A heavy reckoning

Emily Mayhew‘s Wounded was one of the catalysts for my present research project on medical care and casualty evacuation in war zones.  The original idea was to complete four case studies – the Western Front in the First World War, the deserts of North Africa in the Second, Vietnam and Afghanistan – but since then it has expanded to include a detailed analysis of attacks on hospitals and healthcare in Syria and elsewhere.  But running throughout these investigations is an interest in what Emily called ‘precarious journeys‘ – and a determination to break away from the usual academic voice (see here) –  so an announcement of her new book is extremely welcome.

It’s due from Profile in May:

What happens when you reach the threshold of life and death – and come back? As long as humans have lived together on the planet, there have been wars, and injured soldiers and civilians. But today, as we engage in wars across the globe with increasingly sophisticated technology, we are able to bring people back from ever closer encounters with death. But how do we do it, and what happens next? Here, historian Emily Mayhew explores the modern reality of medicine and injury in wartime, from the trenches of World War One to the dusty plains of Afghanistan and the rehabilitation wards of Headley Court in Surrey. Mixing vivid and compelling stories of unexpected survival and giving astonishing insights into the frontline of medicine, A Heavy Reckoning is a book about how far we have come in saving, healing and restoring the human body. But what are the costs involved in this hardest of journeys back from the brink? From the plastic surgeon battling to restore function to a blasted hand to the double amputee learning to walk again on prosthetic legs, Mayhew gives us a new understanding of the limits of human life and the extraordinary costs paid both physically and mentally by casualties all over the world in the twenty-first century.

The book is published in conjunction with the Wellcome Collection, and I should note that Emily has also co-curated the current exhibition Wounded: Conflict, Casualties and Care at London’s Science Museum (more information here and here).  I spent a fascinated couple of hours there when I was in London last month – it is well worth a visit, though the parallels it draws between the Western Front and Afghanistan were too abbreviated for me.

‘Dearer to the Vultures’

Over at the Paris Review Scott Beauchamp has a beautiful short essay that complements my own reading of Harry Parker‘s Anatomy of a Soldier: ‘Dearer to the Vultures‘.

Here’s how it begins:

My memories of war are fractured: faces disappear like smoke while literal plumes of smoke, their specific shapes and forms, linger on vividly for years. I remember the mesh netting, concrete, and dust smell of tower guard, but the events of entire months are completely gone. I remember the sound of a kid’s voice, but not anything he actually said. I guess that’s what Tim O’Brien meant when he wrote about Vietnam, “What sticks to memory, often, are those odd little fragments that have no beginning or end.”

Parker Anatomy of a soldierMemories of people, too complex to carry through the years, fall apart. It’s easier to find purchase on memories of objects. The weapon I was assigned on my first deployment to Iraq was an M249 SAW, or what we would colloquially and inaccurately refer to as the “Squad Assault Weapon.” I remember the way it felt to disassemble—the slight give of the heat-shield assembly, its tiny metal pincers clinging to the barrel. I remember the sound of the feed tray snapping shut on a belt of ammunition. And I remember the tiny rust deposits on the legs of my weapon’s bipod, which would never go away, no matter how hard I scrubbed with CLP (Cleaner, Lubricant, and Protectant oil). I remember my SAW’s voice and the things it said.

During my second deployment, I served as the gunner in a Bradley Fighting Vehicle. We ran over two Soviet-era landmines that had been stacked on top of each other. Besides a few bruises and perforated eardrums, everyone in the crew was fine. When I would try to tell people the story back home, civilians would get caught up on the descriptions of objects they had never heard of, objects that were integral to understanding my experience of the event. “Were you hurt?” Not really, I’d say, but my head slammed against the ISU, and since we had the BFT mounted in a weird place, that sort of got in the way. “What’s an ISU and a BFT?”

I came to realize that the barrier in explaining my injuries to civilians wasn’t quite phenomenological so much as it was ontological. Everyone has experienced pain, fear, and frustration, but not everyone knows what an Integrated Sight Unit is or has had their face slammed into one. Even in just trying to narrate the events to family members, it seemed like any understanding of my trauma would have to come through a knowledge of the materials around me that made the trauma possible: the ISU, the Bradley Fighting Vehicle, the way the tracks moved, the type of soil underneath the tracks, how the mine mechanism worked, the radios we used to call in the explosion to base.

