Family health and the Peckham Experiment: 1926-50

Throughout the history of this blog, I have been interested in a growing medical concern for fresh air, sea-water, sun, beach huts, walking gardens, pavilions, pleasure piers, lidos, healthy food and physical fitness.  The problem was that wealthy families could always afford to pay for holiday time in a spa resort or a vigorous ski holiday in the Alps. But what happened to families with inadequate housing, no paid holidays in the fresh air and little access to lidos and pleasure piers?

Swimming pool and diving platform, designed by architect Owen Williams in 1934.

Pioneer Health Centre was specifically set up by a husband and wife medical team (Dr George Williamson d1953 and Dr Innes Pearse d1978) in Peckham, a working class suburb of South London. Motivated by modern ideas of hygiene and good health, the founders wanted to study how light, air, openness and vigorous exercise could be enjoyed by working families and could influence their health outcomes. They did not want to run an illness service; rather they insisted on promoting conditions for personal, family and social well-being.

From 1926-9, the project was started in a small way in St Mary's Road, to serve families living within walking distance. The initial data were written up by the doctors and funding was sought to build a larger centre. Pioneer Health Centre then re-opened in 1935 in a purpose-built piece of modernist architecture.

I am impressed by how the architect, Owen Williams, used modern techniques so that the architecture could play an active role in the Pioneer Health Centre’s philosophy. For example the walls of glass around the Centre were intended to
a] maximise the natural light and
b] retain a structural transparency, representing informality and a welcoming attitude to the community.

The large swimming pool was covered by a glazed roof; all windows could be fully opened, allowing natural air to circulate inside. A flat roof alongside the pool provided ample space for open-air gym classes, as we can see from the photo. Older children had a covered playground that opened directly onto the lovely gardens.

Drs Williamson and Pearse recruited 950 local families to be part of the health-care experiment. For a shilling a week, the families had access to a range of activities eg physical exercise, swimming, games & workshops. Perhaps locals couldn't afford a shilling a week, but the goal was to make the health centre feel like a club which belonged to the families, not an outside charity.

Members were asked to take part in a formal health check each year, and their health was informally monitored as they participated in activities from week to week. The only traditional health treatment on offer was contraception.

Gym class on flat roof top

The core facilities were accommodated by the architect eg cafeteria, games rooms, pool, nursery and gym. The members were actively encouraged to initiate their own choice of classes and activities, using the facilities offered by the Centre at no extra cost eg dress making, ballroom dancing. Self help was the buzz word.

According to Transition Town Tooting, the doctors also recognised the importance of good nutrition, and had a farm providing the centre with fresh, organic produce.

The Centre closed down during World War Two, but was restored and reopened as soon as the soldiers had been demobilised. Alas the bright and breezy Centre finally closed in 1950. It failed for different reasons: firstly it was concerned exclusively with the study and cultivation of health, not with the treatment of disease; secondly it was based exclusively on a limited suburban locality; thirdly its basis was contributory and not free; and finally it didn’t conform to the newly developed NHS structure. But what an amazing concept it had been between 1926 and 1950.

scalloped-glass bay windows right across the front of the Pioneer Health Centre (Pioneer Health Foundation photo)

The old archives from the Pioneer Health Centre, including the medical data collected during the experimental years, are now in the Wellcome Library for the History and Understanding of Medicine.  And a review document, called The Pioneer Health Centre Peckham London, was published in 1949 by the National Trust for the Promotion and Study of Health. For an excellent analysis of the rather radical politics involved in self help and in cooperative health facilities, see Anarchism and the welfare state: the Peckham Health Centre by David Goodway.

Charles Darwin's grandpa, Erasmus. The real genius in the family

Erasmus Darwin (1731–1802) was born in Nottinghamshire where his father Robert Darwin was a lawyer. Presumably the family lived well because Erasmus went to university in St John’s College Cambridge, then studied medicine at the University of Edinburgh Medical School.

Erasmus Darwin House Museum, Lichfield
The Cathedral can be seen behind the house.

In 1757 he moved to Lichfield, Staffordshire to establish a medical practice there. Erasmus became a highly successful physician, and practiced for 50+ years. The doctor liked sex himself, with his wives, mistresses and other peoples’ girlfriends, and warmly prescribed sex as a cure for hypochondria in his patients. Perhaps that was why George III invited him to be his Royal Physician. More probably, the king was interested in Erasmus’ ideas on hygiene, mental health, balanced diet and the proper treatment of wounds.

Clearly Erasmus was far from a standard suburban GP. He was an inventor of extraordinary breadth, including a canal lift for barges and some weather monitoring machines, both of which were needed by local industry. Alas Erasmus did not patent any of his inventions, even his very clever flushing toilet. He seemed to believe that invoking patents would damage his reputation as a doctor. However his friend Matthew Boulton, another creative thinker and successful inventor, had no such scruples.

Best of all Erasmus co-founded the Lunar Society of Birmingham in 1765, a discussion group where thinking industrialists and natural philosophers could get together in an exciting environment. In 1776 he formed the Lichfield Botanical Society, translating the works of a Swedish botanist into English. The result was two, well thought out publications: A System of Vegetables (early 1780s) and The Families of Plants in 1787.

Erasmus Darwin House Museum, display

Erasmus Darwin was a very close friend of Josiah Wedgwood (1730–95), the founder of the pottery firm, Josiah Wedgwood and Sons. Josiah Wedgwood was also a prominent abolitionist so perhaps they shared a number of important values. Anyhow, so close were the two families that Josiah’s granddaughter, Emma Wedgwood, married Erasmus’ grandson, Charles Darwin. Sir Francis Galton (1822–1911) grandson of Erasmus and cousin of Charles Darwin, was another extraordinary polymath in that family.

