wards of urban hospitals. Along the admitting line, the medical gaze – even an inexperienced one – would have seemed miraculous with orders barked sending patients here and there according to a quick glance at bloody injuries, affixing complex Latin terms to each and telling patients that they would soon be fine.21 But many doctors would have had comparatively little experience with psychosomatic illness, and shell shock patients could not be so easily diagnosed and dispatched. Here a terse, derisive tone served to protect the integrity of the medical gaze, implying that any difficulty in determining the diagnosis was due to the vague symptoms, not a lack of understanding.22 At the same time, public ridicule and derision established distance between nervous soldiers and the other men in the ward, be they patients or doctors. Soldiers housed in general wards who cried, wet the bed, awoke with nightmares, or suffered from hysterical somatic symptoms all drew attention to the full range of possible male behaviours, challenging binary conceptions of gender. Shock patients were a constant reminder that men were indeed emotional and capable of breaking down under pressure. Humour and gossip restored equilibrium within the gendered space of the general hospital ward. It othered nervous men by reconstructing them as feminine perversions of a male ideal – as emotional cowards, a “nurse’s pet,” or a nude body to be assaulted. By emphasizing the “otherness” of nervous men, doctors and somatic patients reaffirmed their own masculinity. To do otherwise

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A Weary Road

required them to look beyond their own experience and cultural conditioning to accept that “brave men” could also become “cowards” – an impossibility for most.23 The typical course of treatment at a general or stationary hospital was overseen by a generalist and began with a clinical examination and interview by a doctor who was more likely to be a surgeon or general practitioner. For example, Private William Jones H., a thirty-six-yearold embalmer from Strathroy, Ontario, arrived in France in April 1915 with the CAMC and then went absent without leave twice following the fighting at Givenchy in mid-June. After enduring seven days of Field Punishment No. 1 – which meant being tied to a post for several hours a day – he reported sick and was diagnosed with neurasthenia. On admission to No. 2 Stationary Hospital on 15 July 1915, his attending physician, Henry Charles Elliot Sr, a fifty-year-old surgeon practising at Cobourg, Ontario, conducted a more thorough examination than had been possible at the CCS.24 Elliot began by interviewing his patient, asking him general questions about his age and length of military service; other physicians often asked about their patient’s prior medical history or family illnesses, noting any significant revelations on a chart, known as a “Medical Case Sheet.” Next the physician asked about the patient’s specific symptoms and the onset of his specific condition. William H. told Elliot that he was suffering from nervousness, rheumatic pains, and stiffness of the joints.25 In addition to recording the patient’s own description of his condition, the doctor also noted any additional symptoms and complaints which he observed or elicited through conversation but which were not specifically mentioned by the patient. In H.’s case, Elliot wrote: “He complains of involuntary movement of the limbs, insomnia, anorexia, irritability, and morbid fears and dreams.”26 Next the physician performed a brief physical exam. Temperature, pulse, and respiration were typically all recorded and then monitored over the duration of the patient’s stay in hospital. Patients like H. were usually asked about their bowel movements too and, if irregular, given a laxative to prevent the “auto-intoxication” which was thought to result from the accumulation of toxic substances in the colon. Those with vague pains were also sent for an X-ray (if a machine was available) and most patients were given a Wassermann Test, which involved extracting a small blood sample and then examining it for syphilis antibodies in the hospital laboratory. This test was used to rule out syphilitic insanity as the underlying cause. Once the physical exam was concluded, the physician normally



Treatment of Evacuated Cases 127

made a few remarks about the patient’s physical appearance and demeanour, and sometimes indicated a prognosis on the chart. The initial meeting between patient and physician usually ended with a brief prescription for diet, rest and exercise with instructions to return the patient within a set number of days for another, shorter follow-up visit. In H.’s  case, he was put on a milk diet, ordered to rest, and prescribed bromides to help him sleep. Over the next ten days he was seen four more times by the doctor for a brief examination – notes on the progress of the case were made. But by the 25th day, although his physical condition had improved, he was transferred to England for further specialist treatment as many of the underlying mental symptoms remained. Because nervous soldiers were treated alongside other medical and surgical cases at the base, they were sometimes victimized by staff and other patients. For example, Private Cecil G., a thirty-one-year-old civil servant, joined up in 1914 and served two years in the trenches before being knocked unconscious by a shell at Vimy Ridge. When he came to he vomited and was shaking all over. In hospital he began to suffer from terrible nightmares as well as headaches, tremors, and vague pains that came and went. G. was self-conscious and felt that the other patients were always watching him. “He was unable to remain in one ward because he thought the patients believed he was ‘swinging the lead,”’ recorded G.F. Boyer, his neurologist at Granville Special Hospital in England. “He would break down and cry when he thought of it. Then he believed he was being watched by the patients and that there must be something the matter with him.”27 Private A.B., a British soldier in the Army Service Corps, broke down at the front in the spring of 1915 after he received a letter stating that his wife had died. When B. lapsed into a severe depression he was sent to hospital, where he told his doctor that the other men constantly made fun of him. His chart noted coldly that despite his fears, “he does not appear to have either visual or auditory hallucinations.”28 Shell shock patients often overheard other patients gossip about them or openly tease them. They invariably stood out, not only because they were not visibly wounded, but also because they tended to be among the few patients retained in the hospital at least for a day or two as the rest of the patients were evacuated. Hunter Campbell L. was a twentyyear-old university student when he joined the CEF in the fall of 1915. Decorated for bravery and promoted in the spring of 1916, he was blown up by a shell on the Somme. Although he kept going, he began to suffer from uncontrollable panic and crying fits until he was

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evacuated by his RMO. In 1936, he told a Department of Pensions and National Health psychiatrist that he had been tormented in hospital by the other patients. “I was the only bed patient [in the hospital],” he recalled. I had claustrophobia, and could not have any bed clothes on me. The consequence of being the only bed patient was that there were [sic] a lot of taunting, and that sort of thing. One time, I was not supposed to get out of bed, but I got up and started to struggle along the wall to go to the lavatory. I was pretty weak and shaky and wobbly, and was going by the cleaning room where the fellows were shining buttons, and someone said something about the “Nurse’s pet.” They thought I was just being pampered apparently, and I remember stopping and saying “who said that?: I  don’t remember ever finding out that happened. Apparently I lit into about a dozen of them – I was strong as a horse. I don’t remember anything except that the benches were all broken.29

Nursing Shell Shock Patients At the base, nervous soldiers most often found more sympathy from nursing sisters. While it is the voice of attending physicians that often speaks the loudest through the medical charts and reports they created, treatment was almost the exclusive responsibility of the unit’s nursing sisters.30 Indeed, the “rest cure” was a euphemism for nursing care, which meant that these women were responsible for not only overseeing a patient’s convalescence, but also managing the day-to-day functioning of the ward with its male staff of orderlies and attendants.31 The role of a wartime nurse was little different than it was in civilian life, at least in terms of her official duties on the hospital ward. “The work of a Base Hospital, from a Sister’s standpoint,” reported one nursing sister attached to No. 7 Canadian General Hospital, “is a steady routine of dressings, temperatures and diets. Here she has a chance to know her patients in between – to write their letters, to get them books, to laugh over their funny tales from the trenches.”32 Nurses were the primary caregivers in the military hospital, as they were in civilian treatment centres. As Cheryl Warsh argues, it was generally acknowledged that any successful form of rest therapy required skilled and dedicated nursing sisters.33 It was they who would have the most contact with patients and would, ultimately, create an environment conducive to



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cure. At the Homewood retreat in Guelph, Ontario, nurses were “responsible for the patient’s cleanliness and dress, meals, exercise, occupation, amusement, ‘general quietness and good conduct’ and ‘calls of Nature,’ all in an appropriately firm yet sympathetic manner.”34 At the same time, nurses were used to administering to patients regardless  of the diagnosis or illness and had only to apply their professional  training in slightly different ways to direct nervous patients towards recovery.35 From the point of view of a professional nurse, bodily rest was justified by the fact that the patient had undergone “a sudden jarring of the vital machinery” – a shock that could be literal as in the case of a shell explosion or figurative as in the death of a comrade – or worry about a friend or family member back home. Rest would allow the body to right itself, although nurses understood that the specific form of rest would have to be tailored to the individual patient. “In these cases, rest must be a relative term,” continued the editors of Canadian Nurse. “Some people cannot endure lying down in a darkened room, when some mental shock has unnerved them, and yet this is precisely what other patients may need.”36 It was recommended that patients be allowed to move around the ward freely if it seemed to improve a patient’s demeanour, while minor aches and pains could be soothed but not coddled. Above all, a nurse was to avoid adding to “the impression that things have gone wrong. It is such a great thing in nerve cases to create a normal atmosphere. By talking in one’s ordinary voice, and doing the obvious everyday duties, many patients can be greatly helped by the nurse, while fussiness defeats its own object.”37 It was rest combined with the reassurance of routine and the minimization of symptoms that was essential to a successful outcome. “Besides exercising the technical knowledge of her profession,” recalled one nurse attached to a Canadian hospital in 1915, “she exerts a wholesome and uplifting influence on the soldier and her ministrations help to give him confidence – the assurance that he is being brought back to the normal conditions of life.”38 In time this would help the patient come back to the world. Diet was almost as important as rest. At the front, soldiers ate a monotonous ration of meat and bread: officially, each man was supposed to receive 14 oz. of fresh beef per day and one pound of bread. In practice, though, shelling and bad roads meant that fresh food often failed to make it up the line and those in the trenches had to live off tinned or “hard” field rations. These consisted of canned corned beef, a meat and vegetable stew known as “Machonochie’s Meat,” various types of jam,

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and hard tack biscuits which had to be soaked in tea or hot water before they could be consumed. While unpleasant and boring, it provided around 4000 calories per day. But most men hated the food.39 In hospital, food served a therapeutic function. Some Canadian nurses were trained as dietitians and were assigned to carefully control and monitor patient meals. “The feeding of sick patients is quite a different thing from the rationing of an Army,” wrote a nurse dietitian assigned to No. 3 Canadian General Hospital. The food value – or to put it technically – the number of calories, with regard to patients, depends entirely upon what you can manage to get the patient to consume of the food you have cooked. This being the case, the appetite of these sick patients must be tempted and cater to, and the food must not only be good, but must also be appetizing in appearance and taste and must be served up in such a way that the patient will consume and relish it. It is therefore essential, in prescribing diets for patients in wards, that each patient should get the sort of diet which he is able to assimilate.40

Nervous patients were often described by their doctors as “underweight” with a “poor appetite” upon admission. Many had general gastric complaints and some even refused any food at all. Convincing such patients to eat regular meals was an essential part of therapy. Indeed, in the absence of other objective measures, body weight was often used as a cipher for improvement. An increase in weight indicated that a patient’s general condition was improving with a decrease implying the opposite. “We do little enough for them, goodness knows,” wrote Sophie Hoerner, a nursing sister with No. 1 Canadian General Hospital, “but it seems to make the most wonderful difference. The hot soup we give them, the wash and change, and they go away different human beings. This is most interesting and by far the most worthwhile work I have yet done.”41 On the face of it, rest and diet were simple regimens, but they required a skilled and caring practitioner to be effective. But in treating nervous patients, nurses also had to deal with their emotional trauma, which required precise timing and keen powers of observation. As the editors of the Canadian Nurse recommended in January 1916, successful treatment required the nurse to administer not only to the body, but also to the mind, and spirit. “My first duty in nursing a patient who is suffering from mental shock,” read an injunction from the editors, “is to remember that all my treatment and care must be threefold, because



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such a patient is suffering from injury to body, soul, and spirit. Briefly, a nurse’s work in such cases is to try to help the threefold nature of the patient to regain its equilibrium.”42 Patients often spoke of their horrific experience to their caregiver and the nurse had to be prepared both to listen and to make the exchange therapeutic rather than detrimental. “There are five very bad cases, heart-rending, and the stories they tell of what they see in the trenches are harrowing,” wrote Hoerner. “They are not boastful, any of them, but seem so glad to find someone that is interested in them. They say that they like the Canadian Sisters and that it is Heaven here. Nearly all of them want to go back to England just for a day.”43 Edith Appleton, a nurse stationed in a variety of front-line British hospitals along the lines of communication, marvelled at how frankly and freely shell shocked soldiers spoke to her about their experiences at the front. “We had a convoy of 399 in yesterday,” she wrote in September 1916, but only 70 wounded. By far the majority of the sick were suffering badly from shellshock. It is sad to see them – they dither like palsied old men, and talk all the time about their mates who were blown to bits, or their mates who were wounded and never brought in. The whole scene is burnt into their brains and they can’t get rid of the sight of it. One rumpled, raisin-faced old fellow said his job was to take bombs up to the bombers, and sometimes going through the trenches he had to push past men with their arms blown off or horribly wounded, and they would yell at him, “Don’t touch me,” but he had to get past, because the fellows must have their bombs. Then he would stand on something wobbly and nearly fall down – and see it was a dying or dead man, half covered in mud. Once he returned to find his own officer blown to bits – a leg in one place, his body in another. Another man told me quite calmly, “Our Div was terribly cut up, because we had to be a sacrifice to let the others advance … and they did advance all right.”44

Nurses played an important role in shell shock treatment simply by being present to listen to soldiers talk about the horrors they had seen – witnessing their trauma helped contain psychological damage.45 In this context, the juxtaposition of the caring female nurse with the cold, hard male orderlies and doctors encouraged men to talk about their experiences.46 It was, in other words, culturally acceptable for a man to engage in an emotionally intimate act with a woman who had assumed the archetypal mothering role of the caregiver.47

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While men may have responded emotionally to nurses because of a gendered expectation that women were naturally nurturing caregivers, as trained professionals nurses manipulated these expectations for ther­ apeutic purposes and were trained to take control of the dialogue and use it to help the patient deal with their trauma. The editors of Canadian Nurse told their readers: If the patient has had a great mental shock of a distressing nature, and can speak of it, do not forbid this. If what one dreads and fears is carried out into the open, one loses one’s fear, and so here I should let the painful topic be frankly mentioned (otherwise the patient will certainly brood in secret!), and then I should try to get the conversation into other channels. When such patients cannot cry, and cannot speak of their trouble, and seem simply numbed, it is indeed difficult to give the mind rest, and real sympathy and that psychic instinct that is so invaluable in mental nurses will alone give one the cue. Sometimes the thought of others – friends or relatives affected by the same news or trouble – will help a patient to regain a normal outlook. But in all cases I should try to get my patient’s confidence, and make sure that I know the whole state of the case. I should want my patient to feel I was at hand as a helper in case of need, never in the way, never out of it. I should watch for any mental symptoms, and report to the doctor any personal details, such as appetite, amount of sleep, action of bodily organs, etc. I should encourage any occupation likely to help the brain retain its normal state, giving light diet and plenty of fresh air, as accessory treatment.48

Nurses did not need to be nurturing caregivers, but rather to create an impression of emotional intimacy so as to stimulate the patient’s desire to talk. All the while, though, the nurse was to remain an objective observer and not become involved in the situation as a lay person might. When nurses wrote about these exchanges, they made it clear that they viewed them as both emotional exchanges between two individuals and clinical conversations between patient and therapist. “A weary road these men have trod,” wrote Sophie Hoerner in early July 1915. “Some of them go right to pieces. Their nerve has gone and they cry like babies. Others just stare and say nothing, have such a vacant look. Some with stern looks and lots of fight in them still.”49 But even while she empathized with them, Hoerner gently pressed her patients to talk about their traumatizing experiences and wrote about the results. “The awful slaughter seems to go on and one can see no end to it all. It’s all



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tremendously interesting,” she wrote on 15 July to a female friend named Molly back home. “One man showed me to-day a bullet that had killed his comrade. He broke down completely and couldn’t tell me anymore. He is badly wounded himself.”50 These exchanges were thus little different than the talk therapy advocated by Charles Myers. The word “interesting” was frequently used by nurses to describe their work with nervous patients. Nurses working in general hospitals along the lines of communication were often regretful to see their patients leave, often with little improvement. As Edith Appleton remarked, “Seventeen of my shellshocks [were sent] off to Le Havre [today], where they are to receive special treatment. I should have liked to keep them here, treating them would be very interesting.”51 The experience remained ingrained in the minds of nurses like Edna Howey of No. 5 Canadian Stationary Hospital, in part because so many of the cases were young and pitiful. “Another thing I’d like to stress was the fact that those young people who were shell-shocked,” she told an interviewer in 1978. It was really pathetic. The finest young man from Owen Sound, that my brother went to high school with, was shell-shocked. When he was able to be home after, it was pathetic to see him. He never came back – it was cruel … The whole thing had been just too much for him and he was never able to come back. Such a fine young man and fine family. My brother used to go to see him and oh, it was just so pitiful! There are quite a number of shell-shocked patients like that, I know. Especially the very young ones – from being up the line. Some of those boys, of course they did put their ages back because they were anxious to go, were not much more than children.52

Patient Outcomes Eventually, after a week or two in hospital patients were either released to duty, sent to a convalescent depot, or returned to the front. As Dr William J. Collins, a doctor attached to one of the base hospitals on the coast, wrote: If the men seem only to require a few days rest and a minimum of treatment, they are sent to a “convalescent” camp on the downs above the town, to which a staff of medical officers is attached. Men whose wounds

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being quite slight require nothing but ordinary dressings to secure their rapid healing are also sometimes sent to this camp. On the other hand, men whose wounds, though more or less serious, may be expected to have healed completely in less than three weeks are either admitted to a local hospital or re-embarked on the train after their wounds have been redressed, and the men themselves more or less re-clothed, and sent on to a distant base. As for the walking cases which do not come within any of the foregoing categories, and whose wounds or general condition is of such a character that they are not likely to be well for at least three weeks, they remain in or about the hospital until the next outgoing hospital ship has taken on its load of stretcher cases from the hospitals and trains, and are then sent on board for treatment at some hospital in Great Britain.53

It was the attending physician’s job to make a discharge decision, but evacuations were often precipitated by word of a new push at the front and the prospect of incoming casualties. Patients waited in expectation, many still hoping that they would be sent to England rather than returned to duty. “It is almost pitable to watch [the patients’] faces as the Medical Officer slowly comes down the ward,” wrote one nursing sister, “marking the various cases for Convalescent Camp, back up the line, or for ‘Blighty.’ There are disappoints sometimes, for everyone cannot go to an English Hospital to recuperate, but the joy on the face of some poor soul who has been out perhaps eighteen or twenty months, when he sees his Hospital card inscribed for ‘Blighty’ is almost pathetic.”54 This joy was juxtaposed with the anxiety and dread which others felt when ordered back to duty or to a convalescent camp in preparation for a later return to the front. The surviving admission and discharge books of No. 2 Canadian General Hospital at Le Tréport record thirty-four Canadian nervous or mental patients in 1915 among a total of 1204 patients. Of the thirtyfour, about 30 per cent returned to duty; 20 per cent were sent directly to England, while the remaining 50 per cent were sent to other hospitals at an evacuation centre, usually to Boulogne where they could be more quickly moved to England.55 At No. 2 General, the average stay was 11.68 days. No. 16 (British) General Hospital, also at Le Tréport, admitted thirteen Canadians during 1915 and transferred all but one to evac­ uation hospitals at Boulogne. The remaining patients were sent directly to England. At No. 16 General Hospital, the average stay was only 8.62  days. Once they reached the evacuation hospitals at Boulogne, most patients could expect to spend only a day or two in hospital



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before being sent to England for treatment. No. 7 Stationary Hospital at Boulogne, which exclusively treated officers, admitted twenty nervous and mental patients during 1915 from a total of 170 patients. Of the twenty, eleven (55 per cent) were diagnosed with neurasthenia while seven (35 per cent) were labelled with shock or concussion; the remaining two were diagnosed with DAH and insomnia. On average, patients spent two days in hospital; 90 per cent were evacuated to England. The only patient returned to duty (albeit after a period of extended leave) spent ten days in hospital.56 British hospitals in France and Belgium were not intended to be primary care centres, but chokepoints along an evacuation route to the coast, where minor cases could be sifted out and the serious ones expedited during their trip to the rear.57 In practice, while those with somatic wounds usually moved quickly from CCS to base, shell shock patients spent several weeks meandering through various hospitals, only remaining in one place for a few days at a time before being evacuated.58 Generally, patients spent longer periods in general and stationary hospitals than in the CCS, but as they moved further from the front, fewer and fewer returned to duty. But just because a man was marked “for duty” did not necessarily mean that he went straight back to the front – or even returned to his unit at all. Regardless of whether further treatment at a depot was recommended or the patient was to go directly back to duty, he would most often be sent to a convalescent depot at the base for rest, physical training, and reassignment before being sent back to his unit. This was as much a logistical necessity as it was a medical decision. Patients had to be grouped, transportation arranged, and sent up in batches known as drafts, and it was at the depots all across France that these were organized. During 1915, convalescent depots were established at all the major bases, including Boulogne, Rouen, Le Havre, Le Tréport, Wimereux, Étaples, and Camiers, each providing accommodation for up to 1000 recovering soldiers under canvas and often included elaborate recreation grounds, dining areas, and baths.59 Although convalescent depots were fully staffed with medical personnel, they were less treatment centres than reconditioning platforms and thus tended to accept patients who only required a few days’ rest with little additional treatment.60 At the convalescent depot, the context of treatment shifted yet again. From the patient’s perspective, while a stay in the hospital carried the possibility of a trip to England, a convalescent depot meant an eventual return to the front. As reconditioning centres, they were not necessarily pleasant places – here “rest” often

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meant endless drill and physical exercise designed to restore men to fighting fitness who had been out of the line for several weeks or a few months. “When in mud and filth ‘up to our necks’ we were always wishing for a nice ‘cushy’ job behind the lines or in England,” recalled Lieutenant Charles Henry Savage, a twenty-five-year-old clerk from Waterloo, Quebec, “but after a short time away the average soldier began to forget about the disadvantages of the front and longed to be back in his own unit with his friends. Of course, when he got back and lay out in muddy trenches with ‘beaucoup’ shelling going on, he cursed himself for [being] a dithering fool, but he came back. Life in reserve battalions and convalescent depots was not attractive. Too much drill, too much ‘eye wash,’ too many instructors: few of us were sorry to rejoin our units up the line.”61 A return to duty happened in stages. First came the hospital convalescent ward, then the base convalescent depot, then a corps or army depot, and finally the march to the front. At each stage, anxieties heightened and former shell shock patients often had several days in which to relive their initial fears. Many began to relapse. For example, Corpo­ ral William P., a twenty-four-year-old stationary engineer living in Montreal, joined the 14th Battalion in September 1914 and arrived in France the next February. P. survived the gas attack at Ypres and was promoted to corporal after the death of several of the battalion’s original NCOs. His unit then went to Festubert. “There were four of us digging a latrine,” he later recalled, and they were shelling very hard, we were in reserve, and the shells seemed to come over right among us. I do not remember anything for about two or three hours. I cannot say how long, but I know I got scratches only from shrapnel, on my fingers, and they were bandaged up and I tried to carry on, and the colonel in the line, told me to go out. Sgt. Bissell was in the line, and I went to the battalion dressing station, and he told me to walk across to the field [ambulance] station, and going there, coal boxes and box cars were coming over, and I don’t know whether one came near me or not, and I do not remember any more. I do not remember getting to the field dressing station at all.62

P. was evacuated from the field ambulance to No. 11 General Hospital at Boulgone. Although he had been “blown up” by a shell and could not remember his time there, according to his medical records his chief complaints were superficial but painful shrapnel wounds to his hands.63



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After five days in hospital, he was transferred to a convalescent camp on 22 May and gradually began to make his way back to the lines when nervous symptoms began to appear, becoming more pronounced the closer he got to the front.64 “It is interesting to notice,” neurologist Colin Russel later recorded at a special hospital in England, “that Cpl [P.’s] symptoms referable to the nervous system, developed two weeks after he had returned to the Base in France suffering from superficial wounds in hands. Just prior to being returned to his lines he developed headache and by the time he had reached the advanced base had developed into a termor [sic] of the jaw. Soon his lower limbs were also affected to such an extent that he could not move round at all.”65 It was not that Russel suspected P. of intentionally malingering or faking his symptoms to avoid duty. On the contrary, he believed that when faced with the prospect of going back to the trenches, nervous symptoms naturally and quite normally developed once the fear instinct heightened and the patient began to draw on his own memories of trauma and combat. “In a place of relative safety,” like a hospital, he wrote, “[the patient] sees the result of other similar catastrophes. He naturally recalls his emotional reaction. He remembers the numbness, weakness, and tingling of his legs or of his arm or the inability to cry out [when he was buried]. With this suggestion in this period of weakness, fatigue, and discouragement, under the promptings of his frustrated instinct [of self-­preservation] may come the realization of his disability with a development of paraplegia or a wrist drop or an aphonia or any other of the numerous disabilities that vary according to the suggestion.”66 It was a common reaction. Many men relapsed before returning to duty. For example, Private Henry W. of the 27th Battalion, who was blown up and buried by a shell at St. Eloi, was evacuated to Boulogne, where he spent five weeks in hospital, and was then sent to a convalescent camp for a week. But as he returned to his unit, he broke down again and was sent back to the base, this time to Le Havre. After three weeks there he was again “sent up the line,” only to break down after two days, and returned to Le Havre, where he was finally invalided to England.67 Private Harry S. of the 1st Canadian Mounted Rifles served four months in the trenches when he began to develop various aches, pains, and heart palpitations. He was sent back to No. 18 General Hospital for nine days and then released to a convalescent camp once his symptoms subsisted. But after two weeks at the Étaples depot, his symptoms returned and he was sent to No. 18 General. This time he spent a month in hospital and was

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again sent to the convalescent camp when his doctors felt he had made a full recovery. After a couple of weeks, just before he was to go back up the line, his symptoms returned and he was sent to Le Havre for invaliding to England. He finally arrived in “Blighty” on 28 March – nearly three months after first entering hospital.68 This relapse phenomenon is best understood as a factor of expectation. As a nervous soldier initially made his way from the front to a field ambulance dressing station, he would have known that there were two possibilities: he could be sent to some form of rest station or evacuated. Most soldiers, like Sidney Hampson, an Englishman who enlisted in Saskatchewan early in 1915, hoped for a trip to “Blighty.” “Glad to say that I am still kicking,” he wrote to his family in the winter of 1916, “but [I] would like to get a nice little blighty, one good enough to get me back to old Canada.”69 Securing a “perfect wound” was at the forefront of the soldier’s mind in the trenches – even before the shock of being injured wore off. As Ernest Taylor, an Alberta soldier with the 1st Canadian Mounted Rifles, remarked in a letter to his sister in 1915: “When a fellow gets wounded the first question one asks is whether it is a ‘blighty’ and if the reply is in the affirmative everyone says ‘lucky beggar,’ but of course this must be taken with a grain of salt.”70 Indeed, the mythology of the perfect flesh wound was pervasive and formed an important part of the oral culture of the trenches.71 But in asking the proverbial question, “Have I got a blighty?” the wounded infantryman was acknowledging that he also understood that not every wound or illness would win him a trip to England. While he may not have understood the specific organizational structure of the medical services, front-line soldiers would have known this simply by observing the experiences of comrades with either nervous or somatic injuries – some of whom returned from the field ambulance, some of whom did not. He may also have been told by his Regimental Medical Officer that he would be going to a rest station rather than England. At the rest station, a soldier was told to expect that he would return to duty within a few days to a week. Although patients would have seen other men evacuated to the CCS, these transfers often took when a senior officer inspected the camp for malingerers, shirkers, cowards, and the unfit which was intended to make it a shameful event.72 Many others were sent to convalescent or sanitary companies, which meant either endless drill or punishing labour digging out latrines and horse stalls. In the soldier’s mind, then, the available alternatives to returning to duty were stigmatized or unpalatable: a man could either go back to



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the trenches, be evacuated as a coward, or work in a labour company twelve hours a day. This knowledge encouraged recovery as the psychosomatic symptoms which gave expression to the original psychological distress might no longer serve to improve the soldier’s well-­being, perhaps even harming him further. While some severely distressed soldiers certainly chose to exchange stigma or unpleasantness for self-preservation, many others did not and got well, returning to duty. If they broke down a second time, like Private Richard A., it was likely that they had crossed a psychological threshold where the benefits of evacuation outweighed the psychological or physical costs. During major actions, though, rest camps might be closed entirely and every nervous or mentally ill patient evacuated, regardless of the severity of their symptoms. As soon as a soldier was marked for evacuation, either from a rest camp or a dressing station, expectations changed as the social or physical costs paled in comparison to the greater possibility of reaching England or Canada. There was, in other words, no reason to expect a quick return to the front nor any downfall to maintaining symptoms. In the absence of these stimuli, patients had little psychological incentive to recover and symptoms became more or less fixed. The experience of Willim P. and other relapse cases helps to explain why front-line treatment in a rest station was more successful in returning patients to duty than similar regimens in hospitals along the lines of communication. When P. was admitted to No. 6 Stationary Hospital in mid-June, just before he reached the front, and then evacuated to Eng­land for specialist treatment, his symptoms became more or less “fixed” – that is, reinforced and refined by the positive result they produced. Whereas the shell wound did not result in a trip to Eng­ land, nervous symptoms did. The further a patient travelled from the front, the more his symptoms contributed to a sense of self-­preservation, while the ridicule and suspicion endured in hospital made patients more combative. As a result, at each stage in the evacuation process, return-to-duty rates dropped. Once a patient was struck off strength from his unit – that is, evacuated to a CCS – it was more likely than not that he would eventually end up in hospital in England. Yet it is worth noting that as patients made their way to the base, a small number returned to duty from each hospital. Collectively, though, this group comprised a sizable minority. A comprehensive study undertaken in the mid-1930s by the Department of Pensions and National Health suggests that 44 per cent of all patients evacuated from the CCS were treated in hospitals in France or Belgium

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and returned to duty without crossing the channel.73 In explaining these figures, C.H. Archibald, a physician working for the Department, suggested that in the absence of psychiatric specialists patients benefited from an attentive listener who allowed them to articulate their feelings, a day or two of rest, and “a chance to collect themselves before going back to their units.”74 While a majority of patients were evacuated to England, it was a smaller number than is sometimes claimed. The Treatment Network in Britain At the beginning of the war, most shell shock cases sent to the base were invalided to England via ambulance or hospital ships that crossed the Channel in flotillas to Southampton and later Dover or Avonmouth.75 From there they were loaded onto trains and sent to clearing or receiving hospitals.76 The medical services in England had a distinctly civilian character and the employment of civilian experts, first in advisory and later in managerial, roles allowed specific personalities and professional agendas to influence the development of casualty management and treatment networks.77 Following Aldren Turner’s recommendations, in March 1915 the War Office published Notes for the Guidance of Officers in Charge of Military, Territorial, and Auxiliary Hospitals, which required that nervous evacuees be sent to the 4th London General Hospital, Denmark Hill while psychotic patients would be sent to the clearing centre at the Royal Victoria Hospital, Netley in Southampton.78 From Denmark Hill, patients were distributed to specialized wards throughout the Unit­ ed Kingdom, including military treatment (as distinct from clearing) wards for nervous patients at Queen Square, King’s College, and Netley as well as the Moss Side State Institution, Maghull.79 Turner would oversee the system as Neurological Consultant to the Forces in England while continuing to practise at Denmark Hill and Queen Square, as he had done before the war.80 The majority of hospital beds in England were created through appropriation or cooperation with civilian organizations. In 1914, the War Office took control of existing asylums and poor-law infirmaries to establish the various “war hospitals” that dotted the English and Scottish countryside until the final wards were disbanded in 1921.81 These institutions retained their existing civilian staff of doctors, nurses, and orderlies, supplemented by RAMC personnel, and provided the majority of beds by war’s end.82 As in France, Canadian soldiers were evacuated to England as part of  the BEF. At first, Dominion troops were sent from British clearing



Treatment of Evacuated Cases 141

hospitals to special Canadian hospitals at No. 11 Canadian General Hospital, Moore Barracks; the Queen’s Canadian Military Hospital, Beachborough Park; or the Duchess of Connaught’s Hospital, Clive­ den.83 However, as the number of wounded grew during the early spring of 1915, it became impractical to extract them from the endless convoys of British wounded.84 Following the release of Notes for the Guidance of Officers in Charge of Military, Territorial, and Auxiliary Hospi­ tals, Canadian soldiers too were treated in much the same way as other British and Commonwealth wounded: they were first sent to Netley or Denmark Hill and then distributed to other English (or Canadian) hospitals as bed space permitted.85 For British and Canadian soldiers, the clearing hospitals at Netley and Denmark Hill were portals between the military and civilian worlds, between overseas and home. Nervous patients entered through one door as wounded combatants who had been scrutinized and often viewed with suspicion; if confirmed as neurotic, they exited through another into the world of the civilian neurasthenic. If they were deemed a “mental” case, which was assumed to include only hereditary forms of psychosis, they exited through still another as lunatics, dispatched into the civilian asylum system. The former were officially regarded as honourably wounded by the military until June of 1916 and were allowed to wear the wound stripe, a badge awarded by the army to be sewn on the uniform’s sleeve, a visual indicator of bravery.86 As honourably wounded soldiers, they were also allowed to take a pension.87 Psychotic soldiers, as well as those accused of cowardice or malingering, were not seen as honourably wounded and were ineligible for a pension, a category of illness that carried significant social stigma. The clearing hospital might have been a transitional space, but the interactions that took place there between patient and doctor had a profound effect on the rest of their lives.88 Netley had been the British army’s primary military hospital since its construction after the Crimean War on Southampton Water. The hospital opened to patients in 1863 and over the next five decades received sick and wounded soldiers from campaigns in all corners of the Empire. To treat insane soldiers, a smaller lunatic asylum known as D Block was opened on the grounds in 1870 and, after an expansion in 1908, could house up to 124 patients.89 The primary task of the physicians attached to the clearing ward was to confirm or reject the diagnosis made overseas and to determine whether the patient would be sent to a lunatic asylum or redirected for neurological treatment, often at

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Denmark Hill or Queen Square. The approach to diagnosis and treatment at Netley was conservative, rooted in the more somatic conceptions of nineteenth- century military medicine. According to Stanford Read, the military neurologist in charge of D block, when an overseas patient arrived in his ward, his medical documents were collated and circulated to the attending physician, who made notes on each case in preparation for a longer interview. Family and personal histories were then taken in addition to a narrative overview of the soldier’s military career. Questions were asked about the man’s symptoms and the origins of his specific case; “lastly,” Read noted, “a brief examination of the mentality [would be] made, adding any marked abnormal neurological signs or bodily lesions.”90 Patient case sheets show that Netley doctors searched their patient’s physical appearance and family histories for the so-called stigmata of degeneration, using quick interviews to form judgments about innate intelligence, hereditary diseases, and the patient’s adherence to dominant moral, class, and gender norms which, in turn, were used to indicate pre-existing tendencies towards deviance. In combination, these observations either suggested or excluded hereditary causes and, by proxy, psychotic mental illness. Al­ though this type of diagnosis was constructed as an objective process, it was inherently subjective, relying on the doctor’s observations about the patient’s appearance and bearing as well as his use of language and his ability to express himself verbally. “Cerebration very slow,” wrote Lieutenant Frederick T.D. Clindening after interviewing Private George B., a farmer from outside Winnipeg in April 1916, a “shock” case from the 2nd Canadian Mounted Rifles. “Expression puzzled and vacant on being questioned … Dull and stupid. Can give no account of himself … He is dull, slow, stuporous, memory absolutely adrift.”91 Another patient, Albert C. of the 2nd Battalion, was described in May 1915 as “dull and lost.” His doctor recorded that “he will not answer when spoken to, simply grins, is slow in movement and will remain in one position if not moved … a long dull faced looking man.”92 Nineteen-year-old Private John Thompson B., attached to the 3rd Canadian Field Ambu­ lance, was said to be “quiet and dull. Has delusions and hallucinations. Has a very silly grin at times … He is dull and slow in action and appearance.”93 B.’s “delusions and hallucinations” included hearing the voices of dead comrades tell him at night that he had failed to do his duty and was “working his ticket.”94 Another patient was again said to be “dull, stupid, and slow in responding to questions”; still another



Treatment of Evacuated Cases 143

was “confused, stupid [with a] defective memory.”95 To the Edwardian mind, these traits, facial expressions, mannerisms, and physical features were the stigmata that signalled an underlying hereditary, degenerative neuropathology and were thus diagnostic.96 The main receiving or clearing hospital for nervous cases was the 4th London General (Territorial) Hospital, Denmark Hill. Unlike Netley, which remained a thoroughly military institution, Denmark Hill was staffed by civilian doctors, nurses, and orderlies and was overseen by “temporaries,” civilians who had taken an acting commission in the RAMC for the duration of the war. This meant that while the process at Netley could be standardized because most of the staff were drawn from the ranks of the regular RAMC, civilian “consulting” neurologists and psychiatrists were used to a great deal more autonomy.97 Diagnostic procedures were correspondingly more diverse. Many physicians took detailed notes on the patient’s family and personal history, noting occupations and previous illnesses, as well as the specific circumstances which marked the onset of their symptoms. Detailed physical or laboratory testing was carried out in some cases, including vision testing and blood work. Most doctors at least made a note about one or more of the patient’s symptoms or indicated that it appeared to be the result of a shell explosion or concussion.98 Some neurologists also tried to differentiate between their subjective and objective observations using the phrase “he says” before recording a verbatim statement from the patient and “facts observed by myself” before writing down their own impressions.99 In the winter and spring of 1916, attempts were made to standardize differential diagnosis with the introduction of pre-stamped case sheets that asked a series of questions about the patient’s military service: was he wounded, gassed, blown up by a shell, or buried? How long was he unconscious?100 On the whole British and Canadian patient case files from Denmark Hill suggest that during the first two years of war, most doctors took a bio-psychological approach to diagnosis, emphasizing both somatic causes like shell explosions and psychological expressions of fear and horror.101 Under Turner’s direction, Denmark Hill became the primary British research site for the study of shell shock through investigations led by himself and Frederick W. Mott, a sixty-two-year-old pathologist from the Claybury Asylum temporarily attached to the hospital. As a neuropathologist, Mott had a similar outlook to Turner. He was convinced that the higher functions of the mind had their roots in the physical

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structures of the brain, which meant that nervous and mental disorders required an identifiable pathological basis.102 Mott was a researcher and not a clinician, but unlike the United States or Germany, Britain had no private neurological research hospitals. In 1908, Mott set out to establish an English “receiving house” for voluntary patients with nervous or minor mental disorders to study and treat patients before they developed incurable psychoses.103 He convinced Henry Maudsley to give £30,000 to build a new facility attached to King’s College, modelled on Kraeplin’s Munich clinic and similar to Adolph Meyer’s Phipps Clinic at Johns Hopkins University.104 At the outbreak of war, the new Mauds­ ley hospital had only been partially completed. In the war, Mott saw an opportunity to both expand his research program and deploy his civilian knowledge to assist returning wounded – not dissimilar from the approach taken by Aldren Turner. The neuropathologist thus took up a temporary appointment as a major in the RAMC and had himself posted to the neurological extension of the No. 4 London Gen­eral, across the street from the Maudsley construction site at Denmark Hill. In 1916, the Maudsley opened as a war hospital, becoming part of the Denmark Hill extension under Mott’s direction.105 Treatment at No. 4 London General (Territorial) Hospital involved a combination of rest, modified diet, hydrotherapy, and talk therapy. “Only common-sense and interest in the comfort, welfare, and amusement of these neurotic patients are necessary for their recovery,” wrote Mott. To contemporary neurologists, common sense meant the Weir Mitchell rest cure, carried out in “light airy wards, and day rooms for meals and recreation, plenty of single rooms for the isolation of cases that are troubled with noises or require special attention.” Hydrotherapy was found to be effective in relaxing the patient and convincing him that all that was scientifically possible was being done to treat him. “Especially valuable are the baths, so, that every soldier can get a warm or cold spray bath every day,” he wrote. “The warm baths, and especially the continuous warm baths … are especially valuable for promoting the action of the skin, of relaxing the tired muscles, and by their soothing influence helping to induce sleep.” Similar results were accomplished through electrotherapy, which usually involved passing harmless galvanic or high frequency currents through tired muscles to help provide exercise and again stimulate the senses.106 Given that therapy was largely defined by rest, nurses were re­ sponsible for providing the majority of care, following a monotonous



Treatment of Evacuated Cases 145

routine of bed rest, reassurance, and dieting. According to Mary Mac­ Innes, a British nurse attached to No. 4 London General, each ward was staffed by a head nurse, two trained sisters, two “probationers,” and two orderlies. “According to Major Mott,” wrote MacInnes, “‘the prime essential is an atmosphere of cure,’ together with good food, complete rest for those who need it, plenty of visersion for those who can bear it, and freedom from responsibility. Happily there is a strong tendency towards recovery. It is such a joy to see them change. They come in tremulous and undone, but presently they begin to say, ‘I feel better in myself’ and shortly their extraordinary cheerfulness is in process of re-establishment.”107 Once sufficiently rested, talk therapy was designed to convince patients that their symptoms actually had psychological origins and to alleviate them through a combination of suggestion and persuasion.108 This might take the form of rational persuasion as advocated by Dubois and Dejerine or it could involve more heroic interventions. The only rule was that whatever worked was acceptable. According to MacInnes, hypnotism was tried at Denmark Hill, although it was the e­ xception rather than the rule.109 So was the type of faradic electricity most often associated with Queen Square. Dr Lewis Yealland, a Cana­dian neurologist attached to that hospital, used static faradic currents applied with a wire brush, a form of treatment that has often been mischaracterized as “disciplinary.”110 In reality, as Stefanie Linden, Edgar Jones, and Andrew Lees point out, Yealland used faradism in the same way as hydrotherapy and other physical treatments: to provoke a sensory reaction that would help convince the patient that symptoms of anesthesia or paralysis could be alleviated.111 Faradism was usually applied with a weak current and stronger static electricity was only used in severe cases in which there was profound anesthesia. Here it should be remembered that in some patients with functional disorders, the loss of sensation and feeling was nearly complete, meaning that although the level of electricity would be painful to a “normal” person, it would barely be felt by the patient.112 The physicality of Yealland’s treatment reinforced the notion that the soldier’s condition was curable and could be removed via the seemingly “miraculous” technologies of the modern hospital and was thus a heroic form of the more conventional rational persuasion.113 Whether such interventions involved discussion or deception, the aim of treatment was similar: to remove the symptom by convincing the patient that they were destined to recover.

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Canadian Patients in England Psychotic patients and those requiring longer periods of treatment were usually transferred to other hospitals. For British patients, this often meant a war ward in a civilian lunatic asylum or a trip to the new Moss Side State Institution, Maghull which had been designed as an epileptic colony before the war before it was acquired by the War Office in December 1914.114 At first Canadian patients were treated alongside their British comrades, but in the summer of 1915 this changed when the Department of Militia and Defence acquired a former neuras­thenic spa known as the Granville Hotel in Kent, which was converted to a special shell shock hospital.115 The Granville was intended to act as a primary treatment centre for Canadian shell shock cases and a convalescent centre for orthopedic surgical patients, both of whom would benefit from the types of machinery and expertise required to administer the rest cure.116 Granville would thus be able to admit Canadian patients directly from the clearing wards at Denmark Hill and Netley as well as other British war hospitals and Canadian convalescent homes, effectively centralizing shell shock treatment for Canadians evacuated to England at one special hospital. On opening in mid-November, the hotel’s main bar became the admitting room, the ladies’ washroom the operating room and the private bar an additional treatment room. The two main dining rooms, the billiard room, the theatre, and the hotel’s existing treatment rooms all retained their original uses. Shell shock patients would be housed in the hotel’s former writing and smoking rooms.117 The treatment of shell shock cases was overseen by the hospital’s chief neurologist, Captain Colin Kerr Russel, who took charge of Gran­ ville’s nervous cases on 3 December 1915.118 Russel, who was one of the first Canadian-born physicians to specialize in neurology, had gone overseas in 1914 with No. 3 General Hospital organized at McGill University where he lectured before the war.119 When he first went to France, though, he was attached to a surgical hospital stationed along the lines of communication and he had thus been employed as a generalist working on the medical wards.120 Russel initially had little success treating patients in the field with standard methods. After excluding organic disease to arrive at a neurotic diagnosis, Russel proceeded with the standard approach that he learned at Queen Square and taught at McGill. He told the patient that his condition was not due to an organic disease or injury and then tried to treat the symptoms through the type of talk therapy known as rational persuasion. This method, adapted



Treatment of Evacuated Cases 147

from the writing of Dubois and Dejerine, involved eliciting a life history from the patient so as to determine the origin of the “fixed idea” responsible for the symptom. Once discovered, the physician’s task was to use this evidence to convince the patient that their symptoms were “all in their head.” One of Russel’s first cases in France was a man “admitted to [the] ward with all the outward and visible signs of a right hemiplegia of a severe type. The history of the onset was suggestive. After a foot bath parade, when lined up, the order was given ‘right turn.’ He could not ‘right turn’ so he had to ‘left about turn.’ Just previous to this he had had pain in the left shoulder.”121 In the course of treatment, the soldier eventually told Russel that “he was a regular in the Imperial army and his time, seven years, would be up in one month. Since joining the army he had married and now had three children. He wished to leave the army at the expiration of his time.”122 Russel deduced that this was, in fact, the source of the underlying suggestion, or fixed idea: the man had surmised that if he developed an illness that prevented him from continuing in the army, he would be allowed to return to civilian life at the end of his contractual period of service. This knowledge in hand, Russel then tried to reason with him but had little success. “In spite of my explanation that that would be impossible,” Russel recalled, “as he would naturally go on the reserve list and the reserves had been called out, he maintained that it was quite possible – perhaps later he would join the Army Service Corps – and so on.” Russel found that although the man’s symptoms soon disappeared, he could not convince him that they had arisen from a flawed, irrational idea. He thus returned the soldier to duty, but whether he ever made it back to the front is unknown.123 In an article published in the Canadian Medical Association Journal in 1916, Russel described another similar case which he treated at the McGill war hospital: A young man was admitted to my ward in No. 3 Canadian General Hospi­ tal with a diagnosis of epilepsy [… so] I camped in that ward until he had another attack. Fortunately I did not have to wait long, and I saw that it was not of a genuine nature and I put it up to him. His story was this: He had been at the front for twelve months, since the days of the German ­retreat, and had had no leave. He felt that it was due him. Moreover, he showed me a letter from his sister, stating that his brother had been ­severely wounded, and it was a question whether his leg could be saved. His aged mother had taken it very badly and was very ill and was praying

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for his return. He said when he thought of all this he felt so badly that it just seemed to get worse and worse until he had an attack. He admitted that he could control them. I told him that the Army authorities tried to be just and if he had been at the front for twelve months without leave, it was coming to him, but he must realize that to behave in such a way was really doing the essential part of himself a greater hurt than if he were wounded, and so on, and that if he would play the game, I would send him to the Base with a recommendation for leave. I kept him in a week or ten days longer and the change in him was remarkable. He was bright and active and cheerful around the place, and had no more attacks.124

Here Russel again tried to reason with the patient, but again he failed. To provoke a cure, he was forced to fall back on his power as a physician-captain in the army to recommend the leave that the soldier so desperately desired. In other words, when rational persuasion failed, he resorted to bribery. He suspected, though, that the main reason for his failure was the lack of a suitable environment and the time necessary to conduct the detailed analytical work required. From his work in France, Russel concluded that there were two basic categories of patient: those who were genuinely hysterical or neurasthenic, similar to the types of cases regularly seen in civilian practice, and malingerers. By malingering, Russel meant the intentional simulation of illness – but he also acknowledged that most cases were not so cut and dried as to allow the physician to easily determine whether the simulation was conscious or unconscious.125 In most cases, he felt, there was an element of psychological deception, but “it is difficult to determine how much the patients themselves are deceived,” he wrote. “One can readily realize that the longer they are allowed to go on deceiving themselves, the more difficult will be their disillusionment.”126 In December 1915 Russel was transferred to Granville hospital as its first neurologist, providing an opportunity to create his own clinic. Unlike British civilian specialists like Turner, Mott, MacDougall, or Rivers, Russel’s approach would not be constrained by the limitations of an existing hospital ward and its staff, but could be built from the ground up to suit his own methods and the needs of his patients. It is sometimes forgotten that civilian institutions continued to operate their civilian wards during the war – Queen Square, for example, only converted a third of its beds to war use – which meant that old rivalries, ideologies, and clinical practice carried over.127 The main variation at those institutions was instead in the turnover of staff who, it must be



Treatment of Evacuated Cases 149

remembered, were also largely allowed to treat their patients as they saw fit because most were prominent consulting psychologists or neurologists temporarily seconded to the RAMC from university and hospital appointments.128 Most also continued to see civilian patients during the war, so that wounded soldiers only made up a portion of their work.129 Forced to improvise a new hospital system from scratch, the Dominions developed dedicated military treatment networks in England so that Canadian or Australian hospitals exhibited a martial culture similar to that of hospitals overseas. Typically, the men admitted to Granville exhibited some combination of psychological and psychosomatic symptoms, had been under severe fire, and had often been knocked “senseless” by an exploding shell.130 Mark T. was no stranger to military service, having served in the 1st Battalion, Oxford Light Infantry for several years before moving to Vancouver, where he became an electrician. T. joined the CEF in September 1916 and arrived at the front just before the Battle of Vimy Ridge. On 12 June 1917 at Messines there was a heavy German barrage and several of his comrades were caught out in no man’s land in the fire. T. went to look for them and was knocked unconscious, presumably from an exploding shell. When he awoke in hospital he had a “violent tremor of hands, marked twitching of head,” and a “buzzing headache”; he also reported pain down his spine, insomnia, a poor memory, and general weakness. After some time, he began to develop a general functional paralysis.131 Dr. MacLeod described him as a “typical case of hysterical shell shock. Was not able to walk or stand and had violent tremor of whole body.”132 A smaller number exhibited similar symptoms but had seen little service at the front. George Robert J. was a dispatch clerk in Manitoba before the war and joined the 2nd Canadian Division in Winnipeg in December 1914. J. arrived in France early in 1916, but “shortly after going to the front, began to feel weak.” His doctor recorded that he was repeatedly “short of Breath, [had] severe gastric trouble, would vomit almost every day, had pain (hot burning) in stomach from 1/2 hour to 1 1/2 hrs after eating, [and that] vomiting always relieved pain. [He] became very nervous, heart very irritable, had fainting spells. His condition became so bad he could not carry on. Was sent back to hospital.”133 A few, like Corporal Mark T., exhibited the stereotypical symptoms of shell shock. Some patients refused to admit that they were suffering from nervous conditions at all. Private Frank G., a twenty-five-year-old lithographer

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from Toronto when he joined the CEF in the fall of 1914, arrived in France in September 1915 with the 29th Battalion. “Patient had been in trenches 9 months and was sleeping very poorly and rather nervous,” noted his doctor on admission to Granville. “Did not report sick and says that MO sent him to hospital because he was wandering about and acting queerly. He does not remember doing so.”134 By the time he arrived at Granville he was sleeping well and had a strong appetite. He had no “complaints” other than a strong aching over his left temple and he insisted that he was not nervous.135 However, on examination, his hands shook noticeably. The specific mechanisms of therapy at Granville varied according to the nature of the patient’s symptoms, but treatment was almost always based on Russel’s belief in rational persuasion and what he was increasingly calling “disillusionment therapy.” Patients with mild, exhaustion-type symptoms were first given a thorough physical examination intended to convince them that their symptoms were not due to organic illness. “In the treatment of shell shock,” explained Russel, “it is important to obtain the patients [sic] confidence, and therefore a careful physical examination should be undertaken and the man assured that there is no real disease and that his recovery is assured.”136 In such cases, patients were assumed to be exhausted and thus prone to mild suggestion, but not highly irrational. Given the mild nature of the majority of symptoms (insomnia, headache, vague pains, weakness), there was no specific “fixed” suggestion to be overcome. Instead, the physician’s task was to ease the patient’s fear of severe illness and then to prove to the patient that a cure was inevitable by demonstrating improvement through hydrotherapy, massage, and rest. Once the patient was convinced that he was healthy in body, a modified rest cure was all that Russel believed was necessary to restore him to mental and physical health and an eventual return to duty.137 However, in cases exhibiting severe functional, psychosomatic symptoms, rest would merely be a prelude to further psychotherapeutic treatments that would aim to restore the patient to rationality, erasing the “fixed” suggestion that produced the functional symptoms. All patients, then, received a modified rest cure, sometimes supplemented by Russel’s rational persuasion.138 In his work with sixty cases of psychogenic paralysis at Granville, Russel came to believe that every soldier (regardless of whether he won a medal or was tried for cowardice) experienced fear which, in some cases, led to the breakdown.139 But why did some men win medals and



Treatment of Evacuated Cases 151

others develop shell shock? Russel believed that it came down to a question of heredity. The war, he argued, had created new and multifaceted pressures that induced many civilians to join the army who had “absolutely no taste nor inclination for the life that they must necessarily follow, and no stomach for the dangers that they must be called upon to face.”140 Men whose “education and tastes” made them unsuitable for military life had never developed the necessary self-control to endure battle. They could not, argued Russel, be expected to sustain the pressures of fatigue, mental strain, and fear.141 “Under the constant roar of shells and the insults of explosions,” explained Russel, combined with natural physical fatigue, the individual’s equanimity is very soon worn to shreds and his effort at self-control worked to the limit, so that he is quite ready to believe, in this suggestible state of mind, that any muscular stiffness, which he might have experienced in civil life without apprehension, denotes some grave disease and causes a grave limitation of the functions of the part affected; or, if a shell falls close enough, so that possibly he is knocked over by the concussion and bruised, even to a slight degree, by falling earth and debris – much more so if he is badly bruised – strong arguments are added in the mental conflict on the side of self-preservation and he is persuaded to believe that he has sustained some grave bodily injury, that his spine has been fractured, especially as it is quite possible that for some time he may actually have, following the concussion, a numbness in the lower extremities and inability to use them; and, apparently, under the emotional excitement it happens that the intellectual control, normally exerted by the higher centres, is often lost and no organic injury whatever has occurred. Apparently, the lower, or emotional centres, once having got control, strive to maintain it until by some means the higher centres are stimulated to regain their natural activity.142

Russel’s clinical goal was thus to stimulate the patient in such a way that he could restore his “higher centres” to regain mastery of the patient’s mind. Once patients were sufficiently rested, sometimes after several weeks of initial treatment, Russel would meet with them and begin the process of persuasion and re-education cure. The first step was to acquire the confidence of the patient which required a careful examination of the part of the body which appeared to be paralysed. “The presence, or absence, of any wasting of muscles should be noticed,” he wrote,

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remembering always that mere disuse can bring about considerable wasting, but this is usually of a rather general type; next the reflexes and tendon jerks should be tried, and finally the sensibility of the skin to painful stimuli. It must always be borne in mind that the whole examination, from the taking of the history to the final test, should be made without asking any leading question, and with the greatest care not to suggest any answer which may, or may not, be expected. The whole onus of the reply should be left to the patient.143

Once the possibility of organic disease had been dismissed, the patient would be told that they were suffering from a form of psychogenetic paralysis. Russel noted that the patient’s initial reaction was almost invariably one of denial, as they seemed to assume that they were being accused of malingering. Russel then used this fear to convince the patient that they could be cured. With a sympathetic tone, he would tell them that he had seen many such cases and it was understandable and normal for the patient to have lost control of himself under trying circumstances, but now that the nature of the condition had been discovered he would be cured. Only true malingerers, he told them, would fail to recover.144 Russel’s next task was to convince the soldier that he could, in fact, move a paralysed limb or speak. “In this case, it is customary to explain again the loss of control and its course,” he wrote in the Canadian Medical Association Journal, “and state that if sufficient incentive were present he would move the limb without effort.”145 This incentive would usually take the form of a “strong, sudden and unfamiliar stimulus” that would activate a withdrawal reflex. Once the patient saw the limb move, Russel believed, he would soon regain control of it.146 The incentive was often faradic electricity applied with a wire brush. Faradism has often been portrayed as a painful form of electroshock therapy which disciplined patients into submission with pain. As Linden, Jones, and Lees have shown, this was not the case. The amount of current flowing through the wire brush varied, and while it might be painful in some instances, those with psychogenic paralysis felt little due to nearly complete anesthesia.147 For Russel, the wire brush was only a tool to restore a patient’s rationality, disillusioning them about the nature of their condition and convincing them to accept that it had a psychogenic origin. For example, Private Thomas O.’s symptoms were recorded as chronic vomiting, headache, insomnia, nightmares, amnesia, paralysis of the legs, and depression. The house doctor



Treatment of Evacuated Cases 153

recorded that O. was of superior intelligence and he was sent for daily massage and prescribed medication for his vomiting to rest up before he was taken to Russel. After a month, on 14 January 1917, O. was sent for persuasion. He was told that his condition was psychogenic and that he would soon be able to move his limb. At first, the patient was given a low dose of current from the wire brush, applied to his legs – the natural reflexes responded and O. moved his legs and was soon able to walk with some difficulty. “At first was very emotional and threw himself on the floor,” recorded his doctor, “but gained control of himself and later applied the brush to his own thighs. The tremor of the left leg disappeared entirely and that of the right leg.”148 For Russel, the wire brush could provide the necessary incentive to convince a patient’s so-called rational mind to overcome the grasp of the more primitive fear response. Once he felt the jolt of electricity and saw a paralysed limb move, he would be faced with clear evidence that the condition was not physical. This reinforced Russel’s initial statement to the patient that he was suffering from a psychogenetic illness and supported his promises of a quick and speedy cure. The wire brush was not the only possible incentive though. Russel also employed a device which he called an “optical detective.” As one former medical student later recalled, “This was a peep-hole box which he designed when overseas during the First World War, to detect monocular blindness in hysterical or malingering soldiers. By means of a clever arrangement of mirrors, a test object inside the lighted box appeared to be viewed by the patient’s good eye, when in fact it was being seen by the supposedly ‘blind’ eye.” The patient would look into the box and then report that he could not see the object with his “bad” eye. Russel would agree, and then open the box, demonstrating the trick to the patient in order to convince them that they could, in fact, see perfectly.149 Both the wire brush and the optical detective had the same purpose: they provided clear, unequivocal evidence that the patient’s condition was not due to a pathological process. When accompanied by rational persuasion, such tools provided the necessary “disillusionment” that had eluded Russel in France. The Canadian neurologist believed that once the patient was presented with such clear evidence, irrational suggestions of injury would be robbed of their power and the patient’s higher faculties would be restored to a position of superiority. Once taught to control the fear instinct, Russel believed, the patient could no longer be susceptible to breakdown.150

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Figure 5.1  Outcome of cases by month of admission, Canadian Special Hospital, Granville, 1915−1917

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10%



Treatment of Evacuated Cases 155

During the war Granville reported some of the highest success rates in the British Empire. As illustrated by figure 5.1, hospital admission and discharge books show that of the 710 nervous and mentally ill Canadian patients admitted between November 1915 and August 1917, 86 per cent of nervous patients were discharged from Granville to some form of duty. The remaining 8 per cent were sent for convalescence or further treatment, with 5 per cent discharged from the army as medically unfit, while the outcome for about 1 per cent of cases is unknown.151 In June 1916, Russel submitted a copy of his first draft paper on shell shock treatment to Carleton Jones in order to obtain permission to publish his findings in the Canadian Medical Association Journal. His success was noted and his work was soon sent onto Alfred Keogh at the War Office, where it was eventually brought to the attention of the Secretary of State for War, earning Russel a mention in dispatches.152 Conclusion The CCS, stationary, and general hospitals were the first treatment centres where shell shocked patients received any form of formal therapy. Shell shocked soldiers moved quickly through the CCS to stationary and general hospitals along the lines of communication, although a small number of the milder cases were sent back to corps and army treatment centres or even to duty. Those who were evacuated were lumped in with the somatically wounded and ill, sent to general wards at stationary and general hospitals along the lines of communication. There were mixed reactions at these hospitals to nervous men who seemed otherwise healthy. Some patients were ridiculed and made fun of while others languished in attic wards on the coast with few attempts at therapy. In the absence of specialist centres, treatment was of a general nature. Men were ordered to rest, given a modified diet, and a rudimentary form of talk therapy was incorporated into ward routine. Although the more formal forms of psychotherapy advocated by Charles S. Myers were uncommon, many soldiers responded positively to the tried methods of the neurasthenic hospital, which were easily imported from the civilian sphere. The main function of the physician in shell shock cases was to rule out underlying organic or hereditary causes. Once this was accomplished, the patient was sent to a retention ward for care. In this respect, nurses played an important and often overlooked role in shell shock therapy. Under their care,

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many patients recovered and were sent either directly back to duty or to convalescent depots.153 In general, though, treatment had mixed results. Many patients who went to convalescent depots ultimately failed to return to their units or even to light duty behind the lines. Faced with the prospect of a return to the front, many had a relapse and broke down. This only added to the sense of crisis that was beginning to grip the medical services and military authorities during the summer of 1916.

Chapter Six

The BEF’s Shell Shock Crisis on the Somme, June–November 1916

During the five-day bombardment that preceded the first day of the Battle of the Somme, Private A.G. Earp of the 1/5th Royal Warwickshire Regiment was in the line when the German artillery started firing an intense counter-barrage. After two hours of heavy shelling, he quit his post, telling a sergeant that he was nervous and could not stand it any more, retreating on his own to a dugout in the supports.1 Because Earp had wilfully run away rather than seek medical attention, he was charged with cowardice in the face of the enemy. At his trial on 10 July, Earp’s platoon and company commanders as well as his RMO defended his actions saying that he had been suffering from shell shock and therefore, they felt, he was not responsible for his actions. However, a retroactive diagnosis was not considered a legitimate excuse for misconduct and, found guilty, Earp was sentenced to death – a punishment that had to be confirmed by the commander-in-chief, Sir Douglas Haig. While many men with similar convictions had been pardoned earlier in the war, in the summer of 1916 senior officers viewed the Earp case as an egregious example of a type of behaviour that they felt was becoming increasingly common: men were self-reporting with shell shock and using the diagnosis to put limitations on their participation in the fighting. According to a report filed on 20 July, Lieutenant Colonel G.C. Sladen, Earp’s commanding officer, claimed that his unit’s performance during two attacks at the beginning of July had been hampered by similar infractions committed by men with “very bad physique and fighting spirit.”2 After the battalion took a series of German trenches on the 16th, he said, “At least 40 men were incapable – would not use rifles, bayonets, or even move – consequently [the] trench was nearly recaptured by [a] small enemy bombing party and [the] battalion lost heavily

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in killed and wounded whereas a few good men could easily have driven back [the] enemy.” Sladen felt that a large percentage of the men in his battalion were “utterly useless” and that more than one hundred were “petrified with fear.” Other officers were then reporting similar acts of disobedience and perceived cowardice. If the British Army were to succeed on the Somme and avoid a collapse in either morale or manpower, men had to be kept at the front, by fear if necessary, where they would fight and die. When Haig confirmed Earp’s sentence, ordering him shot at dawn, he wrote on the death warrant: “How can we ever win if this plea is allowed?”3 During the summer of 1916, while the Canadians remained stationed on the largely quiet front at Ypres, the British Army faced a serious epidemic of shell shock cases on the Somme, and in the wake of the crisis its policies began to change. Because the Canadian approach to shell shock was determined by the British Army’s medical services, this chapter turns to the BEF to examine how senior officers came to “discover” and then respond to the shell shock phenomenon during the summer and autumn of 1916. Although the divisional stopping system had effectively reduced wastage during the first two years of war, as the scale of casualties increased it was no longer possible to take a liveand-let-live attitude towards nervousness. Throughout the summer, senior officials in the medical services struggled to understand why so many men suddenly seemed to be breaking down and worked frantically to stem the tide of evacuations. While the British Army never suffered from a catastrophic collapse of morale on the Somme, rising shell shock rates demonstrated that many men had reached the limit of their willingness to endure. By the time the Canadians were rotated to the Somme for the second big push of the offensive, on 15 September 1916, it was clear that divisional stopping had failed as a policy, but it was unclear what would replace it. Shell Shock as a Military “Problem” There is little evidence to suggest that senior officers, in either the regular army or medical services, became concerned about shell shock before June 1916. The rise in nervous illness within the Canadian Corps that spring went largely unnoticed outside Second Army. In large measure this was because the BEF’s casualty reporting system measured wastage in the aggregate, aside from specific diseases like typhoid, plague, and trench foot. To complicate matters, the figures that were



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reported to GHQ were inaccurate, as they had been intentionally manipulated to minimize front-line “sick wastage,” a category that did not include soldiers treated and released by divisional and corps medical units – nor men evacuated from employment or sanitary companies. As a result, there would have been few indications that shell shock rates were increasing, apart from a general uptick in the evacuation rate. In January 1916, Arthur Sloggett’s office noted that although the number of wounded was decreasing, the evacuation rate remained high, which his office believed indicated irregularities in the way casualties were being reported at the front and in the rear.4 There was little sense that more and more soldiers were becoming ineffective due to nervous illness and it is telling that when Sloggett appointed a new Consultants Advisory Board that spring, he included medical experts like Sir Anthony Bowlby, Sir G.H. Makins, and Sir W.P. Herringham to tackle various types of surgical problems, poison gas, sanitation, food safety, pathology, and infectious disease, but did not name anyone to specialize in shell shock.5 As far as the BEF’s medical authorities were concerned, shell shock remained a legitimate form of war wound unless it had been clearly and intentionally labelled as sickness by doctors at the front.6 This delineation between wounded and sick not only affected the way wastage was tallied, but also had direct implications for pensioning. Those categorized as wounded were also allowed to wear a wound stripe, which signified that they had been injured by enemy action while sick soldiers were not. To address perceived reporting irregularities, in early June Sloggett issued orders clarifying the BEF’s official definition of what constituted a wound. “The term ‘Wound’ means an injury caused by, or arising from, the enemy and includes injuries by rifle gunfire, by bombs, bayonet, liquid fire etc.,” he wrote. “Shock to the nervous system caused by bursting shells and the effects of inhalation of poisonous gases, although producing no visible traumata are to be regarded as wounded. Casualties due to injuries independent of any act of the enemy should be entered as “sick,” but may be marginally noted as ‘Injured accidentally.’”7 In any case that might be ambiguous, field ambulance doctors were to write “W” and “S” beside the diagnosis in the admission and discharge books to differentiate between “an injury caused by, or arising from, the enemy” and those caused by accidents and mishaps.8 Subsequent doctors were prohibited from changing the sick classification “notwithstanding any statement made by the patient as to the trauma having been caused by the act of the enemy.”9 As Sloggett clarified

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in a second memorandum sent a few days later, this would also apply to cases of shell shock which were to be recorded as either “shock, shell” and “concussion, shell,” with “W” and “S” used to differentiate between wound and sick classes.10 While this created two categories of shell shock, it is important to note that these orders maintained “wound” as the default classification in cases of nervous illness. It would be up to a medical officer at the front to specifically list a nervous soldier as “sick” – something that most were disinclined to do in the absence of clear evidence suggesting a defect of personality. In sharing their hardships and trauma, most medical officers were willing to give soldiers the benefit of the doubt. Colonel Charles S. Myers, the Cambridge psychologist who had, by 1916, become a roving “Specialist in Nerve Shock,” feared that these new orders would actually make it easier for soldiers to self-report, something that he believed was becoming increasingly common.11 During the winter and spring of 1916, Myers found that a growing number of hospital patients were willingly volunteering that they were “‘suffering from shell shock, Sir,’” when he felt, “there was nothing appreciably amiss with them save ‘funk.’”12 Anecdotally, it seemed that more and more men were essentially self-diagnosing, and querying colleagues at the front, Myers learned that others shared his concerns. One RMO lamented that it had become common for men arriving at his aid posts to have already “diagnosed” themselves with shell shock, while an ADMS told him that in some battalions, the diagnosis had become “fashionable, if not catching.”13 Another ADMS put his concerns even more bluntly: “The men have got to know the term and will tell you quite glibly that they are suffering from ‘shell shock’ when really a very different description might be applied to their condition.”14 Myers believed that official use of “shell shock (wound)” would only encourage self-reporting and should be discarded in favour of a less impressive-sounding term.15 “I considered that if the term were changed to ‘nervous shock,’” he recalled in his memoirs, “the number of cases would be reduced, that fewer would be disposed to boast of suffering from this disorder, and that the term would [more accurately] cover cases of shock not due to shelling.”16 Myers thus proposed establishing a series of “filtering centres” near the headquarters of each British Army where cases of nervous and mental illness could be effectively triaged, presumably by a doctor with expertise in the field.17 In early June, Myers summarized his ideas in a report that he submitted to the DMS, Lines of Communication, Tom Percy Woodhouse, the



The BEF’s Shell Shock Crisis on the Somme 161

medical officer overseeing care in the evacuation zone and his direct supervisor. Although Woodhouse seemed uninterested in Myers’s suggestions regarding diagnosis, he supported the creation of army filtering centres, writing that they would likely “relieve the increasing pressure on the accommodation of Base Hospitals and also … check the wastage consequent upon the needless evacuation to England of slight cases.”18 However, Myers’s report landed on the DMS’s desk while the British Army was preparing for the largest offensive in its history.19 Woodhouse was conscious that Sloggett was busy overseeing preparations for the Somme Campaign, so despite the merits of Myers’s proposals, he opted to table any discussion of reform. The real challenge was, though, that every soldier could legitimately claim to have been exposed to shell fire: what criteria could be used to determine the veracity of individual claims of trauma? The First Phase of the Somme Campaign At the Chantilly Conference in early December 1915, Sir John French, then commander-in-chief, had agreed to cooperate with Joseph Joffre to mount a combined assault in France while Russia and Italy struck the Central Powers from the east and south. Douglas Haig, who replaced French a few weeks after that conference, would have preferred to concentrate the British effort in Flanders, but acquiesced to Joffre’s view. Initially the plan was for the British to play a limited role north of the river Somme, but following Germany’s surprise attack at Verdun in February, the BEF was left to make the main effort.20 Historians debate whether Haig intended to mount an attritional campaign from the start, whether he thought he could actually achieve a strategic breakthrough, and the degree to which his plans were affected by the French struggles at Verdun. What is clear, though, is that the plan of attack proposed by Fourth Army’s commander, Henry Rawlinson, and modified by Haig, was too ambitious, calling for a massive assault by Fourth Army along a 26-kilometre front followed by an exploitive phase under a new Reserve Army commanded by Hubert Gough. The initial infantry attack was to follow a five-day preliminary bombardment by more than 1500 British guns firing 1.5 million shells, and it was hoped that this would destroy the German wire and machine-gun emplacements, smoothing the way for a 2000 metre advance on the first day alone.21 Artillery preparation was thought critical because the majority of the attacking forces would be drawn from the green troops of Kitchener’s

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New Armies comprised of civilian soldiers.22 At first Haig had little faith in these unproven troops, but by the end of June the commanderin-chief felt that never had soldiers been “better trained.”23 The Medical Services too felt well prepared. By 1 July 1916, they had cleared 36,237 bed spaces along the lines of communication which seemed more than ample to accommodate the expected number of wounded. The scale of the offensive and the nature of the terrain also required some critical modifications to evacuation procedures. Given the narrow frontages in some sectors, medical officers had pioneered a new corps-level evacuation scheme which saw all divisional field ambulances grouped into three clusters, with each bearer section forming one part of an integrated corps-level advanced dressing station, walking-wounded post, and main dressing station. As the Somme was a planned offensive, the DRSs and other corps-level rest stations were closed down in advance, with patients either sent back to duty or evacuated. This happened a few days before zero-hour in order to maximize bed space, as the CCSs also had to be cleared of patients and grouped in twos in rear of the front line, re-situated along broad-gauge rail lines to quickly transport the wounded to stationary and general hospitals further back. On the first day of the offensive there were six CCSs in rear of Fourth Army with accommodation for around 9500 patients. Wounded were expected to arrive from the front in stages: serious lying-down cases first, sitting cases next, and the walking wounded and sick last. It was thought that each group could be quickly moved on to make way for more, and in this way, Fourth Army anticipated that it could handle up to 24,000 cases a day.24 Large numbers of nervous casualties first began to appear on the Somme during the five-day bombardment leading up to the offensive. Admission and discharge books survive for two Fourth Army CCSs from late June and early July 1916: No. 3 CCS at Puchevillers in the northern sector, which cleared casualties from X Corps, and No. 34 CCS at Vecquemont, which cleared the southern sector behind XV Corps.25 During the five days leading up to 1 July 1916, both CCSs treated 965  casualties, 7.5 per cent of which were for neurasthenia, DAH, or shell shock – the vast majority of the latter were either listed as “wounded” or carried no designation, meaning that they were treated as wounded. One of those was thirty-year-old Thomas Henry R., a labourer from Drugoville, Ireland, who joined the Royal Irish Rifles in September 1914. R. reached France in early October 1915 and served on the Western Front until, on 28 June 1916, he was buried in a trench by a shell. In the



The BEF’s Shell Shock Crisis on the Somme 163

absence of a DRS, he was sent back to No. 3 CCS with shell shock and eventually evacuated to the base.26 Another was Edward Ernest D., a twenty-year-old footman from Surry. D. also reached France in October 1915 and reported with shell shock on the 29th of June. Whether it was constant shelling or the tension of waiting to go over the top, a growing number of men felt they had to escape the front before the offensive began. Others like Private A.G. Earp of the 1/5th Royal Warwickshire Regi­ment ran away and were never counted as casualties.27 At 7:20 on the morning of 1 July 1916, British soldiers went into battle. In many places along the line they found that the wire had not been cut, the German defenders were still very much alive, and their machine-gun emplacements well manned.28 The carnage was worst on VIII Corps’s front, where attacks directed at Gommecourt and Serre both ended in disaster. There, as 29th Division advanced towards Beaumont Hamel, the first wave of infantry met heavy machine-gun fire when they crested the top of their own parapet, and although some men made it to the first enemy’s line, the attack floundered. While long lines of men marching shoulder to shoulder, mowed down by machineguns, remains the popular image of the Somme, the tactics employed and the results obtained varied from one part of the front to another. Results were similarly disastrous in many places along the northern portion of the front, while at the southern end of the British line, both 18th and 30th Divisions had been able to reach their objectives. As Robin Prior and Trevor Wilson note, many historians of the campaign ignored the fact that where the German defences were strongest British gains were smallest and vice versa. With hindsight it is clear that the first push of the offensive was a miserable disaster, but this was not the perception at GHQ, where conflicting reports and the mixed results seemed to suggest that the German line might be close to collapse. For Sir Douglas Haig, the fact that some troops had reached their objectives suggested that those who failed must not have made sufficient effort.29 Adding to this perception was the reporting of the medical services, which were overwhelmed by casualties.30 Broken ground, enemy shelling, and the failure of the attacking troops to advance their line, especially in the north, meant that few casualties could actually be brought in before dark in the worst sectors.31 As a result, on that first night it seemed that casualties had been far lighter than expected, with only 7764 officers and men admitted to CCSs, mainly on the southern front, where the results had been less disastrous.32 Indeed, at 10:00 that night, Fourth Army’s DMS, Surgeon General M.W. O’Keefe, filed a situation

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report with GHQ saying that in the southern area, all the CCSs were getting “very crowded” and that cases were still accumulating. In the northern sector, though, where the offensive had failed, O’Keefe said that only one of the CCSs was starting to get full, while the other hospitals still “have a good many vacant beds.”33 At GHQ, these reports created the impression that casualties were light in the northern sector and heavy in the south, which supported the view that the attack had not been pressed hard enough where it failed. That night Haig infamously wrote in his diary: “North of the Ancre, VIII Corps said they began well, but as the day progressed, their troops were forced back into the German front line, except two battalions which occupied Serre Village, and were, it is said, cut off. I am inclined to believe from further reports that few of VIII Corps left their trenches.”34 When Haig wrote this entry, he did not know (nor could he from O’Keefe’s dispatches) that many of VIII Corps men had been killed or were still wounded, laying out in no man’s land – many would not be evacuated for three days. Even as the true scale of the disaster became evident, it proved difficult for Haig and other senior officers to shake these initial impressions. Although nervous casualties initially seemed light, they gradually began to increase as the days went on. In the north, No. 3 CCS treated 2768 soldiers during the first three days of the battle, with the vast majority of cases arriving on the 2nd (1904).35 Of these, 85 (around 3 per cent) were cases of nervous illness, mostly listed as “shell shock (w).” The pattern was similar in No. 34 CCS, although the numbers of cases were much larger. During the first three days of July, the hospital treated 2560 patients, 116 (5 per cent) of whom were diagnosed with some form of nervous illness.36 In the south, the heaviest day was the 3rd, when 1043 cases arrived in 24 hours. These rates of nervous illness were not out of the ordinary and, of course, no effort was made to track them separately from other sick and wounded. But if casualties were relatively light on the first few days, it was probably because so many men had either been killed or wounded by shot and shell. Many soldiers did not, in fact, report until several days after. In No. 34 CCS, nervous casualties accounted for an average of 17 per cent of cases between 4 and 9 July, or 361 of 2196 admissions. Although it suffered the heaviest losses of any unit on 1 July, in regard to nervous casualties the experience of the Newfoundland Regi­ ment was probably typical. The regiment, which was raised by the independent Dominion of Newfoundland, was part of 87th Brigade and had served with distinction as part of the regular 29th Division at



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Gallipoli the previous autumn. It began the morning of 1 July in reserve along a line of trenches known as St John’s Road, waiting to reinforce the first wave of the advance. At 8:45 that morning, the regiment’s commanding officer, Lieutenant Colonel Arthur Hadow, received orders to move forward with the Essex Regiment to the German first line, even though it was uncertain whether those trenches were still in enemy hands or not.37 Hadow’s notes indicate that he sent twenty-six officers and 772 other ranks into the attack, retaining a 10 per cent reserve of fourteen officers and eighty-three men in the reserve trenches. With­ in minutes of going over the top, the Newfoundlanders were decimated  by machine-gun fire from three sides as they advanced down a shallow bowl to the enemy stronghold at Y Ravine. Many of the men of the 1st  Essex Regiment, which was supposed to advance beside the Newfoundland Regiment, reported that they had difficulty making it up to their jumping off positions through communication trenches already clogged with dead and wounded soldiers from the failed first wave; according to Brigadier General Cayley’s dispatches, few actually went forward.38 By 9:45 it was all over. After reporting to brigade that his battalion had failed to reach the German lines, Hadow collected the survivors and marched them back to St John’s Road, where he conducted a devastating roll call: at that point five officers were confirmed dead, eleven were thought wounded, and ten were missing – all twenty-six men who went into the attack; 710 other ranks were unaccounted for.39 Including the 10 per cent reserve, there were now only fifteen officers and 174 men left in the battalion, ninety-one of whom returned from the disastrous assault unscathed. Information came in slowly over the next few hours as the wounded and those trapped in no man’s land began to trickle in; most waited until after dark to crawl back to their own lines. The next afternoon, Hadow revised his casualty list to record ten officers killed, fifteen wounded, and one missing with sixty-one other ranks killed, 419 wounded, and 203 still listed as missing. As no prisoners had been taken that day, the missing had all been killed.40 Of the 189 officers and men who survived the attack, at least fourteen (7.4 per cent) reported with shell shock in the days after 1 July, none of whom were admitted to hospital until the 2nd. As was often the case, many men tried to stick it out as long as they could. On 2 July five men were evacuated with nervous illness, on the 3rd the total was six, with four more sent out until the battalion left the line on 9 July.41 Private Raymond Robert L., a twenty-year-old English bank clerk working at

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the Bank of Montreal in St John’s, went over the top on 1 July and was knocked unconscious by a shell in no man’s land. Two days later he crawled into the British lines and was taken to hospital, where he was diagnosed with shell shock – months later he was still suffering from headaches, memory loss, and fatigue.42 Some of the nervous casualties, though, also appear to have developed among soldiers from the battalion reserve who had the good fortune to avoid going over the top on 1 July. One of those was private Herbert Lawrence V., a labourer from St John’s who joined the regiment on 28 May 1915. V. was held back from the advance, attached to the divisional reserve, and first reported sick on 9 July after a shell burst close beside him, after which he had a fit and lost his ability to speak.43 Sent to the 88th Field Ambulance, V. managed to return to his unit a few days later, but when the regiment went back into action in October, he broke down again, was evacuated through Rouen, and invalided to Netley in early December.44 When the battalion left the trenches on the 9th, one of the few officers who survived the attack without being physically wounded, Lieutenant Francis Knight, was also evacuated with shell shock.45 Shell Shock Revealed Over the next nine days, the British Army pushed on, taking the villages of Contalmaison and Ovillers la Boisselle, driving towards Berna­ fay, Caterpiller, and Mametz Woods in the north and Trones Wood in the south. Although neither Haig nor the medical authorities had any systematic means of tracking shell shock admissions and evacuations, as the offensive continued, anecdotal reports of nervous, timid troops and large numbers of shell shocked soldiers co-mingled to sustain GHQ’s initial impression that the BEF had a lack of fighting spirit. One of the most significant incidents took place on 9 July. The previous night, the commanding officer of 97th Infantry Brigade, Lieutenant Colonel J.B. Jardine (a recent replacement), ordered the 11th Border Regiment to occupy a small section of German trenches (what amounted to a forward bombing post). Later he claimed not to have known that on 1 July the battalion had suffered similar casualties to the New­ foundlanders, with more than 500 men killed, wounded, or missing, including all twenty-five officers as well as the CO and three company commanders. On the 2nd, the battalion had been withdrawn from the line and reorganized into two companies, absorbing hundreds of replacements which brought it up to at least half-strength: eleven officers



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and 480 men by the night of 8 July.46 At 8:00 pm on 8 July, after the unit had returned to the support lines, one of the newly arrived officers, Lieutenant J. Ross, was given the unenviable task of selecting a mix of 100 veterans and replacements for the raid.47 Soon after choosing his “volunteers” and returning to his dugout, at 8:30 pm three of the wouldbe raiding part went to Ross’s second in command, Lieutenant G. Tynhan, and told him that they were suffering from shell shock and could not take part in the operation. They asked for permission to see the medical officer and Tynhan excused them to go to the rear. “Within 10 minutes,” the officer later recalled, “one or two dozen men came to get similar permission as they said they could not stand it.” Tynhan panicked as he realized that the attacking force was beginning to dissolve. “I tried to reason with them to pull themselves together,” he said. “I failed in this but said that they must go on with the operation.”48 Rebuffed, the men went to Lieutenant Ross. “About 9 p.m. on the 9th some men came to my dug-out and said they were reporting sick as their nerves could not stand it,” he later told a committee of inquiry. “They wished to see the MO. [But] I thought that if I allowed this all the men of the party would do the same as their nerves were in the same condition. I therefore refused the request.” The raiding party had turned into a mob, returning a few minutes later with its leaders insisting that they were all now officially reporting sick and that they had a right to see the battalion’s medical officer. Ross, unsure of what to do, went to the unit’s temporary commanding officer, Captain H.C. Palmer, who had only just been seconded from the 2/King’s Own Yorkshire Light Infantry. Palmer saw little alternative but to send for Captain Kirkwood, the unit’s RMO. Kirkwood, who was the officer to have survived the 1 July attack, proved sympathetic. Having served with many of the men assigned to the raiding party for several months, he could empathize with them, having shared the terror of that first day on the Somme. In his medical  opinion, the heavy losses “had had a most demoralising effect, and the men had not recovered their mental equilibrium.” All, he felt, had endured exceptional trauma as, in addition to mounting the failed ­attack on the 1st, they had been forced to carry rations under unusually heavy shell fire, dig out the bodies of their fallen comrades, and go days without sleep. In his mind, there was no doubt that the men were indeed “shell shocked,” so he filled out a certificate requiring them to be sent en masse to the field ambulance. However, when a nervous Palmer passed the note to the brigadier for confirmation, it

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was countermanded and the attack was ordered to go ahead as planned. Later that night, when Ross ordered the party to pick up bombs at the battalion depot and follow him to the front line through the labyrinth of communication trenches, one by one the group dissolved as some men took “wrong turns” while others “got lost” going up the line. Just after midnight, the operation had to be called off because by the time they reached their jumping off place, there was no one left to mount the assault.49 The 11th Borderer’s incident touched off a minor but significant panic in the Reserve Army and at GHQ. To senior British officers, it appeared to be a clear-cut incidence of cowardice. As the Reserve Army’s Deputy Adjutant General wrote: “It is inconceivable how men who pledged themselves to fight and uphold the honour of the country could degrade themselves in such a manner and show an utter want of manly spirit and courage which at least is expected of every soldier and every Britisher.”50 The brigadier’s mistake (and only a few of those concerned above the divisional level thought that it was just that) in ordering a badly mauled battalion to carry out a questionable attack had raised an uncomfortable question: how far could the British Army, which had absorbed 108,221 replacements in the month of July alone, be pushed before it broke?51 Before the battle, Haig had been confident that, man for man, British soldiers were better fighters and better motivated than their German counterparts and this had allowed him to justify the carnage on the Somme as a “wearing out” phase preparatory to a later decisive battle.52 But if depleted units could not be quickly rebuilt and the men were allowed to choose the terms of their participation in the fighting, it would be impossible to continue waging offensive warfare. What made the 11th Borderers incident particularly dangerous in the eyes of the military authorities was that Kirkwood’s actions had effectively eliminated any possibility of disciplinary action and thus there was little the army could do to deter similar situations from developing in future. Whereas soldiers like Private Earp who ran away could be charged and executed as a warning (however ineffective such a warning might have been), men who sought and received medical permission to avoid combat had a clear and unambiguous defence against prosecution, even within the scope of the army’s arbitrary system of justice. The case highlighted the fact that there was no mechanism to resolve disputes between the medical and operational branches of the fighting forces: the regulations assumed that RMOs would always put



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the fighting efficiency of the army ahead of personal concern for their men, which was their official duty. So, when a court of inquiry was called at 32nd Divisional Headquarters to investigate the 11th Border­ ers incident it found that the unit’s medical officer, Captain Kirk­ wood, had overstepped his authority by undermining the attack order and that no matter how scared or tired men were, they could not be excused from duty for medical reasons alone. As the commander of 32nd Division concluded, the RMO had shown “undue sympathy with the men on the occasion. Sympathy for sick and wounded men under his treatment is a good attribute for a doctor but it is not for a MO to inform a CO that his men are not in a fit state to carry out a military operation. The men being in the front line should be proof that they are fit for any duty called for.”53 Although many front-line British medical officers later recalled taking a firm attitude towards shell shock cases, this usually referenced the fact that they first tried to shame men back to duty; paradoxically, most also remembered sending the majority of cases to the base during the Somme, which was precisely the problem in the eyes of the military.54 It did not matter how doctors felt about shell shock cases, what mattered was whether they left the front or not. Ordinary soldiers were also clearly sympathetic towards their shell shocked comrades. Chaplain John Duffield, who was attached to the Bantams during the war, was emphatic that shell shock was never associated with cowardice by the men at the front. “They really were broken men,” he recalled to an interviewer at the Imperial War Museum. “There was no cowardice about it. We were all frightened. I used to go along the front-line trenches in the First World War scared to death. I’m not ashamed of that. I still carried on.”55 Men could emphathize as friends suffered and broke down, so long as it appeared that they first tried to persevere. If they collapsed, most felt they deserved to be evacuated. Albert Day of the 1/4th Gloucestershire Regiment recalled, “Men cried and you couldn’t stop them crying and shaking and one day the medical officer was satisfied that the man really had had it, well, he had to go down, down the line … They just couldn’t face up to it anymore.”56 In making their own evaluations about what constituted cowardice and bravery, men differentiated between those who broke down and those who ran away or failed to stand up to the normal terror of life at the front – the former deserved sympathy while the latter did not. “If a fellow had a bit of a nervous temperament he can completely breakdown [under bombardment],” recalled Pte. P.H. Stockwell, who served with the 1/6th and 1/8th Battalions London Regiment. “If he breaks down

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and its visible and observed by NCOs or officers he’d be put in the charge of the medical officer who shepherd him back somewhere to be looked after. But you get the other chap who breaks down and runs away from it. I’m afraid there’s nothing much for him but to be put up against a wall and shot.”57 For the men at the front, there were clear and important differences between these two responses and while some accepted that punishment might be necessary in the latter type of case, it is doubtful that the military authorities would have agreed about how or where to draw the line between legitimate suffering and cowardice. On the Somme, the compromise between the army, doctors, and ordinary soldiers began to break down as definitions of cowardice and legitimate illness started to diverge with significant consequences for the manpower situation. Similar incidents at the beginning of July hardened the link between shell shock and what the military author­ities perceived as fear, cowardice, or lack of drive. The 1/5th Royal Warwick Regiment case described at the beginning of this chapter was  one, another was that of the 38th Welsh Division, ordered to take the eastern portion of Mametz Wood on 7 July.58 That morning, the 16th Welsh Regiment and 11th South Wales Border Regiment went over the top, but were held up by machine-gun fire from the eastern edge of the woods and fell back.59 After two more attempts to get forward, their attack was called off by the divisional commander as the men were said to be exhausted, while battalions reported heavy casualties, including twenty-one officers and 388 other ranks killed or wounded.60 Yet the casualties that reached the divisional field ambulances were mainly walking or sitting cases, including a number of shell shocked soldiers  and sick evacuations and even these did not begin to approach the numbers reported at the front.61 On the other side of the woods, the 38th Division’s attack had been matched by a similar assault by 17th Division which had been far more successful, raising questions about the seriousness of the German resistance encountered on the eastern portion of the woods. When news of 38th Division’s failure reached GHQ, Haig dashed off an angry letter to Henry Rawlinson (Fourth Army’s commander) explaining that considering 17th Division’s success, he did not feel that 38th Division’s attack had been a “credible performance.”62 As a result, the divisional commander was sacked and the attack was renewed under a new officer on the 10th. Over the next two days, the rest of the woods were eventually taken after heavy fighting, but not without further controversy. Despite encountering only limited German resistance, the second wave of attacks were a confused mess, as some men lost direction in the woods



The BEF’s Shell Shock Crisis on the Somme 171

and others refused to go forward at all. As conflicting reports again came in from the front, some asking for reinforcements to consolidate a full success and others to avoid the complete destruction of the attacking forces, the general in command of 113th Infantry Brigade went forward to evaluate the situation for himself. As he approached the tree line – such as it was after weeks of bombardment – he met large groups of soldiers “running back in panic,” although there was no indication that the Germans were mounting any sort of concerted defence; nor did there even seem to be much enemy firing going on. It seemed that British soldiers were mistaking friendly gunfire for German and had whipped themselves into a panic. It was clear that the morale of several battalions had broken and by the evening the men were so exhausted and frightened that the brigadier reported that any sound caused “a good deal of panic and wild firing … which only ceased when the exhausted troops fell asleep.” The Brigadier felt that men could no longer be trusted as, during the day, “moral[e] gradually became reduced until the smallest incident caused a panic.”63 A few days after 113th Brigade left its trenches, Brigade Major H.R. Bently drafted a memorandum evaluating their performance. Al­ though he said that the attack began well with the “utmost gallantry by all ranks in the face of a heavy fire,” he then described some disturbing trends: After the wood was entered, however, and certainly by the time the first objective was reached the sting had gone from the attack and a certain degree of demoralization set in. The desire to press on had vanished and it was only by the most strenuous efforts on the part of a few officers that it was possible to make progress. The demoralization increased towards evening on the 10th and culminated in a disgraceful panic during which many left the wood whilst others seemed quite incapable of understanding, or unwilling to carry out the simplest order. A few stouthearted Germans would have stampeded the whole of the troops in the wood. Later in the night, rapid fire was opened on the slightest alarm and several of our men were hit and one officer was killed by the indisciplined [sic] action … It should be brought home to all ranks of your unit that if we are to be of value as a fighting unit we must brace ourselves for a more determined effort and be prepared to make greater sacrifices. NCOs especially should take to heart the lessons of Mametz Wood and be made to understand that they must back their officers up and see that the men under them obey their orders … Another serious matter is the leakage from the

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firing line. Men, other than stretcher bearers, are on no account to be allowed to go to the rear with the wounded … In future battle police will be established to take the names of all such shirkers who will be tried by Court Martial.64

While it is difficult to criticize men for running from a desperate situation, it is also clear that the fear, panic, and flight had been disproportionate. One important contributing factor was that when men accompanied the wounded to the rear or fled the battlefield themselves, they ended up in divisional or corps collecting stations where they were fed, given a hot meal, and a chance to rest with little incentive to return to the front.65 As the numbers of effective soldiers in the trenches dwindled, fear of course grew until panic set in. The results of these types of situations were potentially disastrous. The Crisis As the summer fighting dragged on, the number of nervous casualties continued to grow, reaching crisis proportion at the end of July and beginning of August. On 14 July, the second phase of operations began with an advance on Delville Wood to the ridge extending from Guillemont through High Wood to Thiepval, which the British reached (with the exception of Thiepval) on 12 September. As indicated by figure 6.1, the figures from No. 34 CCS show that shell shock accounted for about 10 per cent of all evacuations during the first three weeks of July, or 1016 of 10,383 patients.66 On six separate days that month, nervous casualties actually exceeded 15 per cent of admissions. In an attempt to stem the tide of evacuations, on 21 July the DMS, Re­ serve Army, agreed to reopen the CRSs, which had been closed in preparation for 1 July. This diverted cases of mild shell shock and other forms of nervous illness away from the evacuation centres to corps rest stations; the effect of the new policy was evident at No. 34 CCS. As is clear from figure 6.1, beginning on the 22nd the number of nervous casualties dropped by nearly 50 per cent, and from 22 July until the end of November, shell shock only accounted for about 5 per cent of evacuations.67 While the adoption of a corps-level stopping system during active operations reduced the number of evacuations, it did little to discourage soldiers from self-reporting with shell shock or leaving the front for the safety of a rest station. A detailed examination of admissions to

180 160

Shell Shock Cases

140 120 100 80 60 40 20 0

18 22 26 30 4 8 12 16 20 24 28 1 5 9 13 17 21 25 29 2 6 10 14 18 22 26 30 4 8 12 16 20 24 28 1 5 9 13 17 21 25 29 June July August September October November

Figure 6.1 Daily shell shock admissions, No. 34 Casualty Clearing Station, June−November 1916

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A Weary Road

No. 14 Field Ambulance, the only British field ambulance on the Somme for which admission and discharge books have survived, reveals that the number of soldiers seeking treatment for nervousness may have grown following the adoption of the corps-level stopping. During the fighting at High Wood between 22 and 27 July, No. 14 Field Ambulance operated one of the new corps collecting stations for the walking wounded of 5th and 7th Divisions.68 As indicated in table 6.1, on the first night (22/23 July), more than 47 per cent of admissions were for shell shock alone and thereafter rates never fell below 18 per cent for the next two weeks. In total, of the 3472 soldiers who passed through No. 14 Field Ambulance between 22 July and 4 August when the hospital was withdrawn, 842 or 24 per cent were admitted with shell shock.69 These figures are almost identical to those printed in the official medical history for the field ambulances attached to 2nd Division, which show that between 26 July and 11 August, 501 cases of shell shock (wounded) were treated in the various field ambulances (some operating walking wounded posts and others front-line dressing stations), representing about 21 per cent of all casualties.70 The surviving evidence suggests that many of the nervous casualties which flooded into field ambulances in July and August were mild cases characterized by the same type of exhaustion-related symptoms described by Canadian doctors at Mount Sorrel. While most of the Brit­ ish  records that would facilitate qualitative and quantitative analysis were destroyed, the records of the Australian and New Zealand Corps (ANZAC) are more complete, similar to those preserved in Canada, and provide a window into the crisis. The ANZAC Corps was similar to the Canadian Corps both in terms of its size and its relationship to the BEF, but had received its baptism of fire during the landings at Gallipoli on 25 April 1915. It served on the peninsula for the remainder of the year until the evacuations in December and January. The ANZACs first went into action on the Somme on 22 July during the fighting for High Wood and, like neighbouring British units, reported unusually high rates of nervous illness. Although the newly arrived Aussies and Kiwis were yet to establish a CRS, the walking wounded station at Vadencourt Chateau recorded 448 cases of nervousness among the 2121 soldiers admitted between 22 and 27 July, about 21 per cent of the total.71 According to Lieutenant Colonel W.W. Hearne, the officer in charge of the 2nd Australian Field Ambulance, which operated the Vadencourt hospital, “very many of these cases would be more appropriately described as physical or nervous exhaustion and … they

Table 6.1 Shell shock admissions to No. 14 (British) Field Ambulance, July 1916 22 July

23 July

24 July

25 July

26 July

27 July

28 July

29 July

30 July

31 July

1 August

2 August

3 August

4 August

Total

Shell shock admissions

88

46

75

62

20

59

119

122

163

49

14

21

3

1

842

All admissions

810

98

362

187

110

329

450

330

480

180

39

81

15

4

3475

% of shell shock admissions

10%

47%

21%

33%

18%

18%

26%

37%

34%

27%

36%

26%

20%

25%

27% (Avg)

Source: A&D Books, No. 14 Field Ambulance, MH 106/26–30, NA.