Harry Parker, a former British Army Captain, recently published Anatomy of a Soldier, a novel that puts forward an object-oriented ontology of war: an assertion that the material objects sharing the battleground with humans play an equal role in the composition of reality itself.

And the rest is equally worth reading, including some interesting reflections on ‘the rush from the intimate to the inanimate’ –and its limitations.

I first wrote about Anatomy of a Soldier here, followed it up with a notice of an interview with Harry Parker at the Imperial War Museum here (where I’m currently working, deep in the Research Room), and finally summarised my conference presentation on the book and its implications in San Francisco here (‘Object Lessons’: the presentation slides are available under the DOWNLOADS tab).

Wounded

Somme medical dispositions.001

This summer London’s Science Museum is staging an exhibition that is of direct relevance to my current research on casualty evacuation from war zones over the last hundred years:  Wounded: Conflict, Casualties and Care.  It opens on 29 June and is designed to commemorate the centenary of the Battle of the Somme:

57,000 casualties were sustained by British Forces on 1 July 1916, the first day of the Battle of the Somme, creating huge and unprecedented medical challenges. Wounded: Conflict, Casualties and Care, a new exhibition opening at the Science Museum on 29 June, will commemorate the 100th anniversary of this battle and the remarkable innovations in medical practices and technologies that developed as a result of this new kind of industrialised warfare.

During the First World War ten million combatants were killed, but double that number were wounded and millions were left disabled, disfigured or traumatised by their experiences. The challenges were immense. For medical personnel near the front line treating blood loss and infection was the immediate priority in order to save lives. However medics also encountered new forms of physical and mental wounding on a scale that had never been seen before, creating huge numbers of veterans returning home with serious long term care needs.

At the centre of the exhibition will be a remarkable collection of historic objects from the Science Museum’s First World War medical collections, illustrating the stories of the wounded and those who cared for them. From stretchers adapted for use in narrow trenches to made-to-measure artificial arms fitted back in British hospitals, medical technologies, techniques and strategies were pioneered or adapted throughout the war to help the wounded along each stage of rescue and treatment. Visitors will also see unique lucky charms and improvised personal protective items carried by soldiers on the frontline alongside examples of official frontline medical equipment.

I’m looking forward to seeing this over the summer.  The organisers note that:

 Warfare has changed dramatically over the last one hundred years, but similarities remain with the military medical challenges faced today, both through the experiences of the wounded and in their treatment and care. The Wounded exhibition team has worked closely with two UK charities that were formed during the First World War, Combat Stress and Blind Veterans UK, to draw out these parallels and share the personal experiences of soldiers wounded in more recent conflicts.

You can find some of my preliminary thoughts on casualty evacuation from the Western Front here and here, and on twenty-first century casualty evacuation in Afghanistan here and here.  Some of the differences between the two systems are summarised in this slide from a presentation on the project I gave in 2014.

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Much  more to come!

Divisions of Life

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My main presentation at the AAG in Chicago was part of a session organised by Noam Leshem and Alasdair Pinkerton on Remnants of No Man’s Land: history, theory and excess (more on their larger project here).  Here is an extended summary of what I had to say, together with some of my slides, but bear in mind that this all had to be done in 20 minutes so there wasn’t much room for nuance.  Neither was there time to discuss civilian entanglements, both volunteers and victims, nor the sick: the presentation focuses on the wounded, even though the problems of trench foot, ‘trench flu’, and a host of other diseases were also extremely important.  They do all receive attention in the larger project from which this is extracted.  One last, geographical qualification: my discussion is limited to the evacuation of British and imperial troops from the Western Front.

My starting-point was the strange disappearance of the wounded from the field of battle.  As John Keegan wrote in The Face of Battle, in most histories the ‘wounded apparently dematerialize as soon as they are struck down’; he was writing specifically about General Sir William Napier’s account of the battle of Albuera in 1811, but the point is a sharp one that can be enlisted as part of a more general critique of military history.

In the case of the First World War, the emphasis on those who lost their lives – on the dead not the wounded – derives not only from the sheer scale of the slaughter but also from the enduring landscape of memorialisation and commemoration.  When John McCrae‘s elegaic poem ‘In Flanders Fields’ is recited every Remembrance Day – ‘In Flanders fields the poppies grow, between the crosses, row on row’ – it is all too easy to forget that he wrote those lines not only to commemorate the death of a close friend but that he did so at Essex Farm Advanced Dressing Station:

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What lies behind those haunting lines – and that medical outpost – is a vast canvas of wounded men, which Christopher Nevinson captured as ‘The Harvest of Battle’ (below).  The dead occupy the foreground, but behind them is the endless, moving panorama of the wounded whose precarious journeys took most of them far beyond ‘No Man’s Land’.

