MEDICAL ARRANGEMENTS FOR THE TREATMENT OF THE SICK AND WOUNDED
—THE PROVISION OF HOSPITALS AND CLINICS
As already stated in a previous chapter, in the first stages of the
negotiations of 1915 for the internment of Ps. of W. attention had been
directed solely to the hospitalization in Switzerland of one category of
prisoners, viz., that of the tuberculous; but very shortly, under the
pressure of public opinion, further attention had been drawn to the
advisability of extending the principle to other categories, with a view
to the inclusion of disabilities of a very varying nature. The
discussions were continued during 1915, with a view to the realization
of an enlarged programme, and in January, 1916, a first list, comprising
twelve categories of disabilities or wounds, had been prepared and
agreed upon, including that of tuberculosis, and the first essays of
internment were made on the 26th of January, 1916, commencing with 200
tuberculous cases. By the 14th of February 1,247 French and German Ps.
of W. had been interned in the regions of Montana, Montreux, Leysin, the
Bernese Oberland, the Quatre Cantons, and Davos, comprised of men of the
aforesaid categories.
By the 16th of February the list had been increased to twenty
categories, to be afterwards reduced in June and July, 1916, to
eighteen. These lists formed the basis of the work done by the so-called
"Itinerant Commissions of Swiss Medical officers," who were authorized
to proceed to Germany, France, and England for the examination and
selection for internment in Switzerland of all those prisoners found to
be suffering from the diseases or wounds mentioned in the aforesaid
eighteen categories.
The "Médecin d'Armée" was thus suddenly faced with the problem of the
internment and treatment of a number of Ps. of W. largely in excess of
those originally in view, and the whole of his programme had to be
re-cast to meet the needs of a body of Interned, not less than the
strength of an Army Corps. The serious nature of the demands made on the
medical organization of the country may be realized from the fact that
every one of the 30,000 men about to reach Switzerland was suffering
from one or other form of disability, requiring medical attention at the
hands of a Sanitary Service manned and equipped for the ordinary
requirements of the small Swiss Army.
To meet the additional requirements of the medical personnel, medical
officers in civil employ, liable for further service, were mobilized,
and many civilian doctors, not so liable, were called upon for a term of
duty.
As regards the housing of those prisoners whose treatment was not of a
pressing nature, and who formed the majority of the Interned,
accommodation was found in the hotels and châlets with which Switzerland
is so richly endowed. In this respect no difficulty was experienced; but
for those requiring that care and treatment which could only be given in
a hospital, the solution was not so easy, as the necessary accommodation
for the large numbers of sick, with which the country was being flooded,
was lacking.
It is true that many of the private clinics which form so marked a
feature of the modern life of Switzerland had been vacated by their
foreign clients on the outbreak of war; but, as an off-set to this
relief, the mobilization of the Swiss Army threw a strain on the
Sanitary Service and the available accommodation which, perhaps, more
than counter-balanced the relief afforded by the withdrawal of the
foreign element. The "Médecin d'Armée" did not, at the outset,
therefore, find much relief from the release of the private clinics, and
a good deal of improvization had to take place before the difficulty was
satisfactorily overcome.
Military and civil hospitals, already in being in the different regions,
were set apart or partially utilized for the Interned, whilst other
suitable buildings were commandeered, and were installed as hospitals or
convalescent homes.
As to the treatment in the camps, the methods adopted were of a varying
nature. At Château d'Oex, the men were, in the first instance,
distributed amongst the hotels and châlets, without much regard to the
nature of their physical condition, but as soon as the doctors could get
to work, the worst cases were weeded out and sent to the local hospital,
the "Soldanelle." Less serious cases, and those awaiting their time and
turn for surgical treatment, were dealt with in their own establishments.
The "Soldanelle" contained about eighty beds, and had in pre-war days
been equipped solely for the use of visitors requiring rest cures, or
electric or light treatments. The equipment included electric and X-ray
installations, but was deficient on the surgical side. This defect was
made good by the "B.L.R.C.O." at Berne, who presented the hospital with
the complete equipment for an operating theatre.
