To hold the hot hand of the man who talks wild

There have been a lot of war metaphors thrown about since the start of the Covid-19 crisis. Donald Trump has styled himself as a ‘war’ president; commentators compare Boris Johnson to Churchill, both favourably and unfavourably; the ‘Blitz spirit’ has been invoked (and critiqued) as the public response to social distancing and lockdown; and manufacturing has, in an echo of the economic mobilisation of total war, been rallied to supply ventilators and other necessary medical supplies. Our language has become military  with talk of care workers and food supplier being on the ‘front line’, of shirkers and spivs and black markets. In my own home, having reached the end of fourteen days in self-isolation during which we were unable to get any food delivered other than milk and eggs (blessings be on our milkman!), my children have learned a great deal about the history of rationing – and how to bake bread.

But there is another, more difficult way in which the history of war has echoes in today’s crisis. Because, like so many battlefield casualties, those dying with or of Covid-19 are doing so far from their families. The emotional burden that this fact brings with it is something that the history of both British mourning practices and medical care in the First World War can tell us about.

The Victorian ideal of a ‘good death’ – the individual dying in bed surrounded by their loved ones with time to utter final profound, pious words – was, of course, always a myth. [1] That myth, however, was utterly demolished by carnage of the First World War. Men died in large numbers, far from their families. The technology of war had the power not merely to kill but to destroy, even obliterate bodies. The recording and reporting of deaths in such circumstances meant that official news could take time to reach families, often contained only the barest details and could, in some cases, be inaccurate. The result was the reinforcement of the importance of one mourning practice of the pre-war era, that of writing letters of condolence.

While official notification of death could be brief and brutal, a telegram informing the family that their loved one had been killed in action, died of wounds or was missing, it would almost always be followed, or indeed occasionally preceded, by a letter from a commanding officer. In many cases, this would then be followed by letters from the deceased man’s comrades; in some cases, particularly where a man was missing, presumed dead, extensive correspondences grew up between men’s families and the men of their military unit.

These letters were more detailed than the initial announcement, not only celebrating the character of the man in question, but also telling the story of his death. Depending on how well known the man was to his officer and comrades, these letters could be generic or personal in their description of men as individuals. But the detail they contained acknowledged the importance for families of knowing both that their loved one had been known as an individual and also how he had died. As E. K. Smith’s platoon sergeant wrote to his parents, he was ‘only too tell you what actually happened, & being as you say a parent myself, I know you would like even the smallest details concerning the sad event.’ [2]

The descriptions of the death itself could vary in detail, depending on when and where it happened. A death in the midst of an action could be more difficult to describe than one which occurred on quiet day in the line. Almost all, however, had one thing in common – the depiction of the death as ‘clean’ and usually quick. Gerald Stewart’s parents were reassured, for example, that ‘Your son was killed by a bullet and died without suffering any pain. He was not one whit mutilated, and as I looked down at his face as he lay in the battle field I remarked how bonny he looked.’ [3] W. Lindsey ‘was at the time of being wounded splendidly advanced and skilfully leading his men’ while A. R. William’s ‘died a soldier’s death giving his live saving the lives of his comrades.’ [4] Wartime letters of condolence did not seek to tell the truth of death to families who could not be there when their loved one died. Rather they sought to bring emotional solace by emphasising lack of suffering and even heroism in the face of death. While deaths from coronavirus may not lend themselves as clearly to stories of heroic action, the daily newspaper columns giving brief descriptions of those who died points to the need, both of families and society more broadly, to construct a narrative around individual deaths. The need to articulate death as meaningful only becomes more powerful when it occurs at a distance.

Not all or even most of those who died during the First World War did so on the battlefield, however. The system of medical evacuation, which emphasised clearing the ill and wounded from the field in order to leave it clear for combat, meant that many men died in one of the sites of medical care that made up the chain of evacuation. For men who made it as far back as a base or home hospital, there was the potential for their families to be by their sides. Wealthy families could pay to travel to and stay near where their loved one was hospitalised, even as far as the base ports in France. For the majority of families, such travel was beyond their means; in the case of fatal wounds and illness, grants were made available for families to travel to be with their loved ones at the point of death. The importance of such connections was acknowledged by the British state and society at the time.