(c) IWM (Imperial War Museums); Supplied by The Public Catalogue Foundation

In fact, as Emily Mayhew reminds us, ‘being wounded was one of the most common experiences of the Great War’: on the Western Front, she writes, ‘almost every other British soldier could expect to become a casualty’.

But, perhaps not surprisingly, for the first six months of the war the British Expeditionary Force was unprepared for the scale of casualties, and even with the help of civilian volunteers and aid societies – Nevinson briefly served as a medical orderly with the Friends Ambulance Unit, for example – the remarkably long time it took to evacuate the wounded combined with the perilous nature of their improvised journeys to increase the mortality rate.

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And so what Mark Harrison called the military-medical machine had to be speeded up – and moved closer to the field of battle.

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Before every major offensive elaborate plans for medical support were prepared: casualties were ‘cleared’ down the line as far and as fast as possible to make room for the newly injured, casualty clearing hospitals moved closer to the line, ambulances and stretcher-bearers made ready, and ‘down’ trenches designated for the efficient removal of the wounded (below).

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Soldiers wounded in ‘No Man’s Land’ – a term never recognised by the British General Staff, who insisted that they controlled the field of battle right up to the enemy front lines – were often immobilised and disoriented; some crawled into shell holes, seeking refuge below the field of fire, but it could take hours, even days before they were discovered and rescued (I’ll devote a later post to a detailed discussion of some of those cases).

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Sometimes their mates came to their rescue, sometimes the regimental stretcher bearers.  But they too had to find their way through a dangerous and devastated terrain, often with no landmarks to guide them and on occasion made virtually impassable by the thick, cloying mud that was always –  disconcertingly – much more than mud.

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By now, they were in the care of the Royal Army Medical Corps’s Field Ambulance, and their first objective was an Advanced Dressing Station.  

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Treatment at ADS 1917

Those that needed anything beyond simple treatment or emergency surgery were sent on by horse or motor ambulance to a Casualty Clearing Station (a field hospital).

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It was usually here that their first surgeries took place.  The journalist Philip Gibb was shown around a CCS at Corbie and the experience haunted him for years:

After a visit there I had to wipe cold sweat from my forehead, and found myself trembling in a queer way. It was the medical officer—a colonel—who called it that name. “This is our Butcher’s Shop,” he said, cheerily. “Come and have a look at my cases. They’re the worst possible; stomach wounds, compound fractures, and all that. We lop off limbs here all day long, and all night. You’ve no idea!”

CCS Corbie

I had no idea, but I did not wish to see its reality. The M.O. could not understand my reluctance to see his show. He put it down to my desire to save his time—and explained that he was going the rounds and would take it as a favor if I would walk with him. I yielded weakly, and cursed myself for not taking to flight. Yet, I argued, what men are brave enough to suffer I ought to have the courage to see… I saw and sickened. These were the victims of “Victory” and the red fruit of war’s harvest-fields. A new batch of “cases” had just arrived. More were being brought in on stretchers. They were laid down in rows on the floor-boards. The colonel bent down to some of them and drew their blankets back, and now and then felt a man’s pulse. Most of them were unconscious, breathing with the hard snuffle of dying men. Their skin was already darkening to the death-tint, which is not white. They were all plastered with a gray clay and this mud on their faces was, in some cases, mixed with thick clots of blood, making a hard incrustation from scalp to chin. “That fellow won’t last long,” said the M. O., rising from a stretcher. “Hardly a heart-beat left in him. Sure to die on the operating-table if he gets as far as that… Step back against the wall a minute, will you?” We flattened ourselves against the passage wall while ambulance-men brought in a line of stretchers. No sound came from most of those bundles under the blankets, but from one came a long, agonizing wail, the cry of an animal in torture. “Come through the wards,” said the colonel. “They’re pretty bright, though we could do with more space and light.” In one long, narrow room there were about thirty beds, and in each bed lay a young British soldier, or part of a young British soldier. There was not much left of one of them. Both his legs had been amputated to the thigh, and both his arms to the shoulder-blades. “Remarkable man, that,” said the colonel. “Simply refuses to die. His vitality is so tremendous that it is putting up a terrific fight against mortality… There’s another case of the same kind; one leg gone and the other going, and one arm. Deliberate refusal to give in. ‘You’re not going to kill me, doctor,’ he said. ‘I’m going to stick it through.’ What spirit, eh?”…