I wonder how many people, even those who have read Charles’ Darwin’s writings, would know of grandpa Erasmus’ work? In Lichfield, Erasmus developed his system of evolution, and presumably influenced the later ideas of his grandson Charles Darwin. Remember it was Erasmus who wrote the Laws of Organic Life in 1794, dealing with with pathology, anatomy, psychology and the functioning of the body, decades before On the Origin of Species 1859!!! And I wonder how many people, who have seen Joseph Wright of Derby’s well known portrait of Erasmus, realise who the sitter was?

Erasmus Darwin by Joseph Wright, 76 x 64cm, c1792. Derby Museum and Art Gallery.
Dr Darwin, as you can see, was a rather large man.

Erasmus lived in, and modified a large medieval house near the cathedral close, converting it into a brick Georgian town house. It was here that his Robert Waring Darwin (1766-1848) was born, later father of the naturalist Charles Darwin. And it was this building that functioned as Erasmus’ medical practice, the laboratory for his scientific experiments and the Lunar Society’s gathering place.

In Apr 1999, the Lichfield house became a museum and visitor centre dedicated to his life’s work. Once the renovations were completed, the Erasmus Darwin House Museum was filled with his furniture, books, medical equipment and inventions.

Late in life, Erasmus moved to Derby where he formed the Derby Philosophical Society, a daughter organisation of his earlier Lunar group.

Erasmus Darwin, Zoonomia, Vol. I Or, the Laws of Organic Life, 1794. 

What an amazing polymath and Enlightenment thinker Dr Erasmus Darwin was.  He made major contributions to learning in 75 diverse areas which included:

1) abolition of slavery 2) ventilation 3) mental illness 4) microscopy 5) warm and cold fronts 6) afforestation 7) water closets 8) moon's origin 9) treatment of dropsy 10) animal camouflage 11) nerve impulses 12) wind-gauges 13) artesian wells 14) windmills 15) artificial insemination 16) nitrogen cycle 17) manures 18) women's emancipation 19) biological adaptation 20) biological pest control 21) origin of life 22) canal locks 23) outer atmosphere 24) carriage design including steam carriages 25) phosphorous 26) photosynthesis 27) centrifugation 28) cloud formation 29) compressed air 30) rotary pumps 31) copying machines 32) secular morality 33) educational reform 34) sewage farms 35) sexual reproduction 36) evolutionary theory 37) speaking machines 38) exercise for children 39) squinting 40) fertilizers 41) limestone deposits 42) formation of coal 43) steam turbines 44) geological stratification 45) hereditary disease 46) insecticides 47) telescopes 48) language 49) temperance 50) timber production.

Examine Jenny Uglow's book, The Lunar Men: Five Friends Whose Curiosity Changed the World. It was published by Farrar, Straus and Giroux in 2003.

Medical Heritage Trail: University of Sydney

The University of Sydney has created a Medical Heritage Trail, a very informative self-guided walk that covers the medical architecture, museums, libraries and artworks of the first university to be estab­lished in Australasia. I love the idea of Australian universities analysing and publishing their own histories, but I also have a personal fascination – University of Sydney Medical School is my husband’s alma mater.

The Medical Cottage

The University was incorporated 1850 and inaugurated Oct 1852. In 1855, the Government gave the University land at Grose Farm, about 3 ks from the city. The first plans for the University's original building, the Quadrangle, were drawn up by architect Edmund Blacket. By 1862 the famous Great Tower had been completed. But a medical faculty was not thought of, at that stage.

As recorded in the University’s on-line history, Places - Faculty of Medicine Online Museum and Archive, there was an attempt upon the life of Prince Alfred, Duke of Edinburgh on a Sydney beach in 1868. The Duke was taken to Government House and attended by the surgeons of HMS Galatea and HMS Challenger. The Sydney community raised money in thanks, and the Duke asked that the money be used to build a hospital (Prince Alfred Memorial Hospital). The University of Sydney granted the use of University land, provided that a] a portion of the land was reserved for a school of medicine and b] that the hospital be open for clinical teaching to students of the medical school.

The entire medical student body 1887

*

In 1882 Royal Prince Alfred Hospital opened and became the Faculty’s first teaching hospital. That same year, the government agreed to finance a medical school. The Faculty of Medicine was largely shaped by the hard work and brilliance of Sir Thomas Anderson Stuart, who travelled to Australia from Edinburgh. Anderson Stuart took up the Professorship at the University of Sydney in 1883 and immediately began the task of opening the medical school. In that first year, 4 students started their studies in a 4-roomed cottage built behind the Great Hall of the University.

It was a slow start. Of the 29 students who enrolled in the first three University intakes, 11 graduated in minimum time and 3 after repeating one or more years. But confidence in the quality of the medical degree encouraged increased enrolments so that by 1893, 10 years after its inception, there were 100 students.

The Sydney Hospital for Sick Children was founded in 1880 in Glebe. Dr Alfred Roberts, who already had played a key role in the founding of Royal Prince Alfred Hospital and the Coast Hospital, became one of the first surgeons of the Sydney Hospital for Sick Children. By 1884, Sydney Hospital for Sick Children was already recognised as a teach­ing hospital by the University of Sydney. And the very next year, 1885, Callan Park Hospital for the Insane also became a teaching hospital. Designed by colonial architect James, Callan Park Hospital had patients’ wards, joined by a central block which contained med­ical consulting rooms, a library and a pathology museum. Typical of Australian colonial architecture, the building had high ceil­ings, wide verandas, large windows and long covered walkways. The Royal Hospital for Women Paddington didn’t become a teaching hospital for Obstetric training until 1888.

Sydney Hospital for Sick Children, Glebe, c1860

Anderson Stuart wanted a more suitable medical school and in 1887, a new building was commenced. The first part of this Tudor-gothic building, later called the Anderson Stuart Building, was designed by architect Edmund Blacket and finished in 1891. Like mid-late C19th university buildings in Britain, this building had ornate carved elements including crenellations, pinnacles and grotesques.

