SOME MEDICAL ODDS AND ENDS.
FUNCTIONAL BLINDNESS.
At Bethune some of us met for the first time in this war cases of
functional temporary blindness, and many other cases were met with at
various points of the front.
The following example will give an idea of the condition. A young
officer, nineteen years of age, was standing by a haystack in the north
of France when a large Black Maria burst near him, rolled him over, and
plastered him with clay, but did not kill him. The _concussion_ had
thrown him down. He remained unconscious for half an hour, and when he
woke to consciousness he discovered he was “blind.” His mental state
then was terrible. He cried out, “Oh, why wasn’t I killed?” “Won’t some
one carry me out and put me on the parapet of a trench so that I may
be killed?” His grief was pathetic, and one can easily understand it.
A careful examination was made of the interior of the eyes with the
ophthalmoscope and nothing was found wrong. He was assured by the medical
officers that he would certainly recover after perhaps a week or two of
blindness. He was quiet and composed after this, but was a little bit
suspicious that we were only trying to cheer him up. One medical officer
then explained to him what sort of blindness it was: that it was due to
concussion of the nerve of sight, and the delicate structures at the
ball of the eye; that nothing was destroyed, and that a complete rest
would bring back his vision. Next day he was transferred by hospital
train to the Base _en route_ for England. This note, unknown to him, was
pinned on his coat: “Functional blindness. Any medical officer handling
this officer on Hospital Train, Base Hospital, or Hospital Ship, please
tell him that he will fully recover his sight.” Knowing the kind-hearted
nature of the medical profession, one can be sure that he was cheered up
all the way to England. I received a letter from this officer’s mother
some weeks after, saying that her son had completely recovered his
vision, and was as well as ever.
NERVE CONCUSSION
Nerve concussion is a pathological condition that has received more
attention in this war than at any previous time. A young Fusilier at
La Bassée was hit by a bullet through the fleshy part of the forearm.
The wound was a purely flesh one and no important nerve could have been
struck. He had paralysis of the wrist and hand, due to concussion of the
important nerves of the forearm. The bullet in its course did not strike
these nerves. He got completely better in eight weeks.
A Gordon Highlander was struck by a bullet in the right buttock. No
important nerve was struck, yet he had paralysis of the limb owing to
concussion of the sciatic nerve. He got better by rest in bed and massage
of the muscles. A soldier of the Wiltshire Regiment was rolled over
by the concussion of a bursting shell. He retained consciousness, but
could not get up or move his right arm. The right side of his body was
paralysed. He got better by rest. A Bedfordshire sergeant got a bullet
wound through the upper arm, and paralysis of certain muscles supplied by
nerves in the vicinity of the track of the bullet. It was thought that
the nerves were divided, and after the wound had healed the nerves were
exposed at an operation intending to join the severed ends. The nerves
were found to be uninjured, and the incision in the skin was closed up.
He made a complete recovery.
There is also the story of the soldier who suddenly recovered his voice
in the presence of King George. The story is going the rounds of the
hospitals, and it is said that His Majesty was extraordinarily interested
in the phenomenon. This soldier was taken prisoner by the Germans
during our retreat from Belgium. He was picked off the field in a dazed
condition and unable to speak. He was interned later in a prison camp in
Germany and was all this time quite unable to speak. When the exchange of
permanently disabled prisoners of war was recently made between England
and Germany, this man was sent back as permanently incapacitated on
account of being dumb. He was admitted to a hospital near London. One day
the King visited the hospital, and this man on getting up from his chair
as the King entered the ward, inadvertently touched a heating pipe which
was then very hot. He at once exclaimed “Damn,” and was able to speak
perfectly afterwards. The King was very much interested. Was this an
hysterical loss of voice or a concussion? It was a mental shock of some
kind, and the recovery was due to the other shock of touching a hot pipe.
I attended one young officer and three men who had been buried in the
earth when their trench was blown up. The officer and one man were
unconscious, and when the man recovered consciousness he was nervy and
excitable. He had a startled, terrified expression, and when in bed he
would peer round in a wild, anxious way, and then suddenly pull the
blankets well over his head and curl up underneath as if anxious to shut
out his surroundings, or what he thought were his surroundings. He seemed
really to be living through some terrifying experiences of the past few
days antecedent and up to the time when his trench was blown up and he
was engulfed in the mud and _débris_.
The officer recovered consciousness more slowly, and spoke in a curious
staccato speech; his nerves were completely gone, and he had fine tremors
of the lips and tongue and fingers. He told me that his memory had gone,
that he had only a hazy recollection of recent things, which seemed far
away and dim.
DEAF MUTISM.