“Bound to come off,” said the doctor as we passed to another bed. “Gas gangrene. That’s the thing that does us down.” In bed after bed I saw men of ours, very young men, who had been lopped of limbs a few hours ago or a few minutes, some of them unconscious, some of them strangely and terribly conscious, with a look in their eyes as though staring at the death which sat near to them, and edged nearer. “Yes,” said the M. O., “they look bad, some of ’em, but youth is on their side. I dare say seventy-five per cent. will get through. If it wasn’t for gas gangrene—“

He jerked his head to a boy sitting up in bed, smiling at the nurse who felt his pulse. “Looks fairly fit after the knife, doesn’t he? But we shall have to cut higher up. The gas again. I’m afraid he’ll be dead before to-morrow. Come into the operating-theater. It’s very well equipped.”

By now the bureaucratic machine had been activated: labels had been attached to the wounded and field medical cards (‘tickets’) completed; telegrams had been sent to advise families, and nurses had often written letters home on their patients’ behalf.

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The next stage for the most seriously wounded was evacuation by ambulance train to  a base hospital on the French coast.  There was a considerable bureaucracy involved in planning these movements, but for all the neatness and symmetry of the organisational diagrams – part of Clausewitz‘s ‘paper war’ – there were all sorts of delays.

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Priority was given to trains rushing reinforcements, supplies and ammunition to the front, and ambulance trains were frequently marooned in sidings waiting for them to pass so that journeys that might have taken hours could take days.  It was not uncommon for an ambulance train to arrive at a base hospital to find that there was little or no room for new patients and all but the most grievous cases had to travel on to the next.

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Many patients were treated at the base hospitals, but those with more serious wounds were evacuated by hospital ship to Britain.  This stage of the journey was no less dangerous than the previous one: as the war continued, there was an increasing danger of mines and submarines in the Channel.

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A distinctive  geography of the wounded emerged.  If they arrived at Southampton, the most critical cases were taken by train straight to the Royal Victoria Military Hospital at Netley, which treated as many as 50,000 patients during the war.  According to Lyn McDonald,

 ‘Those who could not be accommodated, and those who were seriously wounded but likely to survive a longer journey, were sent on by train to Birmingham, Bristol, Exeter, Leicester, Norwich and Plymouth.  But seven out of every ten hospital trains were directed to London, and during the first days of the Somme they rolled in almost every hour to Charing Cross and Paddington stations.’

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This is, of course, a highly abbreviated account of the casualty evacuation chain, and in the larger project from which this is derived I provide many more details.  But I think I’ve said enough to show that the chain was, in effect, a production line with an elaborate division of labour (again, in the larger study I show how class – or more accurately, rank – gender and race segmented the chain in various ways).  Indeed, in The Politics of Wounds Ana Carden-Coyne argues that what she calls ‘the Taylorist approach in modern war’ – and remember that this was industrial war on the grand (guignol) scale – ‘was particularly evident in the assembly-line style of evacuation and triage.’

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This prompts two concluding observations.

First, what was the instrumental logic that animated the evacuation chain?  After all, it was an expensive undertaking, as Arthur Empey (himself wounded on the Western Front) realised in this re-calculation of the chain:

It may sound heartless and inhuman, but it is a fact, nevertheless, that from a military stand-point it is better for a man to be killed than wounded.

EmpeyIf a man is killed he is buried, and the responsibility of the government ceases, excepting for the fact that his people receive a pension. But if a man is wounded it takes three men from the firing line, the wounded man and two men to carry him to the rear to the advanced first-aid post. Here he is attended by a doctor, perhaps assisted by two R.A.M.C. men. Then he is put into a motor ambulance, manned by a crew of two or three. At the field hospital, where he generally goes under an anaesthetic, either to have his wounds cleaned or to be operated on, he requires the services of about three to five persons. From this point another ambulance ride impresses more men in his service, and then at the ambulance train, another corps of doctors, R.A.M.C. men, Red Cross nurses, and the train’s crew. From the train he enters the base hospital or Casualty Clearing Station, where a good-sized corps of doctors, nurses, etc., are kept busy. Another ambulance journey is next in order — this time to the hospital ship. He crosses the Channel, arrives in Blighty — more ambulances and perhaps a ride for five hours on an English Red Cross train with its crew of Red Cross workers, and at last he reaches the hospital. Generally he stays from two to six months, or longer, in this hospital. From here he is sent to a convalescent home for six weeks.