Anderson Stuart Medical Building, 1891

India's brave soldiers in Brighton, 1914-16

The Royal Pavilion in Brighton was designed in the early C19th by John Nash for Prinny, the pleasure-loving Prince Regent who became King George IV. But did Edwardians realise that the Royal Pavilion had not been a royal residence since 1850?

Queen Victoria loathed this lumping symbol of the dodgy Georgian ancestors whose image she distanced herself from. So in 1850 she sold the palace to Brighton council. [Only the original fittings and furnishings were moved to Buckingham Palace and Osborne on the Isle of Wight, where they remain].

Secretary for War Lord Kitchener was told: "Understanding that the Royal Pavilion at Brighton is specially suited for hospital treatment of Indian troops, the Corporation beg to place it at His Majesty's disposal for that purpose". The palace had a very Indian external architecture and both Islamic and Mughal taste in the interiors. So the Brighton dignitaries thought it would be very home-like for any Indian soldiers who found themselves wounded, 7,500 ks from their families.

Royal Pavilion, Brighton

Nonetheless it was still something of a surprise when, in Nov 1914, builders moved into the palace. Luxury carpets and curtains were removed, linoleum laid over the ballroom and stone-flagged kitchens, and 700 beds were installed under the gilded ceilings and chandeliers. Prinny’s Georgian kitchen was changed into an operating theatre.

Nine kitchens, some catering specifically for Hindu religious laws, were erected in the grounds, and enlisted men from the Indian army were quickly shown how to cook standing up at a western stove. A halal slaughterhouse was opened in town. The Sikh temple was a marquee erected in the Pavilion grounds. Muslims were able to use the lawn in front of the Dome, as this was facing East.

In early December, the first Indian patients arrived from the Western Front.

 Brighton Corporation commissioned Allen H Fry to take official photographs of the hospital, which were then issued as real postcards

Clearly there was a wonderful opportunity for propaganda. The avuncular care of King George V for his wounded Indian subjects was central to the spin doctoring. It seemed that King George insisted on giving up his own bed, and was prepared to roll bandages for his lads. In fact King George and Queen Mary only visited the Brighton Pavilion once, as far as I can see. They presented the Victoria Cross to an Indian soldier and had the event filmed (11 minutes of footage survive). Yet the publicity continued to suggest that, despite no royal being in the palace for 64 years, Brighton Pavilion was still the royal couple’s home and that they spent each day, playing cards with the patients and writing letters to the soldiers’ loved ones.

Were they hidden motives for helping the wounded Indian comrades? Rosie Llewellyn-Jones suggested that small groups in India, both Muslim and Hindu, were actively working against imperial rule, in collusion with Germany and the Ottoman Empire. If Turkey entered war on the German side, there was an added concern - Indian Muslims might not be prepared to fire on fellow Muslims fighting for Turkey. It was essential, therefore, to show that the differing religious groups were being well cared for.

Sikh soldiers in the music room, by CHH Burleigh. Brighton Museum.

A souvenir book was published, with text in English and Urdu, and given to former patients on their return to India. The book promoted an idyllic image of the hospital and the care they had received: "In many an Indian village in the years to come, these soldiers, their fighting days long over, will talk to their children's children of the Great War. Their faces will then glow with pride as they tell of the day when they were lying wounded in a Royal Palace, and the King and Queen came to their bedside." Postcards of the same caring images were sold in the hope they would be posted home to India.

The Daily News acknowledged that the Indian soldiers were mown down in such numbers that existing hospitals behind the lines and on the south coast of England could not cope. 1.5 million Indians enlisted during the First World War, of whom 43,000 were killed and 65,000 were wounded. As more and more Indian soldiers were wounded, two other buildings in Brighton were turned into hospitals. The York Place schools were converted into a hospital for the more heavily wounded troops, while the Elm Grove workhouse, renamed the Kitchener Hospital, treated the less wounded.

These three Brighton hospitals, so urgently opened for 2000+ Indian casualties, were told they were closing when the Indian divisions were withdrawn from France. By January 1916, there were no patients left.

So the Pavilion had become a media spectacle and a source of propaganda, for the royals, for Brighton and for Britain. Only recently has the war time history of Brighton and its Royal Pavilion has been reanalysed and displayed. Since late 2010, the Royal Pavilion has mounted a permanent exhibition, displaying the Indian hospital, complete with archive photographs, paintings, beds, uniforms, medical equipment and newsreel footage.

King George and Queen Mary visited the hospital, 1915.

Readers will enjoy the book by Joyce Collins called Dr Brighton's Indian Patients, December 1914-January 1916. It was published in 1997 by Brighton Books Publishing.

William Bland - convict, surgeon, politician, inventor

“Lost and Found” is a television programme that focuses on the contents of The State Library of NSW, one of Australia’s loveliest heritage buildings. Inside lurk plenty of amazing, yet little known stories that shine a light on Australian history in the earliest decades. One character I had never heard discussed, except at the University of Sydney Medical Museum, was Dr William Bland.

William Bland (1789–1868) was born in London, the son of D Robert Bland. He trained in medicine and was qualified by the Royal College of Surgeons as surgeon's mate in the navy in 1809. He was promoted to the rank of naval surgeon in 1812. While serving on a navy ship in Bombay, this middle class naval officer was involved in a brawl with the purser. As a result, Bland fought a duel with the purser and killed him. Bland was tried for murder in Bombay in 1813 and found guilty. It is not clear why he was recommended for mercy, but luckily he was only sentenced to transportation for seven years. He was not hanged.

Dr Bland, c1845, oldest daguerreotype known in The State Library of NSW

Bland was shipped to Australia, reaching Hobart Town in January 1814 and then Sydney in July 1814 where he was a prisoner of His Majesty’s at Castle Hill gaol. Once again the gods shone on William Bland - he was totally pardoned in January 1815! Presumably this was because Bland was the first private doctor to arrive in Australia.