However, even where money was available and families were able to travel, only a tiny minority were able to be at there for men dying in hospitals. And for men dying in Casualty Clearing Stations or dressing stations, family visits were never an option. For the vast majority of men dying in sites of care during the war, those by their sides at the end were care providers – nurses, chaplains and medical orderlies. To these men and women fell the task of ensuring not only that the story of a man’s death was told to his family but, even more importantly, that he did not die alone.

The emotional labour that this entailed was immense. George Swindell, a Royal Army Medical Corps stretcher bearer recalled the period he spent seconded to a moribund ward, nursing men whose wounds were too serious to treat alongside a chaplain, as one of the most difficult of his military service. [5] As Alice Kelly has noted in relation to nurses, ‘A large part of the … role was comforter, and all of the nurses’ accounts record the men seeking comfort from the author, both physically and mentally.’ [6] Chaplains, working in religious traditions of death bed visiting and vigil, might have some experience with this form of labour. Nurses and orderlies as a rule did not. Yet throughout the war they acted as bridges between the dying and their families, taking final messages to pass on to loved ones, reassuring the dying that they were cared for and not alone.

If the conditions reported on hospital wards in Spain and Italy are anything to go by, this is a form of labour that hospital staff will increasingly be required perform as part of their care for Covid-19 sufferers. The nature of the illness is such that they must be isolated from their family in extremis, and treated by carers shielded, where available, by extensive personal protective equipment. In such circumstances, where the dying sufferer is isolated, with limited physical contact with other people, the importance of communicating emotion between the sufferer and their loved ones becomes even more important. This will come, as it did for caregivers in the First World War, on top of immense physical strains to simply provide care for all those suffering.

Are there lessons to be learned from this history? Until comparatively recently, the emotional labour of carers was not the subject of much discussion. [7] And, as the late Sir Michael Howard noted, ‘historians may claim to teach lessons …. But “history” as such does not.’ [8] But in acknowledging the significance of the role that care providers, not just doctors and nurses but nursing assistants, orderlies, even cleaning staff, can potentially play in bridging the distance between the dying and those they love and who love them, we can, perhaps, more fully appreciate the care being given not only to the bodies of individual patients but to the psyche of society as a whole.

In 1917, Private W.H. Atkins wrote a poem in praise of the quiet heroism of the men of the Royal Army Medical Corps, including the nursing orderly:

Oh! it’s weary work in the white-washed ward,

Or the blood-stained Hospital base,

To number the kit of the man who was hit

And cover the pale, cold face,

To hold the hot hand of the man who talks wild

And blabs of his wife or his kids,

Who dreams he is back in the old home again,

Till the morphia bites, and he loses his pain

As sleep settles down on his lids. [8]

Today, in hospitals up and down the country and across the world, carergivers will be doing similar weary work. It may not earn as much recognition as the physical labour of medical caregiving or the danger that they will be putting themselves in of catching a potentially fatal illness. But this necessary emotional work is heroic nonetheless.

[1] Pat Jalland, Death in the Victorian Family (Oxford: Oxford University Press, 1996); David Cannadine, ‘War and Death, Grief and Mourning in Modern Britain’ in Mirrors of Mortality: Studies in the Social History of Death, ed. Joachim Whaley (London: Europa, 1981), pp.187-242.

[1] G. Gould, letter to Mrs. E. Smith, 24th January, 1916, Letters of E. K. Smith, Documents.2535, Imperial War Museums, London (IWM).

[2] Lt.-Col. S MacDonald, Letter to Mr Stewart, 14th April, 1917, Papers of G. Stewart, Documents.8572, IWM.

[3] W. Gillam, letter to Mr Lindsay, 4th August, 1917, Papers of W Lindsay, Documents.11765, IWM; Lt. Collinson, letter Mr Williams, Papers of A. R. Williams, Documents.4436, IWM.

[4] George Swindell, ‘In Arduis Fidelus: Being the story of 4 ½ years in the Royal Army Medical Corps’. TS memoir, RAMC 421, The Wellcome Library, pp. 118–19.

 [5] Alice Kelly, ‘”Can One Grow Used to Death?”: Deathbed Scenes in Great War Nurses’ Narratives’ in The Great War: From Memory to History, eds. Kellen Kurschinski, et. al. (Waterloo, Ontario: Wilfred Laurier University Press, 2015), p.338.