A question in connection with this operating theatre was raised at the
time by the "Médecin d'Armée," which is of some interest as illustrating
the point of view of the Swiss Medical Staff in respect to the surgical
treatment of serious cases. When I first suggested to Colonel Hauser the
desirability of bringing this hospital up to date by the addition of an
operating theatre, he threw cold water on the scheme, on the ground that
Château d'Oex had never been intended as an operating centre, and its
equipment as such might and would, probably, lead to the performance of
operations by local surgeons, when such operations had best be left to
the specialist. There was no gainsaying this argument, and for a time
the matter was left in abeyance; but when an immediate operation had to
be conducted at Château d'Oex, in a hastily improvised room, as the only
means of saving the life of an officer suffering from acute
appendicitis, the need for a suitable operating theatre again came
prominently to notice, and Colonel Hauser gave his consent for its
installation.
In the course of the first twelve months some 400 minor operations were
carried out in this theatre by Dr. Brüstlein, who fully justified his
reputation as a rising young surgeon. Occasionally operations of a
serious character were also performed there, with the assistance of
specialists who were called in for the occasion, Dr. Arndt, of Berne,
amongst others. The hospital thus served an excellent purpose in
relieving the specialized institutions of minor cases, for which the
accommodation would have proved insufficient.
The nursing personnel consisted of orderlies, both Swiss and British.
The latter were untrained, but acquired in the course of time a certain
skill and readiness in their duties. As regards women nurses, the
doctors at Château d'Oex were firmly opposed to their employment, as
being contrary to the usual custom of Swiss military hospitals, and it
was only at my repeated instance, after considerable opposition, that an
offer to supply Swiss nursing sisters at the expense of the "B.L.R.C.O."
was accepted.
Another difficulty, and one for which no immediate remedy could be
found, was experienced in the lack of properly qualified masseurs. In
this respect the Sanitary Service was faced with a very real difficulty.
Most of the trained masseurs of the Swedish type had left the country on
the outbreak of war, and the number available from all sources for the
use of the Interned was totally inadequate. Training schools were at
once opened, but it was not until the end of 1916 that the deficiency
was made good.
Meanwhile the Sanitary Service was subjected to much severe and
exaggerated criticism, owing to the refusal of the authorities to accept
assistance from outside. The attitude of the "Médecin d'Armée"
_vis-à-vis_ of the aid offered by the Red Cross organizations of the
Allies with regard to the supply of nurses, masseurs, etc., was
influenced in no small measure by the decisive stand taken by Swiss
Trade Unions, who were jealously opposed to the employment of foreign
labour to the detriment of the Swiss worker. He was obliged to give due
consideration to popular opinion on the subject, and to follow the lead
of his Government, so that in many cases the acceptance or
non-acceptance of the assistance offered was determined _for_ him, and
not _by_ him. I may safely assert that his decisions were never inspired
by personal prejudice, or based on a narrow or jealous view.
As regards Mürren, no local hospital being available, cases requiring
any special treatment were sent to the District Hospital at Interlaken,
or to the hospitals at Berne, Lucerne, and Fribourg. Two small wards
were set aside in one of the hotels for patients suffering from ordinary
ailments, and a good deal of medical work was carried out in the hotels,
sun cures being much in favour for the treatment of open wounds, etc.
For massage and orthopædic exercises a gymnasium was installed, with
apparatus of a useful kind. We were indebted to the generosity of a
Swiss friend for certain of the more delicate and costly pieces for
vibratory exercises. The equipment consisted of twenty-five apparatuses
for "mécanothérapie," two for "faradization," and one for
"galvanization." During 1916 above 253 cases were treated, of which 96
were by massage, 45 by "électrothérapie," and 112 by "mécanothérapie";
180 men were subjected to sun cures.
A description of the District Hospital of Interlaken, where so much work
was done for us, will serve to illustrate the general type of civil
hospitals placed at the disposal of the general public all over
Switzerland. This hospital is divided into wards of five to ten beds,
affording accommodation for some 150 patients. The personnel consists of
a resident surgeon with a staff of doctors capable of dealing with all
the ordinary work of the district. The surgeon in charge had served his
novitiate under Professor Kocher, of Berne, and was well known
throughout the length and breadth of the Bernese Oberland as a very
skilful operator.
I may here call attention to a marked feature of the civil work in
Switzerland, in that many of the most promising young surgeons and
practitioners of the country, after their early years of study and
association with such masters of their art as Professors Kocher and
Roux, take up their life-work in the smaller towns, where they build up
a reputation in their turn, second only to that of their erstwhile
masters. The peasants and the general public have, therefore, at their
very doors, up and down the country side, specialists of a high order of
professional skill. Perhaps in no country in the world are there
specialists so widely distributed as in Switzerland, much to the
advantage and well-being of the people. These doctors live hard and
frugal lives, and give their services for fees which in our country
would be considered derisory; but they lend lustre to a Sanitary Service
which is held in high esteem by their countrymen, and which is the
admiration of the foreigner within their gates.