He immediately began private medical practice in Sydney, which apparently did very well, to the extent that in 1817 he was able to afford an assistant. But clearly he didn’t learn to stay out of trouble. In September 1818 Bland was back in court and convicted of libel against noone less that the Governor, Lachlan Macquarie. This time the good doctor was given a hefty fine and sentenced to 12 months imprisonment which he served at Parramatta.

Bland returned to his private medical practice, and in 1821 began a long association with the Benevolent Society, providing much needed medical services at the Castle Hill lunatic asylum. This was the colony's first mental hospital, established in 1811, which was in fact an old barn surrounded by a stockade. He must have been a very busy man, since he was also on the staff of the Sydney Dispensary. Plus he lectured and wrote on important medical topics such as Dislocations, Sanitary Reform and Bites of Venomous Snakes in Australia. The surgical instruments that he invented were published in The Lancet.

Most people agreed that despite his argumentative and somewhat prickly personality, Dr Bland was an able and patient surgeon who showed selfless affection for the sick and the poor.

133 Macquarie Street, Sydney, built on land that Dr Bland once owned.

For a medical man, I think some of his greatest contributions were, surprisingly, in the field of education. In 1830 Sydney College, which later became the very prestigious Sydney Grammar School, was founded with William Bland as president. He was also a generous benefactor to the Sydney Mechanics School of Arts and helped in its formal opening in 1833. [Happy Mechanics’ Institutes were my favourite providers of education to working families in the 19th century].

Only on one occasion was he a major promoter of higher education yet was not credited for his contributions. Dr Bland was very involved in the foundation of the University of Sydney, but his name was dropped from the senate because former convicts were excluded from taking part in the management of that august institution.

Bland was a person of well thought out political views. In 1830 he actively opposed attempts to alienate large areas of crown land, and in 1831 joined the committee of the Australian Landowners Association to fight against land regulations. At another public meeting in 1830 a committee, which included Bland, was formed to demand legislation by representation and to appoint a parliamentary agent in the House of Commons. 

NSW Parliament House, Macquarie Street, Sydney

He had some failures. Petitions demanding representative government and trial by jury failed in 1830 and 1833. But he also had amazing successes. Clearly having been a transported convict and a gaolbird was no handicap, politically. Bland was an elected member of the NSW Legislative Council twice (1843–48, 1849–50) and after the introduction of responsible government, was appointed to the NSW Legislative Council once (1858–61). A banquet was held in July 1856 to celebrate the granting of a new Constitution by the British government. Dr Bland was given the honour of chairing the evening.

In 1858 he was given a valuable award for his services to the community.

Perhaps the greatest medical office that he achieved was becoming the inaugural President of the Australian Medical Society, following its foundation in 1859.  Bland continued in active medical practice until his death.

In 1861 he was surprisingly declared a bankrupt, even though he had at one time been a large landowner, with property at Prospect Hill, Hunters Hill, Yass etc. What went so badly wrong? Bland died intestate in Sydney in 1868 at a decent age, and the family graciously accepted a state funeral. Not bad for an ex convict.

Sydney University had become a very impressive campus, 1859

I am very grateful to the author of  Duelling Surgeon, Colonial Patriot: The Remarkable Life of William Bland, Robert Lehane, for sending me a copy of the book. Unfortunately it was published by Australian Scholarly Publishing in Dec 2011, long after I had written this post. However there was more and more to learn about Bland, as I soon found out. Never has a person lived his life so brightly in the public gaze.

I am sure that much of the information. available on the public record, Bland would have prefered not to have seen in print. After discovering his wife's infidelity, for example, Bland placed an advertisement in the Gazette, warning vendors not to extend any credit to his (first) wife Sarah since he was no longer going to cover any of her debts. Worse still he had more court appearances, on both sides of the litigants' tables, than most people had had hot dinners. Some were very petty indeed.

Other projects would have made him very proud. For example, Bland proceeded with a very tricky operation on patients' aortas that had never been successful before. Although Bland's patients also died, he wrote up the surgical data in immaculate detail in The Lancet, building up a body of evidence that would revolutionise surgery after the introduction of anaesthesia. Another breakthrough came via Bland's collection of venomous snakes. He analysed the impact of each venom in minute detail and wrote up the treatments, both successes and failures, in The Lancet.

This was a man who moved from the ridiculous and degraded, to the sublime and heroic, and back again. Often.

Mary Slessor - a religious feminist in Victorian Nigeria

I would not, I think, choose a woman missionary worker as a role model for young women today, if religion was her only contribution to feminism. But Scottish missionary Mary Slessor (1848-1915) was different.

Mary Slessor (centre) and some of her charges

Mary was born in Aberdeen and moved to Dundee in her pre-teens when her dad was looking for work. Times were tough in 1859 so young Mary had to work as a labourer at a jute mill. Luckily she worked only half of each day, and attended the mill school run by the company for the rest. Old Mrs Slessor was deeply religious and it was not surprising when young Mary followed her mother’s values.

Mary joined a local mission teaching the poor and decided to dedicate her life to Spreading The Word for the Presbyterian Church. She was trained up at the Foreign Mission Board in Edinburgh and was shipped out to Africa in 1876. I was particularly impressed that she learned to speak Efik, the language of the Calabar people, and in time mastered it. Most of us struggle learning French and German in school, relatively easy languages in comparison with Efik.

Calabar region of Nigeria

Mary Slessor went to live among the Efik people in Calabar, now in Nigeria (on the west coast of Africa). The colonial power, Britain, maintained control of the country. But Britain seemed to be more interested in the maintenance of trade for importers and exporters back home, rather than in the welfare of the Nigerians.

This White Queen of Calabar, as Mary became known, took huge risks. She successfully fought against the killing of twins at infancy, adopting them instead, banned the eating of human flesh and tried endlessly to improve the status of women. Most important from my point of view, Mary  established hospitals for small pox patients and later made vaccinations available to the children.