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A Weary Road

should be classified as Sick rather than as Wounded.”72 As was the case with other walking wounded stations, though, such cases had to be evacuated, as in the midst of the fighting there was no effective way to funnel the men back to the front without impeding the removal of the wounded. To deal with these minor cases, on 28 July, the ANZACs established a CRS which allowed field ambulances to divert nervous soldiers to the Corps Collecting Station, reducing evacuation rates. Of the 1398 nervous cases admitted to No. 2 Australian Field Ambulance from 28 July to 22 August, 1209 (86 per cent) were diverted to the CRS; only 189 had to be sent directly to a CCS.73 The officer commanding the ANZAC CRS at the beginning of August shared Colonel Hearne’s assessment: “[The shell shock] cases have been much less severe in type and a large number of cases are not suffering from Shell Shock at all on arrival,” he wrote to the DDMS on 18 August 1916, “but were merely bruised by trenches being blown in and by burying. During the last week a certain number of cases have been sent here, in whom nothing could be found to justify their having been sent down.”74 While most of these men were returned to their units within a few days, the adoption of the corps stopping system did little to stop men from temporarily choosing to leave the front for a rest and may actually have encouraged men to do so. From 28 July to 22 August, nervous illness actually increased in some units, accounting for more than 33 per cent of all 4205  admissions to the No. 2 Australian Field Ambulance.75 In some units, officers complained that mounting casualties and the loss of shell shock cases to the CRS were actually making it difficult to hold the allotted section of frontage.76 Echoing the Canadian reports written after Mount Sorrel, one senior Australian officer commented that mild cases were not actually clinically nervous, “but [suffering] from physical and nervous prostration which for the time incapacitates them in much the same way, and which in many cases, particularly in that of officers, is due very largely to the complete absence of sleep, night after night, and who eventually break down with symptoms similar to veritable minor shell-shock cases.”77 It is unclear from the surviving records when Arthur Sloggett’s office became aware of the rise in shell shock rates. On 8 July, he asked the DMS, Lines of Communication, T.P. Woodhouse, to provide figures for the number of “insane” soldiers evacuated to England during the three months preceding the beginning of the new offensive, but he did not mention shell shock; he also seems to have been concerned that insane soldiers were being kept in France rather than being evacuated.78 While



The BEF’s Shell Shock Crisis on the Somme 177

he must have been well acquainted with anecdotal examples before the Somme, Sloggett’s war diary makes no mention of the problem in July. It is likely that the DGMS only became aware of the scope of the shell shock crisis gradually during late July and early August as his office began to investigate general increases in evacuations for minor forms of illness and so-called trivial wounds. Two weeks after the Somme offensive began, Sloggett received a dispatch from Alfred Keogh at the War Office, complaining that large numbers of “mild” cases had been arriving in England despite the fact that there was little wrong with them. “They don’t go back,” he wrote, “for the feeling is that when they have come home others should go out and take their turn, so mild cases coming to England are lost.”79 Officially, Woodhouse was responsible for ensuring that when men were evacuated from the front, they were only sent on to England if it were medically necessary. The next day, Sloggett reminded the DMS of this point and urged him to use the various con­ valescent and base depots to warehouse as many men as possible. To that end, the DGMS ordered the creation of a massive convalescent depot at Cayeux that could house up to 5000 men.80 Yet Sloggett also understood that evacuations from base hospitals were only part of the problem: if unnecessary losses were to be prevented, he believed that efforts would have to begin at the front.81 Investigations at field ambulances and casualty clearing stations soon revealed that significant numbers of admissions were for minor forms of wounds and illness and that in some sectors, nervous illness and exhaustion accounted for almost 30 per cent of cases. By the beginning of August, Fourth Army’s commander, Henry Rawlinson, feared that the evacuation of minor cases would soon have a serious effect on manpower at the front.82 One of the main reasons that minor casualties had grown so dramatically was that the new corps casualty schemes adopted by Reserve and Fourth Armies had removed many of the safeguards designed to ensure that soldiers could not leave the battlefield without the permission of a medical officer. Because divisions were being asked to fight on narrow frontages, the field ambulances of each corps had to act as a team with their bearer divisions, establishing advanced dressing stations close behind the front lines to receive sitting and lying cases from regimental aid posts, while the tent divisions created one or two main dressing stations several thousand yards behind, managing evacuations to the CCS. The corps rest station, which was actually a collecting post for the walking wounded, was not run by a specific unit but was cobbled together from a few doctors detailed from the staff of the DDMS and

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A Weary Road

some personnel and equipment from the various field ambulances. The corps scheme made the evacuation of sitting and lying cases more efficient by maximizing bed space and ambulance transports, but it also meant that there was almost no oversight of the walking wounded. During active operations soldiers were still essentially free to leave the field and, so long as they could walk on their own, would be directed to a collecting station where, for the first time, they met a doctor. Indeed, collecting stations were expected to handle as many as 3000 cases per day – far more sometimes than the dressing stations. There soldiers would be fed and given an opportunity to rest. More serious cases would be sent on to the CCS while, at least in theory, others would be returned to their units. But unlike with the divisional stopping system, there were few logistical supports or incentives to facilitate returns to duty as soldiers had already left their divisional area and the oversight of their comrades.83 Towards a BEF Policy By the middle of August, Sloggett had reached the view that the largest cause of unnecessary wastage was nervous illness and exhaustion. With a new phase in the Somme offensive scheduled to begin in midSeptember, the DGMS began to contemplate measures to reduce evacuations. As with other “new” problems of the war, his first move was to appoint a special consultant to investigate and provide advice. Since March 1915, C.S. Myers had been the only shell shock specialist in France, and he thus appeared to be the logical choice, but Sloggett and other senior officers in the medical services were wary of the psychologist.84 In his memoirs, Myers claimed that his strained relationship with senior members of the RAMC was a symptom of the organization’s inherent backwardness and its distaste for psychological thinking.85 While this was undoubtedly true from Myers’s perspective, he was an outsider – an academic nonetheless – who had difficulty communicating in the straightforward, practical way expected by other military officers. It did not help that he had a nasty penchant for self-promotion, which made him something of an object of ridicule along the lines of communication.86 Personality conflicts aside, Sloggett knew Myers had little formal training in neurology or psychiatry and even less clinical experience when there were well-respected and well-known doctors who could claim that expertise. Yet he also knew more about shell shock than anyone else in the BEF. On 15 August, the DGMS appointed

INDIVIDUALS

Sir William Orpen, Just Come from the Chemical Works, Roeux: 21st May 1917. Imperial War Museum, IWM ART 3013

Sir William Orpen, Three Weeks in France, Shell Shock. Imperial War Museum, IWM ART 3013

War Neuroses, 1917. Wellcome Library, London, Moving Image and Sound Collection

Sir William Orpen, Depiction of a shell shocked soldier standing at the edge of a dugout, 1917. Imperial War Museum, IWM ART 2376

Sir William Orpen, A gaunt, shell-shocked and wounded British soldier stands in a trench, smoking a cigarette, 1917. Imperial War Museum, IWM ART 2653

Lieutenant Colonel Gordon Holmes and Captain Colin Russel at a field hospital in France during Russel’s 1917 trip to the front. Osler Library of the History of ­Medicine, McGill University, Colin Kerr Russel Fonds (P98), Box 2/5/7, Folder 5

LOCATIONS

The Aftermath of the Canadian Counterattack at Mount Sorrel, Mid June 1916. This photo illustrates the effect that a barrage of high explosive shells had on the physical landscape, literally bringing the earth to a boiling trommelfeuer, pulverizing trenches and dugouts. Library and Archives Canada Mikan No. 3194768

Still from a film: Taking papers from a shell shocked British soldier, Battle of the Somme, 1916. Imperial War Museum, IWM Q79513

Typical Canadian Field Ambulance tents and wards, June 1916. Library and Archives Canada Mikan No. 3395741

Wounded Canadians and German Prisoners at a Dressing Station, Passchendaele, Fall 1917. These soldiers are cases of minor wounds and exhaustion waiting to be assessed by a physician at the dressing station. Library and Archives Canada Mikan No. 3397037

Men Enjoying a Meal at 12th Field Ambulance Soup Kitchen, November 1916. Soup kitchens were attached to divisional and corps rest stations to provide men an opportunity to rest and collect themselves during battle. Library and Archives Canada Mikan No. 3395487

“A” Ward, Field Ambulance Ward, June 1916. The wards of divisional rest stations would have been housed in buildings like these or in bell tents. Library and Archives Canada Mikan No. 3395746

No 3 Canadian Casualty Clearing Station, July 1916. A typical CCS with surgical and treatment wards housed in more permanent buildings. Library and Archives Canada Mikan No. 3395754

“A” Ward, No. 3 Canadian Casualty Clearing Station, July 1916 Library and Archives Canada Mikan No. 3395756

Gerald Edward Moira, No 3. Canadian Stationary Hospital at Doullens, Beaverbrooke Collection of War Art, Canadian War Museum. Doullens was home to one of the special shell shock centres run by Frederick Dillon from late 1916 until early 1918. Canadian War Museum, CWM 19710261-0427

An exterior view of the Citidel at Doullens No. 3 Canadian Stationary Hospital, which was located in an old French fortress from 1916 to 1918. Author’s Collection.

One of the wards at Granville Special Hospital, Buxton, Christmas 1917. This room was a converted common room in the old resort spa. Library and Archives Canada Mikan No. 3394756

TREATMENT

Nursing Sister bringing food to French wounded, No. 8 Canadian General Hospital, September 1917. Library and Archives Canada Mikan No. 3395853

In the Treatment Department, Granville Canadian Special Hospital, Ramsgate. Library and Archives Canada Mikan No. 3395868

Treatment Department, Granville Canadian Special Hospital, Ramsgate, 5 November 1917. Library and Archives Canada Mikan No. 3395866

Use of Electrical Apparatus. Slow Sinusoidal Electricity. Applying electrodes at root of splanchnic nerves in splanchnoptosis with resultant cerebral anaemia found in shell shock. Otis Historical Archives, National Museum of Health and Medicine, Reeve 41477

Use of Electrical Aparatus. Bergonic chair for giving general electric treatment for psychological effect, in psycho-neurotic cases. Otis Historical Archives, National Museum of Health and Medicine, Reeve 41476

High frequency vacuum tube for peripheral stimulation – Use of Electrical Apparatus. Otis Historical Archives, National Museum of Health and Medicine, Reeve 41482

Physical Reconstruction. Static Treatment. Patient on left – Spinal Arthritis, receiving sparks. Patient on right – Catarrhal Deafness receiving effleuve. Otis Historical Archives, National Museum of Health and Medicine, Reeve 41523

Cold spinal douche. From Guy Hinsdale. Hydrotherapy: A Work on Hydrotherapy in General. Phiadelphia: WB Saunders, 1910, 255



The BEF’s Shell Shock Crisis on the Somme 179

Myers Consulting Psychologist, but split his authority with Gordon Holmes, the prominent Queen Square neurologist, who became the BEF’s Consulting Neurologist.87 During the first years of the war, Holmes had been stationed at No. 13 General Hospital at Boulogne, where he studied and treated brain injuries, taking part in pioneering neurosurgical operations with his close friend and colleague Percy Sargent.88 One of his post-war students, Macdonald Critchley, remembered that “he had no time for woolly thinking, airy speculation, or high faluting [sic] notions. He examined every patient from top to toe, taking no shortcuts.”89 This “down-to-earth” attitude meant that he also had “no time for neurotics and hysterics, and less than none for the pagan gods of psycho-analysis.”90 Once, Critchley remembered, a young beauty queen had been admitted to Queen Square suffering from mild but persistent tension headaches. When Holmes looked at her chart, he immediately turned to the attending physician and, jerking his thumb towards the door, told him to “get rid of her.”91 Like most of his Queen Square colleagues, Holmes took a bio-psychological approach to shell shock, emphasizing the basic somasticity of all mental phenomena.92 While Sloggett has sometimes been criticized for his treatment of Myers, in the context of Edwardian medicine the decision to appoint both a neurologist and a psychologist was unusual. It was also a clear signal that he was departing from Keogh’s organization on the home front, which placed control of nervous illness squarely in the hands of London’s neurological community. Sloggett also listened to Myers more than the psychologist would later admit. Based in part on the report he had submitted to Woodhouse in early June, Sloggett’s next move was to establish clearer guidelines to distinguish cases of shell shock (wounded) from shell shock (sick), while also creating special treatment centres close to the front – what Myers had called “filtering centres” – for the milder cases. Sloggett’s 21 August orders dictated that only soldiers exhibiting “definite lesions and symptoms which necessitate prolonged hospital treatment” were to be evacuated to the base. As Lieutenant Colonel Begg of the New Zealand Division noted, this meant “cases of unconsciousness following the bursting of a shell in close proximity, injured eardrums, paralysis or paresis, aphasia, etc.” were to be considered wounded, while cases of “hysteria, neurasthenia, debility, etc.” were to be listed among the sick.93 Another important change was that doctors were told to list “sick” cases under headings other than shell shock, such as debility or exhaustion, which better described their condition.94 While this was not

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A Weary Road

quite what Myers had intended (“shell shock” remained in use), it seemed to be a workable compromise for an army in the midst of a major engagement. Sloggett’s orders still required front-line doctors to differentiate cases based on the perceived severity of the symptoms rather than their aetiology: the more serious cases would still be evacuated, but the milder cases which had filled field ambulances and CRSs during August had to be retained at the front. To accommodate exhaustion cases, Sloggett ordered each army to create a special holding centre close to the firing line where large numbers of shell shock (sick) patients might be observed, triaged, and given a chance to rest and recover.95 These special hospitals, known as shell shock (sick) centres, were the first hospitals established by the BEF specifically to treat nervous illness at the front. However, they were not meant to replace divisional or corps-level rest stations, but were intended to form a supplemental barrier to evacuation. Patients would never be admitted directly from main dressing stations, but would instead be transferred from DRSs and CRSs after a week or so of rest-treatment or diverted from CCSs.96 In Fourth Army, the first centre was established by the 1/1st South Midland CCS at Vacquemont at the end of August which, soon after, was taken over by No. 21 CCS.97 The hospital was adapted from a camp for the lightly wounded which had opened on 21 July 1916 with accommodation for around 1000 soldiers and, as it was removed from the main evacuation lines, would not interfere with the already clogged routes from the front.98 It was not a permanent special hospital; instead, various medical units would rotate through the grounds providing staffing on a temporary basis. Treatment involved only sedatives, rest, and observation.99 In the Reserve Army, the shell shock (sick) centre was established on 28 August at No. 35 CCS, which had similarly been operating an army rest camp in a fifteenth-century citadel outside of the ancient city of Doullens.100 Removed from the city and surrounded on all sides by wide fields, the hilltop hospital was roughly 30 kilometres behind the front line, away from the railways, and also away from crowded evacuation routes.101 The special shell shock centres were not true special hospitals in that they were neither staffed by experts nor were they designed to offer any special form of treatment: like DRSs and CRSs they were established in general hospitals and were only intended to delay evacuations, keeping soldiers with milder symptoms close to the front in the hope that time and rest would allow them to return to duty. In essence, they created a new army-level stopping system. It was not a permanent solution, but a temporary expedient



The BEF’s Shell Shock Crisis on the Somme 181

necessary to see the final phase of the Somme fighting through to the end of the 1916 campaigning season. The Canadians on the Somme The Canadian Corps, three divisions strong with a fourth division training in England, spent most of the summer of 1916 holding the line around Mount Sorrel, avoiding the carnage of the July battles.102 In early September, in front of the besieged village of Courcellete, the Canadians relieved the tired ANZACs where they were attached to the Reserve Army. The move provided fresh reinforcements for Haig’s long planned hammer blow centred on Flers-Courcelette, which would take place along a two-army front with the cavalry optimistically forming up behind, ready to exploit the anticipated breakthrough for an advance on Bapaume.103 It was thought that casualties would be heavy – perhaps as bad as on 1 July. Although both the Canadian Corps’s DDMS General G.L. Foster and Colonel A.E. Ross (ADMS, 1st Canadian Division) had visited the Somme at the end of the first month of the campaign and had more than six weeks to study the new corps evacuation schemes, it represented a significant departure from their pre­ vious experiences.104 On the Somme, the DDMS (corps) would be in charge of the collecting zone along the entire front, which would in turn be divided into three areas, each under the command of one of the divisional ADMSs.105 The forward or “T” area would include the advanced and main dressing stations as well as two collecting stations for the sick and slightly wounded. The former would feed directly to the CCSs, while the latter two would send patients to Vadencourt Chateau, where stragglers and walking wounded would be triaged at the corps collecting station and either evacuated or given a rest at the corps rest station in the “s” or support zone. The sick and injured from the reserve trenches and staging areas would be handled by additional field ambulances in an “r” zone.106 Given the growth in nervous casualties earlier in the summer, special precautions were taken in some units to protect against excessive casualties. “Owing to numerous cases of men reporting sick during active operations, complaining of pretended shell shock and other trivial ­ailments,” wrote the DDMS, XV Corps (1st New Zealand and 41st  Divisions), “at each Advanced Dressing Station of the Corps an experienced Medical Officer will be told off, whose sole duty will be to examine all these men and to return those to duty forthwith who are

182

A Weary Road

not suffering from an ailment sufficient to incapacitate them from performing their duties.”107 To enforce the order, police posts were established behind the front line where armed officers could march suspected malingerers and shirkers back to the front. Names would be taken and if soldiers appeared in the returns of another field ambulance, they might be charged with desertion or cowardice. Officers were to be examined personally by the ADMS and only accepted for treatment on his orders.108 This approach seems to have been unique to XV Corps, which suffered some of the heaviest casualties earlier in the summer. The Canadians, by contrast, had orders to treat slight cases of shell shock in their DRSs, while serious cases would be sent to the rear in the “ordinary way.” It was only at the CCS that nervous men were actually triaged: soldiers with marked symptoms were listed as wounded and sent straight to the base, while those who appeared likely to recover in a matter of a few days were labelled as sick and diverted to No. 35 CCS at Doullens – a process that often took several days and might take up to a week depending on the severity of the fighting.109 At 6:20 a.m. on 15 September, General Turner’s 2nd Canadian Divi­ sion, which had been so badly mauled and performed so poorly at St.  Eloi the previous spring, was to make the main thrust along a 2000-­metre corps front and, assisted by seven of the British Army’s new tanks, push a kilometre into the German trenches.110 They were fresh but largely inexperienced troops: 2nd Canadian Division assimilated 8498 replacements from the beginning of February, a turnover of about 65 per cent of the divisional strength. In terms of officers, Turner’s troops had suffered more than 100 per cent casualties during those same six months and the division as a whole had absorbed 609 officer replacements representing about 130 per cent of average strength monthly.111 “I don’t think the boys realized they were in for a big show,” recalled A.N. Davis, a private in the 47th Battalion who had himself arrived at the front after St. Eloi, and in the 1960s remembered going into the trenches on the Somme as a young inexperienced soldier. “They knew they were going over on a large scale. A lot of them thought it was easy and a lot of them thought it was hell, it all depended on where you were at, the shelling you got and what you ran into. Some of them had it fairly easy and some of them had it fairly hard.”112 The night before the offensive began the Germans mounted a spoiling attack which was beaten back and, as the artillery unleashed a heavy bombardment, the Canadians went over the top. As happened on 1 July, the enemy machine guns opened up while the Canadians were moving



The BEF’s Shell Shock Crisis on the Somme 183

over the scarred moonscape of no man’s land, but there were fewer defenders this time. By hugging the ground and inching their way forward, they gradually made it to the first line of German trenches. After heavy, often hand-to-hand fighting, at 8:00 a.m. the German position was in Canadian hands – even the strong German forces in an old, ruined sugar beet factory had surrendered.113 But on either flank, the ad­ vance  had not been so easy and no cavalry went forward – Bapaume remained in enemy hands. Over the next two months, Canadian and British troops had to continue the slow grind north of Courcelette towards Grandcourt with 1st, 3rd, and finally 4th  Canadian Divisions each taking their turn in the line. The fighting for Regina Trench, which ringed the outskirts of Courcelette, was the most brutal of the entire Canadian portion of the campaign, and it took  several tries between 1 October and 11 November before the trench line finally fell. On the 18th, a final push for Desire Trench a few hundred metres north of Courcelette marked the final day of the Somme campaign.114 In many respects it was some of the worst fighting of the war for the Canadians, characterized by the same high explosive artillery duels and stationary trench battles between two determined enemies as had taken place the previous spring in the Ypres salient.115 “The conditions were so bad there that we could only stand twenty-four hours in the line and twenty-four hours out,” recalled Private C. Carmichael of the 47th Battalion. “We were there for about six weeks on account of the shelling and conditions. We fought Regina Trench and the conditions were so terribly bad there that the band that we used to use as stretcherbearers had hip gun boots with the belts, you know, and the mud was so bad to get the wounded out of Regina Trench that the stretcherbearers’ straps for their boots broke and they just carried the wounded out on stretchers in their bare feet.’116 But although the fighting was hard, for the first time it was also offensive warfare, so that the men had the chance to take ground and strike back at their enemies in a way that they could not have done in the stationary artillery duels of the spring. Frank Maheux, who broke down after passively enduring the strain at St. Eloi, told his wife that knowing they were achieving their objectives and being able to kill German soldiers allowed him to deal with the loss of his comrades. “God we lost heavy,” he wrote on 20 September 1916. “All my camarades killed or wounded, we all only a few left but all the same we gain what we were after, we are in rest dear wife it is worse than hell, the ground is covered for miles with dead, corpses all over and your

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Frank push all true that without a scratch pray for me dear wife, I need it very bad … I went thru all the fights the same as if I was making logs. I baynetted some killed lots others. I was caught in one place with a chum of mine he was killed beside me when I saw he was killed I saw red we were the same like in a butchery the Germans when they saw they were beaten they put up their hands up but dear wife it was to late.”117

Joanna Bourke has argued that the imposed passivity of stationary warfare caused men to break down by preventing them from acting upon their desires for revenge as well as providing an acceptable, aggressive outlet for their fear.118 In this sense, the fighting at Courcelette may have been less traumatic. Shell Shock in the CEF Waging offensive warfare, though, also meant that the Canadians took appalling casualties: 8501 killed and 17,642 wounded.119 Official statistics list 1406 cases of shell shock, neurasthenia, or hysteria during September, October, and November 1916, representing about 8 per cent of non-fatal casualties. At first glance, this suggests that nervous casualties dropped significantly from the spring battles, but this probably reflects a change in diagnostic terminology rather than an absolute reduction in casualties. For example, an examination of the surviving admission and discharge books from 1st Canadian Division’s three field ambulances for the Somme fighting reveals a total of 959 unique admission for all types of nervous and mental illness between their arrival on the Somme on 2 September and their withdrawal from the front on 9 October. Of these patients, only 55 per cent were admitted with one of the three diagnoses captured by official statisticians, whereas during the spring fighting almost every patient was admitted with a diagnosis of shell shock. On the Somme, shell shock (which includes both the sick and wounded categories) accounted for only about 44 per cent of the nervous cases reported in 1st Canadian Division, with neurasthenia and hysteria accounting for 3 and less than 1 per cent respectively. Fol­ lowing Sloggett’s 21 August orders, it would appear that Canadian doctors had begun to use more descriptive terms like exhaustion (19   per cent) and “contusions (shock),” or “burial (shock)” (24 per cent). Assuming that the official statistics cited above captured a similar proportion of the casualties, the total figure may have been closer to 2950 cases, or about 17 per cent of non-fatal casualties.



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While nervous casualties were supposed to be funnelled into the medical system in an orderly fashion after the physically wounded had been cleared away, during the heat of battle this was rarely practical, so that shell shock cases often became stragglers who were sent – or ran on their own – towards the rear.120 For example, Hubert M. Morris, a stretcher-bearer working with No. 10 Canadian Field Ambulance recalled that during the later stages of the Somme “an apparently shell shocked soldier followed us to our dressing station, shivering and flopping even when shells were falling far away. At the A.D.S., Capt. Johnson gave him a cursory examination and then tied the tag on his tunic button authorizing hospitalization. With that, our shell shocked friend took off like a deer towards the rear. Capt. Johnson shouted at me ‘Catch that man’ but he outran me.”121 During the autumn of 1916, a number of soldiers reported strange encounters with solitary shell shocked men wandering around the rear areas or lurking in old dugouts and trenches.122 In another instance, John Henry Clash, a plumber from Vancouver who enlisted on 29 June 1915, recalled standing at the door of a dugout when a high explosive shell crashed down in front killing one man and wounding another. “The concussion had knocked my steel helmet off,” he said. “I had a Bull Durham cigarette and that fell out of my mouth and my mess tin burst open. I remember I just picked up my helmet and I remember saying, I don’t think it’s healthy around here without one of those on and took my mess tin and cigarette and lit it again and I walked down and got my dinner. Instead of going back to the hut I went down in the signaller’s dugout and that is one reason I didn’t go to the hospital with shock. Nobody seemed to bother about me down there but it really affected me.”123 While it was largely a creation of the evacuation system itself, the association between straggling, shirking, and nervousness helped perpetuate the view that shell shock was synonymous with cowardice. While the military authorities and senior medical officers worried that front-line doctors were being too lenient with nervous soldiers, the growing number of mild cases was beginning to break down the rapprochement between doctors and men. Colonel Fotheringham, who had been sympathetic to the plight of shell shocked soldiers when he first arrived at the front in the fall of 1915, was no longer so forgiving.124 After the bloodletting at St. Eloi and Mount Sorrel, and then the heavy casualties at Courcelette, Fotheringham had little patience for soldiers self-reporting with nervous illness, many of whom he felt were simply tired or scared. McGill physician Andrew MacPhail, noted in his diary

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how the pressures of army medicine had changed a man he had known for decades to be a cool and caring physician. “Col. Fotheringham came to-day to examine men who are recommended for permanent employment at the base,” he wrote on 23 September 1916 in reference to a group of shell shocked soldiers. “The war is telling on him. To one man he said, ‘You will return to duty and stay there till you are shot. That’s what you enlisted for.’ Two years’ ago he would not himself have suspected that he could be capable of uttering such a sentiment. I have seen harmless country doctors develop into perfect bullies, and themselves unaware of it.”125 Macphail, who had never been sympathetic, attributed the increase in breakdowns to the influx of new recruits. “At mid-day 800 men paraded before a medical board with a view to being sent to the base, for service there,” he wrote in his diary on 5 October. “Many of them have only been in France for a week or two. They are mere debris gathered up in Canadian cities, kept in camp for a year, shipped to France where they break down at the first trial. They are the voluntary recruits, men so feeble that they have acquired no place in the social order, and are therefore free to enlist.”126 Although both Fotheringham and Macphail felt that nervous soldiers were more likely to be young, new recruits, the evidence does not support those conclusions. The men who broke down in the fall of 1916 were in all respects typical of the CEF as a whole. Of the 959 nervous soldiers admitted to 1st Canadian Division field ambulances in the fall of 1916, there is detailed data on age and length of service for 277 patients, representing about 30 per cent of the whole. The average age at admission was 27.74 (median: 26), which was slightly above the mean age in the CEF as a whole, which was 27. This suggests that in terms of age, shell shocked soldiers were typical CEF recruits – and on the whole no younger than their comrades. Certainly, there were exceptions like Joseph A. Gussie McBride, a self-styled real-estate agent from Millbrook, Ontario, who enlisted on 6 November 1914 at the age of 15. He broke down on the Somme on 20 September 1916 and was evacuated as shell shock (wounded).127 But for every underage teenager who broke down, there were also overaged men in their late forties or fifties. Thomas Dillon Chaney, a moulder from PEI, also lied about his age when he enlisted in the infantry on 30 August 1915: he was already 53, although he said he was 40. He broke down twice in the fall of 1916 before being invalided back to Canada.128 Shell shocked soldiers were also no less experienced than their comrades. On average, they had been in the army over seventeen months



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and had spent nearly eight months serving at the front (median: six months) before breaking down – of course some had been there since the beginning of the war and others only a few days. We can evaluate whether this was significantly longer or shorter than the norm by comparing it with normal wastage rates. During the eight months prior to November 1916, 1st Canadian Division’s average monthly strength (other ranks) was 13,704 and during that period, each month the division reported an average of 1937 soldiers struck-off strength killed, wounded, injured, or sick – a total wastage figure of 15,494 that does not include men treated in field ambulances or corps rest stations as they were not struck-off strength. This means that by the fall of 1916, the average soldier could expect to become a casualty due to sickness, injury, or a wound after seven months of service in the line. This actually suggests that on average, the nervous soldiers of 1st Canadian Division spent slightly more time in the trenches than their comrades before breaking down.129 During the Somme fighting, nervous Canadian soldiers were gradually funnelled towards the main corps rest station in the Vadencourt Chateau, a seventeenth-century manor house with a large courtyard and turreted tower that had been taken over as a hospital earlier in the year. The brick home was used as the main admitting and surgical ward, while the patients – and there was space for more than 1000 at a time – were housed in 130 bell tents and twelve marquees pitched on the surrounding grounds.130 The Canadians had inherited the site from the Australians when the ANZACs left the Somme in early September, and during the rest of the fall, several field ambulances took turns staffing the hospital. It was a busy place. “Patients come down in motor ambulances and Lorries and [are] taken off in [a] stone courtyard,” Colonel Robert Wright, the commander of No. 1 Field Ambulance recorded in his diary. They are then “fed in the large hallway, dressed in next room, then entered in books by clerks sitting in [the] doorway of [the] billiard room and [their] equipment [checked] by [a] clerk in [the] 2nd billiard room door.”131 Despite the spacious accommodations, the rest station overflowed at peak times during the fighting and additional space had to be made at the collecting stations and sick hospitals intended for units holding the supports in the R zone. Macphail, working in No. 4 Field Ambulance, recalled just one such night during the aftermath of the first attempt to take Regina Trench in early October. “Last night at 11 came in upon us in buses, lorries, and trucks an overflow of men who were slightly wounded, sick, and weary,” he wrote. “They

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were on the way to a Rest Station but that was crowded with 700 patients. We took them in and placed them anywhere – in the harness room, in the ante-room, wherever there was a dry spot. No one spoke or asked for anything. They lay where they could, and slept as if they were in the pleasantest place in the world.”132 Treatment remained rest, a warm meal, a bath, and change of clothes if that was possible. Patient Outcomes Each of the 959 nervous admissions to 1st Canadian Division field ambulances were tracked through personnel files and the available admission and discharge books as soldiers were transferred from one hospital to another. This made it possible to determine a final outcome in 691 cases (72 per cent of all admissions).133 One of the most significant differences with the Somme rest stations was that field ambulance personnel had been ordered to restrict bed space so as to prevent overcrowding and so were only to keep patients for a maximum of four days.134 The previous spring, some rest stations had orders to retain men for up to two weeks if they seemed likely to return to duty. On the Somme, the average period of hospitalization was 4.04 days, but patients who returned to duty directly from the field ambulance were kept in the DRS or CRS for an average of seven days, while patients sent to the CCS were only in a field ambulance for a day or less. This suggests that the decision to evacuate was made relatively quickly and, in this sense, the creation of the army shell shock centres probably encouraged field ambulance doctors to more frequently send borderline cases to the rear rather than keep them for observation when space was tight.135 In total, 391 soldiers (57 per cent of known cases) were struck-off strength and evacuated to a CCS, while 300 (43 per cent) returned directly to duty from a field ambulance, DRS, or CRS. This suggests that on the Somme, evacuation rates (at least from field ambulances) increased significantly in comparison with those at St. Eloi and Mount Sorrel. Despite the creation of special shell shock centres, when a soldier was marked for evacuation from a field ambulance, he rarely returned to duty. An examination of the surviving admission and discharge books for the nine CCSs which were assigned to evacuate Canadians from the Somme shows a total of 811 evacuations from the Canadian Corps between 1 September and 30 November 1916. Of these, 641 (79 per cent) were sent on to the base and only nine (1 per cent) were returned to duty or sent back to a divisional rest camp. Surprisingly, only



The BEF’s Shell Shock Crisis on the Somme 189

146 patients, or 18 per cent of cases sent to a CCS from the field ambulances, were redirected to Fifth Army’s special shell shock sick centre at No. 35 CCS.136 Unfortunately, that hospital’s admission and discharge books have not survived, so no comprehensive analysis of outcomes is possible. However, there is some anecdotal evidence which suggests that few of these soldiers returned to duty. The war diary for No. 35 CCS reveals that between 28 August and 11 November 1916 (when No. 3 Canadian Stationary Hospital took over the shell shock wards at the citadel), the hospital admitted a total of 1325 sick and 1525 wounded patients (from all across the BEF), most of whom were described as suffering from shell shock. Of these, 76 per cent were evacuated by motor ambulance, usually in batches spaced out every two or three days, with the remainder returning to duty. On one level, this suggests that No. 35 CCS may have been successful in returning a quarter of soldiers to duty who might otherwise have been evacuated, but effectiveness should not be overstated. Once sent from a field ambulance to a CCS, a soldier had a 95 per cent chance of eventually being evacuated to the base.137 The case of Private Thomas A., a carpenter from Medicine Hat, Alberta, was typical. A. joined the CEF in February 1915 and arrived at the front in late June 1916 as part of a reinforcement draft to the 7th Battalion. At the end of August his unit marched with the remainder of the Canadian Corps from Ypres to the Somme, and after two weeks of heavy fighting, on 28 September A. was admitted to No. 3 Field Ambulance suffering from concussion and shell shock. That same day, he was sent to the walking-wounded collecting post run by No. 5 Field Ambulance, where he spent the night. The next morning, A. was slated for evacuation and sent to No. 29 CCS, where it was determined that his symptoms were relatively mild so he was redirected back to No. 35 CCS at Doullens with a number of other patients for observation. After three days at the shell shock (sick) centre he showed little improvement and so was sent via a motor ambulance convoy to No. 3 General Hospital at Boulogne, arriving in England a week later.138 Al­ though the creation of shell shock (sick) centres and the army level stopping system were intended to reduce evacuations, they only succeeded in adding an additional stage to the process and did not have the intended effect: in the Canadian Corps, at least, evacuation rates actually rose in comparison with the spring even as the number of shell shock casualties fell. The evidence suggests that in the fall of 1916, the most crucial decisions were still being made in regimental aid posts and field ambulances.

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As the campaign entered its final phase, the military authorities and the medical services thus began to search for a better approach that would both reduce evacuations and keep “mild” cases of nervous illness in the trenches. For the army, the summer’s fighting had firmly tied shell shock to larger fears about morale and discipline: men could not be allowed to choose the terms of their own participation or the fighting forces would become unreliable. The medical services, though, had no easy solutions. Most doctors agreed there were legitimate forms of nervous illness that deserved treatment, but most of the casualties admitted to rest stations and the special centres now seemed to be borderline or questionable cases. In this context, questions of diagnosis and aetiology could no longer be avoided, nor could the army’s concerns that civilian RAMC doctors were unreliable. As one shell shock doctor, William Johnson, later recalled, by the summer of 1916 “everyone in the fighting zone realized how thin was the line which separated the milder cases of psycho-neuroses (and these formed the majority of the patients) from those individuals whose disability lay in an insufficient stoutness of heart.”139 The Lessons of the Somme Given the nature of the casualty reporting system, the search for solutions naturally began at the corps level. In this respect, the ANZACs, which had reported some of the highest nervous casualty rates on the Somme, played a central role. Like the Canadian medical services, the ANZAC medical forces were almost entirely composed of civilian doctors who had enlisted in the Australian Imperial Force (AIF) or New Zealand forces, and so were new to the unusual nature of military medicine. The ANZACs had, of course, cut their teeth on trench warfare at Gallipoli, the scene of some of the most horrific fighting to that point in the war, which provided important context when they reached the Somme.140 The tropical climate, poor sanitation, and logistical complications at Gallipoli created no end of problems for the medical services as wastage rates from sickness and disease soared, especially after the landings at Suvla Bay in August.141 The ANZAC Corps DDMS, Colonel C.C. Manifold, was well known and respected in the British medical services, having served in the Indian Army before the war and worked as a field medical officer on the Western Front in 1914. He seems to have been an exceptionally competent officer and was well liked by the Australians and New Zealanders



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when he arrived in September: contemporaries described him as having “great activity of mind” and an “intense perhaps rather restless energy.”142 As we saw earlier in the chapter, the weekly statistics collected from field ambulance commanders indicated that something had changed since the ANZACs arrival in France and began to paint a comprehensive picture of the scale of the growing shell shock problem. His first reaction to the growth in casualty figures was to conclude that something in the character of the fighting must have changed, that more men were being driven to report, perhaps by the intensity of the shelling and the increased use of high explosive rounds. Perhaps, he surmised, the battlefield was simply becoming a more traumatic space. “The fighting which took place on the battlefield of Pozieres was of that severe sustained nature calculated to bring out any tendencies to nervous strain or breakdown from shock,” he wrote. As every trench carried by our men was not only gained in the face of the fiercest fire from machine guns and HR shrapnel, and when gained was held for days and nights always subjected to an incessant tornado of HE fire from heavy guns. This was the first occasion upon which the Divisions of this Corps had ever undergone this incessant continuous downpour of heavy projectiles. On the Peninsula they had received a severe baptism of fire on many occasions, but mostly when either in the heat of our advance or when occupying deep well-constructed shell proof dugouts. On the Somme there was nothing of this sort. Trenches which before our capture of them our guns had knocked to pieces and which were again knocked to pieces often together with the bodies of their occupants, were the only shelter and days had to elapse before such trenches could be consolidated and made even splinter proof.143

Within the prevailing bio-psychological model, it was easy for Mani­ fold to accept that terrific shelling might produce greater casualties, with shock induced cases exhibiting more acute hysterical symptoms. So, Manifold was surprised to learn from his field ambulance commanders that most shell shock patients were actually presenting with mild symptoms suggestive of fatigue and exhaustion rather than the classical form of nervous shock.144 Lieutenant Colonel A.W. Wilson, one of Manifold’s field ambulance commanders, felt that inexperienced and overworked front-line doctors were using shell shock as shorthand for any miscellaneous or vague injury sustained during a shell barrage. “Most of our RMOs and Ambulance MOs went into the Somme

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offensive with a very ill-defined, preconceived idea of ‘shell shock,’ he told Manifold, “and meeting there the results of intense artillery concentration for the first time we all allowed men to pass through our stations, men whom undoubtedly” should have been retained at the front.145 Part of the problem seemed to be that medical officers were viewing nervousness through a civilian lens rather than adhering to the stricter rules laid out by the army. As Manifold observed, “Medical Officers were not, in all Battalions, men with experience of warfare or of a disciplinary control of men in bulk; and there were instances in which, in consequence of this they were over soft hearted towards men who perhaps suffered more from a sense of active apprehension of what might come, rather than from any actual definite impression inflicted upon his nervous system.”146 In the DDMS’s view, a lack of experience and military ethos had allowed shell shock to become a catchall just as it had contributed to the sick rate at Gallipoli. Manifold gradually came to the opinion that a feedback loop between symptoms and diagnosis best explained the dramatic rise in nervous casualties. It seemed that as knowledge of shell shock spread through the ANZAC ranks in early 1916, the diagnosis lost any semblance of stigma until it actually became a normalized, almost expected, part of soldiering for both the men at the front and their doctors. Knowledge of shell shock evolved and spread organically through the BEF as stories from the home front made their way to the trenches with new recruits, as myths took shape and were retold in dugouts, and as men watched other soldiers crack and disappear – or return from a brief holiday at the rest station. This had reshaped the expectations of soldiers and their doctors about what men could and could not be expected to endure in battle. By the summer of 1916, “shell shock had been written up greatly both in the lay and Medical press,” Manifold concluded, “and there was almost a tendency to regard it as a Society Doctor’s patients might a new fashionable complaint. There was a readiness to place all sorts of manifestations due to fatigue and other condition such as nervous apprehension not uncommon in nature, down to shell shock both on the part of the sufferers and of the Medical Officers; and so it became a ready diagnosis to make and to accept.” But the exact relationship between diagnosis and symptoms was difficult to explain – each seemed to mirror the other. What was certain in Manifold’s mind was that as the diagnosis of nervous illness crystalized around the shell shock concept itself, the number of nervous soldiers reporting with its symptoms rose in tandem – a general trend



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which was evident across the BEF as a whole but most obvious in the case of the newly arrived Australians.147 On the face of it, it might sound as if Manifold thought that the shell shock epidemic was a form of mass hysteria, but this would have required him to accept that large numbers of otherwise brave, manly soldiers could also be simultaneously emotionally unstable. This, though, would have embraced a more elastic view of masculinity than was culturally acceptable. Instead, Manifold chose to explain the epidemic in terms of a conscious psycho-physiological choice. Like many of his contemporaries, Manifold believed that every soldier at the front had to use his more evolved – and hence inherently masculine – intelligence centres to control the more primitive, biological, and essentially feminine fear instincts that always threatened to overpower a soldier in combat. In other words, in the face of incessant shell fire, the driving instinct to flee had to be checked by the masculine will to hold on. It was, he acknowledged, a difficult internal struggle in which any small event might upset the balance. Manifold thus argued that the concept and acceptance of “shell shock” had duped otherwise honourable men into giving in when they might otherwise have held on. As soldiers struggled to stay in the trenches under trying circumstances, he argued, they also had to contend with the knowledge that a doctor would allow them to escape with honour if they would only choose to interpret the physical sensations of fear as shell shock. The notion that shell shock provided an honourable exit that had not previously been available was legitimized and even encouraged, Manifold surmised, by the army’s decision to allow shell shocked soldiers to wear the wound stripe, eliminating any official ambiguities about the meaning of the diagnosis. In his mind, this seemed to allow them to make a logical, legitimate choice to survive and flee, not because they were inherently cowards or ill, but because the opportunity provided by shell shock had tipped the balance, weakening their resolve to hold on. At the end of August 1916, Manifold summarized his findings in a report which he submitted to the DMS, Reserve Army. In it, the ANZAC DDMS argued that the majority of front-line shell shock patients were actually suffering from mental exhaustion and physical fatigue, rather than a true neurosis or psychosis. They had been encouraged to report as wounded, he said, rather than stick it out in the trenches by an increasingly laissez-faire diagnostic approach that not only made it acceptable but also normal for men to interpret any fear or mild physical stimulus as a thing called shell shock. As he explained:

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Many men who are suffering from simple strain and lack of sleep will see things out for another 12 or 24 hours at perhaps a most critical period when their services are indispensable, and will do this, buoyed up by a high sense of duty and the instinctive desire to stick it out and to set an example, as well as the sense of shame at failing to do so. If, on the other hand, to this man is offered, as is under present condition of classification, an easy and honourable quittance by withdrawing as “wounded,” it is quite likely that he may accept this solution, the failing condition of his own physical and nervous system also abetting him in yielding to it, when he never would have done so had he not been ensuring his appearance on the list of those honourably wounded in battle by quitting.148

From these observations, Manifold drew a conclusion that would have an important effect on the development of the BEF’s shell shock policy over the next two years: “Were it known that the classification of wounded would only hold after searching examination later on, it might be quite possible that the man in question would continue to hold out until relieved in the ordinary way, and not yield to the temptation to quit.”149 The solution, he argued, was to limit the diagnosis of shell shock to those who had been blown up or otherwise injured by a shell explosion. To ensure that doctors were not too quick to use the diagnosis, he recommended that it now involve a third-party investigation, which would also serve to cast suspicion on shell shocked soldiers. Arthur Sloggett greeted Manifold’s report with enthusiasm.150 Intro­ ducing a third-party arbiter into the diagnostic process would address the army’s concerns about the mindset of civilian doctors while also serving to cast suspicion on the diagnosis itself – which was what C.S. Myers had suggested was necessary back in June. From his point of view, the logical conclusion was to ignore the subjective medical evidence and evaluate the military context in which the symptoms first appeared. Every soldier had to face danger and death on a regular basis, which would always provoke a fear response, even in the bravest of men. Soldiers who controlled their fear and only developed symptoms in the midst of battle after an unusual and exceptionally trying event rendered them incapable of exerting that control could be said to be suffering from a legitimate form of nervous shock. But those who gave into their fear before a battle or in the course of events which had to be considered normal for all soldiers were indeed failing to do their duty as men. In this analysis, the only “objective” criteria would be to allow a



The BEF’s Shell Shock Crisis on the Somme 195

man’s commanding officer to determine whether the soldier had been exposed to exceptional forces on the battlefield or not – if he had, he could be given the benefit of the doubt, and if not, he would be sent back to his unit or perhaps even court-martialled. Such an investigation would require significant cooperation from the Adjutant General, George H. Fowke, whose office was tasked with managing all personnel matters, including wound designations and discipline.151 Fortunately for Sloggett, Fowke was an unremarkable soldier but an earnest administrator. Decorated for his efficiency (rather than bravery) during the siege of Ladysmith in 1899, he later served as attaché to the Japanese Army in Manchuria during the Russo-Japanese War and had a bureaucratic mind.152 In early November, Sloggett and Fowke issued orders which outlined the BEF’s new approach to shell shock, based largely on Manifold’s recommendations. They began by defining the difference between cowardice and “true” nervous illness along the lines suggested by the ANZAC DDMS, saying: “Those who, when engaged with the enemy, fail to maintain mental equilibrium do so either: 1. Because they are lacking in the nerve stability which must be assumed to be inherent in all soldiers, or 2. Because they have been subjected to some extraordinary exposure not incidental to all military operations.”153 The remaining text of the order is important and worth quoting at length: Those who have committed themselves for the first of the above reasons cannot be allowed to escape disciplinary action on the ground of a medical diagnosis of “Shell Shock” or “Neurasthenia” or “Inability to stand shell fire.” It has too often happened that officers and men who have failed in their duty have used such expressions to describe their state of non-effectiveness, and medical officers, without due consideration of the military issues at stake, have accepted such cases as being in the same category as ordinary illness. The undesirability of disposing of such cases in this way should be brought to the notice of Administrative Medical Officers, between whom and the “A” Branch of the Staff of the Formation concerned there should be close co-operation in dealing with each case on its merits. It should be for a Court Martial to decide where the evidence as to the existence of actual disease is such as to justify absolving an offender from penal consequences. The Commander-in-Chief considers it desirable that all cases of nerve failure should be retained in the Army Area until they have been carefully

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investigated and have been found to involve no disciplinary aspect. If the medical condition necessitates early transfer to the Base, all possible particulars that may be required for future disciplinary action should be obtained before the transfer is carried out. Nerve failure believed to belong to the second class of cases, those due to extraordinary exposure, should not be classified as wound on medical authority alone. The diagnosis “shell shock wound” should in no case be made until the evidence of the commanding officer of the officer or soldier affected has been obtained that his condition originated immediately upon his being exposed to the effects of a specific explosion.154

In effect, this directive split diagnostic authority between medical personnel and regular officers. The former were to verify symptoms and make judgments about the medical nature of the case, but the question of legitimacy and thus the use of the diagnosis of shell shock would be put to the patient’s commanding officer who would have to confirm whether the soldier had indeed suffered exceptional exposure or not. In effect, this diminished the power of front-line doctors while making shell shock a suspicious diagnosis subject to the same type of investigations required in cases of self-inflicted wounds and venereal disease. Conclusion In assessing the lessons of the Somme, senior medical officers came to the conclusion that the only way to regain control of soldiers’ minds and bodies was to restrict the power of both doctors and soldiers to define the meaning of their experiences. To that point in the war, it had been up to soldiers in the trenches to establish what constituted acceptable masculine behaviour in the face of fear and terror. While the parameters of the conversation were set by broader social mores, as the fighting intensified and soldiers suffered they created a space which allowed them to give voice to their suffering in acceptable ways. Medi­ cal officers accepted that “shell shock” was a legitimate condition because it served a practical purpose in the trenches by providing men with a way to discuss and express their suffering. Although rest stations and employment companies were tolerated, on the Somme the BEF crossed an important threshold, so that it seemed to the military authorities that shell shock had become a cover for cowardice. At GHQ, the shell shock crisis stemmed from two interrelated but separate problems: while soldiers seemed to be using shell shock to



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impose limits on their participation in the fighting, many front-line doctors were also seemingly failing in their duty as gatekeepers. The medical authorities only gradually became aware of the scale of the problem and so took incremental steps to manage the crisis. The creation of both a standard case definition and shell shock (sick) centres marked the beginning of a process of centralization and imposition of restrictions on medical authority that would characterize British shell shock policy for the remainder of the war. In both cases, Sloggett’s decision to take action grew out of the suspicion and confusion that characterized the first phases of the Somme campaign. It was a reactionary process motivated by fear and indicative of the always contentious relationship between regular army medical officers and civilian “temporary officer” physicians. In restricting diagnostic decision making and centralizing treatment protocols at the army level, Sloggett began an overhaul of the casualty evacuation system that would continue for more than a year. Since the nineteenth century, the British Army had always given RMOs and divisional field ambulance officers a wide range of powers, trusting them to serve the needs of the army first and their patients second. Yet even as Sloggett began to redefine the relationship between brass hats and white coats in order to keep more men fighting at the front, as the Canadian experience demonstrates, fewer and fewer soldiers were actually being returned to duty from the rest stations, thanks to the new system of corps casualty evacuation which made it easier for men to self-report and more difficult to keep them close to their own units. Although front-line doctors were generally sympathetic, by the end of the Somme campaign they too found that it was becoming increasingly difficult to balance their ethical responsibilities as physicians and their military duties as army officers. The policy adopted by the BEF in October 1916 represented a compromise between the medical, operational, and judicial arms of the British Army. In effect, it placed strict limitations on the power of frontline medical doctors to use certain diagnostic terminology, delegating that authority to a line officer whose judgment would be based on his military experience rather than any training in nervous illness. The decision signalled a rejection of not only the established casualty management system, but also the expertise and competence of the medical profession. The army was as much questioning the loyalty and honour of British doctors as it that of was British soldiers.

Chapter Seven

Managing Shell Shock at the Front, October 1916–June 1917

Private Arthur A., a twenty-one-year-old labourer from Eel River Crossing, New Brunswick, enlisted in June 1915, arriving in France the next April as a replacement in the 26th Battalion after the terrible casualties at St. Eloi. A. spent the next nine months in the trenches, seeing action at Mount Sorrel and the Somme. Throughout early January 1917, the 26th Battalion was in the support trenches, preparing to make a large raid on the German trenches at Angres involving several battalions as well as the explosion of a mine under an enemy strongpoint. On the 10th, his battalion learned that the raid was tentatively scheduled for the night of 15/16 January and over the next few days the young soldier’s stomach began to hurt. Just before his unit went up the line on the 14th, he reported sick to his RMO, who sent him to No. 5 Field Ambulance with gastritis. After a couple of days at the main dressing station, his symptoms had not improved, although there did not appear to be any sign of organic illness. So he was sent to the DRS run by No. 6 Field Ambulance, where he remained for the next two weeks with shell shock. When he returned to his unit at the beginning of February, the trench raid was over and A. settled back into life at the front.1 Then at the beginning of April, a massive artillery preparation began before the Canadian attack at Vimy Ridge – an unending trommelfeuer which the Germans called the “week of suffering.” As Z day approached, A. became anxious and again tried to report sick. This time his RMO “said he was fit for duty” and refused to give him leave to go to the dressing station. Tellingly, the doctor did reassign him to a marginally safer role in the 5th Canadian Trench Mortar Battery.2 Private A., though, used his transfer to illegally flee the front, and in his own words: “I beat it at Vimy Ridge.” During the heavy fighting on the morning of 9 April, A.



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ran away from his unit and went on his own to a field ambulance claiming to be suffering from shell shock, and in the chaos of battle he was evacuated. But A. understood the implications of his actions. Without the ability to ask for a brief rest, as he had done in January, he was forced to make a conscious decision to flee. This left him feeling that he was “a coward and nervous.”3 This chapter examines how the BEF tried to manage shell shock casualties following the crisis on the Somme. To protect its traditional areas of authority and its autonomy, the medical services adopted a policy which centralized diagnosis and treatment in special shell shock centres that were established in stationary hospitals and CCSs a few dozen kilometres behind the line. While this development of “forward psychiatry” has usually been portrayed as a great psychological awakening and the brainchild of C.S. Myers, it was, in fact, an organic process sustained by many voices which saw front-line treatment systems gradually brought in line with those in England. The result was a system that emphasized older bio-psychological concepts, thereby denying the legitimacy of most types of war trauma. Implementing the Lessons of the Somme In November 1916, the four divisions of the Canadian Corps left the Somme for Arras, where they joined Henry Horne’s First Army, taking up positions in trenches between Souchez and Neuville-St. Vaast facing the forward slopes of Vimy Ridge. The Arras front was supposed to be a quiet part of the line, and the Canadian Corps would spend most of the next five months in the monotonous slog of trench warfare. Given the static, passive nature of the fighting, wastage was to be managed via a corps-level stopping system comprised of divisional field ambulance rest stations, CRSs, sanitary companies, labour battalions, and a new Canadian Corps Convalescent Camp.4 When the Canadians arrived at Arras, First Army was just beginning to implement the new shell shock regulations issued by DGMS Arthur Sloggett and Adjutant General Henry Fowke at the end of October. These stated that all cases of shell shock, neurasthenia, and “loss of nerve” lacking visible wounds were no longer to be retained in divisional and corps rest stations, but would be transferred to special army-level shell shock hospitals where each case could be evaluated from a disciplinary point of view. There written testimony would be solicited from front-line officers, and if it was found that a soldier had lied about what happened to him at the

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front, he might be court-martialled. If it was determined that he was telling the truth (or if no evidence of deceit could be found), he might be treated and returned to duty or evacuated. The most important point was that the diagnosis of “shell shock (wound)” was supposed to be restricted to soldiers whose commanding officer had confirmed that they had, in fact, been “exposed to the effects of a specific explosion.”5 In theory, the new system was supposed to standardize the diagnosis and treatment of nervous illness within the BEF. In practice, though, a lack of specialist expertise and specific diagnostic (or evidentiary) guidelines meant that each army and, to a lesser extent each corps, developed its own version of the policy. In Fourth Army, for example, the use of the term “shell shock” was banned in the front lines in early November 1916, replaced by “shell concussion” and “nervous shock.” While the former would be treated as “normal wounded” and transferred to a DRS or evacuated, the latter would always be considered “sick” and would be sent to the army’s special shell shock centre at No. 21 CCS. Only there were doctors permitted to use the term “shell shock.”6 In Second Army, all cases of shell shock or nervousness were sent to No. 12 CCS, regardless of diagnosis, where they were personally evaluated by the DMS; only when there were “definite lesions and symptoms” could they be evacuated.7 Fifth Army forced its front-line doctors to use the phrase “Not Yet Diagnosed (NYD)” and to add a query when cases of nervous illness rending a diagnosis of “NYD (? Shell Shock)” or “NYD (? Nervousness).” NYD was not a new or unusual abbreviation and was already routinely used in admission and discharge books for any questionable clinical presentation, such as in “NYD (? Influenza)” or “NYD (? Pyrexia).” The hope was that whereas an actual diagnosis of “shell shock” implied a degree of medical certainty to the patient, the inclusion of a query indicated confusion and uncertainty. Only at the special hospital could a nervous diagnosis actually be affixed to a patient.8 In First Army, to which the Canadian Corps was attached, DMS W.W. Pike separated all forms of nervousness into two general categories: “genuine cases of ‘shell shock’ and those of loss of nerve power.”9 However, this differential diagnosis would still take place in the front line where doctors retained the ability to evacuate cases of the former “in the ordinary manner” so long as there was “clear proof” that the case was “genuine.” This meant that patients who were diagnosed and then evacuated from the front line as “shell shocked” would still be sent to the regular CCS along with other sick and wounded. Only when a case relied exclusively on “a personal



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statement by an officer or soldier” were patients sent to the army’s special hospital for further observation and evaluation. While each army tried to implement the new system by restricting the use of the shell shock diagnosis and funnelling at least some patients to the special army centres, there was no consensus as to where diagnostic authority was to reside: in the front lines or at the special centres. Moreover, none of these sets of orders specified what constituted the “proof” necessary to arrive at a “legitimate” diagnosis (whether that was called concussion or shell shock).10 At the end of 1916, there was little agreement as to the purpose of the special centres: were they for diagnosis, discipline, treatment, or all three? This ambiguity reflects the reactionary nature of the process which led to their creation. Since the first winter of static warfare, the BEF’s knee-jerk response to an array of medical problems had been to establish special hospitals dedicated to exhaustion, infectious disease, venereal disease, self-inflicted wounds, and other ailments in forward areas.11 Despite the name, though, these were not “special” hospitals in the sense that they were staffed with experts in the field, but were conceived as collecting centres designed to warehouse “problematic” categories of sickness that did not fit neatly into existing evacuation protocols. As such, they were run by field ambulances and CCSs on a non-permanent, rotational basis and consulting specialists (when available) were only brought in on an ad hoc basis. This reflected the British medical services’ long-standing tradition of limiting front-line care to general surgery and medicine, with more specialized operations held back in the evacuation and treatment zones. This was supposed to unencumber an advancing army and keep casualties safe, and it made sense a generation earlier when battlefield surgery was still in its infancy. Like so much in the BEF and the medical services in particular, though, this approach had been challenged by the experience of the Somme, where the medical services experimented with abdominal and orthopedic surgeries as well as specialized treatment for gas casualties close to the front in CCSs and even in a few field ambulances.12 Patient outcomes improved significantly, as did evacuations, and so, by the fall of 1916, specialization was being considered in a number of difficult areas, including shell shock treatment – although the army proceeded on most fronts with a characteristic level of caution. As we saw in the previous chapter, the first special shell shock (sick) centres were created on the Somme during the summer of 1916 for organizational reasons, to centralize diagnosis and observation of borderline

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cases.13 In fact, it was intended to use them for both shell shock and mild gas cases: both forms of illness that the military authorities felt were open to abuse. By the summer of 1916, each soldier had been provided with a box-respirator which, when used properly, could provide effective protection against gassing. In the same way as trench foot was seen as an avoidable illness, so too might gas injuries indicate a breakdown in morale or command within a unit as, when properly led, most cases should have been avoided – at least that was the prevailing thinking at GHQ. Shell shock and mild gas poisoning were linked because they both involved self-reporting and mild subjective symptoms, and carried the possibility of simulation or malingering.14 While gas poisoning cases proved relatively easy to recognize, cases of shell shock were more difficult to prove or disprove, even after several days’ observation. As a result, armies began searching for doctors with expertise in nervous illness to oversee diagnosis and treatment. On 25 November 1916, William Brown, a neuro-psychologist and physiologist from King’s College, who served on the Somme as a front-line medical officer, was reassigned by the DMS, Fourth Army to its special centre at No. 21 CCS, where he became the first shell shock specialist to work in the evacuation zone.15 Although after the war Brown would become something of a radical psychologist and leading figure in the psychoanalytic movement in Britain, he was more conventional in his approach to nervous illness in the autumn of 1916. After graduating from Oxford in the spring of 1914, Brown went to study physiology under Frederick Mott at King’s College and spent the first war years as a temporary captain at Denmark Hill and Maghull, where he was a house physician to Mott, Aldren Turner, and R.G. Rows.16 Turner described him as having “a well-equipped mind [and …] a large practical experience” and spoke glowingly of his wartime service.17 Like his teachers, Brown took a bio-psychological view of shell shock, believing that the functional symptoms observed in hysteria were caused by “structural changes” originating in the psychic impulses created by physical or emotional changes in the chemistry or physiology of the nerve fibres; both his experience in England and on the Somme led him to believe that these changes could be reversed by various types of psychotherapy, including rational persuasion, hypnosis, and abreaction.18 While this opened the possibility of front-line treatment, it made the process of diagnosis even more complicated: doctors would need to evaluate a range of influences including front-line trauma, length of service, and family and personal histories, and look for signs of an underlying



Managing Shell Shock at the Front 203

neurological disease. At No. 21 CCS, Brown initially had free rein in the absence of clear diagnostic and treatment protocols and he used the conventional approaches he learned during the first years of war in England, although he was also able to focus more on the psychoanalytical forms of therapy he eventually came to champion.19 On admission, he separated “slight” cases from “severe.” The former were treated with rest, tonics, “moral suasion” and light work, while the latter were given suggestion, hypnosis, and “abreaction of emotional states.”20 Brown’s methods had mixed results during his first two months at No. 21 CCS. While he was able to send the majority of the “slight” cases back to duty after an average of seven days’ rest, the majority of the more severe cases had to be evacuated. This may have reflected Brown’s view that “all cases with history of loss of speech, hearing, or similar defect, [were] unlikely to be fit for service in the line again.”21 Outside of No. 21 CCS, most of the special hospitals were little more than army-level rest camps, playing a remedial role in the casualty system. When the Canadian Corps reached the Arras front, First Army’s special shell shock hospital was at No. 32 CCS, St. Venant.22 It seems to have been chosen for no other reason than it occupied an empty wing of a civilian French women’s lunatic asylum – and there is no indication that the staff of the hospital received any assistance from the civilian asylum’s doctors.23 In practice, No. 32 CCS was little more than an army-level rest station reserved for nervous patients. Staff would observe questionable cases and use the evidence submitted by field ambulance doctors to determine whether to press charges, evacuate the soldier, or return him to duty. An expert opinion could be solicited in difficult cases, but this had to be provided by the army’s overworked “Specialist in nerve diseases,” C.S. Myers – and he only managed to visit the hospital once during November and December.24 Limited Change at the Front The Canadian Corps sent few soldiers to No. 32 CCS in November and December 1916, which meant that despite the creation of a new system of special hospitals, the majority of nervous soldiers continued to be treated within the existing divisional or corps rest system until the end of the year. The admission and discharge books for Nos.  1 and 2  Canadian Field Ambulances, which ran the two main divisional dressing stations for 1st Canadian Division, show thirtyone men admitted with nervous illness between 1 November and

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31 December 1916. Of these, 23 per cent were evacuated directly to a CCS, 55 per cent were transferred for treatment to the DRS or CRS, while 19 per cent were returned directly to duty. Only one soldier (3 per cent) was sent directly to the army’s special hospital.25 It would appear that the outcomes once a soldier reached a DRS were also little changed from earlier in the war. The admission and discharge books for both the 1st and 3rd Divisional Rest Stations (No. 3 and No. 10 Field Ambulance) for November and December 1916 show that of the soldiers sent to a DRS, 33 per cent were evacuated, while 20 per cent were returned to duty: only 4 per cent were sent to No. 32 CCS.26 One of those was Pte. Robert George C., a twenty-oneyear-old machinist from Toronto who had been a member of the Queen’s Own Rifles before the war. C. was an unusual case as he had been diagnosed with hysteria three times before he was sent to No. 32 CCS: in November 1915 at Ypres, in early August 1916, just before the Canadians moved to the Somme, and a third time just before his unit went over the top at Courcelette. The first two times he spent three days at a divisional rest station with a “hysterical” pain in his right ankle before returning to duty. The third time, he was sent to the Reserve Army’s shell shock receiving centre at No. 35 CCS, where he spent nineteen days in hospital, returning to his unit on 25 September. On 13 November he was admitted to No. 2 Canadian Field Ambulance with shell shock and two days later was sent to No. 32 CCS for further evaluation. After a week at St. Venant, C. was confirmed “shell shock (wounded)” and was evacuated to the base despite the fact that he did not appear to have been near a bursting shell; nor is there any evidence from his commanding officer in his medical records.27 The largest group of DRS patients (43 per cent) were sent to the newly created Canadian Corps Convalescent Camp (23 per cent), a divisional employment company or other field ambulance (16 per cent), or the Cana­ dian CRS (4 per cent).28 Although the admission and discharge books for the Canadian CRS, which was run by No. 4 Field Ambulance, have not survived, that unit’s war diary records that of the 1350 patients admitted to the CRS between its creation on 23 November and the end of the year, 55 per cent were returned to duty while 18 per cent were evacuated. According to these records, only one case of shell shock was transferred to No. 32 CCS on 14 December 1916.29 This suggests that the existing system of case management survived largely unchanged in the Canadian Corps.



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Towards a New Approach The Adjutant General’s office recognized that the creation of special centres had done little to address the problem of diagnosis and evacuation and had merely added another stage to the process. The problem, he believed, was the medical service’s use of a variety of loose diagnostic terms that encouraged men to think of shell shock as a wound while also giving them the benefit of the doubt. Following Fourth and Fifth Armies’ approach, in the third week of November Fowke proposed a new restriction that would reverse the burden of proof, banning the term shell shock altogether and replacing it with two new categories: explosion (wound) and nervousness. The former, he argued, might be limited to soldiers who became “physically non-effective from direct contact with the effects of a specific explosion caused by an enemy shell without producing any visible wound” for which there was “direct evidence of the fact of exposure to the specific explosion.” The latter would encompass all other cases and be subject to disciplinary review. Accord­ ingly, he wanted to delay diagnosis until a soldier reached a special hospital where his case could be evaluated by a neutral party (not necessarily a doctor) who would look at the situation in the context of the man’s service record at the front.30 As Ben Shephard argues, this seems to have been what Fowke had always envisioned since the creation of the centres was proposed in late August, but Sloggett resisted, seeing Fowke’s proposal as a threat to the professional autonomy and expertise of the medical services.31 “I do not think … that it will be possible to obtain direct evidence of direct contact with effects of a specific explosion during battle when there is a heavy bombardment – or during barrage fire,” he countered; “and it might be as well to leave out the condition of direct evidence and to trust to the medical officer’s discretion and knowledge of the circumstances and such evidence as he can get from the man’s company or platoon.”32 In the fall of 1916, Sloggett was determined to protect the reputation and position of the medical services. The DGMS did not, though, have a coherent plan, and so looked for ideas from within the medical services that would keep the process of diagnosis firmly in the hands of physicians. By coincidence, he received a paper from C.S. Myers only a few days after his exchange with Fowke in which the psychologist summarized the BEF’s approach to shell shock and made several additional recommendations for future steps.33 In fact, Myers was not

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trying to influence BEF policy, but to secure permission to publish his work in the British Medical Journal. Although Sloggett refused, citing concerns from the War Office Press Bureau, he found the paper a “useful” document and had it distributed to each army on 4 December at a meeting of DMSs at General Headquarters.34 Although often described as a revolutionary treatise on the treatment of shell shock via psychotherapy, Myers’s paper was actually more of an administrative summary of best practices. It began with a conventional account of shell shock’s aetiology, suggesting that although the symptoms were indistinguishable whether the shock arose “from the physical effects of an explosion or from emotions excited (fear, horror, etc.),” in every case “it is the disturbance in the emotional system which is responsible for the mental derangement.”35 He thus reached the same conclusion as Brown: milder cases could be treated and returned to duty following a period of rest at a special casualty clearing station, while “cases with serious mental symptoms [had to be sent] to special mental wards at the base.” Nevertheless, he wrote, these “should be carefully separated from severe mental disorders, e.g. dementia.”36 If patients failed to recover at the base, he believed they should be transferred to Netley and “from there to one of the special hospitals set aside for such cases, where they come under specially qualified medical officers.”37 The bulk of Myers’s paper proposed a set of guidelines for the physical and administrative organization of the special hospitals. He noted that successful treatment appeared to depend on “three essentials”: promptness of action, a suitable environment, and psychotherapeutic measures.38 This reflected both his own experience treating patients along the lines of communication and the methods which were already in vogue within British neuro-psychiatric circles. For Myers, the treatment process began in the trenches with RMOs using “moral suasion” to keep as many men at the front as possible. Given that fear was thought to be contagious, though, he felt that if a man had to be sent to hospital, it was best to send him directly to the army’s shell shock centre, bypassing field ambulances and rest stations altogether. But these centres, he argued, “should be as remote from the sounds of warfare as is compatible with the preservation of the ‘atmosphere’ of the front. It must, therefore, be neither within easy range of bombardment, nor within sight of England.”39 There patients could be segregated into ­different wards for milder cases, those likely to need evacuation, suspected malingerers, and disciplinary cases.