If by wounds he is unfitted for further service, he is discharged, given a pension, or committed to a Soldiers’ Home for the rest of his life, — and still the expense piles up. When you realize that all the ambulances, trains, and ships, not to mention the man-power, used in transporting a wounded man, could be used for supplies, ammunition, and reinforcements for the troops at the front, it will not appear strange that from a strictly military standpoint, a dead man is sometimes better than a live one (if wounded).

Hence, for example, the orders recorded by A.M. Burrage:

The instructions given to stretcher-bearers are rather harsh. “ If you find two men wounded, and can take only one away, take away the one more likely to make a fit soldier again.” Therefore the one more urgently in need of attention must be left to die, because he would walk with a limp and would never again be able to carry a pack. Sound business, of course, but just a little hard.

Kate Luard captured another dimension of this when she wrote in January 1915:

‘The ambulance trains do so much bringing the British Army from the field that I hope some other  trains are busy bringing the British Army to the field, or there can’t be many left in the field…’

And Emily Mayhew provides this bleak vignette from a medical orderly that captures the seemingly insatiable drive of industrial war:

An ordinary train, similar to the one that had brought him to the front, was at one end unloading reinforcements, while at the other end it was filling up with wounded men.

The logic, then, was one of ‘salvage’; four out of every five men wounded on the Western Front were returned to the fighting, which was the over-riding objective of the military-medical machine.

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Second, the division of labour was also a division of life: the dead from the wounded, the dying from the ‘salvageable’, and the wounded from the unwounded or yet-to-be-wounded.  The last was not the least.  For breaching that separation could have the most unsettling consequences of all:

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Journeys from No Man's Land.058

 ***

What started me on this journey was Emily Mayhew‘s brilliantly conceived Wounded and an excellent series of articles by Martin Bricknell in the Journal of the Royal Army Medical Corps: see in particular here.

You can also find more on the casualty evacuation chain from the Western Front at Beyond the Trenches here and here, the Long, Long Trail here, the Medical Front here, and the Royal Army Medical Corps site here.

My larger project examines the evacuation of casualties, combatant and civilian, from four combat zones 1914-2014: the Western Front during the First World War, the deserts of North Africa during the Second World War, Vietnam, and Afghanistan.

Writing the wounds of war

ramc-ypres-1915

Apart from trying to keep up with developments in Syria and Iraq – on which more shortly – I’ve also been continuing my reading on medical care on the Western Front.  I’ve now finished The Backwash of War, and what a bleak little book it is.  There’s very little about medical care – largely because in many respects there seems to have been very little of it in Ellen La Motte‘s field hospital – and much of the discussion is a deeply disturbing account of the cynicism of military violence: the generals who visit only to pin medals on the blankets of the dying, the contempt between medical orderlies and patients (who have no time for those who are not serving on the front lines), and the seemingly endless, agonising deaths of patients.  But that was precisely what gave the author her title:

The sketches were written in 1915 and 1916, when the writer was in a French military field hospital, a few miles behind the lines, in Belgium. War has been described as “months of boredom, punctuated by moments of intense fright.” During this time at the Front, the lines moved little, either forward or backward, but were deadlocked in one position. Undoubtedly, up and down the long reaching kilometers of “Front” there was action, and “moments of intense fright” which produced fine deeds of valor, courage and nobility. But where there is little or no action there is a stagnant place, and in that stagnant place is much ugliness. Much ugliness is churned up in the wake of mighty, moving forces, and this is the backwash of war. Many little lives foam up in this backwash, loosened by the sweeping current, and detached from their environment. One catches a glimpse of them—often weak, hideous or repellent. There can be no war without this backwash.