In 1891 the British government set up a system of vice-consular justice in Calabar. Mary Slessor had established such an influence over the locals that consul-general Sir Claude Macdonald made her a vice-consul, the first woman to be so appointed in the British Empire. Justice was certainly done, though her court could be a little bit personalised and eccentric.

Mary Slessor Church in Calabar

In 1898, Mary Slessor returned to Scotland, touring the Edinburgh churches and talking endlessly about the horrors she had seen. Although slavery had been banned by the British in the Nigerian Protectorate in 1848, well before Mary’s missionary work started, she still moved Scottish worshippers to tears with tales of slave markets and cannibalism fifty years later.

It is said that the land and people of Calabar were changed by her heroic efforts. I am certain that her legacy IS remembered in Scotland because I have read all the reviews of her life. But it is also said that she is fondly remembered in Nigeria as The White Queen of Calabar or Mother of All the Peoples. I haven’t read any African reviews of her work, but I do know that when she died in Nigeria in 1915, Mary given a state burial. She had spent 39 years there.

Ten pound note with Slessor's portrait

The Mary Slessor Journal of Medicine is an official publication of the University of Calabar Teaching Hospital in Nigeria. The University of Calabar Teaching Hospital is housed in the former Saint Margaret Hospital in Calabar, a health care facility established in 1897 as the first centre of secondary health care in Nigeria. Mary's grave still stands on a hill some 200 metres from this teaching hospital.

It actually took some time before Britain recognised her contribution. Mary was the first woman to appear on a Scottish Clydesdale Bank ten pound note, in 1998; her portrait appears on the obverse of the £10 note, replacing David Livingstone’s. On the reverse, Slessor is depicted holding children in her arms alongside a map of Nigeria.

Slessor with some of her adopted children

Florence Nightingale: dedicated but no saint

William and Frances Nightingale, both from staunch Unitarian families, married in 1818 and left home on a long tour of  Europe. They had their two daughters (Parthenope and Florence) en route. Eventually the family returned to England in 1821 and settled down in William's inherited properties in Derbyshire where he owned and managed an active lead smelter. The main family home was Lea Hurst in Derbyshire, Florence's beloved childhood home.

Lea Hurst, Derbyshire

Unitarians believed that social evils were humanly created, not God inflicted, and therefore could be remedied by human efforts. In the early C19th, Unitarians were closely identified with the campaign for social and political reform. The scholarly William educated his two daughters well.

Florence became increasingly frustrated at the kind of life wealthy young women led. God was still calling her to His service, but He had not made it clear how she was to serve Him. Nursing was a possibility, but it was regarded as menial employment, needing neither study nor intelligence, suitable only for prostitutes and alcoholics (or perhaps Catholic nuns). In 1846 she met Earl Shaftesbury, famous politician and reformer, who showed Florence government reports called Blue Books. She became a self-taught authority on hospitals and sanitation, although with zero experience. She also met Sidney Herbert, Secretary of War, who became the most important contact she ever made.

Roll Call in Crimea, by Lady Butler, bought by Queen Victoria

After a Nile trip in 1850, Florence dabbled in nursing training in Alexandria. In Aug 1851 Florence gained some real experience as a trainee nurse in the Kaiserswerth Institution of Protestant Deaconesses in Dusseldorf, where she was a probationer. And between Aug 1853-Oct 1854, Florence went into residence in her first position, as the superintendent of a rundown Establishment for Invalid Gentlewomen, 1 Upper Harley St. That was the sum total of her medical training and experience!

In July 1853 Russia occupied territories in the Crimea that had previously been controlled by Turkey. Britain & France anguished over Russian expansion and tried to achieve a withdrawal. Turkey declared war on Russia and in Sep 1854, the Crimean War reluctantly began.

Through the first ever war correspondents, the British public learnt of the horrific condition of wounded soldiers. Secretary of War Sidney Herbert, her long time friend, agreed to allow Florence and 38 other lay women to nurse British soldiers in the war zone. She was Superintendent of the Female Nurses in Hospitals in the East.

The party arrived in Constantinople in Nov 1854. The Barrack Hospital in Scutari was old but they were assured by Sidney Herbert of abundant supplies and good facilities. The unfortunate nurses walk into horror; there was nothing there! The sick and wounded soldiers had no blankets, no clean water and totally inadequate food. In these conditions it was not surprising that war wounds only accounted for 1 death in 6 in army hospitals. Diseases like typhus, cholera and dysentery raged, accounting for the rest of the deaths. Furthermore the army doctors did not want nurses there, especially female nurses.

The fetid wards at Scutari. Lithograph by Robert Rigg, National Library Medicine.

In Feb 1855 the mortality rate at the hospital was 43%. Florence was given the task of properly organising the barracks hospital after Battle of Inkerman. At Scutari Barracks Hospital she was in sole control of 2,500 sick soldiers. The soldiers adored the gentle nurses, mopping their fevered brow. The introduction of female nurses to military hospitals was a huge success.

But the soldiers were packed into overcrowded, filthy corridors with poisonous blocked drains beneath. Many of the deaths were preventable, caused by fever caught IN hospital. The Lady with the Lamp image, gliding serenely through the corridors at Scutari, took on a horrible irony. The Russians weren’t killing British soldiers; British army hospitals were. Florence did nothing to improve conditions and got typhus herself.

To show the nation's gratitude for Nightingale, a public subscription was organised in Nov 1855 while she was still in Crimea. The money collected was to enable her to continue her reform of nurse education in the civilian hospitals of Britain. In Jul 1856, the war was over. Florence returned home in Aug 1856 and was surprised to find that the war had made her a national heroine to the troops and public.

The hero treatment triumphantly vindicated her claim that lay women could nurse soldiers without gross indecency taking place. This opened up new career opportunity for middle-class, Protestant women, AND it improved the quality of female nurses. She visited Queen Victoria and Albert to talk about the war, and found Queen a great supporter of women’s professional advancement.