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Although the special hospitals envisioned by Myers have sometimes been described as forward psychiatric psychiatric units, this was not the case.40 In terms of treatment Myers recommended rest and a modified diet for mild cases and, for more acute cases, the type of practical psychotherapy advocated by Dejerine and Dubois before the war. “The guiding principles of psycho-therapeutic treatment at the earliest stages should consist in the re-education of the patient so as to restore his memory, self-confidence, and self-control,” he wrote. “For this restoration of his normal self, a judicious admixture of persuasion, suggestion, explanation, and scolding is required.”41 However, Myers, like Brown, felt that the type of intensive psychotherapy required to effect a cure could only be done at a base hospital, where doctors would have the time to secure the “attention, interest and confidence of the patient”; otherwise it would be “a sheer waste of time” to treat serious cases at the front.42 He wrote: “At the Base, it will be often found possible to retain cases for a longer time than is possible in the receiving centres at the front,” he noted, “and to give them more thorough observation. They should be placed under the care of a Medical Officer who has special interest in and experience of the disorder.”43 The centres, as described by Myers, would be specialized units designed to assess and triage patients: those likely to return to duty quickly would be given a few days’ rest, while others would be evacuated. Myers’s paper was typical of the “lessons learned” memorandums produced by all arms of service after the Somme in that it was both summative and proscriptive.44 Although historians have been fascinated by Myers’s observations on psychotherapy and his “three essentials,” in 1916 these were all but ignored in favour of administrative and organizational aspects. After discussing the paper at the meeting between Sloggett and the other DMSs in early December, Surgeon General Pike recorded that only two points “were emphasized” at the meeting: “1. Patients should not be near the sea & 2. Should be out of sound of gun fire.”45 In some cases, this meant that the shell shock hospitals would have to be relocated. Fifth Army’s DMS only added that such a reorganization would require “more facilities for nerve specialists.”46 A précis of the paper, which was circulated a few weeks later, noted these same points, but also emphasized the importance of segregating mild cases from severe, as well as the need to evacuate more serious cases.47 Myers’s paper had two immediate effects. First, two of the armies on the Western Front relocated their shell shock hospitals further to the

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rear and away from the sound of the guns; second, a search was initiated to find specialists to run those wards. By the end of December, First and Second Armies had opened a shared army shell shock centre at No. 4 Stationary Hospital, Arques, while Third Army’s moved to No. 6 Stationary Hospital, Frévent, where it would also function as an overflow hospital for the two northernmost armies. Fourth Army’s centre remained at No. 21 CCS, Corbis, just as Fifth Army’s continued to operate No. 3 Canadian Stationary.48 This underscores the point that the centres were not seen as front-line treatment centres. At St. Venant, for example, First Army’s centre had been located approximately 20 kilometres behind the front lines just north of Bethune.49 When it moved to Arques (outside St. Omer), it was 60 kilometres further to the rear and about 80 kilometres from the front line. No. 6 Stationary Hospital at Frévent was also around 45 kilometres from Third Army’s front line southeast of Arras, while No. 3 Stationary Hospital remained about 35 kilometres from Fifth Army’s front. The closest special centre, No. 21 CCS, was still more than 30 kilometres from the trenches. On the southern portion of the front, the nature of the rail network meant that this was about as far back as that hospital could be without outstripping the railway network. To staff the wards, Sloggett favoured doctors with experience on the front lines over those with specialist training but no time in the trenches. One of the few doctors that Sloggett’s office could find with both was Frederick Dillon, a Scots RMO who had worked as an assistant medical officer at the Northumberland House Asylum before the war and as a clinical assistant at the West End Hospital for Nervous Dis­ eases in London.50 In mid-December, Dillon was transferred from his battalion to run No. 6 Stationary Hospital’s shell shock ward, but the other two hospitals had to be given to physicians with no significant experience treating nervous or mental illness. Major D.W. Carmalt Jones, who took over No. 4 Stationary Hospital at the end of December, was a bacteriologist who had served in the Territorial Army before the war. Like Dillon, he had been mobilized as an RMO in 1914–15 before taking a position at the general hospital at Wimereux. As the founding chair of the Department of Bacteriotherapeutics and dean of the medical school at Westminster Hospital, Carmalt Jones was not a natural fit for the job. In fact, he would have preferred to run one of the army’s front-line laboratories and seems to have gone to No. 4 Stationary as a favour to his friend Gordon Holmes, Sloggett’s Consultant Neurologist, whom he knew from his student days during a brief internship at



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Queen Square.51 Fifth Army’s centre at No. 3 Canadian Stationary Hospital was put under the supervision of Harry Manley Nicholson, a Toronto physician and lecturer in physiology at the University of Toronto before the war, who went overseas as a battalion RMO in 1915.52 Although Myers objected to Nicholson, accusing him of a “lack of interest” and suggesting a psychologist from England be sent in his place, he failed to secure a change.53 Myers’s proposals also had a further unintended consequence. Be­ cause jurisdiction over the special hospitals would be split between the DMS, Lines of Communication, in the rear areas and the DMS, Army, at the front Sloggett decided to divide authority over the hospitals between Gordon Holmes and C.S. Myers. From 31 December, Holmes would be responsible for cases in First through Third Armies while Myers would oversee the Fourth and Fifth – in effect, each had responsibility for two special hospitals as well as a number of base hospitals along the coast.54 Myers took the decision personally. In his memoirs, he wrote that he objected to his new title of “Consulting Neurologist,” which he felt made him responsible for somatic cases that he did not feel qualified to examine.55 This may have been true, but he also resented the loss authority to Holmes. A few days later, Myers wrote to the DGMS threatening to resign unless he be allowed to retain the title of Consulting Psychologist, not only in his new sector, but to the entire BEF. Sloggett, of course, had to refuse this ultimatum and so Myers asked that he “relieve him of his services in France.”56 He was granted several months’ sick leave to England beginning in the third week of January.57 The First Special Army Shell Shock Centres At the beginning of 1917, each army had an operational special centre under a dedicated officer (although their level of experience varied) as well as a clearer role in the evacuation chain.58 However, Myers’s abrupt departure effectively left Gordon Holmes as Sloggett’s only shell shock adviser, giving voice to a less sympathetic and more biologically oriented point of view. In 1916, Holmes was a rising star in British neurology, the heir apparent to Hughlings Jackson, William Gowers, and Victor Horsley at Queen Square. In many ways, he was the type of firm disciplinarian and bio-psychologically oriented neurologist that Fowke might well have appointed to the position, had he had the chance. Although he published nothing on shell shock, during the autumn of

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1915 he delivered the Goulstonian lectures to the Royal College of Physicians on spinal injuries in warfare, drawing upon his experiences working in France and at Queen Square on gunshot and shell injuries to the nervous system with Percy Sargent. In three sessions, Holmes described the various types of injuries he had seen. In most cases the responsible lesions – even the tiniest ones – were readily identifiable, but there were also cases, which he called “spinal shock,” in which patients suffered only superficial contusions to the head or spine, but which nevertheless appeared to have affected the reflexes, sensory perception, strength, and muscle memory. Unable to find a physical lesion in the cord or brain, Holmes concluded that the shock itself must have interrupted “the neuronic impulses that normally flow continuously from the higher to the lower levels of the central nervous system.” In these cases, contusions were suitably diagnostic insofar as they demonstrated the existence of the shock itself and thus pointed to a clear aetiology, even if the precise cause were unknown. This was significant because it was the contusions which differentiated cases of “spinal shock” from what might otherwise have been called hysteria. Had the young beauty queen Holmes once kicked out of Queen Square endured a fall or other trauma before admission, he might well have been more sympathetic.59 Holmes’s wartime case notes show that he took a similar approach to the shell shock patients he treated at Queen Square in England. Indeed, during the war Holmes tended to show more sympathy to soldiers who had been knocked unconscious by an exploding shell or endured some other sort of unusual experience,60 but tended to be less empathetic towards those who broke down without any visible trauma.61 At Queen Square, Holmes relied on a combination of both family, personal, and occupational histories as well as a subjective assessment of the patient’s bearing, mannerisms, and appearance to determine whether a case was deserving or undeserving of sympathy. Holmes had little experience of shell shock, having treated only a handful of cases at Queen Square during the first two years of war and soon came to rely for advice on his friend D.W. Carmalt Jones. The First Army shell shock centre was housed in an ancient chateau with “plenty of space,” recalled one of its doctors, including “a football ground and improvised golf course, a stream with a bathing pool and spring board, and the hospital largely functioned as a convalescent camp.”62 In a comprehensive study of the hospital’s British admission and discharge books preserved by the Medical Research Committee, Edgar Jones, Adam Thomas, and Stephen Ironside found that admission rates fluctuated



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over the course of 1917 with the nature of the fighting, waxing during periods of intense action and waning during relative calm.63 In total some 3580 British soldiers were admitted to the hospital and, on average, spent about twenty-five days there, the longest stay being 150 days; the typical patient was about twenty-seven years old and had been at the front an average of 11.2 months before breaking down.64 From New Years’ Day 1917 until mid-October, when the Canadian Corps moved north to Passchendaele, most Canadian shell shock patients were also treated at No. 4 Stationary Hospital or, when bed space was at a premium, in the overflow ward at No. 6 Stationary Hospi­tal, Frévant. Although the figures generated by Jones et al. do not include Canadian soldiers, a comparative analysis reveals few differences. In total, 424 Canadians were admitted to No. 4 Stationary Hospital between December 1916 and September 1917. The average stay was slightly shorter at twenty-two days, although one patient spent nearly three months in hospital. As with British patients, the average patient was twenty-seven years old, had spent roughly twenty months in the army, and had been at the front for nearly nine months before breaking down.65 The vast majority of Canadian casualties came from infantry units, 80 per cent, while 9 per cent were from labour battalions or railway troops, 6 per cent the artillery, and 3 per cent the engineers. A further 2 per cent came from the office of the Canadian Corps General Staff.66 Holmes valued Carmalt Jones’s insight not only because the two men were friends, but because the latter followed a similar approach to the one Holmes was familiar with at Queen Square. On admission, each patient was given a thorough physical examination and a detailed case history was taken. This was an involved process. Doctors at the special hospital did not have access to a patient’s military file or his previous medical records and thus had to rely almost entirely on a soldier’s statements. In addition to talking to the patient, they developed a questionnaire that they sent to patients’ commanding officers to establish whether there were grounds to believe that the symptoms arose from “direct contact” or some defect of character. These questionnaires were kept secret from patients and were comprised of a series of basic questions that might have been asked of any civilian patient’s family, adapted to wartime: when did the soldier report sick? How long had he been at the front? Had he been in any recent fighting? Was there a difference in how he behaved in trench warfare and active operations? Did his condition arise from an “an explosion occurring in his immediate

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vicinity” or “a long period of trench service”? What was the opinion of the RMO?67 For Carmalt Jones, the decisive diagnostic factor was the discovery of a neurotic predisposition – or its exclusion by proving “direct contact.” While awaiting the results of the questionnaire, the bacteriologist would estimate the patient’s “personal ‘nerve’” by the so-called common method of asking him about his “capacity to work on heights, manage horses, and the like; games and sports followed; [and] history of ‘nervous breakdowns.’” He would then look for specific physical signs that might point to organic illness and note any stigmata of degeneration, including “narrow palate and crowded teeth, simian hand and coarse skin.” These constituted de facto evidence of neuropathic predisposition. Carmalt Jones believed that “shell shock” encompassed two distinct types of disorder that happened to share the same subjective symptoms. Preferring to use the term “war neurasthenia,” he divided his patients into acute and chronic types. The former, he thought, were always acquired conditions that had been “rapidly induced by some of the accidents of warfare” such as being blown up or buried and could thus occur in so-called normal individuals exposed to unusually traumatic stimuli. Chronic cases, by contrast, arose only over comparatively long periods of time and were suggestive of an inherited predisposition. “There is enormous difference in the resisting powers of individuals,” he wrote; “some men come down in a few weeks, a few have lasted three years and a half, and all intermediate stages are to be found, but they appear to depend much more on a man’s individual qualities than on his circumstances, that is, they are a matter of heredity rather than environment.”68 Diagnosis and Treatment at No. 4 Stationary For Carmalt Jones, though, diagnosis only had a bearing on pensionability, because unlike William Brown and C.S. Myers, he was confident that he could restore the majority of cases to duty without prolonged treatment at the base using conventional treatment techniques based on rational persuasion and functional re-education. At No. 4 Stationary, Carmalt Jones began by assuring all his patients that “they were not invalids in the ordinary sense, they were not ill, they had no wounds, no infection, nothing wrong with heart or lungs or other organs; they were merely strained and exhausted, and would soon recover.” He allowed more serious cases to rest in bed for a day or two, perhaps with



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bromides to help them sleep, but as soon as possible he put all shell shock patients on a strict regimen of physical training, route marches, and fatigue work to drive home the message that they were essentially healthy. Because of his background, Carmalt Holmes was naturally sceptical of any form of psychotherapy which appeared to offer a miraculous cure, especially hypnotism and suggestion, which he believed were essentially interchangeable terms.69 Instead of tricking the patient with “mysterious powers,” as he called any form of suggestion, he followed Dejereine’s method of instilling confidence in the patient by creating an atmosphere of cure. “Encouragement,” he said, “is, in my opinion, far more effectively given by way of demonstration than by way of suggestion. The difference is this: ‘You think you cannot walk, but I now put it into your head that you can’: as compared with ‘You think you cannot walk, follow my instructions; observe you are walking.’ Exponents of hypnotism have told me that this is suggestion; I am unable to see it.”70 Rational persuasion and re-education were accompanied by a variety of distraction and “demonstration” therapies including massage and faradic electricity applied with the wire brush.71 During the first six weeks of 1917, No. 4 Stationary discharged eighteen of the twenty-nine Canadian patients admitted to hospital (62 per cent) to full duty with their original units at the front.72 One of these was Private George A., an upholsterer working in Hamilton, Ontario, who joined the 67th Pioneers in September 1915 at the age of twenty-five. A. was first admitted to hospital with shell concussion on 21 November 1916, but he soon recovered and was back with his unit at the front by the middle of December. On the 27th, though, he again reported sick and spent ten days in a DRS before being evacuated to No. 4 Stationary Hospital on 20 January. After twelve days in hospital undergoing functional re-education, Carmalt Jones discharged him back to duty and he remained there – even earning a good conduct badge – until April 1918 when he was transferred to the Canadian labour pool.73 It was a typical case among the hundreds treated at No. 4 Stationary. Although similar to the “success rate” reported by divisional and corps rest stations at various points in 1915 and 1916, those statistics had never been tracked and so Carmalt Jones’s system appeared to be revolutionary. A New Shell Shock Policy Only a few weeks after taking over the hospital, Carmalt Jones announced that he had been able to restore around 60 per cent of patients

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to full duty whether they were serious or mild cases – men who otherwise would have been lost from their front-line units.74 Based on this experience, he drafted a memorandum outlining a series of recommendations for adoption throughout the BEF which he sent to the hospital’s commanding officer, Colonel A.L.F. Bate, who quickly forwarded them up the chain of command, through Holmes’s office, until they reached Sloggett’s desk in the first week of February.75 While Myers had argued that only the milder cases could be treated close to the front, Carmalt Jones promised that his method would “secure the return of all possible cases to their units.” He proposed that the best way to make this happen was to convince patients that this was, in fact, the only possible outcome, essentially denying the legitimacy of their illness and anything except the most basic form of rest and talk treatments. “It is therefore allowed to be understood among patients,” he wrote, “that they will return to the front as soon as fit, without alternative, and that evacuation to England or transfer to a Base will not be considered. For the same reason patients are not allowed to consider themselves invalids, but are got up at the earliest possible moment, employed on fatigue, exercised at physical drill, taken on route marches, and when practicable, engaged at their trades. As soon as physically fit they are returned to their units, that is, when they are free from symptoms, can do a full day’s work, sleep well, and have ordinary emotional control.”76 Once soldiers no longer conceived of themselves as sick patients, he argued, their symptoms would disappear on their own, and once they got back to the front they would convince others that medical avenues of escape had been closed. Consequently, he hoped, shell shock admissions would drop. But this would require strict medical discipline: to make the system work, it would be necessary to discharge as many men from the hospitals as quickly as possible, even those likely to relapse, because “if discrimination is exercised here, much of the potential value of the Centre will be destroyed.”77 Acknowledging that this meant that unstable men would inevitably be returned to their units, he added: “It is probably most fair, both to the man and to his Officers, to send the OC of his unit a statement of his history, and for the CO to deal with him according to his discretion, either by employment in the line, in the transport, or at the Base.”78 Carmalt Jones’s approach corrected what many in the army saw as an imbalance between the more forgiving approach of civilian doctors and the disiciplinary concerns of the army. Whereas Brown and Myers believed it was necessary to treat both a patient’s symptoms and the



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underlying cause of the breakdown, Carmalt Jones believed that in the prevailing military context, concerns about manpower and discipline trumped everything else. Returning to the RAMC’s basic mission, which was to ensure that the efficiency of the fighting forces was not encumbered by the need to care for the sick and wounded, he proposed to concentrate only on removing symptoms and returning men to duty when they were physically fit. This meant accepting that some, and perhaps even many, would be mentally unwell when they went back to the trenches. Of course, some men would still need to be sent to the rear, but they would be a minority. Yet Carmalt Jones clearly believed that shell shock or war neurasthenia was a legitimate response to the stresses and traumas of war, but he was prepared to publicly deny that reality and to bar soldiers from treatment in the interests of military discipline. As Colonel Bate recorded in his diary after a meeting with Carmalt Jones, “The principal object of these shell shock centres is to initiate early and effective treatment in order to secure the return of all possible cases to their units and the employment on useful work of as many as possible of the rest, military interest being the only consideration under the circumstances.”79 This military-minded approach had significant appeal for DGMS Sloggett because it provided a medical pathway towards meeting Fowke’s demand that soldiers not be allowed to choose the terms of their participation in the fighting.80 On 13 February, Sloggett’s office issued a memorandum entitled “In­ structions for Dealing with Cases of Suspected Shell Shock and Neuras­ thenia” which provided a new basis for shell shock management, diagnosis, and treatment.81 Under these regulations, all cases of nervous illness would be sent directly to a special hospital upon admission to a regimental aid post, field ambulance, or CCS. However, as had already been done in Fifth Army, the use of the diagnosis “shell shock” or “neurasthenia” was banned in the front lines, replaced with the terms NYD (? Shell Shock) and NYD (? Nervousness), which were to remain on the patient’s medical cards and papers “until a carefully considered diagnosis based on sufficient evidence has become possible.”82 In the meantime, an officer appointed by each corps or division would ensure that transfers to the special hospital were followed by a report from the patient’s commanding officer or another “responsible witness” on the circumstances of the case. At the special hospital, the neurological or psychological specialist would be the only person allowed to use the term “shell shock,” which would now be strictly limited to soldiers able to produce “evidence as to direct contact with an explosion.”83 Soldiers

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would only be evacuated to a CCS with the wounded if they had been “buried or blown up by explosion,” or suffered some other tangible close call with a shell, while all other cases would be diagnosed according to the RAMC’s official nomenclature of diseases with neurasthenia, hysteria, or another mental illness. These would not to be listed as battle casualties and could not be evacuated without the permission of the Adjutant General’s branch and so, in the meantime, had to be “retained at the special medical unit allotted for their reception.”84 In effect, this meant that unless a soldier could prove that he had been blown up by a shell and was thus suffering from a “genuine” disease, he would be sent back to his unit or assigned elsewhere in the army to other duties, not because he was well but because the army would not recognize his suffering.85 These new regulations standardized several practices already in use across the BEF, drawing on restrictions and procedures adopted in Fourth and Fifth Armies, combining them with some of Myers’s proposals as well as Carmalt Jones’s strategy of denial. Yet embedded in these instructions were important but subtle changes, not the least of which was the end of the term “shell shock (sick).”86 In effect these orders meant that nervous illness was no longer to be treated in the lines or at divisional and corps rest stations. The restrictions imposed on diagnosis, especially where it would take place and under what circumstances, also placed limitations on front-line doctors’ authority while shifting decision-making burdens entirely to the specialists at the army shell shock centres. While this met Fowke’s demands for a more restrictive, martial approach, Sloggett ensured that diagnostic power resided with the medical services. However, the specialists in charge could only exercise this authority once the necessary evidence arrived from the front – a cumbersome bureaucratic process that was bound to create endless administrative problems when casualties were heavy. At the army centres, specialists would be free to use whatever methods they believed necessary to return the largest number of men to duty, and this quickly became their primary purpose. In practice, though, as the experience of the Canadian Corps demonstrates, the process through which “direct contact” would be officially established was cumbersome, arbitrary, and begged evasion by busy field ambulance doctors and nervous soldiers alike. First, a request for information had to be written out by the attending doctor at the front (presumably between surgeries) on a confidential army



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form that listed the soldier’s name, service number, and unit. It noted that the soldier was “being evacuated on urgent medical grounds” by a certain field ambulance to a certain hospital and stated that the soldier had been diagnosed only provisionally with shell shock or neurasthenia.87 This form had to be filled out in triplicate with one copy accompanying the patient on his journey to the special hospital, another going to GHQ, and the third to the Assistant Adjutant General of the relevant army. The Assistant Adjutant General would then forward copies of the correspondence back to the soldier’s own corps, specifically to the office of the Deputy Assistant Adjutant General, which would then investigate the case. This meant that each hospital admission for suspected shell shock or neurasthenia generated a flurry of paperwork. In the Canadian Corps, the Deputy Assistant Adjutant General’s special shell shock officer was Captain Harold S. Gray, an unmarried, twenty-two-year-old clerk from London, Ontario, who had served in the militia’s 26th Regiment before the war.88 Each day Gray received a list of admissions from the special hospital, which he had to cross-­ reference with a pile of shell shock forms from corps headquarters. When he found a name without a corresponding form, he had to write to each man’s unit asking for more information about the circumstances of the soldier’s case. Responses came scrawled on field messages, the back of old daily orders, or other scraps of paper – rarely on the prescribed paper. Although the query initially went to the patient’s commanding officers, if the battalion’s doctor was available it was usually him who replied. However, battalions were comprised of around 800  men who were constantly being struck-on and -off strength, so senior officers, including the RMO, could rarely claim to offer any direct evidence. Indeed, medical officers struggled to grasp the new requirements’ rationale and actively resisted their imposition. As Captain Hugh Mac­Kinnon, the medical officer of the 20th Battalion, explained that spring: “I fail to see the importance of written statements from the Regimental MOs on such cases. In some cases the man shocked may be alone and we have to go entirely by his statements. In other cases he may be the only one left of several and one has to go by his findings and statements of the patient. Then, sir, in the [Regimental Aid Posts] we have no room or time to investigate and go openly into such cases. It takes some time to send runners to go for particulars from company commanders who in most cases don’t know anything about it.”89

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Vimy Ridge The new shell shock regulations went into effect only a few weeks before the Battle of Vimy Ridge began on Easter Monday, 9 April 1917. In this, the most famous Canadian action of the war, the Canadian Corps was tasked with supporting the northern flank of the larger British effort east of Arras, which was itself a diversionary attack intended to draw German reserves away from the main French effort in the Cham­ pagne. For months, the Canadian and British soldiers of First Army drilled on new weapons, practised across full-scale mock-ups of the battlefield, and learned how to hug a creeping artillery barrage that would lead them onto their objectives.90 But gaining the ridge came at a heavy price: 3598 killed and 7004 wounded in only six days of intense fighting between 9 and 15 April 1917.91 Official figures show 201 cases of shell shock, neurasthenia, and hysteria in the Canadian Corps during the month of April, only about 2 per cent of non-fatal casualties.92 At Vimy it was more difficult for soldiers to obtain a shell shock diagnosis as the new regulations favoured soldiers actually bruised or otherwise physically affected by shellfire. For example, Private James B. of the Princess Patricia’s Canadian Light Infantry, a thirty-four-year-old soldier who had been at the front since the summer of 1916, was “blown by [a] shell into the air on April 9th 1917 at Vimy.” According to his medical records, he was knocked unconscious for more than ninety minutes while he was taken by a comrade to No. 9 Canadian Field Ambulance. His unconscious state and visible contusions allowed doctors there to immediately make a diagnosis of shell shock (although technically this was not allowed) and send him via a CCS to the 2nd Australian General Hospital rather than to the special hospital. There B. complained of headaches, deafness, dizziness, tremors, and functional paralysis of the legs. A few scrapes on his face and the testimony of his friend was enough for doctors at the field ambulance to conclude that he had indeed suffered exceptional exposure at the front.93 The absence of visible wounds, though, automatically cast suspicion. In the case of Private Harry B., a steam engineer from Brighton who emigrated to Indian River, British Columbia, before the war, doctors were quick to note that although he claimed a “shell blew him over and threw him on his face … there [was] no visible bruising,” and so he was sent to the special hospital to await a diagnosis and confirmation of direct contact.94 It is safe to assume that the majority of the decrease in reported admissions reflects changes to diagnostic processes rather than levels of suffering.



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Senior medical officers in the Canadian Corps complained about the arbitrary nature of the distinction made between cases of nervous illness caused by direct contact with a shell and cases of exhaustion. When told by First Army’s Deputy Adjutant General that his division was sending too many “disingenuous” nervous men to the rear who had not had direct contact with a shell, Colonel W.W. Ford, the ADMS, 2nd Canadian Division, responded: “Cases of neurasthenia should be evacuated. This is a serious nervous disease, requiring treatment in a special hospital. If by “genuine” is meant “proper,” the answer is in the affirmative.”95 For Ford, a “proper case” was one in which symptoms required medical attention – the issue of how those symptoms came about was irrelevant. In many cases, though, doctors found that even soldiers who had been blown up by a shell were denied a shell shock diagnosis at the special centres because of a lack of corroborating evidence. On 5 May, Colonel H.A. Chisholm, ADMS, 4th Canadian Divi­ sion, told the Adjutant General’s office that as far as his officers were concerned, any soldiers evacuated from the front with shell shock or neurasthenia had been “considered Battle Casualties by the Field Am­ bulances. Owing to the stress of work and number of casualties among Officers of the Units Concerned, it is not possible to get a statement from the Officers in immediate command of these cases for very good reasons. When the cases are absolutely genuine cases of shell shock during a heavy action they are evacuated as such.”96 Indeed, in the chaos of trench warfare, it was absurd to ask front-line doctors and officers to verify that specific soldiers had or had not been blown up or otherwise had direct contact with a shell. For example, when a private from the 3rd Battalion reported with shell shock after the fighting at Vimy Ridge, his platoon commander was forced to say that although he had been “under heavy shell fire and he became very nervous and was unable to carry on,” he did not personally witness any “direct contact with an explosion.”97 What the army required was a response like that of Sargent Lamb, in command of one of the 3rd Battalion’s other platoons. He wrote to say that Private J. Watts “on the 19th April was in the trenches when a shell burst in his vicinity and buried him for a few minutes. I was a witness of this occurrence and helped to dig him out.”98 But while many soldiers shared Watts’s experience, in the confusion of battle and considering casualties, such direct testimony proved exceedingly rare. Yet there was room for resistance within the system: nothing stopped officers from lying or exaggerating. In fact, Captain Leppard of the 15th Battalion had a typewritten form

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drawn up onto which he could write the details of each soldier sent back with shell shock. The form began with a black space for the soldier’s name and number and was followed by a printed declaration that read: “was in direct contact with shell fire,” which suggested that he took the exercise less seriously than some.99 However, this was precisely the point of the system: without direct evidence, most men would be forced to return to the front or be shamed into accepting another diagnosis, which the army hoped would discourage others from reporting. One of the easiest ways medical officers could evade the new regulations was to use alternative diagnostic terminology that was not covered by the regulations. An examination of the surviving 1st and 2nd  Canadian Divisions’ field ambulance admission and discharge books shows that the officially sanctioned terms “NYD (? Shell Shock)” and “NYD (? Nervousness)” actually accounted for no more than 20 per cent of admissions for nervous illness during March, April, and May 1917. More common were diagnoses like concussion or Disordered Action of the Heart (DAH). The latter, which had all but disappeared by the end of 1915, suddenly came back into vogue during the winter of 1917, accounting for between 15 and 20 per cent of front-line admissions. DAH was, of course, a more nebulous and flexible term that could encompass a wider variety of functional somatic symptoms often attributed to shell shock. Under the new regulations, which only dealt with shell shock, it was also less open to scrutiny.100 It is probable that doctors resurrected DAH to evade the new regulations. For example, Private Frank B. of the 14th Battalion was admitted to a field ambulance in the winter of 1917, and although diagnosed with DAH and sent to hospital, he had few heart-related symptoms. His doctors recorded that his blood pressure was 130 over 80, that his heartbeat was normal, and that there was no evidence of a murmur – at times, though, he experienced “some palpitation.” His pulse was also steady and normal – 96 beats per minute on exercising and 84 within two minutes of resting. His main symptoms were areas of hyperasthesia (unusual sensation) on the left side of the body, tremor of the extremities, shortness of breath, vertigo, tightness in the chest, and a general feeling of nervousness. These were all symptoms consistent with typical cases of shell shock or neurasthenia – especially considering that the soldier had also been blown up on the Somme. However, the fact that he remained on duty for several months before reporting ill made it difficult to link his symptoms to a specific trauma, and so DAH provided a ­viable alternative.101



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Indeed, there was little to stop front-line doctors from using other symptom-based diagnoses such as myalgia, debility, or gastritis to evade regulations. On the front lines, the vagueness of these terms had an appeal as they could be used to quickly communicate the nature of a patient’s suffering to other doctors while avoiding any need to explain what was actually at the root of the problem, thus circumventing the army’s increasingly cumbersome regulations.102 In 1st and 2nd Cana­ dian divisions there were hundreds of admissions for myalgia and debility in the late winter and spring of 1917, even during the heavy fighting at Vimy Ridge when one would expect that “vague pains” might not be an acceptable excuse to avoid duty at the front. Presumably most of these soldiers would have been suffering from aches and pains related to the physical stresses of life in the trenches rather than nervous illness, but it is telling that many were also later re-diagnosed with neurasthenia or shell shock. For example, Private Charles P. B., an American from Grand Rapids, Michigan, who enlisted at Wind­ sor on 30 March 1916, arrived in France as a reinforcement after the Somme. Within three months the twenty-two-year-old was evacuated to Eng­land with debility. At the beginning of March, his battalion, the 67th  Pioneers, were busy making preparations for the battle of Vimy Ridge where he was subjected to heavy shelling. Ball was never blown up, concussed, or physically injured in the barrage, but he lost his nerve and reported sick and was then sent to No. 2 Field Ambulance. There he was examined and appears to have stayed the night before returning to the trenches the next day. Because there was no history of personal contact with a shell explosion, a shell shock diagnosis would not stand up to scrutiny and, because the soldier was young and had only been in the front lines for a few weeks without seeing any action, he could hardly be considered neurasthenic in comparison with the other soldiers who had endured the horrors of the Somme. So, as he later told his doctors, “he returned to the lines for a couple of days but was unable to remain owning to extreme nervousness [and that] he lost consciousness several times.” Returning to the field ambulance on 10 March, B. complained of nervousness, general pains, headache, severe heart palpitations, bad dreams, and fainting spells. Reluctant to send him back to the front, the doctor diagnosed him with “debility” and evacuated him to No. 42 CCS rather than send him to the army receiving centre for nervous cases. Ball spent several weeks resting at No. 20 General Hospital at Camiers before being sent to England, where his diagnosis was immediately changed to neurasthenia.103 Likewise,

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James Alexander B., a painter from Strathroy, Ontario, spent seven months in the trenches before he began to feel nervous, developing pains in the back and legs as well as a cough and low-grade fever. He eventually reported sick just before the battle of Vimy Ridge and was sent to hospital with myalgia. When he arrived in England, he was admitted to Granville Special Hospital, where he was re-diagnosed with neurasthenia. After several courses of massage and hydrotherapy he was eventually sent to a convalescent hospital and then discharged medically unfit.104 Despite the willingness of medical officers to evade the system, in the winter and spring of 1917 traumatized soldiers faced a less sympathetic medical system in which the advantage inevitably went to longer-­ serving men who were well known in their units with friends able and willing to speak up for them. Misfits, outcasts, and “new men” were inevitably at a disadvantage. For example, when Gray asked the medical officer of the 21st Battalion to confirm that two shell shocked soldiers, Privates S.L.C. and C.G., had endured exceptional exposure at Vimy, he gave different answers for each man although he had no personal knowledge of either case. “[C.] came out of the Front Line in an apparently terrified condition,” he explained, “jumping and crying out at each shell explosion. He has always been nervous and afraid … [G., in contrast,] had a statement from me to the effect that he said he had been blown up by a shell and woke up three hours later – 8:30 am on April 9th – in Zivy Cave, and now jumped nervously under shell fire. He has previously been a good conscientious worker as a stretcher-bearer.”105 The implication was that C. was a scared, timid soldier and that it would be wrong to describe his condition as shell shock. Although the doctor had not personally seen G. get blown up by a shell, he was willing to give this “conscientious worker” the benefit of the doubt. The specific, passive wording he used – which acknowledged only hearing from G. that he had been blown up – was a clever attempt to lend some legitimacy to the argument, but it basically meant that in both cases the doctor was unable to do more than say he had seen the patient at the aid post.106 Although these judgments were no more subjective than in previous battles, a negative opinion of a soldier now did more than stigmatize the individual; it served to deny him medical care. Officers need not be sympathetic, though, to advocate for the evacuation of nervous casualties: nervous men could be a liability in battle because they were thought to be unreliable, which, it was feared, would sap morale and perhaps even cause unnecessary casualties if they were



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kept in the line. When the Adjutant of the 52nd Battalion was questioned about why Private D. had been evacuated when it was understood that he had not been subject to exceptional exposure, he told Canadian Corps Headquarters that the evacuation was necessary for morale. He said that he would be “very glad” if D. could be evacuated with shell shock “as he has been a continuous source of trouble to us since the Somme operations and is absolutely useless. If our line is bombarded at all he does not seem to be able to restrain himself and his nerves seem to collapse. Not only is he useless in the line but is a source of danger to the rest of the men as they never know what he will do.”107 Although sceptical at first, First Army Headquarters acquiesced and ordered the man sent to the rear.108 Similarly, the medical officer of the 7th Battalion reported that he had evacuated one soldier even though he was doubtful about the legitimacy of his condition because he did not want him to go into the trenches before the “big show” at Vimy. “Prior to leaving Camblain l’Abee for front line, he said he was not fit to go to trenches having been before medical boards in England. I saw nothing the matter with him but sent him before ADMS for confirmation and he did not return.”109 This perception that nervous men were a liability actually helped further Carmalt Jones’s goal of stigmatizing and delegitimizing nervous illness. Although suffering soldiers clearly had to take greater risks to seek medical care, many were willing to risk their sense of masculinity and position within the army to escape the front. Spr. Edward L. was one of the Canadian tunnellers working below Vimy Ridge and on the evening of 31 March 1917, left the front line to report with shell shock at No. 74 British Field Ambulance. There he told his doctors that he had been blown up by a shell during a heavy bombardment while working close to the front and his nervous state seemed to confirm his story. “During this man’s stay in hospital,” reported Captain J.C. Hawke, one of the field ambulance medical officers, “he has exhibited signs of great nervousness. Last night, when in bed, because a heavy bombardment commenced, patient leapt up and walked up and down the ward in a state of trembling and fear, and he did not sleep all night.” Given his state, L. was sent to No. 4 Stationary Hospital with the provisional diagnosis of “NYD? Shell Shock.” According to the regulations, Carmalt Jones sent an inquiry to the 255th Tunneling Company’s medical officer, asking about the circumstances of his breakdown. Two days later he replied: “So far as I am aware, Sapper L. has not been in close proximity to bursting shells, either now or at any other time. For about

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15 months he has acted as Sanitary Orderly in back billets.” Lacking direct evidence of “exceptional exposure,” L. was ordered back “to his unit forthwith, in order that disciplinary action may be taken.”110 Whether he was tried or not is unknown. But one effect of the new orders was that men like L. could be charged with a range of offences including desertion or cowardice because any “lies” would be used as  evidence of intent. However, the decision to prosecute was always left up to the divisional commander, who was allowed to use his discretion to decide whether a court martial would be useful for maintaining discipline.111 As Teresa Iacobelli has shown, military judicial authority was seldom exercised with either precision or purpose so that the decision to refer cases to the Adjutant General’s office was ­almost always arbitrary.112 Improved Outcomes? Following the creation of the new system, between 15 February and 31 May 1917 a total of 185 Canadians were admitted to Carmalt Jones’s shell shock ward. Of these, 34 per cent were evacuated to the base for further treatment with shell shock or neurasthenia, while 8 per cent were given a new diagnosis for organic disease. The remaining 57 per cent were discharged from hospital to duty, 29 per cent returning directly to their units at the front, while the remainder went to convalescent camps and to rear-area units for base duty. This is consistent with Carmalt Jones’s claim that around 60 per cent of patients could be quickly returned to duty. However, on average patients spent eighteen days in hospital and those who returned to the front spent the most time at No. 4 Stationary, around twenty-one days. While this was a faster turnaround time than would have been possible if soldiers were sent to the base, it was actually far longer than had been the norm in divisional and corps-level rest stations earlier in the war.113 Surprisingly, soldiers who were given “legitimate” diagnoses at the special hospital were more often the ones sent back to duty. Of the seventy-eight Canadian soldiers who were evacuated, only about 15 per cent had a confirmed diagnosis of shell shock (wounded). The largest number (37 per cent) were sent to the base still labelled “NYD (? Shell Shock),” while the rest were described as “nervous” (35 per cent), “NYD (? Nervousness)” (4 per cent), or hysterical (3 per cent). One of these was Pte. Joseph Walter F., a twenty-three-year-old labourer from Resti­ gouche County, New Brunswick, who enlisted for overseas service in



Managing Shell Shock at the Front 225

May 1916. F. reached the front in November 1916 and was attached to a labour battalion behind the lines until the middle of March 1917, when he joined the 25th Battalion. On 7 April, two days before the battle of Vimy Ridge began, he was evacuated to hospital after reporting that he had been blown up by a shell. F. reached No. 4 Stationary on 9 April, diagnosed with “concussion” and appears to have told his doctors that he had been blown up during the fighting for the ridge. How­ever, upon further investigation it was discovered that he had been in No. 1 Canadian Field Ambulance when the Canadians went over the top and had to be evacuated to make room for incoming casualties. At No. 4 he was accordingly re-diagnosed “NYD (? Shell Shock)” and sent to the base. F. eventually reached England and was sent back to Canada, where he continued to claim that he had been blown up by a shell at Vimy Ridge.114 Another was Private Joseph Henry G., a mechanic from Windsor, Ontario, with five years’ experience in the Canadian militia. G. joined up in September 1915 and arrived in France in the summer of 1916 and was one of the “unfit” replacements that Macphail and Fotheringham complained about when he joined the 18th Battalion. Over the next eight months he was in and out of the line with various complaints, being assigned to base duty only to be reassigned to the front time and again. On 10 April 1917 he reported sick with “general malaise and shock” and was sent to No. 4 Stationary as “NYD (? Shell Shock), where he spent twelve days in hospital before being invalided to the base with the same diagnosis as he was unable to demonstrate “direct contact” with a shell. G. eventually returned to the front in late June 1917, but within three weeks was back in hospital with shell shock, although this time he had the contusions to prove it. Sent to England this time for treatment, he only rejoined the 18th Battalion just after the Drocourt-Quéant Line was captured in early September 1918, returning to Canada in the summer of 1919.115 Again, somewhat paradoxically, of those who returned to duty, 42 per cent were sent back with a confirmed somatic diagnosis of “shell shock (wound),” DAH (19 per cent), or concussion (5 per cent). Of the remainder, 23 per cent retained the original diagnosis of “NYD (? Shell Shock), while 28 per cent were described with some variant of “nervous.” Yet there was often little that seemed to distinguish a “genuine” case from an illegitimate one except for the subjective judgment of the doctor. For example, George Herbert A., a labourer from Montreal serving in the 19th Battalion, reached the front at the beginning of Decem­ ber 1916 and reported sick at Vimy Ridge in the days leading up to the

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beginning of the offensive.116 Like Private Joseph Henry G., he arrived at No. 4 Stationary Hospital on 10 April, then spent the next forty-eight days in hospital – one of the longest stays that spring – before being discharged directly to duty at the front with his old unit on 28 May 1917. Although there was no record of his being admitted to a field ambulance (suggesting that he had left the front on his own initiative), he was eventually diagnosed as “shell shock (w).” Within two months, though, he was back at the hospital, again diagnosed with suspected shell shock. As he had done at Vimy, A. left the line on 6 August just before the Canadian attack at Hill 70 began. At No. 4 Stationary he told doctors that he had been on a working party at the front when suddenly he was “blown up” by a shell that killed three of his comrades and wounded four others. I “was taken to the RMO who sent [me] sick,” he said. However, when queried his commanding officer reported that A. had not, in fact, been blown up by a shell and that the events he described never happened. The 19th Battalion was in divisional reserve, far behind the front, from 1 to 5 August and only went into the line on the 6th – the only casualty that day was an officer and no further losses were incurred before A. reached No. 4 Stationary.117 As Carmalt Jones noted, though, diagnosis was less about medical accuracy than sending an appropriate message to soldiers at the front that certain types of behaviour would not be tolerated. “The distinction [between legitimate and illegitimate],” he wrote at the end of 1917, “is of little clinical interest, but was required by the higher authorities for disciplinary reasons.”118 In general, evacuation cases were given a more stigmatizing diagnosis to make patients feel that they were under a cloud of suspicion. In contrast, while soldiers given a “genuine” diagnosis may have been allowed to wear a wound stripe, they were more often sent back to the front which conveyed a clear message: there was no easy avenue of escape. The reduction in officially reported casualties led DGMS Sloggett to believe that the shell shock problem had at last been solved. That winter, weekly statistical returns from the special hospitals showed only a fraction of the admissions seen on the Somme, and there were no alarming messages about field ambulances and CCSs overwhelmed by shell shocked men. This was reinforced by Sir Wilmot P. Herringham, one of Sloggett’s most trusted friends and advisers, who was sent by the DGMS to visit each special hospital and report back on their operations during the winter of 1917.119 Herringham was a consultant physician at St Bartholomew’s Hospital, London and Vice-Chancellor of the



Managing Shell Shock at the Front 227

University of London and his expertise was in the diagnosis and treatment of diseases of the kidneys rather than psychiatry or neurology. Before the war, he was best known as a reformer of medical education and as an advocate for more rigorous clinical research.120 But he had been at the front a long time. After improvising a hospital to treat Belgian refugees in September 1914, Herringham was asked to go to France as a medical consultant, where he quickly became an important member of Sloggett’s inner circle, second only to his friend Sir Anthony Bowlby in his influence with the DGMS.121 The pair spent much of their time overseas making investigations on Sloggett’s behalf into a variety of military-medical problems, which included studying the first cases of trench feet in the winter of 1914–15 as well as the first Canadian gas cases at Ypres later that April.122 Like Bowlby, Her­ ringham had a clear understanding that the requirements of military medicine differed from those of the civilian world, and for Sloggett this was his most important attribute.123 After a meeting of the DGMS’s advisory committee in early February, Herringham began his tour of the stationary hospitals and CCSs assigned to care for shell shock cases in each army area.124 He was neither surprised by the number of casualties nor particularly mystified by the variability of the symptoms as he recognized that they were similar to the type of nervousness commonly seen in private practice.125 The majority, he believed, were genuine in so far as the patients were not intentionally simulating their condition – even those who were openly lying were deceiving themselves at least in part – and in his view, most seemed to truly wish to return to the front as quickly as possible. Her­ ringham was particularly struck by the success reported by Carmalt Jones at No. 4 Stationary Hospital.126 In explaining why some men broke down and others did not, Herringham followed that doctor’s lead, arguing that many had a “temperament which, either from an inborn predisposition or from adverse circumstances, is unable to meet the ordinary trials of life with the firmness of an ordinary man.”127 But this also meant that most patients – especially the milder cases – could be quickly and easily returned to duty with a quick rest, adequate food, and a little encouragement. Herringham believed that Carmalt Jones’s method of rational persuasion was the most effective form of treatment because it helped soldiers regain the self-control they would require to succeed in the trenches. “They were told that they would soon be all right again, and just as men recover from other frights they recovered from this,” he wrote.

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Some insisted that they had not been in the least afraid, but that their condition was due to some physical cause which they could not explain. The only way to cure such men was to convince them by quiet reasoning that they really had been frightened out of their wits, and then to point out to them that everyone was horribly afraid, but that brave men did not give way under the stress, and now they realised the true state of the case they must resolve to control themselves and play their part with the others. Many went back with this determination. Some succeeded, and even won decorations for bravery, but probably the greater part eventually broke down again.128

Herringham thus submitted a favourable report to the DGMS’s office on 3 April, just before the beginning of the Battle of Arras, concluding that the specialists in charge of the new wards had clearly “developed great skill in dealing with [these cases] and cured the majority in a comparatively short time.”129 Although Herringham’s positive report confirmed for Sloggett that the new system was operating effectively, operations at Arras and Vimy had also identified a number of limitations. On 2 April, Colonel Bate noted that it was growing increasingly difficult for Carmalt Jones to secure the necessary statements from front-line units, especially for the men evacuated from First Army, which bore the brunt of the heavy fighting.130 “As the diagnosis depends on the written information,” he wrote, “it is impossible to dispose of these cases (and at the same time comply with GHQ instructions) unless the written details are available, i.e. the facts as to how the condition was brought about as for instance in cases of ‘shell shock’ how far the [patient] was exposed to ‘shell burst,’ if burned or otherwise exceptionally exposed. It would appear that during battle periods the info is difficult to procure and hence long delays necessitate keeping cases a long time undiagnosed.”131 At the beginning of April, though, First Army units were still in the preparation phase for their assault at Vimy and Arras and the problem only grew worse once actual operations began a few days later.132 As officers at the front were killed or wounded, it sometimes became impossible to find someone to make a statement with knowledge of the case. In other instances, front-line units were simply overwhelmed with the work of fighting the war and refused to respond to queries or evasive, non-­ committal answers. The situation was not unique to No. 4 Stationary Hospital. At No. 3 Canadian Stationary Hospital, which handled shell shock cases for Fifth



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Army, as early as 19 March 1917 there were 135 cases of “NYD (? Shell Shock)” clogging up the wards awaiting the necessary paperwork to formalize a diagnosis and proceed with treatment. To ensure that cases did not slip through the cracks, evacuations were explicitly banned on 16 April by Fifth Army’s DMS so that by 14 May there were nearly 750  patients in hospital – double its bed capacity. On 21 May alone, 164 shell shock patients were sent to the hospital and not one of them was accompanied by the necessary paperwork.133 Without a statement one way or the other, nervous soldiers were supposed to remain at the special hospitals indefinitely. But as casualties mounted, it became increasingly difficult to retain large numbers of patients who were essentially only waiting on paperwork that might never show up.134 During the month of April, for example, No. 4 Stationary admitted a total of 2393 wounded of all kinds, although the unit had officially only been allotted 300 beds.135 On 28 April, though, there were still 873 patients in hospital, many of which were in Carmalt Jones’s now overflowing shell shock ward – two weeks later there were nearly 1300.136 In addition to the practical need to free up bed space, the threat of air raids also made it inherently risky to keep so many men piled up in corridors or stacked up in outside wards improvised from bell tents. At the beginning of May, Carmalt Jones told First Army’s Adjutant General that “if the various circulars on evacuation are adhered to strictly the evacuation of shell shock cases will not be workable in a short time.”137 When orders came down from First Army’s DMS at the end of the month to clear up space, the only solution was to ignore the regulations and evacuate patients who were still waiting on their paperwork – some of whom consequently remained officially undiagnosed.138 To avoid a new evacuation crisis, Carmalt Jones recommended that the hospital send nervous patients to convalescent camps where they could continue their treatment and then return to duty. A series of convalescent camps had been established the previous year along the lines of communication in order to provide the space necessary to retain patients in France who were not yet physically fit to return to duty; after a period of hardening, it was intended that most convalescent admissions would be sent to base depots, where they would join reinforcement drafts to make their way back to the front.139 Transfers started at the beginning of May and the first to go were patients whose paperwork was incomplete but had been given a positive prognosis. For example, Sapper Herbert James A., a Welsh machinist living in Winnipeg,

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was admitted to No. 4 Stationary Hospital on 24 April 1917 and diagnosed with DAH. After twenty days in hospital he was transferred to No. 2 Convalescent Depot, Boulogne, and spent the next two months in various French camps until he finally returned to duty on 10 July.140 However, the number of cases continued to rise throughout the month and into the next, so that by 18 June, there were over 1000 cases of shell shock at No. 4 Stationary Hospital.141 In order to make space for the dozens of new cases which continued to arrive on a daily basis, more and more soldiers had to be transferred to convalescent camps including those whose paperwork was not yet complete, leaving them with only a provisional diagnosis. Yet a large part of the problem was the same as that reported on the Somme: many of the men sent to the special hospital were not suffering from “shell shock” so much as fatigue and exhaustion. “The number of admissions for shell shock NYD are increasingly rapidly,” wrote Colo­ nel Bate, “but it is thought that a fair percentage should not be associated with the term shell shock being considered hereof. Cases of men partially broken down as a result of prolonged and physical strain owing perhaps to continuous exposure and and [sic] heavy work.”142 Carmalt Jones and Colonel Bate discussed the matter with Gordon Holmes and Sloggett’s Deputy Director General, W.G. Macpherson, at the beginning of June as the hospital began to literally overflow with patients: 1011 cases of shell shock and neurasthenia alone by the 19th. It was clear that the special hospitals were increasingly being used as rest stations and that the paperwork involved in processing hundreds of admissions a week would soon swamp the staff. Holmes thus concluded that the only solution was to ensure “that more care should be taken at the point before diagnosing” the cases.143 At the beginning of June, Sloggett’s office revised his February orders to strengthen the authority of army-level specialists by placing further restrictions on the use of the shell shock diagnosis at the front while also streamlining the paperwork involved and regularizing evacuations of undiagnosed patients. As Fowke and Haig later explained to the Army Council, thinking at GHQ had been heavily influenced by both C.C. Manifold’s observations on the Somme and Carmalt Jones’s reports submitted during the winter of 1917. In the spring Fowke wrote on Haig’s behalf, saying: The reports to which I refer emphasize the fact, which is a matter of common knowledge, that for every isolated case of a man’s nervous system



Managing Shell Shock at the Front 231 being unavoidably affected by shell fire, there is a large number of men who have it within their power either to keep their nerves under control or to collapse and go sick. It is inevitable that the determination of some of these men should be undermined by the knowledge that another, whose experiences may be to them indistinguishable from their own, has been rewarded by an honourable distinction for going sick in similar circumstances. The danger to moral [sic] is well put in the report of Captain K.W. Jones [sic] in the words, “It is an awful strain on a man’s nervous system to stick in a trench which is being heavily crumped, and there is really no reason why whole battalions should not go down ‘shell shocked’ once you admit the right of any man to do it.”144

At GHQ, the preferred solution was to ensure that men did not actually have the right to self-identify as shell shocked, or to leave the lines with any form of nervous illness without official sanction from a medical officer. In point of fact, though, this had always been the case and what Fowke did not say was that part of the problem was that medical officers had seemingly been all too willing to allow men to leave the trenches with such a diagnosis. The decision was made to remove the ability of both men and front-line doctors to make such a determination and to place that power in the hands of hand-picked experts like Carmalt Jones, still stationed in the army area, who the army hoped would prove to be less sympathetic. Not Yet Diagnosed Nervous (NYDN) On 13 June 1917, Haig’s headquarters issued General Routine Order (GRO) 2384 accompanied by an interpretation bulletin from Fowke, AG 6902. which affirmed that the shell shock centres were the primary diagnostic and treatment sites, giving the specialists stationed there exclusive authority over nervous illness in the BEF. RMOs and field ambulance doctors would henceforth be forbidden to make any form of nervous diagnosis – even a provisional one – in the front lines. This policy was a logical extension of earlier moves to stifle talk of shell shock at the front while also discouraging patients from thinking of themselves as ill. These new orders went as far as to state: “In no circumstances whatever will the expression shell shock be made use of verbally or be recorded in any regimental or other casualty report, or in any hospital or other medical document.” To further shroud the condition in secrecy, front-line doctors were only to write the abbreviation

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NYDN on field medical cards, standing for “Not Yet Diagnosed – Ner­ vous” although soldiers were not supposed to be told what those letters stood for. All NYDN cases would then be immediately transferred to one of the army centres where they would be examined and diagnosed as before. The chief difference was that the army shell shock specialists would now be in charge of the whole process, including obtaining the necessary evidence from each patient’s commanding officer. To this end, the army drew up a new form, W3436, which consisted of two sections. The top portion, stating the patient’s version of how they had come to be injured, was to be filled out by a specialist at the shell shock centre. This was forwarded to the soldier’s commanding officer, who was asked to read the statement and, in the bottom section, to either confirm or deny the soldier’s version of events, returning the form to the shell shock specialist. This small modification ensured that the paperwork would flow more efficiently between specialists at the rear and officers at the front, cutting out the intermediate step of involving ADMSs and DDMSs in the collection of paperwork. But it was also symbolic of the new trust which senior BEF officers placed in these ­army-level doctors.145 Under GRO 2384 and AG 6902, specialists would continue to make the diagnosis of shell shock on the basis of the evidence derived from their medical examination of the patient as well as the information supplied by the soldier’s commanding officer on the W3436 form. If the evidence clearly demonstrated that symptoms occurred as a result of “direct contact with a specific shell explosion or from some extraordinary exposure to the effects of enemy weapons over and above that to which other soldiers were at the same time and place exposed,” the patient could still be diagnosed as “Shell Shock (Wound)” and he would be permitted to wear the wound stripe. Where there was no evidence of exceptional exposure, doctors had several options. If there were no symptoms at all “beyond those of ordinary fatigue and exhaustion incidental to the strain of battle and common to all soldiers,” the patient could be quickly marked NAD for “No Appreciable Disease” and returned to duty even before the paperwork was completed. If there were only minor symptoms evident, patients would be treated with rest and drill before being returned to duty, either NAD or recovered. Only in exceptional cases, defined by severe and stubborn symptoms, were patients to be evacuated to the base. Tellingly, these instructions also removed the requirement that the special hospitals wait for paperwork to



Managing Shell Shock at the Front 233

be completed before men were discharged from hospital – documents would now be forwarded on after a man was either sent back to another hospital or returned to duty. It was hoped that this would provide shell shock specialists with the flexibility necessary to manage cases effectively while still ensuring that the basic tenets of the system devised over the course of the previous ten months remained consistent: the symptoms of nervous illness alone would no longer provide a legitimate reason to evade duty at the front.146 After the war, C.S. Myers claimed that this new approach was based on a report which he submitted to Sloggett after visiting French neurological centres in June 1917.147 As he recalled: Thus, after more than twelve months of unremitting effort, despite persistent opposition and even misrepresentation of my views, I saw my main recommendations put into effect – the (virtual) abolition of the term “shell shock”; the provision of special receiving “centres” both in Army Areas and at the Bases, and of an expert Medical Officer at each of these “centres” and in each Mental Ward for the appropriate treatment and disposal of all “nervous” and “mental” patients and for the separation of the “sheep” from the “goats.”148

Although historians have taken these claims at face value, Myers did not actually submit his recommendations until early August 1917, long after the publication of GRO 2384 and AG 6902.149 Instead, as Fowke himself explained, those orders drew on a variety of sources to officially bring an end to the jurisdictional dispute which had defined the army’s approach to shell shock since the Battle of the Somme by recognizing that diagnostic authority resided exclusively in the medical corps. By placing shell shock specialists in charge of case management, logistical arrangements, diagnosis, and treatment, it would now be up to doctors alone – albeit with input from front-line officers – to determine which cases were “genuine” and which were “illegitimate.” The Adjutant General and members of his office would no longer oversee the process and would instead rely on the medical authorities to report cases in which intentional deception or malingering was suspected. While this was essentially a tacit recognition that it would be next to impossible to effectively track paperwork on thousands of individual soldiers, the effects were the same. As far as Haig and Fowke were concerned, the necessary safeguards were now in place to protect the BEF from shell shock.

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Conclusion By the summer of 1917, the shell shock epidemic had abated. New diagnostic regulations at the front had reduced both reporting and admissions so that nervous casualties dropped from over 20 per cent of non-fatal wounded to between 2 and 5 per cent. Meanwhile, special hospitals were claiming to return between 50 and 70 per cent of patients to duty after a short stay in hospital, which meant that most of these men seemed to be returning to the front. This all meant that during the Battle of Arras, field ambulances were not clogged with nervous soldiers as they had been on the Somme, even if special hospitals had difficulty processing the paperwork involved with treating shell shocked soldiers. There were no illusions about the reasons for these successes, though. The BEF had made it harder for soldiers to self-report, more difficult for even the most sympathetic front-line doctors to evacuate men to the rear, and even more difficult for those who were sent to the special hospitals to reach the base. At the special hospitals, those with acquired conditions were presumed to have transient symptoms and were almost automatically returned to duty. Those with chronic conditions were increasingly looked on as being defective and were evacuated to the base more frequently, although many were also sent back to the front even though doctors expected them to relapse. When the army and its doctors used the word “cure,” they meant that soldiers had been discharged from hospital and had been earmarked for a return to duty. As Carmalt Jones noted, military necessity trumped all other considerations, including the well-being of patients and so, if symptoms could be reduced that was good, but symptomatic soldiers were also made to go back to the front unless they were physically incapable of carrying on. The publication of GRO 2384 and AG 6902 was the final step in a year-long process of delegitimization. The adoption of the term NYDN did not mean that the military authorities believed that nervous illness did not exist; on the contrary, it recognized that it was a very real threat. NYDN was instead a sleight of hand or exercise in deception designed to prevent soldiers and doctors from discussing emotional suffering. Without euphemistic terms like “nervous,” “neurasthenia,” or “shell shock” to shroud emotional suffering, many prospective patients had no way of seeking care without transgressing masculine norms. Legitimacy now rested on “exceptional exposure,” which was difficult to prove and subjective. As William Johnson, one of the shell shock doctors who would soon be deployed to a special hospital at the



Managing Shell Shock at the Front 235

front, wrote after the war: “The position taken up by the military authorities may be summed up thus. The psycho-neuroses cannot be ignored. Certain cases require medical care. The subject is, however, so bound up with the maintenance of moral[e] in the army that every soldier who is non-effective owing to nervous breakdown must be made the subject of careful enquiry. In no case is he to be evacuated to the base unless his condition warrants such a procedure.”150

Chapter Eight

Illusions of Success: The NYDN Centres, June–December 1917

Gunner Robert A., was a twenty-one-year-old bank clerk when he enlisted at Montreal on 23 March 1916. Attached to the 2nd Canadian Divisional Artillery Column, he arrived in France in July 1916 and endured more than eighteen months’ heavy fighting, although he was never in the front-line trenches as a gunner. On 1 November 1917, during the fighting at Passchendaele, German shells began to rain down on his unit as A. unpacked ammunition at the 25th Canadian Battery, CFA when a high explosive round burst almost under A.’s feet. The force of the blast may well have been partially contained by the deep, heavy mud that filled the battlefield and the force of the explosion threw him up into the air and off the road into the muck, knocking him unconscious for twenty-four hours. As his commanding officer later recalled: “[He] got the full force of the shock and we expected that he had been blown to pieces,” but he was soon dug out when his comrades realized he was alive. Labelled NYDN, A. was sent to the Canadian Corps Rest Station run by No. 2 Field Ambulance, where he was diagnosed with “debility” and remained for four days in the hope that he might recover and return to duty. However, the gunner’s symptoms were severe: his body constantly shook and he stuttered so badly that no one could understand what he was saying. On the 5th he was evacuated to Second Army’s NYDN Centre at No. 15 CCS, run by Lieutenant Colonel W. Taylor, where he remained until his story was confirmed by his commanding officer on 22 November. Diagnosed as “Shell Shock (wounded),” A. was evacuated to England and eventually returned to Canada wearing a wound stripe on his arm to indicate that he had been wounded by the enemy in battle.1



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In June 1917, British GHQ issued new orders that were intended to both reduce evacuations for nervous illness while also standardizing the process of diagnosis and treatment, placing those tasks in the hands of experts working in special treatment centres rather than front-line field ambulance doctors. Historians have assumed that the new Not Yet Diagnosed Nervous (NYDN) system largely accomplished those goals, even if some have been sceptical of the results obtained.2 This chapter examines diagnosis and treatment in the front lines and at the special centres as well as the experience of ordinary patients in the wake of these changes. As the experience of A. at Passchendaele suggests, the practices that evolved at the front bore little resemblance to the requirements of official doctrine. The NYDN Policy By the end of April 1917, it was clear that the Nivelle offensive was failing and that the British Army could begin to adjust its plans accordingly.3 The Commander-in-Chief, Sir Douglas Haig, turned his attention to the long-anticipated offensive in the Ypres Salient, to begin in midJune with an attack by Plumer’s Second Army at Messines, which would be followed a few weeks later with a general advance on Passchendaele Ridge by Gough’s Fifth Army; naval landings and a sweep up the coast would come at some later point.4 This meant shifting Gough’s Fifth Army north in mid-June while First, Fourth, and Third Armies each extended their frontage, going on the defensive in the south. Haig told his army commanders that resources were limited and they would have to “cut their coats” accordingly – manpower would be at a premium as never before.5 Infantry, labour units, engineering battalions, and artillery would all be stripped from the southern armies and sent north, husbanded for the main assault. In order to hide these transfers, the Commander-in-Chief ordered First Army, which included the Canadian Corps, to continue its advance east of Vimy Ridge towards Lens to confuse the enemy and gain a better defensive line between Hill 70 and Méricourt.6 British strategy was based on Haig’s assumption that after the bloodletting at the Somme and Verdun, the German army might collapse if pushed hard enough.7 The new Not Yet Diagnosed Nervous (NYDN) system was conceived at GHQ as part of a larger plan to reduce wastage and protect the fighting efficiency of the British Army ahead of

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these new campaigns. Through GRO 2384 and AG 6902, diagnostic and treatment authority were officially removed from generalists working in front-line units to specialists stationed further to the rear, albeit at hospitals still located within an army area. At the front, RMOs and field ambulance personnel were no longer allowed to use the terms shell shock or neurasthenia and were instead to mark patients as “Not Yet Diagnosed (Nervous)” or NYDN. This was not actually a diagnosis, but a placeholder indicating to potential patients, other soldiers, and medical personnel that expert investigation was required to confirm or deny illness.8 At the field ambulance, NYDN soldiers were supposed to be sent immediately to a receiving CCS, which would then transfer them to the special centre. As one of the specialists in charge of those centres recalled, the new policy was supposed to work as follows: All cases in the Army Area, who are provisionally diagnosed NYDN are sent to us for examination and final diagnosis. When a patient is admitted the Medical Officer fills in para 1. of AFW 3436 on which is shown the patient’s condition on admission and a statement by the patient as to the causes leading or claim to have led to his disability. This form is sent to the OC of the man’s unit who adds a certificate that the man has, or has not, been subjected to “exceptional exposure” with as full and corroborative details as possible. This form is then returned for final diagnosis.9

This arrangement was intended to serve both administrative and medical purposes, keeping men close to the front, where it was easier to verify the circumstances of the breakdown and to return men to duty while also recognizing the fact that “once the man got to the Base it was a struggle to get him back again.”10 Neither GHQ nor the medical services envisioned the NYDN centres as permanent hospitals, but as specialist wards attached on a rotational basis to existing CCSs and stationary hospitals. They operated as sections of those hospitals headed by an officer with the title of “neurologist” (whether he was a specialist in that field or not) with the rank of captain or major. He was joined by at least one and sometimes two junior “neurologists” in training as well as one or two specially trained nursing sisters.11 Some hospitals also employed special gym instructors, orderlies, and masseurs, although this was not universal.12 When the centres shifted from one hospital to another, the special staffs moved with them, so that, for administrative purposes, neurological departments reported directly to either Gordon Holmes or C.S. Myers, the



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consulting neurologists for the northern and southern sectors respectively, as well as the officer commanding the host hospital. However, soldiers admitted to NYDN centres always remained under the jurisdiction of their own army regardless of whether they were treated at a stationary hospital (which was officially attached to the DMS, Lines of Communication) or a CCS in the physical army area.13 NYDN in Practice Doctrine and official policy often diverged in significant ways from front-line practices, and this was true also within the medical services. In this case, it should be remembered that even though GRO 2384 and AG 6902 grew logically from internal discourses within the medical services, they were also imposed on army doctors by Haig’s headquarters and GHQ. As such, they represented a significant external form of control on a branch of the army dominated by civilian doctors accustomed to operating within a profession that normally rejected any form of outside regulation. It is not surprising, then, that the orders were implemented in ways that allowed army doctors to preserve their professional autonomy while meeting the goals and requirements set out by GHQ. The orders issued under GRO 2384 and AG 6902 were less a rigid set of immutable policies than a series of flexible guidelines meant to guide and inform practice. As a result, there were often disagreements within the medical services about how they should be interpreted, especially considering that the two officers in charge of implementing the system, Holmes and Myers, came from different professional backgrounds and had been on the periphery of the formative discussions. Indeed, the boundary between the northern and southern sectors of the front would shape case management during the summer and early fall of 1917. For example, one of the earliest but most significant sources of disagreement arose between Holmes and Myers over how far forward these new hospitals should be situated. While Myers wanted to push the NYDN centres as far forward as possible, Holmes preferred to keep them further back. Their disagreement came to a head in June and July 1917 when Fifth Army moved from the Somme front to the Ypres Sa­ lient, switching between Myers’s and Holmes’s jurisdiction. In Febru­ ary  and March, as Fifth Army followed the German army back to the Hindenburg Line, the DMS C.E. Nichol, found it increasingly impractical to send nervous casualties over 50 km to No. 3 Canadian Stationary

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Hospital, Doullens.14 After consulting with Myers, the Deputy Director General, Medical Services (DDGMS), W.G. Macpherson, suggested that he try, as an experiment, to “deal with shell shock in forward CCSs.”15 So in April 1917 what Myers called an Advanced Sorting Centre was established at No. 47 CCS, Varennes, less than 25 km behind the front lines under the direction of W.B. Davy, a general surgeon with little or no experience working with nervous patients.16 But like Car­malt Jones, Davy proved to be an uncompromising medical officer who was adept at returning men to duty simply by declaring them free of “real” illness, which impressed both Nichol and Myers.17 Despite earlier recommending that the special hospitals be kept back from the front, within the sound of friendly guns but out of the range of enemy artillery, Myers quickly became an advocate for what historians later called forward treatment.18 Given Davy’s success, when Fifth Army relocated from the Somme to the Ypres Salient in June 1917, Nichol hoped to keep the NYDN centre under his firm hand at No. 47 CCS, Dozinghem (near Poperinghe), which was less than 20 km from the new front line.19 Holmes, who was in charge of nervous cases at Ypres, initially expressed concerns both about Davy’s qualifications and whether enemy shelling might affect the recovery of nervous patients, but he reluctantly agreed to continue the experiment.20 Holmes’s concerns had a sound basis: the Somme had been a relatively quiet front in the winter and spring of 1917, while the Ypres Salient was the focus of the British Army’s 1917 offensives at Messines and Passchen­ daele. So when the CCS began to come under direct shelling during the lead-up to the first phase of the Passchendaele offensive in the third week of July, Holmes told Nichol to move the NYDN centre further to the rear as “No. 47 CCS is now too noisy.”21 The DMS, though, was insistent, reminding Holmes that he once remarked that “the sound of shells near [the] treatment centre made recovery more permanent”; he only agreed to relocate it to No. 62 CCS, Bandagehem, some 15 km further to the rear, after DGMS Sloggett personally intervened on Holmes’s behalf.22 Thereafter, as indicated in appendix A, the special hospitals were located an average of about 45 kilometres from the front lines and never less than 25 kilometres. While this disagreement may have reflected an ideological cleavage between Holmes and Myers, as the psychologist later asserted, there were also clear differences in the way both men interpreted the new NYDN orders and envisioned the role of the medical services. In the northern sector, DMSs and DDMSs were encouraged to keep as many



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nervous soldiers in front-line units as possible, which in effect gave the special centres a remedial function within the evacuation chain. Al­ though it seems paradoxical, Holmes’s policy was consistent with a literal reading of GRO 2384, which specified that patients should only be sent to a special hospital when “transfer from their units or division is unavoidable,” which gave DMSs and DDMSs the freedom to define just what “unavoidable” actually meant.23 Holmes called for an initial period of three to seven days’ treatment in a rest station; only then, if a patient failed to respond, would he be sent to the special hospital. As early as 19 June, a few days after GRO 2384 was published, Second Army DDMSs issued clarifying directives advising divisional officers that whenever possible nervous patients would be “retained, treated, and returned to their units” from divisional and corps rest stations under diagnoses such as exhaustion or debility. Only when a case was “obviously one requiring treatment of more than a week or ten days” was the soldier to be sent directly to the special hospital.24 The policy was the same in First Army, although medical officers initially had some difficulty squaring the contradictions between instructions to “strictly adhere” to GRO 2384 with orders requiring them to keep as many men at the front as possible. So, after verbal orders failed to reduce evacuations, in early July DMS H.N. Thompson explicitly told DDMSs: Cases which arrive at Field Ambulances marked “N.Y.D.N.,” but who are suffering from no symptoms beyond ordinary fatigue or exhaustion incidental to the strain of battle and common to all soldiers, should be returned to duty, when fit, marked “N.A.D.” (no appreciable disease) – Fatigue, etc. Cases marked “N.Y.D.N.” who merely suffer from minor symptoms, or from an over-wrought mental condition, and who require only a short period of treatment or rest, will not be sent to the Special Centre, but retained in the Divisional Area. On Discharge, they will be diagnosed in accordance with the medical nomenclature suitable to their symptoms, but the word “Shell Shock” will not be used [emphasis added].”25

Unofficially, this resurrected the old divisional and corps stopping system, which dominated case management before and during the Battle of the Somme with the special hospitals acting as an additional check on evacuations. Gordon Holmes even attended court martials at CRSs in cases where soldiers claimed to have been suffering from nervous illness.26 This meant that in the northern part of the front, despite GRO

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2384 and AG 6902 they would play a secondary rather than primary role in the diagnosis and treatment of nervous illness. While the northern armies resurrected the older divisional and corps stopping system, DDMSs in the southern armies were encouraged to evacuate all nervous casualties directly to the special centres. In III Corps, for example, which abutted First Army at the northern end of Third Army’s portion of the line, DDMS Colonel W. MacDonald was forced to issue a clarifying order days after Thompson’s directive informing subordinates that despite what was happening to the north, no special instructions or supplemental memoranda on the management of NYDN casualties had been issued in Third Army and that the provisions of GRO 2384 were to be strictly complied with, meaning that casualties were to be evacuated directly to the special hospitals and not retained at the front.27 As we will see, this discrepancy would create significant confusion and cause serious organizational problems when units rotated between the northern and southern sectors as they would frequently do during the fighting that summer and later in the autumn. One of the motivations behind Holmes’s approach was that it allowed the medical services to hide nervous casualty figures through an elaborate bit of creative accounting that exploited another technical point in the orders. In GRO 2384, Haig’s staff had ordered RMOs and field ambulance medical officers to avoid using the term “shell shock” and to refrain from entering “any diagnosis” on an official form; instead, they were to enter the term NYDN only on the “field medical card or other transfer paper” and to leave diagnosis to the specialists at the army centre. While GHQ’s intention was to prevent front-line doctors from using the term “shell shock” in order to reduce the possibility of self-reporting and suggestion, a more literal reading justified changes to the way casualties were recorded and reported.28 As a Second Army directive from June 1917 explained: “It is obvious that [NYDN] is only a provisional [diagnosis], and no such diagnosis should appear on the records of a Medical Unit unless the case is transferred to another Medical Unit for further observation and a definite diagnosis.”29 Instead of using NYDN, front-line doctors were told to change the diagnosis to debility, exhaustion, myalgia, fatigue, or some other general category of illness – or to simply keep patients off the books altogether if they returned to duty.30 As the DDMS II ANZAC Corps, Colonel Charles M. Begg, explained to confused medical officers: “Under no circumstances must a diagnosis of “NYDN” appear in A36 [the admission and discharge register], unless the case has been evacuated to a Casualty



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Clearing Station. ADMSs are responsible that the evacuation of such cases is reduced to a minimum.”31 This meant that the admission and discharge books for divisional and corps rest stations would only show cases of NYDN when they were sent to the special hospital; others were to be entered under another diagnosis. “If the above practice is followed,” Begg explained, “it will be seen that the return called for in AG 6902 … will be a ‘NIL’ return.”32 In essence, this meant that no matter how many nervous cases went through a field ambulance rest station, only transfers would actually be reported as casualties. The Canadian Corps and Hill 70 The gap between policy and practice in the northern sector of the line is clear from a detailed examination of the Canadian Corps’s experience during the fighting for Hill 70 and Lens that August. During the summer of 1917, No. 4 Stationary Hospital continued to operate First Army’s NYDN centre, while Horne’s troops, including the Canadian Corps that was now led by Canadian Lieutenant General Sir Arthur Currie, made a staged step-by-step advance across the Douai plain from Vimy.33 Their objective was the coal-mining city of Lens, ringed by slag heaps and red-brick suburbs smashed by months of incessant artillery fire. The Germans were determined to hold this important hub in their new defensive position known as the Siegfried-Stellung and used the ruined houses to create fortified machine-gun posts while digging deep trenches to protect the city. Horne’s and Currie’s plan was to take Hill 70 on the morning of 15 August with 1st, 2nd, and 4th Canadian Divisions and to allow the German Sixth Army to counterattack up the gentle slope, which they hoped would result in heavy enemy casualties. Then 2nd and 4th Divisions would push into Lens itself, driving the Germans out into the open ground beyond.34 While the capture of Hill 70 was a resounding success, the assault on Lens was a costly failure which quickly devolved into street fighting in the ruined suburbs surrounding the northwestern part of the city.35 The fighting at Hill 70 and Lens took place across a hellish landscape of ruined houses and mine tailings, and in addition to the usual barrage of high explosive shells, the Canadians also launched burning oil-drums at the enemy which encased the battlefield in an oppressive black smoke made thicker by the poisonous gases and smoke unleashed by both sides. From the safety of the artillery lines, Canon Frederick Scott, the Canadian Corps’s Head Chaplain, watched the nightmare

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unfold below. “At four-twenty-five, the guns burst forth in all their fury,” he recalled in his memoir, “and all along the German line I saw not only exploding shells, but the bursting oil drums with their pillars of liquid fire, whose smoke rose high in the air with a peculiar turn at the top which looked like the neck of a huge giraffe. At once the Germans sent up rockets of various colours, signalling for aid from their guns, and the artillery duel of the two great armies waxed loud and furious. I stood on the hill with some of our men, and watched the magnificent scene. Nothing but the thought of what it meant to human beings took away from our enjoyment of the mighty spectacle.”36 Those human beings were, of course, Canadian soldiers and as they went over the top behind a creeping barrage, the German first and second lines atop Hill 70 fell relatively easily. Over the next days, the Sixth Army launched no fewer than twenty-one consecutive and ultimately futile counterattacks as Horne and Currie had hoped. Tired Canadians revelled in the opportunity to shoot enemy soldiers over open ground, taking revenge for months of pent-up anger. As D.E. Macintyre, an intelligence officer at 2nd Division Headquarters remarked in his personal diary, few men had used their rifles to any great effect since the onset of trench warfare, “so much so that many soldiers would do nothing to an enemy unless he came within bombing range for it never occurred to him to use his rifle.”37 Now they did so with relish. “It was thrilling to watch the Germans coming over the hill,” recalled C.S. Holmes of the 25th Battalion. “We were ordered to hold fire and the first wave came over, marching shoulder to shoulder … They gave them a range of two hundred yards then the order came down to give them hell, and they died right there; that whole wave just died right on that two hundred yard line. They were no sooner down then … another wave came up there”38 In shaky handwriting, Pte. Frank Maheux of the 21st Battalion told his wife that he saw the Germans “coming in bunches” and that they “shot them down like rabbits … It was a butchery.” Maheux, who had been treated in a rest station for nervousness after the debacle at the St. Eloi craters, felt that the experience at Hill 70 left him “pretty near crazy,” although he made sure to tell his spouse that even though his writing looked shaky, “my hand don’t tremble so much.”39 During the battle, the medical arrangements for the Canadian Corps were made by the new DDMS, J.T. Fotheringham, who had replaced Colonel G.L. Foster after he had been promoted to DMS, Canadian



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Expeditionary Force, in London the previous fall. According to Fotheringham’s orders, cases of suspected nervous illness would be marked NYDN at regimental aid posts and sent along with the other sick and slightly wounded to a walking wounded post. “When opportunity permits,” these cases would be transferred to the CRS, run by No. 10 Canadian Field Ambulance; from there only the most serious cases that failed to respond to rest would be sent to the CCS, where they would be redirected to the special army centre.40 This was essentially the same system that had been used during the latter phases of the Somme fighting, during operations at Courcelette and Regina Trench. During the fighting for Hill 70 and Lens, admission and discharge records show that Canadian field ambulance doctors continued to record NYDN cases on their books regardless of whether the case was transferred to the special centre or eventually returned to duty – although they also used a number of euphemistic terms too. A detailed analysis of these records for 1st Canadian Division confirms that nervous patients were typically given several days rest in a DRS or CRS and were indeed only evacuated to the special centres if they failed to respond to this form of rest treatment. In August 1917, Nos. 1 and No. 2 Canadian Field Ambulances ran main dressing stations for 1st Canadi­ an  Division but recorded only eight admissions diagnosed NYDN in their admission and discharge books. Most 1st Division NYDN cases were instead admitted directly to No. 3 Canadian Field Ambulance, which operated the sick and walking wounded post during the fighting and a DRS in more quiet periods. It recorded a total of forty-nine NYDN admissions that month, of which only thirteen (27  per cent) were evacuated to the NYDN centre while thirty-six (73 per cent) were transferred to No. 10 Canadian Field Ambulance’s CRS.41 An analysis of unique admissions to 1st Division main dressing ­stations, its DRS, and the CRS show that roughly half the patients labelled NYDN during August 1917 returned to duty from front-line units without seeing a specialist or being subjected to the rigorous investigation seemingly required under GRO 2384 and AG 6902. Of all the Canadian NYDN cases treated at the CRS, 48 per cent were sent back to duty after an average of nine days in hospital, while the other 50 per cent were evacuated to the special hospital after a mean of three days.42 For example, Private Ambrose C., a twenty-three-year-old carpenter from Penobequis, New Brunswick, was sent to the 26th Bat­ talion in May 1917 to replace casualties sustained at Vimy Ridge. On

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14 August, during the attack on Hill 70, C. reported to 2nd Canadian Division’s rest station run by No. 4 Canadian Field Ambulance, where he was labelled NYDN. After six days as a patient there, he was transferred to the CRS, where he spent three days in hospital before being returned to duty.43 In another case, Thomas F., an Irish teamster who emigrated to Maple Creek, Saskatchewan, in the years before the Great War, was admitted to No. 10 Field Ambulance NYDN on 16 August and was discharged to duty five days later. On his field medical card, NYDN was struck out and replaced with “WD” for wound, followed by NYD.44 Only those cases that failed to respond to treatment were sent to the special centre, representing about 67 per cent of 1st Division NYDN admissions in August 1917. Roger A. was with the 8th Battalion when he was blown up and buried by a shell west of Lens on 15 August 1917. A. walked on his own to a dressing station and was sent first to No. 3 Field Ambulance and then to the CRS. After a few hours in hospital, doctors found that he had heart palpitations and was extremely nervous and so evacuated him to No. 23 CCS; he arrived at the neurological ward at No. 4 Stationary Hospital on the night of 17 August.45 This means that only the most serious cases – about half the admissions labelled NYDN – were sent to First Army’s special hospital.46 Of course this number is actually inflated given that there was also a growing list of admissions for myalgia, debility, exhaustion, and other forms of minor illness, which likely captured many soldiers who would have been diagnosed with shell shock a year earlier. This would suggest that official statistics showing only 139 cases of nervous illness within the Canadian Corps are significantly lower than the actual total – at least by half and probably much more, although the nature of the records do not allow us to construct a more concrete estimate.47 Passchendaele Given that official statistics were being recorded in order to reduce the tally of nervous casualties, it is not surprising that during the fighting at Passchendaele taking place at the same time, Fifth and Second Armies reported that evacuation rates declined significantly from those seen a year earlier on the Somme. But even though we need to be sceptical of these figures, the war diaries of the Second and Fifth Army medical units reveal few of the problems with management of nervous illness so apparent on the Somme. In fact, DMS, DDMSs, and ADMSs made few references to nervous casualties after the adoption of the new



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system in June and July 1917, which suggests that even if casualty rates did not decline as significantly as their reports suggested, management was indeed improving – at least by the type of metrics that the army used to measure such things. In the northern sector of the front, any improvement was a result of the combined effects of the informal practices adopted there to minimize reporting and stage treatment between rest stations and special hospitals. Here the case of I ANZAC Corps is especially illustrative because at the height of the Passchendaele campaign, it was transferred from Myers’s southern sector to the north and thus had to adapt quickly to a very different environment. During the summer of 1917, I ANZAC Corps had been attached to Third Army on the Somme front west of Amiens, where the policy was to immediately transfer any NYDN case to No. 3 Canadian Stationary Hospital, Doullens.48 I ANZAC Corps moved north to lead the second phase of the offensive at Passchendaele in mid-August, which was scheduled to begin on 20 September. At that point, Second Army special NYDN hospital was located at the New Zealand Stationary Hospital, Wisques, with a second overflow ward nearby at No. 15 CCS, Ebblinghem.49 Reported nervous casualties were kept relatively low during the summer months, but during the first week of the campaign’s second phase, Second Army reported just over 900 NYDN cases, so that by the 27th, both special hospitals exceeded their bed capacity, while more than 300 patients were still awaiting transfers from front-line CCSs.50 This understandably alarmed Surgeon General Porter who was not only concerned about the spike in reported casualties but also believed that a traffic jam in the evacuation chain might cost gravely wounded soldiers their lives.51 Accordingly, he told the officer in charge of the New Zealand Stationary Hospital special ward, Captain Theodore G. Gray, a Scottish alienist who had worked in asylums in both Auckland and Dunedin before the war, to summarily evaluate all the cases “for whom [form] 3435 has been rendered and who will not be fit for duty within a few days.”52 And over the next week, Gray quietly transferred hundreds of patients to the base to clear front-line units for the physically wounded, lamenting that many of these cases could have returned to duty had he been less pressed for bed space.53 While Porter’s decision eliminated the backlog and saved a difficult situation, it invited scrutiny because it went against standing orders which prohibited “unnecessary” evacuations.54 The admission of hundreds of NYDN cases at the end of September was an unexpected spike – more than double normal rates – in reported

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casualties and this provoked a frantic hunt to find the source of the deviation.55 British authorities soon focused their attention on I ANZAC Corps, which was responsible for the vast majority of the cases, with 350 alone coming from the 5th Australian Division, which had the right part of the advance on 26–27 September.56 Hauled before Corps Com­ mander William Birdwood, DDMS C.C. Manifold, who of course had found himself in a similar situation on the Somme a year earlier, put blame squarely on the shoulders of 5th Division’s ADMS, Colonel W.W. Hearne, telling the corps commander that the unusually high number of cases could “only be attributed to reckless evacuation.”57 But Hearne, who had been similarly chided after the Somme, was not content to again take the blame and wrote a lengthy rebuttal. “The operations around Polygon Wood on 25/26/27th were attended by particularly heavy fighting on the right sector of the Corps front,” he told Corps Headquarters, “with the result that a disproportionately high percentage of shell shock and gassed cases occurred … These cases, though really battle casualties are, pending investigation, classed as “sick” [and evacuated], no matter how severe they be … I am compelled to believe that DDMS, 1st A&NZAC was fully aware of this defect in the system laid down.”58 It would seem that Manifold, recently arrived from the southern sector, had assumed that given the overarching nature of GRO 2384 and AG 6902, the arrangements in force there would also hold true in the north, and so he made no special provision for NYDN cases in the medical arrangements he issued in advance of the attack at Polygon Wood.59 While publically blaming Hearne, Manifold scrambled to bring I ANZAC Corps into compliance with what he was soon informed were normal, standing procedures within Second Army. As DMS Porter explained, because many of the NYDN cases were only “suffering from exhaustion brought on by excessive fatigue, insomnia, nervous apprehension and similar causes” and because “under this diagnosis they have to be evacuated to the special Centre for NYDN cases which entails [a] complicated procedure and investigation,” this was to be avoided whenever possible as it was “quite unnecessary in such simple cases.” Therefore, all the Second Army medical officers normally ensured “that the term NYDN is not used loosely and that when the term Asthenia, or Debility will cover such cases, that this entry is made, and the term NYDN is kept only for the more complicated cases.”60 It is telling here that he recommended the shortened and unconventional term “asthenia” rather than neurasthenia in order to again



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avoid nomenclature that required reporting. In another explanatory note, he told Manifold that the significance of this approach was that it allowed the medical services to retain such cases in DRSs and CRSs – so much so that if soldiers were in future unnecessarily sent to a CCS, they would be sent back to those front-line units.61 Porter believed that had this policy been followed by I ANZAC Corps at Polygon Wood, most of the so-called “excess” cases of NYDN would not have been labelled as such and bottlenecks at the special hospitals and CCSs avoided. Once I ANZAC Corps implemented the Second Army policy in advance of the next stage in the offensive, NYDN admissions plummeted, returning to so-called “normal” levels, even during the heavy fighting in October and early November. As Manifold recalled in early 1918, “The rule that all cases marked by an RMO NYDN had to be sent to this special hospital told detrimentally and later on the rule was modified… RMOs were instructed when they were uncertain as to a case being due to anything more than fatigue and an active apprehension, to put on the Field Medical Cards NYD (Fatigue?) which gave the Field Ambu­ lance Commander a freer hand.”62 In his mind, this affirmed the conclusions of his August 1916 report, namely, that the shell shock phenomenon was a product of both suggestion and loss of control. “Cases became much fewer as the Passchendaele Operations continued although the shell fire never slackened,” he wrote in February 1918. “This is what we may invariably look for and though these slighter cases may be genuine enough up to a certain point, yet the rapid decrease in numbers shows that except in the gravest form which is very rare, the whole matter rests upon a power of inhibition and control being fully exercised by the man in question.”63 While many front-line medical officers certainly shared Manifold’s point of view, it is hard to escape the conclusion that any “rapid decrease in numbers” was more the result of labelling and reporting than it was representative of an actual decrease in the incidence of nervous illness. The effects of changes in nomenclature were also apparent in the experience of the Canadian Corps, which relieved I ANZAC Corps before Passchendaele village in mid-October 1917, arriving to a pocked-marked battlefield, metres deep in mud. The Canadians, then still on the Lens front, had been pulled from First Army to lead the third and ultimately final phase of the campaign: the assault on the village itself. Although the Canadians, like I ANZAC Corps, were also transferred north, First Army was already part of Holmes’s northern sector and so procedures were similar, although not identical, to those of Second Army.64 When

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they arrived east of Ypres, it was clear that the nature of the ground would pose new challenges and make any reduction in the workload of the medical services essential. “The Belgian Front is the worst I have seen so far,” Andrew Robert Coulter of the 4th Canadian Field Ambu­ lance recorded in his diary. After passing through Ypres everything is utterly desolate. Shell holes without number merge into one another and are so close together that walking among them is almost impossible. Nearly all are full of water of a green colour or tinged red with blood. Roads, except those kept in repair to bring up supplies are completely obliterated. Thousands of dead horses and mules as one goes further up men mutilated beyond description lay everywhere … The wounded have to be carried nearly five miles, in many places mud up to one’s knees and it sometimes takes as long as 10 hours to get a man from the front line to an ambulance and as many [to get the] wounded again on the road out.65

In preparation for the attack on 26 October, Porter reminded DDMS Fotheringham that the term NYDN was to be avoided as much as possible and that “care will be taken that this diagnosis is only used in genuine cases.”66 While First Army had issued similar directives, as we saw earlier, the Canadian Corps still regularly employed the term NYDN even if a significant number of cases were also being captured by other diagnoses. So, although actual evacuation procedures changed little between Lens and Passchendaele, this subtle directive had important consequences for both the ways in which front-line admission and discharge books were kept and how casualties were reported. At Pass­ chendaele, where the Canadian Corps fought between the middle of October and beginning of December, Canadian field ambulance doctors appear to have admitted cases under a variety of labels and rarely employed the term NYDN. As a result, the admission and discharge books of No. 2 Canadian Field Ambulance, which ran the CRS during much of the fighting, only show seven NYDN admissions between 14 October and 21 November 1917.67 This makes it impossible to track front-line NYDN admissions or to compare them in a meaningful way to official reports, as most were hidden among the hundreds of cases of sickness, which rose to one case of illness for every two cases of wounds during the peak of the fighting.68 Official statistics show that in October and November 1917, there were only 240 cases of nervous illness within the now 100,000-man



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strong Canadian Corps – an admission rate of only about 3.5 men per day as compared with 4.5 per day in August. Yet these figures clearly represent only those cases which were sent to the special hospital and it is uncertain how many more were treated and released at the front or evacuated under other diagnoses. During the fighting at Hill 70 and Lens in August, the special hospital responsible for NYDN cases was No. 4 Stationary, Arques, while at Passchendaele it was usually the New Zealand Stationary Hospital, although many Canadians were also sent to the overflow wards at No. 15 CCS. Between 14 June and the end of September, No. 4 Stationary hospital admitted 186 Canadians, with the bulk of admissions coming in August soon after the fighting at Hill 70 and Lens. The average age of these patients was twenty-seven, in line with that for the CEF as a whole, and the typical patient had spent a year and nine months in the army with nine months’ service in the field. In comparison, the New Zealand Stationary Hospital recorded eighty-three admissions and No. 15 CCS sixty-three for a total of 145 cases between the end of September and December 1917. Average ages and length of service were comparable. This gives a total of 331 Ca­ nadians treated at the special centres during the latter half of 1917, when official statistics, which we know already significantly underestimate total admissions for a variety of reasons, show roughly double that number: 655 cases for the same period. Given that at Hill 70 and Lens about double the official tally of cases were treated and released in front-line field ambulances, it is not unreasonable to suggest that as few as 25 per cent of Canadian cases were sent to a special centre. Certainly, it is no more than 50 per cent.69 The “Disappearance” of Shell Shock GRO 2384 and AG 6902 had surprisingly little impact on the ways in which front-line doctors managed cases of nervous illness, which helps to explain an otherwise deafening silence in the manuscript sources: Canadian and British doctors rarely, if ever, mention the imposition of the NYDN system in their letters, diaries, and personal papers. This is mirrored by a similar degree of silence, or what might more accurately be described as an inexplicable continuity, in the personal papers of ordinary soldiers. But given the foregoing analysis, from the perspective of the common soldier at the front, there would have been few differences in the way nervous men and their comrades interacted with both the medical services and military bureaucracy,

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except for the nomenclature entered on army forms they never would have seen. Despite the army’s attempts to delegitimize and control the reporting and treatment of nervous illness, men still exhibited its symptoms and continued to evaluate their comrades’ behaviour through the lens of shared experience; whether those responses to combat were officially termed NYDN, shell shock, or debility mattered little to the men at the front, where shell shock, in fact, remained the preferred term. In cases where nervous soldiers were seen by others as “old sweats” who had already done their bit, there was rarely any antipathy shown towards them.70 It was understood that the longer a man spent at the front, the more likely he was to break down and that he would eventually outlive his usefulness to the army and his comrades. Lieutenant Albert George Lunt of the 4th Battalion recalled: “You know, you couldn’t get any sense out of those guys [with shell shock] at all. They had just stood the bombardment so bad in the trenches that they just didn’t have any wits about them [anymore].”71 In effect, they were understood to have done their duty and deserved evacuation. As Pte. Todd, also of the 4th Battalion, observed after the war, it was not entirely altruistic, as the unreliability associated with a nervous breakdown meant that those soldiers posed a potential risk to their comrades – real or imagined.72 Sympathy was thus as much utilitarian as it was humane. In the imagination of the soldier, it was time in the field and observed trauma which continued to separate the legitimate from illegitimate cases. The idiosyncratic debates about the nature of shell shock which so gripped the medical profession at London and British GHQ in 1915 and 1916 did not involve ordinary soldiers or front-line doctors. Men at the front continued to rely on a somatic, mechanized understanding of nervous illness which lent support to dominant conceptions of masculinity, which emphasized the need for perseverance. Like Maheux, men learned by observation and word of mouth to both expect and accept breakdown as a logical consequence of prolonged soldiering because it was understood to wear out and fray the nerves.73 This process was accepted as a fact of life and did not necessarily change the way soldiers saw their comrades, as Bernard Trotter explained to his wife Marjorie. “The present [company commanding officer], Bentley, was a rubber planter in the Malay States – a good officer, and a very pleasant chap,” he wrote. “He shows signs, however, of the long strain of his work out here in a nervous tension that is affected by sometimes very insignificant things. At such times he swears a bit at the servants, and expresses



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his opinions of the C.O. and other interfering factors in language more forcible than elegant. It is so obviously, however, the result of nerves, that one can’t blame him seriously. He is very considerate of his men and subordinates.”74 This meant that when men did break down, they were usually considered to have been “wounded” by other soldiers, so long as they were seen to have both made an effort to endure and shared in the process of accumulated trauma. Of course it was also accepted as fact that men could break down quickly after an especially harrowing event such as a close call with a shell. “Poor Bill Ballie was shelled shocked a few days ago,” Bertram Howard Cox, a bank clerk from Manitoba who had been born in Barbados, wrote to his mother. “He had a very narrow escape, as the shell burst just a few feet from him. I was talking to him afterwards, and he was quite conscious, only shaking all over as though it were 100 degrees below zero. He has gone to the base for a few months. Another fellow, standing next to him was badly shelled shocked, bleeding from his nose and ears, and unconscious.”75 So long as men were seen to have done their bit, it was understood that there was little difference between those who were physically shaking without visible injury and those bleeding from the concussive force of a shell explosion. Although GHQ tried to legislate against this type of live and let live attitude, as in other aspects of war experience, policies that aimed to regulate aspects of trench culture that had some operational benefits proved almost impossible to enforce. However, this did not mean that all cases of nervous illness were automatically accepted as legitimate. “A man or officer who gets shell shock has all my sympathies for that may come to any one at any time,” Major Thomas James Leduc, a farmer from Armstrong, British Columbia, in the 2nd Canadian Mounted Rifles told his wife in mid-July 1917, “but I despise a coward.”76 Cow­ ards were those who failed to make the attempt to endure or broke down without first gaining the acceptance or comradeship of their contemporaries. Often these were men newly arrived at the front who had not yet gained admission into the closed circle of old sweats. It is telling that in oral interviews given long after the war ended, aging veterans like Lieutenant Lunt often remembered these shell shocked soldiers as “mostly young fellows, young boys … [who] should never of been up there.”77 However, at the time men like Lunt were also only young men – the lieutenant from Hamilton was only twenty-four when he joined the CEF in the early winter of 1915. Indeed, as we have seen, the average age of shell shock patients admitted both at the front and to

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rear-area hospitals was consistently around twenty-seven years old, comparable to the average age of a typical CEF soldier. As new arrivals, though, these green men must have seemed especially young, naive, and innocent – all the more so in memory. Unknown soldiers were rarely given the same benefit of the doubt. For example, during the abortive Canadian push into Lens in August 1917, Pte. Donald Fraser of the 31st Battalion recalled how a newly arrived replacement reacted to the order to go forward and scout enemy trenches. “The order stunned him,” Fraser wrote. “He looked at me and in a quivering voice said ‘he did not see why he should have to go – he was a new man and did not have any war experience … Besides I am not feeling very well.’” Unsympa­ thetically, Fraser told him matter-of-factly: “Now is your opportunity to get the experience … Buck up.”78 As we have seen before, Fraser was more willing to be sympathetic to an old friend. Diagnosis at the NYDN Centres While there were clearly important continuities in both the front-line management of nervous casualties as well as the patient experience, in 1917 there were significant changes to the way cases of nervousness were managed behind the lines. Until the creation of the special hospitals after the Battle of the Somme, most cases of nervous illness evacuated from the front were sent to non-specialist base hospitals along the coast. The creation of a network of army-level hospitals, which began in December 1916 and continued throughout the winter of 1917, initiated a process of standardization which ultimately proved to be successful. Whereas it is difficult to generalize about treatment in front-line units, the special centres developed a more or less uniform approach to diagnosis and treatment – even across the north-south divide that otherwise defined casualty management. When Theodore Gray took charge of the special shell shock ward at the New Zealand Stationary Hospital in late August 1917, he noted that a special hospital had four main functions, which we will examine in turn: 1. The reception of cases. 2. The separation of true cases of “shell shock” (wound) from the various other psycho-neuroses and physical diseases which have been provisionally diagnosed NYDN. 3. The evacuation of such cases as are not likely to be fit for service within a reasonable period.



