12 November 2013

Repairing British and Australian soldiers after WW1

In the article "Horrors of Anzac aftermath laid bare",  The Age Newspaper in Melbourne tried to uncover WW1 soldiers' personal stories. The timing was perfect - just in time for the 100th anniversary of the war in 2014. Private Bertram Byrnes' war service record, for example, is on the Australian National Archives website. It tells, in sparse, bureaucratic language, that Byrnes enlisted at 24, served in France and was twice wounded in action. The last injury, a gunshot wound to the face in September 1918, saw him invalided home. But there is only one letter from him in the records, written in 1938, the year before the war broke out. Byrnes asked for duplicates of service medals lost in a bushfire; he wanted to wear them on Anzac Day.

Mind you, reading the service dossier tells us very little about Private Byrnes or his family, or his wound and what it actually did to him and those he loved. A medical report by Repatriation doctors refers to ''much facial disfigurement''. The wound was so severe that he dribbled constantly and had to live on what was called ''slop food''. His disfigurement, altered little by a series of painful operations, was such that most employers rejected him - he was shunned, ostracised, took up a remote block of land as a soldier settler, and found himself too weak to work it.

In the Repatriation Reports you can hear the hushed voices of what they called ''the whispering men'', men whose lungs were corroding, who died years after the war from the effects of being gassed. You can see the shaking bodies of the nerve cases - a war-wrecked generation crippled by physical and psychological scars. And women's voices are threaded through this extraordinary archive; wives struggling to survive on inadequate pensions; mothers pleading the case of disabled sons; daughters afraid of violent, traumatised fathers.

But history is much more than an endless catalogue of horrors. There is a great dignity, for example, in Bertram Byrnes. A man whose face was shattered but who dressed in a suit the day they took his photograph, a father who struggled to provide for his family, a veteran who wanted to wear his medals on Anzac Day. Like a generation of our countrymen and women, his battles didn't end in 1918.


After WW1 ended in Britain, tragedy continued for a lifetime for those who never saw their husbands, sons or fathers again. Even for those soldiers who managed to return home alive, the armistice offered little consolation to those who were indelibly marked by war, with their missing legs and their horribly scared faces. But in Britain and elsewhere, the misery couldn't be avoided - those physic­ally damaged by the fighting could not be locked away in asylums or prisons. Somehow those young men had to get civilian jobs, find a wife, have babies and run normal homes.

Ex-serviceman wearing a prosthetic plate attached to spectacles. 
Photo credit: Gillies Archives, Queen Mary's Hospital Sidcup. 

In discussing the public rhetoric of bodily and facial reconstruction, Suzannah Biernoff concent­rat­ed on the written evidence - newspapers, magazines and the records of medical staff. The response to facial disfigurement was defined by an anxiety that was specifically visual. Patients refused to see their families and fiancés; children reportedly fled at the sight of their fathers; nurses and orderlies struggled to look their patients in the face. Some soldiers were so severely mutilated that passengers got out of their train seats and moved to other carriages.

How many soldiers were physically devastated as a result of the war? Joanna Bourke (BBC History 4, 14, April 2013) says 41,300 British soldiers had one or more of their limbs amputated. That number did not include Australians, New Zealanders, Canadians, South Africans, Indians or anyone else who came to the rescue of the motherland. Nor does it include injuries other than limb amputations.

One New Zealand plastic surgeon, Dr Harold Gillies, was a man who had worked in France during the war with the Red Cross. With a team of artists and sculptors back in post-war Britain, he developed many techniques of plastic surgery on 5,000+ soldiers with facial injuries. Dr Gillies slowly and carefully rebuilt the human wrecks he met in his Queen Mary’s Hospital in Roehampton, and gave them new lives. 

The limbless men were also treated at Queen Mary’s Hospital where most were fitted with artificial limbs. With convalescence and physiotherapy, the men could walk again and rejoin the land of the living as equals. I am assuming the government agreed to paying the enormous and endless health care costs for two important reasons: a] to honour the soldiers' sacrifice in war and b] to make them productive members of an integrated, post-war society. The quid pro quo, as Professor Bourke noted, was that the limbless men had to take responsib­ility to practise endlessly with their artificial limbs and to "pass" as able-bodied citizens.

The Royal Pavilion in Brighton was converted into The Pavilion Hospital for Limbless Men, quickly opened in 1916 to accommodate this sudden flux of devastating wounds and modelled on the Roehampton House hospital. A workshop was built on the grounds of the Pavilion so that patients could learn new skills in carpentry and engineering, to help in their future careers. Open spaces allowed the men to play team sports.

A plaster cast is made in order that the eventual mask will perfectly cover all facial injuries 
General Hospital, Wandsworth
Photo credit: Imperial War Miuseum

Fiona Reid, in Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-30, found that the men suffering shell-shock had the most difficult recovery, because their wounds were impossible to see. Many military commanders believed the shell-shocked soldiers were simply malingering, while civilians back at home thought the wide eyed, jittery men were lunatic. After the war, the situation was made worse because many of the shell-shocked strug­gled with a pension system that failed to give them security. Thus the conflict between the political rhetoric and the lived experience of many wounded ex servicemen continued for 20 years. How could the nation memorialise the war and remember the unending sacrifice made by the men, while at the same time forgetting the shell-shocked?