In the aftermath of the Crimean war, it became obvious that a top military hospital was needed in Britain. The Royal Victoria Military Hospital at Netley became the biggest military hospital ever built. Stretching .5k on Southampton Water, the huge red brick complex was built in 1856-63 (and later demolished). It received wounded soldiers from across the British Empire and had an army nursing school.

Nothing could stop the critics focusing on the Crimean debacle. Yet the embarrassed government dithered and the army refused to allow investigations. So Nightingale published her Notes on Matters affecting the Health and Efficiency and Hospital Administration of the British Army and pushed her political contacts for a Royal Commission. Finally in 1857 the government had no choice.

Scottish Dr John Sutherland visited Crimea in 1855 at the request of Palmerston, heading up the Sanity Commission. He was later appointed to a series of posts that gave him responsibility for military hospitals in Britain and India, and became Florence’s closest ally.

Florence Nightgale recovering from Crimea-guilt and from disease

Nightingale had all her hospital notes from Crimea, but she didn’t know how to analyse them. So her first task was to have the government statistician, William Farr, teach her professional statistics. Nightingale quickly learned how to use graphs, charts and tables, based on her hospital notes. She was thus an innovator in the collection, tabulation, interpretation and graphical display of descriptive statistics. Florence became the first woman elected to Fellow of the Statistical Society in 1860.

Soon the data clarified what had happened i.e terrible hygiene at Scutari in 1854-5 had killed more men than any battle! After a mental break down Florence took to bed, where she remained for the rest of her life. She never again made a public appearance, attended a public function or issued a public statement. But it didn’t stop her from working. A new, finer Florence was born from Crimea-guilt, and the campaigns she ran from her sick bed were critical in the development of good public health. The evidence she gave to the 1857 Sanitary Commission, resulted in the formation of the Army Medical College.

Nightingale's scientific analysis of the Crimean data, 1856

After 1858 Florence was recognised as the leading expert on military and civilian sanitation in India. Newly assigned viceroys to India visited her home for briefings, before travelling. Nightingale published two reforming books in 1859, Notes on Hospital and Notes on Nursing. They were very popular, and were expanded in 1860-1 with a special section on infant care. This was civilian health care!

With the support of wealthy friends and after publicity from The London Times, Florence raised £59,000 to improve the quality of nursing. In 1860 she used this money to found the Nightingale Training School and Home for Nurses at St Thomas' Hospital, supervised from her London flat. The first students began in June 1860 and the school, the first professional training school for nurses, went on to be a success!

Once trained, her nurses were sent to staff hospitals in Britain and abroad, and to establish nurse training schools on the Nightingale model. In 1860 her best known work, Notes on Nursing, was republished. Her principles of nursing: careful observation and sensitivity to the patient's needs, were translated into 11 foreign languages.

But good nurses needed good hospital buildings and she, of course, had clear ideas on how hospitals should be designed. In the late 1850s she published a number of articles on the Sites and Construction of Hospitals and in the 1860s advised on specific building projects. She had a major influence on the subsequent design of both civil and military hospitals. This was amazing. For someone who had had almost zero nursing training, little experience running a ward and an utterly disastrous experience in Crimea, Nightingale was now building success on success. She had become so famous that by the time the Royal Hampshire County Hospital was built early 1860s, the architects felt obliged to consult Florence on the building’s design.

Florence Nightingale and her graduating nurses at Claydon House.

Her ultimate goal was to revise all public health care in the UK. Nightingale was clearly not a modest woman, nor a woman easily fazed by seriously huge tasks. In 1864-7, and still bed ridden, she worked on setting up home nursing system, and designing an obstetric hospital, barracks for married soldiers and hospitals for the insane & poor. Importantly she helped to stop the practice of putting all sick and poor people together: men, women, children, insane and sane.

Rural hygiene was a concern, so Florence also became involved in the development of community nursing in Liverpool. This led to the wide spread establishment of both the District Nursing Service and the Health Visitors. Many Nightingale-trained nurses became pioneers in these fields.

Deaths in childbirth were continuing. So a training school for midwives was founded at King's College Hospital London in 1861. By having small birthing wards and clean conditions, deaths from puerperal fever dramatically dropped in her facilities. She published the results in Notes on Lying-In Hospitals, 1871.

That project on maternal health care appeared to be the end of her active career which had spanned only 20 yrs: from Kaiserwerth 1851 to utter failure in Scutari to hospital designs and nursing training 1871 when she was 51, but what an action-packed 20 years that had been. Her reforms, which WERE profound, came after the Crimea debacle. They struck at the roots of public health, dealing with hospitals, care of soldiers, infant care & psychiatric centres, culminating in the founding of District Nursing. And her writings analysing health care all remain. She wrote on Indian issues for 40+ years.

Nightingale helped to turn nursing into a respectable profession for capable, middle class, Protestant women. Arguably her training school was one of her greatest contributions to medicine. Although she was sometimes ahead of her time, she was sufficiently part in her culture to have very Victorian views and behaviours.

Battling medical obstinacy would make anyone seek allies, as the primary method of achieving reform, even Florence Nightingale. The trouble was that no-one lived up to her hopes; everyone eventually let her down. Even the cleverest people were not as focused or analytical or committed as she was. Nurses who married, and therefore HAD to leave nursing, were traitors to Nightingale and to the profession. Politicians who took up other issues were unreliable. She must have been a tough person to live with.

The end came in Aug 1910 when she died at 90.

Louis Pasteur, rabbits and sex in Australia

I reread my article on The Divine Sarah Bernhardt in Australia, 1891: sex, theatre and sun, and decided it talked too much about sex romps with young scientists and not enough about the scientific problem at hand. The hard research work for this topic was done by Stephen Dando-Collins whose book is called Pasteur’s Gambit: Louis Pasteur, the Australasian Rabbit Plague and a Ten Million Dollar Prize, published by Vintage Books in 2008.