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4. The treatment of all other cases with a view to as early return to duty as possible.79 Upon arrival at a special hospital, patients were sorted into wards according to the severity and type of symptoms with cases of “fatigue and exhaustion incidental to the strain of battle and common to all soldiers” separated from those with more serious symptoms.80 The former might be kept in the hospital’s exhaustion ward for a few days of rest and observation and if no further complications arose, they would be diagnosed “NAD” for “No Appreciable Disease” and returned directly to their units. However, as happened at the New Zealand Stationary Hospital in September, a sudden rush of casualties might necessitate the evacuation of men who might otherwise be thought ready to return to duty in seven to ten days.81 More serious cases were admitted for observation to separate wards in the hospital according to the nature of their symptoms, but they were still officially considered to be as yet undiagnosed. On admission, the neurologist would personally fill out the new army form W3436, which was meant to streamline the investigative element of the process. On part I of the form, he wrote down the patient’s basic information, the hospitals he had been transferred through, his symptoms, and a five-line summary of the man’s own explanation as to why he had broken down. Part II was left blank and was sent to the soldier’s commanding officer, who was asked to certify whether the soldier had or had not been “subjected in the course of his duty to exceptional exposure,” leaving ten lines for a detailed explanation.82 Neurologists could only make a final diagnosis after reviewing these completed and returned forms, although special allowances were made to evacuate cases still undiagnosed in emergencies.83 Soldiers said to have endured some form of exceptional exposure were classified as wounded, usually with shell shock, although some were also labelled as neurasthenic if the cause was thought to be chronic rather than acute. All others were put down as sick and diagnosed “in accordance with the ordinary medical nomenclature indicated by the symptoms.”84 This ensured that the army’s official list of acceptable diagnoses was used, which, in most “unexceptional” cases, restricted doctors to “neurasthenia” or one of the varied terms allowed for psychosis. Despite the appointment of specialists and the segregation of patients by type, diagnosis remained a difficult question fraught with controversy. The move to ban the term shell shock had, after all, been an important part of GHQ’s strategy to delegitimize the condition. To

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understand the problem, it is important to remember that during the winter of 1916–17, Haig and Fowke came to accept the view – championed by some in the medical services like C.C. Manifold – that awarding a wound stripe to shell shocked men created what they called a “great unfairness,” that is, a situation in which “a larger number of soldiers who control themselves after severe effort see others decorated who have failed to do so.”85 As Fowke explained in a letter from himself and Haig to the Army Council, I do not deny the possibility of unfairness in exceptional cases, but I think that in the vast majority of instances the question whether a man’s nervous system sustains a permanent injury owing to his being buried, or blown in the air, depends on the quality of the nervous system with which he was naturally endowed. However much sympathy one may feel with the man whose nervous system has succumbed under the strain, it is not, I think, logical to decorate him with a badge in contrast to the man whose nervous system has successfully resisted a similar experience.86

The military authorities felt that there was an undeniable logic to this line of argument, but it hinged on a key and ultimately faulty assumption: that experts in nervous or mental illness could more accurately determine which cases deserved a wound stripe and which did not than those at the front. It is clear, for example, that Fowke assumed that the concept of predisposition would naturally discredit most soldiers’ claims on a badge, and in this respect this reflected the information he was receiving from the medical services. But while it was true that most experts would clearly have agreed with this assertion, there was no agreed upon way to determine where the influence of a nervous constitution ended and the effects of lived experience began. Therein lay the problem. As Gray lamented to his commanding officer in September 1917, the chief issue with diagnosis at the special hospitals was that despite GRO 2384, “no one has so far formulated an acceptable definition of the term ‘shell Shock’ which at present includes any nervous or psychosis arising from the stress of war [sic].”87 Al­ though Haig and Fowke thought their orders would bring clarity to the situation by placing cases into the hands of experts, it actually served to muddy the waters. In large measure this was because GRO 2384 tried to impose a new universal diagnostic standard by requiring evidence of “exceptional exposure” for the shell shock diagnosis. This term was a compromise



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term which arose in the course of the lengthy discussions between Sloggett and Fowke during the fall and winter of 1916–17, in which the DGMS consistently tried to talk the Adjutant General away from his original desire for a more militarized diagnostic requirement, namely, that a case of shell shock would require “direct evidence” of a specific shell explosion. Sloggett managed to gradually move Fowke away from this view by emphasizing the medical services’ need for professional flexibility. While this was certainly true, what the DGMS might have more truthfully said was that it was impossible to apply a monolithic universal diagnostic standard in a field of medicine in which the experts themselves had yet to agree upon nomenclature, case definitions, or basic treatment protocols. The adoption of the term “exceptional exposure” in place of “direct evidence” was thus an important compromise which preserved the authority of the medical services. In effect, these words acknowledged that cowardice and bravery were relative, changeable concepts – that there were indeed limitations on what men could be expected to endure in the face of the enemy. Yet as we will see in the final chapter, as might have been expected, Haig and Fowke agreed to the terminology based on a colloquial understanding of the words, so that as they gradually became aware that they actually expanded rather than contracted conceptions of legitimacy, they reacted with a palpable degree of horror. This culminated in yet another attempt by GHQ during the winter of 1918 to outlaw the term and to mandate that all cases of nervous illness be classified as sick rather than battle casualties, no matter how “exceptional” the soldier’s exposure to combat had been.88 For the specialists tasked with diagnosing shell shock, the use of exceptional exposure as the key diagnostic criterion made the work easier while helping to standardize approaches across the Western Front. Of­ ficially, exceptional exposure was defined as any type of combat experience that was “more intense or prolonged than that which others in the same area of operations endured without being similarly affected.”89 This meant that a man need not be blown up by a shell to be considered wounded, but had to have endured some form of trauma that went beyond the “normal” experience of his comrades. For example, John Edward C., a twenty-five-year-old tinsmith from Toronto serving in the 58th Battalion, was admitted to No. 10 Canadian Field Ambulance on 28 June 1917 during heavy fighting around the village of Avion, one of the suburbs south of Lens. On his admission to No. 4 Stationary Hospital, Carmalt Jones noted that he had a headache, pain in his chest,

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and a cough. C. told him that on the 28th, he had been in the trenches at Avion when his unit came under heavy shellfire and that he was blown up, knocked unconscious, and buried for “most of the day” until he regained consciousness in the dressing station. Major Dougall Carmi­ chael, the 58th’s second-in-command, confirmed C.’s story. “On the morning of 28th June,” he wrote on form W3436, “at about 2:30 am Pte. C. was with one of the attacking companies on Avion Trench. During the attack and on the flank which Pte. C’s platoon was supporting, a dugout was blown up by the bombing. Numerous casualties were caused and one man was killed by the concussion – no wounds being found on the body. Pte. C. apparently received his injuries from the same cause.”90 At No. 4 Stationary Hospital, Carmalt Jones accordingly diagnosed C. with shell shock W, which entitled him to wear the wound stripe, and he was evacuated to the base, eventually returning to the 58th Battalion in January 1918. Under the new system, an unusually long period of service at the front could also constitute a valid explanation for nervous symptoms, even when there was no evidence of specific trauma. For example, Joseph G., a twenty-seven-year-old insurance agent from Montreal serving with the 22nd Battalion, was admitted to No. 4 Stationary on 8 July 1917 suffering from a headache, vague pains, and insomnia. He told the neurologist that he had been in the trenches with “shells bursting all round,” but could not remember what happened until he found himself in an advanced dressing station, where he was “unmanageable.” His commanding officer, Lieutenant Colonel T.L. Tremblay, noted that G. had indeed suffered exceptional exposure, writing: “This man has been with our Battalion for almost two years and during this time has undergone severe bombardments that have apparently affected his nervous system.”91 G. was diagnosed with neurasthenia and sent to a convalescent camp, eventually joining a labour battalion behind the lines before being discharged to Canada, medically unfit. In essence, the medical use of the term “exceptional exposure” simply codified the referential standards used by ordinary soldiers and field ambulance doctors at the front. Standardization was also brought about through a program of appointments, training, and apprenticeships which eventually guaranteed that neurologists rather than psychologists dominated the culture of the new centres.92 Between June 1917 and November 1918, the first cadre of specialists, that is, Carmalt Jones (First and Second Armies), Frederick Dillon (Third Army), William Brown (Fourth Army), and William Johnson (Fifth Army), trained at least twelve other neurologists



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to diagnose and treat shell shock in the special centres.93 Ironically, in this high-stress environment turnover was high, with at least four senior neurologists suffering either from nervous breakdown or another form of unexplained physical collapse between July 1917 and the end of the war. As indicated in appendix A, by the end of the war Johnson was the only original army neurologist still at the front, while the special centres were then in the hands of a second and even third or fourth generation of more biologically oriented neurologists. In this regard, Captains G.P. Gibson (First Army), E.P. Harding (Second Army), G.L. Brunton (Third Army), Hills (Fourth Army), and J. Watson (Fifth Army) have largely been forgotten but actually treated far more patients than men like William Brown, who left France in early March 1918. The departure of C.S. Myers in October 1917 left Gordon Holmes in charge of appointments across the entire BEF, and so, not surprisingly, the specialists he chose were either trained neurologists or part of the orthodox British clinical establishment. This meant that while there was still some diversity of opinion about the aetiology of shell shock, the cosmology of the special hospitals became increasingly homogeneous. The Doctrine of Exceptional Exposure Because exceptional exposure was both an arbitrary and changeable standard, it could inform but not explain cases of nervous illness. It was clear, as Fowke even acknowledged, that when men were exposed to the same stimuli they could suffer different outcomes, so that declaring that a man had indeed been exposed to an exceptional form of trauma merely confirmed that he was not lying and did nothing to address the larger question of whether “nervous inheritance” or acquired life experiences actually caused the breakdown – a problem that was increasingly being raised in 1917 in connection with pensioning. One of the daily tasks of NYDN specialists was thus to define some mechanism through which to assign causality to either a soldier’s nervous constitution or a traumatic experience. In the context of three years of war and the experience of the Somme, the older metaphorical concepts associated with the term “nerves” no longer seemed sufficient to explain why some people broke down and others did not. To stitch soma to psyche, these specialists began to use a new language of instinct and emotion, one that was increasingly steeped in the psycho-physiological metaphors of evolution, adaptation, and instinct rather than nervous energies. In this respect, the work of Scottish

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physician and “anatomical” psychologist William McDougall was highly influential.94 According to McDougall, the instincts were defined as “certain innate specific tendencies of the mind that are common to all members of any one species, racial characteristics that have been slowly evolved in the process of adaptation of species to their environment and that can be neither eradicated from the mental constitution of which they are innate elements nor acquired by individuals in the course of their lifetime.”95 Drawing on the work of Herbert Spencer and Francis Galton, McDougall saw the instincts as reflexive and part of a “psycho-physical process, involving psychical as well as physical changes.”96 For McDougall, the instincts were base, undesirable remnants of an animalistic past, so that each species, the various human races, and sexes could each be plotted hierarchically according to the degree to which primitive rather than evolved characteristics governed their actions and character.97 The instincts were not only thought to be biological in the sense that they were innate, but McDougall also thought they had a physiological reality within the structures and chemistry of the brain. He argued that when stimulated by external sensory forces, impulses “descend to modify the working of the visceral organs, the heart, lungs, blood-vessels, glands, and so forth, in the manner required for the most effective execution of the instinctive action”; this affective response was what he characterized as the expression of emotion.98 Only the more highly evolved but delicate powers of “intelligent control” could repress instinctual forces, a power that had to be taught, learned, and continually practised.99 Men especially had been taught control, he argued, from childhood through education and religion, but were always on the brink of losing their grip on these powerful but unpredictable primitive emotions. McDougall’s work was appealing because it provided a scientific rationale that confirmed pre-existing assumptions about the nature of shell shock, or the war neuroses as they were increasingly being called. Like Carmalt Jones and Frederick Dillon, most of the neurologists appointed to the special centres spent time at the front as RMOs or field ambulance doctors, and so brought aspects of trench culture to bear on their work. By 1917, one of the most important assumptions was that psychological breakdown in wartime was a form of subconscious but wilful abandonment of self-control, differing from cowardice only in the sense that the man who broke down lacked the intent to flee. McDougall’s theories were appealing because they provided both a psychological and physiological explanation for observed phenomena. Like



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nerves, it was an elastic framework that could accommodate both selective readings of Freudian theory – avoiding the sexualized, unscientific language that so appalled many English doctors – as well as the somatization of instinct, emotion, and repression. As the editors of The Lancet told readers in the winter of 1919: “In our English fashion we have essayed a compromise between the old and the new, and many have come to regard the war neuroses as essentially identical with those of civil life, except in so far as the events of the battlefield are novel excitant factors and the instinct of self-preservation more potent than the instinct for the propagation of the species.”100 Frederick Dillon, who headed Third Army’s special hospital from December 1916 to October 1918 (for most of that time it was attached to No. 3 Canadian Stationary Hospital) and personally trained several neurologists who later went on to head other army centres, wrote a clear and concise summary of how McDougall’s ideas influenced the development of a near universal standard of differential diagnosis at the special centres. Dillon argued that the emotions were “the central affective aspect of an instinct, aroused by its special stimuli and producing its special conative effects.”101 In this sense, instinct became the reflex and emotion its affective expression. “An instinct or emotion is an inborn disposition,” he wrote, “that it sub-serves a definite biological function, and can no more be got rid of by willing, repressing, or training than the liver, the thyroid, or any other organ of the body, that it is excited by certain special stimuli, it is not surprising that when the special stimuli appear the associated emotion should be aroused.”102 Whereas Freud attributed conversion symptoms to the repression of purely psychological conflicts that had no somatic reality, Dillon somaticized the conversion process, arguing that “fear produc[ed] an emotional shock inhibiting the activities of the whole of the cortical structures.” In other words, the experience of intense fear, or rather a man’s attempt to control it, was presumed to rewire the brain, resulting in a loss of control over certain aspects of function – providing a physiological explanation for repression.103 As Dillon explained the process in the autumn of 1917 to a Canadian neurologist: “[A] Patient hears [a] shell [and] is filled with terror [and] cries out. The sound of his voice or [his] attempt to use it strikes up the emotion again therefore he represses it.”104 In this case, Dillon believed that the “cortical structures connected with phonation and production of audible sounds” had been physically connected to the emotional physiology of fear so that an attempt to control one caused the other to fail – a sort of neural short

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circuit. In essence, Dillon argued that trauma inverted the normal relationship between the primitive and evolved centres of the mind, raising the former over the latter so that patients were unable to regain control of the instinctual affect.105 Dillon’s explanation of the war neuroses was summative rather than  innovative, capturing the consensus of the middle ground between some, like William Brown, who were more psychologically oriented and others who emphasized physiology. Yet in practical terms, the differences between the two extremes were minor. At the psychological end, Brown did not feel the need to somaticize the process of repression, yet he still agreed with Dillon’s basic assertion that shell shock resulted from a loss of control brought on by the repression of intense fear.106 At the other extreme, William Johnson felt that emotional repression must have a physiological basis and proposed that it was caused by an over-stimulation of the adrenal and thyroid glands, perhaps by an increase in blood pressure or glucose levels during the heightened anxiety of the fear response.107 As Brown noted, though, such minor theoretical disagreements had little effect on practical issues like case management and treatment.108 From the army’s perspective, though, this view tended to heighten scepticism about shell shock – after all, it was difficult to explain how an unintentional loss of control was in fact different from cowardice without resorting to overly verbose explanations involving theoretical biological processes or repression. For practical minded soldiers like Haig and Fowke, these observations merely confirmed their worst fears about shell shock and only spurred on their quest to eliminate the diagnosis from casualty lists.109 Treatment at the NYDN Centres One of the other advantages of the new bio-psychological consensus was that it dovetailed neatly with existing ideas about treatment, and over the course of 1917–18, this too became more standardized. On first admission at a NYDN centre, patients were typically kept in in bed for between three to four days and up to a week, rarely longer, in order to undo the effects of physical fatigue.110 During this initial phase, sleep was thought to be essential and might be induced if necessary with doses of bromides, paraldehyde, or hyoscine.111 As William Johnson, who ran the NYDN centre at No. 62 CCS (first for Fifth and later Second Army) explained, winning the trust of patients was essential, and so they were



Illusions of Success 263 thoroughly examined, and after organic disease had been excluded the patient would be told his “cure” would take place at a such a time on a certain day. In the interval thus elapsing before active treatment was attempted – usually three to four days – the soldiers were exposed to the “atmosphere of cure” which was maintained in the ward and would see recovery occurring in patients around him … The actual cure of each patient was carried out in a separate hut which was fitted up as an electrical and medical room. Here the medical officer and his patient remained closeted until recovery was complete. As regards the methods employed, the intensity of treatment naturally varied with the individuality of the patient, his previous history, and so on. In all methods, treatment was by suggestion. It was invariably commenced by explaining the nature of the condition to the man and assuring him of the complete absence of organic injury to his nervous system. The methods of suggestion employed were based on Babinski’s teaching. Here the personality of the medical officer is always of greater importance than the particular method. The more convincing the medical officer, the less often should he have to resort to such devices for reinforcing his suggestion as the practice of light hypnosis, or the application of mild current of faradism … For complete treatment, the strong “suggestion” of recovery must merge into persuasion, and this finally into methods of re-education, which must include psychic as well as physical measures.112

Carmalt Jones, Brown, Johnson, and Dillon all employed variants of Dejerine’s method of rational persuasion, agreeing that the essential factor was gaining a patient’s trust to use feelings of remorse, conviction, and expectation to effect a cure.113 As Frederick Dillon explained, persuasion meant trying to “arouse the will into action,” a process that could require significant time, and so shortcuts were often thought necessary and might include the wire brush, shaming, hypnosis, and isolation.114 These methods, though, were typically reserved for so-called problem cases. The majority of those admitted to the NYDN centres were treated with what Brown and Dillon both called “abreaction,” a concept that, although first introduced by Freud and Breuer in psychoanalysis, took on multiple meanings within the discourses of British neurology. Brown appears to have used abreaction in its Freudian sense, although he explicitly rejected “Freud’s sexual theory of the origin of the psychoneuroses” and his clincial approach more closely resembled that of Janet’s psychological therapy than psychoanalysis.115 Dillon, by contrast, used abreaction colloquially to mean something akin to

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“revelation” rather than catharsis and this seems to have been the more common meaning employed by other specialists at the time. Rather than use his time with patients to identify the emotional root of suffering, as Brown claimed to do, Dillon’s version of abreaction sought to force them to admit that they had behaved in a shameful, unmanly way. Unlike in the Freudian version, there was no attempt to uncover the root nature of the conflict or to bring the supposed unconscious desire into consciousness.116 Although Dillon claimed in his published writings on the subject that abreaction required the physician to employ a sympathetic tone, it is clear that its underlying purpose was to shame patients, coercing them into accepting that their actions had been unwarranted, emotional overreactions – by intimation: they had not behaved as proper men. Dillon met his patients in a secluded tent and after listening to their story, began to press them on the nature of their fears, and although he called the process abreaction, it drew heavily upon the methods suggested by Dejerine and Dubois before the war. A transcript of one of those interactions which Dillon himself described as typical sheds light on how psychotherapy functioned at the front. “On the road up to the trenches when the shelling took place you began to feel, shaky, nervous and jumpy as you have described. You know now what it was that made you feel like that?” Dillon asked one patient: Patient: As you have explained, doctor, I see now that it was fear. Medical Officer: If you think of the matter further, what is it that you are afraid of? Of being wounded or of death? Patient: (after some hesitation). I suppose it can only be that. Medical Officer: Is it very distressing for you to think of shelling and bombing and death? Patient: (with a shudder). It is, doctor, it makes me feel nervous and rather sick. Medical Officer: Let us, nevertheless, continue to think of it. Give yourself a bad five minutes. Insist on looking the situation in the face, and thinking it out. It will, no doubt, make you feel distressed, but you will find yourself much better afterwards. You agree? Patient: Yes, doctor. Medical Officer: Let us consider the fact of going back to the trenches, and machine guns, shells. Think of the men already there sticking it out. You were able to stick it out yourself before you were wounded. Is that not so?



Illusions of Success 265 Patient: Yes, doctor. Medical Officer: Let us go further and suppose that shells are dropping here just now; that they are outside this tent; that one explodes in here this moment, and that we see bits of ourselves flying over the ropes. What of it? Is it so very terrible? Patient: (after a pause) It is not really so bad after all.117

As Dejerine taught before the war, the goal of rational persuasion was to convince patients that their thoughts or actions were irrational and that it would be impossible to achieve the aims they desired. Yet it is important to note that in this example, which Dillon characterized as an ideal interaction, the patient’s fear was not actually irrational: if he returned to the front, he might indeed be killed. The notion that one’s own body might be blown apart by a shell explosion was, undeniably, a terrible thought – even in the context of Edwardian masculinity. Dillon was less interested in making soldiers face their fears than he was in convincing them that it was wrong to give expression to those fears and that the proper way to face that reality was to act like a man and control any emotional response to combat. In forcing patients to agree that death was not something to be feared but welcomed, “this, psychologically, implied the arousing of the self-regarding sentiment,” he concluded. “When the implications of the condition had been explained to the patient, that his personality had been overwhelmed for the time being by the emotion of fear and that he could not remain satisfied with this, it acted as an appeal to his self-respect. Apart from a very transient arousal of shame, in fact, the usual immediate reaction was to bring forward the great self-sentiment. Experience bore out the fact that it was not so much the arousal of the emotion that was of importance, but the loss of normal control.”118 Conclusion During the summer and fall of 1917, policy and practice began to diverge in significant ways, especially in the northern part of the front line under the command of neurologist Gordon Holmes. In June 1917, GRO 2384 and AG 6902 laid out specific rules that were meant to discourage self-reporting of shell shock and outlawed the use of that diagnosis in the front lines. These orders also gave official sanction to the network of special army-level centres that had developed in the wake of the Battle of the Somme and gave specialists working there

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full authority over all cases labelled NYDN in each army area. While Sir Douglas Haig and Adjutant General Fowke seem to have believed that this would restrict medical authority, the medical services actually seized on the opportunity which they provided to reclaim control over the management of shell shock cases. While historians have assumed that most cases of nervous illness were sent to NYDN centres following their creation in June 1917, this was not the case. In the northern sector of the front nervous soldiers were initially treated in frontline field ambulance rest stations, as had been the case since January 1915, and nearly half continued to return-to-duty from those makeshift hospitals. Although the diagnosis of shell shock was indeed banned at the front, senior medical officers encouraged front-line doctors to employ a variety of euphemisms to reduce reporting, undermining the Adju­tant General’s ability to accurately track the incidence of nervous illness in the BEF. These measures, which were eventually adopted throughout the BEF following Colonel C.S. Myers’s resignation in October 1917, restored the medical services’ control over one of its most challenging problems. As the experience of the Canadian Corps at Lens and Passchendaele makes clear, there was also continuity in the ways patients and doctors experienced and evaluated cases of shell shock at the front. In fact, in adopting the concept of “exceptional exposure” as a defining criterion of the “shell shock wound” diagnosis, the new NYDN policy actually affirmed popular and informal mechanisms of understanding which ordinary soldiers used to evaluate the legitimacy of their comrades’ suffering. Given a scientific basis through the adoption of a new bio-psychological interpretation of traumatic nervous illness which emphasized the importance of self-control and inherited predisposition, the special hospitals situated an average of 45 kilometres behind the front lines became a middle ground where the culture and attitudes of front and rear mixed. While specialists were quick to adopt treatment methods that had more commonly been employed in hospitals in England or at the base, they proved more unwilling than the military authorities had hoped to reject most cases of nervous illness as illegitimate. The special hospitals created across the BEF during the summer of 1917 only treated a small percentage of the men who broke down at the front during the fighting that summer and fall. As we will see in the next chapter, although the specialists working at the hospitals claimed



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to have achieved significant success, returning upwards of 80 to 90 per cent of patients to duty, this was also never actually the case. What the special hospitals did do, though, was to create a mechanism whereby cases of nervous illness could be officially given sanction or rejected as illegitimate. As far as the army was concerned, the specialists working at those hospitals remained far too sympathetic towards patients who were increasingly being constructed as unmanly men, incapable of controlling their emotions.

Chapter Nine

Failure and Retrenchment, 1917–1918

Louis D., a coachman born in Sussex, England, was one of the first people to enlist in the CEF during the summer of 1914. Although D. went overseas with the first Canadian contingent, he was assigned to the 12th Canadian Infantry Battalion, which was kept behind in England when 1st Canadian Division went to France in February 1915. D. spent nearly four years training other soldiers in Britain and was promoted twice to sergeant before he reverted to the ranks in order to get to the front as a private. D. reached the trenches with a draft to the 20th bat­ talion just as the war was coming to an end on 6 November 1918. With the German army in full retreat, the 20th Battalion was then marching all day from dawn to dusk just to maintain contact with the fleeing enemy. On the 10th, D. went into combat for the first time as his battalion pushed on to the town Belain, southwest of Mons. During the advance, heavy German machine-gun fire forced the Canadians to dive from one house to the next by alternate rushes until nightfall brought an end to the fighting. The Canadians took roughly fifty casualties that day, but captured some of the last prisoners of the war. The next morning at 8:00 am, the 20th Battalion received word that the Armistice would go into effect three hours later. Although the war was over, within a week D. began to break down. On 19 November he was admitted to First Army’s special hospital at No. 6 CCS, labelled NYDN. A few days later he was diagnosed with neurasthenia and debility and evacuated to the coast. D. was the last Canadian soldier treated at a forward psychiatric centre during the Great War.1 In early 1918, as the BEF’s leadership absorbed the lessons of the Passchendaele campaign, it became clear that the NYDN centres had failed to live up to the promises of their greatest proponents. Once



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again, Haig and Fowke revised the system, this time in favour of an approach that would ultimately remove much of the autonomy and authority delegated to specialists over the course of 1916–17. By the end of the war, the NYDN centres became little more than specialized triage centres tasked with funnelling nervous soldiers from front-line units to ancillary labour companies in the rear, while divisional and corps rest stations regained their importance. The lessons learned during the course of 1917–18 suggested that specialists were no better equipped to treat nervous illness than generalists. Analysing Outcomes The centralization of diagnosis and treatment in NYDN centres had a twofold purpose: to discourage self-reporting and to improve returnto-duty rates. GHQ measured progress towards achieving those goals via weekly reports from each army that the Deputy Adjutant General, Major General E.R.C. Graham, compiled and compared against figures from the Somme campaign a year earlier.2 At first, GHQ had reason to be optimistic. Graham found that during the summer of 1917, reported shell shock admissions had dropped a remarkable 75 per cent.3 Initially, there was also good reason to believe that many of the cases being admitted to hospital were also returning to duty more quickly and consistently. Both Carmalt Jones at No. 4 Stationary Hospital and William Brown at No. 21 CCS reported that they were able to return upwards of 65 to 70 per cent of soldiers to duty in only a few days’ time using a combination of rest, persuasion, and cursory psychotherapy.4 Similar results were cited by Frederick Dillon, in charge of Third Army’s special centre at No. 3 Canadian Stationary Hospital.5 When Fifth Army moved to the Passchendaele front in June, William Johnson opened that army’s special centre at No. 62 CCS, Bandagehem, and despite a heavy influx of cases during the first phase of the Battle of Passchendaele, the neurologist reported that he only had to evacuate 12 per cent of his patients to the base, sending the other 88 per cent back to duty.6 Relapse rates were also said to be low, ranging from less than 5 per cent at No. 3 Canadian Stationary Hospital to 10 per cent at Johnson’s centre.7 When declining admission rates were examined alongside the growing num­ ber of soldiers who were returning to duty, the evacuation rate – meaning the number of men who were transferred to base hospitals outside of the army area – had seemingly declined by more than 90 per cent from the Somme.

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How accurate were these figures? We know that army-level statistics compiled in 1917 only included a fraction of total admissions for conditions that would have been classified as shell shock in 1916. In the first instance, soldiers treated and released at rest stations close to the front – which the experience of the Canadian Corps suggests continued to account for 50 per cent of all cases – were never included. More important is the fact that armies did not actually track NYDN admissions specifically, only recording cases in which soldiers were diagnosed with nervousness, neurasthenia, hysteria, and shell shock (wound) as well as those returned to their units labelled NAD. This means that men initially labelled NYDN but subsequently re-diagnosed with exhaustion, fatigue, debility, myalgia, etc. were excluded from the returns Graham compiled. The admission and discharge books of the New Zealand Stationary Hospital and No. 15 CCS, which handled Canadian admissions from Second Army during the fighting at Passchendaele suggest that around 40 per cent of the 146 nervous patients admitted to those two special hospitals were admitted under a diagnosis that would not have been recorded on official returns.8 This helps to explain significant discrepancies between official tallies created at GHQ and those generated at the front.9 At the same time, it is clear that return-to-duty rates were being significantly overstated. In a study of the admission and discharge registers from No. 4 Stationary Hospital, Edgar Jones and colleagues found that although Carmalt Jones claimed to have returned around 65–70 per cent of soldiers to duty, only a small portion of patients (36.1 per cent) actually returned directly to some form of duty, the remainder being transferred to convalescent depots (35.1 per cent) or other hospitals (27.2 per cent).10 Even those who went back to duty did not necessarily go back to the trenches: only 16.9 per cent were listed as returning to full or light duties at the front, while 19.6 per cent left hospital assigned to base duty.11 Although a lack of patient records and convalescent depot registers prevented Edgar Jones and colleagues from determining what actually happened to patients when they left hospital, the Canadian records are more complete and allow us to take their analysis further. Between January and September 1917, No. 4 Stationary Hospital was the primary NYDN centre for the Canadian Corps, treating 425 Canadian patients. Of these, 21 per cent of were listed as returning to duty, 14 per cent were discharged to base duty, while 26 per cent were transferred to a convalescent camp; the remainder were sent to another hospital (33 per cent) or readmitted to No. 4 Stationary with an organic disease (5 per cent)



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– similar to the numbers reported by Jones et al. To examine what happened to soldiers listed as “discharged to duty,” one third (31) of patient service records, including their medical records, were examined in detail. The majority of these patients, 84 per cent, returned to duty with their original units at the front, typically within seven days of discharge, although in about 7 per cent of cases it took more than a month to reach the trenches. The remaining 16 per cent were readmitted to hospital or redirected to base duty in France or England before reaching their units. Those who made it back to the front remained on strength in the trenches for an average of 320 days before being transferred to the base, relapsing, or becoming casualties. This suggests that only about 17 per cent of the patients returned directly to duty from No. 4 Stationary.12 Although small in number, the soldiers who did return to the trenches seem to have functioned effectively at the front. In the above sample, 20 per cent were promoted, mentioned in dispatches, or awarded a medal after rejoining their units. For example, James Harold H., a twenty-year-old labourer from Palmerston, Ontario, joined the CEF in early 1915 and served at the front for nearly eighteen months before he was admitted NYD Shell Shock in late April 1917 after the fighting at Arleux. After three weeks of treatment, H. returned to duty with the 4th CMRs, and during an attack at Passchendaele that fall he acted as a runner when five German snipers began to pick off the officers and men of his company. As his commanding officer later reported, grabbing a rifle, H. “crept forward, shot the foremost sniper, captured the remaining four and compelled them to carry his wounded Officer back to our line. He then rejoined his company and assisted in consolidating the captured position; according to his CO, he set a ‘splendid example of courage and initiative.’”13 H. was killed east of Cambrai in October 1918, but was awarded the Distinguished Conduct Medal, the British Army’s second highest award for bravery. Although specialists like Carmalt Jones believed that soldiers were unlikely to be of much use to the army after breaking down, this was clearly not always the case. By the end of the war, 41 per cent of the men in the sample who returned to duty were still serving with their original units at the front, had been wounded by shot or shell, or killed in action. A further 26 per cent had been reassigned to base duties in France or to a labour battalion. Even so, relapses appear to have been more common than was reported during the war. It appears that figures commonly cited as relapse rates would be more accurately described as readmission rates, meaning they measured the number of soldiers who returned to the

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same hospital after discharge rather than the number of men who brokedown after returning to duty. NYDN centres and fighting units moved frequently, so it is not surprising that many men relapsed and were then admitted to a different hospital, and so were never counted. For example, William Edward B., an engineer from Bolton, England, living in Toronto, was twenty-five when he joined the 124th Battalion, Canadian Pioneers, in December 1915.14 As an engineer, he was quickly promoted to sergeant. On 22 July 1917, B. was moving up to the front west of Lens when a shell burst in front of him. Although he was not physically hurt, he later told his platoon commander that he was suffering from concussion, that the explosion “frightened him, [he] was trembling [and] lost consciousness.”15 On 31 July, Carmalt Jones diagnosed B. with neurasthenia and ordered him returned to duty; he arrived back at the front four days later. However, B. had a difficult time readjusting to life at the front and after only a couple of weeks suffered from what his comrades described as an “epileptic fit.” As epilepsy was treated differently than NYDN cases, B. was sent directly from a CCS to No. 25 General Hospital at the base and, after a lengthy stay, was reassigned to a labour battalion. Fred G., a teamster from Toronto, joined the CEF shortly after his twentieth birthday in January 1916.16 In late May 1917, G. was treated at No. 4 Stationary for shell shock after surviving an intense barrage of high explosive shells. Although he returned to his unit on 11 July, by later October he had begun to tremble, stammer, and suffer from debilitating headaches as well as crying fits. By that point, the Canadian Corps had moved to Ypres in preparation for the attack on Passchendaele, and so when he broke down a second time on the 22nd, he was sent to No. 62 CCS, where he was diagnosed with neurasthenia and reassigned to a labour unit in England.17 In total, nine of the thirty-one patients who returned to duty (33 per cent), relapsed and had to be evacuated. Although army doctors used relapse rates to measure success, both in terms of treatment outcomes and as an indicator of prognosis, relapse cases still provided the army with a significant period of service in the trenches before being readmitted to hospital: on average, the typical soldier spent fifty days in the front line with his unit before returning to hospital. While the army might see this as a more positive outcome than doctors sometimes allowed, from a humanitarian perspective it is clear that many of these men were forced to suffer in silence and to endure additional trauma before receiving the help they felt they deserved. This led some to take desperate action. Private Fred



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B. from London, England, enlisted at Calgary, Alberta, in late 1915 and arrived at the front with a reinforcement draft to the 102nd Battalion on 21 August 1916. That winter, he reported vertigo, heart palpitations, and severe stomach cramps and was sent to No. 4 Stationary. After a month of treatment, he returned to duty but remained nervous at the front, and so a few months later was transferred to a labour battalion. After several more attempts to gain admission to hospital, B. deserted two days before Christmas 1917 and somehow made it back to England, where he seems to have lived in London for a time before reporting to a Shorncliffe hospital as an overseas casualty in early February. B. was eventually discharged from the army as a nervous casualty in England and was never formally charged.18 Others, of course, were not so lucky. This all suggests that while some men clearly did return to duty in the trenches from the special hospitals to perform militarily useful service, this was far from a typical outcome. In evaluating the effectiveness of the NYDN centres, it is also important to acknowledge that even limited successes can be exaggerated through the aggregation of outcome statistics which hid significant fluctuations in return-to-duty rates. In fact, at all the centres for which statistics have survived, returnto-duty rates steadily declined over time. This pattern is clearest at No. 4 Stationary where, as indicated by figure 9.1, the hospital was far more successful during its first five months operating as a special shell shock centre than it was later in the year when it became a NYDN centre. Between January and May 1917, Carmalt Jones discharged nearly 40 per cent of Canadian patients to full duty at the front, sending only about 9 per cent to base duties and 8 per cent to a convalescent camp (36  per cent were evacuated to the base). During the period June to Septem­ber, after the passage of GRO 2384 and AG 6902, this pattern was inverted, with 38 per cent of patients discharged to a convalescent camp, 18 per cent going to base duty, and 9 per cent to full duty at the front (evacuations remained approximately the same). For the Canadian Corps, both phases included roughly equal periods of low-intensity trench warfare punctuated by roughly a week of heavy fighting at Vimy and Lens. At Frederick Dillon’s special centre attached to No. 3 Cana­ dian Stationary Hospital, a similar pattern is evident. During the first four months of operations, December 1916 to March 1917, that hospital admitted 400 patients, of which Dillon claimed to have returned all but twenty (95 per cent) to duty.19 Between April and July 1917, though, the return-to-duty rate declined to around 80 per cent, and then to 72 per cent in August.20 Thereafter the rate fell to around 50 per cent for

100% 90% 80% 70% 60% 50% 40% 30% 20%

1916

1917 Unknown

Other Hospital

Conv. Camp

Figure 9.1 Canadian patient outcomes at No. 4 Stationary Hospital, 1916−1917

August

July

June

May

April

March

February

January

December

0%

November

10%



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the remainder of the war.21 A similar pattern is clear in reports from Johnson’s Second Army centre at No. 62 CCS.22 Several factors gradually reduced return-to-duty rates over time. When hospitals first opened as special treatment centres, existing casualties were “cleared out” via transfers and evacuations, which freed up hundreds of beds for incoming patients. Although the special hospitals also received an initial influx of transfer cases, it usually took several weeks to fill the available bed space, which was then expanded – sometimes doubled – through the addition of tented marquees and hutted overflow wards. When a hospital approached maximum capacity, the treatment staff had to find alternatives to both evacuation and discharge. Although the fighting on First Army’s front was relatively mild during the summer of 1917, peaking during the advance on Lens in July and August, No. 4 Stationary Hospital reached capacity just as the new regulations went into effect in the middle of June 1917. The paperwork involved in tracking NYDN cases was significant, specifically the requirement that cases not be returned to duty, transferred, or evacuated until a W3436 form had been circulated and completed by the patient’s commanding officer. The special centres all began to buckle under the weight of record-keeping requirements, and return-to-duty rates fell as a result. Special hospitals thus went through something of a life cycle characterized by a period of initial success, a plateau phase as the hospital approached capacity, followed by a period of overwork and significant difficulty. During this final phase, as evacuations necessarily increased, various auxiliary methods were also used to divert patients away from the base and to keep outcome reports positive. For example, beginning in May and June 1916, Carmalt Jones began to use convalescent camps, usually No. 7, Boulogne, as a holding centre for men with incomplete paperwork as well as borderline cases, that is, patients who were neither fit for duty at the front nor sufficiently ill to require evacuation but who had been in hospital for several weeks. While this approach began as a temporary expedient to deal with overcrowding, it soon became routine and was justified on the grounds that camp life provided both an opportunity for physical retraining and an atmosphere of cure in which nervous soldiers would be in constant contact with men recuperating from physical wounds.23 However, this was a positive spin that distorted the situation. Although No. 7 Convalescent Camp was created along with similar centres in 1915–16 to prevent men only requiring physical conditioning from being evacuated to England, they also became a

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natural home for “problem cases,” that is, men suffering from minor forms of illness and wounds that did not require hospitalization but which still precluded a return to duty. Located more than 100 kilometres from the front, well outside army areas, it is also difficult to argue that they provided the type of “atmosphere of cure” envisioned by senior military-medical officials. “The camp routine was very easy, and we had plenty of time to ourselves,” recalled Frederick E. Noakes, a patient at No. 7. “On certain days of the week, when it was fine, there was a ‘route march’ for those who were fit to attend, though this term was merely a formal name for a pleasant country walk, in a rough semblance of military formation … Within the Camp, ample amusement was provided for us by several large huts under the auspices of various ‘war-charity’ organizations. The Red Cross maintained a large concerthall, in which there were frequent variety shows or orchestral concerts, some of which were very good.”24 The important role played by convalescent camps within the NYDN system is clear. At the end of September 1917, when the Canadian Corps left First Army for Passchendaele, fully 44 per cent of the 127 Canadian patients admitted to No. 4 Stationary during the previous two months had been discharged to convalescent camps.25 According to Fowke, it was the army’s policy to send as many men to these camps as quickly as possible, so there is no reason to think that this pattern was atypical.26 These transfers hid large numbers of evacuations. Although all the registers listing British admissions and discharges from convalescence camps were destroyed after the war, Canadian patient records survive.27 According to the books kept by No. 7 Convalescent Camp, Boulogne, only 24 per cent of the 155 Canadian nervous patients sent there between mid-April and the end of September 1917 returned to the front, while a further 30 per cent were earmarked for base duty on the French coast or, more usually, in England. The most common outcome (46 per cent) was to be transferred to another base hospital or convalescent centre, and men indeed seem to have shuffled from one camp to the next, sometimes over a period of months.28 For example, Private James B., an American who enlisted in the CEF at Camp Borden on 28 September 1916 and was admitted to hospital with shell shock on 22  June 1917 after three months in the trenches, was transferred to No. 7 Convalescent Depot on 18 July after twenty-nine days at No. 4 Stationary. After a week at Boulogne, he was sent to No. 10 Convales­ cent Depot, Escault, where he spent two weeks before again being transferred to a depot at Trouville on 4 August. At the end of that month



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he was readmitted to hospital with shell shock and eventually went before a medical board which reclassified him as fit for permanent base duty in mid-September 1917.29 Private William B., a farmer from Lindsay, Ontario, was admitted to No. 4 Stationary Hospital from the 49th Bat­ talion as a suspected shell shock case on 10 June 1917. After a month in hospital he was sent to No. 7 Convalescent Depot and then transferred twice more until, on 29 July 1917, he reached No. 3 Canadian Base Detail Rest Camp, where he remained for the next eight months, except for two weeks’ leave in November. During that time, he was sent before a medical board for examination and reclassification no less than six times until, finally, on 9 March 1918, he was sent to a Canadian labour unit in England.30 Although B. and B. were both recorded as having returned to duty on the books of No. 4 Stationary Hospital, this reflected doctors’ assumption that they would soon make their way back to the front rather than the reality that such an outcome was far from certain. A detailed examination of the service records for 15 per cent of the nervous patients treated at No. 7 Convalescent Deport shows that about 45 per cent of patients eventually returned to some form of duty at the front, often after moving through several camps. Of the remaining patients, 36 per were discharged to duty with labour units after spending an average of 172 days in various rest or convalescent camps – one patient spent 328 days moving between hospitals and convalescent deports before being sent to base duty in England. Only about 10 per cent of patients were ultimately discharged as medically unfit without first being given some form of duty. Men returning to duty from the camps do not seem to have adjusted nearly as well to life at the front as those sent directly back to the trenches from the special hospitals: just under half either relapsed or were transferred to a labour unit within six weeks of reaching the front.31 These statistics force us to further question the return-to-duty rates reported by NYDN centres. When cases are tracked over time and from one hospital to another, this analysis suggests that roughly 45 per cent of patients sent to No. 4 Stationary were eventually evacuated to base hospitals on the coast, either directly from the NYDN centre or via a convalescent depot. Only about 30 per cent returned to duty at the front, while another 25 per cent were given less dangerous work at the base. Of those who did return to the trenches, including both direct transfers and convalescent patients, between 30 and 50 per cent quickly relapsed. In evaluating these figures, it needs to be recalled that in 1915–16 divisional and corps rest stations were able to return 50–60 per

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cent of nervous patients to duty, usually within two weeks, with a much lower relapse rate. While this discrepancy likely reflects the fact that rest station cases were, by definition, less severe than those evacuated to the special centres, it nevertheless presents a serious challenge to the argument that specialized psychiatric treatment in forward areas produced more positive outcomes, from the perspective of either patients or the military authorities. These conclusions are clearly at odds with the accounts published in the contemporary medical literature.32 But most of the statistics cited by army neurologists were based on expected rather than observed outcomes, meaning they were compiled from case notes without any follow-up studies. It was assumed that patients discharged from hospital to duty, either directly or via convalescent camps, actually returned to their units. As we have seen, this was not always the case. At the same time, it is important to remember that this body of literature was also shaped by wartime censorship, and so the published sources only tell aspects of the story that the military authorities wished to see in print.33 Between November 1916 and the Armistice, most army neurologists tried to publish papers on shell shock, but had to send them to Assistant Director General, Medical Services (ADGMS), W.G. Macpherson, for approval prior to submission to a medical journal. Macpherson was highly selective in choosing which papers were allowed to go to press.34 Theoretical or abstract papers on the aetiology and symptoms of shell shock, such as the series of “Contributions to the Study of Shell Shock” written by C.S. Myers, went largely unchallenged. In contrast, essays that could conceivably be of use to the enemy, either because they revealed operational details or betrayed deficiencies in the BEF’s management of psychiatric casualties, were almost always rejected. For example, one of Myers’s papers on the management of shell shock during the Somme was turned back in November 1916, as was a similar paper written by Carmalt Jones in March 1917.35 Frederick Dillon complained to a Canadian colleague during the summer of 1918 that he had written and submitted three different articles on the management and treatment of shell shock cases at the regimental and army levels, but that all had been rejected by the ADGMS’s office.36 The only paper he was able to get published during the war was a theoretical discussion of the role of instinct in the generation of the war neuroses.37 During the summer of 1918, Gordon Holmes also submitted a paper, entitled “Treatment and Management of the Psychoneuroses as They Appear in Combatant Armies”; a censor’s note indicates that his paper argued



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that “success is most certainly assured [but only] when adequate clinical methods can be rationally employed under suitable conditions.”38 It too was rejected. Of front-line neurologists, only William Brown published a detailed account of his work at an army centre while the fighting continued, and he seems to have evaded Macpherson’s controls by resigning his commission and returning to England in March 1918, submitting his article in May of that year.39 It was also wholly optimistic and ignored many of the problems identified at the other centres. Although Carmalt Jones, Frederick Dillon, and William Johnson all published accounts of their work after the war, they smoothed out any fluctuations in outcomes by reporting only aggregate statistics while rationalizing failures as being the consequence of predisposition. Learning Lessons in the BEF It is also clear from contemporary records that senior military officers had serious doubts about the effectiveness of front-line psychiatric treatment and that the pressures they exerted on doctors to get nervous men back to duty affected the way patients were treated and managed. This, in turn, shaped the outcome statistics reported after the war. For example, during the heavy fighting at Passchendaele, Fifth Army’s DMS, B.F. Skinner, repeatedly visited Johnson’s hospital, criticizing the neurologist’s management of NYDN cases. His main complaints were that Johnson was reluctant to send men back to duty, either by labelling them “NAD” and transferring them to a corps or divisional rest station or by reassigning them to labour duties; he also felt that Johnson had a penchant for keeping “light cases” in hospital under “unnecessary” observation. Skinner’s preferred approach for NYDN cases would have been to use the special hospitals only to triage cases and then get them working in some form of light duty as quickly as possible.40 Before Johnson arrived at No. 62 CCS at the end of July, Skinner made arrangements with the centre’s doctor, W.B. Davey, to transfer soldiers deemed fit for duty to the new British agricultural units then being established behind the lines. With Germany resuming unrestricted submarine warfare, these army farms were meant to provide fresh food to the troops at the front, thus relieving pressure at home.41 They were something of a pet project for Skinner, who believed that sending physically fit convalescent cases to farms “would be a good means of employing NYDN [cases] who required rest on completion of treatment”; he also clearly hoped to use the farms to reduce the number of NYDN cases under

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treatment at No. 62 CCS in the belief that few would make effective soldiers again.42 In contrast, Johnson preferred to try a range of psychotherapeutic and persuasive therapies before transferring men to convalescent or labour camps, but from Skinner’s perspective this took too much time. As casualties mounted – exceeding 1200 in hospital that August – the matter came to a head and the DMS sacked the hospital’s commanding officer, accusing him of being “incompetent to run a CCS,” and then demanded that Johnson take some action to get NYDN cases immediately into physical retraining.43 Within two weeks, the neurologist had appointed a gymnastics instructor, was organizing sports and physical drills for patients, and had begun redirecting patients to agricultural labour. Although the NYDN population plummeted just as Skinner hoped it would, this reflected the new transfer policy and did not mean that men were being given any form of real treatment.44 Nevertheless, by the middle of September, the DMS recorded that the hospital was functioning more effectively. Johnson later reported that he was able to return an aggregate of 55 per cent of cases to duty, but as with other special centres, this included cases labelled NAD, those sent to convalescent camps and depots, and cases transferred back to corps rest stations. No follow-up studies were ever conducted to see whether men sent to farms actually went back to duty. Although the system of convalescent camps, farming units, and labour battalions helped reduce pressure at the special hospitals and ­increase return-to-duty rates, it also created a series of new and unforeseen problems that further aggravated the military authorities. Although the special hospitals operated within an army area, regardless of how far to the rear they were situated, convalescent camps were attached to the lines of communication or to the base, and so patients sent to those units had to be officially transferred out of the army area. This meant that when soldiers relapsed at a convalescent camp or failed to improve, they could not be readmitted to an army area special hospital and had to be evacuated to the base. This, though, kept evacuation cases off the army’s books. Another wrinkle was that only officers working under the authority of the DMS, Lines of Communication, could assign a patient to base duty. As C.S. Myers recalled, this created the perverse situation in which army neurologists could only recommend patients for base duty if they had first been struck-off strength of their front-line units, which was not supposed to happen to patients admitted to the special hospitals and thus required special permission on a case-by-case basis.45 Transfers to convalesecent camps simply



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became easier to process. As a result, though, during the summer and fall of 1917 large numbers of nervous soldiers started to accumulate in the wards of all the base hospitals as they were evacuated from various camps and convalescent units along the lines of communication.46 In response, in late August 1917 Gordon Holmes designated No. 32 Stationary Hospital, Wimereux, as a new special base hospital for shell shock cases and thereafter tried to concentrate evacuated cases there as much as possible – the very situation which the new June orders had been issued to prevent.47 Although it was officially a British unit, No. 32 Stationary Hospital was created from the Australian Voluntary Hospi­ tal in 1916 and was staffed mainly by Australian expats who enlisted in England and Scotland at the outbreak of war.48 It was not the sort of  hospital with an “atmosphere of the front” envisioned at GHQ. American neurologist Harvey Cushing visited the hospital in the summer of 1917 and recalled that it had a “famous mess in what was the Wimereux Golf Club,” and that one could see the white cliffs of Dover from the hospital steps overlooking the beach below.49 There the shell shock ward was run by Major Sydney W. Patterson, a pathologist from Melbourne who was doing his doctorate of science at the University of London when war began.50 Like many other so-called army neurologists, Patterson appears to have had little training in nervous or mental illness, specializing instead in gastroenterology.51 Treatment at No. 32 was general in nature and was patterned after the methods developed by Holmes and Carmalt Jones, specifically suggestion and persuasion including the use of the wire brush.52 On admission, patients were classified according to the severity of their symptoms: the worst cases were given bed rest, moderate cases escorted walks along the beach, while milder or recovering cases did full route marches accompanied by a physical drill.53 When men had sufficiently regained their strength, they were discharged for further conditioning to No. 14 Convalescent Camp, where they eventually went before a medical board. Few, though, seem to have returned to service and most were evacuated to England once they were physically fit.54 C.S. Myers was instrumental in bringing these problems to light. In late July 1917, the psychologist visited the French army to study their methods of front-line treatment for the first time.55 To that point in the war, French and German approaches to shell shock had been largely ignored within the BEF, although they had been given some attention by the home forces.56 As Myers later recalled in his memoir, he found the organization of the French system to be far superior to the British.

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The French used a series of advanced sorting centres, similar to the one he helped create at No. 41 CCS during the spring of 1917, where nervous casualties were identified and triaged within eight hours of admission to hospital. Cases requiring more treatment than simple rest were then sent to a series of army neurological centres with about 200 beds each, situated within 25 kilometres of the front lines, comparable to the British NYDN centres. But whereas the British centres were severely understaffed, so that sometimes more than a thousand patients were placed under the care of a single officer, the caseload at the French hospitals was never allowed to grow beyond 100 per neurologist. However, it was the organization of the French system that Myers liked. He was dismissive of their treatment methods, which relied on the use of painful galvanic electricity and the complete, often inhumane, isolation of patients.57 Upon returning to the British lines on 2 August 1917, Myers told DGMS Sloggett that they could learn much from the French approach. As he later recalled: “Whereas in the French Army few cases were evacuated [to the base], in the British Army a much larger number were then being transferred to the Bases, and a considerable proportion of these were being evacuated thence to the United Kingdom.”58 Summa­ rizing his findings for Sloggett later that fall, Myers recommended that the BEF create both advanced sorting centres and special NYDN hospitals in each army area and that the caseload per specialist be set at around 75 to 100 patients. In Myers’s proposal, the sorting centres would take on the function of the rest stations, albeit under a specialist, treating cases likely to return to full duty within a few days via rest, diet, and exercise. Their essential function, though, would be to allow an expert to triage cases and make a prognosis in each case, with the more severe patients being immediately sent to the NYDN hospital in the army area, which would thus have a true treatment function, avoiding the need for evacuations to the base. According to Myers, officers in charge of the special hospitals should have been given final say over the disposition of patients, streamlining the return-to-duty process while eliminating the Byzantine requirement that before reassignment cases first be transferred out of the army area.59 Otherwise, Myers predicted, unnecessary evacuations to England would only continue to increase. Although Sloggett is often portrayed as Myers’s foil, in fact the two men appear to have had a constructive relationship and the DGMS clearly respected the psychologist’s opinions more than has sometimes



Failure and Retrenchment 283

been allowed – even by Myers himself.60 Based on Myers’s recommendations, a neurological conference was held in partnership with the French at La Panne in October 1917, which both Myers and Holmes attended. Afterwards, again on Myers’s recommendation, Sloggett banned the use of both galvanic shock and isolation in BEF hospitals.61 The army also adopted the psychologist’s suggestion that patients be allowed to go directly from a special hospital to modified duty without requiring transfer to the base. However, his was not the only voice in the mix. As the Myers noted in his memoir, “Sir Arthur was a man of great courage and rollicking geniality [who was] endowed with an unusual facility for choosing the most competent Officers available, with special scientific or administrative ability, for the most important work.”62 Although Myers valued this quality when it allowed his opinions to be heard, he sometimes had difficulty accepting that Sloggett also sought a range of advice. A natural tendency towards feeling unappreciated and overlooked was only heighted by the very real bad blood that had developed between Myers and a number of other officers, including the DMS, Lines of Communication, Tom Percy Wood­ house, and apparently D.W. Carmalt Jones. Woodhouse was always hostile towards the psychologist and seems to have done his best to run him out of the army. That fall, he interpreted Myers’s recommendations as a personal attack on his management of LOC hospitals, hyperbolically asserting that the psychologist had accused him and his regular army colleagues of allowing large numbers of patients to be unnecessarily evacuated to England against army orders. Although this was not the real point of Myers’s argument, the DMS nevertheless distributed the memo to all the senior medical officers overseeing British base hospitals for comment. Myers felt this undermined his authority, making it difficult for him to continue doing his job effectively. In November he asked Sloggett a second time to relieve him of his duties in France so that he could return to England and this time the DGMS agreed. The next day Woodhouse recommended Carmalt Jones for Myers’s replacement, but Sloggett vetoed the promotion and gave Holmes jurisdiction over neurological cases across the whole front instead.63 While the medical services began to reassess its management of shell shock, officers at Haig’s headquarters were also beginning to suspect that casualty figures were being underreported and manipulated. As Deputy Adjutant General E.R.C. Graham told the commander-in-chief in early January 1918, although the special centres had only reported

284

A Weary Road

around 4000 cases of shell shock (wound) during the last half of 1917, this likely accounted for only 40 to 50 per cent of the real total, which must have been closer to 10,000 – and so not far off the alarming numbers seen on the Somme.64 And he quite correctly attributed the discrepancy to changes in diagnosis rather than a marked decrease in actual admissions.65 This had in part been revealed through a series of interim reports from the special hospitals which, although positive on the whole, tended to confirm the suspicions of men like DMS Skinner by suggesting that large numbers of cases were untreatable and best dealt with through redeployment to non-combat tasks.66 For example, Frederick Dillon told his superiors that he had begun to divide his patients into two classes: individuals diagnosed “shell shock (wound)” with a “normal resisting power” that broke down after exceptional exposure, either due to an unusually long period of service or a specific shocking event; and “sub-normal individuals with impaired resisting powers.”67 While Dillon believed that the former comprised roughly 56 per cent of cases and could respond positively to treatment, he feared the latter could never be effectively treated because the “defect” which caused them to break down was constitutional rather than acquired.68 Embedded in this analysis was the suggestion that the second group was comprised of men who had an inherent “inability to withstand the special stimuli of active warfare,” which registered as cowardice to Fowke and others at GHQ.69 The CAMC’s Doubts As in France, despite optimistic reports from both front-line units and the Canadian special hospitals in England, questions began to be asked by senior members of the CAMC when the number of nervous casualties under treatment started to exceed the number of predicted evacuations. Between February and July 1916, official statistics compiled at the front showed that 2332 cases of shell shock, neurasthenia, and hysteria had been admitted to hospitals in France and Belgium from the Canadian Corps.70 The majority of these (57 per cent) were said to have been treated and released to duty in theatre, with only 1014 cases requiring evacuation to England. This meant that only about 1345 shell shocked men should have been sent to hospitals in England from the start of the war to July 1916. However, when the statistics kept by Cana­ dian medical boards in Great Britain were compiled for a report that August, they showed more than 5000 nervous patients were receiving



Failure and Retrenchment 285

treatment in England during the period February to July 1916 alone – nearly four times the expected number.71 Given this discrepancy, Colo­ nel Frederick Gault Finley, a fifty-six-year-old Australian professor of medicine who taught at McGill before the war, was asked to launch an investigation into shell shock in order to “obtain data to serve as a basis for future action.”72 The next winter, Finley visited hospitals in France and Belgium, spending most of his time at the new shell shock centre at No. 6 Stationary Hospital, Frévent, where he met Frederick Dillon. Finley reported that of the 400 patients Dillon treated from December 1916 to March 1917, he had been able to return a remarkable 95 per cent to full duty at the front.73 These findings were at least partially verified by Colonel H.A. Chisholm, the ADMS, 4th Canadian Division, who told Finley that not only were the new special shell shock hospitals returning more men to duty, but that only about 5 per cent of them appeared to relapse once they got back to the front. However, he disputed Dillon’s claim that almost all returned cases were going back to the trenches: only half, he said, proved capable of front-line service, while the other half had to be employed in the rear areas.74 Finley thus concluded that the figures from the spring and summer of 1916 were an aberration, due largely to the fact that many mild cases snuck through to the base under other diagnoses, and that the British authorities now had the situation under control. Although Finley was optimistic, he clearly felt uneasy about the lack of follow-up studies given the impressive and unusual claims coming from the special centres.75 After returning to England, he began to plan a comprehensive study of 100 consecutive cases invalided from France during the first two years of war in order to uncover what actually happened to them after they had supposedly been returned to duty. How­ ever, this proved impossible given the chaotic state of the Canadian records, scattered as they were across dozens of hospitals in France, Belgium, England, and Canada. So Finley improvised by proposing a more limited follow-up study of sixty patients successfully treated and released to duty from Colin Russel’s care at Granville Hospital – Russel had, after all, reported both a similar methodology and impressive results to what was then being employed at the front.76 In the spring of 1917, the young neurologist was a rising star in the Canadian medical profession, thanks in part to a study of 60 “hysterical” cases he had already published in the Canadian Medical Association Journal, where he claimed to have returned 80 per cent of his patients to duty using a practical, non-theoretical form of rational persuasion that he called

286

A Weary Road

functional re-education. Russel’s work drew the attention of senior officers in the CAMC as well as his old Queen Square teacher, Aldren Turner, who brought his findings to the attention of Alfred Keough at the War Office, subsequently earning him a mention in dispatches.77 By the winter of 1917, Russel had also begun to doubt his original findings.78 Awarded three months’ leave at the end of 1916, the neurologist boarded the S.S. Olympic to spend Christmas with his wife and children in Canada, where he met one of his former patients, Sergeant Albert B., one of the first men he treated at Granville.79 B. was a thirty-one-year-old married cooper living in Toronto when he joined the 39th  Battalion in August 1915. He had been in the British Army for twelve years before the war and so was made a sergeant, but he never went to France.80 On 4 November 1915, he was in a bad motorcycle accident while training in England, developing photophobia and a psychogenic limp. Over the next four months, B. was sent to four different hospitals, and at each his symptoms worsened. On 2 February 1916 he was admitted to Granville with spinal concussion and spent the next 101 days in treatment, including rational persuasion with Russel.81 By the end of May, B.’s symptoms had disappeared and Russel believed he had been cured, and so discharged the man to full duty in the trenches; B. was his first and most significant success.82 So, months later, when Russel met B. on the deck of the Olympic, he was taken aback.83 In talking with the soldier, the neurologist learned that after leaving Granville, B. went first to the Canadian Casualty Assembly Centre (CCAC) – the main weigh-point between England and France for returning soldiers – where all his old symptoms returned, then worsened. In and out of hospitals over the next few months, at the beginning of September the Standing Medical Board (SMB) discharged B. to Canada, medically unfit for further service.84 No one ever followed up with Russel, and the neurologist began to wonder what had happened to the rest of the soldiers he claimed to have sent back to duty as well as those being treated for nervous illness at the front.85 Preliminary investigations revealed that several other cases had also not returned to duty as he ordered. “I would be very much interested [in conducting a follow-up study],” he told Finley, “and I think it might be instructive if we could find how these men have carried on.”86 It took several months to track down all the cases as many of the men had been in and out of hospital several times after they left Granville. When the papers were compiled, Canadian Headquarters, London, found that when discharged soldiers were reassessed by the SMB at the CCAC depot in Folkstone, they were often sent for additional treatment



Failure and Retrenchment 287

or physical conditioning rather than returned to duty at the front. This meant that they were rerouted back to a Canadian hospital, but one receiving “local cases” rather than overseas patients, usually No. 11 Canadian General Hospital at Moore Barracks. Once back in the medical system, they might be transferred several more times (including back to Granville or Buxton), but under a new case number, before being again discharged to the CCAC, where they would have a new assessment by the SMB – then the whole process often began anew. As a result, it was not uncommon for some soldiers to spend years in England, bouncing from one hospital to another following an endless succession of contradictory medical board decisions.87 The results of the Granville study were compiled in late May 1917 and distributed to Russel and Finley the next month. Of the fifty-four patients the army managed to track down, only five (9 per cent) had actually returned to full duty while another twenty-six (47 per cent) never left England; either they had been scheduled to be sent on permanent base duty after a period of reconditioning or were still awaiting re-boarding at the CCAC – on average, the latter had been waiting 316 days. A further 36 per cent of Russel’s patients had already been discharged from the army and sent to Canada as medically unfit. Whereas Russel claimed to have returned 71 per cent of his patients to full duty, in reality fewer than 10 per cent ever made it back to the Con­ tinent – and none did so in a timely fashion: on average it took more than six months for a returning soldier to reach the trenches.88 Given that this report seriously undermined Russel’s earlier claims of success, for the purposes of this study a 15 per cent sample of Granville case files were selected at random from the admission and discharge books (totalling 107 patients), and the service files, including medical records, were then examined in detail.89 Consistent with Russel’s reported results, about 76 per cent of the nervous patients in the sample were listed on Granville documents as “discharged to duty at the front,” while 13 per cent were sent for further treatment at another hospital and 9 per cent were discharged to Canada as medically unfit. Further examination of the service files shows the inverse to be true. Of the 107 soldiers examined, only 8 per cent ever returned to active duty at the front, 14 per cent were assigned to permanent base duty in England, while 76 per cent were ultimately discharged to Canada without returning to duty. Those discharged to Canada often spent many months – even years – moving between one hospital and another in England, in either treatment or convalescence, before finally being sent to the Canadian

288

A Weary Road

Discharge Depot.90 The final outcome in the remaining 2 per cent of cases could not be determined from the available records. At best, only 22 per cent of the Granville sample ever contributed to the war effort again, either at the base or at the front.91 In this sense, both contemporary and retrospective analyses of outcomes align. These findings help explain the discrepancy between official casualty figures compiled at Corps Headquarters and reported admission rates in England. In the first instance, a large number of soldiers were clearly crossing the Channel with non-psychiatric diagnoses and then being sent for treatment after they broke down in “Blighty”. Others re-­ entered treatment time and time again and were double, triple, or even quadruple counted. This led Finley to a pessimistic conclusion: “There is singularly little likelihood of any of these [cases of shell shock] becoming fit for active service. It is, therefore, recommended that they be returned to Canada with as little delay as possible.”92 This made frontline treatment all the more important. Despite what must have been considerable personal embarrassment, Russel agreed.93 After a brief period of hospitalization for exhaustion in July 1917, the neurologist sought permission to visit Canadian and British hospitals in France in order to study shell shock treatment at the front in the hopes of explaining his own failures and reducing evacuations to Canada.94 During his visit to the front, Russel stayed with Gordon Holmes at Boulogne and visited all the major shell shock centres, meeting with Carmalt Jones, Frederick Dillon, C.S. Myers, and William Brown. The rationale he devised to explain the failure of his own treatment methods encapsulates the consensus view on shell shock at the end of the war. As Russel explained to the Canadian DGMS, nervous patients were comprised of two distinct groups, those who broke down due to exceptional exposure (so-called genuine cases of “shell shock”) and neurasthenics, “the sub-normal individuals with impaired resisting powers and the normal individuals who break down as the result of prolonged strain not of exceptional character.” The former, Russel concluded, were comprised of essentially normal people of normal intelligence who could be more or less easily treated through any number of methods based on a combination of rest, suggestion, and rational persuasion. “For the proper cure of these cases,” he concluded, “it is considered essential that the patient should be made to consciously recognize that his symptoms are the result of the action of the natural ­instinct of self-preservation – a primitive instinct expressed by the emotion fear.”95 As Russel later explained in more detail, “In the immediate



Failure and Retrenchment 289

presence of danger the individual who does not get at least a thrill of fear is not intelligent and the extent of fear naturally should correspond to the gravity of the danger. Fear is not cowardice. It is a very normal reaction to instinctive urges born in all animal life, which has made possible a continuation of the species. Fear only becomes cowardice when it obscures the function of intelligence and the educational principles and ideas which each of us may have acquired in our youth.”96 The goal of the physician was therefore to restore the higher reasoning centres to a position of control. Yet in cases where the individual was supposedly subnormal, this would be impossible because those same reasoning centres were defective, due to bad breeding, poor education, or immoral behaviour. In this sense, then, Russel accepted Dillon’s argument that shell shock treatment was largely effective – when the cure failed, it became evidence of the patient’s culpability. Retrenchment While such rationalizations helped parry potential criticisms of neurology and psychiatry, none of this painted a positive picture for the military authorities. And as early as the end of 1917, Haig and Fowke were beginning to have grave doubts about the medical services’ ability to manage nervous illness during the coming year. These were heightened by the fact that the German army was widely expected to begin the next campaign season with a final great offensive designed to win the war before the American army arrived on the Western Front in force. For Haig, who was keenly if uncharacteristically aware of the dangers such a campaign might pose to the survival of the BEF and the Franco-British alliance, the question of morale was never more important. Any suggestion that the British Army might be morally unprepared for the onslaught was significant.97 GHQ’s initial response was to place further restrictions on evacuations and to reduce the power and influence of NYDN specialists by making several important modifications to the system. During the winter of 1917–18, Fowke issued new instructions to “retain in the army areas those men who are only slightly and temporarily affected,” and to send all other patients requiring more prolonged treatment to convalescent camps or agricultural duties as quickly as possible, rather than to special “Neurasthenic hospitals, where the reciprocal study of one another’s symptoms may delay the patient’s cure.” Recognizing that some patients were unlikely to ever return to combat, he also ordered

290

A Weary Road

cases that were “really serious and require prolonged treatment [to be] evacuated to England.” Finally, the Adjutant General also changed reporting requirements to obtain more accurate information, requiring each army to submit a weekly return to GHQ indicating the number of patients labelled NYDN actually housed in special hospitals, convalescent camps, and extension wards..98 The decision to increase surveillance of the medical services and to shift the focus of rehabilitation away from interventionist forms of treatment towards work and repurposing soldier’s labour was a tacit admission that the front-line treatment experiment had failed. Although the NYDN centres were never closed, specialists now had to emphasize diagnosis and triage over treatment, and so their role and prestige was greatly diminished. In the aftermath, William Brown, who had always been the most psychiatrically-oriented army neurologist, resigned his post at No. 41 Stationary Hospital in late February 1918 and then returned to England. Carmalt Jones, who had transferred to No. 32 Stationary Hospital to oversee neurological treatment at the base in October 1917, also found himself out of a job when that unit ceased to treat NYDN cases following the Adjutant General’s new policy; he finished the war as a consulting physician to the British Army in Egypt.99 Although William Johnson and Frederick Dillon remained Army Neu­ rologists to Second and Third Armies – Johnson until the end of the war and Dillon until he personally broke down with neurasthenia in October 1918 – new specialists had to be chosen for First, Fourth, and Fifth Armies. As a final step, during the early winter of 1918, Haig and Fowke moved to outlaw the diagnosis of shell shock altogether. Because this would affect both the home and overseas forces, it could not be done through a general order from BEF headquarters and required the consent of the Army Council in London. On 17 January 1918, Haig asked the War Office to ban the diagnosis of shell shock on the grounds that it was legitimizing behaviour that might threaten the stability and efficiency of the army. Haig explained that although the NYDN system had been created in order to “ascertain the extent to which the patient had been subjected to the direct effects of explosion,” it had led “to the unsatisfactory position that a man who was blown up in an explosion without suffering any mental ill-effects was passed over without mention while the man whose nerves gave way under the same experience got the credit of being wounded and the gold stripes.”100 He thus proposed that any case of “shell shock” should always be classified as sick



Failure and Retrenchment 291

and no longer recorded as a battle casualty under any circumstance. As Fowke later explained in more detail, the real purpose of this change would have been to further stigmatize the condition and discourage men from admitting that they had lost their nerve. Senior officers, he said, felt that it was a matter of common knowledge, that for every isolated case of a man’s nervous system being unavoidably affected by shell fire, there is a large number of men who have it within their power either to keep their nerves under control or to collapse and go sick. It is inevitable that the determination of some of these men should be undermined by the knowledge that another, whose experiences may be to them indistinguishable from their own, had been rewarded by an honourable distinction for going sick in similar circumstances.”101

The goal at GHQ was the same as it had been in 1916: to encourage men to remain at the front as long as possible. The German Spring Offensives The Army Council was still debating Haig’s proposal when Operation Michael began on 21 March 1918 with a massive attack against Fifth and Third British Armies. Over the next two weeks, the German Second, Seventeenth, and Eighteenth Armies advanced nearly 70 kilometres towards Amiens, across the landscape scarred by the Somme fighting in 1916. During the battle, Hubert Gough’s Fifth Army collapsed, suffer­ ing a staggering 90,000 casualties as units fell back before the German onslaught. Many of these were prisoners (roughly 75,000 from Fifth and Third Armies combined), and as communications broke down, rumours swirled that the BEF’s morale was indeed beginning to break.102 NYDN admissions soared as the evacuation system began to sag under the weight of massive casualties. On 26 March, as Fifth Army retreated, the staff of No. 41 Stationary Hospital found themselves on the front lines and quickly had to evacuate their quarters at Gailly, first for the relative safety of Amiens, then, at the end of the month, for Fouilloy.103 In the chaos, nervous casualties from Fifth Army were evacuated directly to the base, with the rest of the sick and wounded and the NYDN centre shut down when No. 41 Stationary Hospital became an emergency surgical hospital. As nervous men streamed into CCSs and base hospitals during the harried withdrawal, it proved impossible

292

A Weary Road

to sort them from the thousands of other stragglers and panicked soldiers clogging the routes back from the front, not to mention complete the required paperwork. Even so, as indicated by table 9.1, by the week ending 30 March, there were reported to be over 2100 officers and men in BEF hospitals who had actually been labelled NYDN, up from 395 at the beginning of the month. How many more were admitted under various other diagnoses – or never tracked at all – is impossible to say. To clear beds, base hospitals began pushing NYDN cases into ancillary units, so that by the beginning of April there were more than 800 cases in convalescent camps and more than 500 housed temporarily in cottage hospitals, huts, and marquees opened to absorb the overflow. At the base, inexperienced doctors did their best to cope with the ­influx. Lieutenant Colonel M.M. Rattray, the commanding officer of No.  26 General Hospital, Étaples, recalled that as the situation at the front deteriorated, his base hospital effectively became a casualty clearing station, although it had neither the beds nor the surgical and nursing staff to handle patients streaming into his wards by the hundreds. NYDN admissions began to arrive in significant numbers at No. 26 General on the 24th, so that by the 28th there were more than 420 cases in a hospital with only about 1200 beds. The hospital was so full that incoming surgical patients had to be evacuated after a dressing change directly to England, as there was no place to put them; even the convalescent camps were overflowing. In the chaos, the cumbersome rules restricting diagnosis and evacuation of nervous patients meant that beds needed for surgical cases had to be given to NYDN patients waiting on paperwork; they could not be evacuated to England without a diagnosis, but they were not allowed to be diagnosed with shell shock or neurasthenia at the base. As Rattray confessed in his personal diary, he resented these patients taking beds away from the physically wounded: “The NYDN cases, many of them absurdly trivial and described truthfully by one officer as ‘shell fright’ blocked the whole place.” By the end of the month, special permission was obtained from the DGMS to evacuate NYDN cases directly to England under symptomatic diagnoses like debility, gastritis, or exhaustion in order to free up bed space.104 The Canadian Corps, which was again attached to First Army during the winter and spring of 1917–18, did not participate directly in the fighting, although several mounted units were sent to reinforce Third Army. Holding a formidable defensive position atop Vimy Ridge, the German advances during Michael took place to the Corp’s south, while the next phase of the Spring Offensives, Operation



Failure and Retrenchment 293

Georgette, which began in mid-April, cut a deep swathe into First Army’s lines just to the north of the corps boundary.105 But because the NYDN system operated at the army level, the Canadian Corps still felt the effects of the German attack. Between 31 March and 4 May, First Army suffered 19,700 casualties, of which 611 were recorded as NYDN admissions.106 When First Army CCSs had to retreat on 13 April, stationary hospitals were again left to act as de facto clearing stations, so that No. 39 Stationary hospital, which housed First Army’s NYDN centre, closed its neurological ward in order to accommodate frontline surgical teams.107 Although Sloggett tried to prevent DMS N.M. Thomp­son from evacuating patients en masse to the base by opening a new special hospital at a CCS in Wavrans, there was no real alternative.108 However, steps seem to have been taken to prevent the overcrowding and chaos that had gripped Fifth Army’s withdrawal: nervous patients were admitted to hospital with symptomatic diagnoses that gave doctors more freedom to manage the case. During April and early May, some 13,000 sick were admitted to hospital from First Army alone – a remarkable number given the scale of the fighting; how many of these might have been suffering from some form of ­battle trauma is unknown. Although the Canadian Corps avoided the German offensive, there was an evident strain on the men who were fully aware that to the north and south, other British forces were in full retreat. Pte. Frank H. of the 85th Battalion, a merchant seaman from Sydney Mines, Nova Scotia, was admitted to No. 39 Stationary NYDN in mid-March after spending nearly a year in the trenches.109 When he was carrying rations to the front, his unit was caught in a shell barrage and although he was not physically wounded, he was knocked unconscious. He complained of “terrible pain in the back of his head,” considerable trembling, and difficulty sleeping due to bad dreams. When the special NYDN hospital was shelled, H. was evacuated to the base along with the other patients. During April 1918, nervous admissions in the Canadian Corps spiked more than 300 per cent from 3.8 per week during the first three months of the year to 13.110 The Hundred Days The last hundred days of the war witnessed the Canadian Corps’s most intensive period of fighting during the war. Between the Battle of Amiens on 8 August 1918 and the Corps capture of Mons on the early morning

294

A Weary Road

Table 9.1 Weekly summary of NYDN and other patients in BEF Hospitals, March−June 1918 Patients in hospital on the week ending: NYDN cases

Hospitals

23 Feb. 02 Mar. 09 Mar. 16 Mar. 23 Mar. 30 Mar. 06 Apr. Officers Men

Conv. depots

Officers Men

Detention Officers hospitals, Men huts, marquees, etc. Total

Officers Men

Other casualties

BEF sick

Officers Men

Wounded

Officers Men

Total wounded (including NYDN)

Officers

Ratio of NYDN cases to wounds

Officers

Men

Men

3

2

1

0

67

50

57

55

6 129

13 Apr.

74

25

21

1156

596

782

0

0

0

0

0

15

0

1

45

26

36

22

15

529

847

482

0

0

0

0

0

0

319

436

0

476

0

0

0

393

521

276

3

2

1

0

6

89

25

22

112

395

529

77

620

2078

1964

1540

335

318

343

354

541

364

322

8519

9263

9057

9260

13,462

9598

14,767

63

90

263

276

1933

675

1128

1880

1840

7278

23,096

46,265

12,867

26,502

65

91

263

282

2022

700

1150

2275

2369

7355

23,716

48,343

14,831

28,042

3%

1%

0%

2%

4%

4%

2%

17%

22%

1%

3%

4%

13%

5%

Source: War Diary, DGMS, BEF, February–June 1918, WO 95/47, NA.