In some part, perhaps, La Motte’s account reflects differences between British and French medical provision.  Lyn Macdonald‘s The roses of no man’s land (which contains all sorts of insights into the geographies of medical evacuation and provision en passant) suggests that ‘Lying wounded on the battlefield [at Verdun] a French soldier was as good as dead, for there was little chance of his being brought in, and if he had the good luck to be rescued and taken to a hospital there was only one chance in three that he would leave it alive.’   By the end of the war, she continues, of France’s 1,300,000 war dead more than 400,000 had died of their wounds: ‘a proportion that was larger by far than those of any other nation and was due in considerable measure to the makeshift conditions and lack of skilled care in all but a few of the hospitals.’

The politics of wounds

This isn’t to romanticise the experience of those wounded in other armies, of course, but it adds another dimension to what Ana Carden-Coyne calls ‘the politics of wounds’.   Her new book, due out in the fall, The politics of wounds: military patients and medical power in the First World War (Oxford University Press), is high on my reading list for my new research project:

The Politics of Wounds explores military patients’ experiences of frontline medical evacuation, war surgery, and the social world of military hospitals during the First World War. The proximity of the front and the colossal numbers of wounded created greater public awareness of the impact of the war than had been seen in previous conflicts, with serious political consequences.

Frequently referred to as ‘our wounded’, the central place of the soldier in society, as a symbol of the war’s shifting meaning, drew contradictory responses of compassion, heroism, and censure. Wounds also stirred romantic and sexual responses. This volume reveals the paradoxical situation of the increasing political demand levied on citizen soldiers concurrent with the rise in medical humanitarianism and war-related charitable voluntarism. The physical gestures and poignant sounds of the suffering men reached across the classes, giving rise to convictions about patient rights, which at times conflicted with the military’s pragmatism. Why, then, did patients represent military medicine, doctors and nurses in a negative light? The Politics of Wounds listens to the voices of wounded soldiers, placing their personal experience of pain within the social, cultural, and political contexts of military medical institutions. The author reveals how the wounded and disabled found culturally creative ways to express their pain, negotiate power relations, manage systemic tensions, and enact forms of ‘soft resistance’ against the societal and military expectations of masculinity when confronted by men in pain. The volume concludes by considering the way the state ascribed social and economic values on the body parts of disabled soldiers though the pension system.

But all this is about military patients: what of civilians who are wounded or become ill in war zones?  The BackWash of War provides one vignette that is worth reporting in full.  It’s titled ‘The Belgian Civilian’:

‘A big English ambulance drove along the high road from Ypres, going in the direction of a French field hospital, some ten miles from Ypres. Ordinarily, it could have had no business with this French hospital, since all English wounded are conveyed back to their own bases, therefore an exceptional case must have determined its route. It was an exceptional case—for the patient lying quietly within its yawning body, sheltered by its brown canvas wings, was not an English soldier, but only a small Belgian boy, a civilian, and Belgian civilians belong neither to the French nor English services. It is true that there was a hospital for Belgian civilians at the English base at Hazebrouck, and it would have seemed reasonable to have taken the patient there, but it was more reasonable to dump him at this French hospital, which was nearer. Not from any humanitarian motives, but just to get rid of him the sooner. In war, civilians are cheap things at best, and an immature civilian, Belgian at that, is very cheap. So the heavy English ambulance churned its way up a muddy hill, mashed through much mud at the entrance gates of the hospital, and crunched to a halt on the cinders before the Salle d’Attente, where it discharged its burden and drove off again.

Medical Provision, Ypres, 1915

‘The surgeon of the French hospital said: “What have we to do with this?” yet he regarded the patient thoughtfully. It was a very small patient. Moreover, the big English ambulance had driven off again, so there was no appeal. The small patient had been deposited upon one of the beds in the Salle d’Attente, and the French surgeon looked at him and wondered what he should do. The patient, now that he was here, belonged as much to the French field hospital as to any other, and as the big English ambulance from Ypres had driven off again, there was not much use in protesting….

‘A Belgian civilian, aged ten. Or thereabouts. Shot through the abdomen, or thereabouts. And dying, obviously. As usual, the surgeon pulled and twisted the long, black hairs on his hairy, bare arms, while he considered what he should do. He considered for five minutes, and then ordered the child to the operating room, and scrubbed and scrubbed his hands and his hairy arms, preparatory to a major operation. For the Belgian civilian, aged ten, had been shot through the abdomen by a German shell, or piece of shell, and there was nothing to do but try to remove it. It was a hopeless case, anyhow. The child would die without an operation, or he would die during the operation, or he would die after the operation….