[6] Carol Acton and Jane Potter, ‘”These frightful sights would work havoc with one’s brain”: Subjective Experience, Trauma, and Resilience in First World War Writings by Medical Personnel’, Literature and Medicine 30(1), 61-85, here 62.

[7] Michael Howard, The Lessons of History (New Haven: Yale University Press, 1991), p.11.

[8] W. H. Atkins, ‘The R.A.M.C.’, The ‘Southern’ Cross 2 (June 1917).

Who Cares? Call for Papers

Next March the Health, Medicine and Society and Women, Gender and Sexuality research clusters in the School of History at the University of Leeds will be jointly running a conference on histories of care.  There will be a conference website in due course, but as this is taking some time to set up properly, I am posting the Call for Papers here as well.

Who cares?: The Past and Present of Caring

Monday 27th – Tuesday 28th March, 2017

School of History

University of Leeds

A collaboration between the Women, Gender and Sexuality, and the Health, Medicine and Society research clusters.

Call for Papers

Deadline for Abstracts: 13th January 2017

 

At all stages of life, people give and receive care. Rapidly changing demographics are affecting the dynamics of care, and now more than ever, gender-based expectations of caregiving in history are being called into question. A growing emphasis on personal well-being denotes a generation that is complicating traditional notions of care.

The way care has been understood and delivered has developed across time.  Approaches to care have historically been and continue to be changed and challenged by spatial, temporal, and socio-political boundaries. This conference seeks to shed light on care within communities and across borders, exploring changes in its perception throughout history and how it intersects with different ages, cultures, and identities.

Our keynote speaker will be Professor Holly Furneaux, Cardiff University, author of Military Men of Feeling: Masculinity, Emotion and Tactility in the Crimean War (OUP, 2016).

The conference will also include a half-day workshop exploring issues associated with care in academic institutions. Through a discussion of parenthood, experiences of supporting family members, and mental health, this workshop will provide a space to explore how researchers at all stages of their academic careers care for themselves and for others. This session aims to highlight difficulties currently experienced within higher education, and identify workable ways the academe can help to ensure personal well-being, and further support staff and students in their varied roles as carers.

Submissions are now invited for 20-minute papers on subjects which may include but are not limited to:

 

–       Varieties of medical care

–       Gender and caregiving

–       Self-care and mental health

–       Care in the military

–       Care and the family

–       Care and the life cycle

–       End of life care

–       Care and the non-human

–       Care and marginalised communities

–       The economies of care

–       The politics of care

–       Critical care

 

We particularly welcome proposals from postgraduate and early career researchers.

Submission guidelines

Abstracts must be no longer than 250 words for 20-minute papers.

Please send abstracts to hisccon@leeds.ac.uk no later than 13th January 2017. Please ensure abstracts contain your name and institutional affiliation (if any).

Any general enquiries may be sent to hisccon@leeds.ac.uk

The things we do not talk about

Things have been a bit quiet on the blogging front for the past couple of months. This has been for a few reasons.

a) I have been preparing for the end of my current project (which officially finished last week) by doing rather a lot of other writing – conference papers for the imminent summer conference season, a book proposal, detailed chapter outlines, even some things that some day may actually start to look like chapters of the book I want to complete this summer.
b) I have been preparing for the beginning of the next project, which should start in September, by finalising a number of administrative details including, most time-consumingly it turns out, organising an ethical review of the project and responding to several ethical queries raised by the body funding the work. Because the basis of the project involves documentation relating to the medical histories of ex-servicemen from the First World War, this has turned out to be more complicated than anticipated, as I will come back to in a minute.
c) Three members of my close family are suffering from illnesses which have involved a significant commitment of temporal and emotional resources from me, including multiple trips to the US. The severity of these conditions ranges from the life-threatening to the debilitating but all have been life-altering, both for the sufferers and for those of in their immediate family who, along with a variety of medical professionals, are seeking to care for them.

Now, you may have noticed that I am being rather vague about the specific details of the illnesses that have become such a central part of my life recently. This is deliberate. I have spoken in more detail about what is happening with various friends and colleagues who may be able to identify some or all of the family members I am referring to. Even then, outside my family and one or two very close friends whose support in maintaining my own equilibrium has been invaluable to me, I have not confided the precise details of diagnosis, treatment or prognosis.