20 Apr.

Failure and Retrenchment 295

27 Apr.

04 May

11 May

18 May

25 May

23

16

11

3

7

2

527

463

262

186

76

62

01 Jun. 0 30

08 Jun. 0 81

15 Jun.

22 Jun.

29 Jun.

0

2

1

104

93

82

1

0

1

0

0

0

0

0

0

0

0

438

341

282

289

336

115

96

82

59

49

34

0

0

0

0

0

0

0

0

1

0

0

608

530

501

366

599

607

348

606

926

865

804

24

16

12

3

7

2

0

0

1

2

1

1573

1334

1045

841

1011

784

474

769

1,089

1,007

920

538

470

462

475

415

419

470

375

608

609

598

12,937

12,318

11,054

12,161

10,276

10,314

8638

9,727

13,842

14,822

14,204

925

707

429

294

293

365

341

223

240

140

158

22,364

17,321

8306

5740

6230

6447

6361

5,311

4,611

3,062

3,364

949

723

441

297

300

367

341

223

241

142

159

23,937

18,655

9351

6581

7241

7231

6835

6,080

5,700

4,069

4,284

3%

2%

3%

1%

2%

1%

0%

0%

0%

1%

1%

7%

7%

11%

13%

14%

11%

7%

13%

19%

25%

21%

296

A Weary Road

Table 9.2 Weekly summary of NYDN and other patients in BEF hospitals, July−November 1918 Patients in hospital on the week ending: NYDN cases

Hospitals

Officers Men

Conv depots

Officers Men

Detention Officers hospitals, Men huts, marquees, etc. Total Other casualties

BEF sick

Officers

06 Jul.

13 Jul.

20 Jul.

27 Jul.

03 Aug. 10 Aug. 17 Aug. 24 Aug.

1

0

0

4

0

0

0

0

28

36

31

81

161

128

153

145

0

0

0

0

0

0

0

0

28

13

16

18

13

11

11

12

0

6

3

4

5

0

7

3

618

545

582

518

460

492

529

632

1

6

3

8

5

0

7

3 789

Men

674

594

629

617

634

631

693

Officers

487

363

347

283

278

380

311

493

12,288

6787

6868

6252

8251

9655

8417

10,723

Men BEF wounded

Officers

Total wounded (including NYDN)

Officers

Ratio of NYDN cases to wounds

Officers

Men Men

Men

177

94

155

321

317

876

523

1093

4229

2241

3270

9158

8121

16,497

12,195

21,523

178

100

158

329

322

876

530

1,096

4903

2835

3899

9775

8755

17,128

12,888

22,312

1%

6%

2%

2%

2%

0%

1%

0%

14%

21%

16%

6%

7%

4%

5%

4%

Source: War Diary, DGMS, BEF, July–November 1918, WO 95/48, NA.



Failure and Retrenchment 297

31 Aug. 07 Sep. 14 Sep. 21 Sep. 28 Sep. 05 Oct. 12 Oct. 19 Oct. 26 Oct. 02 Nov. 09 Nov. 16 Nov. 1

1

1

0

0

0

0

1

0

0

142

0 0 149

145

142

142

159

94

94

97

97

34

25

0

0

0

0

0

0

0

0

0

0

0

0

3

4

5

3

2

0

0

0

5

0

0

3

2

2

5

3

5

2

7

9

13

17

10

15

615

601

677

642

560

785

985

1,018

1,118

1,105

1,006

955

2

2

6

4

6

2

7

9

13

18

10

15

760

754

827

787

704

944

1,079

1,112

1,220

1,202

1,040

983

493

438

419

389

448

341

439

525

648

779

759

513

11,242 11,025 10,797

12,575

14,689

14,385

16,415

14,402

11,404 10,347

8846 10,652

1,421

1337

398

29,422

27,861

9433

1423

1339

404

30,182 28,615 10,260

912

786

764

403

639

147

17,101 19,075 34,089 18,475

752

17,202

16,152

8,586

13,359

2,945

919

795

777

421

649

162

17,888 19,779 35,033 19,554

18,314

17,372

9,788

14,399

3,928

756

860 866

1568 170

0%

0%

1%

1%

1%

0%

1%

1%

2%

4%

2%

9%

3%

3%

8%

4%

4%

3%

6%

6%

7%

12%

7%

25%

298

A Weary Road

of 11 November, First Army, of which the Canadians were a part for most of this period, advanced dozens of kilometres as the German army made a headlong retreat for the Rhine. At GHQ, the NYDN question remained firmly intertwined with fears about morale and command and control. It is telling that at the height of the Georgette crisis, Haig and Fowke tried again to convince a hesitant Army Council to ban the diagnosis.111 Although the serving members of the council had initially agreed with GHQ’s recommendation, the Secretary of State for War, Lord Derby, changed his mind, arguing that such a move would go against public opinion while creating a sense of injustice among veterans. On 13 April, Fowke proposed a compromise whereby it was decided to restrict the diagnosis of “Shell Shock (Wound)” to a special medical board appointed in England at the War Office. In France and Belgium, nervous casualties would be listed as sick and it would be up to individual soldiers to apply directly to the War Office to be re-listed as battle casualties, but only if they actually required evacuation to England – a policy that seemed likely to have the effect Haig desired while allowing the army to publically claim that all soldiers were still being treated equally.112 It took time, though, for the new orders to be issued and GRO 4692 only superseded the early orders on 6 August 1918, keeping the existing system intact but abolishing the use of the term shell shock in France and Belgium, even at special hospitals.113 Under GRO 4692 and a second interpretive memorandum issued by the Adjutant General’s office to replace AG 6902, NYDN hospitals became little more than sorting centres.114 As Captain J. Watson explained when he opened the reconstituted Fifth Army’s NYDN centre at No. 51 CCS in mid-August 1918, the goal was to push as many patients through the centre and into convalescent camps and labour companies as quickly as possible. With only around 200 beds, the centre was by design unable to retain large numbers of patients: 30 beds were allotted to new arrivals or acute cases, 20 to mental cases and prisoners, and the remaining 150 to convalescent patients. Hospital routine is also revealing. On admission, patients were put on bed rest for four days in the acute section and then automatically rotated to the convalescent ward, where they were “kept fully employed at useful work” until they were discharged to a Fifth Army labour company, usually to man one of the army farms. As a result, most patients became convalescents without ever receiving a diagnosis or treatment, or even seeing a doctor. In fact, ironically orderlies were under strict instructions to keep patients away from medical officers as much as possible in the belief that contact with



Failure and Retrenchment 299

doctors would only enhance a patient’s symptoms through suggestion: “unless reporting sick” patients were not to “be seen by MO for at least a week.” Of course, by that time, they were supposed to have been already passed over to the convalescent ward and on their way to a farm. The main role of the physician was therefore to oversee case management and to deal with “stubborn” but supposedly more easily treatable “hysterical” cases of mutism, aphonia, or paralysis, usually via persuasion with the wire brush.115 As the British armies advanced dozens of kilometres a week during the Hundred Days, the medical services raced to keep up. This meant that First Army had to change NYDN centres four times between August and November, shifting the hospital from No. 1 and No. 6 CCS, Wavrans, to No. 12 Stationary Hospital, St. Pol, and finally to No. 6 CCS, Bois de Montigny. Under the system that went into effect on 6 August, the process of admission and investigation became more streamlined. According to GRO 4692, when an RMO sent a nervous casualty to the special hospital, he was to record as much information as possible on the soldier’s field medical card to avoid the need to subsequently fill out additional paperwork.116 Form W3436, which had caused so many problems in 1917, was now only to be used “in certain cases of this nature,” which appears to have meant instances in which the field medical card failed to provide sufficient information with which to make a diagnosis or when there was a question of malingering.117 As the fighting became more mobile, it became increasingly difficult to find auxiliary employment for nervous patients behind the front. During the long period of stationary warfare, the static nature of the front made it possible to establish farms, convalescent camps, and employment companies all within the army area. But as the armies advanced, this was no longer possible and soldiers who might become ineffective, even for a few weeks, had to be evacuated to the base. The admission and discharge books from Nos. 30 and 6 CCSs show a total of 50 admissions for the periods 31 August to 15 September and 4–11 November 1918 (the records for the remaining periods have not survived), all of which were transferred to base hospitals.118 This, in turn, required the army to reopen several NYDN wards at the base in order to handle the influx of cases, so that by the end of August there were six hospitals accepting nervous other ranks and four taking officer patients.119 By the end of the war, cases sent to base hospitals were almost always evacuated to England, as had been the case in 1914–15. The triage

300

A Weary Road

process which took place between aid post and base hospital was intended to divert borderline cases and those that might have been labelled as cowardice earlier in the war to labour battalions and rest centres. It was only the most serious cases that actually reached the coast. For example, Private Frank G., a twenty-seven-year-old air brake cleaner and tester from Calgary, Alberta, was drafted under the Military Service Act and reported for duty on 4 January 1918. Arriving at the front during the aftermath of the Battle of Amiens on 10 August, G. was attached to the 49th Battalion and he spent approximately three weeks in the trenches before he broke down at the end of the month. Admitted NYDN to the special centre at No. 30 CCS on 29 August 1918, G. told his doctors that he was standing just behind the front line on 29 August when two shells burst simultaneously on either side of him. Physically unwounded, he was “dazed, confused, and unable to talk, and for the time being could not hear; he was trembling so bad he had difficulty in getting along.” After two and a half weeks at No. 30 CCS, he was evacuated to No. 26 General Hospital and then to England. There G. continued to dream about the front, even though he told doctors he was only in the trenches about three days; at Granville they noted that he “admits frankly that he had the ‘wind up.’”120 The effect of the new system on outcomes is evident in the records of No. 11 CCS, which operated Second Army’s NYDN centre from 24 May to 11 November 1918. William Johnson, who is more often associated with No. 62 CCS, was in charge of the ward, having transferred through a series of CCSs during the German Spring Offensives, eventually ending up at No. 11 by the third week in May. Preserved by the Medical Research Committee in the 1930s, the admission and discharge books for that hospital show 936 British soldiers admitted with various diagnoses associated with nervous illness, the vast majority (82.3 per cent) being labelled NYDN. In the spring and summer of 1918, the average patient age remained twenty-seven years old, with most soldiers reporting 3.5 years of military service and nearly eighteen months spent at the front. The typical stay at No. 11 CCS was only fifteen days, and hospital routine consisted mainly of physical exercise, route marches, cold showers, massage, and games.121 Although Johnson later claimed to have returned 55 per cent of soldiers to duty, his claims do not stand up to close scrutiny. In accordance with Fowke’s new policy, the largest group of patients (40.8 per cent) were almost immediately transferred to Second Army’s Agricultural Labour Companies. The next largest group (37.6 per cent) were dispatched to the base, while a further



Failure and Retrenchment 301

13.4 per cent were transferred for treatment at another hospital along the lines of communication, usually No. 4 Stationary. Only 3.8 per cent, or thirty-six men, were sent directly back to duty in the front lines. Thirty-nine soldiers, or 4.2 per cent, were transferred to perform light duties at the base. It is difficult to square patient outcomes at No. 11 CCS with the statistics reported by Johnson after the war. It is clear from these figures that like Carmalt Jones, Johnson included soldiers sent to farms and convalescent camps among those returned to duty. Most striking, though, is the shift in outcomes between the summer of 1917 and 1918. In 1917, Johnson initially reported sending 88 per cent of men back to duty, but by the fall of 1918 it was only about 8 per cent. However, by aggregating the statistics across the whole period, it is possible to suggest a general return-to-duty rate of around 50 per cent, a figure that grossly misrepresents these significant fluctuations over time. On the face of it, NYDN admissions appear to have declined across the BEF as the battlefield became a more mobile place while the German army made a fighting withdrawal towards the Rhine. As indicated by table 9.3, First Army, which spearheaded the BEF’s advance from the end of August to the Armistice, reported 713 NYDN cases during that period of heavy fighting. During the same timeframe, First Army listed 49,182 wounded, which suggests that NYDN cases accounted for only about 1.5 per cent of non-fatal casualties.122 The Canadian Corps, which took a leading role in First Army during the Hundred Days, reported only 144 NYDN cases between August and November, as shown in table 9.3, a figure that aligns with a post-war analysis of field medical cards.123 Because NYDN diagnoses were no longer required to be recorded in field ambulance admission and discharge books, it is impossible to evaluate the relationship between these official figures and admissions to regimental aid posts and rest stations. Anecdotal evidence from those sources shows significant numbers of admissions under symptomatic diagnoses and euphemisms, and it may well be that as in previous years, these numbers represent only between 40 and 60  per cent of the total. A similar situation prevailed in the Australian Expedi­ tionary Force (AEF), which identified only 296 NYDN cases throughout all of 1918, including the period of heavy fighting during the German Spring Offensives as well as the advance to victory.124 Within the AEF, there were another 197 cases of concussion, exhaustion, hysteria, and neurasthenia admitted to field ambulances during 1918 which were not included under the NYDN heading. This again suggests that official

302

A Weary Road

Table 9.3 NYDN cases and other casualties as reported by First Army, August−November 1918 Admissions for week ending 03 Aug. 18

NYDN cases

Other wounded

Other sick

NYDN cases as % of wounded

15

590

2024

3%

10 Aug. 18

18

328

2236

5%

17 Aug. 18

34

491

2291

7%

24 Aug. 18

32

536

2705

6%

31 Aug. 18

88

6310

3483

1%

07 Sep. 18

100

9700

3541

1%

14 Sep. 18

78

2080

3255

4%

21 Sep. 18

59

1206

2930

5%

28 Sep. 18

47

4377

2309

1%

05 Oct. 18

49

8181

2158

1%

12 Oct. 18

42

3620

2651

1%

19 Oct. 18

64

4191

2462

2%

26 Oct. 18

26

2024

3139

1%

02 Nov. 18

22

2004

2758

1%

09 Nov. 18

30

2391

3127

1%

16 Nov. 18

9

1153

3285

1%

23 Nov. 18

2

26

1440

8%

715

49,208

45,794

1%

Total

Source: H.N. Thompson, “Statement of all cases dealt with under headings of nervous, neurasthenia, hysteria, etc., Shell Shock (Wound),” Weekly Reports for August– November 1918, WO 95/198, NA.

tallies may have comprised only around 60 per cent of total admissions, a figure that has remained throughout the war. In evaluating 1918 figures, it is important to keep a variety of caveats in mind: they do not include rest station cases, men given symptomatic diagnoses, and those who never made it to hospital. Either far fewer men received treatment for nervous symptoms during the final Hundred Days campaign or under-reporting became more prevalent. It may well be that as the front became more mobile in the summer of 1918 and the German army started its massive retreat, men were less likely to feel helpless and to interpret their responses to



Failure and Retrenchment 303 Table 9.4 NYDN cases by diagnosis and outcomes as reported by the Canadian Corps, 1918

Admissions for week ending

NYDN cases admitted to hospital

Neurasthenia

Shell shock (wound)

NYDN

Discharged Evacuated to duty to base

Discharged Evacuated to duty to base

Discharged Evacuated to duty to base

29 Dec. 17

6

1

0

0

0

1

0

05 Jan. 18

4

0

1

0

0

0

0

12 Jan. 18

2

0

0

1

0

1

0

19 Jan. 18

0

1

0

0

0

0

0

26 Jan. 18

0

2

1

2

0

2

0

02 Feb. 18

9

0

1

1

0

1

0

09 Feb. 18

2

0

2

0

0

0

0

16 Feb. 18

1

2

0

0

0

0

0

23 Feb. 18

5

0

0

0

0

0

0

02 Mar. 18

4

0

0

0

0

1

0

09 Mar. 18

0

0

0

0

0

0

0

16 Mar. 18

3

0

0

0

0

1

0

23 Mar. 18

8

2

0

0

0

4

0

30 Mar. 18

9

1

1

0

0

0

0

06 Apr. 18

12

0

8

0

4

0

0

13 Apr. 18

10

0

1

0

0

4

22

20 Apr. 18

10

0

1

0

0

2

5

27 Apr. 18

20

1

0

0

0

12

7

04 May 18

9

0

0

0

0

1

0

11 May 18

4

0

0

0

0

0

0

18 May 18

1

0

0

0

0

0

0

25 May 18

1

0

2

0

0

0

0

01 Jun. 18

7

0

1

0

0

2

0

08 Jun. 18

3

0

0

0

0

0

0

15 Jun. 18

2

0

0

0

0

0

0

22 Jun. 18

0

0

0

0

0

0

0

29 Jun. 18

4

0

2

0

0

2

0

06 Jul. 18

2

0

0

0

0

2

0

304

A Weary Road

Table 9.4 NYDN cases by diagnosis and outcomes as reported by the Canadian Corps, 1918 (cont.) Admissions for week ending

NYDN cases admitted to hospital

Neurasthenia

Shell shock (wound)

NYDN

Discharged Evacuated to duty to base

Discharged Evacuated to duty to base

Discharged Evacuated to duty to base

13 Jul. 18

0

0

0

0

0

0

0

20 Jul. 18

1

0

0

0

0

0

0

27 Jul. 18

1

0

0

0

0

1

0

03 Aug. 18

0

0

1

0

0

0

0

10 Aug. 18

0

0

1

0

0

0

2

17 Aug. 18

0

0

0

0

0

0

0

24 Aug. 18

0

0

0

0

0

0

0

31 Aug. 18

23

0

0

0

0

0

0

07 Sep. 18

29

0

2

0

0

0

1

14 Sep. 18

8

1

7

0

0

0

1

21 Sep. 18

6

0

4

0

0

0

0

28 Sep. 18

20

6

11

0

0

0

0

05 Oct. 18

15

16

5

0

0

0

3

12 Oct.18

13

3

4

0

0

0

0

19 Oct. 18

10

10

3

0

0

0

0

26 Oct. 18

10

11

3

0

0

1

0

02 Nov. 18

5

1

4

0

0

2

0

09 Nov. 18

4

0

0

0

0

0

0

16 Nov. 18

1

0

3

0

0

0

0

23 Nov. 18

1

0

0

0

0

0

0

285

58

69

4

4

40

41

Total

Source: H.N. Thompson, “Statement of all cases dealt with under headings of nervous, neurasthenia, hysteria, etc., Shell Shock (Wound),” Weekly Reports for August– November 1918, WO 95/198, NA.



Failure and Retrenchment 305

combat as problematic and requiring medical attention.125 An examination of the letters, diaries, and memoirs of Canadian soldiers shows that contemporary references to shell shock and nervous illness are far less prevalent for 1918 than in previous years – similarly, the private and official records of medical officers are also largely silent on the subject. But in many ways, this was the most intense period of combat that the Canadians had experienced during the whole war: during the Hun­ dred Days casualties from shot and shell increased dramatically as the  Entente armies advanced between August and November 1918. The Canadian Corps, which was approximately 120,000 men strong at that point, sustained more than 35,000 casualties during the Hundred Days – more than at Vimy Ridge and the Somme combined.126 If some men felt buoyed by the prospect of a retreating enemy, others may well have been physically wounded or killed when they might otherwise have been traumatized by the experience of battle. Of course, it is also worth remembering that most men appear to have broken down only after several months in the trenches, so there may not have been enough time for the tens of thousands of fresh replacements that were streaming to the front to develop the symptoms of nervous illness. While many of these men were conscripts, there is no evidence that they suffered disproportionately from nervous or mental illness at the front. Given the army’s more restrictive approach to diagnosis and treatment, it is more likely that under-reporting became widespread during 1918. It is clear, for example, that in the fall of 1918 BEF medical officers were being given more training to deal with nervous illness and were being explicitly told not to report NYDN cases whenever possible.127 Major C.L. Chapman, the DDAMS of the Australian Corps, who lectured at the Australian Corps School for Medical Officers, told trainees that the NYDN approach was a “very bad system. [The term should be] sparingly employed as every case must be sent to a special hospital. The OC of special hospital is the only man who can mention the word (shell shock). No case should be diagnosed NYDN. Other cases should be diagnosed Fatigue, Exhaustion, etc.” (emphasis added).128 In effect, medical officers were being encouraged to deal with nervous cases within their battalions whenever possible. This involved learning to take both a proactive, paternalistic approach to the management of morale as well as remedial steps to deal with soldiers as they began to break down.129 By 1918, the growing consensus was also that “bravery is less a natural quality and is more a matter of definite mental struggle and decision,” as one medical officer succinctly put it.130 This meant,

306

A Weary Road

then, that one of the duties of a medical officer was to promote a “cheerful outlook” and to help guide soldiers’ mental outlook towards constructive ends, which in the view of the military authorities meant protectingthe will to fight.131 One set of instructions issued that spring suggested that officers encourage men to discuss the war, their circumstances, and their participation as much as possible, for it was thought to be a healthy way for the men to deal with the strain of living life under fire. The role of the officer was thus to supervise the discussion and to help men “to take a correct view of the current topics of the day as they appear in the Daily Press, and [assist] in getting these matters in the correct perspective … The offensive spirit can be fostered and encouraged, and this will surely result in greater efficiency and increased cheerfulness of outlook.”132 This proactive approach to morale, which sought to shape men’s opinions rather than discipline transgressions, was accompanied by a new emphasis on corrective action. Major George Strathy, a thirty-four-yearold doctor from Toronto serving as the RMO of the 44th Battalion, noted that when “a man reports that his nerves are gone I never allow him to leave the line until the tour is finished, on account of the effect on the other men. I speak to his company commander, and if his record is good, he is kept on some easy duty, such as gas guard in the dugout. Then when we leave the line he is given work at the Base or transferred to the Divisional Employment Company, or some work well behind the fire zone.”133 In cases like these, soldiers were never admitted to hospital, but were dealt with solely through a change of employment. Policy did not change the way men responded to combat and they continued to suffer in the same ways they had throughout the war.134 Despite an official ban on the use of the phrase “shell shock,” men continued to use those words to describe a variety of feelings ranging from exhaustion to severe nervous illness. After the Battle of Amiens, in midAugust 1918, William J. O’Brien of the 25th Battery, Canadian Field Artillery, used “shell shock” to describe feelings of exhaustion and frustration. “I am as keen as any to win this war and beat an enemy that the world has grown to hate,” he wrote in his diary. “In spite however of my desire to see victory crown our attempts I am horribly ‘fed-up’ and shell-shocked. This latter condition does not fortunately manifest itself during danger, but before it … I hope to live sufficiently long to signify by my acts and thoughts some measure of my intense gratitude to the Creator for his constant watch over my safety. I have no presentiment



Failure and Retrenchment 307

of disaster but the thief in the night is still abroad and I fear him while relying ever on the consoling advice: Ask and ye shall receive, etc.”135 For O’Brien there was clearly no shame in the label, nor did it necessarily indicate incapacitation – instead, it was a state of being or a feeling. Soldiers clearly treated cases of nervous illness among old sweats differently than among new recruits. One of the most decorated Cana­ dian soldiers of the war, Corporal Francis Pegahmagabow, a twentyseven-year-old Anishnabe marine fireman from the Shawanaga First Nation in Northern Ontario when he enlisted in the 1st (Western Ontario) Battalion in August 1914, ended his war in a shell shock hospital.136 As a scout and sniper, “Peggy” was at the sharp end of the fighting for nearly three and a half years and claimed to have personally killed 378 enemy soldiers. On 2 September 1918, following the Canadian assault on the Hindenburg Line, Pegahmagabow was sent forward with a small party to knock out a German machine gun that was inflicting casualties on an exposed flank. Although he managed to silence the weapon, he was blown up by a shell and rendered unconscious. A few days later Peggy found himself at a field ambulance, where he was labelled NYDN and sent to No. 12 Stationary Hospital, which was then acting as First Army’s NYDN centre. There Captain G.P. Gibson, the attending neurologist, noted that he was confused and disoriented and that he complained of being “nervous and shaky” when he was in the trenches. Pegahmagabow was soon invalided to England, where he was diagnosed with exhaustion psychosis.137 No one questioned his bravery or why he broke down: after nearly four years in France on the front lines – a remarkable feat of survival – Pegahmagabow was clearly worn out and that was acceptable to his comrades and doctors. The same was true of men like Sapper Thomas C., serving with the 9th Battalion, Canadian Engineers, who also broke down after years at the front. C. was admitted to the 10th Canadian Field Ambulance on 27 August 1918, nervous, shaking, and unable to sleep. He told doctors that the previous summer he and two friends were talking near the Spoil Bank at Ypres when a shell landed and killed both his comrades, and blowing C. up into the air, end over end. “Since then,” he said, “[I] … have not stood shell fire well.” On 26 August he was asleep in a cellar in Arras when “shells fell on the house and he lost control of his nerves.” As a comrade led him to the field ambulance he was again blown up by a shell. Although his commanding officer verified that he was indeed blown up several times and certified that his condition

308

A Weary Road

was due to “exceptional exposure,” C. was diagnosed NAD and treated (but not diagnosed) for neurasthenia and then evacuated to the base on 13 September 1918.138 As the British armies advanced dozens of kilometres a week during the Hundred Days, the medical services raced to keep up. This meant that First Army had to change NYDN centres four times between August and November, shifting the hospital from No. 1 and No. 6 CCS, Wavrans, to No. 12 Stationary Hospital, St.-Pol, and finally to No. 6 CCS, Bois de Montigny. Under the system that went into effect on 6 August, the process of admission and investigation became more streamlined. Accord­ ing to GRO 4692, when an RMO sent a nervous casualty to the special hospital, he was to record as much information as possible on the soldier’s field medical card to avoid the need to subsequently fill out additional paperwork.139 Form W3436, which had caused so many problems in 1917, was now only to be used “in certain cases of this nature,” which appears to have meant instances in which the field medical card failed to provide sufficient information with which to make a diagnosis or when there was a question of malingering.140 As the fighting became more mobile, it became increasingly difficult to find auxiliary employment for nervous patients behind the front. During the long period of stationary warfare, the static nature of the front made it possible to establish farms, convalescent camps, and employment companies all within the army area. But as the armies advanced, this was no longer possible and soldiers who might become ineffective, even for a few weeks, had to be evacuated to the base. The admission and discharge books from Nos. 30 and 6 CCSs show a total of 50 admissions for the periods 31  August to 15 September and 4–11 November 1918 (the records for the remaining periods have not survived), all of which were transferred to base hospitals.141 This, in turn, required the army to reopen several NYDN wards at the base in order to handle the influx of cases, so that by the end of August there were six hospitals accepting nervous other ranks and four taking officer patients.142 By the end of the war, cases sent to base hospitals were almost always evacuated to England, as had been the case in 1914–15. The triage process which took place between aid post and base hospital was intended to divert borderline cases and those that might have been labelled as cowardice earlier in the war to labour battalions and rest centres. It was only the most serious cases that actually reached the coast. For example, Private Frank G., a twenty-seven-year-old air brake cleaner and tester from Calgary, Alberta, was drafter under the Military Service Act



Failure and Retrenchment 309

and reported for duty on 4 January 1918. Arriving at the front during the aftermath of the Battle of Amiens on 10 August, G. was attached to the 49th Battalion and he spent approximately three weeks in the trenches before he broke down at the end of the month. Admitted NYDN to the special centre at No. 30 CCS on 29 August 1918, G. told his doctors that he was standing just behind the front line on 29 August when two shells burst simultaneously on either side of him. Physically unwounded, he was “dazed, confused, and unable to talk, and for the time being could not hear; he was trembling so bad he had difficulty in getting along.” After two and a half weeks at No. 30 CCS, he was evacuated to No. 26 General Hospital and then to England. There G. continued to dream about the front, even though he told doctors he was only in the trenches about three days; at Granville they noted that he “admits frankly that he had the ‘wind up.’”143 The nature of the surviving records precludes making definitive conclusions about why shell shock admissions shrank so dramatically. Because the British Armies were advancing so quickly, NYDN centres changed frequently, sometimes on a weekly basis, and record-keeping was minimal. Surviving admission and discharge books provide a snapshot into some of these centres, but are the least complete for any period in the war. Moreover, so many different diagnoses and euphemisms were now being intentionally or colloquially employed that it is impossible to assess the prevalence of shell shock in the Hundred Days with any degree of certainty. What is clear is that when cases of nervous illness were diagnosed according to policy, most patients were diverted into agricultural work or rest camps, or were simply transferred from one NYDN centre to another. The apparent absence of shell shock that fall can be explained at least in part as a product of reclassification and intentional blindness on the part of the military authorities. Of course, the absence of reported cases during the Hundred Days would later be held up by some psychiatrists as evidence of the effectiveness of socalled forward psychiatry. There is little evidence to suggest that psychiatry played an important role in either diagnosis or treatment during the Hundred Days; it was instead complicit in an ideology of denial. Conclusion Although neurologists attached to the special hospitals claimed significant success returning men to duty using a variety of treatment methods, these claims soon fell under scrutiny from a variety of sources both

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within the medical services and at GHQ. Although neurologists had been deployed to the front on the assumption that their special expertise would help improve treatment outcomes, this proved not to be the case. Although all the NYDN centres reported some initial success, over time return-to-duty rates fell while evacuation rates climbed. Within an atmosphere of heightened surveillance, motivated in part by fears about army morale, GHQ took steps to further reduce the autonomy and professional freedom of army neurologists, using work and labour to treat nervous illness rather than medical interventions. By the end of the war the NYDN centres functioned as triage centres that were used to reroute patients to the base, while the main burden of case management had been returned to front-line medical personnel. The Canadian Corps played an important role in the final battles of the war as it spearheaded the British advance on Mons. But if the Cana­ dians, along with the Australians and New Zealanders, became the shock troops of the British empire, the experience of the medical services reminds us that those Dominion forces remained but small parts of a larger British Army. The policies which dictated how Canadian soldiers suffering from nervous illness would be managed were forged without any input from Canadian officers at GHQ and at various army headquarters. Once they left the care and control of their own field ambulance personnel, Canadian soldiers entered an imperial medical system where they were treated by British, Australian, New Zealand, and South African doctors. Only when cases of nervous illness were evacuated to England did Canadians return to the care and control of Dominion medics. Canadian physicians working at special hospitals in England made similar claims to their British counterparts at the front, suggesting that they could return most cases of nervous illness to the front using a variety of standard techniques based largely on suggestion and persuasion. Yet these too proved to be specious. By the end of the war, the NYDN system proved to be ineffectual in returning men to duty at the front and too cumbersome to be effective in managing the large number of cases which could be expected during periods of intense fighting. Yet while this may have posed a direct challenge to the expertise and claims of specialists like Colin Russel or Frederick Dillon, neurologists deployed a convenient explanation to parry potential challenges. They concluded that although their methods were sound, the majority of their patients were predisposed to nervous illness and thus untreatable.

Conclusion

The preceding pages make claims that challenge traditional interpretations about the way shell shock was experienced and managed within the British Expeditionary Force, and by extension the Canadian Corps, in France and Belgium. The traditional view of battlefield treatment holds that although nervous illness was known before 1914, the military medical services were ill prepared to deal with an influx of casualties at the beginning of the Great War. In France and Belgium, historians have argued, shell shock was perceived as a new and different type of traumatic injury caused by the concussive force of exploding shells; as casualties mounted steadily, peaking during the Battle of the Somme, various psychological and somatic theories vied for acceptance. C.S. Myers has often been cast as the standard bearer for the psychological school, while Gordon Holmes represents the neurologists. The former is typically presented in a positive light, representing progressive forces, while the latter symbolizes an older and less humane Victorian world view. Although the army begrudgingly adopted Myers’s forward psychiatric approach, it quickly abandoned it because psychological approaches were too radical. This doomed the army to repeat the same mistakes in the next war, forcing doctors and officers to relearn old lessons. In a larger sense, then, traditional views of shell shock align with a school of thought that sees the Great War as a watershed of modernity, not only in terms of the history of psychiatry, but also in art, literature, poetry, music, film, and politics. The first generation of shell shock historians relied primarily on memoirs and periodical literature, emphasizing shell shock’s apparent novelty while dividing diagnosis into psychological and somatic paradigms and treatment into disciplinary and analytical approaches. These historians did not

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differentiate between what happened at home and overseas, assuming that both narratives followed a similar path, even though the evidence they used was typically generated by doctors, patients, and hospitals in England.1 Revisionist scholars argue against the view that the Great War made a decisive break with the past, suggesting that older world views and cultural tropes continued to hold much sway into the post-war world. In the study of shell shock, this critique played out via a second wave of scholars using patient and hospital records to situate shell shock within larger pre-war discourses of traumatic illness and masculinity, painting a more nuanced view of diagnosis and treatment as well as individual suffering. With a few exceptions, though, these scholars focused on patient care, lived experiences, and policy development in England or Canada, rather than on what happened at the front. It has been argued here that there were significant differences between the ways in which the medical services approached casualty management at home and overseas. The evidence forces a reconsideration of the traditional and revisionist narratives, offering a more complex and nuanced account of shell shock in the Great War.2 Before the First World War, military doctors anticipated that a general European war would result in significant casualties, at least some of which, perhaps many, would be attributable to both traumatic and non-traumatic forms of nervous illness. In the Victorian and Edwardian periods, British and Canadian doctors were taught to see nervous illness within a bio-psychological paradigm that used somatic language and metaphors to describe symptoms while employing both rest and practical forms of talk therapy to alleviate suffering. The language of military medicine, though, remained conservative, emphasizing the role of shock and physical exhaustion, even though doctors surreptitiously acknowledged the importance of psychological factors. This may well have been because theoretical debates had little practical application to military life: unlike their civilian counterparts, army doctors did not have to choreograph their diagnoses and treatments to align with the concerns of the medical marketplace. In fact, experience in South Africa and second-hand observations made during conflicts in Asia and the Balkans suggested that most wartime cases would continue to be treatable in the lines by generalists with a combination of rest and modified diet. The language doctors and patients employed in the British Army served martial rather than civilian purposes, preserving military efficiency while explaining how otherwise brave men

Conclusion 313

might suddenly exhibit behaviours that could, in other contexts, be ­associated with cowardice. In 1914 and early 1915, nervous casualties continued to present as they had in South Africa, and so were managed according to existing doctrine as non-surgical cases, treated alongside other forms of sickness and injury. Nervous soldiers were diagnosed by Regimental Medical Officers in the front lines and then sent successively to field ambulances, casualty clearing stations, and base hospitals on the coast. Although many improved spontaneously with rest and modified diet, the weight of casualties caused by shot and shell and the onset of static warfare combined to put pressure on the medical services to keep as many men as close to the front as possible. By the end of 1914, large numbers of nervous cases were being evacuated to England alongside other forms of minor sickness, and although the majority were there discharged from hospitals to duty, most did not return to the front lines for many months. To more effectively manage non-surgical cases, including what was increasingly being called “shock,” the medical services adopted the divisional stopping system, creating a series of divisional and later corps and army rest stations as well as employment and labour companies designed to hold patients with minor illnesses and injuries close to the front. The intention was to avoid evacuation in order to allow men to return to duty much faster. Although the divisional stopping system was not created to manage nervous casualties alone, by the winter of 1915 men suffering from shell shock would almost always be sent first to a rest station for observation and, only if they failed to recover, earmarked for evacuation to the base. The Canadian soldiers who went to war in 1914–15 were part of a larger British imperial army of which the medical services were a fully integrated part. When 1st Canadian Division arrived at the front in February 1915, Canadian doctors adopted the divisional stopping system, learning to use field ambulance rest stations as triage centres where the more severe cases could be sorted from those likely to recover with a few days’ rest. Evidence from admission and discharge books suggests that upwards of 60 per cent of the nervous casualties treated at these stations were thought to have recovered spontaneously after a week to ten days, returning to full duty at the front with only a small number of relapses occurring over the next few months. As men came and went from the rest stations with a variety of types of illness, ordinary soldiers began to see these sites as havens, temporary sites of refuge where men could go to calm their nerves and restore their will to

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persevere. This helped to normalize what was increasingly being called shell shock by both men and doctors at the front and civilians at home, legitimizing the condition by linking it to a specific Edwardian sense of masculinity equating manliness with perseverance. Men encouraged one another through a variety of social cues to hold on as long as possible, but were willing to seek a “holiday at the rest station” before they actually broke down because they also believed that this would actually extend their ability to endure. Although wary of the possibility of shirking and malingering, doctors and the military authorities tolerated this rapprochement because it provided a release for the physical and psychological pressures of life at the front. By the beginning of 1916, shell shock had become an engrained and complex part of trench culture. The words themselves were used by doctors, officers, and ordinary soldiers as shorthand for a variety of responses to combat ranging from mild fatigue to severe psychological or even physical trauma. The idea of shell shock was flexible, capturing a range of symptoms or behaviours that could be seen as legitimate in one context and illegitimate in another – in once instance it could be a synonym for cowardice and in another a mark of bravery. This reflected the shared trauma of the trenches, which created an ever-changing experiential threshold that separated normal levels of trauma – what was perceived as universal or common forms of suffering – from the extraordinary or unusual, like being buried by a shell or surviving several major actions over a period of months. It was understood by those at the front that this threshold might be crossed suddenly after a shocking event or over time through the accumulation of trauma. When individuals used the words “shell shock” they did so within a specific context which referenced this threshold: if a soldier was known to his comrades and was believed to have done his bit, he was treated sympathetically. Newer soldiers – men who were not necessarily younger in age than the average but were perceived that way by old sweats at the front – were typically seen as being more cowardly and less manly. These points of reference were never fixed but constantly changing as generations of replacement soldiers cycled through battalions, changing over roughly every six to eight months. It also meant that when cases of shell shock were observed, treated, or disciplined away from their original units, they were more likely to be viewed with suspicion and derision. This made shell shock, or more specifically the attitudes attached to soldiers labelled in that way, highly changeable.

Conclusion 315

Until 1916, the rest system approach functioned relatively smoothly because it provided a means of relieving tension at the front while maintaining morale – so much so that it became embedded in early-war trench culture. Yet as early as April 1915, there were signs that the divisional stopping system would be unable to cope in times of crisis. During the Canadian baptism of fire at the Second Battle of Ypres, field ambulances became so overwhelmed that most cases of nervous illness were pushed to the rear with other casualties. Second Ypres also showed that in the terror of battle, judgments about legitimacy, bravery, cowardice, and endurance became meaningless. Doctors, officers, and men at the front accepted that battle was a traumatic event and expected that some men would break down. Nervous evacuations increased during intense periods of combat because more and more men crossed the threshold between manageable levels of trauma and the exceptional. With hindsight, the first indications of a looming evacuation crisis can be uncovered during the Canadian actions at the St. Eloi Craters and Mount Sorrel, when between 20 and 30 per cent of all casualties evacuated from the front were suffering from some form of traumatic response to combat. In April and June 1916, a combination of factors came together to cause large numbers of men to break down simultaneously. These were the increased use of high explosive as opposed to shrapnel shells, which intensified the terror of enemy barrages; the growing length of service of many of the Canadians then holding the line; and the breakdown in command and control and unit coherence caused by massive physical casualties or the inexperience of officers. Having learned that nervousness was a normal and even expected response to combat, men began to self-report in larger and larger numbers as more and more men began to experience an exceptional form of trauma like being blown up by a shell. In other words, the horrors of war intensified faster than men could adapt. Sympathetic and overwhelmed doctors tended to see these cases as legitimate and sent them for medical treatment at the rear. However, there is no indication that the military authorities had any sense of the scale of the problem at the time, although some in the medical services certainly did express concerns and efforts were made to control the ways in which the wound stripe was awarded to suffering soldiers. Shell shock reached the attention of the military authorities and became a crisis simultaneously during the Battle of the Somme. Be­ tween July and November 1916, Newfoundland, British, Australian, New

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Zealand, and Canadian units reported levels of casualties similar to those at St. Eloi and Mount Sorrel. This precipitated the collapse of the divisional stopping system. As evacuations soared, shell shock ceased to be a marginal aspect of the larger wastage problem and was elevated to be a significant issue of concern for both the military authorities and senior members of the medical services. The military authorities’ initial reaction was coloured by the wider failure of the Somme campaign, so that for them the shell shock crisis became symptomatic of a larger collapse in morale and fighting spirit. While there were a few instances in which units failed to go forward and traumatized men were singled out and punished for “showing cowardice in the face of the enemy,” the larger critique was more subtle and sustained. Although there was no widespread collapse of morale, the medicalization and normalization of shell shock, and specifically the divisional stopping system, provided ordinary soldiers with the means to resist military authority and set limits on their participation in the fighting. Most men proved willing to endure significant hardship and even extensive forms of trauma, but there was an agreed upon threshold which few proved willing to pass beyond without seeking relief from suffering. The Somme also revealed the extent to which traditional relationships between front-line medical officers and enlisted men had changed since the start of the war. Although the official mission of both regimental and field ambulance medical officers was to maintain the efficiency of the fighting forces, guarding against malingering, the growth of the RAMC, which mirrored the expansion of the army, meant that more and more of its doctors were civilians with little military experience. They not only proved sympathetic to the men under their command, sharing as they did in the trauma and horror of life under fire, but also participated in the renegotiation of codes of conduct that normalized and legitimized nervous illness. Although it proved difficult for senior officers to accept, the normalization of shell shock and the development of the divisional stopping system served a very practical but uncomfortable purpose: men on the verge of breakdown posed a very real threat to the lives and morale of their comrades and it was often thought safer to encourage them to self-diagnosis and seek a rest than it was to compel them through fear of punishment to remain at the front. During the Somme offensives in 1916, the BEF’s senior military and medical leadership came to believe that the army had to take a more active role in controlling nervous illness or admit to a serious morale crisis. This would involve changing the behaviour and attitudes not

Conclusion 317

only of ordinary soldiers, but also of officers and doctors. Although experts like C.S. Myers and Gordon Holmes have often been given centre stage in discussions of the official response to the shell shock crisis, it was a discussion shaped by a number of actors operating both within and outside of the medical services – only a few were specialists in nervous illness. Because the BEF’s approach to the shell shock problem had both disciplinary and medical aspects, initial attempts to forge a new management strategy were jointly overseen by the Adjutant General’s office and the Director General, Medical Services. What followed was a year-long process to establish both a universal case definition and to create a centralized and standardized approach to diagnosis and treatment. The first question hinged on finding some objective criteria that would allow the army to recognize some forms of suffering as legitimate, such that soldiers could be lawfully excused from combat or punishment, while clearly marking other behaviours as deviant. From the outset, Adjutant General Henry Fowke preferred a narrow case definition that would have outlawed the term “shell shock” altogether, placing the burden of proof on the soldier, such that those who lacked physical evidence of a near-death experience could be court martialled for dereliction of duty. Senior members of the medical services, by contrast, preferred a more elastic definition in the hopes of protecting the professional authority and autonomy of front-line doctors. While some men were victimized by the army’s medical services, doctors were also capable of humanity, compassion, and empathy, which posed its own problems for professional soldiers tasked with maintaining the fighting efficiency of front-line units. While the RAMC fought internal battles to control and regulate a new cadre of medical officers increasingly drawn from the civilian world and unaccustomed to the unique demands of military medicine, DGMS Sloggett also recognized that employing universal criteria like exposure to shell explosions would fail to capture all the various forms of suffering that his doctors believed were legitimate. It was a process of negotiation – the compromise came to be known as “exceptional exposure,” a criterion which addressed the referential ambiguity of life at the front, accommodating some of the demands of ordinary soldiers, while maintaining diagnostic flexibility. The key point was that legitimacy would continue to be determined in reference to normative experience, and although this privileged the trauma claimed by soldiers who suffered a close call with a shell, it also ensured that other types of cases could be accommodated. But this also meant that

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the medical services agreed to abandon use of the term shell shock, so that in June 1917 the Adjutant General’s office replaced it with the phrase Not Yet Diagnosed Nervous (NYDN). These decisions reflected a largely non-medical and non-specialist negotiation between the competing interests of the military authorities, the medical services, and ordinary soldiers. Although experts like C.S. Myers, Carmalt Jones, Gordon Holmes, and C.C. Manifold provided input, there was no real schism nor any great debate between psychologists and neurologists. Most seem to have agreed that this approach would help reduce selfreporting and encourage men to return to duty. The question of developing a standardized approach to treatment was dealt with simultaneously. Historians have traditionally argued that these debates led to the creation of the first forward psychiatric centres, that is, the deployment of psychiatric specialists to front-line areas to enable the quick treatment of neuro-psychiatric disorders or operational stress injuries. Attempts to link developments on the Western Front in 1916–17 to what happened in later wars are clearly based in a selective reading of the evidence as well as hindsight. Beginning in July 1916, some corps began to centralize the collection of nervous casualties at casualty clearing stations to better enable other hospitals in the rear to process men wounded by shot and shell. With input from a variety of sources, including experts like C.S. Myers and Gordon Holmes as well as surgeons and generalists working at field ambulances and at administrative posts at the divisional and corps levels, these centres gradually evolved from being triage stations to take on the functions of true special hospitals. These developments were not the brainchild of C.S. Myers nor were they modelled on the French experience at Verdun; instead, they evolved organically following a general pattern of specialization and centralization that characterized the growth of the British medical services across the Western Front. The standardization of distinct diagnostic and treatment models at those hospitals took place during the winter and spring of 1917 while Myers was on leave in England, and followed the non-psychiatric approaches developed at No. 4 Stationary Hospital. That hospital’s “neurologist,” D.W. Carmalt Jones, was actually a bacteriologist who found favour with the army because he understood the unique pressures of military medicine, not because he had any special expertise. Jones’s approach was wholly conventional, based in the well-understood bio-psychological models that prevailed before the Great War. Using a combination of rest, practical talk therapy, suggestion, and persuasion, Jones claimed to be able to

Conclusion 319

return large numbers of men – upwards of 60–70 per cent under treatment – to full duty at the front. The ethos of Carmalt Jones’s cure was to try and convince patients from the outset that they were actually healthy and that their symptoms were either inconsequential or imagined. This was formalized into a proscriptive cure through elaborate rules and regulations that sought to control interactions, both overt and subtle, between the medical profession and shell shocked men. In this sense, Carmalt Jones’s methods coincided with the army’s adoption of the term NYDN, which, the bacteriologist believed, would assist him in de-medicalizing and delegitimizing the phenomena. The result of this approach was that both the army and the medical services would try to evaluate success in terms of the overall numbers of nervous men admitted to hospital as well as return-to-duty rates. The actual health and well-being of soldiers was never part of the equation. While this may have made some sense to the military authorities who were tasked with winning a major war, it was more difficult to justify even by the moral and ethical standards of the day. What is most remarkable, though, is that this conclusion was reached despite the fact that so many people engaged in these debates accepted that shell shock was a legitimate outcome of war – indeed most, including Haig and Fowke, seem to have believed at various times that at least some men would inevitably and unavoidably break down in battle. This is clear from the fact that they only reluctantly sought to prevent shell shocked men from applying for the wound stripe, and so long as a soldier was diagnosed shell shock (w), he was entitled to wear the badge until as late as August 1918. This was also consistent with the view that shell shock was a form of physical injury, not to say that it was necessarily the result of the concussive force of exploding shells, but rather of physical exhaustion, shock, and collapse. In this context, official attempts to deny the reality of shell shock and to reduce treatment to something of a shaming ritual become difficult to defend because they were intentional acts taken with understanding rather than ignorance. In other words, the army was fully cognizant of the fact that as it adopted the new NYDN protocols, it was sending men back to battle that even its own doctors and officers believed had been wounded by enemy action. As reprehensible as they may seem, these decisions were justified on the grounds that men could never be allowed to choose the terms of their own participation and that the army needed as many soldiers at the front as possible. And from this perspective, the Byzantine intricacies and contradictions of the NYDN approach seemed to hold great

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promise that it would do just that. During the Battle of Arras and at Passchendaele, reports of nervous casualties never approached the levels seen on the Somme, returning to the levels seen in 1914–15. Armylevel shell shock centres – now called NYDN centres – housed in casualty clearing stations and stationary hospitals within each army’s command area also claimed to be able to return between 60 and 90 per cent of men to duty using a variety of techniques, most based on the type of civilian methods then in vogue on Harley Street in London. Yet these were not forward psychiatric centres in the sense that they operated within the sound of the enemy guns or even close to the front lines. On average, most were located around 50 kilometres from the front – some of the largest were nearly 100 km to the rear and closer to the coast then the trenches. Men also did not arrive there quickly but continued to pass through a succession of front-line aid posts, rest stations, and employment companies before being sent for treatment. Finally, they were not necessarily staffed by experts in the fields of neurology, psychology, or psychiatry: many of the doctors that practised at those centres, which rotated frequently between hospitals, were general practitioners, academic researchers, or surgeons. Tellingly, it was these men that seem to have always held the most sway within the military hierarchy. The NYDN system was greeted with scepticism and resistance by Canadian doctors and officers. Field ambulance doctors, insulted that their professional authority was under assault, argued that denying care to suffering men was immoral and militarily dangerous, exposing internal contradictions within the army approach. If shell shocked men had to be treated as cowards and sent back to duty, the army’s own logic suggested that this might pose a serious risk to morale and cohesion. As early as the Battle of Vimy Ridge, attempts to regulate diagnosis and evacuation, specifically the requirement that “legitimate” cases of shell shock require evidence of exceptional exposure, proved nearly impossible to enforce. Field ambulance doctors chose to employ other types of diagnoses not covered under the new regulations, while frontline officers often proved more than willing to confirm the claims of soldiers under their command. While it is true that we cannot assume all claims of trauma were legitimate because malingering, after all, is a long and storied tradition in the army, it is also clear from contemporary records that most officers and doctors felt outright lying or exaggeration to be rare. Even in cases where men were clearly not telling the truth about their front-line experiences – either because they were not

Conclusion 321

in the line when they said they were or because an incident they recounted did not actually happen – they were usually given the benefit of the doubt. How did these shifts and changes in policy affect the way ordinary soldiers and officers viewed nervous illness and responded to the trauma of combat? As the experience of the men of the Canadian Corps makes clear, there was continuity in the ways patients and doctors ­experienced and evaluated cases of shell shock at the front. In fact, in adopting the concept of “exceptional exposure” as a defining criterion of the “shell shock wound” diagnosis, the NYDN policy actually affirmed popular and informal mechanisms of understanding and social control which ordinary soldiers were already using to evaluate the legitimacy of their comrades’ suffering. The horrors of war, of course, also continued unabated and men continued to break down. What is remarkable about the available evidence, though, are the silences. Letters, diaries, and memoirs written by soldiers serving in 1915–16 are full of references to shell shock and nervousness, while those from the latter stages of the war make fewer overt references to shell shock, even though men continued to comment on the state of “their nerves.” This may, in fact, reflect the “success” of the NYDN approach in that it helped to guide the evolution of trench culture and the discourses of ordinary men. Yet it is equally clear that if men felt any injustice about how they or their comrades were treated by medical officers after the imposition of this new regimen, it does not come through in their writings. Of course, this does not mean that they did not feel those things, but there is also no evidence to suggest that nervous illness was suddenly re-stigmatized. Again, this may reflect the cases reviewed in the Canadian Corps in which doctors and officers found ways to subvert the regulations, to stick to the letter of the law or to ignore its sprit, and to continue to find ways to negotiate and mediate discussions of suffering and trauma. As with any bureaucratized system, the metrics used by the army and the medical services to measure success at the new NYDN centres were open to abuse by administrators and clinicians anxious to demonstrate their worth. In terms of overall admissions, most of the drop between the summer and fall of 1916 and 1917 can be accounted for in reporting changes. In the first instance, it is clear from field ambulance records that as late as the fall of 1917, roughly 50–60 per cent of the men reporting sick with nervous symptoms were still quietly being treated and released at field ambulance rest stations or being reassigned to

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perform work elsewhere in the divisional or corps structures. Whereas these front-line cases made up the bulk of admissions during the 1916 crisis, when they were recorded on official returns, they were intentionally kept off the books in 1917 in order to create the appearance that casualties were declining. But there were other important changes to reporting too. Cumbersome processes and bureaucratic inefficiencies combined with a sense of injustice among front-line doctors to encourage unsanctioned changes in diagnostic terminology. Even while admissions to the special hospitals for shell shock and NYDN plummeted, they rose for DAH, debility, myalgia, exhaustion, and other symptomatic diagnoses. At least some of these cases would have been classified as shell shock a year earlier and were often re-diagnosed as such when they reached the base. Although the records do not allow us to make any firm estimates, it is clear that nervous casualties were being significantly under-reported in 1917–18, perhaps by as much as two thirds to three quarters. This in turn suggests that the army’s new protocols had very little effect on admissions, and so, even when measured by the army’s own metrics, the standardization of the NYDN label did not achieve its purpose. At the same time, return-to-duty rates at the NYDN centres were consistently embellished. At all the hospitals for which records are available, it is clear that the term “return to duty” actually meant any form of discharge from hospital that did not result in an immediate evacuation to the base. Most of these were not, in fact, returned to duty, but were reassigned either to labour and agricultural units or to base duties; most were also first sent to convalescent camps for reconditioning. Only a small handful went straight back to the front. Although some of the transfer cases did eventually return to front-line units, these too were in the minority. Of all the men who reached the trenches, though, most had usually spent several weeks – more often months – in the rear areas before re-shouldering a rifle. Many also quickly relapsed upon their return. For all the hospitals where the records allow us to test reported outcomes against the information contained in patient case files, return-to-duty versus evacuation rates were found to be the inverse of what was actually claimed during the war. But it is also clear that discrepancies between reported and observed outcomes were not the result of intentional deception, as evidenced by the reaction of individuals like Colin Russel who discovered their mistakes during the war itself. Instead, they reflect the limitations of wartime record-keeping, official censorship, a lack of time for research, and the desires of a small

Conclusion 323

group of specialists who were anxious to validate their professional claims to expertise. We must conclude, though, that when measured by the army’s own yardsticks, the success rate of the special hospitals was no better and, in many cases much worse, than field ambulance rest stations which offered no special forms of therapy. These discrepancies are not only evident with hindsight but became known to the medical services and the military authorities as early as the fall of 1917. In fact, only six months after the special NYDN centres were created, GHQ began to receive reports which indicated that nervous casualties were not only being under-reported but also that return-to-duty rates were being exaggerated. In the first instance, it was understood by December 1917 at the Adjutant General’s office that reported NYDN admissions represented only 40–50 per cent of total cases – not including men given another euphemistic epitaph. It was also clear that the growth of labour units and agricultural companies was being sustained by patients discharged from the NYDN centres – men who were not actually returning to duty at the front. Year-end reports confirmed that although much of the early optimism proved to be unsustainable, it could be explained by the fact that hospitals went through something of a life cycle. Each hospital began its tenure as a special centre with hundreds of empty beds and a reasonable caseload for the staff. As the weeks passed and fighting intensified, the beds gradually filled until the wards were literally overflowing with patients. This, in turn, necessitated an increase in evacuations and early discharges, while staff spent less and less time with each patient. As remedial discharges and emergency evacuations became the norm, “success” rates dropped. Psychological and neurological approaches failed equally. During the Great War, roughly 50 per cent of patients could be returned to some form of duty no matter what type of treatment was employed. What really mattered was how quickly a man was removed from the traumatic stimuli of the front line, which is why non-specialists working in field ambulance rest stations had the greatest success rates, at least when measured by the army’s metrics. Although this appears to have been generally understood at the time, it was largely forgotten after the war, probably because there was no cadre of surgeons and general practitioners eager to stake out that claim. There were, though, neurologists, psychiatrists, and psychologists eager to use the war to reinforce or establish their specializations and claims to expertise in the treatment of nervous and mental illness. The impressive statistics quoted in the periodical and memoir literature need to be read carefully, with a

324

A Weary Road

close eye to chronology, and context. What those reported outcomes all have in common is that they are aggregates, which by definition smooth out significant deviations from that mean. Often they only pertain to a subgroup of patients, men diagnosed as shell shock (wounded) or neurasthenic. What this study shows is that these publications provided evidence about what physicians wanted to believe themselves about the promise of psychology, neurology, or psychiatry, not what they accomplished during the war. This, in turn, brings our understanding of overseas treatment more in line with what we now know about the differences between theory and practice at evacuation hospitals like the Maudsley or Queen Square. The realization that specialist treatment had failed to achieve its promise set off a broad discussion within the neurological and psychiatric professions about the nature of nervous illness and its treatability. After much soul searching, most mainstream neurologists and even some psychologists rationalized an explanation that protected their claims to special expertise, falling back on the older argument that nervousness was a heritable trait, linking it to degeneracy. In this analysis, the functional symptoms typically associated with shell shock arose owing to a temporary loss of higher reasoning power, due to either a commotional or emotional shock or lengthy period of strain. The men who responded to the various forms of rational persuasion practised at hospitals at the front and in England were portrayed as “normal” individuals with “normal” nervous constitutions, temporarily affected by the shock of battle. Those that failed to respond had to have some internal defect, that is, a hereditary predisposition to nervous breakdown or some intellectual defect. While this view had moderated somewhat by the time that the War Office Committee of Inquiry into Shell Shock produced its official report into shell shock, the idea persisted that there had been a small number of legitimate “commotional cases” of shell shock among “normal” individuals and a much larger number of “emotional cases” among subnormal soldiers.3 In England this prompted the committee to recommend that the army adopt strict screening standards in future wars to weed out potentially problematic men who might be identified via various stigmata of degeneration.4 In Canada, leading experts like Colin Russel, C.B. Farrar, and J.P.S. Cathcart returned from their war experience to promote the view that shell shock was, in many cases, a symptom of degeneracy and bad breeding.5 As other works have shown, this rationalization had a profound effect on the post-war lives of veterans and their families who struggled to

Conclusion 325

demonstrate that ongoing suffering had been caused by wartime trauma rather than some pre-existing social, emotional, or physical defect.6 Although the army never closed the shell shock centres, early in 1918 it reversed course. During the final year of war, the military and medical authorities adopted what might be called an army-level stopping system – essentially a scaled-up version of the divisional approach developed in 1915. In January 1918, Haig and Fowke sought to remove diagnosis and treatment for nervous illness from the front lines to hospitals in England on the assumption that men who failed to spontaneously recover with a few days rest would be unlikely to ever do so in theatre. While this proposal was debated for several months, and delayed several times by the German Spring Offensives, it eventually went into effect in August of 1918. Meanwhile, the NYDN centres became army-level triage centres where men who failed to recover in field ambulances and corps-level rest stations were sent for evaluation. By the winter of 1918, most of the original shell shock specialists, including C.S. Myers, Carmalt Jones, and William Brown, had also been reassigned to other posts or returned to England, and the special centres were in the hands of a new generation of trainees, many of whom had little experience in the field. It became policy at those hospitals for the attending physicians to have as little contact with patients as possible in order to discourage the perception that they were ill. By the end of the war in November 1918, men were processed through the wards according to a strict schedule, the goal of which was to reassign them to productive labour behind the lines, rather than return them to combat at the front. What is most remarkable about the way shell shock was experienced at the front was that most men were able to persevere for so long, many of them choosing to continue to fight long after their nerves began to give way. This does not diminish the reality, though, that that conflict left a sizeable number of Canadian, British, Australian, New Zealand, South African, and Newfoundland soldiers traumatized for life. Official Canadian statistics suggest that around 16,000 men were diagnosed with some form of nervous illness during the war, representing about 4 per cent of those who served overseas, or 10 per cent of the non-fatally wounded.7 The numbers for Britain and the other Dominions are similar. Some returned home to live normal lives. Others always lived under war’s shadow. Still more developed the symptoms of what was called “burn-out syndrome” years later. During the war and after, shell shocked soldiers were rarely passive victims, but tried to gain control

326

A Weary Road

over their own lives, negotiating with doctors, officers, and pension officers to ascribe meaning to their suffering and lived experiences. It  is worth remembering that they found that meaning not only in the  ways they broke down, but also in the ways that they survived and persevered. For the history of psychiatry, the Great War was never a watershed moment, at least not in terms of patient experience or the types of outcome achieved. There were neither great revolutions in psychiatric thought nor any real discoveries of scientific importance. The group of neurologists that dominated the field of nervous medicine in Britain and the Empire before the war continued to oversee the management of shell shock overseas and, in Canada at least, the neuro-psychiatric branch of the Department of Veterans Affairs. The war encouraged exploration in a number of fields and changed the way people thought about nervous illness, but in ways that would ultimately prove to be scientific dead-ends. By war’s end the old pre-war framework of nerves that had proved so popular with middle-class neurasthenics was on the wane, but it was replaced with a new fatalistic view of human nature that emphasized the importance of heredity and biological predisposition rather than the primacy of lived experience and personal trauma central to the psychological approach. The latter had little effect on all but a few soldiers of the Great War. Although there was a brief moment in the summer of 1916 when shell shock posed a significant threat to the military effectiveness of the British army, for much of the war it was only one among many medical problems faced by soldiers, doctors, and the military authorities. In fact, from a military point of view shell shock was always a more marginal problem than trench foot, measles, influenza and pneumonia, or venereal disease. But like self-inflicted wounds, which were rare but occupy an important position within the medical discourse of the Great War, shell shock was important for what it represented: a challenge to military authority and the army’s monopoly over the lives of men in uniform. When the military authorities became concerned about shell shock, it was usually because they were concerned about morale and discipline more broadly. What is most remarkable about the army’s response to shell shock was not that some nervous men were executed during the war – an appalling fact that is unfortunately entirely consistent with the manly militarism of the day – but that so much dissent was actually tolerated by figures like Haig and Fowke.

Conclusion 327

For most of the war, nervous illness was self-regulated within the ranks by an evolving and complex sense of what it meant to be a masculine soldier and of how brave men should behave in the face of adversity. While diagnosis, treatment, and casualty management offer us few lessons for the present, so intricately tied to the culture and ethos of the day, there is one overarching lesson that we can take from the story of shell shock. This is that as long as young people are sent to war, some of them will inevitably break down under the trauma and strain of battle. As long as this happens, armies will continue to struggle to manage these casualties and will fret about morale, discipline, and fighting efficiency. Specialists will also offer their counsel and will argue that this time the problem can be solved.

Appendix A

Special Shell Shock Hospitals and NYDN Centres in Army Areas

Canadian Corps Hospital

Opening date

Closing date

Location

Doctor

No. 35 CCS

22 August 1916

6 November 1916

Doullens

Unknown

No. 32 CCS

5 November 1916

31 December 1916

St. Venant

Unknown

No. 4 Stationary Hospital

1 January 1917

26 August 1917

Arques

D.W. Carmalt Jones

No. 39 Stationary Hospital

26 August 1917

12 October 1917

Aire

T.B. Unwin (CO)

New Zealand Stationary Hospital

23 October 1917

14 December 1917

Wisques

Captain T.G. Gray

No 15 Casualty Clearing Station

20 September 1917

14 December 1917

Ebblinghem

W. Taylor

No. 39 Stationary Hospital

14 December 1917

Early April 1918

Aire

T.B. Unwin (CO) or Captain Somerville, RAMC

No. 8 Casualty Clearing Station

30 April 1918

1 June 1918

Wavrans

Captain Somerville

No. 1 Casualty Clearing Station

2 June 1918

1 August 1918

Wavrans

Unknown

No. 12 Casualty Clearing Station

1 August 1918

20 August 1918

Wavrans

Unknown

No. 30 Casualty Clearing Station

31 August 1918

15 September 1918

Wavrans

Unknown

No. 12 Stationary Hospital

15 September

4 November 1918

St. Pol

Captain G.P. Gibson

No. 6 Casualty Clearing Station

4 November 1918

11 November 1918

Bois de Montigny

Captain G.P. Gibson

330

Appendix A

First Army Hospital

Opening date

Closing date

Location

Doctor

No. 32 CCS

6 November 1916

31 December 1916

St. Venant

Unknown

No. 4 Stationary Hospital

31 December 1916

26 August 1917

St. Omer

D.W. Carmalt Jones

No. 39 Stationary Hospital

26 August 1917

18 April 1918

Aire

T.B. Unwin (CO)

German Spring Offensive – No Active NYDN Centre No. 8 CCS

30 April 1918

2 June 1918

Wavrans

Captain Somerville

No. 1 CCS

2 June 1918

8 August 1918

Wavrans

Unknown

No. 30 CCS

8 August 1918

15 September 1918

Wavrans

Unknown

No. 12 Stationary Hospital

15 September 1918

6 November 1918

St. Pol

Captain G.P. Gibson

No. 6 Casualty Clearing Station

6 November 1918

11 November 1918

Bois de Montigny

Captain G.P. Gibson

Second Army Hospital

Opening date

Closing date

Location

Specialist(s)

No. 12 CCS

1 December 1916

2 January 1917

Hazebrouck

None

No. 4 Stationary Hospital

2 January 1917

7 September 1917

St. Omer

D.W. Carmalt Jones

New Zealand Stationary Hospital

8 September 1917

14 December 1917

Wisques

Captain T.G. Gray

No 15 Casualty Clearing Station

20 September 1917

14 December 1917

Ebblinghem

W. Taylor

No. 62 CCS

14 December 1917

8 April 1918

Bandagehem

W. Johnson

No. 63 CCS

8 April 1918

30 April 1918

Bandagehem

W. Johnson; E.P. Harding

No. 58 CCS

30 April 1918

24 May 1918

No. 11 CCS

24 May 1918

11 November 1918

Second Army in Italy

W. Johnson; E.P. Harding Moulle

W. Johnson; E.P. Harding



Special Shell Shock Hospitals 331

Third Army Hospital

Opening date

Closing date

Location

Doctor

No. 6 Stationary Hospital

1 November 1916

2 July 1917

Frévent

F. Dillon

No. 3 Canadian Stationary Hospital

3 July 1917

2 May1918

Doullens

F. Dillon; C.H. Reason

No. 21 CCS

2 May 1918

8 May 1918

Wavrans

F. Dillon; J.P. Lawson

No. 45 CCS

8 May 1918

24 August 1918

Auchy-lesHesdin

F. Dillon; J.P. Lawson; J. Watson

No. 6 Stationary Hospital

24 August 1918

12 October 1918

Frévent

Captain J.P. Lawson; F. Dillon

No. 6 Stationary Hospital

12 October 1918

20 October 1918

Frévent

Captain J.P. Lawson

No. 43 CCS

20 October 1918

11 November 1918

Beaulencourt

Capt. G.L. Brunton

Fourth Army Hospital

Opening date

Closing date

Location

Doctor

No. 35 CCS

22 August 1916

6 November 1916

Doullens

Unknown

No. 21 CCS

November 1916

21 March 1917

Corbie

William Brown

No. 13 CCS

21 March 1917

23 May 1917

Gailly

William Brown

No. 41 Stationary Hospital

23 May 1917

17 December 1917

Gailly

William Brown

No. 62 CCS

17 December 1917?

29 March 1918?

Bandagehem

W. Johnson

No. 4 CCS

1 April 1918

13 April 1918

Pont Remy

Captain H.W. Hills

No. 12 CCS

13 April 1918

31 August 1918

Longpré

Captain H.W. Hills

No. 41 Stationary Hospital

7 September 1918

30 September 1918

Gailly (Cerisy)

Captain H.W. Hills

37 CCS

30 September 1918

18 October 1918

Maricourt

Captain H.W. Hills

58 CCS

19 October 1918

11 November 1918

Tincourt

Captain H.W. Hills

332

Appendix A

Fifth Army Hospital

Opening date

Closing date

Location

Doctor

No. 32 CCS

22 August 1916

5 November 1916

Doullens

None

No. 3 Canadian Stationary Hospital

6 November 1916

13 January 1917

Doullens

None

No. 3 Canadian Stationary Hospital

13 January 1917

31 March 1917

Doullens

Harry Manley Nicholson

No 47 CCS

31 March 1917

20 June 1917

Varennes

W.B. Davy

No 47 CCS

20 June 1917

23 July 1917

Dozinghem

W.B. Davy

No. 62 CCS

24 July 1917

17 December 1917

Bandagehem

W. Johnson

No. 41 Stationary Hospital

17 December 1917

4 March 1918

Gailly

William Brown

No. 41 Stationary Hospital

4 March 1918

26 March 1918

Gailly

None

German Spring Offensive – No Active NYDN Centre No. 51 CCS

9 August 1918

7 October 1918

Covecque

J. Watson

39 Stationary Hospital

7 October 1918

26 October 1918

Aire

J. Watson

39 Stationary Hospital

27 October 1918

11 November 1918

Lille

J. Watson

Appendix B

A Note on First World War Medical Sources

This book is based on a wide array of sources drawn from Canadian, British, and Australian archives. In combination, these records allow us to reconstruct a more complete picture of how the medical units of the British Army functioned at the front during the Great War than previously thought possible. Many of the records are scattered while others are new and so their use requires some discussion. The official records kept in London, Ottawa, and Canberra are the starting point for any examination of how medical units functioned at the front, and these each have different strengths and weaknesses. The British official records are the most comprehensive, including the war diaries (WO95) of the Director General, Medical Services (DGMS), BEF; the Directors, Medical Services (DMS) for each army; the Deputy Director, Medical Services (DDMS) for each corps; and the Assistant Director, Medical Services (ADMS) for each division. There are also war diaries for each field ambulance, casualty clearing station, general and stationary hospital as well as the administrative officers that oversaw various aspects of care (sanitation, lines of communication, bases, etc.). All of these records are now available online through the National Archives website (http://www.nationalarchives.gov.uk/), but as anyone who has studied them will know, they vary widely in terms of content and comprehensiveness. Often they are perfunctory, listing correspondence received and sent, sometimes providing a short summary of important decisions, other times not. In effect, they usually consist of little more than a skeletal index to the activities of the unit, organizing information for historians by date with references to numbered memoranda, reports, charts, and orders that were kept elsewhere in lengthy administrative files. Unfortunately, most of the latter no longer exist, destroyed

334

Appendix B

after the completion of the official histories in the 1930s and 1940s to conserve archival space. Some important documents are still appended to the monthly war diaries, others can be found in the appendices belonging to other units within the same chain of command. Still others have been preserved within the subject files organized by the Medical Research Committee (MH106) or the operational records of the various armies (WO158). Sometimes they can also be located in personal papers housed at the Wellcome Trust, the Royal Army Medical Corps Museum, or in other private collections. All too often they are missing completely.1 The digitization of war diaries in the United Kingdom, Canada, and Australia, combined with the advent of personal digital archival photography, has gone a long way towards facilitating the linkage of surviving records. Downloadable files make it possible for historians to comb through thousands of pages in a triage process that would have been too time consuming to consider in an earlier era when archival work was confined to the reading room. Digital photography also allows researchers to collect large volumes of material during the restrictive hours offered by most institutions, preserving the files in their entirety for later digestion. Even as this process yields important results, it also confirms how little actually remains from the administrative and policy records of the RAMC. Official paper files in Canberra and Ottawa fill many of the gaps in the British records. The administrative records of the ANZACs and Canadian Corps, held at the National War Memorial in Australia and Library and Archives Canada, were largely preserved and so are far more complete than their British counterparts. Here it is important to keep in mind that Dominion formations always served within a British chain of command, as part of a British Army. This was especially true of hospital units which, with the exception of field ambulances, were wholly integrated into the British evacuation system. The files of the respective corps-level DDMSs often include the circulars, memoranda, reports, orders, and correspondence mentioned in the war diaries of the DGMS and the army-level DMSs. The same is true of hospitals along the lines of communication, at the base, or in England. Because the Dominion formations were rarely attached to the same army or administrative entity at the same time, their records are mutually supportive rather than overlapping. The Canadian and Australian material is also supplemented by files copied by Australian official historians in the 1920s and 1930s from British records that were later destroyed (AWM



First World War Medical Sources 335

25 and 51).2 Although patchy, these records include a variety of higherlevel documents that were collected in order to specifically document how policies and orders were formulated at General and army headquarters before being issued to lower-level formations. In other words, many copies of British documents once thought lost still exist in the Australian and Canadian archives. Getting information on the patient experience of various diseases and injuries is also difficult, especially for shell shock. Soldiers’ letters, diaries, memoirs, and recorded oral histories have been the main sources used by medical historians, but this is very much a hit and miss process: although a seemingly unlimited number of records are available for researchers to browse, unless one knows that a specific soldier was shell shocked, or suffering from another disease or type of wound, finding references to a specific form of experience is often the product of luck or accident. Cases of well-known shell shocked men figure prominently in the historical literature and in the popular imagination because they are so readily accessible. Again, databases of digitized records and the creation of detailed online finding aids has simplified the process by allowing researchers to full-text search large bodies of records. The RAMC files and personal papers digitized by the Wellcome Trust, the indexes to the Imperial War Museum’s oral history and memoir collection, and the letters and diaries put online through the Canadian Letters and Images Project are invaluable for researchers. Yet keyword searches also have their limitations as they are dependent on both the researcher selecting the “right” terms as well as the accuracy of the transcription, description, or Optically Character Recognition (OCR) software used to digitize the material. Information on physician perspectives is easier to acquire. Here medical journal articles, published during and after the war, as well as postwar memoirs and textbooks have traditionally been the main sources of information, supplemented by personal papers housed at various repositories. While these are invaluable, they are not without their problems. First of all, we mainly know the names of only the most prominent physicians in a given wartime field, or at least those who were actively working to publish about their work on specific diseases or types of injuries. This again tends to lead us back to the same records again and again without knowing whether the treatment methods being described were typical or unusual. Some historians have been able to use the archives of hospitals located in England that preserved their wartimes records (like Queen Square and the Maudsley), including the case notes of attending physicians, to investigate these questions in more detail.3 These studies

336

Appendix B

have confirmed that much of what was published during the war did not describe “typical” courses of treatment, nor were wartime publications always reliable. In other words, these sources raise as many questions as they answer. What is largely absent from the scholarship are the experiences of ordinary soldiers, that is, the men who did not leave written records but constituted the majority. In large measure, it has been nearly impossible to identify which men suffered from which conditions during the war. The task of grouping patients by type of disease or injury could be done via the hospital admission and discharge registers that each British and Imperial hospital, from frontline field ambulances to convalescent homes, were required to keep during the war. This register of patients included the soldier’s name, regimental number, unit, days at front, date of admission, disease or injury, days in hospital, date of discharge, and final disposition (i.e., whether he was transferred to another hospital, discharged to duty, or died in hospital). After the war, the British Medical Research Committee used the records to complete the official medical histories and the volume entitled Casualties and Statistics, but because of the sheer scale of the records, elected to keep only a sample of books from each type of hospital. These are now preserved at the National Archives in MH106/1-2078, and while they have been used to great effect by historians, they can only provide a snapshot of what happened at one particular hospital. Again, these were not so much chosen at random as selected based on the hospital’s location, participation in particular actions, or specialization.4 Even where the admission and discharge books exist to identify specific soldiers suffering from certain conditions, the corresponding medical records are also often frustratingly lost. At each hospital in the evacuation and treatment zones, doctors and nurse kept a specific Medical Case Sheet, temperature chart, and other records for each patient. These were usually (but not always) sent with the soldier from one hospital to the next and were eventually placed in the soldier’s personal military file. At the end of the war, the Medical Research Committee appears to have extracted most of these case sheets from the personnel files and only kept examples to illustrate specific diseases or injuries and their treatments. These are now housed in MH106/2079-2384, arranged thematically by year, but their coverage is neither random nor representative: for example, the preserved shell shock and neurasthenia sheets only cover 1914 to mid-1916.



First World War Medical Sources 337

Again, the Canadian records allow us to fill some of the gaps left by the Medical Research Committee. Library and Archives Canada holds all the admission and discharge books not only for Canadian hospitals at home and overseas, but also for any British or imperial hospital that treated Canadian soldiers (RG150). British, Australian, New Zealand, and South African hospitals kept separate registers for Dominion troops and, after the completion of the official histories, these were transferred to the Department of National Defence in Canada. They sat unnoticed until 2003, when they were rediscovered in the basement of an Ottawa warehouse and transferred to the archives. Because Canadian soldiers were treated like any other imperial soldier, these records allow us to examine how they moved through the hospital system at any point in the war. Furthermore, like the British books, they also act as an index to specific diseases and types of injury, but in the Canadian case, patient medical records still are part of each of the 620,000 First World War personnel files (RG150). These medical records are detailed and comprehensive, at least in terms of the information they provide on how doctors and nurses viewed their patients. Yet they also often contain quotes from the soldiers taken down during examinations and interviews which, with some qualifications, provide a few ordinary patient voices. These records allow us to identify so-called silent patients: those who chose not to identify as shell shocked during the war but were labelled as such by the army or who kept silent in the years after. The names obtained from the admission and discharge books and the medical records obtained from personnel files can, in turn, be crossreferenced with digitized letters, diaries, and memoirs as well as the thousands of oral history transcripts compiled by the Canadian Broadcasting Corporation during the 1960s (held at Library and Archives Canada in RG41). These allow us to construct a more nuanced picture of the experience of shell shock by listening to the words and stories of men who were connected to that form of suffering by army doctors, but who kept silent for one reason or another. The same will be true for other forms of disease as well as “silent wounds” like gas poisoning. Furthermore, these files make clear that in many cases soldiers were treated by non-specialists and remind us that most of the doctors that served on the Western Front did not write down their experiences. Yet their story too can be accessed from patient records, and in the case of shell shock, at least, it is clear that typical forms of treatment had little to do with the methods which figure most prominently in the literature.

338

Appendix B

In combination, these types of sources allow us to reconstruct a more complete picture of diagnosis, treatment, and patient experience. They allow us to test our assumptions about diagnosis and treatment often derived from contemporary publications. Systematic investigation of these records will allow researchers to pose new questions of old evidence and to reconsider questions that may have been answered some time ago.

Notes

Introduction 1 War Diary (WD), 10th Battalion, 22 February 1915, RG 9, Series III-D-3, Volume 4919, File: 372, LAC; Daniel Dancocks, Gallant Canadians: The Story of the Tenth Canadian Infantry Battalion, 1914–1919 (Calgary: Calgary Highlanders Regimental Funds Foundation, 1990), 15–16. 2 Lieutenant G.R.F., “With Canada at the Front: An Address by Lieut. G.R. Forneret before the Empire Club of Canada, Toronto,” 13 January 1916, Empire Club of Canada, http://speeches.empireclub.org/60485/data. 3 F., “With Canada at the Front.” 4 Dancocks, Gallant Canadians, 17–19; WD, 10th Battalion, 8 March 1915, RG 9, Series III-D-3, Volume 4919, File: 372, LAC. 5 F., “With Canada at the Front.” 6 Proceedings of a Medical Board, 8 October 1915, RG 150, Accession 1992–3/166, Box 3203 – File 7, LAC; WD, 10th Battalion, marginal note for 15 March 1915, RG 9, Series III-D-3, Volume 4919, File: 372, LAC. 7 Medical Case Sheet, The Queen’s Canadian Military Hospital, 333852, 20 March 1915, RG 150, Accession 1992–3/166, Box 3203 – File 7, LAC. 8 WD, 10th Battalion, marginal note 15 March 1915, RG 9, Series III-D-3, Volume 4919, File: 372, LAC. 9 A. Young, ed., The War Memorial Volume of Trinity College, Toronto (Toronto: Printer’s Guild, 1922), 93. 10 Medical Case Sheet, The Queen’s Canadian Military Hospital, 333852, 20 March 1915, RG 150, Accession 1992–93/166, Box 3203 – File 7, LAC. 11 The literature on shell shock is vast and readers are advised to consult the bibliography at the end of this text for a full list of sources. Two good

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Notes to page 5

historiographical analyses are Tracey Loughran, “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and Its Histories,” Journal of the History of Medicine and Allied Sciences 67, no. 1 (2012): 94–119 and Loughran, “A Crisis of Masculinity? Re-writing the History of ShellShock and Gender in First World War Britain,” History Compass 11, no. 9 (2013): 727–38. 12 D. Kaufmann, “Science as Cultural Practice: Psychiatry in the First World War and Weimar Germany,” Journal of Contemporary History 34, no. 1 (1999): 125–44; Marc Roudebush, “A Patient Fights Back: Neurology in the Court of Public Opinion in France during the First World War,” Journal of Contemporary History 35, no. 1 (2000): 29–38; Annessa C. Stagner, “Healing the Soldier, Restoring the Nation: Representations of Shell Shock in the USA during and after the First World War,” Journal of Contemporary History 49, no. 2 (2014): 255–74; Allan Young, “W.H.R. Rivers and the War Neuroses,” Journal of the History of the Behavioral Sciences 35, no. 4 (1999): 359–78. 13 Stephen Garton, “Freud versus the Rat: Understanding Shell Shock in World War I,” Australian Cultural History 16 (1997/8): 45–59; Nathan G. Hale, Freud and the Americans: The Beginnings of Psychoanalysis in the United States, 1876–1917 (New York: Oxford University Press, 1971); Harold Merskey, “After Shell Shock: Aspects of Hysteria since 1922,” in German Elias Berrios and Hugh Lionel Freeman, eds., 150 Years of British Psychiatry: The Aftermath, Vol. 2 (London: Gaskell, 1991), 89–118; Fiona Reid, “‘His nerves gave way’: Shell Shock, History and the Memory of the First World War in Britain,” Endeavour 38, no. 2 (2014): 91–100; Michael Roper, “From the Shell-Shocked Soldier to the Nervous Child: Psychoanalysis in the Aftermath of the First World War,” Psychoanalysis and History 18, no. 1 (2016): 39–69. 14 Edgar Jones and Simon Wessely, “The Impact of Total War on the Practice of British Psychiatry,” in Roger Chickering and Stig Förster, eds., The Shadows of Total War: Europe, East Asia, and the United States, 1919–1939 (Cambridge: Cambridge University Press, 2003), 121–48. 15 Ted Bogacz, “War Neurosis and Cultural Change in England, 1914–22: The Work of the War Office Committee of Enquiry into ‘Shell-Shock,’” Journal of Contemporary History 24, no. 2 (1989): 227–56; Edward M. Brown, “Between Cowardice and Insanity: Shell Shock and the Legitimation of the Neuroses in Great Britain,” in Everett Mendelsohn, Merritt Roe Smith, and Peter Weingart, eds., Science, Technology and the Military (Dordrecht: Kluwer Academic Publishers, 1989), 323–45; Tracey Loughran, “ShellShock and Psychological Medicine in First World War Britain,” Social History of Medicine 22, no. 1 (2008): 79–95.



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16 Gwen A. Parsons, “The Construction of Shell Shock in New Zealand, 1919–1939: A Reassessment,” Social History of Medicine 26, no. 1 (2013): 56–73; Ruth Rae, “An Historical Account of Shell Shock during the First World War and Reforms in Mental Health in Australia 1914–1939,” International Journal of Mental Health Nursing 16, no. 4 (2007): 266–73. 17 For an overview of how diagnostic terminology has changed over time see Marc-Antoine Crocq, “From Shell Shock and War Neurosis to Posttraumatic Stress Disorder: A History of Psychotraumatology,” Dialogues in Clinical Neuroscience 2, no. 1 (2000): 47–55. 18 Johanna Church, “Literary Representations of Shell Shock as a Result of World War I in the Works of Virginia Woolf and Ernest Hemingway,” Peace & Change 41, no. 1 (1 January 2016): 52–63; Trevor Dodman, Shell Shock, Memory, and the Novel in the Wake of World War I (New York: Cambridge University Press, 2015); W. Hipp, The Poetry of Shell Shock: Wartime Trauma and Healing in Wilfred Owen, Ivor Gurney and Siegfried Sassoon (Jefferson, NC: McFarland & Co., 2005); Daniel Anton Kaes, Shell Shock Cinema: Weimar Culture and the Wounds of War (Princeton: Princeton University Press, 2009); Susan Kent, Aftershocks: Politics and Trauma in Britain, 1918–1931 (London: Palgrave, 2009); Elaine Showalter, “Rivers and Sassoon: The Inscription of Male Gender Anxieties,” in Margaret Randolph Higgonet, ed., Behind the Lines: Gender and the Two World Wars (New Haven and London: Yale University Press, 1987), 61–9; Emma Sutton, “Shell Shock and Hysterical Fugue, or Why Mrs Dalloway Likes Bach,” First World War Studies 2, no. 1 (March 2011): 17–26. 19 Paul Fussell, The Great War and Modern Memory (Toronto: Oxford University Press, 2000). 20 Pat Barker, Regeneration (London: Viking Press, 1991); The Eye in the Door (London: Viking Press, 1993); The Ghost Road (London: Viking Press, 1995). See also Michèle Barrett, “Pat Barker’s Regeneration Trilogy and the Freud­ ianization of Shell Shock,” Contemporary Literature 53, no. 2 (Summer 2012): 237–60. 21 Lord Southborough, Report of the War Office Committee of Enquiry into “ShellShock” (London: HMSO, 1922), 190–5; William Johnson, “Neurasthenia and War Neuroses in France,” in W.G. Macpherson et al., eds., History of the Great War Based on Official Documents: Medical Services—Diseases of the War, Volume II (London: HMSO, 1923); Andrew Macphail, History of the Canadian Forces, 1914–19: Medical Services (Ottawa: Department of National Defence, 1925); Colonel A.G. Butler, Official History of the Australian Army Medical Services: Volume III, Special Problems and Services (Canberra: Australian War Memorial, 1943).