‘After a most searching operation, the Belgian civilian was sent over to the ward, to live or die as circumstances determined. As soon as he came out of ether, he began to bawl for his mother. Being ten years of age, he was unreasonable, and bawled for her incessantly and could not be pacified. The patients were greatly annoyed by this disturbance, and there was indignation that the welfare and comfort of useful soldiers should be interfered with by the whims of a futile and useless civilian, a Belgian child at that. The nurse of that ward also made a fool of herself over this civilian, giving him far more attention than she had ever bestowed upon a soldier. She was sentimental, and his little age appealed to her—her sense of proportion and standard of values were all wrong. The Directrice appeared in the ward and tried to comfort the civilian, to still his howls, and then, after an hour of vain effort, she decided that his mother must be sent for. He was obviously dying, and it was necessary to send for his mother, whom alone of all the world he seemed to need. So a French ambulance, which had nothing to do with Belgian civilians, nor with Ypres, was sent over to Ypres late in the evening to fetch this mother for whom the Belgian civilian, aged ten, bawled so persistently.

‘She arrived finally, and, it appeared, reluctantly. About ten o’clock in the evening she arrived, and the moment she alighted from the big ambulance sent to fetch her, she began complaining. She had complained all the way over, said the chauffeur…. She had been dragged away from her husband, from her other children, and she seemed to have little interest in her son, the Belgian civilian, said to be dying. However, now that she was here, now that she had come all this way, she would go in to see him for a moment, since the Directrice seemed to think it so important….

‘She saw her son, and kissed him, and then asked to be sent back to Ypres. The Directrice explained that the child would not live through the night. The Belgian mother accepted this statement, but again asked to be sent back to Ypres. The Directrice again assured the Belgian mother that her son would not live through the night, and asked her to spend the night with him in the ward, to assist at his passing. The Belgian woman protested.

“If Madame la Directrice commands, if she insists, then I must assuredly obey. I have come all this distance because she commanded me, and if she insists that I spend the night at this place, then I must do so. Only if she does not insist, then I prefer to return to my home, to my other children at Ypres.”

‘However, the Directrice, who had a strong sense of a mother’s duty to the dying, commanded and insisted, and the Belgian woman gave way. She sat by her son all night, listening to his ravings and bawlings, and was with him when he died, at three o’clock in the morning. After which time, she requested to be taken back to Ypres. She was moved by the death of her son, but her duty lay at home. Madame la Directrice had promised to have a mass said at the burial of the child, which promise having been given, the woman saw no necessity for remaining.

“My husband,” she explained, “has a little estaminet, just outside of Ypres. We have been very fortunate. Only yesterday, of all the long days of the war, of the many days of bombardment, did a shell fall into our kitchen, wounding our son, as you have seen. But we have other children to consider, to provide for. And my husband is making much money at present, selling drink to the English soldiers. I must return to assist him.”

YPRES 1915

‘So the Belgian civilian was buried in the cemetery of the French soldiers, but many hours before this took place, the mother of the civilian had departed for Ypres. The chauffeur of the ambulance which was to convey her back to Ypres turned very white when given his orders. Everyone dreaded Ypres, and the dangers of Ypres. It was the place of death. Only the Belgian woman, whose husband kept an estaminet, and made much money selling drink to the English soldiers, did not dread it. She and her husband were making much money out of the war, money which would give their children a start in life. When the ambulance was ready she climbed into it with alacrity, although with a feeling of gratitude because the Directrice had promised a mass for her dead child.

“These Belgians!” said a French soldier. “How prosperous they will be after the war! How much money they will make from the Americans, and from the others.”‘

It would obviously be absurd to generalise from one vignette, but there’s clearly a different politics at work in this narrative,  and a complex set of political geographies too.  For a careful reading of La Motte’s account, in parallel with Mary Borden‘s The forbidden zone, you could do no better than Margaret Higonnet‘s introduction to her Nurses at the front: writing the wounds of the great war.  I’ve now started on a series of accounts about the work of field ambulances, and one which resonates with the events described in La Motte’s vignette is William Boyd‘s letters from 7 March to 15 August 1915 published as With a field ambulance at Ypres (1916), which you can download free here.

But all this – important – talk about writing the wounds of war should not blind us (me) to the role of visualising the wounds of war, and to the work done by artfully composed (and surely sanitised) images like the one that heads this post…