Prof Louis Pasteur with rabbits, by Holding, 1887

The problem was simple. In 1859 British-born pastoralists had wanted to make Australia more like their homeland, so they released rabbits and partridges into the bush. Anyone who knows the reproductive habits of rabbits will realise that within 20 years, the entire Australian continent was overrun by a rabbit plague. The economies of the eastern colonies were totally threatened. The NSW premier, Sir Henry Parkes, was desperate. So in 1887 he launched an international competition with a huge financial award ($10 million, in today’s money) for any successful scientist.

Professor Louis Pasteur was certain he had the remedy against rabbit plagues and wanted to travel to Australia himself, but he was ill when he read of the competition in a Paris newspaper. So he sent his brilliant nephew Dr Adrien Loir (1862-1941), a handsome young scientist, to represent the family business – the Pasteur Institute.

Dr Adrien Loir, Prof Pasteur's nephew

Dr Loir believed he could knock the rabbit problem off in a very short time, so he only had enough money for six week’s travel and accommodation in Australia. Alas for him, the competition stipulated that the scientists had to test out their cures for a complete year. Fortunately, while Loir was cooling his heels in Melbourne, a job fell into his lap. The major beer makers in Melbourne asked Dr Loir to teach the Pasteur method to the brewers, and paid him very well for his efforts.

Stephen Dando-Collins' book

Eventually Dr Loir was invited to Sydney, to propose Uncle Louis’ solution to Australia’s rabbit problem. The wire manufacturers tried to sabotage the Pasteur entry into the competition, since they hoped to make a fortune building rabbit proof fences around the nation. Plus there were a couple of doctors on the judging panel who actively supported Pasteur’s old critic and rival, Professor Robert Koch. Only the premier, Sir Henry Parkes, wanted to help Team Pasteur, spending a small fortune to erect a laboratory for them on Rodd Island, in Sydney Harbour.

The Rodd Island laboratory had another, almost incidental success. Dr Loir offered an impressive anthrax vaccine trial to the NSW Colonial government. When this was successful at greatly reducing anthrax, Dr Loir produced the vaccine in commercial amounts in the Rodd Island facility.

The Rabbit Commission didn’t give a prize to anyone in the end, but Dr Loir really wanted to stay in Australia and continue his work here. You will have to read the Dando-Collins book to see why the Rodd Island facilities, so hugely successful, eventually failed. In brief, we can say that the eventual Madame Loir hated living on the island and went back to France. Dr Adrien Loir bitterly resented his wife’s sabotage of his important work, and although he dutifully followed her back to France, in time he ran off with the maid and lived an exotic life in Africa and South America.

Rodd Island, Sydney Harbour

Beautiful Rodd Island was used from 1888-90 as a laboratory by scientists working for the Pasteur Institute on the rabbit infestation problem. From 1890-94 its facilities were used to manufacture sheep and cattle vaccines for anthrax and pleuro-pneumonia. After 1894, the laboratories were demolished and the research station residence was converted into a dance hall, which still exists. Over the past 120 years it has been a quarantine station, a USA Army training depot and a pleasure-ground for the ordinary working families of Balmain and Rozelle. The island is now part of the Sydney Harbour National Park and visitors can enjoy an interesting exhibition of photos and memorabilia within the grounds. Dr Loir's house was restored and opened to the public in 1996.

Dr Adrien Loir's two volumes of scrap-books, left by his daughter Dr Marie-Louise Hemphill, are in the Basser Library in the Australian Academy of Science, Canberra. They concerned his two visits to Australia: one in 1888-9 and the second in 1890-3. There are two other volumes of the same kind (not in the Basser Library) which apparently covered Dr Loir's later visits to South Africa and South America and his period as Director of the Pasteur Institute in Tunisia. In all these travels he was acting as the representative of Louis Pasteur, in relation to the development of protective inoculation against anthrax, rabies and other diseases.

Red Cross, Red Crescent, Red Star of David

The founder of Red Cross, Henry Dunant, was a Swiss citizen who had accidentally found himself in Italy at a time when French and Austrian victims from the Battle of Solferino (in 1859) were lying around uncared for.  He quickly organised the women of the town to provide medical and transport assistance to the wounded. Dunant himself built temporary hospitals and arranged for decent medical supplies to be brought in.

Very soon after, Dunant wrote A Memory of Solferino and had it published in 1862. Its effect was quite a surprise in that many Europeans were interested. He described the carnage he had found in Soferino and described the efforts his team of volunteers had made, trying to help the wounded. Would it be possible to get an agreement between governments to give medical attention to the injured, wherever they fell (in battle or from natural disasters)?

The answer was a resounding yes! The International Committee of the Red Cross is a humanitarian institution that was formally founded in 1863 in Geneva. The International Red Cross and Red Crescent Museum in Geneva holds the original document of that first Geneva Convention:

Agreements reached at the first Conference, 1863.

Somehow, at that moment in time, all the nations of the world agreed to give the Red Cross authority under international humanitarian law to protect the victims of all wars! I cannot imagine the nations of the world ever agreeing to an organisation with international rights again.

In order to not force their Islamic citizens to be carried in ambulances with Christian symbols on the side, Ottoman officials in 1876 requested that a red crescent be used to mark their ambulances and that the Christian cross would be removed. Thus the red crescent emblem was first used on Islamic ambulances during the war between the Ottoman Turks and Russia (1877–8). It took a while before the crescent symbol was accepted by the Red Cross Society, but it was formally adopted in 1929, and so far 33 Islamic states have taken it up.

British women driving ambulances in France, World War I.

“National” Red Cross and Red Crescent societies have always concentrated on natural disasters within their own borders. The “International” Committee of the Red Cross and Red Crescent Society, on the other hand, tended to concentrate on situations of warfare across borders. The International Federation of Red Cross and Red Crescent Societies was founded in 1919 and still coordinates activities between the all the individual national societies. The Federation Secretariat is well located in neutral, central Geneva.