Before concluding this account of the sanitary organization of Mürren, I
must add a word regarding an important branch of that work inaugurated
at the "Manor Farm." This châlet, the property of an English lady, Miss
Simpkin, served in pre-war days as a pension for British and American
visitors. It was beautifully situated, two kilometres from Interlaken,
on the shore of the Lake of Thoune, and Miss Simpkin conceived the happy
thought of offering it to the medical authorities as a convalescent home
for soldiers suffering from neurasthenia, shell shock, heart, etc. The
offer was gladly accepted. Twenty officers and men were in constant
residence there, and it would be difficult to exaggerate the care and
kindness lavished on them by this devoted lady.
Apart from the treatment afforded by the ordinary camp organizations,
with their associated hospitals as already described, the principle was
adopted of utilizing, so far as practicable, the services of specialists
in such centres as Berne, Fribourg, Lausanne, Montreux, Geneva, etc. We
thus find many of the best-known professors and doctors of Switzerland,
some of whom have a world-wide reputation, actively engaged in their own
hospitals in the service of the Interned.
At Berne: Professors Kocher, Capt. Dr. Matti, Dr. Arndt, Dr. Kocher.
At Lausanne: Professor Roux, Dr. Dufour.
At Montreux: Dr. Chessex.
At Geneva: Dr. Julliard, Dr. Machard.
At Fribourg: Dr. Clement.
A special Sanitary Establishment was also created by the "Médecin
d'Armée" at Lucerne, in June, 1916, with 190 beds and a staff of eleven
doctors, known as the "Armée-Sanitäts-Anstalt," destined for the common
use of the Interned of all nations for operative work in connection with
bone-grafting, tendon-transplantation, brain and nerve surgery, and
complicated plastic movements. The beds were distributed as follows: 6
to officers, and 78 to French, 22 to British, and 84 to German N.C.Os.
and men, the different nationalities being accommodated in different
wards. This hospital was well equipped from a scientific point of view,
and was supplemented by annexes to which the convalescents were
transferred. The annexe set aside for the British was the congeries of
châlets at Seebourg, four kilometres from Lucerne, owned by the London
Polytechnic Society. This was kindly placed at my disposal by the
Society, and was further utilized for the accommodation of men attending
the classes for technical instruction established under the auspices of
the B.R.C.S., London. The "A.S.A.," however, proving unequal to the
ever-increasing strain, had to be supplemented on September 8, 1916, by
the addition at the "Clinique Générale," Geneva, under the direction of
Dr. Julliard, of a _service_ for the treatment of lesions of the jaw and
face. Another _service_ was also opened by Dr. Machard, at Geneva, and a
third by Dr. Matti, at the Salem Hospital, at Berne, also for lesions of
the face and jaw.
The specialization demanded was in this way gradually placed at the
service of the Interned, but its creation was not the outcome of a day.
The year 1916 was a transition period of trial and evolution, during
which many mistakes were made, but which ended in the development of an
efficient organization capable of meeting all demands. That the Swiss
Sanitary Service, both in its military and civil branches, should have
met so readily demands of so unprecedented a nature, shows a remarkable
spirit of originality and adaptability, which is deserving of record and
acknowledgment.
One other special establishment, set apart in 1917 for the use of the
Allies, was that of the Fribourg Hospital. Early in that year I received
a visit from the Comtesse de Zürich de Reynolds, informing me of a
scheme initiated by herself and the Baronne de Montenach, both residents
of Fribourg, for the equipment of a large hospital on the outskirts of
the town, built originally by the municipality as a Maternity Hospital,
but which for financial reasons had never been opened as such. The
municipal authorities had expressed their willingness to hand over the
building as a Military Hospital dedicated to the use of the Allies for
the period of the war, and funds were being collected with the intention
of transferring it, after equipment, to the "Médecin d'Armée." The
hospital was calculated to provide beds for about 120 officers and men,
at a cost originally estimated at frs. 100,000. Of this sum, frs. 75,000
had already been promised, by French Red Cross sources, to Mme. de
Montenach, who was devoting herself more especially to the
Franco-Belgian side of the question.