How strange, since the first medical study of shell shock appeared in The Lancet in 13th Feb 1915. It was estimated that already by December 1914, 10% of British officers and 4% of enlisted men were severely injured by nervous and mental shock.

Professor Bourke believed that the absent limbs of amputees came to exert a special patriotic power, to the extent that the disabled soldier could be hailed as ‘not less but more of a man’. Facially injured men were horrific to look at and were avoided by civilians at all cost, but those men were also recognised for their sacrifice. In fact almost all the physically wounded bore the visible proof of their valour and sacrifice. Men who were _mentally_ disturbed by war were the only ones who had to live with the suspicion of malingering.


Andrew said...

There was a great RN podcast I listened to and Byrnes' case was talked about. We don't want our citizens fighting wars, especially those where are not directly affected, but at least I hope and think good services are now in place.

Hels said...


*nod* I rarely think of war as a solution to international problems. It is almost always catastrophic, for both soldiers and for civilians.

But I don't think good services were automatically in place, as a _right_ for young men who had given so much for their nation.

Firstly civilians were horrified at the sight of ugly, deformed young men. The young men had no social life and not many employment opportunities either.

But even the government was reluctant to pay for endless services that would be required and suspected the men of cashing in on their wounds. In my opinion services were a right, not a reluctant charity.

Pat said...

I think shell shock was the worst. The neighbour when I was growing up was scary. His wife eventually left home and took the babies with her.

Proud Kiwi said...

Go Dr Harold Gillies! New Zealand rocks!

Janene said...

War is hell long after it's over, as your post reminds us. Sad but fascinating information, Held. We owe veterans so much.

Hels said...


That is so true.

Everyone our age will know someone who returned from WW2 damaged - a father, uncle, next door neighbour, a teacher. Our neighbour lost a leg in war, and he adapted to civilian life very well. But I found the stump quite scary.

Hels said...

Proud Kiwi

Dr Harold Gillies was indeed a very special man!! Iif it wasn't for him, there would have been no specialist hospital dealing with catastrophic facial injuries in the UK. He and his team made lives worth living again.

Hels said...


Well put. Just because the armistice has been signed, it doesn't mean that civilian life is normal again - soldiers and their families often suffer on for many years.

Big D said...

Great Article.
We tend to assume that after a war, the men we sent out there will just come home and pick where they left off.
Some men just never get that option.

Hels said...

Big D

governments certainly do expect that the men we sent out there will just come home and pick where they left off. But that was always impossible..in every war in history. And it was always unreasonable to put the responsibility for reintegration on the young men themselves.

Yes repatriation hospitals were built for active soldiers and for ex-servicemen. But I must admit to finding "Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-30" deeply disturbing.

Anonymous said...

That is why America's current wars are so worrisome! They are all coming home (both men and women!), some are intact and others are not and never will be. Yet we have a 'volunteer army' that mostly derives from young people who can't find work in the civilian sector.
James Morgan
Olympia, WA USA

Hels said...


It is so difficult, in every country and in every war *nod*. Young people are putting their lives on the lines for their country, either through conscription or via volunteering.

To treat returning soldiers with less than top quality medical, psychiatric and every other services would be immoral. If a nation doesn't want to pay for the necessary services, don't send the soldiers away in the first place.

Mandy Southgate said...

PTSD has always fascinated me, especially in the context of the Vietnam and world wars. It was an area I focused on a lot during my studies in psychology and it is indeed a hidden illness, incredibly difficult to understand and often difficult to detect amongst the many strange (and often private) symptoms.

This is a really interesting post. I eventually stopped watching Boardwalk Empire but thought the depiction of the soldier with the facial injury was very well done.

It occurs to me that we're making the same mistakes now. Not enough is done to educate the public in the UK that men are in fact seriously injured in these wars and that they must be welcomed back and integrated back into communities. Instead, they become invisible in a way, suffering in private.

Hels said...


The response after WW1 to seriously injured soldiers was really rather nasty .... that the men were malingering, that shell shock didn't exist as a real medical condition, that the ex-soldiers should just get a job and pay for their own health care etc etc.

I don't know if young men were exploited in the same way in WW2, Vietnam etc but hopefully we have become smarter and more honest as the 20th century went on. If nations don't want to look after soldiers when they come home, don't send them off to war.

Leaving men to suffer in private was a destructive option ....destructive to the soldiers, their wives and their employers.

Hels said...

Britain at War Magazine: The Second Year of the Great War: 1915 has an article called "First Medical Study of Shell Shock". It detailed the symptoms (but not yet treatments) published in The Lancet by Captain Charles Mysers in Feb 1915.