Several cases of deaf mutism have occurred during the hard fighting
near Ypres and La Bassée, and these are certainly very curious. The men
so afflicted have written down that shells burst near them, that they
were thrown down, and remembered nothing more for a time. On coming to
again, they were deaf and dumb. These men also show other signs of nerve
shock; they are restless, troubled with sleeplessness, and have anxious
expressions. Generally all get completely well in a few weeks, but some
of the cases remain mute for a much longer time.
LICE.
The medical officer at the front to-day has other duties besides those of
attending to the sick and wounded. He is concerned with the prevention
of disease, with water supplies, sanitation of billeting areas and
camps, means to prevent frostbite, and so on. He has also to advise on
methods of treating and avoiding vermin. Lice are, without a doubt,
one of the terrors of war. These little beasts are not harmless. They
take a high place in the sphere of destructive agents. I would group
them in the class with shrapnel bombs and high explosives. Wherever
many men are gathered closely together, and hygienic laws, owing to
military needs, are in temporary abeyance, there will lice be found,
constituting themselves one of the terrors of war. Officers and men get
them, and once these pests gain entry to one’s wardrobe they entrench
themselves in their battalions and divisions, and require very drastic
efforts to dislodge. In the early fighting in Flanders and in Northern
France, on the Marne and Aisne, these beasts gave us great trouble. They
are most active at night when one gets warm in bed. It is not the bite
that counts, but, as the old French Countess once expressed it to a
Minister of State, it is “toujours le promenade.” The promenading causes
irritation and insomnia. Scratching produces excoriations of the skin,
and then a whole lot of sequent complications. Lice are factors in the
spread of typhus fever, and when typhus visits an army in the field it
carries death and desolation to thousands. To illustrate the point read
this extract from a letter written from an English hospital in Serbia:
“The great scourge of this country is typhus fever. It was introduced
by the Austrian prisoners at Christmas. Out of 2500 Austrian prisoners
at Uskub, 1000 had died of fever and 1200 were down with it. It is a
terrible disease, and is carried not by infection but by lice. One has to
take tremendous precautions to avoid these creatures.”
The majority of our wounded taken from the fighting line at La Bassée
to the hospital at Bethune were infested with lice. Lice invaded the
clothing of all who handled these poor fellows, and very drastic measures
had to be taken to combat the scourge.
The following story will illustrate the vitality of these nasty little
beasts. Our Field Ambulance once stopped at a small town in Northern
France and was billeted in a French convent. The good sisters allowed
us the use of the schoolrooms, the kitchen, and some of the bedrooms.
All the officers were anxious to get their shirts and linen washed. The
laundrywoman duly appeared and boiled all these articles, and the sisters
ironed them for us. On the afternoon of the ironing the Mother Superior
and two sisters came to us in a state of excitement, talking rapidly, and
evidently overcome with amazement. They explained that our shirts had
been boiled and then dried in the open air. When they began to iron the
necks of our shirts the lice sprang to life and were exceedingly active.
They assured us solemnly that scores sprang to active life under the
comfortable warmth of the hot iron. I do not doubt the story. The heat
had matured the chitinous envelope in which the young lice lay, and out
they came, joyous, active, and sportive on the nice warm surface. Hence
the amazement, the uplifted hands, and the consternation of the good
sisters. The riddle of their extermination has not yet been completely
solved, but measures are in active progress. It is an unsavoury subject,
but it is a very important one for troops in camp and in the field.
SHELL FUMES.
“Thou shalt not kill,
But do not strive
Officiously to keep alive.”
A great deal has been written on the effect of shell fumes in this war.
So much is hearsay and so little really authentic, that one cannot
dogmatise.
One naval surgeon said that men exposed to fumes of bursting shells
develop acute pneumonia, which proves fatal as a rule. This is supposed
to be due to the nitric peroxide produced by the explosion.
Artillery officers have told me that stories were going the round of the
batteries that the Germans fired certain shells at our aeroplanes which,
on bursting, set free certain gases which intoxicated the aviators.
A French gunner-major circumstantially related that a German trench
which had been heavily shelled with turpinite shells was found full of
dead Germans, standing or sitting in life-like attitudes and with faces
_quite black_. He said that the look-out man was lying in his natural
attitude holding field-glasses to his eyes. He was apparently alive, but
was really dead, stiff, and with black face and hands. These statements
have not been confirmed, but the stories of similar incidents are many.
There is no doubt that lyddite and melinite fumes can, when inhaled,
produce sudden poisonous changes. I have myself seen British soldiers and
German prisoners, after having been exposed to these fumes, come in with
deeply yellow jaundiced skin. One man, in fact, looked exactly like a man
suffering from acute jaundice.