An examination of the building showed me that it was eminently suited
for the purpose, and a visit to Fribourg made it clear that the medical
faculty of the town, as well as the authorities, were deeply interested
in the scheme. The "Médecin d'Armée" also adopted it with warm approval,
but told me that the funds allocated to him by the Allies would not
admit of the capital expenditure involved. As we were at that time
awaiting the arrival of a fresh British contingent from Germany, for
whom further hospital accommodation was most desirable, the scheme made
a strong appeal to me, and I felt no hesitation in placing it before the
British Red Cross Society in London, with a request for a donation of
frs. 30,000. This sum was immediately placed at my disposal, and in a
very short time the ladies at Fribourg had the satisfaction of
transferring to the "Médecin d'Armée" a hospital equipped from top to
bottom, the total expenditure being about frs. 150,000 in all.
Here some forty of our soldiers lay side by side with the French and
Belgians, and benefited greatly by the highly skilled work of Captain
Dr. Clement and his able assistants. Mme. de Zürich de Reynolds was
untiring in her interest in and kindness to our men, as well as their
Allied comrades. I am happy to be able to cite this as one amongst the
many instances of kindness and practical sympathy of our Swiss friends.
It gives me pleasure to record the fact that the Swiss surgeons often
spoke to me of the cheeriness of our men whilst under treatment, their
quiet acceptance of operative work, and their powers of endurance. One
surgeon, when commenting on these temperamental qualities, accounted for
them by the love of the British for the open air life, their addiction
to sport, and the quality of their diet.
In preparing a comparative return of mortality in Switzerland during the
years 1916 and 1917, I found, to my surprise, that the percentage of
loss by death of Interned French and Belgians more than doubled that of
the British. I understood from my French colleague, Comte de Manneville,
that his figures by no means represented the total losses of his
countrymen, as so many of them had, on arrival in Switzerland, been
repatriated as "grands blessés." How many of them had died in France he
could not tell, but doubtless a considerable number, as the majority
were in the last stages of tuberculosis. That fell disease appears to
have been more common to the French than to the British whilst in
captivity in Germany.
The mortality amongst the British in Switzerland from all causes during
the years 1916 and 1917, out of an average of about 2,000 men, amounted
to fourteen only, most of whom died of tuberculosis, pneumonia, or
accident—a gratifying record as far as Swiss surgeons are concerned,
when the sum total of their surgical work is taken into account.
Many of the Leysin patients had been sent out of Germany by the
Itinerant Commissions on the mere suspicion of tuberculosis, and these
men failed to understand that their condition could be in any way
dangerous. The restrictions imposed as regards smoking, drinking, and
exercise, the lying out in the open in a recumbent attitude, exposed to
sun and air for six to eight hours per diem, and the general want of
freedom thereby involved, proved extremely trying to them, and they
were, I am afraid, often a thorn in the side of the medical officers. On
one occasion they persuaded the doctors to give them permission to play
a friendly game of football with other enthusiasts of the camp, with
results disastrous to certain of their number, who realized, perhaps for
the first time, that unusual strain could only lead to hemorrhage or
other evils of a cognate nature.
A large proportion of the sick were drafted to Château d'Oex, or Mürren,
as completely cured, after a residence at Leysin from six months to a
year. The percentage of incurables was small, and there is no doubt in
my mind that the treatment, as practised in the Swiss Sanatoria, is of
immense advantage to those not far advanced in the disease.
As regards an important branch of treatment, viz., that of dentistry,
provision was made by the "Médecin d'Armée" as part of the ordinary
medical work. This, however, owing to the strain imposed by the
mobilization of the Swiss Army, proved totally inadequate, and it was a
great relief to me when, in June, 1916, I received a letter from Mr.
Joseph A. Woods, M.D.S., L.D.S., offering me his personal service in
Switzerland. He wrote to me as follows:—
"My proposition would be to go to some suitable centre for, say, one
month. I would take all necessary instruments and supplies and would
attend to any Interned who would care and need to have such treatment.
The whole service would be entirely gratuitous, whether to officers or
men, and, as far as possible, I would, in addition to operative
treatment, fit artificial dentures or make splints or other appliances
in any cases of jaw injuries. I would be personally responsible for the
expenses. I should, of course, accept any regulations or conditions
which may be in force and would loyally fall in with them."
