MEDICAL AND SURGICAL TREATMENT OF THE INTERNED
—INSPECTION BY LIEUT.-COLONEL SIR R. JONES, R.A.M.C.
Our men had not long been settled at Château d'Oex when they were
inspected by Colonel Hauser, who mentioned to me his surprise at finding
an unusually high percentage in need of surgical treatment, the
percentage being much higher than in the case of the French, Belgian, or
German Interned. He appeared to be satisfied at the time with the
adequacy of the medical and surgical arrangements at our disposal, but
expressed some concern at a feeling, common to both officers and men,
that their surgical treatment was being unduly delayed. He said that the
same feeling had prevailed amongst the French and Belgians at an earlier
date of the Internment, but that this was based upon a totally erroneous
impression. Patients, in their anxiety for an early restoration to
health and activity, often failed to realize the danger of premature
operative work, and he had been forced to direct his surgeons to
exercise due caution. Recrudescent purulent outbreaks had already
occurred amongst the French, with fatal consequences, as the result of
premature work, and he was determined that his surgeons should not in
the future be led away by any signs of impatience on the part of the
Interned. He begged me to believe that his officers were acting in the
interests of each individual officer and man, and that if operations
were deferred, there was good reason for the decision taken. He had
evidently warned Major Mercanton, the "Chef de Région," of the necessity
for caution in certain classes of surgical work, for, whilst
accompanying the first train conveying the men from Montreux to Château
d'Oex, I was present when a conversation on this subject took place
between the latter and Captain de la Chaux, the D.M.O. of the camp.
Major Mercanton warned his subordinates of the advisability of
proceeding slowly in the first instance. Apart from the necessity of
dealing with urgent cases as they might arise, he recommended a rest of
at least a month, in order that the effect of good food and change of
climate might be watched before any operative work was undertaken. He
also dwelt at length on the danger of blood-poisoning due to the foci of
bacteria. I felt at the time that whatever minor evils might result from
excessive caution, the greater evil of premature surgery would, within
the limits of human judgment, be avoided.
It was a matter of interest to me to learn from Colonel Hauser that, as
in the case of the French and Belgian Interned, his officers were
already being criticized as a result of this cautious attitude, and that
the criticism amounted to a suspicion of neglect. This suspicion may
have been aggravated to some extent by a feeling amongst certain of the
officers that reasonable facilities were not being granted them for
treatment by private Specialists. The regulations affecting this
question gave the officer the right of consultation with, and treatment
by, a Specialist, but with the proviso that the charges incurred should
be debited to the Sanitary Department only, when the necessity for
calling in the Specialist had been allowed by the responsible camp
doctor. In the case of his non-approval, the charge had to be met from
the private purse of the officer. The D.M.Os. took the point of view
that, in the majority of cases, treatment could be as well conducted in
the camp by the regular Medical Staff as by the Specialist, and as
trustees for the proper expenditure of the funds placed at their
disposal by our Government, they did not feel themselves justified in
employing the Specialist in other than exceptional cases. The charges
involved by this latter procedure would, of course, have proved heavier
than in the former, and though they did not attach undue importance to
the financial side of the question, they did not feel inclined to ignore
it altogether. On the one hand, the medical officers complained of the
capricious nature of the demands made by our officers for specialized
treatment, when the ordinary camp treatment would have amply sufficed,
and held the opinion that the latter had no regard whatever for the
financial interests of our Government. On the other hand, our officers
cast doubts on the quality of the professional skill available in the
camp, and criticized the cheese-paring policy of the medical officers.
The one view was directly opposed to the other, and it looked as though
it would be difficult to arrive at an understanding on the question. The
conclusion which, after conversations with both sides, I personally came
to was, that the camp doctors (I am only speaking of Château d'Oex, for
the same difficulty was not experienced elsewhere) were disposed to
adhere too closely to the letter of their instructions, and were not
sufficiently flexible in their dealings with either officers or men.
They were too inclined to treat our soldiers as they would their own
Swiss compatriots; a great mistake, as, in doing so, they made no
allowance for the weaknesses and suspicions of men who had been
subjected to hardships of a trying nature during a period of long
confinement, and whose nerves were vibrating and sensitive to a degree.
Moreover, the mentalities of the Swiss and British soldier were very
different, and to judge of one soldier by the other could only lead to
error and misunderstanding.