It is also said that the fumes induce drowsiness. Turpinite shells were
employed at one stage of the war and are to be employed again. M. Turpin
has recently been at the front with a French battery. Certainly turpinite
does emit dangerous fumes. Many believe that it is some form of cyanogen
gas—allied to prussic acid.
* * * * *
The force of these high explosives is well illustrated by an occurrence
of 25th January. Previous to making an assault the Germans fired a mine
under our front trench near the railway east of Cuinchy. The explosion
hurled a piece of rail weighing 25 lbs. a distance of over a mile, into a
field close to where some of our men were working.
It is reported that on 1st February the detonation of one of our lyddite
shells in the enemy trenches on the embankment south of the canal, threw
a German soldier right across the railway and the canal amongst our men
on the north side of the latter.
At Fort Condé, on the Aisne, the air concussion of a bursting shell from
a French 75 mm. lifted a large four-wheeled country waggon bodily out of
a yard and planted it on the roof of a barn. The waggon was not injured.
A bursting shell is the very incarnation of violence. Lord Fisher said
that “The Essence of War is Violence. Moderation in War is Imbecility.
Hit first. Hit hard. Hit everywhere.” The big shells to-day do all this.
The fumes emitted by bursting charges of lyddite, melinite, or turpinite
must not be confused with the poison gases sent out over our men by the
Germans. The lyddite and melinite are put in the shells for a definite
object which is permitted by the Hague Convention, and by the opinion of
mankind generally. Their object is to burst the shell at the desired
time and distance, and plaster the enemy with the iron or shrapnel. They
are not intended to kill, and do not kill by poisonous fumes. The German
poison gas is intended to kill, and does produce intolerable agony and
lingering deaths, and for this the German stands accused before High
Heaven.
NEURASTHENIA OR “NERVES.”
Many officers and some men have been sent back from the front in France
and Flanders suffering from Nerves. These men are not “nervous” as the
public generally understand that term. They are brave and courageous men
who are anxious to do their duty. They are, moreover, men who have done
their duty in the face of a determined foe, have endured great hardships
and discomforts in the trenches and batteries, and have faced death in
all the many hellish shapes that it assumes to-day. I said “many officers
and some men” have been so afflicted, and it is true that the officer
is much more prone to get “nerves” than is the simple soldier. The life
of the officer is one of responsibility and worry, but the soldier’s
mental lot is simpler—he just does what he is told and has “not to reason
why.” The education and upbringing of the officer are different, as a
rule, from that of the soldier, and heredity has an influence on a man’s
nervous organisation. In civil life anyone can call to mind certain boys
and girls who are more “nervous” than others. I do not mean more afraid
of danger or more effeminate, but more likely to be exalted or depressed
by certain circumstances than their more stolid neighbours. What is true
of homes and of schools is equally true of nations. Unreal though it
sounds, there is no doubt that the Germans are more emotional than the
French, and German leaders know full well the emotional side of their
people. The German is easily exalted and can be easily depressed. The
Frenchman can be made furiously angry when he is affronted or insulted,
but he is not easily depressed, and he is too cautious to be easily
exalted. The German soldier and people must be strengthened and mentally
sustained by stories of German victories and prowess, but the Frenchman,
like the Englishman, is most formidable when he knows the worst there is
to know and is “up against things.”
It may be that our officers who develop neurasthenia at the front are
more emotional and imaginative than those who do not, but they are no
less courageous. An officer was sent to England for neurasthenia, and
felt ashamed to tell his friends that he was sent back as his “nerve
was gone.” He was not in the list of wounded, yet his brain and nervous
system had received a wound as much as the man with a bullet-hole through
his shoulder, and the treatment for these “mental wounds” is like that
for most other wounds, “time and rest,” but the mental wound also
requires quietness. The officer with the mental wound, the nerve shock,
the neurasthenia, cannot be treated successfully in the general wards
of a noisy hospital. He must be put in quiet and peaceful surroundings
and live in an atmosphere free from noise, bustle, and commotion. His
treatment must also be directed by physicians who are authorities on this
subject. A successful general practitioner or a renowned obstetrician are
not likely to achieve brilliant results in treating neurasthenia.
Fortunately the medical profession has already arranged special provision
for these nerve cases, and the results, I am sure, will be eminently good.