This generous proposition naturally commended itself to me, and with the
approval of the "Médecin d'Armée," and the sanction of the War Office,
Mr. Woods was appointed Head Dental Surgeon to the British Interned. He
immediately closed down his private practice at Liverpool, and exactly
three weeks later reached Berne, bringing with him a large stock of
instruments and general dental supplies. It was a good thing he did so,
for all such stocks had run very low in Switzerland, and the problem of
supply has since then become increasingly difficult. Mr. Woods, at my
request, made Mürren his centre, and within a few days most of the
officers and 200 men were on his register as prospective patients. His
original offer to remain one month was extended to three, and then as
the work increased, owing to fresh arrivals from Germany, he decided, on
my representations, to remain for a much longer period, and in fact only
left the country when the camps were closed down on the repatriation of
all Ps. of W. in the autumn of 1918, having thus completed two years and
four months voluntary service with British troops in Switzerland. The
camps at Interlaken (where he fitted up an additional surgery), Gunten,
Meiringen, Seebourg, Leysin and Château d'Oex, also came within his
purview at one time or another. Leysin and Château d'Oex were
subsequently, in August, 1917, placed in dental charge of Mr. W. I. Law,
L.D.S., where the work was almost as heavy as at Mürren. Mr. Law's
expenses were defrayed by the North-Midland Branch of the British Dental
Association, supplemented by a donation from the B.R.C.S., London. The
services of Mr. Woods were entirely honorary: all expenses, both
professional and personal, were met by him, and no fees or charges of
any sort were accepted under any circumstances.
The following summary will give some idea of the magnitude of his work:—
Total number of patients treated 1,229
Visits 6,033
Operations 9,725
Restorations (dentures), etc. 673
Mr. Woods laid himself out to give as full dental treatment as though he
were in his own private consulting-room at home, and to avoid the
suggestion or appearance of merely giving the bare essentials of dental
treatment. The fact that 99 per cent. of the officers, and about 80 per
cent. of the men, consulted him, shows how entirely he obtained the
confidence of all ranks, and how necessary a dental service was. He was
able, by a series of lectures and demonstrations, to impress upon all
his patients the extreme importance of dental hygiene.
Writing on the subject of his work, he mentions that, like all other
members of his profession, he had been anxious since the outbreak of the
war to be of service to his fellow-countrymen, and when he saw that Ps.
of W. were being transferred to Switzerland, he felt an overpowering
desire to offer a dental service to them. That this loving desire has
received a wonderful fulfilment, the foregoing record amply shows, a
fulfilment towards which he was so well assisted by Mrs. Woods, who gave
up all her time and strength in the furtherance of her husband's task.
It is a pleasure to add that Mr. Woods received the heartiest support of
Captain Dr. Llopart, the Directing Medical Officer at Mürren, and of the
Swiss Dental Service.
As regards the provision of artificial limbs, it is casting no slur on
the Swiss medical authorities and Swiss artisans to say that they were
unable to meet the demands of the Interned. In Switzerland, as in other
countries, trained artisans skilled in this class of work were lacking,
and the type of limb in use was in no wise suitable for the demands of
modern life; in short, good artificial limbs were unprocurable in the
country, and though some of the men were fitted out locally, the
majority preferred to wait in the hope that a more suitably-designed
limb would have been evolved before their return to England. A few
officers were supplied with artificial legs by a Lyons firm, with which
they were satisfied at the time, but whether these compared favourably
with the home product I have not heard. Lady Dorothy Dalrymple did
useful service at Château d'Oex in supplying peg-legs, which proved most
useful.
A few words here as to the expenses caused by the administration and the
medical care of the Interned will not be out of place. The foreign
Governments concerned engaged to pay to the Swiss Government, in
liquidation of these expenses, 50 centimes per diem for every officer
and man interned, with an additional sum of 50 centimes for those under
treatment for tuberculosis. This payment covered charges for the pay and
allowances of all Swiss officers and men engaged in the service of the
Interned; hospital expenses of every kind and nature except food; hire
of offices and expenses of installation; allowances to Interned men
working in the administrative offices of the Interned, or employed as
masseurs, etc.; also the laundry of officers and men.
It was only by the exercise of a careful economy that the expenditure
was maintained within the limits agreed upon, but I understand that, as
the Internment developed, the funds placed at the disposal of the Swiss
Government were found sufficient for the purpose.