This is for two reasons. Firstly, these medical details are not mine to share. They are, by all accepted ethical standards, the information of the patients. They have chosen to share this information with me (thankfully, as this has allowed me to offer what support I can to people I love very much and who are important to me), but have not necessarily chosen to share it more widely. It is not my right to share it in ways that they might not wish me to, however much the information shapes my own life. Indeed, on at least one occasion I have been asked specifically not to discuss the situation in detail with people outside the immediate family.

But, even if I had the explicit permission of the primary individual to share this information, there are other important considerations I need to take into account before discussing these illnesses. Because the sufferer and I are not the only ones involved. Coping with these conditions has, in all three cases, involved important interconnected networks which include, from my perspective, my husband, my parents, my siblings, my dad’s wife and her daughters, my children and my in-laws. All of us within these networks have our own emotional relationship with the illnesses and those suffering from them (as well as a variety of other additional stresses in our live – new jobs, house moves, professional concerns, etc.) Not all of us might be comfortable with a public discussion of the details of the medical matters that are shaping all our lives so profoundly.

Which brings me back to those ethical questions that I have been attempting to answer over the past six weeks. I was asked, among other things, to confirm that the information I will be collecting and analysing for the project is in the public domain and does not contravene any data protection laws. As it happens, the information is all publicly available and, because the subjects whose data is being scrutinized are dead, data protection laws do not apply. However, I was also asked to consider whether I was likely to reveal information (specifically medical details) that might be considered sensitive to those who are living. And here the issue of confidentiality arises. Because while the data involved may not be that relating to any living person, there is the possibility that the stories the data has to tell – about medical conditions and the care provided and received for these conditions – might be considered sensitive by surviving family members. Information about the nature of a wound or illness might be exposed which challenges the family stories told about a relative. Details of care might reflect new light on the behaviour of surviving family members. Embarrassing details about the effects of wartime injuries might emerge. As I haven’t yet done the research, I don’t know if such information will emerge; even if it does, I cannot predict whether any individual family or family member might be negatively affected by the information if they ever become aware of my research. Ethically I cannot ignore the possibility and must consider what contingencies I must put in place to ideally prevent and, in the worst case, remedy, any such effect.

The result has been a number of long and very fruitful conversations, in person, on the phone and via email, with a variety of archivists, data protection officers and researchers working in related ethical fields. The ultimate conclusion is that I will keep the sensitivity of the information I am dealing with in mind as I undertake and eventually publish my research. I will pseudonomise sources, although this will have to be balanced by the necessity of maintaining appropriate conventions of citation for my field. And I will continue discussing, with peer reviewers, with colleagues, with archive and university officials, the appropriate course to take in the specific contexts that may (or may not) arise.

There is, it turns out, no simple concrete answer to this sort of ethical question, and nor should there be. But I think it is helpful for me to acknowledge that, throughout this process my sensitivities and consequent decisions will be shaped, in part, by my awareness of my own willingness to share my family’s medical history in public. If I am unwilling to discuss certain details of my own family’s situation, including both the patients and carers, in public, how much can I ask of the families of the men I am researching? The answer is, at the moment, I don’t know, although I suspect it will change over time. However, I can say that my personal experience has re-emphasised for me the importance of the project I will be undertaking. Because to fully understand medical care-giving, whether historically or today, we must acknowledge and understand the role, and consequent sensitivities, of the family.

2 for 1

I realise it has been a long time since I have posted anything.  I am still writing a lot – conference papers, a journal article, an introduction and a couple of guest posts on other blogs.  I have just been gifted a bit of time today, so I am hoping there will be a new post later this morning.

In the meantime, in case you missed them, my guest posts on disability and masculinity and the medical evacuation process can be found here and here.

A question about a footnote

Yesterday I attended the launch of the new British Council report Remember the World as Well as the War at the House of Lords.  The report explores international knowledge and understanding of the First World War, and the headlines here in Britain have mainly focused on the apparent lack of British knowledge of the war. This, interestingly, was not the tone of the discussion which took place yesterday.  The document was introduced by John Dubber, who co-authored it with Dr Anne Bostanci, before being discussed by Parliamentarians Keith Simpson and Baroness Young of Hornsey, with a final contribution from Dr Catriona Pennell, the historical consultant.  The debate was then opened up to contributions from the floor, which included, most pertinently, inquiries as to how the British Council was planning to use the document to engage the public with the debates it raises, as well as suggestions that similar, comparative research be carried out in the US and proposals for collaboration with other organisations to spread the document’s reach.