342

Notes to pages 6–7

22 Michel Foucault, The Birth of the Clinic (New York: Pantheon Books, 1973); Foucault, Madness and Civilization: A History of Insanity from the Age of Reason (New York: Vintage Books, 1965); Andrew Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England (New York: St Martin’s Press, 1979); Thomas Szasz, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (New York: Harper and Row, 1970). 23 Eric Leed, No Man’s Land: Combat and Identity in World War I (Cambridge: Cambridge University Press, 1979); Thomas Brown, “Shell Shock and the Canadian Expeditionary Force, 1914–18: Canadian Psychiatry in the Great War,” in C. Roland, ed., Health, Disease and Medicine: Essays in Canadian History (Toronto: Hannah Institute, 1983). 24 Eric T. Dean, Shook Over Hell: Post Traumatic Stress, Vietnam, and the Civil War (Cambridge, MA: Harvard University Press, 1999); Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton, NJ: Princeton University Press, 1997). 25 M. Stone, “Shellshock and the Psychologists,” in W.F. Bynum, M. Shephard, and R. Porter, eds., The Anatomy of Madness: Essays in the History of Psychiatry, Volume II: Institutions and Society (New York: Tavistock, 1985), 242–71. 26 Anthony Babington, Shell-Shock: A History of the Changing Attitudes to War Neurosis (London: Leo Cooper, 1997); J.M.W. Binneveld, From Shell Shock to Combat Stress: A Comparative History of Military Psychiatry (Amsterdam: Amsterdam University Press, 1997); J.T. Copp and Mark Osborne Humphries, Combat Stress in the 20th Century: The Commonwealth Perspective (Kingston, ON: Canadian Defence Academy Press, 2010). 27 Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge, MA: Harvard University Press, 2001). See also Edgar Jones and Simon Wessely, Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War (New York: Psychology Press, 2005); Peter Leese, Traumatic Neurosis and the British Soldiers of the First World War (Basingstoke: Palgrave Macmillan, 2002). 28 Terry Copp and Bill McAndrew, Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939-1945 (Montreal-Kingston: McGill Queen’s University Press, 1990). 29 Works that make the connection between shell shock and earlier wars and civilian medicine include Marijke Gijswijt-Hofstra and Roy Porter, eds., Cultures of Neurasthenia from Beard to the First World War (Amsterdam, New York: Rodopi, 2001); Edgar Jones and Simon Wessely, “The Origins of British Military Psychiatry before the First World War,” War & Society 19, no. 2 (2001): 91–108; Edgar Jones et al., “Post-Combat Syndromes from



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the Boer War to the Gulf War: A Cluster Analysis of Their Nature and Attribution,” British Medical Journal 324, no. 7333 (2002): 321–4; Martin Lengwiler, “Psychiatry beyond the Asylum: The Origins of German Military Psychiatry before World War I,” History of Psychiatry 14, no. 53 (2003): 41–62; Paul Lerner, Hysterical Men: War, Psychiatry and the Politics of Trauma in Germany, 1890–1930 (Ithica, NY: Cornell University Press, 2006); Tracey Loughran, “Hysteria and Neurasthenia in Pre-1914 British Medical Discourse and in Histories of Shell-Shock,” History of Psychiatry 19, no. 1 (2008): 25–46; Mark S. Micale and Paul Lerner, Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1939 (Cambridge: Cambridge University Press, 2001); Michael R. Trimble, Post Traumatic Neurosis: From Railway Spine to the Whiplash (Toronto: Wiley, 1981). 30 Jay M. Winter, “Shell-Shock and the Cultural History of the Great War,” Journal of Contemporary History 35, no. 1 (2000): 7–11. 31 Theresa Iacobelli, “Arbitrary Justice?: A Comparative Analysis of Death Sentences Passed and Death Sentences Commuted during the First World War,” Canadian Military History 16, no. 1 (2007): 23–36; Edgar Jones, “The Psychology of Killing: The Combat Experience of British Soldiers during the First World War,” Journal of Contemporary History 41, no. 2 (2006): 229–46; Edward Madigan, “‘Sticking to a hateful task’: Resilience, Humour, and British Understandings of Combatant Courage, 1914–1918,” War in History 20, no. 1 (2013): 76–98; Michael Roper, The Secret Battle: Emotional Survival in the Great War, Cultural History of Modern War (Manchester: Manchester University Press, 2009); Alexander Watson, Enduring the Great War: Combat, Morale and Collapse in the German and British Armies, 1914–1918 (Cambridge: Cambridge University Press, 2008). 32 The formative work in the field is Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830–1980 (New York: Pantheon Books, 1985). See also Joanna Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War (Chicago: University of Chicago Press, 1996); Anthony Fletcher, “Patriotism, the Great War and the Decline of Victorian Manliness,” History 99, no. 334 (2014): 40–72; J.A. Mangan, Manufactured Masculinity: Making Imperial Manliness, Morality and Militarism (Abingdon, New York: Routledge, 2013); Jessica Meyer, Men of War: Masculinity and the First World War in Britain (Basingstoke, New York: Palgrave Macmillan, 2011); Mark Moss, Manliness and Militarism: Educating Young Boys in Ontario for War (New York: Oxford University Press, 2001); Michael Roper, “Between Manliness and Masculinity: The ‘War Generation’ and the Psychology of Fear in Britain, 1914–1950,” Journal of British Studies 44, no. 2 (2005): 343–62.

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33 Joanna Bourke, “Love and Limblessness: Male Heterosexuality, Disability, and the Great War,” Journal of War & Culture Studies (2016), http:// www.tandfonline.com/doi/abs/10.1080/17526272.2015.1106756; Bourke, “Effeminacy, Ethnicity, and the End of Trauma: The Sufferings of ‘Shell-Shocked’ Men in Great Britain and Ireland, 1914–1939,’ Journal of Contemporary History 35, no. 1 (2000): 57–69; Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford: Oxford University Press, 2010); Mark Humphries, “Wilfully and With Intent: Self-Inflicted Wounds and the Negotiation of Power in the Trenches,” Histoire sociale/Social History 47, no. 94 (2014): 369–97; Jessica Meyer, “‘Gladder to be going out than afraid’: Shellshock and Heroic Masculinity in Britain, 1914–1919,” in J. Macleod and P. Purseigle, eds., Uncovered Fields: Perspectives in First World War Studies (Leiden: Brill, 2004), 195–210; Meyer, “Separating the Men from the Boys: Masculinity and Maturity in Understandings of Shell Shock in Britain,” Twentieth Century British History 20, no. 1 (2008): 1–22; Meyer, “Shell Shock as a Self-Inflicted Wound, 1915– 1921,” in Laura Salisbury and Andrew Shail, eds., Neurology and Modernity: A Cultural History of Nervous Systems, 1800–1950 (Basingstoke: Palgrave Macmillan, 2010), 231–44; Meyer, “‘Not Septimus now’: Wives of Disabled Veterans and Cultural Memory of the First World War in Britain,” Women’s History Review 13, no. 1 (2004): 117–38; George L. Mosse, “Shell-Shock as a Social Disease,” Journal of Contemporary History 35, no. 1 (2000): 101–8; Fiona Reid, “‘My friends looked at me in horror’: Idealizations of Wounded Men in the First World War,” Peace & Change 41, no. 1 (January 2016): 64–77. 34 Fiona Reid, Broken Men: Shell Shock, Treatment and Recovery in Britain, 1914–1930 (London: Continuum, 2010); Marina Larsson, Shattered Anzacs: Living with the Scars of War (New South Wales: University of New South Wales, 2009); Peter Barham, Forgotten Lunatics of the Great War (New Haven: Yale University Press, 2004); see also Desmond Morton and Glenn Wright, Winning the Second Battle: Canadian Veterans and the Return to Civilian Life, 1915–1930 (Toronto: University of Toronto Press, 1987); Stephen Garton, The Cost of War: Australians Return (Oxford: Oxford University Press, 1996); Edgar Jones, Ian Palmer, and Simon Wessely, “War Pensions (1900–1945): Changing Models of Psychological Understanding,” British Journal of Psychiatry 180, no. 4 (2002): 374–9; Peter Leese, “Problems Returning Home: The British Psychological Casualties of the Great War,” The Historical Journal 40, no. 4 (1997): 1055–67; Gregory Mathew Thomas, Treating the Trauma of the Great War: Soldiers, Civilians, and Psychiatry in France, 1914– 1940 (Baton Rouge: Louisiana State University Press, 2009); John Weaver



Notes to pages 8–9 345

and David Wright, “Shell Shock and the Politics of Asylum Committal in New Zealand, 1916–22,” Health and History 7, no. 1 (2005): 17–40. 35 Thomas Brown, “Shell Shock and the Canadian Expeditionary Force, 1914–18: Canadian Psychiatry in the Great War,” in C. Roland ed., Health, Disease and Medicine: Essays in Canadian History (Toronto: Hannah Institute, 1983); Terry Copp, Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939–1945 (Montreal-Kingston: McGill Queen’s University Press, 1990); Mark Osborne Humphries and Kellen Kurchinski, “Rest, Relax and Get Well: A Re-Conceptualisation of Great War Shell Shock Treatment,” War & Society 27, no. 2 (2008): 89–110; Mark Osborne Humphries, “War’s Long Shadow: Masculinity, Medicine and the Gendered Politics of Trauma, 1914–1939,” Canadian Historical Review 91, no. 3 (September 2010): 503–31; Terry Copp and Mark Humphries, Combat Stress in the 20th Century: The Commonwealth Experience (Kingston: Canadian Defence Academy, 2011). 36 In addition to Ben Shephard’s and Peter Leese’s books which include chapters dedicated to shell shock overseas, see Edgar Jones and Simon Wessely, “‘Forward Psychiatry’ in the Military: Its Origins and Effective­ ness,” Journal of Traumatic Stress 16, no. 4 (2003): 411–19; Edgar Jones, Adam Thomas, and Stephen Ironside, “Shell Shock: An Outcome Study of a First World War Unit,” Psychological Medicine 37, no. 2 (2007): 215–23; Fiona Reid, “‘Playing the game to the Army’: The Royal Army Medical Corps, Shell Shock and the Great War,” War & Society 23, no. 1 (2005): 61–86; Fiona Reid and Christine Van Everbroeck, “Shell Shock and the Kloppe: War Neuroses amongst British and Belgian Troops during and after the First World War,” Medicine, Conflict and Survival 30, no. 4 (December 2014): 1–24; Ian R. Whitehead, “The British Medical Officer on the Western Front: The Training of Doctors for War,” in Roger Cooter, Mark Harrison, and Steve Sturdy, eds., Medicine and Modern Warfare (Atlanta: Rodopi, 1999). 37 The British records are described in detail in Ian F. Beckett, The First World War: The Essential Guide to Sources in the UK National Archives (Kew: Public Record Office, 2000). 38 Robin Prior and Trevor Wilson, Passchendaele: The Untold Story (New Haven, CT: Yale University Press, 1996), xv. 39 On the writing of the Great War in Canada, see Tim Cook, Clio’s Warriors: Canadian Historians and the Writing of the World Wars (Vancouver: UBC Press, 2006) and Mark Osborne Humphries, “Between Commemoration and History: The Historiography of the Canadian Corps and Military Overseas,” Canadian Historical Review 95, 2 (2014): 384–97.

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40 The literature on the Canadian Corps is large and some of the more important histories include Bill Rawling, Surviving Trench Warfare: Technology and the Canadian Corps, 1914–1918 (Toronto: University of Toronto Press, 1992); Desmond Morton, When Your Number’s Up: The Canadian Soldier in the First World War (Toronto: Random House, 1993); Nicholas Clarke, Unwanted Warriors: The Rejected Volunteers of the Canadian Expeditionary Force (Vancouver: UBC Press, 2015); Tim Cook, At the Sharp End: Canadians Fighting the Great War, 1914–1916 (Toronto: Viking, 2007) and Shock Troops: Canadians Fighting the Great War, 1917–1918 (Toronto: Viking, 2008). Studies of soldiers’ culture have been dominated by the work of Tim Cook. His most important contributions include “‘More as a medicine than a beverage’: “Demon Rum” and the Canadian Trench Soldier in the First World War,” Canadian Military History 9, no. 1 (Winter 2000): 7–22; “The Politics of Surrender: Canadian Soldiers and the Killing of Prisoners in the Great War,” Journal of Military History 70, no. 3 (July 2006): 637–65; “Anti-heroes of the Canadian Expeditionary Force,” Journal of the Canadian Historical Association 19, no. 2 (2008): 171–93; and “The Singing War: Canadian Soldiers’ Songs of the Great War,” American Review of Canadian Studies 39, no. 3 (September 2009): 224–41. 41 For international comparisons, in addition to the works cited above, see Julien Bogousslavsky and Laurent Tatu, “French Neuropsychiatry in the Great War: Between Moral Support and Electricity,” Journal of the History of the Neurosciences 22, no. 2 (2013): 144–54; Irina Sirotkina, “Politics of Etiology: Shell Shock in the Russian Army, 1914–1918,” in Angela Brintlinger, ed., Madness and the Mad in Russian Culture (Toronto: University of Toronto Press, 2007), 117–29; Paul Lerner, “Hysterical Cures: Hypnosis, Gender and Performance in World War I and Weimar Germany,” History Workshop Journal, no. 45 (1998): 79–101; Lerner, “Psychiatry and Casualties of War in Germany, 1914–18,” Journal of Contemporary History 35, no. 1 (2000): 13–28; Irina Sirotkina, “The Politics of Etiology: Shell Shock in the Russian Army, 1914–1918,” in Angela Brintlinger, ed., Madness and the Mad in Russian Culture (Toronto: University of Toronto Press, 2007), 117–29. 42 On the benefits of the comparative imperial approach see Geoffrey Hayes, Andrew Iarocci, and Mike Bechthold, eds., Vimy Ridge: A Canadian Reas­ sessment (Waterloo: Wilfrid Laurier University Press, 2007); Christopher Pugsley, “Learning from the Canadian Corps on the Western Front,” Canadian Military History 15, no. 1 (2006): 5–32; Gary Sheffield, “How Even Was the Learning Curve? Reflections on the British and Dominion Armies on the Western Front, 1916–1918,” in Canadian Military History since the 17th Century: Proceedings of the Canadian Military History



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Conference, Ottawa, 5–9 May 2000 (Ottawa: Department of National Defence, 2001), 125–31. 43 Pierre Nora, “Between Memory and History: Les Lieux de Mémoire,” Representations 26 (1989): 7–24; Ian McKay and Jamie Swift, Warrior Nation: Rebranding Canada in an Age of Anxiety (Toronto: Between the Lines, 2012); Jonathan F. Vance, Death So Noble: Memory, Meaning and the First World War (Vancouver: UBC Press, 1997); Jay Winter and Antoine Prost, The Great War in History: Debates and Controversies, 1914 to the Present (Cambridge: Cambridge University Press, 2005). 44 Charles Rosenberg, Framing Disease: Studies in Cultural History (New Brunswick, NJ: Rutgers University Press, 1990), xiii–xxvi; Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York: The Free Press, 1992), ix–xi; idem, From the Mind into the Body: The Cultural Origins of Psychosomatic Symptoms (New York: Free Press, 1994); Roy Porter, A Social History of Madness: Stories of the Insane (London: George Weidenfeld and Nicolson, 1987), 9–10. 1  Framing Shell Shock 1 Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York: The Free Press, 1992), x; Roy Porter, A Social History of Madness: Stories of the Insane (London: George Weidenfeld and Nicolson, 1987), 9–10. 2 Shorter, From Paralysis to Fatigue, ix –xi; Shorter, From the Mind into the Body: The Cultural Origins of Psychosomatic Symptoms (New York: Free Press, 1994); R.E. Kendell, “The Distinction between Mental and Physical Illness,” British Journal of Psychiatry 178, no. 6 (June 2001): 490; Robert Aronowitz, Making Sense of Illness: Science, Society and Disease (Cambridge: Cambridge University Press, 1998), esp. 10–15. 3 Tracey Loughran, “Hysteria and Neurasthenia in Pre-1914 British Medical Discourse and in Histories of Shell-Shock,” History of Psychiatry 19, no. 1 (2008): 25–46; Shorter, From Paralysis to Fatigue, ix –xi; Shorter, From the Mind into the Body; Kendell, “The Distinction between Mental and Physical Illness”; Porter, A Social History of Madness, 9–10; Aronowitz, Making Sense of Illness, esp. 10–15. 4 See various essays in Andrew Cunningham and Perry Williams, The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 2002); on changing conceptions of disease and the relationship between patient and doctor see N.D. Jewson, “The Disappearance of the Sick-Man from Medical Cosmology, 1770–1870,” Sociology 10, no. 2 (May 1976):

348







Notes to pages 15–16

225–44; Michael Worboys, Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000). 5 Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: Wiley, 1998), 78–81. 6 Micale, Hysterical Men, 34–5. The literature on hysteria is enormous. Readers should begin with the now dated but still valuable historiographical overview Marc S. Micale, Approaching Hysteria: Disease and Its Interpretations (Princeton, NJ: Princeton University Press, 1995), esp. 108–78. See also Ilza Veith, Hysteria: the History of a Disease (Chicago: University of Chicago Press, 1965); Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830–1980 (New York: Viking, 1987); Phillip R. Slavney, Perspectives on “Hysteria” (Baltimore: Johns Hopkins University Press, 1990); Sander Gilman, ed., Hysteria beyond Freud (Berkeley: University of California Press, 1993); Elaine Showalter, Hystories: Hysterical Epidemics and Modern Media (New York: Columbia University Press, 1997); Paul Lerner, Hysterical Men: Way, Psychiatry, and the Politics of Trauma in Germany, 1890–1930 (Ithaca, NY: Cornell University Press, 2003); Andrew Scull, Hysteria: The Biography (Oxford: Oxford University Press, 2009). 7 Wendy Mitchinson, The Nature of Their Bodies: Women and Their Bodies in Victorian Canada (Toronto: University of Toronto Press, 1991), 282–300 and Micale, Hysterical Men, 61–3. On an earlier period see Elaine Showalter, “Hysteria, Feminism, and Gender,” in Sander L. Gilman et al., Hysteria beyond Freud (Berkeley: University of California Press, 1993), 292–4; Roy Porter, “The Body and the Mind, the Doctor and the Patient: Negotiating Hysteria,” Hysteria beyond Freud, 244–5. On the role of hysteria in nineteenth century gender cosmologies see Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830–1980 (New York: Viking, 1987), 52–79; Micale, Hysterical Men, 49–58; Christopher G. Goetz, Michel Bonduelle, and Toby Gelfand, Charcot: Constructing Neurology (Oxford: Oxford University Press, 1995), 168–70; Scull, Hysteria, 108–16; Shorter, From Paralysis to Fatigue, 182–4; Jacques Philippon and Jacques Poirer, Joseph Babinski: A Biography (Oxford: Oxford University Press, 2008), 301–2; Marc S. Micale, “Jean-Martin Charcot and les névroses traumatiques: From Medicine to Culture in French Trauma Theory of the Late Nineteenth Century,” in Mark S. Micale and Paul Lerner, eds., Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930 (Cambridge: Cambridge University Press, 2001), 118–19. 8 J.M. Charcot, Clinical Lectures on Diseases of the Nervous System Delivered at the Infirmary of la Salpêtrière, trans. Thomas D. Savill (London: New



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Sydenham Society, 1889); Janet, The Mental State of Hystericals, xiii–xvii, 251–70, 526–7; Veith, Hysteria, 249; Christian Derouesné, “Pithiatism versus Hysteria,” in Philippon and Poirer, Joseph Babinski, 306–13; Wilson, “Some Modern French Conceptions of Hysteria,” 330–2; J.A. Ormerod, “The Lumleian Lectures on Some Modern Theories concerning Hysteria,” The Lancet, 2 May 1914: 1237–8; Anon., “Société de Neurologie de Paris,” 207–9; Philippon and Poirer, Joseph Babinski, 303–5; S.A.K. Wilson, “Some Modern French Conceptions of Hysteria,” Brain 33, no. 3 (1911): 304; Bogousslavsky, “Hysteria after Charcot: Back to the Future,” 152–3; Editors, “A Theory of Hysteria,” British Medical Journal 1, no. 2517 (27 March 1909): 802; Stanley Finger, Origins of Neuroscience: A History of Explorations into Brain Function (Oxford: Oxford University Press, 1994), 58; Lerner, Hysterical Men, 28–9. 9 Freud, Studies on Hysteria, xix; Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970), 539–46; Loughran, “Hysteria and Neurasthenia in Pre-1914 British Medical Discourse and in Histories of Shell-Shock,” 31; Ormerod, “Two Theories of Hysteria,” 15–18; Shorter, A History of Psychiatry, 143, 147. 10 Micale, Hysterical Men, 49–89; Showalter, The Female Malady, 3–5. 11 Ilana R. Bet-El, “Men and Soldiers: British Conscripts, Concepts of Masculinity, and the Great War,” in B. Melman, ed., Borderlines: Genders and Identities in War and Peace, 1870–1930 (London: Routledge, 1998), 73–94; Joanna Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War (Chicago: University of Chicago Press, 1996); Anthony Fletcher, “Patriotism, the Great War and the Decline of Victorian Manliness,” History 99, no. 334 (2014): 40–72; Joe Lunn, “Male Identity and Martial Codes of Honor: A Comparison of the War Memoirs of Robert Graves, Ernst Junger, and Kande Kamara,” Journal of Military History 69, no. 3 (2005): 713–35; J.A. Mangan, Manufactured Masculinity: Making Imperial Manliness, Morality and Militarism (Abingdon, New York: Routledge, 2013); Jessica Meyer, Men of War: Masculinity and the First World War in Britain (Basingstoke, New York: Palgrave Macmillan, 2011); Mark Moss, Manliness and Militarism: Educating Young Boys in Ontario for War (New York: Oxford University Press, 2001); Michael Roper, “Between Manliness and Masculinity: The “War Generation” and the Psychology of Fear in Britain, 1914–1950,” Journal of British Studies 44, no. 2 (2005): 343–62. 12 George M. Beard, American Nervousness: Its Causes and Consequences – A Supplement to Nervous Exhaustion (Neurasthenia) (New York: G.P. Putnam’s Sons, 1881), vi.

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13 Ibid. and George M. Beard, A Practical Treatise on Nervous Exhaustion (Neurasthenia): Its Symptoms, Nature, Sequences, Treatment (New York: W. Wood and Company, 1880). 14 Beard, A Practical Treatise on Nervous Exhaustion, 9–13. 15 David G. Schuster, Neurasthenic Nation: America’s Search for Health, Happiness, and Comfort, 1869–1920 (New Brunswick, NJ: Rutgers University Press, 2011), 2. 16 Mathew Thomson, “Neurasthenia in Britain: An Overview,” in M. GijswijtHofstra and Roy Porter, eds., Cultures of Neurasthenia from Beard to the First World War (Amsterdam: Rodopi, 2001), 79–80. 17 This discussion of the language of neurasthenia draws on Schuster, Neurasthenic Nation, 56–63; F.G. Gosling, Before Freud: Neurasthenia and the American Medical Community, 1870–1910 (Chicago: University of Illinois Press, 1987), 85–91; and Shorter, From Paralysis to Fatigue, 201–32. 18 R.E. Kendell, “The Distinction between Mental and Physical Illness,” British Journal of Psychiatry 178 (2001): 490–3; Shorter, A History of Psychiatry, 103; Ralph Harrington, “The Railway Accident: Trains, Trauma, and Technological Crises in Nineteenth-Century Britain,” in Mark S. Micale and Paul Lerner, eds., Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930 (Cambridge: Cambridge University Press, 2001), 43–52. See also Eric Caplan, “Trains and Trauma in the American Gilded Age,” in Micale and Lerner, Traumatic Pasts, 57–80; Lerner, Hysterical Men, 25; Herbert W. Page, Injuries of the Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in Their Surgical and Medico-Legal Aspects (London: J & A Churchill, 1883), 143, 195–9. 19 F. Clifford Rose, The History of British Neurology (London: Imperial College Press, 2012), 149–74. 20 Gordon Holmes, The National Hospital, Queen Square: 1860–1948 (London: E&S Livingstone, 1954), 12–21, 48–9; Editors, “Front Matter,” Brain 1, no. 1 (April 1878): 48–9; Rose, The History of British Neurology, 107–44; Shorter, A History of Psychiatry, 90. 21 Loughran, “Hysteria and Neurasthenia in Pre-1914 British Medical Discourse and in Histories of Shell-Shock,” 30. For example, see the lengthy summary of French and German studies in J. Mitchell Clarke, “Hysteria and Neurasthenia, Parts I–IX,” Brain 17, nos. 1 and 2 (1894): 119–78, 263–321. 22 Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900 (New Haven: Yale University Press, 1993), 370–4; for an overview of the Canadian literature see Thomas E. Brown, “Foucault plus Twenty: On Writing the History of Canadian Psychiatry in the 1980’s,”



Notes to page 19 351

Canadian Bulletin of Medical History 2 (1985): 23–49 and “Dance of the Dialectic? Some Reflections (Polemic and Otherwise) on the Present State of Nineteenth-Century Asylum Studies,” Canadian Bulletin of Medical History 11, no. 2 (1994): 267–95. For Australian and New Zealand perspectives see Stephen Garton, Medicine and Madness: A Social History of New South Wales, 1880–1940 (Kensington: New South Wales University Press, 1988); Catharine Coleborne, Madness in the Family: Insanity and Institutions in the Australasian Colonial World, 1860–1914 (Basingstoke: Palgrave Macmillan, 2010). 23 Shorter, A History of Psychiatry, 87–8. 24 James E. Moran, Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec and Ontario (Montreal-Kingston: McGillQueen’s University Press, 2000); S.E.D. Shortt, Victorian Lunacy: Richard Maurice Bucke and the Practice of Late Nineteenth-Century Psychiatry (Cambridge: Cambridge University Press, 1986); David Wright and James E. Moran, eds., Mental Health and Canadian Society: Historical Perspectives (Montreal-Kingston: McGill-Queen’s University Press, 2006). See also James E. Moran, Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec and Ontario (Montreal-Kingston: McGill-Queen’s University Press, 2000); and Geoffrey Reaume, Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870–1940 (Don Mills, ON: Oxford University Press Canada, 2000). 25 F. Clifford Rose, The History of British Neurology (London: Imperial College Press, 2012), 149–74. 26 The literature on the asylum and history of nineteenth-century psychiatry in Britain and the United States is vast. General collections include W.F. Bynum, Roy Porter, and Michael Shepherd, eds., The Anatomy of Madness: Essays in the History of Psychiatry, 3 vols. (London: Tavistock, 1985–8); Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard (New York: Vintage Books, 1988); Marijke Gijswijt-Hofstra, ed., Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the Twentieth Century: Comparisons and Approaches (Amsterdam: Amsterdam University Press, 2005); Marc Micale and Roy Porter, eds., Discovery of the History of Psychiatry (Oxford: Oxford University Press, 1994); Roy Porter and David Wright, eds., The Confinement of the Insane: International Perspectives, 1800–1965 (Cambridge: Cambridge University Press, 2003). For Britain see Peter Bartlett and David Wright, eds., Outside the Walls of the Asylum: The History of Care in the Community, 1750–2000 (London: Atholone, 1999); Anne Digby, Madness, Morality and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge:

352

Notes to pages 19–20

Cambridge University Press, 1985); Marijke Gijswijt-Hofstra and Roy Porter, eds., Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam: Rodopi, 1998); Joseph Melling and Bill Forsythe, eds., Insanity, Institutions, and Society, 1800–1914: A Social History of Madness in Comparative Perspective (London, New York: Routledge, 1999); Scull, The Most Solitary of Afflictions; David Wright, Mental Disability in Victorian England: The Earlswood Asylum, 1847–1901 (Oxford, New York: Clarendon, 2001). For the United States see Gerald N. Grob, Mental Illness and American Society, 1875–1940 (Princeton, NJ: Princeton University Press, 1983) and The Mad among Us: A History of the Care of America’s Mentally Ill (New York: Free Press, 1994); Nancy Tomes, A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum Keeping, 1840–1883 (Cambridge: Cambridge University Press, 1984). 27 McGill University, Calendar of the Faculty of Medicine, 45, 57. 28 Ibid., 68; Sir William Osler, The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (New York: D. Appleton and Co., 1898), 1111. 29 Veith, Hysteria, 213–15. 30 S. Weir Mitchell, Fat and Blood and How to Make Them (Philadelphia: J.B. Lippincott, 1877), 7–8. See also S. Weir Mitchell, “The Treatment by Rest, Seclusion, etc. in Relation to Psychotherapy,” Journal of the American Medical Association 50, no. 25 (20 June 1908): 2035, and Wear and Tear or Hints for the Overworked (Philadelphia: J.B. Lippincott and Co., 1871), 10–22. 31 Mitchell, Fat and Blood and How to Make Them, 42–50. See also Nancy Cervetti, “S. Weir Mitchell Representing ‘a hell of pain’: From Civil War to Rest Cure,” Arizona Quarterly 59, no. 3 (Autumn 2003): 76–80. 32 Shorter, From Paralysis to Fatigue, 142–3; J. Dejerine and E. Gauckler, Les manifestations fonctionnelles des psychonevroses: Leur traitement par la psychotherapie (Paris: Libraires de l’académie de medicine, 1911). 33 Shorter, From Paralysis to Fatigue, 247–9; Paul Charles Dubois, The Psychic Treatment of Nervous Disorders, 7th ed. (New York: Funk and Wagnalls Co., 1909), 103–19. 34 Dubois, The Psychic Treatment of Nervous Disorders, 233–4. 35 Dejerine and Gauckler, The Psychoneuroses and Their Treatment by Psychotherapy, 277 (translation of Les manifestations fonctionnelles des psychonevroses). 36 Baron D.J. Larrey, Surgical Essays (Baltimore: N.G. Maxwell, 1826), 153–206. For surgical essays on the civilian history of nostalgia see Judith Broome, Fictive Domains: Body, Landscape, and Nostalgia, 1717–1770 (Cranbury, NJ: Associated University Press, 2007). For the military context



Notes to pages 20–3 353

see George Rosen, “Nostalgia: A ‘Forgotten’ Psychological Disorder,” Psychological Medicine 5 (1975): 346–51. 37 Larrey, Surgical Essays, 155. 38 Ibid., 155. 39 Matthew Thomson, “Neurasthenia in Britain: An Overview,” in Marijke Gijswijt-Hofstra and Roy Porter, eds., Cultures of Neurasthenia: From Beard to the First World War (Amsterdam: Editions Rodopi B.V., 2001), 79. 40 Ilza Veith, Hysteria: The History of a Disease (Chicago: University of Chicago Press, 1965), 213–15. 41 This quote is taken from a fictional story by Mitchell written from the perspective of one of his patients, but it clearly drew upon his own wartime observations at Turner’s Lane. S. Weir Mitchell, The Autobiography of a Quack and the Case of George Dedlow (Toronto: Copp, Clark Co., 1900), 135–6. See also Joanna Bourke, “Silas Wier Mitchell’s The Case of George Dedlow,” The Lancet 373, no. 9672 (18 April 2009): 1332–3 and Robert I. Goler, “Loss and the Persistence of Memory: ‘The Case of George Dedlow’ and Disabled Civil War Veterans,” Literature and Medicine 23, no. 1 (2004): 160–83. 42 S. Weir Mitchell, “The Treatment by Rest, Seclusion, etc. in Relation to Psychotherapy,” Journal of the American Medical Association 50, no. 25 (20 June 1908): 2035; see also Mitchell, Wear and Tear or Hints for the Overworked (Philadelphia: J.B. Lippincott and Co., 1871), 10–22. 43 Eric T. Dean, Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War (Cambridge, MA: Harvard University Press, 1997), 128–31. 44 S. Weir Mitchell, Fat and Blood and How to Make Them (Philadelphia: J.B. Lippincott, 1877), 7–8. 45 William W. Keen, S. Weir Mitchell, and George R. Morehouse, “On Malingering, especially in regard to Simulation of Diseases of the Nervous System,” American Journal of the Medical Sciences 48 (1864): 367–8. 46 Ibid., 371. 47 A set of case histories for each is presented ibid., 372–94. 48 Ibid., 368. 49 Thomson, “Neurasthenia in Britain,” 86. 50 Edgar Jones and Simon Wessely, “Origins of British Military Psychiatry before the First World War,” War and Society 19, no. 2 (October 2001): 93. 51 Ibid., 95. 52 Ibid. 53 J.D. Howell, “‘Soldier’s Heart’: The Redefinition of Heart Disease and Speciality Formation in Early Twentieth-Century Great Britain,” Medical History Supplement 5 (1985): 35–6.

354

Notes to pages 23–5

54 Theodore Barringer, “Disordered Action of the Heart in British Soldiers,” Journal of the American Medical Association 69, no. 20 (17 November 1917): 1726. 55 Ewald Stier, “Mental Disease in Armies,” The Lancet, 160, no. 4118 (2 August 1902): 306–7. 56 Surgeon General W.D. Wilson, Report on the Medical Arrangement in the South African War (London: HMSO, 1904), 73. 57 Howell, “Soldier’s Heart,” 34–7. 58 Great Britain, War Office, Royal Army Medical Corps Training, 1911, reprinted 1915 (London: HMSO, 1915), 100. 59 William Johnston, Roll of Commissioned Officers in the Medical Service of the British Army (Aberdeen: University Press, 1917), 548–79. 60 J.C. de Villiers, Healers, Helpers and Hospitals: A History of Military Medicine in the Anglo-Boer War, vol. 2 (Pretoria: Protea Book House, 2008), 176–7. 61 Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge, MA: Harvard University Press, 2001), 23. 62 Ibid. 63 Mark Micale, Hysterical Men: The Hidden History of Male Nervous Illness (Cambridge, MA: Harvard University Press, 2008), 278–81. 64 Ibid. See also Mark Osborne Humphries, “War’s Long Shadow: Masculin­ ity, Medicine and the Gendered Politics of Trauma, 1914–1939,” Canadian Historical Review 91, no. 3 (September 2010): 503–31. 65 de Villiers, Healers, Helpers and Hospitals, vol. 2 , 176–7; J.W. Washbourn and H.D. Rolleston, “Pretoria Yeomanry Hospital: Medical Report,” in Countess Howe, ed., The Imperial Yeomanry Hospitals in South Africa, 1900–1902, Volume III: Medical and Surgical Reports (London: Arthur L. Humphreys, 1902), 207. 66 The Royal College of Surgeons of England, “Bowlby, Sir Anthony Alfred,” Plarr’s Lives of the Fellows Online, http://livesonline.rcseng.ac.uk/ biogs/E000224b.htm; Professional Staff, A Civilian War Hospital (London: John Murray, 1901), 128. 67 Professional Staff, A Civilian War Hospital, 129. 68 Ibid. 69 Washbourn and Rolleston, “Pretoria Yeomanry Hospital: Medical Report,” 207. 70 Ibid. 71 Professional Staff, A Civilian War Hospital, 128. 72 Ibid., 131. 73 Washbourn and Rolleston, “Pretoria Yeomanry Hospital: Medical Report,” 207.



Notes to pages 26–9 355

74 Morgan L. Finucane, “General Nervous Shock Immediate and Remote after Gunshot and Shell Injuries in the South African Campaign,” The Lancet 156, no. 4020 (15 September 1900): 808. 75 Professional Staff, A Civilian War Hospital, 129. 76 Ibid., 133. 77 Ibid., 134. 78 Finucane, “General Nervous Shock,” 808. On Finucane’s medical career see obituary in Westminster and Pimlico News, 8 June 1934, accessed at http:// 8brothers.typepad.com/8_keeling_brothers/files/FinucaneDiary.html. 79 Washbourn and Rolleston, “Pretoria Yeomanry Hospital: Medical Report,” 207. 80 Royal College of Surgeons of England, “Bowlby, Sir Anthony Alfred.” 81 Wilson, Report on the Medical Arrangement in the South African War, 112. 82 Professional Staff, A Civilian War Hospital, 133. 83 Finucane, “General Nervous Shock,” 809. 84 War Office, Manual for the Royal Army Medical Corps (London: HMSO, 1904), 49. 85 Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York: The Free Press, 1992), 245–53. 86 Washbourn and Rolleston, “Pretoria Yeomanry Hospital: Medical Report,” 208. 87 Professional Staff, A Civilian War Hospital, 128. 88 Wilson, Report on the Medical Arrangement in the South African War, 112. 89 Professional Staff, A Civilian War Hospital, 131. 90 Wilson, Report on the Medical Arrangement in the South African War, 112. 91 Washbourn and Rolleston, “Pretoria Yeomanry Hospital: Medical Report,” 208. 92 Professional Staff, A Civilian War Hospital, 132–3. 93 Finucane, “General Nervous Shock,” 809. 94 Ibid., 809. 95 Ibid., 808–9. 96 Ibid., 808. 97 Mitchell, Casualties and Medical Statistics, 273. 98 Bowlby suggests that he never saw a case of true rheumatic fever in South Africa but many of rheumatism, and this is corroborated in Edgar Jones and Simon Wessely, “Psychiatric Battle Casualties: An Intra- and Interwar Comparison,” British Journal of Psychiatry 178 (2001): 242. For Bowlby’s view see The Professional Staff, A Civilian War Hospital: Being an Account of the Work of the Portland Hospital, and of Experience of Wounds and Sickness in South Africa, 1900 (London: John Murray, 1901), 127.

356

Notes to pages 30–3

99 Mitchell, Casualties and Medical Statistics, 273. 100 Major T.J. Mitchell, History of the Great War Based on Official Documents: Medical Services, Casualties and Medical Statistics (London: HMSO, 1931), 270–3. 101 Andrew Macphail, History of the Canadian Forces, 1914–19: Medical Services (Ottawa: Department of National Defence, 1925), 4–5. 102 Ross Mitchell, “North-West Rebellion of 1885,” Canadian Medical Association Journal 60, no. 5 (May 1949): 518–21. 103 Alexander Campbell, “An Account of the Advances of the 7th Fusiliers of London to aid in the suppression of the North West Rebellion of 1885,” University of Saskatchewan, University Archives and Special Collections, MSS 49 #17, pp. 32–4. 104 James Kerr, “Report of Surgeon-Major James Kerr, Winnipeg Field Hospital,” 16 April 1886, in Various, The Medical and Surgical History of the Canadian North-West Rebellion of 1885 (Montreal: John Lovell and Son, 1886), 21–2. 105 Commander Z.T. Wood to A.B. Perry, 28 March 1899, File for Regimental no. 2373, Volume 10,043, RG 18, LAC; Diary of Edward Lester, 27 March 1899, repr. in Brereton Greenhous, Guarding the Goldfields: The Story of the Yukon Field Force (Toronto: Dundurn Press, 1987), 200–3. 106 G.F. Jarvis, Secretary of the Militia Council, Decision of 14 November 1906, RG 24, Volume 6307, file HQ 60–4-5, LAC. 107 R.H. Brade, War Office, to Ottawa, 28 June 1904, ibid. 108 Loyne Drum, “History of the CAMC, 1885–1923,” RG 24, Volume 1836, File GAQ 9–28M, LAC. 109 Colonel A.G. Butler, The Australian Army Medical Services in the War of 1914–1918, vol. 1, 2nd ed. (Sydney: Halstead Press, 1938), 3–4. 110 Carmen Miller, Painting the Map Red: Canada and the South African War, 1899–1902 (Montreal-Kingston: McGill-Queen’s University Press, 1993), 397–407. 111 Butler, The Australian Army Medical Services, 1: 8. 112 Macphail, History of the Canadian Forces, 1914–19, 5. 113 Drum, “History of the CAMC, 1885–1923.” 114 Robert Richards, “Mental and Nervous Diseases in the Russo-Japanese War,” Military Surgery 26, February (1910): 188. 115 Ibid., 189–93. 116 Ibid., 188. 117 Ibid. 118 A.G. Kay, “Insanity in the Army during Peace and War and Its Treatment,” Journal of the Royal Army Medical Corps 18, February (1912): 146–58, esp. 153.



Notes to pages 35–8 357 2  Purely Shattered Nerves

1 Army Form I 1237: Medical Case Sheet, entry for 5 October 1914, number 93786, MH 106/2101, NA. 2 Maj. Gen. Sir W.G. Macpherson, History of the Great War Based on Official Documents, Medical Services: General History, Vol. I (London: Macmillan, 1922), 1, 58–62. 3 Ibid., 60; Royal College of Surgeons of England, “Keogh, Sir Alfred Henry,” Plarr’s Lives of the Fellows Online, http://livesonline.rcseng. ac.uk/biogs/E004318b.htm. 4 Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford: Oxford University Press, 2010), 34–6; Francis Howard, “Report of Commission on Medical Establishments,” 109, Copies of the records of the Commission on (Army) Medical Establishments in France, RAMC 1165/1, Archives of the Wellcome Institute (AWI). 5 For specific examples see Howard, “Report of Commission on Medical Establishments,” 110–11. 6 Maj. Gen. Sir W.G. Macpherson, History of the Great War Based on Official Documents, Medical Services: General History, Vol. II (London: Macmillan, 1923), 15. 7 War Office, Royal Army Medical Corps Training, 1911 (London: HMSO, 1911), 108. 8 Ibid., 100–8, quote at 108. 9 Sir Andrew Macphail, Official History of the Canadian Forces in the Great War, 1914–19: The Medical Services (Ottawa: National Defence/F.A. Acland, 1925), 130. See also interview, Dr Maberly Squire Esler, RAMC, 1974, Acc. 378, IWM [Imperial War Museum]. 10 Lieutenant Colonel C.V. Single, “Regimental Medical Work,” Oct. 4th, LHF Ambulance, (c. 1918), AWM 25 481/150, AWM [Australian War Memorial]. 11 Leese, Shell Shock, 34–5. 12 Macphail, Medical Services, 68. 13 In 1914, British infantry brigades were composed of four battalions, but dwindling manpower and tactical changes meant that by 1918 each brigade possessed only three battalions. 14 War Office, RAMC Training, 103. 15 Ibid., 103, 108–16. 16 War Office, RAMC Regulations, 100, 125ff. 17 Sir Anthony Bowlby, “The Work of the ‘Clearing Hospitals’ during the Past Six Weeks,” British Medical Journal 2, no. 2816 (19 December 1914): 1053.

358

Notes to pages 38–41

18 Richard Havelock, “The War: The Management of the British Wounded in France,” British Medical Journal 2, no. 2817 (14 November 1914): 847. 19 Macpherson, Medical Services: General History, vol. 2, 51–2 and map between 76 and 77. In practice there was little difference between general and stationary hospitals, other than their patient capacity. 20 See, for example, the detailed list of hospitals printed on Army Form I 1237: Medical Case Sheet, entry for 14 April 1915, number 93926, MH 106/2101, NA. 21 Macpherson, Medical Services: General History, vol. 2, 84. 22 Special Correspondent in Northern France, “The War: Medical Arrangements of the British Expeditionary Force,” British Medical Journal 2, 2810 (7 November 1914): 805. 23 Army Form I 1237: Medical Case Sheet, number 93780, MH 106/2101, NA. 24 Army Form I 1237: Medical Case Sheet, number 93779, MH 106/2101, NA. 25 Ibid. 26 Army Form I 1237: Medical Case Sheet, number 93778, MH 106/2101, NA. 27 William Johnson, “Neurasthenia and War Neuroses in France,” in W.G. Macpherson et al., eds., History of the Great War Based on Official Documents: Medical Services – Diseases of the War, Volume 2 (London: HMSO, 1923), 1. 28 T.J. Mitchell and G.M. Smith, History of the Great War Based on Official Documents: Medical Services, Casualties and Medical Statistics of the Great War (London: HMSO, 1931), 99–101. 29 A Correspondent, “Medical Aspects of Severe Trauma in War,” British Medical Journal 2, no. 2815 (12 December 1914): 1038–9. 30 “Report of the Medical Society of London: Discussion on Surgical Experiences of the Present War,” The Lancet, 21 November 1914: 1200. 31 Ibid.; a similar case is described in A Correspondent, “Medical Aspects of Severe Trauma in War,” British Medical Journal 2, no. 2815 (12 December 1914): 1039. 32 This is based on totals of 2414 admissions for nervous and mental diseases and 130,916 battle and non-battle hospital admissions to hospitals in France and Belgium from British troops (excluding India and the Dominions) in 1914. Mitchell, Casualties and Medical Statistics, 126, 130–2. 33 Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War (New York: Palgrave, 2002), 52. 34 Army Form I 1237: Medical Case Sheet, entry for 13 February 1915, number 93908, MH 106/2101, NA. 35 Army Form I 1237: Medical Case Sheet, entry for 19 March 1915, number 93859, MH 106/2101, NA.



Notes to pages 41–3 359

36 Army Form I 1237: Medical Case Sheet, entry for 7 March 1915, number 94084, MH 106/2101, NA. 37 Charles S. Myers, Shell Shock in France 1914–1918: Based on a War Diary (Cambridge: Cambridge University Press, 1940), 76–7; Thomas W. Salmon, The Care and Treatment of Mental Diseases and War Neuroses (“Shell Shock”) in the British Army (New York: War Work Committee of the National Committee for Mental Hygiene, 1917), 34. 38 Army Form I 1237: Medical Case Sheet, entry for 2 April 1915, number 93879, MH 106/2101, NA. 39 Myers, Shell Shock in France, 76. 40 “Obituary Aldren Turner,” British Medical Journal, 11 August 1945: 200; Aldren Turner, “Nervous and Mental Shock,” British Medical Journal, 10 June 1916: 830. 41 “Obituary Aldren Turner,” The Lancet, 18 August 1945: 222–3. 42 M.J. Eadie, “The Epileptology of William Aldren Turner,” Journal of Clinical Neurology 13, no. 1 (January 2006): 12–13. 43 Ibid., 10–12. 44 William Aldren Turner, Epilepsy: A Study of the Idiopathic Disease (London: Macmillan and Co, 1907), 10–11; Mervyn J. Eadie and Peter F. Bladin, A Disease Once Sacred: A History of the Medical Understanding of Epilepsy (Eastleigh: John Libbey and Co., 2001), 140–8. 45 Eadie, “The Epileptology of William Aldren Turner,”13. 46 Turner, “Nervous and Mental Shock,” 830. 47 Babington, Shell-Shock, 53; Aldren Turner, “Remarks on Cases of Nervous and Mental Shock Observed in the Base Hospitals in France,” British Medical Journal, 15 May 1915: 833. 48 Turner, “Remarks on Cases of Nervous and Mental Shock,” 833. 49 William Aldren Turner, “Arrangement for the Case of Cases of Nervous and Mental Shock Coming from Overseas,” Journal of the Royal Army Medical Corps 27, no. 5 (1916): 619–20; on the War Office’s early concerns about pensioning see Leese, Shell Shock, 127–9. 50 Johnson, “Neurasthenia and War Neuroses,” 46; Myers, Shell Shock in France, 14–15. 51 Charles Samuel Myers, A Textbook of Experimental Psychology, 2nd ed. (Cambridge: Cambridge University Press, 1911); C.S. Myers, “Charles Samuel Myers,” in Carl Murchison, A History of Psychology in Autobiography, vol. 3 (Massachusetts: Clark University Press, 1936), 217–22. 52 Myers, “Charles Samuel Myers,” 223. 53 Myers, Shell Shock in France, 16.

360

Notes to pages 44–8

54 Myers, Shell Shock in France, 13–17, 53–5, quoted at 54; C.S. Myers, “A Contribution to the Study of Shell Shock: Being an Account of Three Cases of Loss of Memory, Vision, Smell and Taste, Admitted into the Duchess of Westminster’s War Hospital, Le Touquet,” The Lancet, February 1915: 320. 55 See various case sheets for general and stationary hospitals in France from 1915 in MH 106/2102, NA. 56 Medical Case Sheet, unnumbered (11 General Hospital, Boulogne, 12 August 1915), MH 106/2102, NA. 57 Macpherson, Medical Services: General History, vol. 2, 88. 58 Ibid., 84. 59 WD, DMS, III Corps, 8 December 1914, WO 95/695, NA. 60 Ibid.; WD, DMS, Second Army, 1 January 1915, WO 95/285, NA. 61 Assistant Director of Medical Services (ADMS), 1st Canadian Division, “1st Divisional Rest Station,” undated 1915, RG 9, Series III-D-3, Volume 5024, File 814, Part 1, LAC. 62 Ibid. 63 For more on the routine and methods of treatment within a rest station see chapter 4. They are summarized in Major-General Sir Wilmot Herringham, A Physician in France (New York: Longmans, Green and Co., 1919), 62–5. 64 Ibid.; WD, DMS, First Army, 4 January 1915, WO 95/192, NA. 65 Instructions for Prevention of Wastage from Sickness due to Trivial and Convalescents, WO 95/192, NA. 66 No. 14 Field Ambulance, Admission/Discharge Books, MH 106/6 and 7, NA. 67 WD, DMS, First Army, 14 January, WO 95/192, NA; on “stopping” see W.G. Macpherson to O’Donnell, January 1915, WO 95/192, NA. 68 No. 14 Field Ambulance, Admission/Discharge Books, MH 106/1, 2, 3, 4, 5, 6, 7, and 8 NA. 69 Mitchell, Casualties and Medical Statistics, 130–1. 70 This figure includes only British troops and excludes Indian soldiers as was used as it is based on the same data as the number compiled for specific diseases and injuries. Mitchell, Casualties and Medical Statistics, 126. 71 Ibid., 130–2. 3  Baptism of Fire 1 War Office Letter 24/Gen. No. 4234, 10 September 1915 and Army Council Instruction 831, 17 April 1916, WO 293/4, NA; Acting Deputy Minister, OMFC, to Secretary, War Office, 30 November 1917, WO 32/5139, NA.



Notes to pages 48–51 361

2 Macpherson, Medical Services: General History, vol. 2, 42. 3 George Adami, The War Story of the Canadian Army Medical Corps (Ottawa: Canadian War Records Office, 1918), 47–8. 4 General G.L. Foster to Kemp, Overseas Minister, 12 January 1918, MG30 E53, John Taylor Fotheringham Papers, Volume 4, Folder 22, LAC, 2, 4. 5 Great Britain, War Office, Royal Army Medical Corps Training, 1911, reprinted 1915 (London: HMSO, 1915), 100. 6 War Diary (WD), Assistant Director of Medical Services (ADMS), 1st Cana­ dian Division, 11 February 1915, RG 9, Series IIID3, Volume 5024, File 814, Part I, LAC. 7 WD, ADMS, 1st Canadian Division, 7 April 1915. 8 Ibid., 14 April 1915. 9 Ibid., 16 April 1915. 10 No. 1 Canadian Field Ambulance, “1st DRS,” undated 1915, RG 9, Series III, Volume 3752, File: 2–9-4–8, LAC, 3–4. 11 Mark Osborne Humphries and John Maker, eds., Germany’s Western Front: Translations from the German Official History of the First World War, Volume II: 1915 (Waterloo: Wilfrid Laurier University Press, 2010), 156–68. For a succinct history from the Canadian perspective see G.W.L. Nicholson, Canadian Expeditionary Force, 1914–1919 (Ottawa: Department of National Defence, 1964), 49–93; see also Andrew Iarocci, Shoestring Soldiers: First Canadian Division at War (Toronto: University of Toronto Press, 2008), 97–163; Cook, At the Sharp End, 109–60. 12 WD, No. 5 Mobile Laboratory, 22 April 1915, RG 9, Series III-D-3, Volume 5038, File: 871, Part I, LAC. 13 Humphries and Maker, Germany’s Western Front, 156–68. 14 WD, ADMS, 1st Canadian Division, 22 April 1915. 15 Tim Cook, No Place to Run: The Canadian Corps and Gas Warfare in the First World War (Vancouver: UBC Press, 1999), 33–5. 16 ADMS Report of Operations, April 22nd to May 4th at Ypres, RG 9, Series III-D-3, Volume 5024, File 814, Part 1, LAC, 1–2. 17 WD, DDMS V Corps, 23–4 April 1915, WO95/758, NA; WD, DMS Second Army, 22 April 1915, WO 95/285, NA. 18 For the field messages see the more reliable British logs in CAB 145/153, NA. Cook, At the Sharp End, 117–18. 19 Cook, At the Sharp End, 135. See also the diary of 2nd Battalion’s commanding officer, David Watson, 22–24 April 1915, Reel M-10, MG30 E69, LAC. See also G.S. Tuxford, “Narrative of Brigadier General G.S. Tuxford,” 10 March 1916, MG30 E239, LAC. 20 WD, DDMS V Corps, 23 April 1915, WO95/758, NA.

362

Notes to pages 51–4

21 Mary F. Gaudet, ed., From a Stretcher Handle: The World War I Journal and Poems of Pte. Frank Walker (Charlottetown: Institute of Island Studies, 2000), 67. 22 Boyd, With a Field Ambulance at Ypres, 25–6. See also ADMS Report of Operations, April 22nd to May 4th at Ypres, RG 9, Series III-D-3, Volume 5024, File 814, Part 1, LAC, 4. 23 OC No. 3 Company, 15th Battalion to 2nd Bde HQ, 4:00 am, 24 April 1915, CAB 45/153, NA. 24 2nd Bde, CFA to CDA, 4:05 and 4:20 am, 24 April 1915, CAB 45/153, NA. 25 13th Bde to 1st Canadian Division, HQ, 5:00 am, 24 April 1915, CAB 45/ 153, NA. 26 2nd Bde to 1st Canadian Division, HQ, 6:30 am, 24 April 1915, CAB 45/ 153, NA. 27 Cook, At the Sharp End, 150–9. 28 Tim Cook, “Anti-heroes of the Canadian Expeditionary Force,” Journal of the Canadian Historical Association 19, no. 2 (2008): 171–193; Cook, “‘More a Medicine than a Beverage’: ‘Demon Rum’ and the Canadian Trench Soldier of the First World War,” Canadian Military History 9, no. 1 (2000): 6–22; Cook, “The Politics of Surrender: Canadian Soldiers and the Killing of Prisoners in the Great War,” Journal of Military History, 70, no. 3 (July 2006): 637–65; Cook, “The Singing War: Canadian Soldiers’ Songs of the Great War,” American Review of Canadian Studies 39, no. 3 (Sept 2009): 224–41. 29 Herbert Laurier Irwin to Mother and Dad, 27 October 1916, Herbert Laurier Irwin Collection, CLIP, http://www.canadianletters.ca/content/ document-12871. 30 Harry Howland, “March with Me” (unpublished memoir), 1972, Harry Howland Papers, MG 30 E294, LAC. 31 J. Dave McEwen, to W.F. Kerr, 18 June 1915, Cobourg World Collection, CLIP, http://www.canadianletters.ca/content/document-3458. Many soldiers referenced smoking as a way to calm their nerves. See J.M.J. to Sister, 7 December 1916, John Merritt Johnson Fonds, MG30 E429, LAC. 32 Major H.H. Mathews, Memorandum on the 8th Battalion Experience at Second Battle of Ypres, 9, CAB 45/156, NA. 33 WD, No. 5 Mobile Laboratory, 22 April 1915, RG 9, Series III-D-3, Volume 5038, File: 871, Part I, LAC. 34 WD, DMS, GHQ, 4 June 1916, WO 95/44, NA. 35 Ibid. 36 Confidential report by Capt. G.W. Northwood, 8th Battalion, CAB 45/153, NA.



Notes to pages 55–7 363

37 Medical Case Sheet 94013, Northumberland War Hospital, MH 106/2101, NA. 38 Ibid. 39 Iarocci, Shoestring Soldiers, 183. 40 Medical Case Sheet, D Block Netley, 19 May 1915, RG 150, Accession 1992–93/166, Box 2021, File 18, LAC. 41 Ibid. 42 Cook, No Place to Run, quoted on 33; see also 219–20. 43 Quoted in Iarocci, Shoestring Soldiers, 184. Creelman chronicles his breakdown and treatment in a diary from the spring and early summer of 1915; see Diary, J.J. Creelman Fonds, Volume 1, MG30 E8, LAC. 44 Sir Richard Turner to Hetty, 3 May 1915, Sir Richard Turner Papers, CWM No. 19710147–001, Archives of the Canadian War Museum (ACWM). See also Mark Humphries and Lyndsay Rosenthal, “Sir Richard Turner and the Second Battle of Ypres, April and May 1915,” Canadian Military History 24, 1–2 (2015): 1–33. 45 Cook, At the Sharp End, 151–2. 46 Turner to Hetty, 3 May 1915, CWM No. 19710147–001, ACWM. 47 Attestation Paper, Pte. Cyril D.F., RG 150, Accession 1992–93/166, Box 3277–23, LAC. 48 Case Notes Cyril F., 7th Battalion, 11 February 1916, P98 Colin Kerr Russel Fonds, Box 89, File: Neurological, Psychiatric and Psychological Exam Forms, Archives of the Osler Library, McGill University. 49 For other examples see Iarocci, Shoestring Soldiers, 184. 50 Particulars of Disability, Cpl. Thomas F., Veterans Affairs Canada (VAC), VF File 649-F-596, Microfilm 832–5, VAC Repository (VACR), Charlottetown, PEI. 51 Medical Report on an Invalid, Thomas F., 28 October 1915, RG 150, Accession 1992–93/166, Volume 3304, File 43, LAC. 52 DG 123/3/15, First Army Memorandum, 7 April 1915, WO 95/44, NA. 53 Ibid. 54 Adami, War Story of the CAMC, 175–6. 55 DG 627/2, Slogget to Macpherson, 25 April 1915, WO95/44, NA; see also C.S. Nichol, DDMS V Corps, “Report on the Medical Arrangement During the Operations Around Ypres, 22nd April to 13th May, 1915,” 20 May 1915, WO 95/758, NA, 3. 56 Adami, War Story of the CAMC, 176. 57 Cook, No Place to Run, 32–3. 58 Colonel A.F. Duguid to General J.E. Edmonds, 18 May 1925 and attached table: Casualties – 1st Canadian Division, April 1915, CAB 45/155, NA.

364

Notes to pages 57–63

59 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria,” RG 24, Volume 1844, File GAQ 11–11E, LAC. 60 Cook, No Place to Run, 32–3; Iarocci, Shoestring Soldiers, 183–5, 274. 61 Charles S. Myers, Shell Shock in France, 1914–18: Based on a War Diary (Cambridge: Cambridge University Press, 1940), 11–14. 62 Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge, MA: Harvard University Press, 2001), 28–9. 63 WD, DGMS, 4 February 1915, WO 95/44, NA. 64 A&D Books of No. 14 Field Ambulance, August 1914 to April 1915, MH 106/1–13, NA. 65 Compiled from No. 1 Field Ambulance, see Books 1–6b, RG 150, Volume 652, LAC; for No. 2 Field Ambulance, see Books 36–9, RG 150, Volume 512, LAC; for No. 3 Field Ambulance, see books 73–5, RG 150, Volume 514, LAC. 66 Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War (London: Palgrave, 2002), 58–60. 67 Alberta was chosen as a case study because the electronic databases Peel’s Prairie Provinces and Our Future, Our Past contain several dozen news­ papers from major cities, small towns, and unincorperated areas, providing a broad cross-section of coverage. While the content of the papers would have been similar to that of other provinces, the archival resources for Alberta are uniquely deep. See http://peel.library.ualberta.ca/index.html and http://www.ourfutureourpast.ca/newspapr/. 68 “Struck Deaf and Dumb by Explosion of Shells,” Globe and Mail, 19 December 1914, 12. 69 “French Stand War Well,” Crossfield Chronicle, 26 February 1915, 4. 70 Calgary Eye-Opener, 20 March 1915, 1. 71 “Second Courage Comes to Soldiers,” Red Deer News, 5 May 1915, 5. 72 See “Canada’s Roll of Honour,” Edmonton Bulletin, 26 April 1915, 7 and 27 April 1915, 7. 73 The earliest example found is that of Captain Fred Bayliss, who was recorded as “suffering from slight concussion” on 18 May 1915. Ibid., 19 May 1915, 5 and 27 May 1915, 6. 74 Ibid., 31 May 1915, 8. His name is printed here as it was recorded in the newspapers of the time and thus became public record. 75 Ibid., 2 June 1915, 9 and 7 June 1915, 9. 76 Personnel file of Walter James Howe, RG 150, Accession 1992–93/166, Box 4553, File 6, LAC. 77 Sir William Osler, Science and War (Oxford: Clarendon Press, 1915), 19.



Notes to pages 64–9 365

78 Campbell Meyers, “The Canadian Soldiers and Shell Shock,” RG 24, Volume 4268, File MD2–15–2-35, LAC. 79 These were the first months for which accurate statistics were kept. 80 “Monthly Strength of Infantry, 1st and 2nd Canadian Divisions,” RG 24, Volume 1874, File 22(8): Wastage Returns, LAC. 81 See Tim Cook, “Fighting Words: Canadian Soldiers’ Slang and Swearing in the Great War,” War in History 20 (July 2013): 323–44; Cook, “Anti-heroes of the Canadian Expeditionary Force,” 171–93; Cook, “More a Medicine than a Beverage,” 6–22; Cook, “The Borders between Life and Death: Stories of the Supernatural and Uncanny among Canada’s Great War Soldiers,” Keynote address, Congress 2014, 26 May 2014, http://congress2015.ca/ program/video/3387. 82 Interview transcript, Wallace Carroll, RG 41, Volume 9, File: 15th Battalion, Tape 1, page 13, LAC 83 Interview transcript, W.E. Turner, RG 41, Volume 11, File: 27th Battalion, Tape 1, page 2, LAC. 84 Interview with G.U. Francoeur, RG 41, Volume 11, File: 22nd Battalion, Tape 1, pages 5–6, LAC. 85 Diary of Private Donald Fraser, 30 December 1915, MG30 E470, LAC. 86 Transcript of interview with Edward Loucks by Frank Lalor, 13 March 1964, RG 41, Volume 12, File: 31st Battalion, LAC, Tape 1, pages 8–9. 87 For another description from St. Eloi see Archie MacKinnon to Sister, 13 May 1916, MG30 E547, LAC. 88 Diary of Private Donald Fraser, 11 January 1916, MG30 E470, LAC. 89 Ibid., 11 January and 14 March 1916, MG30 E470, LAC. 90 This comes through clearly in oral histories. See various interviews with British soldiers including Interview, John M. Cordy, 23 October 1980, 56th Field Coy, RE Acc. 32896, IWM; Interview, Pte. H.D. Jackson, 75th Field Ambulance, RAMC, 19 June 1975, Acc. 24858, IWM; Interview, Pte. Gerald Dennis (10th Bn, East Yorkshire Regt.) and Cpl. Walter Aust (21st Bn, King’s Royal Rifle Corps by Dennis Gerald, 1981, IWM 8189; Interview, Fred Baldwin by Keith Chambers, Stretcher-Bearer, 100th Field Ambulance, RAMC, 15 May 1975, IWM 24884. 91 WD, No. 3 Field Ambulance, 1 July 1916, RG 9, Series III-D-3, Volume 5027, File 824, LAC; another physical description is provided in Major-General Sir Wilmot Herringham, A Physician in France (New York: Longmans, Green and Co., 1919), 64. 92 WD, DMS, Second Army, 20 June 1915, WO 95/285, NA. 93 Herringham, A Physician in France, 62–5.

366

Notes to pages 69–73

94 Bernard Trotter to Family, 14 March 1917, Bernard Trotter Collection, CLIP, http://www.canadianletters.ca/content/document-2630. 95 Diary of D.E. Macintyre, 28 April 1916, MG30 E241, LAC. 96 John William Law to Mother and Father, 18 February 1916, John William Law Collection, CLIP, http://www.canadianletters.ca/content/ document-49177. 97 “Our Work,” The Splint Record (Newspaper of No. 2 Field Ambulance, CEF), January 1916, 1, RG 9, Series III-D-4, Volume 5080, LAC. 98 Ian R. Whitehead, Doctors in the Great War (London: Leo Cooper, 1999) 233. 99 No. 1 Field Ambulance, Books 1–6b, RG 150, Volume 652, LAC; No. 2 Field Ambulance, Books 36–9, RG 150, Volume 512, LAC; No. 3 Field Ambulance, Books 73–5, RG 150, Volume 514, LAC. 100 WD, DMS, Second Army, 19 June 1915, WO 95/284, NA. 101 Ibid., 20 June 1915, WO 95/284, NA. 102 John McCombie, Medical Service at the Front (New York: Lea and Febiger, 1918), 66–7. 103 DMS First Army to DDMS Corps, First Army, 9 June 1915, WO 95/194, NA. 104 WD, Medical Officer, 31st Battalion, 12 October 1915, RG 9, Series III D 3, Volume 5039, file 872. 105 Ibid. 106 George Swindell, unpublished memoir, George Swindell Papers, RAMC 421/4, AWI, page 120. 107 Excerpt from Major Strathy’s Personal Diary, RG 9, Series III-B-2, Volume 3752, File 3–2-11, LAC. 108 Army Form I. 1237, Medical Case Sheet, Pte. Alphonse H., RG 150, Accession 1992–93/166, Box 4236, File 4, LAC. 109 Ibid. 110 Ibid. 111 Casualty Form, Active Service, RG 150, Accession 1992–93/166, Box 4236, File 4, LAC. 112 “Major-General John Taylor Fotheringham,” Canadian Medical Association Journal 43, no. 1 (July 1940): 87–8. 113 Diary of Lieutenant Colonel John T. Fotheringham, 16 February 1916, MG30 E53, Volume 4, File 21, LAC. 114 John Law to Mother and Father, 12 December 1915, John William Law Collection, CLIP, http://www.canadianletters.ca/content/document49169.



Notes to pages 74–80 367

115 There is inconsistency as to the reason for his admittance. One document suggests that he was “N[ot] Y[et] D[iagnosed] Sick” and another that he had a scald on his face, although the latter appears to have been backdated. See Casualty Form, Active Service, Entry for 12 February 1916, RG 150, Accession 1992–93/166, Volume 5452, file 48, LAC. 116 John William Law to Mother and Father, 18 February 1916, John William Law Collection, CLIP. 117 Frank Maheux to Angelique, no day February 1916, Frank Maheux Papers, MG30 E297, LAC. 118 Frank Maheux to Angelique, 24 April 1916, ibid. 119 Frank Maheux to Angelique, 29 April 1916, ibid. 120 Frank Maheux to Angelique, 7 May 1916, ibid. 121 Frank Maheux to Angelique, 5 June 1916, ibid. 122 Compiled from No. 1 Field Ambulance, see Books 1–6b, RG 150, Volume 652, LAC; for No. 2 Field Ambulance, see Books 36–9, RG 150, Volume 512, LAC; for No. 3 Field Ambulance, see Books 73–5, RG 150, Volume 514, LAC. 123 Compiled from No. 4 Field Ambulance, A&D Books 100, 101, 102, 103, 103A, RG 150, Volume 516, LAC; No. 5 Field Ambulance, A&D Books 135A, 135B, 135C, RG 150, Volume 518, LAC. 124 Ibid. 125 Ibid. 126 Only one 1st Canadian Division A&D book has survived from a field ambulance operating a rest station from the first three months of 1916, but it was the officers’ hospital at Meterin. Only one patient was admitted with shell shock during that period. See No. 2 Field Ambulance A&D Book 41, RG 150, Volume 513, LAC. 127 No. 1 Field Ambulance, Books 1–6b, RG 150, Volume 652, LAC; No. 2 Field Ambulance, Books 36–9, RG 150, Volume 512, LAC; No. 3 Field Ambulance, Books 73–5, RG 150, volume 514, LAC. 128 See WD, DMS, V Corps, 11 April 1915, WO 95/758, NA. 129 WD, ADMS, 1st Canadian Division, 4 August 1915, RG 9, Series III-D-3, Volume 5024, File 814, Part 1, LAC. 130 Ibid. 131 WD, DMS, First Army, Appendix 43, WO 95/194, NA. 132 Mary Gaudet, ed., From a Strecher Handle: The World War I Journal and Poems of Pte. Frank Walker (Charlottetown: Institute of Island Studies, 2000), 63. 133 Diary of D.E. Macintyre, 26 April 1916, MG30 E241, LAC.

368

Notes to pages 80–3

134 WD, DMS, Second Army, May and 15 June 1915, WO 95/285, NA. 135 Personal Diary of Major G.M. Davis, 5th Battalion Medical Officer, 12–13 October 1915, MG30 E11, LAC. 136 WD, ADMS, 1st Canadian Division, 6 March 1915, RG 9, Series III-D-3, Volume 5024, File 814, Part 1, LAC. 137 Casualty Form, Active Service, and Attestation Paper, Pte. William George B., RG 150, Accession 1992–93/166, Box 331, File 50, LAC; WD, 15th Battalion, 26 September–1 October 1915, RG 9, Series III-D-3, Volume 4924, File 390, Part I, LAC. 138 Casualty Form, Active Service and Attestation Paper, RG 150, Accession 1992–93/166, Box 3909, File 45, LAC. 139 Ibid.; WD, 2nd Battalion, 5–6 December 1915 and Appendix A: List of Casualties, RG9, Series III-D-3, Volume 4913, File 353, LAC; No. 3 Field Ambulance, A&D Book 6, RG 150, Volume 652, LAC; No. 2 Field Ambulance, A&D Book 36, RG 150, Volume 512, LAC. 140 Frederick W. Noyes, Stretcher-Bearers – at the Double!: History of the Fifth Canadian Field Ambulance Which Served Overseas during the Great War of 1914–1918 (Toronto: Hunter Rose Company, 1937), 69–70; see also Harold W. McGill and Marjorie Barron Norris, Medicine and Duty: The World War I Memoir of Captain Harold W. McGill (Calgary: University of Calgary Press, 2007), 123. 141 WD, ADMS 2nd Canadian Division, 21 September 1915, RG 9, Series III-D-3, Volume 5024, File 814, Part I, LAC. 142 2nd Division to I Corps, 29 March 1915, WO 95/621, NA. 143 Major-General Sir Wilmot Herringham, A Physician in France (New York: Longmans, Green and Co., 1919), 62–5, quoted from 65. 144 Casualty Form, Active Service, Pte. William George B., RG 150, Accession 1992–93/166, Box 331, File 50, LAC. 145 Casualty Form, Active Service, Pte. James H., RG 150, Accession 1992– 93/166, Box 3909, File 45, LAC. 146 WD, ADMS, 1st Canadian Division, 4 July 1915, RG 9, Series III-D-3, Volume 5024, File 814, Part 1, LAC. 147 WD, ADMS, 1st Canadian Division, 7 August 1915. 148 WD, ADMS, 1st Canadian Division, 25 July 1915. 149 No. 1 Field Ambulance, Books 1–6b, RG 150, Volume 652, LAC; No. 2 Field Ambulance, Books 36–9, RG 150, Volume 512, LAC; No. 3 Field Ambulance, Books 73–5, RG 150, Volume 514, LAC. 150 Memorandum on Convalescent Companies, DMS, First Army, to DDMSs, Corps, 1 May 1915, WO 95/194, NA. 151 WD, DMS, First Army, 4 May 1915, WO 95/194, NA.



Notes to pages 83–90 369

152 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria,” RG 24, Volume 1844, File GAQ 11–11E, LAC. 153 Of the admissions recorded in the books of Nos. 1, 2, and 3 Field Am­ bulances for 1915, only twelve (3.7 per cent) were from the engineers or artillery, the remainder being from the infantry. 154 WD, DDGMS, GHQ, Report for January 1915, WO 95/50, NA. 155 First Army, DMS No. 1257, 14 February 1916, WO 95/194, NA. 156 WD, DGMS, 4 February 1915, WO 95/44, NA. 157 Balmfield to SMO, Base, Boulogne, 19 May 1915, WO 94/194, NA. 158  DDMS/2101/15 RM Sawyer, DDMS, Boulogne to DMS, L of C, 19 May 1915, WO 94/194, NA. This exchange began as a racialized discussion of the Indian Army, which was treated differently on the Western Front than other front-line units. However, it soon broadened out into a more general discussion of evacuation, diagnosis, and shell shock in general. For a discussion of perceptions of the Indian Army see Gordon Corrigan, Sepoys in the Trenches: The Indian Corps on the Western Front, 1914–15 (London: Spellmount, 1999), 237ff. See also DMS, First Army to DGMS, GHQ, 23 May 1915, WO 95/194, NA. 4  The CEF’s Shell Shock Crisis 1 Personnel File, Private John C., RG 150, Accession 1992–93/166, Volume 1916, File 4, LAC; 18th Battalion, “Report of Operations,” April 1916, RG 9, Series III-D-3, Volume 4926, File 398, LAC; Nos. 10 and 17 Casualty Clearing Stations, A&D Books 968, 969, 970, 977, 987, 993, and 997, RG 150, Volumes 570–2, LAC. 2 Brigadier General Sir James Edmonds, History of the Great War Based on Official Documents: Military Operations, France and Belgium, 1916, vol. 1 (London: MacMillan, 1932), 155–7; G.W.L. Nicholson, Canadian Expeditionary Force, 125–36. 3 Edmonds, Military Operations, France and Belgium, 1916, 1, 155–7; Nicholson, Canadian Expeditionary Force, 125–36. 4 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria Admissions Correspond[ed] to Date of Admission by Months,” 16 Novem­ber 1939, RG 24, Volume 1844, File GAQ 11–11E, LAC. 5 A&D Books 75 and 76, No. 3 Canadian Field Ambulance, RG 150, Volume 514, LAC. 6 A&D Books 110a–e, No. 4 Canadian Field Ambulance, RG 150, Volume 516, LAC. 7 See DMS No. 82/1, 12 September 1915, WO 95/51, NA.

370

Notes to pages 90–3

8 It is important to note that this was not the only such German observation post, so capturing it was far from being a strategic necessity. Operations at St. Eloi, 26–9 March 1916 and V Corps, Operation Order 62, 18 March 1916, RG 9, Series III-D-3, Volume 5074, File 5, LAC. 9 General Haldane, “A Brief Account of the St. Eloi Operations,” 1946, WO 95/1377, NA. 10 General Haldane to GOC V Corps, 4 April 1916, ibid. 11 See trench map and aerial photographs from mid-March 1916 in WO 95/ 1426, NA. 12 The preparations are detailed in 9th Brigade’s war diary in the appendices to WO 95/1426, NA. 13 Second Army, Summary of Operations, 22–31 March 1916, WO 95/273, NA, 2–3. 14 WD, 1st Battalion, Northumberland Fusiliers, 27 March 1916, WO 95/1430, NA; GOC 9th Brigade, Operations at St. Eloi, 25th to 29th March 1916, WO 95/1426, NA. 15 Second Army, Summary of Operations, 22–31 March 1916, WO 95/273, NA, 2–3. 16 OC 4th Battalion, Royal Fusiliers to GOC 9th Infantry Brigade, 31 March 1916, WO 95/1431, NA. 17 WD, 4th Battalion, Royal Fusiliers, 28 March 1916 and Report on Operations, ibid. 18 Edmonds, Military Operations, France and Belgium, 1916, 1, 183; Summary of Reports on the Operations at St. Eloi, March 27th to April 18th, 1916, RG 9, Series III-D-3, Volume 5074, File 5, LAC. 19 General Haldane to V Corps, 17 April 1916, WO 95/1377, NA. 20 General Fanshawe (V Corps) to Second Army, RG 9, Series III-D-3, Volume 5074, File 6 – St. Eloi Operations, LAC. 21 Haldane to V Corps, 7 April 1916, RG 9, Series III-D-3, Volume 5074, File 6 – St. Eloi Operations, LAC. 22 Mark Osborne Humphries and John Maker, eds., Germany’s Western Front: Translations from the German Official History of the Great War, Volume II: 1915 (Waterloo: Wilfrid Laurier University Press, 2010), 35. 23 Haldane wrote to Edmond’s historical section in 1946, sending documents to help support his contention that he had been wrongfully dismissed. These were appended to the war diary file for April 1916 in WO 95/1377, NA. 24 Haldane to Fanshawe, 16 April 1916, RG 9, Series III-D-3, Volume 5074, File 8 – “Report on St Eloi, 3rd Division,” LAC, 2–3. 25 Haldane to V Corps, 14 April 1916, WO 95/1377, NA.



Notes to pages 93–7 371

26 Haldane, “A Brief Account of the St. Eloi Operations,” April 1916, WO 95/1377, NA. 27 Haldane to V Corps, 7 April 1916, RG 9, Series III-D-3, Volume 5074, File 6 – St. Eloi Operations, LAC. 28 WD, 4th Battalion, Royal Fusiliers, 28 March 1916 and Report on Operations, WO 95/1431, NA. 29 Haldane to V Corps, 7 April 1916, RG 9, Series III-D-3, Volume 5074, File 6 – St. Eloi Operations, LAC; on shell shocked officers see War Diary, 2/Suffolk Regiment, 30 March 1916, WO 95/1437, NA and Casualty List, 27 March 1916, War Diary, 1/Northumberland Fusiliers, WO 95/1430, NA. 30 76th Brigade Report on Operations at St. Eloi, 31st March to 4th April 1916, RG 9, Series III-D-3, Volume 5074, File 5, LAC, 3. 31 Second Army, “Summary of Operations, 1–7 April 1916,” WO 95/273, NA, 3. 32 Nicholson, Canadian Expeditionary Force, 125–8. 33 Ibid., 140. 34 Donald Fraser, The Journal of Private Fraser, 1914–1918: Canadian Expedition­ ary Force, ed. Reginald H. Roy (Victoria: Sono Nis Press, 1985), 112. 35 See Tim Cook, At the Sharp End: Canadians Fighting the Great War, 1914–1916, vol. 1 (Toronto: Viking Canada, 2007), 324–5; David Campbell, “The Divi­ sional Experience in the CEF: A Social and Operational History of the 2nd Canadian Division, 1915–1918,” unpublished PhD thesis (University of Calgary, 2003), 109–11. 36 Lieutenant Colonel C.A. Ker, “Narrative of Events up to the Occupation of the St. Eloi Position,” 12 April 1916, Papers of Sir Richard Turner, MG30 E46, Folder 9, LAC. 37 Colonel A.F. Duguid, “Bombardments, St. Eloi, 1916,” Notes for unfinished history of the CEF, RG 24, Volume 6992, File, “Volume II: Chapter X,” LAC. 38 Verbal statement by Lieutenant Colonel Snider, 10 April 1916, CAB 45/148, NA. See also the diary entries of W.H. Hewgill, the second in command of 31st Battalion, for 3–7 April 1916, MG30 E16, LAC. 39 WD, Medical Officer, 31st Battalion, 6 April 1916, RG 9, Series III-D-3, Volume 4937, File 429, LAC. 40 War Diary of Lieutenant Colonel Duncan Eberts Macintyre, 28th Battalion, 7 April 1916, MG30 E241, Volume 1, LAC, 146. 41 Transcript of interview with Alfred Tomkins, 13 March 1963, RG 41, Volume 13, File 28th Battalion, LAC, Tape 1, Pages 10–11. 42 Diary of Donald Fraser, retrospective entry dated 3 April 1916, MG30 E470, LAC.

372

Notes to pages 97–100

43 Transcript of interview with A. Findlater by Frank Lalor, c. 1963, RG 41, Volume 12, File 31st Battalion, Tape 1, Pages 11–12, LAC. 44 Captain A.P.O. Meredith, “Report of C Company, 27th Battalion,” 12 April 1916, RG 9, Series III-D-3, Volume 4935, File 422, LAC. 45 R.E.W. Turner, “Report on Operations of the 2nd Canadian Division, 3–7 April 1916,” CAB 45/148, NA. 46 Colonel A.F. Duguid, “Draft Manuscript: German Counter Attack,” RG 24, Volume 6992, File, “Volume II: Chapter X,” LAC. 47 The most detailed account of the actions at St. Éloi remains Tim Cook, “The Blind Leading the Blind: The Battle of the St. Eloi Craters,” Canadian Military History 5, no. 2 (1996): 1–20. See also Campbell, “The Divisional Experience in the CEF,” 141–4. 48 On the controversy see Cook, “The Blind Leading the Blind,” 32–4. For a more sympathetic view see William F. Stewart, The Embattled General: Sir Richard Turner and the First World War (Montreal, Kingston: McGill-Queen’s University Press, 2015), 72–113. 49 A&D Books 968, 969, 970, 977, 987, 993, and 997, compiled from entries for April 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC. 50 Lieutenant Colonel Snider, Summary of Operations, 27th Battalion, 12 April 1916, RG 9, Series III-D-3, Volume 4935, File 422, LAC. 51 The Battalion RMO reported the first cases of “shattered nerves” on 6 April. See WD, Medical Officer, 31st Battalion, 6 April 1916, RG 9, Series III-D-3, Volume 4937, File 429, LAC. 52 Colonel Snider, “Officers, NCOs and Men Worthy of Special Mention,” 30 May 1916, RG 9, Series III-D-1, Volume 4693, Folder 54, File 17, LAC. 53 Transcript of interview with Herbert Snape, 16 October 1964, RG 41, Volume 11, File 27th Battalion, LAC, Tape 1, Pages 12–13. 54 A&D Books 968, 969, 970, 977, 987, 993, and 997, compiled from entries for April 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC. 55 WD, Medical Officer, 31st Battalion, 6 April 1916, RG 9, Series III-D-3, Volume 4937, File 429, LAC. 56 WD, Medical Officer, 31st Battalion, 22 April 1916, RG 9, Series III-D-3, Volume 4937, File 429, LAC. 57 A.F. Duguid, “Rest Stations (winter 1916),” RG 24, Volume 6992, Pages 52–3. 58 Lieutenant Colonel Fotheringham, “Report on Medical Arrangements for 2nd Canadian Division in effect 4 April 1916,” RG 9, Series III-D-3, Volume 5025, file 816, LAC.



Notes to pages 101–5 373

59 No. 5 Field Ambulance was seconded to the newly arrived 3rd Canadian Division, whose field ambulances had yet to cross over from England. See Lieutenant Colonel Fotheringham, “Report on Medical Arrangements for 2nd Canadian Division in effect 4 April 1916,” RG 9, Series III-D-3, Volume 5025, file 816, LAC. 60 Diary of Sir Andrew Macphail, 6 April 1916, MG30 D150, Volume 4, File 4–4, LAC. 61 Ibid., 17 April 1916. 62 Ibid., 17 April 1916. 63 Ibid., 8 April 1916. 64 Ibid., 17 April 1916. 65 A&D Books 968, 969, 970, 977, 987, 993, and 997, compiled from entries for April 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–572, LAC. 66 This is based on subtracting wastage evacuations from total evacuations. Some shell shock cases must have been included among the former, while others were listed among the wounded. This is thus a conservative estimate. See wastage figures in RG 24, Volume 1874, File 22, Volume 1, LAC. 67 A&D Books 968, 969, 970, 977, 987, 993, and 997, compiled from entries for April 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC. 68 Transcript of interview with Gordon Hamilton by Frank Lalor, June 1964, RG 41, Volume 15, File 58th Battalion, LAC, Tape 2, Pages 2–3. 69 D.E. Macintyre, “The Fight for the Craters,” RG 24, Volume 1825, File GAQ 5–67, LAC, 10. 70 For example, see Diary of Private Donald Fraser, cumulative entry for 3 April 1916, MG30 E470, LAC. 71 Henry Botel to Mother and Ted, 14 April 1916, Collection 20100116, File 8, Archives of the Canadian War Museum (CWM). 72 Transcript of interview with Frederick Portwine, c. 1963, RG 41, Volume 11, File 24th Battalion, LAC, Tape 2, Page 3. 73 Personnel File, Lt. A.D. McEtheran, RG 150, Accession 1992–93/166, Volume 6800, File 30, LAC. 74 Transcript of interview with A.D. McEtheran, 29 September 1963, RG 41, Volume 11, File 27th Battalion, LAC, Tape 1, Pages 8–10, see also 15–16. 75 Medical Case Sheet, 24 May 1916 and Casualty Form: Active Service, April entries, RG 150, Accession 1992–93/166, Volume 2793, File 38, LAC. 76 War Diary of Lieutenant Colonel Duncan Eberts Macintyre, 28th Battalion, 7 April 1916, MG30 E241, Volume 1, LAC, 146. 77 Ibid., 11 April 1916.