I discussed this question with Colonel Hauser, who spoke to me on the
subject with the utmost frankness. It was apparently all the more easy
for him to do so, as he had already been through the same phase of doubt
and dissatisfaction with the Interned of our Allies, and had succeeded
in proving to their satisfaction that all was well with their medical
treatment. He pointed out that the conditions under which our men were
being treated were, when compared with those of the Swiss soldier,
exceptionally favourable, and this I believe to have been the case. It
was true, he said, that in respect of food, nursing, etc., no comparison
could be drawn, as either the circumstances differed, or the system
adopted varied in our respective countries in a greater or less degree,
but we could not expect the Swiss Government to adapt itself to the
idiosyncracies of the soldiers of any one nationality; we must be
prepared to judge by results. He could only deplore the lack of
confidence displayed towards his Staff at Château d'Oex, and thought
that our officers were over critical.
I, in reply, stated that I was at a disadvantage in having no qualified
British doctor to assist me, and suggested that a visit of inspection by
a distinguished British surgeon would, in all probability, serve to
allay suspicion on the part of the Interned, and bring about a better
feeling between his Staff and our men. He met the suggestion with
enthusiasm, and said that both he and his Staff would welcome such a
visit. Any officer nominated by the War Office for the purpose would be
warmly received, and be given every facility to make himself acquainted
with the conditions which determine the care and treatment of our
Interned, and the attitude of the Swiss Sanitary Service towards them.
He would be more especially pleased to see a medical expert of
international reputation, as his doctors would have much to gain from an
expert of wide experience.
Thereupon, I lost no time in making the situation clear to the
Authorities at home, and asked that a surgeon of standing should be sent
to inspect and report on the medical treatment, and to advise me as to
the sufficiency or otherwise of the care bestowed upon our officers and
men. Some delay took place before the right man could be found, but at
last Lieut.-Colonel Robert Jones, R.A.M.C. (now Sir Robert Jones), the
distinguished inspector of Military Orthopædics in Great Britain, was
nominated for the purpose by Sir Alfred Keogh, K.C.B., Director-General
A.M.S., and arrived in Berne on December 22, 1916.
He commenced his inspection at once, and in due course visited the camps
at Mürren, Château d'Oex, Leysin, and the hospitals affiliated to these
camps at Interlaken, Berne, and Lucerne. Shortly before his arrival, a
contingent of Ps. of W. had reached Switzerland from Germany, and he
therefore had an opportunity in each of the camps of comparing the
conditions of these newly-arrived men with those who had been in
residence in Switzerland for some time, a matter, to my mind, of great
importance, as Colonel Hauser had contended that the true test of the
efficiency of his Sanitary Service could best be demonstrated by
results, the methods by which those results were achieved being of
secondary importance. In principle, I agreed with this view, and looked
upon it as a very happy circumstance that the arrival of this contingent
had coincided with that of Colonel Jones, who would be able to apply
this test when making his examinations.
As regards the medicine and surgery practised in the camps, Colonel
Jones found the doctors to be well-informed young practitioners, who had
undergone a sound modern training. Assisting at an emergency operation,
conducted by Captain Dr. Brüstlein, at Château d'Oex, he writes:
The technique was good, and the theatre staff compared quite favourably
with many more ambitious theatres at home. This experience gave me
confidence with regard to the conduct of emergency operations in this
camp. Neither at Mürren nor at Leysin is there an operating theatre in
the camp. This is as it should be, as at neither place is there a
surgeon qualified for serious surgical emergencies. Should such
emergencies arise, an operating surgeon would be telephoned for from
Interlaken or from Montreux. The character of the cases is very similar
to those which we find in the ordinary British Military Hospital….
I was much pleased to find that the Swiss doctors were conservative,
and did not show an undue haste to operate. They were beginning to
learn of the dangers of recrudescent purulent outbreaks in those
instances where operations were performed too early. This delay, in one
of the camps, has given rise to suspicion of neglect, a suspicion which
I took pains to dissipate….
The treatment of the Swiss doctors was quite equal to that which we
find in a well-conducted auxiliary hospital at home, and the facilities
offered the men to consult specialists were even greater than we often
find to be the case at home.