At Bethune one able artillery officer was brought into the Clearing
Hospital suffering from neurasthenia. He had been through the retreat,
the fighting on the Marne and Aisne, and at La Bassée, and had done
splendid service with his battery, and had been promoted. When I saw
him he was walking up and down a room like a caged animal. I wished him
good morning, and he pulled up suddenly in his stride, gazed at me with
widely open eyes, and replied in a hesitating staccato voice, “G-g-good
m-m-morning, doctor.” He had never stuttered before. Then away he went
up and down again. I got him to sit down on a box and told him to light
his pipe and talk about himself. He filled his pipe with difficulty,
stuffing the tobacco into the bowl with trembling and agitated fingers.
He broke several wooden matches in trying to light them. He had lost the
fine, practised discrimination necessary to rub a match on the side of
the box, and he “jabbed” his match hard on it. I lit a match and gave it
to him, as I was interested to see how he would light the pipe. He let
that match fall. I lit another, and with this he burned his finger. I
then held a lighted match over his pipe, and in a jerky way he managed
to light the tobacco; but he could not smoke properly, and the pipe soon
went out. In the same jerky way he told me that he was forty-four years
of age and had never been ill before. He was a good rifle shot, and had
killed big game in India. He was a fair billiard player, and had been
a temperate man all his life in all things. Talking in his spasmodic
fashion, he had to stop for a word, and he then waved his hand about and
frowned, as if angry with himself for having forgotten it. Up till a week
ago he had been in perfect health, although the “strain” of the war had
been tremendous; then one of his brother officers and a sergeant had been
killed close beside him, and his guns had to be moved to another position
under a heavy fire. He could not sleep that night, and the firing of the
guns, which previously had not troubled him in the least, now worried
him. Next day he could not eat. In a few days he was a physical and
mental wreck. He was sent to England, and I heard that he had made a
complete recovery.
One officer developed neurasthenia on the Aisne. His regiment had done
brilliantly, but had suffered severe losses. The officer said that he was
going to blow his brains out, so he was invalided into the hands of the
doctors and later made a good recovery. He was suffering from the effects
of strain and mental shock.
Another officer on the staff was standing close by his chief when a
shell fell near, killing his chief outright. The staff officer had to be
sent home for neurasthenia.
Our wounded often show signs of neurasthenia. I well remember at the
hospital at Bethune one man who had had to have his arm off at the
shoulder joint for a bad shrapnel wound. He was dangerously ill and
semi-conscious for several days. When he had fully roused to his
surroundings and the knowledge of his weakness he was like a little
child, crying and begging me to get him away from the sound of the
firing. He said that he would be happy if only he could get away to
some place where he would not hear the sound of the guns. On the day
the German aeroplane dropped a bomb near the hospital the windows of
the building shook and rattled with the concussion, and this poor
devil screamed aloud with terror and tried to get out of bed and crawl
away—anywhere from the sound of the firing.
The French nursing sisters told me that the wounded Frenchmen work
themselves into a terrible state of excitement in hospital when the
firing is very brisk. They beg and beg to be taken away to the south of
France, as far away as possible from the sound of conflict.
These were all brave men with injured nervous systems.
SMALL ARM AMMUNITION.
The Germans have charged the British, French, Russians, and Belgians with
using Dum-Dum bullets. The Austrians have made the same charge against
the Serbians and Montenegrins. The Triple Entente and its Allies have
accused the Germans and Austrians of firing Dum-Dum bullets—so there you
are.
The Dum-Dum bullet was first made at Dum-Dum, near Calcutta. It was
a Lee-Enfield bullet with an imperfect nickel sheath. This nickel or
cupro-nickel sheath in the Dum-Dum stops at the “shoulder” of the
bullet, and the point is therefore bare lead, a continuation of the
core of the bullet. Some modifications of the Dum-Dum exist. By rubbing
the point of a nickel-coated Lee-Enfield bullet on a rough stone the
cover is rubbed off, exposing the core of lead. A saw or file can make
incisions in the long axis of the bullet exposing the lead this way,
but leaving the tip covered with nickel. The destiny of a Dum-Dum is to
break up when it strikes a bone. If it strikes a bone at a high rate of
velocity it fragments and rips and tears the bone and surrounding soft
structures. It is supposed to have greater “stopping power” against an
infantry charge than an undeformed bullet. This supposition is incorrect.
Certainly a Dum-Dum in traversing a limb or the chest can cause terrible
and widespread destruction. In wounds inflicted by a Dum-Dum bits of
the lead core and casing are scattered in various directions. But,—and
this is important,—the same thing can be found in a wound inflicted by
an undeformed Lee-Metford, Lebel, or Mauser bullet. The only certain
proof of the employment of the Dum-Dums is to find them in the trenches
captured from the enemy, or in the cartridge belts of wounded or
prisoners. Again, a man may have a bullet wound with a small entrance
hole and a large, gaping, jagged exit. One unaccustomed to bullet wounds
would immediately say that such a wound was caused by an explosive
bullet. But it can be caused by the ordinary Lee-Metford, Lebel, and
Mauser bullets. I have seen these wounds frequently amongst Germans,
French, and British. The explanation is that the bullet on striking a
bone often carries along with it a fragment, large or small, and it
is this fragment of bone that tears out a passage to the exit wound.