One of Catriona’s key points was that working as historical consultant had been, for her, a good exercise in academic discipline and concision, forcing her to think critically about how to present a huge range of historical argument, covering at least the past 30 years, in 10,000 words.  Indeed, she noted that she had originally presented her collaborators with 17,000 and that, in the editing process, large swathes of the history of the war, including the conflict’s impact on gender and on science and technology had had to be removed.  I have not yet had time read the document in great detail (I spent the train ride home last night reading the book I am supposed to have written a review for by the end of the week) but, as a historian of precisely those two facets of the history of the war, my initial glance the through did suggest that their importance is implicit in parts of the discussion, particularly the complications that they bring to our understanding of the war.

Nowhere is this better illustrated than in the graph on page 7 which charts UK responses to the question ‘Were members of your family/your local community involved in, or directly affected by, the First World War?’  The first responses listed are ‘Yes, a family member fought in the First World War’ (37%) and ‘Yes, a family/community member was involved in the war effort in another way’ (9%).  This second response is glossed with a footnote which reads ‘as carrier, labourer or other support staff (for example munitions support or digging trenches); as medical staff; on the home front (for example in factories) etc.’ [My italics.]

Now, I haven’t been blogging directly about my own research recently, but that footnote goes right to the heart of the question that is at its centre, namely how was the war experienced by men who served in military uniform in non-combatant medical roles during the First World War.  Because the structure of the responses as set out creates a seemingly unbridgable gap between combat and non-combat in terms of war service, a gulf that I am increasingly coming to believe did not exist, or at least could not be sustained, throughout the course of the conflict, within the British armed forces.  R.A.M.C. servicemen certainly saw themselves as soldiers, the comrades and equals of their combatant fellow servicemen, even if they didn’t bear arms.  And those fellow servicemen increasingly viewed R.A.M.C. as equals in terms of service rendered, acclaiming the qualities of endurance and comradeship that were key to understandings of heroism during the war years. Military medical service personnel served and were seen to serve, even if they did not fight, a fact which rather nuances not only the question of in what ways family members engaged with the war, but an earlier one about how the war should be commemorated, illustrated on page 5. In answer to this question, 64% (the decided majority) of UK respondents answered that a focus on human suffering and loss of lives should form the focus of commemorations over the next four years.  Yet the broader, more complex question of how the war was experienced, by those who survived as well as those who did not, was not, apparently an option given to respondents.  It is this question that forms the thrust of my research as a historian, as it does for many other social and cultural historians, and, I believe, motivates the large numbers of people engage in personal, local and regional research and commemoration projects taking place around Britain in response to the centenary.

So I had a rather pernickity question about the methodology used by YouGov (who carried out the polling for the survey) and about how the questions and responses presented to respondents were decided upon, as well as a rather broader one about how the material on gender, medicine and everything else that had to be edited out might be utilised in future to enhance the findings already published.  Last night’s launch, however, focusing as it did, quite rightly, on the global nature of the conflict and its continuing, multifaceted, global legacies, was not the right place to ask those questions.  So instead I am asking them here, or at least, to bring it back to Catriona’s own final question about how projects such as this facilitate the communication of cutting-edge scholarly ideas to a wider public, how do we make pernickity questions about footnotes relevant to that wider audience that is keen to find out how the war affected their family, their town, their region?  Buried in that footnote are some really interesting debates about the nature of service, for men and for women, in wartime and the impact of war on international medical and philanthropic ideals of care and compassion.  These are debates that still have relevance today, for medics in the battlefield and for NGOs such as the Red Cross and Red Crescent, attempting to alleviate the suffering of all involved in contemporary conflicts.  These are discussions that academics are having.  Now, how do we make sure that they form part of the discussion when it comes to international commemoration as well?

Looking Ahead

Happy New Year! I hope you have all had very merry and happy holiday seasons. Mine was lovely, marred only by sickness which struck on Boxing Day and has affected one or other member of my household ever since. Still, sore throats notwithstanding, we KBO.