374

Notes to pages 105–10

78 Medical Case Sheet, Private Richard E., RG 150, Accession 1992–93/166, Volume 2844, File 45, LAC. 79 Transcript of interview with Gregory Clark by Frank Lalor, 24 February 1964, RG 41, Volume 17, File 4th CMR, LAC, Tape 2, Page 4. 80 Transcript of interview with W.C.H. Pinkham, 27 September 1963, RG 41, Volume 11, File 27th Battalion, LAC; Diary of Sir Andrew Macphail, 22 April 1916, MG30 D150, Volume 4, File 4–4, LAC. 81 Medical Case Sheet, Granville Special Hospital, 22 April 1916, RG 150, Accession 1992–93/166, Volume 9137, File 12, LAC. 82 A&D Book 586, Granville Special Hospital, RG 150, Volume 585, LAC. 83 Medical Case Sheet, Granville Special Hospital, 22 April 1916, RG 150, Accession 1992–93/166, Volume 9137, File 12, LAC. 84 Proceedings of a Medical Board, 18 May 1916, RG 150, Accession 1992– 93/166, Volume 9137, File 12, LAC. 85 Diary of D.E. Macintyre, 21 April 1916, MG30 E 241, LAC. i ? 86 Casualty Form, Active Service, entry dated 25 April 1916, RG 150, Accession 1992–93/166, Volume 6904, File 20, LAC. 87 Diary of D.E. Macintyre, 25 April 1916, MG30 E 241, LAC. 88 See also Ian Sinclair to Angus Sinclair (Mother), 1 June 1916, MG30 E432, LAC. 89 Quote is paraphrased from Macintyre’s diary entry for 29 April 1916, MG30 E241, LAC. 90 Diary of D.E. Macintyre, 29 April 1916, MG30 E241, LAC. 91 Casualty Form, Active Service, entry dated 25 April 1916, RG 150, Accession 1992–93/166, Volume 6904, File 20, LAC. 92 Cathcart, “Group A21,” RG 24, Volume 1844, File GAQ 11–11E, LAC 93 Personnel File of Lawrence Earl Johns, RG 150, Accession 1992–93/166, Volume 4844, File 42, LAC; L.E. Johns to Sister, Lawrence Earl Johns Collection, 1 April 1917, CLIP, http://www.canadianletters.ca/content/ document-12024. 94 Generalmajor Reinhold Stühmke, Die 26. Infanterie-Division im Weltkrieg 1914–18: II. Teil. Vom Eintreffen an der Ypernfront Dezember 1915 bis zum Kriegsende (Stuttgart: Büro und Verlagsanstalt, 1927), 20. 95 Diary of a Lieutenant of the 127th Infantry Regiment, 1 June 1916, Volume 18, File “Diary of Lt. –,” Victor Odlum Fonds, MG30 E300, LAC, page 2. 96 W.A. Griesbach, Diary, 2 June 1916, MG30 E15, LAC. 97 Stühmke, Die 26. Infanterie-Division im Weltkrieg 1914–18, 22. 98 See Gordon MacKinnon, “Major-General Malcolm Smith Mercer: The Highest Ranking Canadian Officer Killed in the Great War by Friendly Fire,” Canadian Military Journal 8, no. 1 (2007): 75–82.



Notes to pages 111–14 375

99 Transcript of interview with Stanley Bowe by Frank Lalor, 11 February 1964, RG 41, Volume 17, File 2nd CMR, LAC, Tape 1, Page 6. 100 General H. Flaischlen, Die Württembergischen Regimenter im Weltkrieg, 1914–1918: Das Württembergische Infanterie-Regiment “Kaiser Wilhelm, König von Preussen” (2. Württb.) Nr. 120 (Stuttgart: Chr. Belsersche Verlagsbuch­ handlung, 1938), 36. 101 Translation taken from rough translations in RG 24, Volume 6934, LAC. 102 John Ussher, “Extract from a letter by Lt. Colonel Ussher, 4th CMR,” n.d., John Frederick Holmes Ussher Fonds, MG30 E376, LAC. 103 WD, 4th Battalion, Canadian Mounted Rifles, 2 June 1916, RG 9, Series III-D-3, Volume 4947, File 467, LAC; D.J. Goodspeed, “Prelude to the Somme: Mount Sorrel, June 1916,” in Michael Cross and Robert Bothweel, eds., Policy by Other Means: Essays in Honour of C.P. Stacey (Toronto: Clarke, Irwin, and Co., 1972), 150. 104 General Reinhold Stühmke, Das Infanterie-Regiment “Kaiser Freidrich, König von Prussen” (7. Württ.) Nr. 125 im Weltkrieg 1914–1918 (Stuttgart: Chr. Belser A.G. Verlagsbuchhandlung, 1923), 119–21. 105 Transcript of interview with Stanley Bowe by Frank Lalor, 11 February 1964, RG 41, Volume 17, File 2nd CMR, LAC, Tape 1, Page 8. 106 Ibid. 107 Cook, At the Sharp End, 357–65. 108 Ibid., 357–65. 109 Ibid., 360–1. 110 Agar Adamson to Mabel, 4 June 1916, Papers of Agar Adamson, MG30 E149, Volume 5, File 4 June 1916–30 June 1916, LAC. 111 Goodspeed, “Prelude to the Somme: Mount Sorrel, June 1916,” 153–4. 112 A&D Books 968, 971, 972, 975, 976, 986, 988, 989, 990, 992, compiled from entries for June 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC, and A&D Books 324–8, compiled from entries for June 1916, No. 3 Canadian Casualty Clearing Station, RG 150, Volume 529, LAC. 113 Ibid. 114 The lower figure is based on the books of No. 2 Field Ambulance for June 1916 and the higher figure is derived from the average evacuation rate for 1st and 2nd Divisions in 1915 and early 1916. A&D Books 43 and 44, No. 2 Canadian Field Ambulance, RG 150, Volume 513, LAC. 115 WD, 60th Battalion, 3 June 1916, RG 9, Series III-D-3, Volume 4942, File 447, LAC. 116 Cook, At the Sharp End, 362–3. 117 Ibid., 362.

376

Notes to pages 115–17

118 Diary of a Lieutenant, 127th Infantry Regiment, 8 June 1916, John Frederick Holmes Ussher Fonds, MG30 E376, LAC. 119 1st Canadian Division, “Summary of Operations, 8–15 June,” 15 June 1916, RG 9, Series III-D-3, Volume 4828, File 53, LAC, 2. 120 Cook, At the Sharp End, 370–3. 121 Max Freiherr von Gemmingen-Guttenberg-Fürfeld, Das Grenadier-Regiment Königin Olga (1. Württ.) Nr 119 im Weltkrieg 1914–1918 (Stuttgart: Chr. Belsersche Verlagsbuchhandlung, 1927), 159–60. 122 Diary of a Lieutenant, 127th Infantry Regiment, 8 June 1916, MG30 E300, LAC. 123 Canadian Corps, “Report on the Examination of Prisoners of the 26th Division,” 21 June 1916, RG 9, Series III-C-3, Volume 4105, Folder 19, File 7, LAC. 124 OC, 2nd Battalion, “Counter Attack June 13th,” n.d., RG 9, Series III-D-1, Volume 4690, Folder 46, File 16, LAC. 125 Frank Walker, From a Stretcher Handle: The World War I Journal and Poems of Pte. Frank Walker (Charlottetown: Institute of Island Studies, 2000), 93. 126 Nicholson, Canadian Expeditionary Force, 153–4. 127 A&D Books 968, 971, 972, 975, 976, 986, 988, 989, 990, 992, compiled from entries for June 1916, Nos. 10 and 17 Casualty Clearing Stations, RG 150, Volumes 570–2, LAC and A&D Books 324–328, compiled from entries for June 1916, No. 3 Canadian Casualty Clearing Station, RG 150, Volume 529, LAC. 128 Ibid. 129 A&D Books 43 and 44, No. 2 Canadian Field Ambulance, RG 150, Volume 513, LAC. 130 WD, 3rd Canadian Infantry Battalion, 13 June 1916 (casualties appear to include those from 14 and 15 June as well), RG 9, Series III-D-3, Volume 4914, File 356, LAC. 131 A&D books 43 and 44, No. 2 Canadian Field Ambulance, RG 150, Volume 513, LAC. 132 Ibid.; 1st Canadian Division, Sick and Wounded Statistics, June 1916, RG 9, Series III-D-3, Volume 5024, File 814, LAC. 133 A&D Books 43 and 44, No. 2 Canadian Field Ambulance, RG 150, Volume 513, LAC; 1st Canadian Division, Sick and Wounded Statistics, June 1916, RG 9, Series III-D-3, Volume 5024, File 814, LAC. 134 A.E. Ross, “Report of the Medical Arrangements during the Fighting in the Ypres Salient on the Canadian Corps Front from 13th June to 15th June 1916,” 19 June 1916, RG 9, Series III-D-3, Volume 5024, File 814, LAC, 4–5.



Notes to pages 117–22 377

135 Ibid.; British units were reporting similar casualties and responses around the same time. See Diary of H.W. Kaye, No. 8 CCS, 24 June 1916, Diaries of Service in Military Hospitals in France, RAMC 739/7, AWI. 136 WD, Deputy Director Medical Services, Canadian Corps, 14 June 1916, RG 9, Series III-D-3, Volume 5024, File 812, LAC; WD, ADMS, 2nd cana­ dian Division, 14 June 1916, RG 9, Series III-D-3, Volume 5025, File 816, LAC; WD, DMS, Second Army, 13–14 June 1916, WO 95/285, NA. 137 Diary of John Fotheringham, 14 June 1916, MG30 E53, Volume 4, File 21, LAC. 138 Ibid. 139 C.H. Archibald to Colin Russel, 27 December 1939, P98 Colin Kerr Russel Fonds, Volume 98, File “Neuropsychiatrist Looks at War,” Osler Archives, McGill University. 140 In diaries and letters, men frequently listed shell shock casualties alongside the names of wounded men, which indicates that they viewed shell shock as a form of wound – if not a more severe type of injury. For example, see Claude C. Craig, “Diary,” 8 May 1917, Claude C. Craig Fonds, MG30 E351, LAC; Claude Williams to Pater, 16 May 1917 and to Mother and All, 7 October 1917, Claude Vivian Williams Fonds, MG30 E400, LAC. 5  Treatment of Evacuated Cases 1 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria,” RG 24, Volume 1844, File GAQ 11–11E, LAC. 2 Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford: Oxford University Press, 2010), 66–70; see also Macpherson, Medical Services: General History, vol. 2, 427 and “Medical Arrangements for First Army, Operational Order 1, 6 May 1915,” repr. ibid., 428–30. 3 E.M. McCarthy, Matron-in-Chief, British Troops in France and Flanders, “The Work of the Nursing Staff in Connection with the Casualty Clearing Stations in 1914, Early 1915 and at a Later Date,” 31 July 1919, WO 222/ 2134, NA, accessed at http://www.scarletfinders.co.uk/10.html. 4 Macpherson, Medical Services: General History, vol. 2, 42. 5 Sir Anthony Bowlby, “The Work of the ‘Clearing Hospitals’ during the Past Six Weeks,” British Medical Journal 2, no. 2816 (19 December 1914): 1053; for an example of a precautionary evacuation, see WD, DMS, III Corps, 13–20 December 1914, WO 95/695, NA. 6 Bowlby, “The Work of the ‘Clearing Hospitals’ during the Past Six Weeks,” 1053.

378

Notes to pages 122–6

7 Thomas Brenton Smith, “Clearing: The Tale of the First Canadian Casualty Clearing Station, BEF, 1914–1919,” MG30 E31, Volume 1-X1, LAC, 73–8. 8 Ibid., 86. 9 Ibid., 88. 10 Ibid., 236. 11 Ibid., 234. 12 Ibid., 88; Personnel File: Thomas Brenton Smith, RG 150, Accession 1992–93/ 166, Box 9107, File 5, LAC. 13 Peter Barham, Forgotten Lunatics of the Great War (New Haven: Yale Univer­ sity Press, 2004), 49–50. 14 Harrison, The Medical War, 66–7. 15 A&D Books 863–871, No. 1 Canadian Casualty Clearing Station, 1915, RG 150, Volume 565, LAC. 16 There are a handful of examples of medical case sheets and reports from the first two years of the war preserved in the series MH 106/2102 at the National Archives, Kew. However, these all pertain to “unusual” cases such as delusional insanity, dementia praecox, and general paralysis of the insane. None mention treatment. 17 See Joanna Bourke, “‘Swinging the Lead’: Malingering, Australian Soldiers, and the Great War,” Journal of the Australian War Memorial 26 (April 1995): 10–18. See also George Swindell, unpublished memoir, George Swindell Papers, RAMC 421/4, AWI, page 126–7. 18 Smith, “Clearing,” MG30 E31, Volume 1-X1, LAC, 89. 19 Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge, MA: Harvard University Press, 2001), 80. 20 Smith, “Clearing,” MG30 E31, Volume 1-X1, LAC, 88; Personnel File, Colonel W.T.M. MacKinnon, RG 150, Accession 1992–93/166, Volume 7009, File 41, LAC. 21 See, for example, George Adkins to Louise Adkins, 18 December 1915, George Adkins Collection, CLIP, http://www.canadianletters.ca/content/ document-410. 22 For a discussion of the difficulties encountered by non-specialist physi­ cians in diagnosing cases of nervousness and differentiating “serious” cases from milder forms of distress see F.G. Gosling, Before Freud: Neuras­ thenia and the American Medical Community, 1870–1910 (Chicago: University of Illinois Press, 1987), 30–62. See also Edward Shorter, Bedside Matters: The Troubled History of Doctors and Patients (New York: Simon and Schuster, 1985), 81–92. 23 Marc Micale, Hysterical Men: The Hidden History of Male Nervous Illness (Cambridge: Harvard University Press, 2008), 280–1.



Notes to pages 126–31 379

24 Personnel File of HCS Elliot, RG 150, Accession 1992–93/166, Box 2870, File 51, LAC. 25 Medical Case Sheet, No. 2 Stationary Hospital, 15 July 1915, RG 150, Accession 1992–93/166, Box 4412, File 26, LAC. 26 Ibid. 27 Medical Case Sheet, Granville Special Hospital, 10 June 1917, RG 150, Accession 1992–93/166, Volume 3612, File 6, LAC. 28 Medical Case Sheet 402321, MH 106/2102, NA. 29 Interview of Hunter Campbell L. by Doctor G.F. Boyer, 14 October 1936, RG 38, Volume 282, File Part 3, LAC. Although Boyer worked at Granville hospital, he also became a Pensions and National Health examiner in the postwar period. For more on Hunter L.’s case and his attempts to secure a pension see Mark Osborne Humphries, “War’s Long Shadow: Masculinity, Medicine, and the Gendered Politics of Trauma,” Canadian Historical Review 91, no. 3 (2010): 503–6 and 527–31. 30 Anon., “The Canadian Casualty Clearing Stations Nos. 2 and 3,” Margaret C. MacDonald Papers, MG30 E45, Volume 1, File: “Chapter V: In the Forward Area,” LAC, 3–4. 31 Ibid. 32 “Extracts from Printed History of No. 7 Canadian General Hospital,” MG30 E45, Volume 1, File: “Chapter V: In the Forward Area,” LAC. 33 Cheryl Krasnick Warsh, Moments of Unreason: The Practice of Canadian Psychiatry and the Homewood Retreat, 1883–1923 (Montreal, Kingston: McGill Queen’s University Press, 1989), 107. 34 Ibid. 35 Christine Hallett, Containing Trauma: Nursing Work in the First World War (Manchester: Manchester University Press, 2009), 170–1. 36 Anon., “How Would You Nurse a Patient Suffering from Mental Shock?” Canadian Nurse 12, no. 1 (1916): 33–4. 37 Ibid., 34. 38 Anon., “The Canadian Casualty Clearing Stations Nos. 2 and 3,” MG30 E45, Volume 1, File: “Chapter V: In the Forward Area,” LAC, 4. 39 Desmond Morton, When Your Number’s Up: The Canadian Soldier in the First World War (Toronto: Random House, 1993), 139–42. 40 Anon., “Duties of a Dietitian,” MG30 E45, File “Chapter VI: With L of C and Base Units,” LAC. 41 Sophie Hoerner to “Carrie,” 10 June 1915, Sophie Hoerner Papers, MG30 E290, Volume 1, LAC. 42 Anon., “How Would You Nurse a Patient Suffering from Mental Shock?” 33.

380

Notes to pages 131–7

43 Nursing Sister Sophie Hoerner, 8 June 1915, MG30 E290, Volume 1, LAC. 44 Ruth Cowen, ed., A Nurse at the Front: The Great War Diaries of Sister Edith Appleton (London: Imperial War Museum, 2012), 184–5. 45 Hallett, Containing Trauma, 166–9. 46 Ibid., 167. 47 Micale, Hysterical Men, 281. 48 Anon., ‘How Would You Nurse a Patient Suffering from Mental Shock?’ Canadian Nurse 12, no. 1 (1916): 33–4. 49 Sophie Hoerner to Mollie, 4 July 1915, MG30 E290, Volume 1, LAC. 50 Hoerner to Mollie, 15 July 1915. 51 Cowen, A Nurse at the Front, 185. For example, a letter in the American Journal of Nursing notes: “Many of the overseas nurses spent considerable time with ‘shell shock’ cases; some of these express much interest in this class of patients and have a desire to continue with them.” Yssabella Waters to Editor, American Journal of Nursing 19 (1 June 1919): 714. 52 Transcript of Interview with Edna Nettie Howey, File 20080087–14, Archives of the CanadianWar Museum (CWM), 42. 53 Sir William J. Collins, “The War: Notes and Reflections from the Front,” British Medical Journal 2, no. 2813 (28 November 1914): 938. 54 Extracts from “Printed History of No. 7 Canadian General Hospital,” File: “Chapter V: In the Forward Area,” LAC. 55 Compiled from No. 2 Canadian General Hospital A&D Books 356–8, RG 150, Volume 531, LAC. 56 Compiled from No. 7 Stationary Hospital A&D Books (Canadians) 1870–1, RG 150, Volume 624, LAC. 57 Macphail, Medical Services, 139–40. 58 Ibid., 109. 59 Macpherson, Medical Services: General History, vol. 2, 38–9, 358–9. 60 Sir William J. Collins, “The War: Notes and Reflections from the Front,” British Medical Journal 2, no. 2813 (28 November 1914): 938. 61 Charles Henry Savage, Unpublished and Untitled Memoir, 1936, Charles Henry Savage Collection, CLIP, http://www.canadianletters.ca/content/ document-8359. 62 Transcript of Clinical Interview: Cpl. William P. and Dr. George Boyer, Montreal, Quebec, 28 November 1936, RG 38, Volume 282, LAC. 63 Summary of Photostatic Documents, RG 38, Volume 282, LAC. 64 Casualty Cards, 17 May–26 June 1915, RG 150, Accession 1992–93/166, Box 8020, File 3, LAC. 65 Colin Russel, “Special Report on Cpl. William P.,” 26 May 1916, RG 150, Accession 1992–93/166, Box 8020, File 3, LAC.



Notes to pages 137–40 381

66 Colin Russel, Unpublished Manuscript: “The Neuropsychiatrist Looks at War,” undated, Colin Kerr Russel Fonds, Box 98, File “Neuropsychiatrist Looks at War,” Archives of the Osler Library, McGill University. 67 Medical Case Sheet, Granville Canadian Special Hospital, Ramsgate, 27 June 1916, RG 150, Accession 1992–93/166, Box 10067, File 10, LAC. 68 Medical Case Sheet, Granville Canadian Special Hospital, Ramsgate, 31 March 1916, RG 150, Accession 1992–93/166, Box 9055, File 27, LAC. Many of those who eventually ended up in England had a similar history. For further examples see the Medical Case Sheets and casualty cards for Alexander K., RG 150, Accession 1992–93/166, Box 5078, File 37; Thomas M., RG 150, Accession 1992–93/166, Box 6338, File 22; and John W., RG 150, Accession 1992–93/166, Box 10200, File 6, LAC. These are just a few amongst many. 69 Sidney Thomas Hampson to Brother and Sister, 21 February 1916, Sidney Thomas Hampson Collection, CLIP, www.canadianletters.ca/content/ document-9117. 70 Ernest Taylor to Doll (Sister), 30 December 1915, Taylor-Bury Collection, CLIP, http://www.canadianletters.ca/content/document-2562. 71 On oral culture see Tim Cook, “Black-Hearted Traitors, Crucified Martyrs, and the Leaning Virgin: The Role of Rumor and the Great War Canadian Soldier,” in Jennifer Keene and Michael Neiberg, eds., Finding Common Ground: New Directions in First World War Studies (New York: Brill, 2010), 19–42. 72 WD, Assistant Director, Medical Services, 2nd Canadian Division, 18 February 1916, RG 9, Series III-D-3, Volume 5025, File 816, Part I, LAC. 73 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria,” RG 24, Volume 1844, File GAQ 11–11E, LAC. 74 C.H. Archibald, “Psychoneuroses during the First World War and Since,” National Health Review 8 (1940): 60–3. 75 Harrison, The Medical War, 59–60; Macpherson, Medical Services: General History, 88. 76 Macpherson, Medical Services: General History, vol. 1, 71. 77 Harrison, The Medical War, 58–62. 78 War Office, Notes for the Guidance of Officers in Charge of Military, Territorial, and Auxiliary Hospitals (London: HMSO, 1915), 17. 79 Salmon, The Care and Treatment of Mental Diseases and War Neuroses, 34. 80 Jones and Wessely, From Shell Shock to PTSD, 22. 81 Ibid., 78–9. 82 Ibid., 79; Harrison, The Medical War, 59; Macpherson, Medical Services: General History, vol. 1, 79.

382

Notes to pages 141–3

83 Lawrence J. Burpee, “The Canadian Army Medical Corps,” in Canada in the Great World War – Volume VI: Special Services and Heroic Deeds, etc. (Toronto: United Publishers of Canada, 1921), 93. 84 Sir Andrew Macphail, Official History of the Canadian Forces in the Great War, 1914–19: Medical Services (Ottawa: F.A. Acland, 1925), 161–4. 85 War Office, Notes for the Guidance of Officers in Charge of Military, Territorial, and Auxiliary Hospitals, 3. 86 DG438, 4 February 1915, WO 95/44, NA. 87 Ibid. 88 Leese, Shell Shock, 127–9. 89 Peter Barham, Forgotten Lunatics of the Great War (New Haven, CT: Yale University Press, 2004), 47. 90 Stanford Read, Military Psychiatry in Peace and War (London: H.K. Lewis and Co., 1920), 45. Peter Barham argues that Read’s description of the admission process reflects an unobtainable ideal, due to the volume of patients who passed through Netley. But this was not necessarily the case. Between August 1914 and December 1915, a total of 1762 British and Commonwealth nervous and mental patients passed through D Block, amounting to a manageable average of only around three patients per day. See Barham, Forgotten Lunatics, 47. 91 Medical Case Sheet, 11 April 1916, RG 150, Series 1992/93–166, Volume 144, LAC. For a more thorough analysis of Clindening’s bedside manner and diagnostic approach see Barham, Forgotten Lunatics, 19–20. 92 Medical Case Sheet, 19 May 1915, RG 150, Series 1992/93–166, Volume 2021, File 18, LAC. 93 Medical Case Sheet, 31 December 1915, RG 150, Series 1992/93–166, Volume 1051, File 8, LAC. 94 Ibid. 95 Medical Case Sheet, 20 September 1915, RG 150, Accession 1992–93/166, Box 3595, File 9, LAC; Medical Case Sheet, 24 July 1915, RG 150, Accession 1992–93/166, Box 3615, File 48, LAC. 96 A good summary is Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: Wiley, 1998), 93–9. For a good illustration of how contemporary psychiatrists saw their ideas as progressive and furthering social causes see Ian Dowbiggin, Keeping America Sane: Psychiatrists and Eugenics in the United States and Canada, 1880–1940 (Ithaca: Cornell University Press, 1997). Dowbiggin’s case study of Toronto’s C.K. Clarke is particularly informative. See pages 133–91



Notes to pages 143–5 383

97 Edgar Jones, “Shell Shock at Maghull and the Maudsley: Models of Psychological Medicine in the UK,” Journal of the History of Medicine and Allied Sciences 65, 3 (2010): 388. 98 Medical Case Sheet 402274, MH 106/2102, NA. 99 Medical Case Sheet, 17 August 1915, MH 106/2102, NA. 100 The first of these sheets which I have identified in the files of Canadian patients is dated 9 May 1916. For examples see Medical Case Sheets Pte. John C., 9 May 1916, RG 150, Accession 1992/93, Box 1916, File 4, LAC; Fred Charles A., RG 150, Accession 1992–93/166, Box 243, File 4, LAC. 101 For examples of various essentially somatic approaches, see Frank B., RG 150, Accession 1992–93/166, Box 885, File 12, LAC; Balfour E., RG 150, Accession 1992–93/166, Box 2858, File 30, LAC; Jonas Benjamin F., RG 150, Accession 1992–93/166, Box 3221, File 108, LAC. 102 Anon., “Sir Frederick W. Mott,” British Journal of Psychiatry 72, no. 298 (July 1926): 317; Theodore Lidz, “Images in Psychiatry: Adolf Meyer,” American Journal of Psychiatry 150, no. 7 (July 1993): 1098. 103 Rhodri Hayward, “Germany and the Making of ‘English’ Psychiatry: The Maudsley Hospital, 1908–1939,” in V. Roelcke, P. Weindling, and L. Westwood, eds., International Relations in Psychiatry: Britain, Germany, and the United States to World War II (London: Boydell and Brewer, 2010), 68. 104 Ibid., 68–9; Theodore Lidz, “Adolf Meyer and the Development of American Psychiatry,” Occupational Therapy in Mental Health 5, no. 3 (1985): 35. 105 Jones, “Shell Shock at Maghull and the Maudsley,” 369–70; on the creation of the hospital see Edgar Jones, Shahina Rahman, and Robin Woolven, “The Maudsley Hospital: Design and Strategic Direction, 1923–1939,” Medical History 51 (2007): 358–62. 106 F.W. Mott, “Second Lettsomian Lecture on the Effects of High Explosives on the Central Nervous System,” The Lancet, 11 March 1916: 553. 107 M.S. MacInnes, “Shell Shock,” The Canadian Nurse 13, no. 1 (1916): 723. 108 Jones and Wessely, Shell Shock to PTSD, 33–4. 109 William McDougall as reported in the transcript of “Special Discussion on Shell Shock without Visible Signs of Injury, 25 January 1916,” Proceedings of the Royal Society of Medicine 9 (1916): xxv–vi; MacInnes, “Shell Shock,” 723–4; see also Jones, “Shell Shock at Maghull and the Maudsley,” 388–90. 110 Yealland has often been criticized. See Hans Binneveld, From Shell Shock to Combat Stress: A Comparative History of Military Psychiatry (Amsterdam: Amsterdam University Press, 1997), 111–14; Leese, Shell Shock, 74;

384

Notes to pages 145–8

Shephard, A War of Nerves, 76–8. He is the “villain” of Pat Barker’s novel Regeneration (1993). 111 Stefanie Linden, Edgar Jones, and Andrew Lees, “Shell Shock at Queen Square: Lewis Yealland 100 Years On,” Brain 136 (2013): 1986. 112 Linden et al., “Shell Shock at Queen Square,” 1986; Yealland’s own views are summarized in Lewis Yealland, Hysterical Disorders of Warfare (London: MacMillan, 1918). 113 Memorandum on British Treatment System for Psychotic and Nervous Cases, 11 May 1916, RG 9, Series III-B-2, Volume 3618, File 25–13–10, LAC, 4–5. 114 Jones, “Shell Shock at Maghull and the Maudsley,” 371. 115 General Guy Carleton Jones, Memorandum for the Honourable the Min­ ister of Militia and Defence, Canada, 25 August 1915, RG 9, Series III-A-1, Volume 41, File 8–4–10, LAC; Major F.B. Carron, Responses to the Bruce Report, SW 370, WWI 2002 Accessions, Archives of McMaster University, 6; Lieutenant Colonel Drum, DDMS, Canadian Contingents, to DADOS, Canadian Ordnance, 22 September 1915, RG 9, Series III-A-1, Volume 41, File 8–4–10, LAC; Report on the History of Granville Canadian Special Hospital, Ramsgate, Kent, 10 July 1916, RG 9, Series III-D-3, Volume 5040, File 877, LAC. 116 Ibid. 117 Ibid.; see also “Proposed Alterations and Repairs Required at Granville Canadian Special Hospital,” RG 9, Series III, 3716, File 30–13–2, Volume I, LAC. 118 WD, Granville Canadian Special Hospital, 4 December 1915, RG 9, Series III-D-3, Volume 5040, Part I, LAC. 119 “Casualty Form, Active Service,” Entry for 18 November 1915, Lieutenant Colonel Colin K. Russel, RG 150, Accession 1992/93, Box 8552, File 41, LAC; R.C. Fetherstonhaugh, No. 3 Canadian General Hospital (McGill) 1914–1919 (Montreal: The Gazette Printing Co., 1928), 258. 120 Lieutenant Colonel John McCrae, Report on the Medical Department, November 1915, WD, No. 3 Canadian General Hospital, RG 9, Series III-D-3, Volume 5035, File 853, Part I, LAC. 121 Colin K. Russel, “Psychogenetic Conditions in Soldiers, Their Aetiology, Treatment and Final Disposal,” Canadian Medical Association Journal 9, no. 8 (August 1918): 877. 122 Ibid., 877–8. 123 Ibid., 877–8. 124 Ibid., 878–9.



Notes to pages 148–55 385

1 25 Ibid., 879. 126 Ibid., 881. 127 Gordon Holmes, The National Hospital Queen Square, 1860–1948 (Edinburgh: E&S Livingstone, 1954), 58–9. 128 Jones, “Shell Shock at Maghull and the Maudsley,” 388. 129 Ibid. 130 Medical Case Sheet, Private John C., RG 150, Accession 1992–93/166, Volume 1916, File 4, LAC. 131 Medical Case Sheet, Corporal Mark T., RG 150, Accession 1992–93/166, Volume 9687, File 29, LAC. 132 Ibid. 133 Medical Case Sheet, Private George Robert J., RG 150, Accession 1992– 93/166, Volume 4937, File 10, LAC. 134 Medical Case Sheet, Private Frank G., RG 150, Accession 1992–93/166, Volume 3727, File 49, LAC. 135 Ibid. 136 Colin Russel, “Memorandum: Functional Nervous Disorders,” RG 9, Series III, Volume 3752, File 3–1-4–2, LAC. 137 Ibid. 138 Ibid. 139 Colin Russel, “A Study of Certain Psychogenetic Conditions among Soldiers,” Canadian Medical Association Journal 7, no. 8 (August 1917): 712–13. 140 Ibid., 713. 141 Ibid. 142 Ibid., 714. 143 Ibid., 716–17. 144 Ibid., 717. 145 Ibid., 717. 146 Ibid., 716–17. 147 Linden, Jones, and Lees, “Shell Shock at Queen’s Square,” 1986–7. 148 Medical Case Sheet, Private Thomas O., RG 150, Accession 1992–93/166, Volume 7521, File 26, LAC. 149 F.L. McNaughton, “Colin Russel, a Pioneer of Canadian Neurology,” Canadian Medical Association Journal 77 (1 October 1957): 723. 150 Lecture notes “Psychotherapy,” P98, Colin Kerr Russel Fonds, Box 90, File “Psychotheraputics,” Archives of the Osler Library, McGill University, 4–5. 151 A&D Books, Canadian Special Hospital, Granville, Books 585–596 and 596A, RG 150, Series R611–450–9-E, Volume 585, LAC.

386

Notes to pages 155–62

152 Casualty Form, Active Service, Entry for 18 April 1917, Major Colin Kerr Russel, RG 150, Accession 1992–93/166, Volume 8552, File 41, LAC. 153 Transcript of interview with Nurse Mary Darling, 24 October 1963, RG 41, Volume 20, File RAMC, LAC, Tape 2, Page 2. 6  The BEF’s Shell Shock Crisis on the Somme 1 Juilian Putkowski and Julian Sykes, Shot at Dawn, New and Revised Edition (London: Leo Cooper, 1992), 93–4. 2 Anonymous, “1/5th Royal Warwick Regiment,” ca. September 1916, Burchnell Papers, RAMC 446/18, AWI. On executions see Anthony Babington, For the Sake of Example: Capital Courts-Martial, 1914–1920 (New York: St Martin’s Press, 1983), tables on 228–31. 3 Quoted in Garry D. Sheffield, The Chief: Douglas Haig and the British Army (London: Aurum Press, 2012), 145. 4 Memorandum from DMS, LOC to GHQ, 11 January 1916, WO 95/45, NA. 5 DG 2370/11, 11 April 1916, WO 95/45, NA. 6 Charles S. Myers, Shell Shock in France, 1914–18: Based on a War Diary (Cambridge: Cambridge University Press, 1940), 93–4. 7 DG 2367/36, 7 June 1916, WO 95/45, NA. 8 Ibid. 9 Ibid. 10 DG 383/6A, 13 June 1916, WO 95/45, NA. 11 Myers, Shell Shock in France, 15–18. 12 Ibid., 96. 13 Ibid., 95. 14 Ibid., 95–6. See also Interview, Leonard John Stagg, 2/3rd South Midland Field Ambulance, RAMC by Lyn Smith, 1985, IWM 8764. 15 Myers, Shell Shock in France, 92–3. 16 Ibid., 96. 17 WD, DMS, LOC, 9 June 1916, WO 95/3979/8, NA. 18 Myers, Shell Shock in France, 94–6. 19 Ibid., 96. 20 Robin Prior and Trevor Wilson, The Somme (New Haven: Yale University Press, 2005), 35–56. 21 Ibid. 22 On the variable training of the New Armies see Peter Simkins, Kitchener’s Army: The Raising of the New Armies, 1914–1916 (Manchester: Manchester University Press, 1988), 296–318.



Notes to pages 162–8 387

23 Diary of Sir Douglas Haig, 29 March and 30 June 1916, as reprinted in Garry Sheffield and John Bourne, eds., Douglas Haig: War Diaries and Letters, 1914–1918 (London: Weidenfeld & Nicolson, 2005), 183, 195. 24 Macpherson, Medical Services: General History, vol. 3, 16–49. 25 Ibid., 29. 26 Service File, Thomas Henry R., WO 363, NA. 27 Service File, Edward Ernest D., WO 363, NA. 28 Prior and Wilson, The Somme, 112–18. 29 Ibid., 300–9 30 Fourth Army, “Casualty Returns IVth Army July 1916,” WO 95/447, NA. 31 Surgeon General M.W. O’Keefe, “Somme Operations: First Phase, 1–13 July 1916,” WO 95/447, NA. 32 Fourth Army, “Casualty Returns IVth Army July 1916.” WO 95/447, NA. 33 WD, DMS, Fourth Army, 1 July 1916, WO 95/447, NA. 34 Diary of Sir Douglas Haig, 1 July 1917, as reprinted in Sheffield and Bourne, Douglas Haig, 197. 35 A&D Books, No. 3 CCS, MH 106/311–320, NA. 36 A&D Books, No. 34 CCS, MH 106/680–716, NA. 37 Arthur Haddow, Field Notebook and Diary, Army Book 153, 1916, Devon County Record Office, Hadow Family Fonds 5006, Box 7. 38 General de Lisle, “Report on the Operations of the 29th Division, 30 June to 2 July 1916,” 11 July 1916, WO 95/2280, NA, 7. 39 Hadow, Notebook, page 37. 40 Ibid. 41 Ibid. 42 Personnel File, Raymond Robert L., RG 38, Volume 579, File 1828, LAC. 43 Ibid. 44 Personnel and Veterans File, Herbert L. V., RG 38, Volume 567, File 1566, LAC. 45 Personnel and Veterans File, Lieutenant Francis Knight, RG 38, Volume 481, File 0–77, LAC. 46 WD, 11th Border Regiment, 1–7 July 1916, WO 95/2403/1, NA. 47 “Extract from Proceedings of a Court of Inquiry into Failure of a Party of 11th Border Regiment, 97th Infantry Bde., 32nd Division to Carry Out an Attack, as Ordered, on 10th July 1916,” 10–28 July 1916, Burchnell Papers, RAMC 446/18, AWI. 48 Ibid. 49 Ibid. 50 Ibid.

388

Notes to pages 168–74

51 WD, Adjutant General, BEF, 31 July 1916, WO 95/26, NA. 52 For a similar view from one of Haig’s commanders see Steven Corvi, “Horance Smith-Dorrien,” in Ian Beckett and Steven Corvi, eds., Haig’s Generals (London: Pen and Sword, 2006), 193. 53 “Extract from Proceedings of a Court of Inquiry.” 54 See Interview, Leonard John Stagg, 2/3rd South Midland Field Ambulance, RAMC by Lyn Smith, 1985, IWM 8764; Pte. John McGrath, 18th Bn West Yorkshire Regt by Peter M. Hart, 1986, IWM 9414. 55 Interview, Chaplain John Duffield, Lancaster Bn, Bantam Bde by Margaret A. Brooks, 9 September 1979, IWM 4411. 56 Interview, Albert Day, 1/4th Gloucestershire Regt. by Keith Chambers, 12 February 1975, IWM 24854. 57 P.H. Stockwell, 1/6th and 1/8th Bns London Regt., 17 March 1975, IWM 24866. 58 Anonymous, “1/5th Royal Warwick Regiment,” ca. September 1916, RAMC 446/18, AWI. On executions see Babington, For the Sake of Example: Capital Courts-Martial, 1914–1920, tables on 228–31. 59 WD, 38th Division, General Staff, 6–7 July 1916, WO 95/25369, NA. 60 WD, 16th Welsh Battalion, 7 July 1916, WO 95/2561/3, NA. 61 WDs, 129th, 130th, 131st Field Ambulances, 6–8 July 1916, WO 95/2549– 50, NA. See also WD, 38th Division, 7 July 1916, ADMS, WO 95/2543/1, NA. 62 OAD 53, Haig to Rawlinson, 9 July 1916, WO 95/5, NA. 63 Brigadier General, 113th Infantry Brigade, Report on Action at Mametz Wood, 14 July 1916, WO 95/2552/1, NA. 64 Confidential Memorandum, Captain H.R. Bently (Brigade Major), 16 July 1916, WO 95/2552/1, NA. 65 The collecting station for the 38th Division was run by the 77th Sanitary Company. See their war diary for 6–12 July 1916, WO 95/2550/3, NA. 66 A&D Books, No. 34 Casualty Clearing Station, MH 106/680–716, NA. 67 Ibid. 68 WD, No. 14 Field Ambulance, 21–22 July 1916, WO 95/1540, NA. On corps evacuation methods see Macpherson, Medical Services: General History, vol. 3, 15–18. 69 A&D Books, No. 14 Field Ambulance, MH 106/26–30, NA. 70 Macpherson, Medical Services: General History, vol. 3, 41. On the duties of the field ambulances see ADMS Colonel E. Scott, “Medical Arrangements, 2nd Division,” 26 July 1916, WO 95/1321, NA. 71 AWM 25 885/5, AWM.



Notes to pages 176–9 389

72 Lieutenant Colonel C. Hearne, CO 2nd Australian Field Ambulance to ADMS S Area, 18 August 1916, Australian War Memorial (AWM) 4, Item Number 26/45/11, AWM. 73 Hearne to ADMS S Area, 18 August 1916, AWM 4, Item Number 26/45/11 AWM. 74 DDMS I ANZAC to ADMS, 1st Australian Division, 18 Aug 1916, AWM 25 885/5. 75 Heame to ADMS S Area, 18 August 1916, AWM 4, Item Number 26/45/11 AWM. 76 Butler, Official History of the Australian Army Medical Services: Volume III, 105–6. 77 Colonel C.C. Manifold, “Notes on ‘Shell Shock’ cases which have Passed through some Australian Field Ambulances,” 27 August 1916 as quoted in Butler, Official History of the Australian Army Medical Services: Volume III, 110; WD, DMS, Reserve Army, 31 August 1916, WO 95/532, NA. 78 WD, DMS, LOC, 8 and 28 July 1916, WO 95/3980, NA. 79 WD ?? 80 WD, DGMS, GHQ, 14 July 1916, WO 95/45, NA; WD, DMS, LOC, 2 August 1916, WO 95/3980, NA. 81 WD, DMS, LOC, 23 July 1916, WO 95/3980, NA. 82 WD, DMS, LOC, 2 August 1916, WO 95/3980, NA. 83 G.L. Foster, “Notes on Visit to Fourth Army,” 31 July 1916, RG 9, Series III-D-3, Volume 5024, File 812, LAC. 84 WD, DMS, LOC, 11 May 1916, WO 95/3979, NA. 85 Myers, Shell Shock in France, 89–90. 86 The war diary of the DMS, LOC (which was kept by a staff member, not Woodhouse), is peppered with sarcastic jabs at Myers which stand out because they are unlike any of the other entries about other officers. Two examples are the entries for 11 April 1916, WO 95/3979/8 and 8 January 1917, WO 95/3980, NA. 87 DG 1106/5, DGMS, GHQ, 15 August 1915, WO 95/45, NA; WD, DMS, LOC, 18 August 1916, WO 95/3980, NA. 88 A.D. Macleod, “Shell Shock, Gordon Holmes, and the Great War,” Journal of the Royal Society of Medicine 97, no. 2 (February 2004): 86. 89 Macdonald Critchley, “Gordon Holmes: The Man and the Neurologist,” in Macdonald Critchley, The Divine Banquet of the Brain and Other Essays (New York: Raven Press, 1979), 229–30. 90 Ibid., 233. 91 Ibid., 233–4.

390

Notes to pages 179–82

92 Gordon Holmes, “Spinal Injuries of Warfare,” British Medical Journal 2, no. 2866 (4 December 1915): 816–17. 93 Quoted in Lieutenant Colonel A.D. Carberry, The New Zealand Medical Service in the Great War, 1914–1918 (Auckland: Witcombe and Tombs, 1924), 225. See also DMS, Fourth Army, DMS 794/86, 22 August 1916, WO 95/194, NA. 94 Ibid. 95 DG 2369/43, 21 August 1916, WO 95/45, NA. 96 WD, No. 35 CCS, 28 August 1916, WO 95/416, NA. 97 DMS, Fourth Army, No. 20/40/2, 27 August 1916, WO 95/337, NA. 98 WD, DMS, Fourth Army, 21 July 1916, WO 95/447, NA. 99 Tim Cook, No Place to Run: The Canadian Corps and Gas Warfare in the First World War (Vancouver: UBC Press, 1999), 158–62. On the creation of the new centres see the more detailed instructions in DMS, First Army, No. 794/86, 22 August 1916, WO 95.196, NA. 100 Margaret C. MacDonald, “No. 3 Stationary Hospital in France,” Margaret C. MacDonald Fonds, MG30 E45, LAC; WD, No. 35 CCS, 28 August 1916, WO 95/416, NA. 101 G.W.L. Nicholson, Canada’s Nursing Sisters (Toronto: Samuel Stevens Hakkert and Co., 1975), 93–4. 102 The Second Army in the Ypres salient implemented the system just as the Canadian Corps was leaving for the Somme. See WD, DMS, Second Army, 25 August 1916, WO 95/285, NA. 103 Nicholson, Canadian Expeditionary Force, 167. 104 WD, ADMS, 1st Canadian Division, 23 July 1916, RG 9, Series III-D-3, Volume 5024, File 814, LAC. 105 ADMS, 3rd Canadian Division, “Medical Services in the Somme Fighting,” 20 November 1916, RG 9, Series, III-C-10, Volume 4546, LAC. 106 Ibid. 107 DDMS, XV Corps to Medical Officers, 8 September 1916, AWM 25 885/2, AWM. 108 Ibid. 109 Medical Arrangements, Reserve Army, Operations No. 9, 9 October 1916, RG 9 Series III-C-10 Volume 4540, Folder 2, File 2, File HQ CR 9-B-1, ALC. 110 Nicholson, Canadian Expeditionary Force, 169. 111 Monthly Strength of Infantry, 2nd Divisions, Officers and Other Ranks, c. 1927, RG 24, Volume 1874, File 22, Volume 1, LAC. 112 Oral history transcript of interview between Frank Lalor and A.N. Davis, RG 41 Volume 41, File 47th Battalion, LAC, page 4; Personnel File, A.N. Davis, RG 150, Accession 1992–93/166, Box 2332, File 10, LAC.



Notes to pages 183–7 391

113 Tim Cook, At the Sharp End: Canadians Fighting the Great War, 1914–1916 (Toronto: Viking, 2007), 447–55. 114 Nicholson, Canadian Expeditionary Force, 160–99. 115 See R. Rennie, Operations of the 4th Canadian Infantry Brigade at the Somme, October 1916, Elmer Jones Papers, MG30 E50, LAC. 116 Oral history transcript of C. Carmichael, RG 41 Volume 41, File 47th Bat­ talion, LAC, page 4. 117 Frank Maheux to Angelique Maheux, 20 September 1916, Frank Maheux Fonds, MG30 E297, File 7, LAC. 118 Joanna Bourke, “Effeminacy, Ethnicity and the End of Trauma: The Sufferings of ‘Shell-shocked’ Men in Great Britain and Ireland, 1914–39,” Journal of Contemporary History 35, no. 1 (2000): 58–9. 119 Department of Pensions and National Health, “Group A21 – Neurasthenia, Shell Shock, and Hysteria,” RG 24, Volume 1844, File GAQ 11–11E, LAC. 120 See SSMD, XV Corps to Medical Officers, 8 September 1916, AWM 25 885/2, AWM. 121 H.M. Morris, “The Story of My 3½ Years in World War I,” 11 November 1978, Hubert M. Morris Fonds, MG30 E379, LAC, 20. 122 Diary of D.E. Macintyre, 1 October 1916, D.E. Macintyre Fonds, MG30 E241, LAC; Diary of Donald Fraser, 14 September 1916, page 121, Donald Fraser Fonds, MG30 E470, LAC. 123 Personnel File, John Henry Clash, RG 150, Accession 1992–93/166, Box 1774, File 16, LAC; Transcript of interview of J.H. Clash by Frank Lalor, 21 February 1964, RG 41 Volume 41, File 47th Battalion, LAC. 124 Diary of Lieutenant Colonel John T. Fotheringham, 16 February 1916, MG30 E53, Volume 4, File 21, LAC 125 Diary of Andrew Macphail, 23 September 1916, Andrew Macphail Fonds, MG30 D150, Volume 4, File 4–5, LAC. 126 Ibid. 127 Personnel File of Pte. J.A.G. McBride, RG 150, Accession 1992–93/166, Box 6594, File 48, LAC. 128 Personnel File of Pte. T.D. Chaney, RG 150, Accession 1992–93/166, Box 1617, File 60, LAC; the figures in this paragraph and the next were compiled from the admission and discharge books for No. 1 Canadian Field Ambulance, Books 11 and 12; No. 2 Canadian Field Ambulance, Books 46–50; and No. 3 Canadian Field Ambulance, Books 78–83, RG 150, various volumes, LAC. 129 CEF Registry, Directorate of Records, Department of National Defence, “Other Ranks: Monthly Strength Infantry, 1st Division,” RG 24, Volume 1874, File 22, Volume 1, LAC.

392

Notes to pages 187–92

130 Diary of Colonel Robert Percy Wright, 4 September 1916, McMaster University Archives (MUA). 131 Ibid., 1 September 1916. 132 Diary of Andrew Macphail, 5 October 1916. 133 The remaining cases could not be traced because the relevant records have not survived. There is no reason to believe, though, given the nature of the gaps, that these would have a significant effect on the results. 134 Medical Arrangements, 1st Canadian Division, 26 October 1916, RG 9 Series III-C-10 Volume 4540, Folder 2, File 2, File HQ CR 9-B-1, LAC. 135 Compiled from the admission and discharge books for No. 1 Canadian Field Ambulance, Books 11 and 12; No. 2 Canadian Field Ambulance, Books 46–50; and No. 3 Canadian Field Ambulance, Books 78–83, RG 150, various volumes, LAC. 136 Compiled from the admission and discharge books for No. 3 CCS, Books 898–904; No. 9 CCS, Books 949–55; No. 29 CCS, Books 1055–8; No. 30 CCS, Book 1062; No. 38 CCS, Book 1089; No. 42 CCS Books 1100–1; No. 44 CCS, Books 113–14 and 108–12; and No. 49 CCS, Books 1124–35, RG 150, various volumes LAC. 137 Ibid. 138 Personnel File of Thomas L. A., RG 150, Accession 1992–93/166, Box 109, File 56, LAC; A&D Book 82, No. 3 Field Ambulance, RG 150, Box 515, LAC; A&D Book 1058, No. 29 CCS, RG 150, Box 575, LAC. 139 Johnson, “Neurasthenia and War Neuroses,” 10. 140 On the ANZAC experience at Gallipoli see Robin Prior, Gallipoli: The End of the Myth (New Haven, CT: Yale University Press, 2009) and Joan Beaumont, Broken Nation: Australians in the Great War (Crows Nest, NSW: Allen and Unwin, 2013), 55–156. 141 Michael Tyquin, Gallipoli: The Medical War (Kensington: University of New South Wales Press, 1993), 109–24. 142 Notes on Colonel Manifold, AWM 41/1955, Australian War Memorial (AWM). 143 C.C. Manifold to Headquarters, 1 February 1918, AWM 41/659, AWM. 144 C.O. 7th Australian Field Ambulance to DDMS, I ANZAC, 12 August 1916, AWM 41/659. 145 A.W. Wilson, “Shell Shock and Allied Conditions,” c. February 1918, AWM 41/659, AWM. For a similar report, see C.O. 7th Australian Field Ambulance to DDMS, I ANZAC, 12 August 1916, AWM 41/659, AWM. 146 C.C. Manifold to Headquarters, 1 February 1918, AWM 41/659, AWM. 147 Ibid.



Notes to page 193 393

148 Colonel C.C. Manifold, “Notes on ‘Shell Shock’ cases which have Passed through some Australian Field Ambulances,” 27 August 1916, as quoted in Butler, Official History of the Australian Army Medical Services: Volume III, 110. 149 Ibid. 150 WD, DGMS, BEF, 27 August 1916, WO 95/45, NA. 151 Sir William Robertson, From Private to Field-Marshal (London: Constable and Company, 1921), 197. On Fowke see Anon., “Celebrities of the War,” Army and Navy Illustrated, 20 March 1915: 268. 152 Anon., “Celebrities of the War,” 268–9. 153 G.H. Fowke at All Armies, Secret GHQ Letter AX1549, 14 October 1916, RG 9, Series III-C-10, Volume 4546, Folder 6, File 2, LAC. 154 Ibid. 7  Managing Shell Shock 1 Personnel file, Arthur A., RG 150, Accession 1992–93/166, Volume 114, File 30, LAC; WD, 26th Battalion, 10, 13–16 January 1917, RG 9, Series IIID-3, Volume 4934, File 420, LAC. 2 Ibid. 3 Ibid. 4 WD, DMS, First Army, 11 November 1916, WO 95/196, NA. 5 G.H. Fowke at All Armies, Secret GHQ Letter AX1549, 14 October 1916, RG 9, Series III-C-10, Volume 4546, Folder 6, File 2, LAC. 6 DMS, Fourth Army No. 283/17, 17 November 1916, AWM 25 885/2, AWM. 7 DMS, Second Army No. A/2201/7, 25 November 1916, AWM 25 885/2, AWM. 8 DMS, Fifth Army No. 29d, 21 November 1916, WO 95/532, NA. 9 DMS No. 794/86, 4 November 1916, WO 95/196, NA; F.S. Morrison, 6 November 1916, RG 9, Series III-C-5, Volume 4413, Folder 2, File 10, LAC. 10 Ibid. 11 Harrison, The Medical War, 99–109. 12 Ibid. 13 See DMS, Reserve Army to DDMS, I ANZAC Corps, 14 August 1916, AWM 25 885/2, AWM. 14 Tim Cook, No Place to Run: The Canadian Corps and Gas Warfare in the First World War (Vancouver: UBC Press, 1999), 158–62. On the creation of the new centres see the more detailed instructions in DMS, First Army, No. 794/86, 22 August 1916, WO 95.196, NA.

394

Notes to pages 194–206

15 W.J. O’Connor, British Physiologists, 1885–1914: A Biographical Dictionary (Manchester: Manchester University Press, 1991), 194; WD, No. 21 CCS, 25 November 1916, WO 95/414, NA. 16 Frederick W. Mott and William Brown as reported in the transcript of “Special Discussion on Shell Shock without Visible Signs of Injury, 25 January 1916,” Proceedings of the Royal Society of Medicine 9 (1916): ii–xxviii. 17 William Brown, Psychology and Psychotherapy (London: Edward Arnold, 1921), v–vi. 18 Ibid., 6–7. 19 William Brown, “Precis of Paper on ‘Shell Shock, to Be Read at the Second Meeting of Fourth Army Medical Society, at South Midland CCS,” 21 January 1917 AWM 25 855/1, AWM, 1. 20 Ibid. 21 Ibid., 2. 22 DMS No. 794/86, 4 November 1916, WO 95/196, NA. 23 Macpherson, Medical Services: General History, vol. 3, 271–2; see WD, November and December 1916, WO 95/562, NA. 24 Ibid. The other special centres were: No. 6 Stationary Hospital (Third Army), No. 21 CCS (Fourth Army), and No. 3 Canadian Stationary Hospital (Fifth Army). Second Army did not name No. 12 CCS its special hospital until 1 December. 25 A&D Books, Nos. 1 and 2 Canadian Field Ambulances, Books 13, 50, and 51, Volumes 511–13, LAC. 26 The books for No. 4 Field Ambulance, which ran 2nd Canadian Division’s rest station, have not survived, while the 4th Canadian Division did not join the Canadian Corps until late December. 27 Personnel File, Robert George C., RG 150, Accession 1992–93/166, Box 1453, File 11, LAC. 28 A&D Books, Nos. 3 and 10 Canadian Field Ambulances, Books 82 and 83, Volume 515 and Books 230–3, Volume 523, LAC. 29 Compiled from entries for 23 November to 31 December 1916, RG 9, Series III-D-3, Volume 5028, File 825 Part 1, LAC. 30 DGMS, “Shell Shock,” DG 2367/45, 21 November 1916, WO 95/45, NA. 31 Shephard, A War of Nerves, 46–7. 32 DGMS, “Shell Shock,” DG 2367/45, 21 November 1916, WO 95/45, NA. 33 DG 2218/323, 25 November 1916, WO 95/45, NA. 34 WD, DMS, LOC, 4 December 1916, WO 95/3980, NA; Précises of Meeting with DGMS, WD, DMS, First Army, 4 December 1916, WO 95/196, NA.



Notes to pages 206–9 395

35 Report of the Inter-Allied Sanitary Conference Held at Paris, February 1917, AWM 41/659, AWM (hereafter Myers Paper), 1. 36 Ibid., 2. 37 Ibid. 38 Army, Report of the War Office Committee of Enquiry into “Shell-Shock” (London: HMSO, 1922), 123. 39 Ibid., 124 40 Edgar Jones and Simon Wessely, “‘Forward Psychiatry’ in the Military: Its Origins and Effectiveness,” Journal of Traumatic Stress 16, no. 4 (2003): 411–12. 41 Army, Report of the War Office Committee of Enquiry into “Shell-Shock”, 125. 42 Ibid., 125. 43 Ibid., 124. 44 Mark Osborne Humphries, “Old Wine in New Bottles: A Comparison of British and Canadian Preparations for the Battle of Arras,” in Vimy Ridge: A Canadian Reassessment, ed. Geoff Hayes, Andrew Iarocci, and Mike Bechthold (Waterloo: Wilfrid Laurier University Press, 2007), 65–86. 45 WD, DMS, First Army, 4 December 1916, WO 95/196, NA. 46 WD, DMS, Fifth Army, 4 December 1916, WO 95/532, NA. 47 Myers Paper, AWM 41/659, AWM, 1–3. 48 Minutes of DsMS Meeting, 4 December 1916, reprinted in war diary of 6 December 1916, WO 95/45, NA. 49 W.W. Pike, DMS 794/86, 22 August 1916, WO 95/194, NA; First Army, 1115/148 AQ, 5 November 1916, RG 9, Series III-C-5, Volume 4413, Folder 2, File 10, LAC. 50 Anon., “Obituary: Frederick Dillon,” University of Edinburgh Journal 22, no. 3 (1965): 170. 51 D.W. Carmalt Jones, A Physician in Spite of Himself (London: Royal Society of Medicine Press, 2009), 103–4. 52 WD, DMS, Fifth Army, 26 January 1917, WO 95/532, NA; Personnel File, RG 150, Accession 1992–93/166, Box 7317–47, LAC. For a description of the personnel and life at No. 3 Canadian Stationary Hospital from the perspective of a nurse see Anne E. Ross, “Narrative,” Anne E. Ross Papers, MG30 E446, LAC. 53 WD, DMS, Fifth Army, 26 January 1917, WO 95/532, NA. 54 DG 2369/43, 31 December 1916, WO 95/45, NA. 55 Myers, Shell Shock in France, 20–1. 56 WD, DMS, LOC, 8 and 19 January 1917, WO 95/3980, NA. 57 Ibid., 19 January and 19 February 1917.

396

Notes to pages 209–14

58 DMS First Army 794/86, 5 January 1917, RG 9, Series III-C-10, Volume 4540, Folder 2, File 2, File HQ CR 9-B-1, LAC; Circular No. 115, “Shell Shock,” 29 January 1917, AWM 25 481/8, AWM. 59 Gordon Holmes, “Spinal Injuries of Warfare,” British Medical Journal 2, no. 2866 (4 December 1915): 816–17. 60 See, for example, Case file, Richard A., admitted 8 April 1916, Gordon Holmes Case Notes, 1914–1918, NHNN/CN/27/8, Queen Square Archives (QSA). 61 Case file, William H., admitted 7 September 1916, NHNN/CN/27/9, QSA. 62 Carmalt Jones, A Physician in Spite of Himself, 104. 63 Edgar Jones, Adam Thomas, and Stephen Ironside, “Shell Shock: An Out­ come Study of a First World War ‘PIE’ Unit,” Psychological Medicine 37 (2007): 218–19. 64 Ibid., 215–23. 65 A&D Books, No. 4 Stationary Hospital, Canadians, Book 1864, RG 150, Volume 624, LAC; Books 1500–5, MH 106/1500–1505, NA. 66 Ibid.; Maxime Dagenais, “‘Une permission! C’est bon pour une recrue’: Discipline and Illegal Absences in the 22nd (French-Canadian) Battalion, 1915–1919,” unpublished Master’s thesis (University of Ottawa, 2006), 114–17. 67 Circular No. 43, 25 January 1917, AWM 25 481/8, AWM. 68 Carmalt Jones, “War-Neurasthenia, Acute and Chronic,” Brain 42, 3 (October 1919): 172–6. 69 Ibid., 204. 70 Ibid., 204–5. 71 Ibid., 205–9; quoted in A.D. Carbery, The New Zealand Medical Service in the Great War, 1914–1918 (Aukland: Whitcombe and Tombs, 1924), 320–1. See also Jones et al., “Shell Shock: An Outcome Study,” 216–17. 72 A&D Books, RG 150, No. 4 Stationary Hospital, Canadians, Book 1864, RG 150, Volume 624, LAC; Books 1500–5, MH 106/1500–1505, NA. 73 Medical Records, Pte. George A., RG 150, Accession 1992–93/166, Box 95, File 33, LAC. 74 Quoted in Carbery, The New Zealand Medical Service in the Great War, 320–1 with statistics quoted in WD, No. 4 Stationary Hospital, 15 March 1917, WO 95/4099, NA. 75 See WD, DMS, LOC, 6 and 15 February 1917, WO 95/3980, NA; WD, DGMS, 14 February 1917, WO 95/46, NA. 76 Carmalt Jones to Colonel A.L.F. Bate, Officer Commanding, No. 4 Stationary Hospital, 29 January 1917, AWM 25 885/1, AWM.



Notes to pages 214–19 397

77 Ibid. 78 Ibid. 79 WD, No. 4 Stationary Hospital, 14 March 1917, WO 95/4099, NA. 80 Ibid. 81 This memorandum, numbered DG 2369/43, was issued on 13 February 1917 as noted in the DGMS War Diary in an entry dated the next day (WO 95/46, NA); however, the actual text of the memorandum is missing from the appendices. A full copy of the text issued to Fifth Army was found in AWM 41/659, AWM. The same text, though, was sent as a circular to all DMSs in the forward army areas as well as to medical officers along the lines of communication and issued down to the divisional level. See First Army, 21 February 1917, RG 9, Series III-B-1, Volume 916, File C-63–3, LAC and WD, 14 and 15 February 1917, DMS, LOC, WO 95/3980, NA. 82 W.G. MacPherson for DGMS, DG 2369/43, “Instructions for Dealing with Cases of Suspected Shell Shock and Neurasthenia,” 13 February 1917, AWM 41/659, AWM. 83 Ibid. 84 Ibid. 85 WD, No. 4 Stationary Hospital, 11, 14, and 15 March 1917, WO 95/4099, NA. 86 This point was explained in a 2nd Canadian Division interpretive circular issued a week later. See J.T. Fotheringham, No. 7707, 21 February 1917, RG 9, Series III-B-1, Volume 916, File C-63–3, LAC. 87 See various examples in RG 9, Series III-B-1, Volume 916, File C-63–3, LAC. 88 Personnel File, Captain Harold Siward Gray, RG 150, Accession 1992– 93/166, Box 3754, File 72, LAC. 89 Hugh MacKinnon, CAMC to OC 20th Cdn Bn, 15 May 1917, RG 9, Series III-B-1, Volume 916, File C-63–3, LAC. 90 Although the barrage appears to have devastated German morale, Canadian soldiers reported that the constant noise of the guns was “nerve racking.” See Bill Green, “An Autobiography of World War I,” William A. Green Fonds, MG30 E430, LAC, page 3. 91 Nicholson, Canadian Expeditionary Force, 198, 265. 92 Cathcart, “Group A21,” RG 24, Volume 1844, File GAQ 11–11E, LAC. 93 Medical Records, Pte. James B., RG 150, Accession 1992–93/166, Box 1194, File 38, LAC. 94 Medical Records, Pte. Harry B., RG 150, Accession 1992–93/166, Box 728, File 41, LAC. 95 Colonel W.W. Ford, ADMS to DAAG, HQ, First Army, 24 April 1917, RG 9, Series III-B-1, Volume 916, File C-63-3, LAC.

398

Notes to pages 219–26

96 Colonel H.A. Chisholm, ADMS, 4th Canadian Div to DAAG, 4th Can Div, 5 May 1917, ibid. 97 3rd Battalion to Captain Gray, 15 April 1917, ibid. 98 Field Message, Sgt. Lamb, 3rd Battalion, c. 20 May 1917, ibid. 99 OC No. 4 Company to Captain Gray, 12 May 1917, ibid. 100 A&D Books, Nos. 1–6 Canadian Field Ambulances, RG 150, Volume 511, Books 14–22; Volume 513, Books 51–5; Volume 515, Books 84–7; Volumes 516–17, Books 111–17; Volume 518, Books 135–40; Volume 519, Books 155–62, LAC. 101 Medical Records, Pte. Frank B., RG 150, Accession 1992–93/166, Box 585, File 16, LAC. 102 George Cheever Shattuck, “Medical Work in the British Armies in France,” Transactions of the American Climatological and Clinical Association 35 (1919): 145–6. 103 Medical Records, Pte. Charles P. B., RG 150, Accession 1992–93/166, Box 390, File 50, LAC. 104 Medical Records, Pte. James Alexander B., RG 150, Accession 1992–93/166, Box 397, File 7, LAC. 105 MO 21st Battalion to Captain Gray, 16 May 1917, RG 9, Series III-B-1, Volume 916, File C-63–3, LAC. 106 Ibid. 107 Adjutant, 52nd Battalion to DAAG, Canadian Corps, 15 March 1917, ibid. 108 DAAG, Canadian Corps to 52nd Battalion, 19 March 1917, ibid. 109 MO 7th Battalion to CO 7th Battalion, 13 May 1917, ibid. 110 Various correspondence in RG 9, Series III-B-1, Volume 916, File C-63–3, LAC. 111 WD, No. 4 Stationary Hospital, 7 January 1917, WO 95/4099, NA. 112 Teresa Iacobelli, Death of Deliverance: Canadian Courts Martial in the Great War (Vancouver: UBC Press, 2013), 129–42. 113 A&D Books, No. 4 Stationary Hospital, Canadians, Book 1864, RG 150, Volume 624, LAC; Books 1500–5, MH 106/1500–1505, NA. 114 Personnel file, Pte. Joseph Walter F., RG 150, Accession 1992–93/166, Box 3341, File 39, LAC. 115 Personnel File, Private Joseph Henry G., RG 150, Accession 1992–93/166, Box 3359, File 34, LAC. 116 Personnel File, Private George Herbert A., RG 150, Accession 1992–93/166, Box 150, File 51, LAC. 117 WD, 19th Canadian Infantry Battalion, 1–10 August 1917, RG 9, Series IIID-3, Volume 4928, file 405, Part 2, LAC.



Notes to pages 226–30 399

118 Carmalt Jones, “War-Neurasthenia, Acute and Chronic,” 174. The paper was written in 1917, but not published until 1919. 119 DG/K/393/30, 5 April 1917, WO 95/46, NA. 120 Anon., “Obituary: Sir Wilmot Herringham,” British Medical Journal 1, no. 3930 (2 May 1936): 915–16. 121 Wilmot P. Herringham, A Physician in France (London: Edward Arnold, 1919), 40–1. 122 Personal Diary of Sit Anthony Bowbly, 16 January 1915, 23 April 1915, RAMC 2008/7/2, AWI. 123 Ibid. 124 Ibid. 125 Herringham, A Physician in France, 134. 126 No copy of the report survives, but Herringham dedicated a chapter of his memoirs to the shell shock problem, which provides a good indication as to the nature of his findings. 127 Herringham, A Physician in France, 134. 128 Ibid., 135–6. 129 DG/K/393/30, 5 April 1917, WO 95/46, NA; Herringham, A Physician in France, 139. 130 WD, No. 4 Stationary Hospital, 2 April 1917, WO 95/4099, NA. 131 Ibid., 2 April 1917. 132 Ibid., 9 April 1917. 133 WD, No. 3 Stationary Hospital, 19 March–21 May 1917, RG 9, Series IIID-3, Volume 5033, File 844, LAC. 134 WD, No. 4 Stationary Hospital, 1 May 1917, WO 95/4099, NA. 135 Colonel Bate, Return of Admissions, Discharges, Transfers, Etc. April 1917, Sick and Wounded, 1 May 1917, WO 95/4099, NA. 136 WD, No. 4 Stationary Hospital, 28 April and 14 May 1917, WO 95/4099, NA. 137 Ibid., 1 May 1917. 138 Ibid., 1 May 1917. This problem was not unique to No. 4 Stationary Hospital. See WD, DMS, LOC, 30 April 1917, WO 95/3980, NA. 139 George C. Shattuck, “Medical Work in the British Armies in France,” Transactions of the American Clinical and Climatological Association 35 (1919): 143–4. 140 Personnel File, Sapper Herbert James A., RG 150, Accession 1992–93/166, Box 153, File 32, LAC. 141 WD, No. 4 Stationary Hospital, 18 June 1917, WO 95/4099, NA. 142 WD, No. 4 Stationary Hospital, 1 June 1917, WO 95/4099, NA.

400

Notes to pages 230–8

143 Ibid., 1 and 19 June 1917. 144 Fowke and Haig to Army Council, 13 April 1918, reprinted in WO 163/23, pages 66–7, NA. K.W. Jones is a typographical or transposition error; Fowke is actually referring to D.W. Carmalt Jones’s February 1917 report. 145 General Routine Order 2384, RG 24, Volume 1844, File GAQ 11–11E, LAC. 146 G.H. Fowke to all DMSs, 18 June 1917, RG 9, Series III, Volume 1826, File M 28–15, LAC. 147 Myers, Shell Shock in France, 20–1, 100–2. 148 Ibid., 101. 149 DG/N/2263/267, WD, DGMS BEF, 2 August 1917, WO 95/47, NA. 150 William Johnson, “Neurasthenia and War Neuroses,” in Macpherson, Medical Services: Diseases of the War, vol. 2, 11. 8  Illusions of Success 1 Attestation Paper; Casualty Form, Active Service; AF 3634; Medical Case Sheet, Personnel File, Gunner Robert A., RG 150, Accession 1992–93/166, Volume 55, File 10, LAC. 2 E. Jones, A. Thomas, and S. Ironside, “Shell Shock: An Outcome Study of a First World War ‘PIE’ Unit,” Psychological Medicine 37, no. 2 (February 2001): 215–23. 3 OAD 426, “Record of a Conference held at Noyelle Vion,” 30 April 1917, WO 158/188, NA. 4 Robin Prior and Trevor Wilson, Passchendaele: The Untold Story (New Haven, CT: Yale University Press, 1996), 31–42. 5 Lieutenant-General L.E. Kiggell, GHQ OAD 434, 7 May 1917, WO 158/188, NA. 6 Ibid.; OAD 424, “Note for Conference on 30th April 1917,” 30 April 1917, WO 95/170, NA. 7 Prior and Wilson, Passchendaele, 45–8. 8 Colonel C. Begg, II Australian and New Zealand Army Corps, DDMS No. 1075/17, 19 June 1917, AWM 25 481/191. NA. 9 Gordon Holmes, quoted in Diary of Colin Russel, 16 September 1917, Colin Kerr Russel Fonds P098, Box 100 2/2, folder 5, Osler Library, McGill University. 10 Holmes, quoted in War Office, Report of the War Office Committee of Enquiry into “Shell Shock” (London: HMSO, 1922), 41. 11 WD, No. 45 CCS, 24 May and 15 August 1918, WO 95/416/6; WD, No. 51 CCS, 16 August and 7 October 1918, WO 95/563/5, NA.



Notes to pages 238–43 401

12 WD, No. 62 CCS, 23 August 1917, WO 95/345–3; WD, DMS, Fifth Army, 20 August 1917, WO 95/532, NA. 13 C.S. Myers, Shell Shock in France, 1914–1918 (Cambridge: Cambridge University Press, 1920), 106. 14 WD, DMS, Fifth Army, 25 March 1917, WO 95/532, NA. 15 Ibid., 25 March 1917; Myers, Shell Shock in France, 107. 16 See W.B. Davy, “On the Dressing of Septic Gunshot Wounds,” The Lancet, 9 September 1916: 475. 17 WD, DMS, Fifth Army, 17 and 25 May 1917, WO 95/532, NA. 18 Edward Jones and Simon Wessely, Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War (London: Psychology Press, 2005), 21–4. 19 WD, DMS, Fifth Army, 25 May 1917, WO 95/532, NA. 20 Nichols to Sloggett, DMS No. 29/4, 3 July 1917, WO 95/532, NA. 21 WD, DMS, Fifth Army, 18 July 1917, WO 95/532, NA. 22 WD, DMS, Fifth Army, 19 July 1917, WO 95/532, NA; see also Myers, Shell Shock in France, 107. 23 Adjutant-General G.H. Fowke, AG (b) 6902, 18 June 1917, RG 9, Series IIIB-1, Volume 1826, File M-28–15, LAC. 24 Colonel C. Begg, II Australian and New Zealand Army Corps, DDMS No. 1075/17, 19 June 1917, AWM 25 481/191, AWM. 25 WD, DMS First Army, 10 July 1917, referenced to Appendix 13, WO 95/197, NA. Although the actual appendix is missing from the file, a copy can be found in First Army, “NYDN,” 10 July 1917, RG 9, Series III-B-2, Volume 3618, File 25–13–10, LAC. 26 Diary of Colin Russel, 4 October 1917, Russel Fonds P098, Box 100 2/2, folder 5, Osler Library. 27 Colonel W. Macdonald, DDMS, III Corps, Routine Orders, 16 July 1917, WO 95/696, NA. 28 Haig and Fowke to Army Council, Précis No. 928, Minutes of the Proceedings of, and Precis Prepared for, the Army Council for the Year 1918, WO 163/23, NA. 29 Colonel C. Begg, II ANZAC Corps No. 1075/17, 19 June 1917, AWM 25 481–191, AWM, 1; this policy would be reiterated by Second Army several times during the summer and fall of 1917. 30 Ibid., 1. 31 Ibid., 1. 32 Ibid., 2. 33 Tim Cook, Shock Troops: Canadians Fighting the Great War, 1917–1918 (Toronto: Viking Canada, 2008), 149–68. 34 Nicholson, Canadian Expeditionary Force, 269–97.

402

Notes to pages 243–8

35 Cook, Shock Troops, 306–7. 36 Canon Frederick Scott, The Great War as I Saw It (Toronto: F.D. Goodchild Co., 1922), 198–9. 37 Diary of D.E. Macintyre, 15 August 1917, MG30 E241, page 336. 38 C.B. Holmes interview by unknown CBC researcher, 7 May 1963, RG 41, Volume 11, File 25th Battalion, LAC. 39 Maheux to wife and children, 20 August 1917, MG30 E297, File 10, LAC. 40 H.P. Wright, Special Medical Arrangements for the Coming Offensive, 27 July 1917, Rg 9, Series III-D-3, Volume 5024, File 814, Part 2, LAC. 41 A&D Books, Nos. 1, 2, and 3 Canadian Field Ambulances, admissions for August 1917, Books 25–6, 58–60, and 88–90, RG 150, Volumes 511–15, LAC. 42 One case had no outcome listed. 43 Personnel File, James William C., RG 150, Accession 1992–93/166, Box 1948, File 8, LAC. 44 Personnel File, Thomas F., RG 150, Accession 1992–93/166, Box 3310, File 11, LAC. 45 Personnel File, Roger A., RG 150, Accession 1992–93/166, Box 320, File 48, LAC. 46 A&D Books, Nos. 1, 2, and 3 Canadian Field Ambulances, admissions for August 1917, Books 25–6, 58–60, and 88–90, RG 150, Volumes 511–15, LAC. 47 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria Admissions Correspond[ed] to Date of Admission by Months,” 16 Novem­ber 1919, RG 24, Volume 1844, File GAQ 11–11E, LAC. 48 WD, I ANZAC Corps, Headquarters, AWM 4 1/29/18, AWM; WD, No. 3 Canadian Stationary Hospital, Entries for July and August 1917, RG 9, Series III-D-3, Volume 5033, File 844, LAC. 49 WD, DMS, Second Army, 23 August 1917, WO 95/286, NA. 50 WD, DMS, Second Army, 27 September 1917, WO 95/286, NA. 51 Ibid. 52 WD, New Zealand Stationary Hospital, 27 September 1917, WO 95/4108/2, NA; on Gray’s career in New Zealand see his memoir, T.G. Gray, The Very Error of the Moon (Auckland: Stockwell, 1959). Unfortunately, the book says almost nothing about Gray’s war experiences. 53 Ibid. 54 WD, DMS, Second Army, 27 September 1917, WO 95/286, NA. 55 C.C. Manifold to HQ I ANZAC, 10 October 1917, AWM 25 481/205, AWM; see also CC Manifold, DDMS, I ANZAC, 2 October 1917, AWM 25 885/2, AWM. 56 C.C. Manifold, DDMS, I ANZAC, 2 October 1917, AWM 25 885/2, AWM.



Notes to pages 248–53 403

57 C.C. Manifold to Headquarters, I ANZAC, 10 October 1917, AWM 25 481/205, AWM. 58 ADMS Hearne to AA&QMG, 14 October 1917, AWM25 481/205, AWM. 59 I ANZAC, Medical Arrangements, Operations No. 5, 15 September 1917, AWM4 26/15/20, AWM. 60 C.C. Manifold, DDMS, I ANZAC, 2 October 1917, AWM25 885/2, AWM. 61 Colonel C.C. Manifold, DDMS I ANZAC to I ANZAC AQ, 21 October 1917, AWM25 481/205, AWM. 62 Colonel C.C. Manifold, DDMS Australian Corps, 1 February 1918, AWM 41/659, AWM. 63 Ibid. 64 Herbert Laurier Irwin to Family, 20 February 1918, Herbert Laurier Irwin Collection, CLIP, http://www.canadianletters.ca/content/ document-7657. 65 Diary of Andrew Robert Coulter, 4 November 1917, CWM 20060105–001, CWM. 66 DMS, Second Army, Medical Arrangement for Forthcoming Offensive, 24 October 1917, RG 9, Series III-C-10, Volume 4540, File HQ CR 9-B-1, LAC. 67 A&D Books, No. 2 Canadian Field Ambulance, admissions from 14 Octo­ ber to 21 November 1917, RG 150, Volumes 514, Books 61–2, LAC. 68 Ibid. 69 Group A21, RG 24, Volume 1844, File GAQ 11–11E, LAC. 70 Diary of Herbert Hill White, 14 October 1917, Herbert Hill White Col­ lection, CLIP, http://www.canadianletters.ca/content/document-2740; Personnel File, RG 150, Accession 1992–93/166, Box 10291, File 47, LAC. 71 Lieutenant A.G. Lunt interviewed by Frank Lalor, 27 April 1963, RG 41, Volume 7, File 4th Battalion, LAC. 72 Interview Pte. Todd, RG 41, Volume 7, File 4th Battalion, LAC. 73 Interview Leo Lasnier, RG 41, Volume 11, File 22nd Battalion, LAC; interview with W.V.B. Riddell, RG 41, Volume 7, File 2nd Battalion, LAC. 74 Bernard Freeman Trotter to Marjorie, 29 December 1916, Bernard Trotter Collection, CLIP, www.canadianletters.ca/content/document-2611. 75 Bertram Howard Cox to Mamma, 15 October 1918, Bertram Howard Cox Collection, CLIP, http://www.canadianletters.ca/content/document41714; Personnel File, Bertram Howard Cox, RG 150, Accession 1992– 93/166, Box 2079, File 52, LAC. 76 Thomas James Leduc to wife, 10 July 1917, Thomas James Leduc Collection, CLIP, http://www.canadianletters.ca/content/document-18397. 77 Interview Pte. Lunt, RG 41, Volume 7, File 4th Battalion, LAC.

404

Notes to pages 254–60

78 Diary of Donald Fraser, 21 August 1917, MG30 E470, LAC. 79 Report of Captain Gray on NYDN Cases, 30 September 1917, WO 95/ 4108/2, NA. 80 AG (b) 6902, Circular Memorandum, 18 June 1917, AWM 25 885–6, AWM. 81 Report of Captain Gray on NYDN Cases, 30 September 1917, WO 95/ 4108/2, NA. 82 Copy of W3436, RG 9, Series III-B-2, Volume 3618, File 25–13–10, LAC. 83 AG (b) 6902, Circular Memorandum, 18 June 1917, RG 9, Series III, Volume 1826, File M 28–15, LAC. 84 Ibid. 85 Haig and Fowke (under Fowke’s signature) to the Army Council, 13 April 1918, WO 163/23, NA. 86 Ibid. 87 Report of Captain Gray on NYDN Cases, 30 September 1917, WO 95/4108/2, NA. 88 Précis No. 928, Minutes of the Army Council, WO 163/23, NA. 89 Copy of W3436, RG 9, Series III-B-2, Volume 3618, File 25–13–10, LAC. 90 AFW 3436, 12 July 1917, RG 150, Accession 1992–93/166, Volume 1998, File 18, LAC. 91 AFW 3436, 15 July 1917, RG 150, Accession 1992–93/166, Volume 3353, File 125, LAC. 92 Carmalt Jones, “War-Neurasthenia, Acute and Chronic,” 201; Frederick Dillon, “On the Nature of ‘Shell Shock,’” Bulletin of the Canadian Army Medical Corps 1, no. 6 (September 1918): 80–1; William Johnson, “Neur­ asthenia and War Neuroses in France,” in Macpherson, Medical Services: Diseases of the War, vol. 2, 18–19; William Brown, “War Neurosis: A Com­ parison of Early Cases Seen in the Field with Those Seen at the Base,” Proceedings of the Royal Society of Medicine (Section on Psychiatry), 12 (1919): 55–6. 93 See appendix A. 94 Allan Young, “W.H.R. Rivers and the War Neuroses,” Journal of the History of the Behavioural Sciences 35, no. 4 (Fall 1999): 359–76; William H. Tucker, The Cattell Controvery: Race, Science, and Ideology (Chicago: University of Illinois Press, 2009), 67–9; Russel A. Jones, “Psychology, History, and the Press: The Case of William McDougall and the New York Times,” American Psychologist 42, no. 10 (October 1987): 931–4. 95 William McDougall, An Introduction to Social Psychology, Sixth Edition (London: Methuen and Co., 1912), 23. 96 Ibid., 26. 97 Ibid., 30 and 41–2.