The German bullet is easily extracted from the cartridge. It is almost
impossible to extract the Lee-Metford bullet without strong instruments.
The Germans have made use of this fact to extract the bullet from the
cartridge and put it back “upside down,” that is, with the nickel point
inside the metal cartridge case, and the base with its exposed lead
core outwards. Such a bullet on striking a bone expands and fragments,
and causes great damage. I am not repeating a rumour when I make this
statement. I have seen these cartridges with the inverted bullets in the
belts of German prisoners captured in the trenches. Other surgeons have
seen them also. The French say that it is a common practice amongst the
Germans, and so did our men at Ypres. One German prisoner on the Yser
when confronted with these bullets taken from his own belt, admitted
having used them. He said that his company officer told him that they
were useful to break down barbed-wire entanglements!
There is one interesting point about the German bullet, and that is its
property of spinning on its short axis when it strikes an object. The
centre of gravity of the German bullet is low down on its base, owing
to its long and tapering shoulder. It therefore turns over on reaching
its object. I had on the Aisne one man of the Norfolk Regiment admitted
with a tiny entrance wound between the great and second toes of the foot.
The bullet was found lodged in the large heel bone, and its base was
facing towards the entrance wound. It could not have entered the foot
in that position, because the entrance wound was too small. A bullet
spinning round when traversing a limb can cause considerably more damage
than one that pursues a direct course, and this fact is important in
brain injuries. The bullet penetrates the skull by a small punctured
opening, and then whirls round and round inside the brain. It may then
again strike the bone on the other side with its long axis and cause
considerable shattering and bleeding. This spinning action of the Mauser
was a thing that every surgeon had to remember when treating his wounded.
The Hague Convention of 1907 prohibits “the use of projectiles calculated
to cause unnecessary suffering.” The Hague Declarations of 1899 decide
to “abstain from the use of bullets which expand or flatten easily in
the human body,” such as bullets with a hard envelope which does not
entirely cover the core or is pierced with incisions. The St. Petersburg
Declaration of 1868 agrees to abolish the use of “any projectile of
a weight below 400 grams which is either explosive or charged with
fulminating or inflammable substances.”
The _British Medical Journal_ of 21st November 1914 reports as follows on
the subject of small arm ammunition:
The British service ammunition is known technically as Mark VII. ·303
S.A. Ammunition. The length of the bullet is 1·28 inches; weight, 174
grains; muzzle velocity, 2440 feet per second. The bullet is a pointed
one with an envelope of cupro-nickel which completely covers the core
except at the base. The ordinary German service ammunition is very
similar. Length of bullet, 1·105 inches; weight, 154 grains; muzzle
velocity, 2970 feet per second. This bullet is pointed, with a steel
envelope coated with cupro-nickel covering the cone except at the base.
Both bullets carry out the provisions of the Hague Convention.
There is clear evidence that Germany has not confined herself solely to
this unobjectionable ammunition. Her troops, both in Togoland and in
France, have been proved to have used bullets with a soft core and hard,
thin envelope not entirely covering the core, which type of bullet is
expanding and therefore expressly prohibited by the Hague Convention.
Such bullets, of no less than three types, were found on the bodies
of dead native soldiers serving with the German armed forces against
British troops in Togoland in August, and on the persons of German,
European, and native armed troops captured by us in that colony. All the
British wounded treated in the British hospitals during the operations
in Togoland were wounded by soft-nosed bullets of large calibre, and the
injuries which these projectiles inflicted, in marked contrast to those
treated by the British medical staff amongst the German wounded, were
extremely severe, bones being shattered and the tissue so extensively
damaged that amputation had to be performed. The use of these bullets was
the subject of a written protest by the general officer commanding the
British troops in Nigeria to the German acting governor of Togoland.
Again at Gundelu, in France, on 19th September 1914, soft-nosed bullets
were found on the dead bodies of German soldiers of the Landwehr, and
on the persons of soldiers of the Landwehr made prisoners of war by the
British troops. One of these bullets has reached the War Office. It is
undoubtedly expanding and directly prohibited by the Hague Convention.
I am sure that Germany will be terribly upset at this, for Germany, we
know, pays great respect to the articles of the Hague Convention!