Today is my first back at work since the holidays, although given the silence in the corridors, most of my colleagues have decided that this half a week is a bit pointless and have sensibly stayed away. With only one day in the office, I have mainly been concentrating on clearing my desk in preparation for the new year and, having almost succeeded (there is one proposal still to draft that is proving so intractable that I think yet another cup of tea will be needed to crack it), I thought this would a good opportunity to take a look ahead at what 2013 has to offer.

Firstly we have a great line-up of speakers for the Legacies of War seminar series. Final confirmation of titles is pending (and the full list will be posted in a week or so), but Adrian Gregory and Santanu Das have both agreed to speak, on ‘Did God Survive the Somme’ (!) and on ‘India, Empire and the First World War’. Both should be fascinating.

Before then I will be heading off to London, to the Wellcome Library where I will be on the hunt for memories of and about medical orderlies. Having had my proposal on the experiences of orderlies accepted for the Social History Society’s annual conference in March (see here for details), I am now looking for material to support the conclusions I have been drawing from reading Ward Muir’s Observations of an Orderly.  There is at least one orderly memoir at the Wellcome, plus a long list of potential manuscript sources, so it will be a busy.  I am also hoping to attend the IHR conference on open access, The Finch Report, open access and the historical community while I am there (there is a waiting list).

Also coming up is a meeting at the Imperial War Museum North for academics across the North of England to discuss plans for the centenary commemorations and I will be taking the opportunity to go round the ‘Saving Lives’ exhibition while I am there.

There are also a couple of long term plans that are starting to take shape – workshop for the autumn on the history of medicine and warfare, a journal special issue that I have been putting together for years now that hopefully will find a suitable home this year, plans for a primary school class on First World War medicine that may or may not include an accurate reproduction of a stretcher and work with some of the All Our Stories projects relating to Leeds hospitals during the war that have received funding.

And in the interim there will be reading and writing – lots of both.  There is the article on voluntary medical services and their relation to the military that I have been trying to write for a couple of months now, and the stack of books on the Territorial Army sitting seductively on my desk which will, hopefully, inform it.  There is the aforementioned conference paper on medical orderlies and the related research.  There is a beautiful (literally – the cover image is gorgeous) book from Ashgate to review.  And there is the ever-growing reading list, not including the ten books sitting disconsolate on my ‘to read’ shelf awaiting my attention.

So all in all it looks as if this will be a very busy and hopefully productive year in the annals of Arms and the Medical Man.  I will, of course, keep you updated as I go along.  I hope you enjoy the ride as much as I think I will.

The best laid plans

Well, I was supposed to be going to the gym today, and making a start in Special Collections with various histories of the R.A.M.C. which are held there.  The gym plan foundered on the fact that I have left my trainers at home.  The library plan has gone west due to the fact that I have also left my netbook behind, making note-taking an extremely laborious process, and something of a redundant one as I will, at some point, have to transfer any notes taken on to a computer anyway.

I can’t actually say I am sorry to be missing the gym.  It is a grim, drizzly Monday and the thought of trudging off in this weather to put my body through half an hour of discomfort does not appeal greatly.  The missed library trip is a bit more troublesome.  I reached something of a crisis point at the end of last week when I realised that I currently know more about the history of both the Red Cross (British and International) and the St John Ambulance Brigade in the first two decades of the twentieth century than I do about the R.A.M.C. in that period.  I do know that, after the debacle in South Africa, there were major reforms, associated with Haldane’s other army reforms, but I definitely need more detail on this if I am to properly understand the place of the R.A.M.C. within the wider military structure.  This is vital at the moment as I am struggling to get to grips with the differences between non-combatance and neutrality in relation to the medical services, and the extent to which various medical services were answerable to a national military force as opposed to a wider humanitarian mission.  If I am to have any understanding of the role of voluntary services during the war, I need to have a much better understanding of the political position of the army medical services first.  Actually, it might not be a bad idea to get a sense of the place of the military as a whole in British society, so if anyone can recommend a good history of the Haldane reforms, please do let me know.

In the meantime, lack of portable computing (or at least portable computing with a decent keyboard) means I will be hunkering down in my office with 700 pages on the history of the International Red Cross and a book review to write.  There are worse ways to spend a drizzly day, I suppose.