Notes to pages 260–9 405

98 Ibid., 33 99 Ibid., 41–2. 100 Editors, “The Neuroses of the War,” The Lancet, 11 January 1919: 71. 101 Frederick Dillon, “On the Nature of ‘Shell Shock,’” Bulletin of the Canadian Army Medical Corps 1, no. 6 (September 1918): 80. 102 Ibid., 80. 103 Frederick Dillon, “A Survey of the War Neuroses,” unpublished PhD dissertation (University of Edinburgh, 1920), 181–7. 104 Diary of Colin Russel, 9 October 1917, P98 Colin Kerr Russel Fonds, Box 100 2/2, File 5, Archives of the Osler Library, McGill University. 105 Dillon, “A Survey of the War Neuroses,” 15. 106 William Brown, “The Treatment of Cases of Shell Shock in an Advanced Neurological Centre,” The Lancet 2 (17 August 1918): 198. 107 Johnson, “Neurasthenia and War Neuroses in France,” 18–19. 108 Brown, “War Neurosis,” 55–7. 109 Haig and Fowke (under Fowke’s signature) to the Army Council, 13 April 1918, WO 163/23, NA. 110 Dillon, “A Survey of the War Neuroses,” 188. 111 Ibid., 188–9. 112 Macpherson, Medical Services: Diseases of the War, vol. 2, 36–7. 113 Brown, “The Treatment of Cases of Shell Shock in an Advanced Neuro­ logical Centre,” 197; Dillon, “A Survey of the War Neuroses,” 181–2. 114 Dillon, “A Survey of the War Neuroses,” 189–90. 115 Brown, “The Treatment of Cases of Shell Shock in an Advanced Neuro­ logical Centre,” 198. 116 Dillon, “A Survey of the War Neuroses,” 189–91. 117 Ibid., 191–2. 118 Ibid., 193. 9  Failure and Retrenchment 1 WD, 20th Battalion, 4–19 November 1918, RG 9, Series III-D-3, Volume 4930, File 409, Part III, LAC; Personnel File, Louis D., RG 150, Accession 1992–93/166, Box 2599, File 11, LAC; A&D Book 929, No. 6 CCS, RG 150, Volume 568, LAC. 2 E.R.C. Graham, Report: Table A, 3 January 1918, WO 163/23, Précis No. 928, NA. 3 Ibid. 4 Carmalt Jones, “War-Neurasthenia, Acute and Chronic,” 201; William Brown, “Functional Nervous Disturbances Resulting from Exposure to

406

Notes to pages 269–75

Shell-Fire,” Paper read at Second Meeting of the Fourth Army Medical Society, 21 January 1917, AWM 25/885/1, AWM. 5 Table in Colin Russel Diary, 9 October 1917, Colin Kerr Russel Fonds P098, Box 100 2/2, folder 5, Osler Library, McGill University. 6 WD, DMS, Fifth Army, 19 September 1917, WO 95/532, NA. 7 William Johnson, “Neurasthenia and War Neuroses in France,” in Macpherson, Medical Services: Diseases of the War, vol. 2, 43–4; Frederick Dillon, “Notes,” 4 October 1917, Colin Kerr Russel Fonds P098, Box 98, File “Neuropsychiatrist Looks at War,” Osler Library, McGill University. 8 A&D Books, New Zealand Stationary Hospital and No. 15 CCS, Entries for Autumn 1917, RG 150, Volume 646, Book 2199 and Volume 571, Book 984A, LAC. 9 E.R.C. Graham, Report: Table A, 3 January 1918, WO 163/23, Précis No. 928, NA; WD, DMS, Fifth Army, 2 August 1917, WO 95/532, NA; WD, DMS, Second Army, 27 September 1917, WO 95/286, NA. 10 E. Jones, A. Thomas, S. Ironside, “Shell Shock: An Outcome Study of a First World War ‘PIE’ Unit,” Psychological Medicine 37, no. 2 (February 2001): 220. 11 Ibid. 12 A&D Books, No. 4 Stationary Hospital, RG 150, Volume 624, Book 1864, LAC; Books 1500–5, MH 106/1500–1505, NA. 13 Award Citation, 30 April 1918, RG 150, Accession 1992–93/166, Box 4020, File 26, LAC. 14 Personnel File, Edward B., RG 150, Accession 1992–93/166, Box 1066, File 9, LAC. 15 Form W3436, ibid. 16 Personnel file, Fred G., RG 150, Accession 1992–93/166, Box 3700, File 28, LAC. 17 Ibid. 18 Personnel File, Fred B., RG 150, Accession 1992–93/166, Box 463, File 40, LAC. 19 F.G. Finley, “Shell-shock,” 24 May 1917, page 2, RG 9, Series, III, Volume 3618, File 25–13–10, LAC. 20 Frederick Dillon, “Notes,” 4 October 1917, Colin Kerr Russel Fonds P098, Box 98, File “Neuropsychiatrist Looks at War,” Osler Library, McGill University; Table, Colin Russel Diary, 9 October 1917, Colin Kerr Russel Fonds P098, Box 100 2/2, folder 5, Osler Library, McGill University. 21 This is based on aggregate figures reported by Dillon after the war, which suggested an average return-to-duty rate of 70 per cent for the entire conflict. Because the figures for December 1916 to August 1917 can be found



Notes to pages 275–8 407

in other sources and then excluded, we know that the return-to-duty rate for the period September 1917 to October 1918 fell to just above 50 per cent. See Frederick Dillon, “Neuroses among Combatant Troops in the Great War,” British Medical Journal, 8 July 1939: 66. 22 See discussion on pages 279–84. 23 Haig and Fowke to Army Council, Précis No. 928, Minutes of the Proceedings of, and Precis Prepared for, the Army Council for the Year 1918, WO 163/23, NA. 24 F.E. Noakes, The Distant Drum: A Memoir of a Guardsman in the Great War (Barnsley: Pen and Sword, 2010), 112, quoted at 113–14. 25 A&D Books, No. 4 Stationary Hospital, RG 150, Volume 624, Book 1864, LAC; Books 1500–5, MH 106/1500–1505, NA. 26 Haig and Fowke to Army Council, Précis No. 928. 27 Jones et al., “Shell Shock,” 220–3. 28 A&D Books, No. 7 Convalescent Depot, RG 150, Volume 628, Books 1934–8, LAC. 29 Personnel File, Pte. James B., RG 150, Accession 1992–93/166, Box 862, File 37, LAC. 30 Personnel File, Private William James B., RG 150, Accession 1992–93/166, Box 352, File 36, LAC. 31 A&D Books, No. 7 Convalescent Depot, RG 150, Volume 628, Books 1934– 1938, LAC. 32 Carmalt Jones, “War-Neurasthenia, Acute and Chronic,” 201; Dillon, “On the Nature of ‘Shell Shock,’” 80–1; Johnson, “Neurasthenia and War Neuroses in France,” 18–19; Brown, “War Neurosis,” 55–6. 33 Colin J. Lovelace, “British Press Censorship during the First World War,” in Newspaper History: From the Seventeenth Century to the Present Day, ed. George Boyce, James Curran, and Pauline Wingate (London: Constable, 1978), 307–19; J.M. McEwen, “‘Brass-Hats’ and the British Press during the First World War,” Canadian Journal of History 18, no. 2 (1983): 43–67. For the Canadian context see Jeff Keshen, Propaganda and Censorship during Canada’s Great War (Edmonton: University of Alberta Press, 1996), 97–126; for the British home front see Brock Millman, Managing Domestic Dissent in First World War Britain (London: Routledge, 2014). 34 See various entries in WD, ADDGMS, WO 95/50/6, NA. 35 Ibid., 19 March 1917. 36 Interview with Captain F. Dillon, RAMC, 4 June 1918, RG 9, Series III-B-2, Volume 3752, file 31–4-2, LAC. 37 WD, ADDGMS, 24 July 1918, WO 95/50/6, NA; this paper was published as Frederick Dillon, “On the Nature of ‘Shell Shock,’” Bulletin of the Canadian Army Medical Corps 1, no. 6 (September 1918): 79–83.

408

Notes to pages 279–83

38 WD, ADDGMS, 18 July 1918, WO 95/50/6, NA. 39 William Brown, “The Treatment of Cases of Shell Shock in an Advanced Neurological Centre,” The Lancet 2 (17 August 1918): 197–200. 40 WD, DMS, Fifth Army, 29 July, 2, 16, 20 August 1917, WO 95/532, NA. 41 Lieutenant Colonel J.H. Forrester Addie and Captain A.T.A. Dobson, “Agriculture Behind the Lines in France,” Journal of the Ministry of Agriculture 28, no. 8 (1921): 681–3. 42 WD, DMS, Fifth Army, 24 July 1917, WO 95/532, NA. 43 Ibid., 20 August 1917. 44 Ibid., 19 September 1917; Johnson, “Neurasthenia and War Neuroses in France,” 41. 45 Myers, Shell Shock in France, 106. 46 WD, DMS, LOC, 20 October 1917, WO 95/3980, NA. 47 Surgeon-General R.M.S. Sawyer, DDMS, Boulogne Base, Order 475, 25 August 1917, WO 95/4014/6, NA. 48 Charles Edwin Woodrow Bean, The Australian Imperial Force in France, 1916, 12th ed. (Sydney: Angus and Robertson, 1941), 161. 49 Harvey Cushing, From a Surgeon’s Journal: 1915–1918 (Boston: Little, Brown, and Company, 1936), 113. 50 Anon., “Obituary: S.W. Patterson,” British Medical Journal 10, no. 1136 (21 May 1960): 1575. 51 Ibid. 52 Russel Diary, 16 September 1917, Colin Kerr Russel Fonds P098, Box 100 2/2, folder 5, Osler Library, McGill University. 53 Ibid. 54 Ibid. 55 WD, DGMS, 2 August 1917, WO 95/47, NA. 56 On French approaches to shell shock see Marc Roudebush, “A Battle of Nerves: Hysteria and Its Treatments in France during World War I,” in Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930, ed. Mark S. Micale and Paul Lerner (Cambridge: Cambridge University Press, 2001), 253–79. On French military medicine more generally see Sophie Delaporte, Les médecins dans la Grande Guerre, 1914–1918 (Paris: Bayard Editions, 2003). 57 Myers, Shell Shock in France, 102–6 58 Ibid., 103. 59 Ibid., 105–6. 60 Ibid., 110. 61 WD, DGMS, 2 September 1917, 3 November 1917, 8 January 1918, WO 95/ 47, NA.



Notes to pages 283–6 409

62 Myers, Shell Shock in France, 110. 63 WD, DMS, LOC, 20 November 1917, WO 95/3980, NA; WD, DGMS, 19 December 1917, WO 95/47, NA. 64 E.R.C. Graham, Report: Table A, 3 January 1918, WO 163/23, NA. 65 Ibid. 66 Précis No. 928, Minutes of the Army Council, WO 163/23, NA. 67 Frederick Dillon, “Notes,” 4 October 1917, Colin Kerr Russel Fonds P098, Box 98, File “Neuropsychiatrist Looks at War,” Osler Library, McGill University. 68 Ibid. 69 Ibid. 70 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria Admissions Correspond[ed] to Date of Admission by Months,” 16 No­ vember 1939, RG 24, Volume 1844, File GAQ 11–11E, LAC; Colin Russel to G.L. Foster, 4 July 1917, Colin Kerr Russel Fonds P098, Box 98, File “Neuropsychiatrist Looks at War,” Osler Library, McGill University. 71 Summaries, February to July 1916, P98 Colin Kerr Russel Fonds, Box 98, File “Neuroses – Great War,” Osler Archives. 72 Anon., “Obituary: FG Finley,” Canadian Medical Association Journal, August 1940: 192–3. 73 F.G. Finley, “Shell-shock,” 24 May 1917, page 2, RG 9, Series, III, Volume 3618, File 25–13–10, LAC. 74 Ibid., 2–3. 75 Ibid., 3. 76 Russel to Finley, 11 February 1917, RG 9, Series III, Volume 3618, File 25– 13–11, LAC. 77 Casualty Form, Active Service, Entry for 18 April 1917, Major Colin Kerr Russel, RG 150, Accession 1992–93/166, Volume 8552, File 41, LAC. 78 W.W. Francis, “Colin Russel, the Man,” Canadian Medical Association Journal 77 (1 October 1957): 718. 79 Colin Russel to Finley, 11 February 1917, RG 9, Series III-B-2, Volume 3618, File 25–13–11, LAC; Sailing Orders, 30 September 1916, Major Colin Kerr Russel, RG 150, Accession 1992–93/166, Volume 8552, File 41, LAC. 80 Attestation Paper, Sgt. Albert B., RG 150, RG 150, Accession 1992–93/166, Volume 800, File 30, LAC. 81 Case Summary, RG 9, Series III, Volume 3618, File 25–13–11, LAC. 82 A&D Books, Canadian Special Hospital, Granville, Entry for 2 February 1916, RG 150, Volume 585, Book 595, LAC. 83 Russel to Finley, 11 February 1917, and Note from Russel, undated (marked page 11), RG 9, Series III, Volume 3618, File 25–13–11, LAC.

410

Notes to pages 286–93

84 Case Summary, RG 9, Series III, Volume 3618, File 25–13–11, LAC, 37. 85 Russel to Finley, 11 February 1917, and Note from Russel, undated (marked page 11), RG 9, Series III, Volume 3618, File 25–13–11, LAC. 86 Ibid. 87 Case Summary, RG 9, Series III, Volume 3618, File 25–13–11, LAC, 37. 88 Ibid. 89 A&D Books, Canadian Special Hospital, Granville, RG 150, Volume 585, Books 585–96 and 596A, LAC. 90 Richard Holt, “An Administrative Learning Curve: Casualty Rehabilita­ tion in the Canadian Expeditionary Force,” Canadian Military History 24, no. 1 (2015). http://scholars.wlu.ca/cgi/viewcontent.cgi?article=1761& context=cmh. 91 A&D Books, Canadian Special Hospital, Granville, RG 150, Volume 585, Books 585–96 and 596A, LAC. 92 F.G. Finley, “Shell-shock,” 24 May 1917, page 3, RG 9, Series, III, Volume 3618, File 25–13–10, LAC. 93 Russel to Foster, 4 July 1917, Colin Kerr Russel Fonds P098, Box 98, File “Neuropsychiatrist Looks at War,” Osler Library, McGill University. 94 Ibid. 95 Colin Russel, “Report on a Visit to the ‘Shell Shock’ Centres of the 1st and 3rd Armies of the BEF in France,” RG 9, Series III-B-2, Volume 3618, File 23–13–10, LAC. 96 Colin Kerr Russel, Manuscript Paper, “The Neuropsychiatrist Looks at War,” n.d., Colin Kerr Russel Fonds P098, Box 98, File “Neuropsychiatrist Looks at War,” Osler Library, McGill University, page 4. 97 Stephen J. Harris, Douglas Haig and the First World War (Cambridge: Cambridge University Press, 2008), 442–6. 98 Haig and Fowke (under Fowke’s signature) to the Army Council, 13 April 1918, WO 163/23, NA. 99 Carmalt Jones, A Physician in Spite of Himself, 109–11. 100 Haig and Fowke (under Fowke’s signature) to the Army Council 13 April 1918, WO 163/23, NA. 101 Ibid. 102 David T. Zabecki, The German 1918 Offensives: A Case Study in the Operational Level of War (London: Routledge, 2006), 113–73. 103 WD, No. 41 Stationary Hospital, 26 March 1918, WO 95/4107/5, NA. 104 Rattray Diary, 26 March 1918, No. 26, General Hospital in Étaples, France Collection, RAMC 728/2/8, AWI. 105 Nicholson, Canadian Expeditionary Force, 362–85; Tim Cook, Shock Troops: Canadians Fighting the Great War, 1917–1918 (Toronto: Viking Canada, 2008), 383–98.



Notes to pages 293–305 411

106 H.N. Thompson, “Statement of all cases dealt with under headings of nervous, neurasthenia, hysteria, etc., Shell Shock (Wound),” weekly reports for March, April, and May 1918, WO 95/198, NA. 107 First Army: 794/86, H.N. Thompson to DGMS, GHQ, 2nd Echelon, 18 April 1918, WO 95/198, NA. 108 Ibid.; WD, DGMS, 18–20 April 1918, WO 95/45, NA. 109 Personnel File, Pte. Frank H., RG 150, Accession 1992–93/166, Box 1134, File 45, LAC. 110 H.N. Thompson, “Statement of all cases dealt with under headings of nervous, neurasthenia, hysteria, etc., Shell Shock (Wound), weekly reports for December 1917 to May 1918, WO 95/198, NA. These reports list cases by corps and division. 111 Harris, Douglas Haig and the First World War, 467–74. 112 5 June 1918, Decisions, Minutes of the Proceedings of, and Precis Prepared for, the Army Council for the Year 1918, WO 163/23, NA. 113 GRO 4692, WO 123/201, NA. 114 Ibid. 115 Ibid. and WD, No. 51 CCS, 9–15 August 1918, WO 95/563/5, NA. 116 GRO 4692, WO 123/201, NA. 117 DMS, Fifth Army, Circular Memorandum No. 2, August 1918, AWM 25 885/6, AWM. 118 A&D Books, Nos. 6 and 30 Casualty Clearing Stations, RG 150, Volumes 568 and 575, Books 919, 928–9, 1059, 1065, and 1863, LAC. 119 “Special Hospitals with the British Armies in France for the Diagnosis and Treatment of NYDN Cases (Shell Shock) c. 8–28 August 1918,” RG 9, Series III-B-2 Volume 3618, File 25–13–10, LAC. 120 Personnel File, Frank G., RG 150, Accession 1992–93/166, Box 3636, File 41, LAC. 121 This was the routine that Johnson developed at all his hospitals. See WD, No. 62 CCS, 5 September 1917, WO 95/345–3, NA. 122 H.N. Thompson, “Statement of all cases dealt with under headings of nervous, neurasthenia, hysteria, etc., Shell Shock (Wound),” Weekly Reports for August–November 1918, WO 95/198, NA. 123 Ibid. 124 Nervous Cases Admitted to AEF Field Ambulances, AWM 41/739, AWM. 125 Joanna Bourke, “Effeminacy, Ethnicity and the End of Trauma: The Sufferings of ‘Shell-shocked’ Men in Great Britain and Ireland, 1914–39,” Journal of Contemporary History 35, no. 1 (2000): 58–9. 126 J.P.S. Cathcart, “Group A21 – Neurasthenia, Shell Shock, and Hysteria Admissions Correspond[ed] to Date of Admission by Months,” 16 No­ vember 1939, RG 24, Volume 1844, File GAQ 11–11E, LAC.

412

Notes to pages 305–12

127 “Syllabus for Corps School of Medical Officers, 1918,” AWM 25 881/64, AWM. 128 Major C.L. Chapman, “Lecture on Duties of a Medical Officer in Stationary Warfare,” 1918, AWM 27/370/98, AWM. 129 First Army 677/40, H.N. Thompson, DMS, First Army to Canadian Corps, 23 February 1918, RG 9, Series IIIC5, Volume 4397, File 5, Folder 7, LAC. 130 A.G. Butler, “AAMC and Morale,” 1918, AWM 27 370/15, AWM. 131 H.N. Thompson to DGMS, 30 March 1918, WO 95/197, NA. 132 General Staff Memorandum 208, 4 March 1918, AWM 27/304/29, AWM. 133 Obituary Dr George Strathy, Barrie Examiner, 18 June 1925, 13; excerpt from Major Strathy’s Personal Diary, n.d. 1918, RG 9, Series III-B-2, Volume 3752, File 3–2-11, LAC. 134 For examples of how new soldiers reacted to the horrors of life at the front late in the war see “Personal Experiences and Adventures,” June 1919, Ernest Jasper Spilett Fonds, MG30 E209, LAC. 135 William J. O’Brien, “Send Out the Army and the Navy …,” 14 August 1918, William J. O’Brien Fonds, MG30 E389, LAC. 136 Timothy Winegard, For King and Kanata: Canadian Indians and the First World War (Winnipeg: University of Manitoba Press, 2012), 113–17; Robin Brownlie, A Fatherly Eye: Indian Agents, Government Power, and Aboriginal Resistance (Toronto: Oxford University Press, 2003), 65–8. 137 Personnel File, RG 150, Accession 1992–93/166, Volume 7701, File 23, LAC. 138 Personnel File of Thomas C., RG 150, Accession 1992–93/166, Box 1854, File 13, LAC. 139 GRO 4692, WO 123/201, NA. 140 DMS, Fifth Army, Circular Memorandum No. 2, August 1918, AWM 25 885/6, AWM. 141 A&D Books, Nos. 6 and 30 Casualty Clearing Stations, RG 150, Volumes 568 and 575, Books 919, 928–9, 1059, 1065, and 1863, LAC. 142 “Special Hospitals with the British Armies in France for the Diagnosis and Treatment of NYDN Cases (Shell Shock) c. 8–28 August 1918,” RG 9, Series III-B-2 Volume 3618, File 25–13–10, LAC. 143 Personnel File, Frank G., RG 150, Accession 1992–93/166, Box 3636, File 41, LAC. Conclusion 1 The introduction and bibliography provides a comprehensive list of sources and overview of the literature so it need not be repeated here. In terms of major works in this school, see Anthony Babington, Shell-Shock:









Notes to pages 312–24 413 A History of the Changing Attitudes to War Neurosis (London: Leo Cooper, 1997); M.W. Binneveld, From Shell Shock to Combat Stress: A Comparative History of Military Psychiatry (Amsterdam: Amsterdam University Press, 1997); Thomas Brown, “Shell Shock and the Canadian Expeditionary Force, 1914–18: Canadian Psychiatry in the Great War” in Health, Disease and Medicine: Essays in Canadian History, ed. C. Roland (Toronto: Hannah Institute, 1983); Eric Leed, No Man’s Land: Combat and Identity in World War I (Cambridge: Cambridge University Press, 1979); Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830–1980 (New York: Pantheon Books, 1985); Martin Stone, “Shellshock and the Psychologists,” in The Anatomy of Madness: Essays in the History of Psychiatry, Volume II: Institutions and Society, ed. W.F. Bynum, M. Shephard, and R. Porter (New York: Tavistock, 1985), 242–71. 2 Peter Barham, Forgotten Lunatics of the Great War (New Haven: Yale University Press, 2004); Marijke Gijswijt-Hofstra and Roy Porter, eds., Cultures of Neurasthenia from Beard to the First World War (Amsterdam, New York: Rodopi, 2001); Edgar Jones and Simon Wessely, Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War (New York: Psychology Press, 2005); Peter Leese, Traumatic Neurosis and the British Soldiers of the First World War (Basingstoke: Palgrave Macmillan, 2002); Tracey Loughran, “Shell-Shock and Psychological Medicine in First World War Britain,” Social History of Medicine 22, no. 1 (2008): 79–95; Loughran, “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and Its Histories,” Journal of the History of Medicine and Allied Sciences 67, no. 1 (2012): 94–119; Loughran, “A Crisis of Masculinity? Re-Writing the History of Shell-Shock and Gender in First World War Britain,” History Compass 11, no. 9 (2013): 727–38; Loughran, “Hysteria and Neurasthenia in Pre-1914 British Medical Discourse and in Histories of Shell-Shock,” History of Psychiatry 19, no. 1 (2008): 25–46; Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge, MA: Harvard University Press: 2001); Jay M. Winter, “Shell-Shock and the Cultural History of the Great War,” Journal of Contemporary History 35, no. 1 (2000): 7–11. 3 Ted Bogacz, “War Neurosis and Cultural Change in England, 1914–22: The Work of the War Office Committee of Enquiry into ‘Shell-Shock,’” Journal of Contemporary History 24, no. 2 (1989): 227–56; see also War Office, Report of the War Office Committee of Enquiry into “Shell Shock” (London: HMSO, 1922). 4 War Office, Report of the War Office Committee of Enquiry into “Shell Shock,” 148–88. 5 Mark Osborne Humphries, “War’s Long Shadow: Masculinity, Medicine and the Gendered Politics of Trauma, 1914–1939,” Canadian Historical

414

Notes to pages 325–36

Review 91, no. 3 (September 2010): 503–31. See also Lyndsay Rosenthal, “‘Upon Fertile Soil’: C.B. Farrar, Psychiatry, and the Treatment of Shell Shocked Veterans in Canada, 1917–1939,” unpublished Master’s Research Paper (Memorial University of Newfoundland, Department of History, 2012); Ben Toews, “Canadian Shell Shock and the Feebleminded Threat: Dr. Clarence B. Farrar and the Work of the Ontario Military Hospital at Cobourg,” unpublished Masters Research Paper (Wilfrid Laurier University, Department of History, 2015). 6 Terry Copp and Mark Humphries, Combat Stress in the 20th Century: The Commonwealth Experience (Kingston: Canadian Defence Academy, 2011). 7 Official estimates range between 9600 and 16,100. The former is derived from returns compiled by the Department of Veterans Affairs in the late 1930s, the latter is attributable to its head neuropsychiatrist, J.P.S. Cathcart. Using the ratio of official cases to total cases cited throughout the text by comparing reported cases to those found in admission and discharge books, the former figure would suggest that the total was indeed around 16,000, the figure cited by Cathcart. That number appears to have been compiled from personnel files and while it too is probably far short of the “real total,” it is probably an accurate representation of the approximate number of Canadians officially diagnosed during the war with some form of nervous illness. See RG 24, volume 1844, File GAQ 11–11-E and J.P.S. Cathcart, “The Neuro-Psychiatric Branch of the Department of Soldier’s Civil Re-establishment,” Ontario Journal of Neuro-Psychiatry 8 (1928): 44–59. Appendix B 1 Ian F. Beckett, The First World War: The Essential Guide to Sources in the UK National Archives (Kew: Public Record Office, 2000). 2 Robin Prior and Trevor Wilson, Passchendaele: The Untold Story (New Haven, CT: Yale University Press, 1996), xv. 3 Edgar Jones and Simon Wessely, “Shell Shock at Maghull and the Maudsley: Models of Psychological Medicine in the UK,” Journal of the History of Medicine and Allied Sciences 65, no. 3 (2010): 368–95; Edgar Jones, Adam Thomas, and Stephen Ironside, “Shell Shock: An Outcome Study of a First World War ‘PIE’ Unit,” Psychological Medicine 37, no. 2 (February 2007): 215–23; Stefanie C. Linden, Edgar Jones, and Andrew Lees, “Shell Shock at Queen Square: Lewis Yealland 100 Years On,” Brain 136 (2013): 1976–88. 4 National Archives, “Archival Description, MH106,” http://discovery .nationalarchives.gov.uk/browse/r/h/C10949.

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420 Bibliography Bean, Charles Edwin Woodrow. The Australian Imperial Force in France, 1916. 12th edition. Sydney: Angus and Robertson, 1941. Beard, George M. American Nervousness: Its Causes and Consequences – A Supple­ ment to Nervous Exhaustion (Neurasthenia). New York: G.P. Putnam’s Sons, 1881. – A Practical Treatise on Nervous Exhaustion (Neurasthenia): Its Symptoms, Nature, Sequences, Treatment. New York: W. Wood and Company, 1880. Blandford, G.F. Insanity and Its Treatment: Lectures on the Treatment, Medical and Legal, of Insane Patients. Edinburgh: Oliver and Boyd, 1894. Bowlby, Sir Anthony. “The Work of the ‘Clearing Hospitals’ during the Past Six Weeks.” British Medical Journal 2, no. 2816 (19 December 1914): 1053–4. Brown, William. Psychology and Psychotherapy. London: Edward Arnold, 1921. – “The Treatment of Cases of Shell Shock in an Advanced Neurological Centre.” The Lancet 2 (17 August 1918): 388. – “War Neurosis: A Comparison of Early Cases Seen in the Field with Those Seen at the Base.” Proceedings of the Royal Society of Medicine (Section on Psychiatry) 12 (1919): 52–61. Burpee, Lawrence J. “The Canadian Army Medical Corps.” In Canada in the Great World War – Volume VI: Special Services and Heroic Deeds, etc. Toronto: United Publishers of Canada, 1921. Butler, Colonel A.G. The Australian Army Medical Services in the War of 1914– 1918. Vol. 1, 2nd ed. Sydney: Halstead Press, 1938. – Official History of the Australian Army Medical Services: Volume III, Special Problems and Services. Canberra: Australian War Memorial, 1943. Carberry, Lieutenant Colonel A.D. The New Zealand Medical Service in the Great War, 1914–1918. Auckland: Witcombe and Tombs, 1924. Charcot, J.M. Clinical Lectures on Diseases of the Nervous System Delivered at the Infirmary of la Salpêtrière. Translated by Thomas D. Savill. London: New Sydenham Society, 1889. Clarke, J. Mitchell. “Hysteria and Neurasthenia, Parts I–IX.” Brain 17, no. 1 and 2 (1894): 119–78, 263–321. Collins, Sir William J. “The War: Notes and Reflections from the Front.” British Medical Journal 2, no. 2813 (28 November 1914): 935–45. A Correspondent. “Medical Aspects of Severe Trauma in War.” British Medical Journal 2, no. 2815 (12 December 1914): 1038–9. Cowen, Ruth ed. A Nurse at the Front: The Great War Diaries of Sister Edith Appleton. London: Imperial War Museum, 2012. Cushing, Harvey. From a Surgeon’s Journal: 1915–1918. Boston: Little, Brown, and Company, 1936.

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422 Bibliography Gemmingen-Guttenberg-Fürfeld, Max Freiherr von. Das Grenadier-Regiment Königin Olga (1. Württ.) Nr 119 im Weltkrieg 1914–1918. Stuttgart: Chr. Belsersche Verlagsbuchhandlung, 1927. Graves, Robert. Good-bye to All That: An Autobiography. Revised ed. New York, Doubleday, 1958. Gray, T.G. The Very Error of the Moon. Auckland: Stockwell, 1959. Greenhous, Brereton, ed. Guarding the Goldfields: The Story of the Yukon Field Force. Toronto: Dundurn Press, 1996. Havelock, Richard. “The War: The Management of the British Wounded in France.” British Medical Journal 2, no. 2811 (14 November 1914): 847. Herringham, Major-General Sir Wilmot. A Physician in France. New York: Longmans, Green and Co., 1919. Holmes, Gordon. The National Hospital Queen Square, 1860–1948. Edinburgh: E&S Livingstone, 1954. Holmes, Gordon. “Spinal Injuries of Warfare.” British Medical Journal 2, no. 2866 (4 December 1915): 815–21. Johnson, William. “Neurasthenia and War Neuroses.” In Medical Services: Diseases of the War, Volume II, ed. W.G. Macpherson. London: HMSO, 1923. – Roll of Commissioned Officers in the Medical Service of the British Army. Aberdeen: University Press, 1917. Jones, Carmalt D.W. “War-Neurasthenia, Acute and Chronic.” Brain 42, no. 3 (October 1919): 171–213. Kay, A.G. “Insanity in the Army during Peace and War and Its Treatment.” Journal of the Royal Army Medical Corps 18 (February 1912): 146–58. Keen, William W., S. Weir Mitchell, and George R. Morehouse. “On Malingering, Especially in Regard to Simulation of Diseases of the Nervous System.” American Journal of the Medical Sciences 48 (1864): 367–8. Larrey, Baron D.J. Surgical Essays. Baltimore: N.G. Maxwell, 1826. MacInnes, M.S. “Shell Shock.” The Canadian Nurse 13, no. 1 (1916): 723–4 Macpherson, Major General W.G., ed. History of the Great War Based on Official Documents: Medical Services – Hygiene of the War. Vol. 1. London: HMSO, 1922. – History of the Great War Based on Official Documents: Medical Services – Diseases of the War. Vol. 2. London: HMSO, 1923. – History of the Great War Based on Official Documents: Medical Services – General History. Vol. 3. London: HMSO, 1924. “Major-General John Taylor Fotheringham.” Canadian Medical Association Journal 43, no. 1 (July 1940): 87–8. Maudsley, Henry. The Physiology and Pathology of the Mind. London: Macmillan, 1868. McCombie, John. Medical Service at the Front. New York: Lea and Febiger, 1918.

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Index

Adami, Colonel George, 57 Adamson, Major Agar, 112 Admission and Discharge Books (A&D), 8, 9, 57, 75–7, 80, 89, 99, 101, 108, 113, 122, 134, 155, 159, 162, 174, 184, 188–9, 200, 203–4, 210, 220, 242–3, 245, 250, 270, 287, 299, 300–1, 308–9, 313 Afghanistan, 7 Aisne, 36, 40 Alberta, 59, 98, 138, 189, 273, 300, 308 Albrecht, Duke, 98 alcoholism, 31 Alderson, Lieutenant General Edwin, 98 American Civil War, 19, 21 Amiens, 247, 291, 293, 300, 306, 309 Antwerp, 40 Appleton, Edith, 131, 133 Archibald, C.H., 140 Arleux, 271 Armagh Wood, 109 Armistice, 268, 278, 301 Army Council, 230, 256, 290–1, 298 Army Form (AFW) 3436, 232, 238, 255, 258, 275, 299, 308 Army Medical School, 22

Arques, 208, 251 Arras, 103, 199, 203, 208, 218, 228, 234, 307, 320 asylums, 19, 31, 69, 140–1, 143, 146, 203, 208, 247 Australia, 6, 8–10, 32, 43, 119, 149, 174, 176, 187, 190, 193, 218, 248, 281, 285, 301, 305, 310, 315, 325 Australian Corps School for Medical Officers, 305 Australian Imperial Force (AIF), 190 Avion, 257–8 Avonmouth, 140 Babinski, 16, 263 Bailleul, 44, 68–9, 89 Balmfield, Lt. Colonel, 84 Bandagehem, 240, 269 Bapaume, 181, 183 Barbados, 253 Bate, Colonel A.L.F., 214–15, 228, 230 Battle of Amiens, 293, 300, 306, 309 Battle of Arras, 228, 234, 320 Battle of Batoche, 31 Battle of Colenso, 25–6 Battle of the Somme, 119, 157, 233, 241, 254, 265, 311, 315

444 Index Beachborough Park, 141 Beard, George M., 17 Beaumont Hamel, 163 Begg, Lieutenant Colonel, 179, 242–3 Belain, 268 Belgium, 11, 29, 36, 47, 50, 56, 73, 87, 89, 135, 139, 227, 250, 284–5, 298, 311 Bell, George, 67 Bently, Brigade Major H.R., 171 Benton, Company Sergeant Major, 82 Berlin, 18 Birdwood, 248 Black Marias, 62 Blighty, 38, 55, 134, 138, 288 Boer War, 23–4, 32–3, 39, 74 Boeschepe, 101 Bois de Montigny, 299, 308 Bolougne, 84 Borden, Sir Robert, 32, 98 Borneo, 43 Botel, Henry, 103 Bothwell, Billy, 106 Boulogne, 38, 41–4, 72, 134–5, 137, 179, 189, 230, 275–6, 288 Bowlby, Sir Anthony, 26–8, 121–2, 159, 227 Boyer, G.F., 127 Breuer, Josef, 16, 263 Brielen, 50 British Army Medical Services, 35 British Columbia, 218, 253 British Expeditionary Force Agricultural Labour Company, 11, 279–80, 289, 300, 309, 322–3 Army Service Corps, 127, 147 General Headquarters, 90, 159, 163–4, 166, 168, 170, 196, 202,

206, 217, 228, 230–1, 237, 238–9, 242, 252–3, 255, 257, 269–70, 281, 284, 289–91, 298, 310, 323 Armies: First Army, 45–6, 80, 83, 199, 200, 208–10, 218, 223, 228, 237, 241–2, 249–50, 258–9, 276, 290, 292–3, 298–9, 301–2, 308; Second Army, 45–6, 49, 57, 69, 70, 80, 88, 90, 117, 158, 200, 208, 237, 241–2, 246–9, 258–9, 262, 270, 275, 290–1, 300; Third Army, 208, 242, 247, 258–9, 261, 269, 292; Fourth Army, 98, 161–3, 170, 177, 180, 200, 202, 208, 258–9; Fifth Army, 189, 200, 207–9, 215, 229, 237, 239–40, 246, 258–9, 269, 279, 291, 293, 298; Reserve Army, 161, 168, 172, 180–1, 193, 204 Corps: III Corps, 45, 242; V Corps, 49, 51, 90, 92, 94, 98; VIII Corps, 163–4; X Corps, 162; XV Corps, 162, 181–2 Divisions: 4th Division, 53–4; 5th Division, 174, 248; 7th Division, 174; 17th Division, 170; 18th Division, 163; 29th Division, 163–4; 30th Division, 163; 32nd Division, 169; 41st Division, 181; 38th Welsh Division, 170; Divisional Employment Company, 204, 306 Brigades (Infantry): 8th Brigade, 93–4, 110; 13th Brigade, 51; 76th Brigade, 94–5; 87th Brigade, 164; 97th Brigade, 166; 113th Brigade, 171 Regiments: 1/ Gordon Highlanders, 26, 95; 1/ Northumberland

Index 445 Fusiliers, 41, 91; 1/4th Gloucestershire Regiment, 169; 1/5th Royal Warwickshire Regiment, 157, 163, 170; 1/6th Battalions London Regiment, 169; 1/8th Battalions London Regiment, 169; 2/King’s Own Yorkshire Light Infantry, 167; 4/ Royal Fusiliers, 91–2, 94; 8/ King’s Own Royal Liverpool Regiment, 95; 1st Essex Regiment, 165; 1st Middlesex Regiment, 41; 1st Seaforth Highlanders, 41; 2nd King’s Royal Rifles, 44; 2nd Lancashire Fusiliers, 54; 2nd Royal West Surry Regiment, 25; 3rd East York Regiment, 35; 6th West Yorkshire Regiment, 39; 11th Border Regiment, 166, 168–9; 11th South Wales Border Regiment, 170; 16th Welsh Regiment, 115, 170; Leicestershire Yeomanry, 40; Queen’s Own Rifles, 204; Royal Irish Rifles, 162 Australia and New Zealand Units: Australia and New Zealand Corps (ANZAC), 88, 174, 176, 181, 187, 190, 191–3, 195, 242, 247–9; Australian Corps, 305; 1st New Zealand Division, 181; 5th Australian Division, 248; New Zealand Division, 179 Newfoundland Units: Royal Newfoundland Regiment, 164–5 British Medical Journal, 40, 206 Brown, William, 202–3, 206–7, 212, 214, 258–9, 262–4, 269, 279, 288, 290, 325

Brunton, Captain G.L., 259 Buxton, 287 Calgary, 3, 95, 273, 300, 308 Calgary Eye-Opener, 61 Camblain l’Abee, 223 Cambrai, 271 Cambridge, 43, 160 Camiers, 135 Canadian Army Medical Corps (CAMC), 32, 37, 48, 57, 73, 101, 126, 284, 286 Canadian Casualty Assembly Centre (CCAC), 154, 286–7 Canadian Expeditionary Force (CEF), 1, 3, 11, 48–9, 59, 63, 127, 149–50, 184, 186, 189, 251, 253–4, 268, 271–2, 276 Divisions:1st Canadian Division, 48–9, 53, 64, 70, 75, 77, 109, 113–14, 116, 181, 183–4, 186, 187–8, 203, 243, 245–6, 268, 313; 2nd Canadian Division, 64, 73, 75, 77–8, 88–9, 94–6, 98–9, 100–3, 106, 109, 114, 117, 149, 174, 182, 219–21, 236, 243–4, 246; 2nd Canadian Divisional Artillery Column, 236; 3rd Canadian Division, 80, 90, 92–4, 98–9, 109–10, 112–14, 183, 204 ; 4th Canadian Division, 183, 219, 243, 285 Brigades: 6th Canadian Infantry Brigade, 95, 98; Canadian 2nd Brigade, 51–2; Canadian 3rd Brigade, 52 Regiments (Canadian Militia): 21st Regiment, 87; 26th Regiment, 217

446 Index Battalions: 1st Battalion, 56, 116, 307; 2nd Battalion, 81–2, 115, 142; 3rd Battalion, 72, 115–16, 219; 4th Battalion, 82, 252; 7th Battalion, 52, 55, 63, 189, 223; 8th Battalion, 51, 53–5, 246; 9th Battalion, Canadian Engineers, 307; 10th Battalion, 3, 4; 12th Battalion, 268; 13th Battalion, 51, 55, 115; 14th Battalion, 51, 65, 136, 220; 15th Battalion, 51, 81–2, 219; 16th Battalion, 115; 18th Battalion, 87–8, 103–4, 225; 19th Battalion, 70, 73, 100, 103, 225–6; 20th Battalion, 103, 217, 268; 21st Battalion, 74, 100, 222, 244; 22nd Battalion, 65, 103, 258; 24th Battalion, 103; 25th Battalion, 103, 225, 244; 26th Battalion, 103, 198, 245; 27th Battalion, 65, 95–7, 99, 100, 103– 5, 137; 28th Battalion, 70, 96–8, 103, 104; 29th Battalion, 97, 103, 150; 31st Battalion, 66, 71, 95–6, 98, 100, 101, 103, 254; 44th Battalion, 306; 47th Battalion, 182–3; 49th Battalion, 112, 114, 277, 300, 309; 52nd Battalion, 112, 114, 223; 58th Battalion, 67, 102, 107, 115, 257, 258; 60th Battalion, 112–14; 85th Battalion, 293; 102nd Battalion, 273; 124th Battalion, Canadian Pioneers, 272; 1st Canadian Mounted Rifles (CMR), 110, 137, 138; 2nd Canadian Mounted Rifles (CMR), 111, 142, 253; 4th Canadian Mounted Rifles (CMR), 110–11, 271; 2nd Pioneers, 103; 67th Pioneers, 213, 221;

Princess Patricia’s Canadian Light Infantry (PPCLI), 110, 218 Artillery Batteries: 25th Battery, 306; 25th Canadian Battery, 236; 5th Canadian Trench Mortar Battery, 198 Companies (Special): 255th Tunneling Company, 223; Divisional Convalescent Company, 82; Convalescent Companies, 82–3, 85, 109, 113, 116 Canadian Medical Association Journal, 147, 152, 155, 285 Canadian militia, 31, 225 Canadian mobile field laboratory, 50 Canadian Permanent Force, 31 Canadian Press, 61 Canberra, 9 canteen, 69 Carmichael, Major Dougall, 258 Carmichael, Pte. C, 183 Carroll, Wallace, 65 Cayeus, 177 Cayley, Brigadier General, 165 Champagne, 92, 103, 218 Chaney, Thomas Dillon, 186 Chantilly Conference, 161 Chapman, Major C.L., 305 Charcot, 16 Chelsea Hospital in London, 32 Chisholm, Colonel H.A., 219, 285 Clark, Gregory, 105 Clash, John Henry, 185 Claybury Asylum, 143 Clindening, Lieutenant Frederick T.D., 142 Cobourg, 126 Collins, Dr. William J., 133 Consultant Advisory Board, 159 Contalmaison, 166

Index 447 Contributions to the Study of Shell Shock, 278 Courcellete, 181, 183–5, 204, 245 convalescent companies, 82–3, 85, 109, 113, 116 cowardice, 44, 61, 66, 68, 71–3, 117, 125–6, 138–9, 141, 150, 157–8, 168–70, 182, 185, 193, 195–6, 199, 224, 253, 257, 260, 262, 284, 289, 300, 308, 313–16, 320 Cox, Bertram Howard, 253 Crawford, Lieutenant Colonel S.G., 94 Creelman, Lieutenant Colonel, 55 Crimea, 22, 25, 30, 141 Critchley, Macdonald, 179 Croix du Bac, 45 Crossfield Chronicle, 61 Currie, Sir Arthur, 52, 243–4 Cushing, Harvey, 281 Davey, W.B., 279 Davis, Pte. A.N., 182 Davy, W.B., 240 Day, Albert, 169 Dejerine, Joseph Jules, 19, 44, 145, 147, 207, 263–5 Delville, 172 dental, 69 Derby, Lord, 298 desertion, 68, 182, 224 Desire Trench, 183 dietician, 130 Dillon, Frederick, 208, 258, 260–5, 269, 273, 278–9, 284, 285, 288–90, 310 diseases, infectious disease (generally), 37, 159, 201; dysentery, 34, 46, 85; enteric fever, 30, 34; gastrointestinal, 22, 30, 40, 281; influenza, 47,

55, 106, 200, 326; pneumonia, 47, 326; railway spine, 18; syphilis, 31, 126; typhoid, 158 ; venereal disease, 196, 201, 326 Distinguished Conduct Medal (DCM), 83, 271 Dominions, 8, 24, 32, 36, 48, 64, 97, 112, 140, 149, 164, 310, 325 Doullens, 180, 182, 189, 240, 247 Dover, 140, 281 Dozinghem, 240 Drocourt-Quèant Line, 255 Dubois, Paul, 19, 20, 44, 145, 147, 207, 264 Duffield, Chaplain John, 169 Earp, Pte. A.G., 157–8, 163, 168 Ebblinghem, 247 Eder, M.D., 5 Edmonds, Arthur, 40 Edwardian, 11, 12, 17–18, 53, 143, 179, 265, 312, 314 Egypt, 43, 290 Elliot Sr, Henry Charles, 126 English Channel, 36, 38, 41, 140, 288 Escault, 276 Étaples, 38, 43, 135, 137, 292 Everdinghe, 50 Fanshawe, Hew, 98 femininity, 16, 24, 61, 67, 125, 193 Festubert, 62, 136 Field Punishment No. 1, 82, 126 Finley, 285–8 Finucane, Morgan L., 26–7, 29 Five Fingers Rapids, 31 Flanders, 87, 161 Folkstone, 286 Ford, Colonel W.W., 219

448 Index Ford, Lieutenant Colonel R.W., 27 Fort Selkirk, 31 Foster, G.L. Colonel, 31, 48–50, 56, 101, 181, 244 Fotheringham, Major General John Taylor, 72–3, 117, 185–6, 225, 244–5, 250 Fouilloy, 291 Fowke, Adjutant General, George H., 195, 199, 205, 209, 215–16, 230, 231, 233, 256–7, 259, 262, 266, 269, 276, 284, 289–91, 298, 300, 317, 319, 325–6 France, 11, 19, 29, 36, 38, 40–2, 47, 49, 64–5, 72, 89, 107, 120, 126, 135–7, 139–40, 146–50, 153, 161–3, 176, 178, 186, 191, 198, 209–10, 221, 225, 227, 229, 236, 259, 268, 271, 283–6, 288, 298, 307, 311 Franco-Prussian War of 1870, 71, 23 Fraser, Pte. Donald, 66–7, 95, 254 French, Sir John, 161 Freud, Sigmund, 16, 261, 263–4; Freudian theory, 261, 263–4 Frevent, 208, 211, 285 Gailly, 291 Gallipoli, 165, 174, 190, 192 Galton, Francis, 260 gas (poison), 49, 53, 54–7, 62, 136; chlorine gas, 50–1, 53, 55; gas cloud, 53, 55; gas poisoning, 55–8, 202 Gaukler, 145 General Routine Order (GRO) 4692, 298–9, 308 German Spring Offensives, 291–2, 300–1, 325 German Army, 52, 237, 239, 286, 289, 298, 301–2

Armies: Fourth Army, 51, 98; Sixth Army, 243, 244 Divisions: 26th Wurttemburg Division, 109; 27th Wurrtemburg Division, 109–10 Corps: XIII Corps, 109; XXVI Reserve Corps, 110; Marine Corps, 110 Regiments: 125th German Infantry Regiment, 111, 115; 119th Infantry Regiment, 115; 120th Infantry Regiment, 111; 127th Regiment, 110, 115; 214th Reserve Infantry Regiment, 97; 216th Reserve Infantry Regiment, 97 Germany, 19, 62, 144, 161, 279 Gibson, Captain G.P., 259, 307 Givenchy, 126 Gommecourt, 163 Gough, Hubert, 161, 237, 291 Government of Canada: Department of Militia and Defence, 31, 63, 146; Department of Pensions and National Health, 117, 128, 139; Department of Veterans Affairs, 326 Gowers, William, 209 Graham, Deputy Adjutant General E.R.C., 269–70, 283 Graham, Major General E.R.C., 269–70, 283 Grandcourt, 183 Gray, Captain Harold S., 217, 222 Gray Captain Theodore G., 247, 254, 256 Greer, Major Garnet, 56 Griesbach, Lieutenant Colonel William, 112 Guillemont, 172

Index 449 Hadow, Lieutenant Colonel Arthur, 165 Haig, Sir Douglas, 92, 98, 157–8, 161–4, 166, 168, 170, 181, 230–1, 233, 237, 239, 242, 256–7, 262, 266, 269, 283, 289–91, 298, 319, 325–6 Haldane, Major General James Aylmer, 90–4, 98–9 Halifax, 31, 33 Hamilton, 3, 213, 253 Hamilton, Gordon, 102 Hampson, Sidney, 138 Harding, Captain E.P., 259 Hazebrouk, 40 Hearne, Lieutenant Colonel W.W., 174, 176, 248 heart murmur, 39 Herringham, Sir Wilmot P., 159, 226–8 High Wood, 172, 174 Hill 60, 109 Hill 61, 109 Hill 70, 226, 237, 243–6, 251 Hills, Captain, 259 Hindenburg Line, 239, 307 Hoerner, Sophie, 130–2 Holmes, Gordon, 5, 179, 208–11, 213, 230, 238–41, 244, 259, 265, 278, 281, 283, 288, 311, 317–18 Homewood Retreat, 129 honourably wounded, 64, 141, 194 Hooge, 90 Horne, General Sir Henry, 199, 243, 244 Horsley, Victor, 209 Howey, Edna, 133 Howland, Harry, 52 Hundred Days, 293, 299, 301–2, 305, 308–9 hygiene, 24, 30, 34

Imperial War Museum, 169 Imperial Yeomanry Hospital, 27 India, 22, 26, 190 Indian Army, 190 Iraq, 7 Ireland, 162 Irwin, Pte. Herbert Laurier, 52 Italy, 7, 161 Jack Johnsons, 50, 52, 63 Jackson, Hughlings, 209 Janet, 16, 263 Japanese Army, 195 Jardine, Colonel J.B., 166 Joffre, Joseph, 161 Johns Hopkins University, Phipps Clinic, 144 Johns, Private Lawrence Ear, 107–8 Johnson, William, 190, 234, 258–9, 262–3, 269, 279–80, 290, 300–1 Jones, Carlton, 155 Jones, Major D.W. Carmalt, 208, 211–16, 223, 224, 226–31, 234, 240, 257–8, 260, 263, 269–73, 275, 278–9, 281, 283, 288, 290, 301, 318–19, 325 Keen, William W., 21 Kemmel, 88 Keogh, Alfred, 36, 42–3, 155, 177 Ker, Lieutenant Colonel Charles Arthur, 96 Kerr, Surgeon-Major James, 31 Ketchen, General H.D.B., 95, 98, King’s College, 42, 140, 144, 202 King’s Regulation, 45 Kirkwood, Captain, 167–9 Kitcheners Wood, 50 Kitson, Major, 99 Knight, Lieutenant Francis, 166 Kraeplin, 144

450 Index La Petite, 95 Ladysmith, 195 Lamb, Sargent, 219 Larrey, Dominique Jean, 20–1 Laurier, Sir Wilfrid, 32 Law, Pte. John William, 70, 73–4 Le Havre, 38, 41, 133, 135, 137–8 Le Tréport, 38, 43, 134–5 Leduc, Major Thomas James, 253 Leeds, 35 Lens, 237, 243, 245–6, 249–51, 254, 257, 266, 272–3, 275 Leppard, Captain, 219 Lierre, 40 London Times, 62 London, 9, 18, 30, 32, 36, 40, 42, 47, 62, 105, 140, 143–5, 169, 179, 208, 217, 226–7, 245, 252, 273, 281, 286, 290, 320 Loos, 97, 103 Loucks, Kirke, 66–7 Lunt, Lieutenant Albert George, 252–3 MacDonald, Colonel W., 242 Machonochie’s Meat, 129 MacInnes, Mary, 145 MacKinnon, Captain Harold S., 217 MacKinnon, Major, 125 MacLachlan, Brigadier General, 93 Maclean, W.C., 22 Macphail, Sir Andrew, 37, 101, 107, 185–7, 225 Macpherson, William Grant, 230, 240, 278–9 Maheux, Frank, 74–5, 183, 244, 252 Major, Lieutenant Lionel Hugh, 63 Makins, Sir G.H., 159 malaria, 24, 30, 34, 47

malingering, 22, 25, 27–9, 35, 43, 71–3, 85, 124, 137–8, 141, 148, 152–3, 182, 202, 206, 233, 291, 299, 308, 314, 316, 320. See also swinging the lead Mametz Wood, 166, 170–1 Manchuria, 195 Manifold, Colonel C.C., 190–5, 230, 248–9, 256, 318 Manitoba, 51, 149, 253 masculinity, 6, 8, 12, 17–18, 24, 68, 125, 193, 196, 223, 234, 252, 265, 312, 314, 327 Massey, Mrs., 56 Mathews, Major H.H., 53 Maudsley, Henry 144 McBride, Joseph A Gussie, 186 McDougall, William, 43, 260–1 McGill, Captain Harold, 71, 96, 100 McGill University and war hospital, 19, 146–7, 185, 285 Mcintyre, Captain Duncan Eberts, 70, 96, 104, 106, 244 medical case sheet, 39, 44, 69, 126, 142–3 medical records, 9, 55, 69, 136, 204, 211, 218, 271, 287 Medical Research Committee, 210, 300 Medical Research Council, 44 Medical Society of London, 40 Medical Units and Authorities (see also CAMC), Director General of the Army Medical Services (DGAMS), 36 Director General, Medical Services, BEF (DGMS), 36, 38, 45, 58, 177–8, 199, 205, 209, 215, 226–7, 230, 240, 257, 282–3, 288, 292, 294, 296, 317

Index 451 Deputy Director General Medical Services (DDGMS), 240 Director Medical Services (DMS) various armies, 43, 51, 69–70, 84, 160, 163, 172, 176–7, 193, 200, 202, 207, 209, 229, 239–41, 244, 246, 248, 279–80, 283–4, 293 Deputy Director Medical Services (DDMS) various corps, 45, 84, 176–7, 181, 190, 193, 195, 242, 244, 248, 250 Assistant Director, Medical Services (ADMS) various divisions, 48–50, 160, 181–2, 219, 223, 248, 285 Medical Units and Authorities: casualty clearing stations (CCS), 38, 45–6, 58, 72, 75, 77, 89, 100–2, 106–7, 109, 113–14, 116, 118, 121–2, 124, 126, 135, 138–9, 155, 177–8, 182, 188, 206, 240, 245, 292 British: 1/1st South Midland CCS, 180; North Midland, 80 Canadian: No. 1 Canadian CCS, 123–4; No. 1 CCS, 299, 308; No. 3 CCS, 113–14, 162–4; No. 6 CCS, 268, 299, 308; No. 10 CCS, 102– 3, 113–14; No. 11 CCS, 300, 301; No. 12 CCS, 200; No. 15 CCS, 236, 247, 251, 270; No. 17 CCS, 102, 103, 113, 114; No. 21 CCS, 180, 200, 202–3, 208, 269; No. 23 CCS, 246; No. 30 CCS, 299, 300, 308–9; No. 32 CCS, 203, 204, 281, 290; No. 34 CCS, 162, 164, 172; No. 35 CCS, 180, 182, 189, 204; No. 42 CCS, 221; No. 47 CCS, 240; No. 62 CCS, 240, 262, 269, 272, 275, 279–80, 300

Medical Units and Authorities: field ambulances, 4, 32, 37–8, 41–2, 45–6, 54, 56–8, 68, 69, 71, 75, 80, 89, 100–2, 105, 114, 116, 121, 136, 138, 159, 167, 174, 182, 188–9, 191, 197, 199, 203–4, 215–18, 220–1, 223, 226, 231, 237–8, 242–3, 245, 250, 258, 260, 266, 301, 307, 310, 313, 316, 321, 323 Australian: 2nd Australian Field Ambulance, 174, 176 British: 77th (British) Field Ambulance, 71; 88th Field Ambulance, 166; No.14 British Field Ambulance, 57; No. 74 British Field Ambulance, 223 Canadian: No. 1 Canadian Field Ambulance, 49, 51, 59, 72, 76, 79, 81, 89, 187, 203, 225; No. 2 Canadian Field Ambulance, 4, 49, 70, 72, 76, 79, 81, 113, 116, 203–4, 221, 236, 245, 250; No. 3 Canadian Field Ambulance, 49, 50–1, 56, 68, 76, 79, 82, 89, 108–9, 142, 189, 245–6; No. 4 Canadian Field Ambulance, 75, 78, 89, 101, 104, 187, 204, 250; No. 5 Canadian Field Ambulance, 75, 77–8, 81, 106, 189, 198; No. 6 Canadian Field Ambulance, 101, 198; No. 9 Canadian Field Ambulance, 218; No. 10 Canadian Field Ambulance (Boer War), 32; No. 10 Canadian Field Ambulance, 32, 185, 204, 245–6, 257, 307; No. 14 Canadian Field Ambulance, 46, 58, 174–5 French: French Field Ambulance, 50

452 Index Medical Units and Authorities: hospitals convalescent: No. 3 Canadian Base Detail Rest Camp, 277; No. 2 Convalescent Depot, 230; No. 7 Convalescent Camp, 275–6; No. 7 Convalescent Depot, 276–7; No. 10 Convalescent Depot, 276 general: 2nd Australian General Hospital, 218; 4th London General Hospital, Denmark Hill, 140–6, 202; Lahore Indian General Hospital, 84; No. 1 Canadian General Hospital, 130; No. 2 Canadian General Hospital, 134; No. 3 Canadian General Hospital, 130, 147, 189, 208–9, 228, 239, 261, 269, 273; No. 7 Canadian General Hospital, 128; No. 11 Canadian General Hospital, Moore Barracks, 141, 287; No. 3 General Hospital, 146; No. 11 General Hospital, 42–4, 136; No. 13 General Hospital, 72, 179 ; No. 16 (British) General, 134; No. 18 General Hospital, 137; No. 20 General Hospital, 221; No. 25 General Hospital, 272; No. 26 General Hospital, 292, 300, 309; Toronto General, 63 other: Australian Voluntary Hospital, 281; Beckett’s Park Hospital, 35; Canadian Discharge Depot, 288; Connaught Hospital, Aldershot, 26, 29; Duchess of Connaught’s Hospital, Cliveden, 141; Granville Special Hospital, 105, 127, 146, 148–50, 154–5, 222,

285–8, 300, 309; Maudsley, 144, 324; Moss Side State Institution, Maghull, 140, 146, 202; National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 18, 42, 140, 142, 145–6, 148, 179, 209–11, 286, 324; Queen’s Canadian Military Hospital, 4, 141; Royal Victoria Hospital, Netley, 22, 140–3, 146, 166, 206; St Bartholomew’s Hospital, 26, 226 stationary: New Zealand Stationary Hospital, 247, 251, 254–5, 270; No. 3 Canadian Stationary Hospital, 189, 228, 239, 247, 261, 269, 273; No. 5 Canadian Stationary Hospital, 133; No. 2 Stationary Hospital, 126; No. 3 Stationary Hospital, 208; No. 4 Stationary Hospital, 80, 208, 211–13, 223–30, 243, 246, 251, 257–8, 269–77, 301, 318; No. 6 Stationary Hospital, 4, 139, 208, 211, 285; No. 12 Stationary Hospital, 308; No. 32 Stationary Hospital, 281, 290; No. 39 Stationary Hospital, 293; No. 41 Stationary Hospital, 290–1 Melbourne, 281 Mercer, Major General Malcolm, 110 Mericourt, 237 Messines, 149, 237, 240 Meyer, Adolph, 144 Michigan, 221 Middle East, 22 military medicine, 22, 24, 31–2, 36, 142, 190, 227, 312, 317–18 Military Service Act, 300, 308 minenwefer, 67, 96, 110

Index 453 Mons, 36, 268, 293, 310 Montreal, 101, 136, 166, 225, 236, 258 morale, 8, 10–12, 71, 86, 90, 92–3, 99, 158, 171, 190, 202, 222–3, 289, 291, 298, 305–6, 310, 315–16, 320, 326–7 Morehouse, George, 21 morphine, 29, 101 Morris, Hubert M., 185 Mott, Frederick, 5, 143–5, 148, 202 Mount Sorrel, 88, 108–10, 113, 118–19, 174, 176, 181, 185, 188, 198, 315–16 Myers, Campbell, 63 Myers, Charles, 5, 43, 44–5, 58, 64, 133, 155, 160–1, 178–80, 194, 199, 203, 205–7, 209, 212, 214, 216, 233, 238–9, 240, 247, 259, 266, 278, 280–3, 288, 311, 317–18, 325 Napoleonic Wars, 20 neuropathology, 143 Neuve Chappelle, 4, 41, 49 Neuville-St Vaast, 199 New Brunswick (NB), 198, 224, 245 New South Wales, 32 New Zealand, 9, 10, 119, 174, 179, 181–90, 247, 251, 254–5, 270, 310, 325 Newfoundland, 164–6, 315, 325 Niagara, 105 Nichol, C.E., 239–40 Nicolson, Harry Manley, 209 No Man’s Land, 27, 50, 54, 82, 87, 91, 93, 95, 110–11, 149, 164–6, 183 Noakes, Frederick E., 276 Normandy, 7 Northumberland House Asylum, 208 Northwood, Captain G.W., 54 Nova Scotia, 123, 125, 293

nursing, 29, 32, 44, 120, 122–3, 128–34, 140, 143–5, 155, 238, 292; Appleton, Edith, 131, 133; Canadian Nurse, 129–30, 132; dietician, 130; Hoerner, Sophie, 130–2; Howey, Edna, 133; MacInnes, Mary, 145; nurse’s pet, 125, 128 O’Brien, William J., 306 O’Donnel, T.J., 84 O’Keefe, Lieutenant Colonel M.W., 45, 163–4 Observatory Ridge, 109–11, 115 Ontario, 3, 19, 52, 104, 107, 126, 129, 186, 213, 217, 222, 225, 271, 277, 307 Operation Georgette, 293, 298 Operation Michael, 291–2 Oppenheim, 16 Osler, Sir William, 63 Ottawa, 9, 32, 62, 81 Ottley, Lieutenant Colonel G.G., 92 Ouderdon, 101 Ovillers la Boisselle, 166 Palmer, Captain H.C., 167 Paris, 18 Passchendaele, 211, 236–7, 240, 246–7, 249–51, 266, 268–72, 276, 279, 320 pathology, 14, 22, 51, 159 Patterson, Major Sydney W., 281 Pear, Thomas, 5 Pegahmagabow, Corporal Francis, 307 pensions, 8, 11–12, 32, 43, 84, 117, 128, 139, 141, 159, 212, 259, 326 Perry, Ms., 56 Pike, W.W., 200

454 Index plague, 24, 158 Ploegsteert, 88 Plumer, Hubert, 94, 98, 237 Polygon Wood, 248–9 Poperinghe, 41, 50, 240 Portage la Prairie, 103 Porter, Surgeon General, 247–50 Portland Field Hospital, Bloemfontein, 25–6, 29 Potter, Brigadier General, 93 Pozieres, 191 Pretoria Yeomanry Hospital, 25–6 Prince Edward Island (PEI), 55, 186 Puchevillers, 162 Quebec, 19, 56, 74, 113, 136 railway spine, 18 Ramsgate, 105 Rattray, Lieutenant Colonel M.M., 292 Rawlinson, Henry, 161, 170, 177 Read, Stanford, 142 Red Cross, 56, 276 Red Deer News, 62 Regimental Medical Officer (RMO), 31, 36–7, 39, 40–2, 45, 71, 73–4, 85, 96, 100, 104, 108, 128, 138, 157, 160, 167–9, 191, 197–8, 206, 208–9, 212, 217, 226, 231, 238, 242, 249, 260, 299, 306, 308, 313 Regina Trench, 183, 187, 245 Renilghelst, 57 Rhine, 298, 300 Rivers, W.H.R., 5, 43, 148 Rolleston, H.D., 26, 28 Ross, A.E., 116–17, 181 Ross, Lieutenant J., 167, 168 Rouen, 38, 42, 55, 135, 166 Royal College of Physicians, 210

Royal Irish Fusiliers, 3 Royal Northwest Mounted Police, 31 Rudkin House, 111 Russel, Colin, 5, 137, 146–8, 150–3, 155, 285–9, 310, 322, 324 Russo-Japanese War 1904–5, 31, 195 S.S. Olympic, 286 Sanctuary Wood, 109, 113 sanitation, 24, 34, 159, 190 Sargent, Percy, 179, 210 Saskatchewan, 96, 138, 246 Savage, Lieutenant Charles Henry, 136 Sawyer, General R.M., 84 Science and War, 63 Scotland, 81, 281 Scott, Canon Frederick, 243 Scottish Wood, 67 scrimshankers, 72 Second Battle of Ypres, 49, 56–7, 62, 82, 101, 315 Second World War, 6–7 self-inflicted wounds, 101, 196, 201, 326 Shawanga First Nation, 307 shell shock aetiology, 5–6, 16, 18, 21, 42, 180, 190, 206, 210, 259, 278 approaches to: biological, 10, 16, 193, 209, 259–62, 326; bio–psychological, 10–11, 35, 143, 179, 191, 199, 202, 209, 262, 266, 312, 318; forward psychiatry, 6, 10, 199, 309; neurology, 5, 6, 11, 16–19, 21, 23–4, 42, 63, 127, 137, 140–6, 148–9, 153, 178–9, 203, 208–9, 215, 227, 233, 238–9, 246, 255, 258–63, 265, 269, 278–83, 285–6, 288–90, 293, 307, 309–11,

Index 455 318, 320, 323–4, 326; physiology, 13, 15, 193, 202, 209, 259–62; psychology, 5–7, 10–11, 14, 18, 19, 20, 23–4, 27, 43–4, 55, 66, 99, 113, 117, 131, 139, 143, 145, 148–9, 160, 178–9, 191, 202, 205, 209, 215, 240, 258, 260–3, 265, 281–3, 311–12, 314, 318, 320, 323–4, 326; psycho–physiological, 193, 259–60; somatic, 5, 23–4, 27, 28, 39, 142–3, 179, 225, 252, 259, 261–2, 311–12 banning of term, 205, 233, 290 BEF policy towards: Adjutant General (AG) 6902, 231–4, 238–9, 242–3, 245, 248, 251, 265, 273, 298; General Routine Order (GRO) 2384, 231–4, 238–9, 241–2, 245, 248, 251, 256, 265, 273 cases of, 26, 39, 40–2, 44, 54–6, 63, 72, 81–2, 87–8, 105, 124, 126–7, 136–7, 139, 142, 147–9, 186, 189, 198–9, 217, 236, 257–8, 268, 273, 286 court martial for, 22, 157–8, 172, 195, 200, 224, 241, 317 diagnoses and categories: breakdown, 18, 23, 28, 39, 55–6, 58, 61–2, 66, 68, 72, 74, 88, 93, 108, 113, 150, 153, 169, 186, 191, 212, 215, 223, 235, 238, 252, 259, 260, 316, 324; Combat Stress Reaction (CSR), 7; concussion, 31, 33, 58–60, 62–3, 135, 143, 151, 160, 185, 189, 200–1, 213, 220, 225, 258, 272, 286, 301; dementia, 206; Disordered Action of the Heart (DAH), 23, 25, 29–30, 39–40, 44, 46–7, 58–9, 135, 162,

220, 225, 230, 322; emotional suffering, 5, 7–8, 11, 13, 17, 18, 68, 85, 104, 130, 234; epilepsy, 18, 22, 39, 42, 58–60, 109, 146–7, 272; exhaustion, 15, 20–1, 23, 26–7, 31, 33, 39, 44, 56, 60, 68, 70, 72–3, 85, 95, 99, 101, 104–5, 107–9, 116, 118–19, 124, 150, 174, 177–80, 184, 191, 193, 201, 219, 230, 232, 241–2, 246, 248, 255, 270, 288, 292, 301, 305–7, 312, 319, 322; functional, 15, 18, 23, 25, 27, 29, 64, 145, 149–50, 202, 212–13, 218, 220, 286, 324; gastritis, 122, 124, 130, 149, 198, 221, 292; general debility, 25, 29–31, 39, 47, 58, 179, 221, 236, 241–2, 246, 248, 252, 268, 270, 292, 322; homesickness, 31; hysteria, 16–18, 21, 25–7, 29, 33, 39, 42–3, 58–61, 66–7, 71–2, 89, 101, 107, 120, 123–5, 148–9, 153, 179, 184, 191, 193, 202, 204, 210, 216, 218, 224, 270, 284–5, 299, 301–2, 304; indigestion, 31; insanity, 14–15, 31, 42, 60, 126; mental illness, 6, 7, 15, 19, 33, 39–40, 42–3, 57–61, 76–7, 79, 83–5, 88–9, 107–9, 116, 117, 142, 160, 184, 208, 216, 256, 281, 305, 323; mild traumatic brain injuries (mTBI), 104; myalgia, 28, 39, 58, 122, 221–2, 242, 246, 270, 322; nervous illness, 7, 9–12, 14–15, 18–21, 23–31, 33–6, 38, 40–3, 46–7, 49, 52, 57–8, 63, 68, 72, 84, 88–90, 102, 105, 109, 120, 158–60, 164–5, 172, 174, 176–80, 185, 190, 192, 195, 197, 200, 202–3, 215–16, 219–21, 223, 231, 233, 234, 237,

456 Index 241–2, 245–6, 249–54, 257, 259, 266–7, 269, 286, 289, 300, 305–7, 309–12, 315–17, 321, 324–7; neuralgia, 122; neurasthenia, 4, 16–18, 21, 23, 25–6, 29, 33, 35, 39–44, 46, 54–5, 58–60, 63, 71, 82, 87–8, 99, 107, 120, 123, 125–6, 135, 141, 146, 148, 155, 162, 179, 184, 195, 199, 212, 215–22, 224, 230, 234, 238, 248, 255, 258, 268, 270, 272, 284, 288–90, 292, 301–4, 308, 324, 326; neuritis, 122; neuropsychiatric, 88, 102, 107, 114, 116–18; nostalgia, 20, 21; Operational Stress Injuries (OSIs), 7, 12, 29; Post-Traumatic Stress Disorder (PTSD), 7, 12; rheumatism, 25, 28–30, 31, 58, 126; shock (Shell), 59; soldier’s heart, 23; “spinal shock,” 210, 286; trauma, 12–13, 18, 33, 66–7, 73, 102, 118, 131–2, 137, 159–61, 199, 202, 210, 220, 252–3, 257–9, 262, 272, 293, 314–17, 320–1, 325–7; traumatic neurosis, 16, 18, 23, 26–7, 33, 43, 59, 266 discipline for, 135–6, 138, 157–8, 168, 171–2, 195–6, 203, 205, 224 factors in diagnosis: burial, 42, 66–7, 81, 87, 97, 102–4, 111, 137, 143, 162, 184, 212, 216, 219, 246, 256, 258, 315; constitution, 18, 256, 259, 260, 284, 324; exceptional exposure, 108, 167, 196, 218, 222–4, 232, 234, 238, 255–9, 266, 284, 288, 308, 317, 320–1; heredity, 151, 212, 326; neuropathology, 143, 144; “normal resisting power,” 284; organic cause, 15–18, 20, 22–3, 30, 43,

146, 150–2, 155, 198, 212, 224, 263, 270, 318; pathology, 13–4, 22–3, 42, 51, 143–4, 153, 159, 281; predisposition, 13, 26, 33, 212, 227, 256, 266, 279, 310, 324, 326; stigmata of degeneration, 142–3, 212, 324 labels for, 58–9, 63–4, 122–3, 126, 148, 159–60, 195–7, 199, 200, 203, 205–6, 210, 216, 220–1, 232–4, 238, 241–2 , 249, 266, 270, 279, 284; asthenia, 248; inability to stand shell fire, 195; No Appreciable Disease (NAD), 232, 255, 270, 279–80, 308; Not Yet Diagnosed (NYD), 200, 215, 220, 223–5, 229–30, 246, 249, 271, 293; Not Yet Diagnosed Nervous (NYDN), 231–2, 234, 236–40, 242–3, 245–52, 254, 259, 262–3, 266, 268–70, 272–3, 275–7, 279–80, 282, 289–94, 296, 298–305, 307–10, 318–23, 325; sick (S), 159–60, 179; shock, concussion, 160; shock, shell, 160; wound (W), 159–160, 164, 179, 226, 319 management of, 36–8, 41–2, 44–6, 49, 80–2, 85, 88, 100–2, 107, 121,125–6, 135, 140–7, 161, 164, 176–82, 185, 187, 192–5, 197–8, 200–4, 20,–9, 211, 215–21, 223–34, 237–43, 246–50, 254–6, 266, 269, 271–2, 275, 277, 280–2, 287, 293, 298–300, 305, 308, 310, 313, 315, 319–20, 325; Advanced Sorting Centres, 240, 282; aid post, 36–7, 38, 55, 100–2, 160, 177, 189, 215, 217, 222, 245, 300, 301, 308, 320; convalescent

Index 457 camp, 9, 80, 81, 133–4, 137, 138, 199, 204, 210, 224, 229–30, 258, 270, 273, 275–8, 280–1, 289, 290, 292, 298–9, 301, 308, 322; convalescent company, 82–3, 85, 109, 113, 116; convalescent depot, 45, 123, 133, 135–6, 156, 177, 230, 270, 276–7; convalescent home, 38, 146; convalescent hospital, 123–4, 222; dressing station, 36–7, 40, 45, 49–51, 55, 57, 71–2, 75–7, 81, 89, 100–1, 105, 109, 116, 136, 138, 139, 162, 174, 177–8, 180–1, 185, 198, 203, 245–6, 258; filtering centres, 160–1, 179; forward psychiatry, 6, 10, 199, 207, 268, 309, 311, 318, 320; light duty, 44, 75–7, 79, 82, 156, 279; medical statistics for, 39–40, 46, 27, 57–60, 65, 75–9, 83–4, 88–90, 99, 103, 107, 109, 113–14, 116–17, 120, 135, 154–5, 172–6, 184, 186–9, 204, 211, 224–5, 229, 245, 251, 257, 269–70, 274, 276–8, 284–5, 294, 295–7, 301–4, 321, 322–3; Mont des Cats, 80–1, 89, 106, 113, 123; Mont Noir, 73, 81; NYDN Centre, 236, 240, 243, 245, 262, 270, 273, 277, 291, 293, 298, 300, 307, 309; “r” zone, 181, 187; rapprochement, 85, 88, 117, 185, 314; rest station, 4, 45–6, 57, 68–77, 79–80, 82, 85–6, 89, 101, 106–8, 113, 116–18, 121, 138–9, 162, 172, 177, 180–1, 187–8, 190, 192, 196–7, 199, 203–4, 206, 213, 216, 224, 230, 236, 241, 243–4, 246, 247, 266, 269–70, 277–80, 282, 301–2, 313, 314, 320–1, 323, 325;

return to duty, 39, 45, 47, 71, 77, 82–3, 85, 121–2, 136, 138–9, 150, 180, 186, 188, 207, 229, 234, 236, 255, 266, 270, 273, 275–7, 280, 282, 301, 310, 313, 318–19, 322–3; “s” support zone, 181; sanitary sections, 76–7, 79, 82, 85, 90, 121, 138, 159, 199; self– regulation, 86, 108, 118, 327; self–reporting, 104, 107–8, 114, 157, 160, 172, 185, 197, 202, 234, 242, 265, 269, 315; South African War, 30; “T” forward area (Treatment zone?), 38, 181, 201 perceptions of (civilian), 59, 61–2, 64 perceptions of (medical), 11, 14–21, 23–4, 26–9, 33, 35, 42–4, 49, 63–4, 73, 107, 121–2, 124–5, 131, 133–4, 137, 142–53, 176, 179, 192–4, 202–3, 206, 210, 212, 215, 223, 227–8, 259, 260–4, 283, 289, 292 , 310, 314–15, 317–18, 320, 323–4 perceptions of (military), 6–7, 14, 20–5, 31, 33, 48–9, 51, 83–4, 136–7, 157–9, 230–1, 256, 289–90, 316, 319 perceptions of (soldier), 3, 14, 49, 51–2, 65–71, 73–5, 95, 96, 97, 104–8, 112, 125, 128, 136, 167, 169–70, 183–5, 222, 244, 252–4, 276, 305–7, 309, 314, 316, 321 relapse of, 33, 39, 77, 80, 136–9, 156, 214, 234, 269, 271–2, 277–8, 280, 285, 313, 322 stigma of, 15–16, 18–19, 66, 73–5, 86, 88, 105, 117–18, 138–9, 141–2, 169, 192, 222–3, 226, 291, 321

458 Index symptoms of, anorexia, 126; anxiety, 15, 25, 27, 31, 49, 53, 62, 64, 69, 75, 106, 134, 136, 198, 262; aphonia, 22, 137, 299; claustrophobia, 128; contusions, 58, 184, 210, 218, 225; depression, 15, 20, 25, 29, 31, 61, 106, 127, 152; exaggeration, 4, 20, 22, 26, 28, 39, 71–2, 219, 273, 320, 323; exhaustion, 15, 20–1, 23, 26–7, 31, 33, 39, 44, 56, 60, 68. 72–3, 85, 95, 99, 101, 104–5, 107–9, 116, 118–19, 124, 150, 174, 177–80, 184, 191, 193, 201, 219, 230, 232, 241–2, 246, 248, 255, 270, 288, 292, 301, 305–7, 312, 319, 322; fatigue, 22, 25, 28, 39, 75, 82, 100, 104–5, 124, 137, 151, 166, 191–3, 213–14, 230, 232, 241–2, 248–9, 255, 262, 270, 305, 314; fear response, 44, 50, 53, 56, 67, 72, 102, 108, 132, 137, 143, 150–3, 158, 170, 172, 184, 193–4, 196, 206, 223, 261–2, 264–5, 288–9; hallucinations, 40, 127, 142; headache, 15, 22–3, 25–6, 28, 39, 55, 72–3, 104–6, 127, 137, 149–50, 152, 166, 179, 218, 221, 257–8, 272; heart disease, 22–3, 28, 30; insomnia, 25, 58, 105, 126, 135, 149–150, 152, 248, 258; irritability, 126; lesions, 15, 18, 42, 142, 179, 200, 210; memory loss, 25, 35, 44, 55–6, 104–5, 142–3, 149, 166, 207; nightmares, 61–2, 87, 105, 125, 127, 152, 243; palpitations, 22–3, 25, 39, 105, 137, 221, 246, 273; panic, 4, 50, 53–4, 57, 87, 99, 127, 171–2, 292; paralysis, 15,

18, 22, 25, 29, 145, 149, 150–3, 179, 218, 299; photophobia, 286; psychogenic, 43, 150, 152–3, 286; psychosis, 141, 193, 255–6, 307; psychosomatic, 13, 44, 125, 139, 149–50; ptosis, 26; rheumatism, 25, 28–31, 58, 126; somatic (symptoms), 5, 14–15, 17–18, 21, 23, 30, 35, 44, 64, 70, 84–5, 102, 107, 114, 122, 125, 135, 138–9, 149, 150, 155, 209, 220; tremor, 26, 35, 39, 124, 127, 145, 149, 153, 218, 220, 223, 244, 272, 293, 300, 309; vague pains, 17, 22, 28, 42, 126–7, 150, 221, 258; vertigo, 220, 273; weakness, 22, 25, 27, 105, 137, 149–50; weight, 28, 124, 130 treatments for, bath, 46, 68, 117, 135, 144, 188, 210; bromides, 127, 213, 262; corrective action, 306; diet, 28, 33, 44, 46, 69, 127–30, 132, 144–5, 155, 207, 282, 312–13; disillusionment therapy, 148, 150, 152–3; drugs, 29–30; electricity, 33; exercise, 19, 23, 46, 70, 82, 127, 129, 136, 144, 214, 220, 282, 300; faradic current, 145, 152, 213, 263; galvanic electricity, 22, 29, 144, 282–3; hemiplegia, 147; hydrotherapy, 28, 144–5, 150, 222; hypnotism, 145, 202–3, 213, 263; isolation, 263, 282–3; laundry, 46, 71; massage, 19, 28–9, 33, 150, 153, 213, 222, 300; milk diet, 127; moral suasion, 206; optical detective, 153; psychotherapy, 150, 155, 202, 206–7, 213, 264, 269, 280;

Index 459 rational persuasion, 31, 145–6, 148, 150, 153, 202, 212–13, 227, 263, 265, 285–6, 288, 324; re-education, 151, 207, 212–13, 263, 286; reassurance, 102, 129, 145; relaxation, 69–70, 106, 144; rest cure, 10, 19, 21, 28–9, 31, 33, 35, 39, 42, 44–6, 55–6, 61, 69–70, 73–4, 77, 82, 89, 100–1, 105–8, 114, 116–19, 121–2, 127–30, 132–3, 135, 140, 144–6, 150, 153, 155, 172, 176, 178, 180–1, 188, 199, 203, 206–7, 212, 227, 232, 241, 245, 255, 269, 281–2, 288, 298, 312–13, 316, 318, 325; shaming, 123, 169, 263–5, 319; somatic (treatment), 84–5, 225; talk therapy, 5, 7, 19–20, 44, 131–3, 144, 145–6, 155, 214, 312, 318; wire brush, 145, 152–3, 213, 263, 281, 299 treatment system, 36–8; Advance Base Depot, 84; army level stopping system, 180, 189, 325; collecting zone, 36, 38, 45–6, 48, 89, 121, 181; convalescent depot, 45, 123, 133, 135–6, 177, 230, 270, 276–7; corps level stopping system, 172, 176, 199, 241–2; divisional rest station (DRS), 45–6, 49, 68–72, 74–5, 77, 80–1, 85, 87–9, 100–1, 104, 106, 113, 116–17, 163, 188, 198, 200, 204, 213, 245, 279; 1st Divisional Rest Station, 204; 3rd Divisional Rest Station, 204; Canadian Corps Rest Station, 236; Divisional Sanitation Sections, 76, 79; divisional stopping system, 45–6, 49, 68, 86,

90, 158, 178, 242, 313, 315–16; evacuation zone, 38, 120, 161, 202; Regimental Aid Post, 37–8, 55, 100–1, 177, 189, 215, 217, 245, 301; rest system, 45–6, 88, 109, 117, 119, 203, 315 Shillington, Mrs., 56 Shorncliffe, 2, 273 Siegfried-Stellung, 243 simulation, 148, 202 Skinner, B.F., 279, 280, 284 Sladen, Lieutenant Colonel G.C., 157–8 Sloggett, Surgeon General Arthur, 36, 38, 45, 159, 161, 176–80, 184, 194–5, 197, 199, 205–9, 214–16, 226–8, 230, 233, 240, 257, 282–3, 293, 317 Smith, Thomas Brenton, 123 Snape, Company Sergeant Major Herbert, 99 Snider, Lieutenant Colonel, 96, 99, 105–6 Somme, 88, 127, 158–9, 161–3, 165, 167–71, 174, 177–9, 181–91, 193, 195–9, 201–2, 204, 207, 220–1, 223, 226, 230, 233–4, 237, 239, 240–1, 245, 246, 247–8, 254, 259, 265, 269, 278, 284, 291, 305, 311, 315–16, 320 Souchez, 199 soup kitchen, 56 South Africa, 9, 23–30, 32–3, 35, 38, 46, 87, 310, 312–13, 325 South African War, 25, 30 Southampton, 140 Southborough, Lord, 6 Spencer, Herbert, 260 St. Eloi, 87–8, 90–1, 93–6, 99, 101–5, 108–10, 115, 118, 137, 182–3, 185, 188, 198, 244, 315–16

460 Index St. John’s Road, 165 St. Julien, 51, 54 St. Michael’s Hospital, 63 St. Nazaire, 49 St. Omer, 80, 208 St. Pol, 308 Standing Medical Board (SMB), 286–7 static warfare, 93, 201, 313 Steenwerck, 45 Stier, Ewald, 23 Stockwell, P.H., 169 Strathy, Major George Stewart, 71, 306 stretcher–bearer, 36–7, 51, 172, 183, 185, 22 struck off strength, 45, 78, 139, 187–8, 280 Suakin Campaign of 1885, 32 surgery, 24, 201, 216 Suvla Bay, 190 Swindell, George Henry, 71 swinging the lead, 72, 124, 127. See also malingering Taylor, Lieutenant Colonel W., 236 Territorial Army, 39, 208 The Lancet, 261 Thiepval, 172 Thompson, H.N., 241–2, 293, 302, 304 Tomkins, Lieutenant Alfred, 96–7 Toronto, 72–3, 81, 124, 150, 204, 209, 257, 272, 286, 306 Tremblay, Lieutenant Colonel T.L., 258 trench foot, 45–7, 85, 93, 158, 202, 326 triage, 43, 45, 89, 207, 269, 279, 282, 290, 299, 308, 310, 313, 318, 325 trommelfeuer, 92, 96, 102, 110, 115, 198

Trotter, Pte. Bernard, 69, 252 Trouville, 38, 276 Turner, Aldren, 42–3, 140, 143–4, 148, 202, 286 Turner, Brigadier General Richard, 52, 56, 96, 98, 182 Turner, W.E., 65 Turner’s Lane Hospital, Philadelphia, 21–2 Tynhan, Lieutenant G., 167 United States, 7, 16–17, 19, 21, 87, 144, 221, 276, 281, 289 University of London, 227, 281 University of Manitoba, 51 University of Toronto, 72–3, 209 Vacquemont, 180 Vadencourt, 174, 181, 187 Vancouver, 149, 185 Varennes, 240 Vecquemont, 162 Verdun, 161, 237, 318 veterans, 7–8, 12, 32, 38–9, 41, 65, 74, 87, 167, 253, 298, 324, 326 Vienna, 18 Vietnam War, 5–7 Vimy Ridge, 127, 149, 198–9, 218–19, 221–3, 225, 237, 245, 292, 305, 320 Vlamertinghe, 50–1, 56 Voormezeele, 91, 95 Walker, Frank, 96 Walton, Arthur Harold, 124 wandering wombs, 16 War Office, 32, 36, 43, 140, 146, 155, 177, 286, 290, 298; Army Medical Service, 42; Notes for the Guidance of Officers in Charge of Military, Territorial, and Auxiliary Hospitals,

Index 461 140–1; War Office Committee, 6, 27, 324; War Office Committee of Inquiry, 6, 324; War Office Press Bureau, 206 Washbourn, J.W., 26, 28 Wasserman Test, 126 wastage, 31, 33, 38, 41, 45, 47, 84–6, 89–90, 93, 119, 158–9, 161, 170–1, 177–8, 187, 190, 199, 237, 316 Watou, 49 Watson, Captain J., 259 Watts, Pte J., 219 Wavrans, 293, 299, 308 Weir Mitchell, Silas, 19, 21–2, 144 West End Hospital for Nervous Disease, 208 West London Hospital, 42 Western Front, 47, 49, 90, 106, 162, 190, 207, 257, 289, 318 whiz bang, 81 Wieltje, 49 Williams, General Arthur V.S., 110 Williams, General E.C., 93 Wilson, Lieutenant Colonel A.W., 191

Wimereux, 135 Winnipeg, 31, 33, 95, 142, 149, 229 Wisques, 247 Woodhouse, Tom Percy, 160–1, 176–7, 179, 283 wound infection, 31, 34 Wright, Colonel Robert, 187 Wytschaete-Messines Ridge, 91, 109 x-ray, 126 Y Ravine, 165 Yealland, Dr. Lewis, 145 yellow fever, 24 Ypres Salient, 48–9, 91–2, 109, 183, 237, 239–40 Ypres, 41, 48–53, 55–7, 62, 82, 88, 90–2, 98, 101, 109, 117, 121, 136, 158, 183, 189, 204, 227, 237, 239, 240, 250, 272, 307, 315 Yser Canal, 50 Zwarteleen, 109