Our soldiers are very well situated in all the camps, from the point of
view of access to specialists. Berne, Lucerne, Montreux, and Lausanne
contain most distinguished surgeons—many of them of international
reputation. Careful inquiry proved to my satisfaction that whenever
really necessary a consultation was allowed. These consultations, as
long as recommended by the Directing Medical Officer, were never
charged to British officers or men. I questioned the medical officers
as to the specialists recommended, and was satisfied they were
well-known men. If officers desired to consult any special man other
than the person recommended by the D.M.O. no objection is taken to it,
and so long as the D.M.O. thinks the consultation necessary, no charge
is made for it. Occasions sometimes arise when an officer visits a
specialist without consulting the D.M.O. and in that case he pays his
own expenses. It is always advisable that the officer should consult
the D.M.O. before seeking the advice of the specialist, as it sometimes
happens that the officer chooses a surgeon with a brilliant abdominal
reputation, when he should have consulted a specialist versed in bones.
I had a long talk with the officers on this subject, and explained to
them that they were as well off in the matter of expert opinion as if
they lived in London.
The nursing was mostly of a comparatively unskilled type. Women nurses
were not encouraged, and the duties were performed by orderlies who had
undergone instruction. The disadvantage of this was largely
counteracted by the fact that the surgeons themselves dressed their
cases.
There are too few masseurs. I spoke of this, and I learn that the
shortage is to be remedied. The Swiss authorities are to start a School
of Massage, which several of our men will attend. This may easily prove
to be a vocation of advantage to them after the war.
I visited several of the hospitals where the more serious cases had
been removed for operation. I found the surgeons keen and very
interested in their patients, and the hospital accommodation quite
good. The food was excellent, and I could hear no complaints. In these
various hospitals every type of operative work is done, such as
bone-grafting, tendon-transplantation, brain and nerve surgery, and
complicated plastic operations. I had long conversations with the
staffs, and am now well aware of their views and methods of procedure.
They seemed thoughtful, conscientious and careful men, and I feel our
wounded are safe in their hands.
I found the British officers wanted encouragement, and I trust I was
able to cheer many of them by truthfully assuring them of their
recovery after the war. I endeavoured to instil into them a spirit of
confidence in the doctors with whom they had to deal. In certain more
complicated cases I suggested that the final operation should be
performed upon them on their return. I think I examined every officer.
In respect of the general condition of the men, Colonel Jones writes:—
The newly arrived seemed indifferently nourished, many of them dazed,
and some apprehensive of those in authority. After a very short time,
so I am informed, these conditions are overcome, and the men become
cheerful and trustful. The condition of those who had been in camp in
Switzerland for longer periods was very satisfactory. They looked well
and felt happy, and I had opportunities of examining their charts, and
noted that they soon began to fatten after arriving in camp. Indeed,
they represented generally a well-conditioned body of men. Many spoke
well of their treatment by the Swiss officials, and seemed to
fraternize with the villagers, with whom they were in general accord.
The three camps (Mürren, Château d'Oex, and Leysin) are admirably
chosen … and the residential establishments for the men comprise most
of the well-known hotels of the district. It would be difficult to
conceive of more appropriate or delightful surroundings for men who
have returned from German prisons.
Summarizing his experience of the camps, Colonel Jones stated that:—
The sanitation and housing were excellent; the feeding good in quality
and plentiful; the Swiss doctors in charge well trained and attentive,
and quite competent; the specialists extremely good, and every
reasonable facility afforded for consulting them; the General Hospitals
for serious cases were staffed by competent and often distinguished
surgeons.
This visit of Colonel Jones, and the satisfactory nature of the report,
once and for all set my mind at rest as to the general efficiency of the
service and the skill of the medical officers, and certainly had a
tranquillizing effect on the majority of our own officers and men. The
contrast between the condition of the recent arrivals and those who had
been in residence for some time was most marked, and furnished a proof
of the almost miraculous change effected by the climate, the freedom
from anxiety, and the good work of the doctors. In every camp the two
classes of men were paraded for inspection side by side, and the
difference in their mental outlook and physical condition was of a
marked nature.
Further confirmation of the activities of the Swiss doctors reached me
about this time from another quarter. Having regard to the great mass of
Ps. of W. arriving in Switzerland, the majority of whom had received
insufficient treatment in Germany, the "Médecin d'Armée" found it
necessary to call for an objective and uniform examination of all
wounded men, with a view to obtaining detailed indications for the
treatment of their wounds, and in September, 1916, Dr. Matti, a
distinguished specialist of Berne, was charged with the duty of visiting
the "regions," and of examining every case where surgical and orthopædic
treatment was in question. In December this order was modified, the
"regions" being divided into four zones, for each of which a Specialist
was nominated. The result of these examinations was communicated to me
in due course, supplementing, and, I am glad to say, confirming, the
conclusions drawn, quite independently, by Colonel Jones.