Ambulance and nurses, Palestine, 1940s

Jewish patients were probably not prepared to travel in ambulances marked with Christian crosses either, but they had a bigger problem than mere symbolism. There was a concern that the Jewish Legion of Palestine, a Battalion of the British Army who were fighting to liberate Israel from Turkish rule during WWI, needed medical help. A Jewish ambulance service, called Magen David Adom/Red Star of David, was organised to aid both the Jewish Legion and the ordinary citizens. It was disbanded at the end of WW1.

Magen David Adom (MDA) was not officially chartered until the vicious riots of 1929 against the Jewish citizens who had no access to professional first aid services. While still under the British Mandate, the organisation was founded in Tel Aviv in June 1930 under the care of nurse Karen Tenenbaum, seven Israeli doctors, one hut and one ambulance. They added a branch in Haifa (1931) and in Jerusalem (1934), then a nation-wide network of services was slowly introduced for Jews, Muslims and Christians, reaching a total of 600 ambulances.

During World War Two, only two MDA services were recognised by the British Authorities. It wasn’t until after the state was established that the new parliament passed a law, giving MDA the formal title of Israel's National Emergency Service. From July 1950, Magen David Adom provided services in Israel regarding:

1. emergency medical care,
2. disaster care,
3. ambulances and
4. blood bank service.
5. a tracing service, to locate the children and grandchildren of families lost in the Holocaust.

MDA currently funds c1,200 emergency medical technicians, paramedics and emergency physicians. But in Israel (as in other nations?), Magen David Adom is mainly staffed by volunteers; 10,000+ of them. Today all volunteers complete  a 60-hour course that covers a wide range of topics ranging from common medical conditions and trauma situations... to mass casualty events. Those who pass the course are then sent out across the country and work with local volunteers in ambulances.

MDA headquarters and its blood bank are located at the Tel Hashomer hospital, a place I know very well since I lived there back in 1971 and 1972. The organisation operates 95 stations over the country, with a fleet of over 700 ambulances nationwide. Air ambulance service is provided by Israeli Air Force 669 unit with MEDEVAC helicopters.

Carrying wounded civilians in the 1948 war (Life)

Naturally Magen David Adom applied for membership in the International Red Cross and Red Crescent Movement, as soon as it was founded and fully operational. But it was too late. The "Red Star of David" symbol was not submitted to the ICRC until 1931 and membership for new organisations and symbols was closed at the 1929 conference. The conference decided that if they allowed the Jews to have a red star, instead of a cross or crescent, the Buddhists would want a symbol of their own, the Hindus might request something different etc etc. The Soviet Union avoided the problem by accepting the Red Cross as their official emblem, in order to gain entry.

Every attempt in the decades since 1931 to have Magen David Adom included in the International Red Cross and Red Crescent Movement failed. Until the American Red Cross became involved. The Americans stated that unless Jews, Christians and Muslims could all use their own symbol for their own citizens, they would withhold all administrative funding from the international organisation. From May 2000, the Americans did indeed withhold millions of dollars.... until the Federation of Red Cross and Red Crescent Societies caved in. In June 2006, MDA was recognised by the ICRC and admitted as a full member of the International Federation of Red Cross and Red Crescent societies. It had taken from 1931 to 2006, 75 long long years.

Middle East Affairs Information Centre has a wonderful MDA poster from 1918 and a photo of the first modern ambulance being launched in 1931.

19th 20th Century History Images has a fine photo of Red Cross women running an ambulance service in 1928.

Genetic Health Courts in Germany 1933-9

The science of eugenics in the early 20th century was based on a simple principle: If the most disabled citizens in society were not prevented from reproducing their genetic flaws in the next generation, society as a whole would be heavily burdened. This might sound bizarre to modern ears, but in societies where “national health” was allowed to take total precedence over “individual health”, it seemed perfectly acceptable.

A eugenic utopia in the Inter-War period was thought of as providing a very healthy environment for society, maximising the possibility of desirable genetic qualities and minimising the possibility of undesirable genetic qualities. If a eugenically sound society could be achieved, improvement of the social environment would be both inevitable and admirable. And the society would save a fortune in health care costs, at least for those people who needed to be cared for in asylums.

Such a utopia was desired in more than one country. I'll cite just two examples. By the 1930s, more than half the states in the USA had passed laws that authorised the sterilisation of "inmates of mental institutions, persons convicted more than one of sex crimes, those doomed to be feeble-minded by 10 tests, morally degenerate persons and epileptics." Sweden also had eugenics-based legislation enacted in 1934, primarily to prevent mental illness and disease in the general community. It is estimated that c60,000 Swedes were sterilised under the 1934 law, before the law was eventually overturned well after WW2.

But it was German race hygiene that had a more radical vision of a eugenic utopia than other countries, largely because the pre-1933 political climate in Germany was already hospitable to such ideas. Dr Franzblau noted that even before Hitler came to power, there were 23 chairs of racial hygiene in German Universities.
*
The assumption of power by the Nazis in 1933 made the implementation of eugenic legislation even better accepted. The new German legislation said: “Any person suffering from a hereditary disease may be rendered incapable of procreation by means of surgical sterilisation, if the experience of medical science shows that it is highly probable that his descendants would suffer from some serious physical or mental hereditary defect”.

The poster asked: Who would want to be responsible for these three handicapped children?

At no stage was the German policy anti-natal. The Nazi government paid for top quality research, designed and delivered public education campaigns, and introduced laws that aimed at eliminating alcohol, tobacco and syphilis from young couples. A vast public health scheme was developed and clinics were created to deal with the problems of child and maternal health. Abortion was banned. Getting married and having children wasn't just tolerated; it became a national duty for the racially fit.

More than that, it was emphasised that sterilisation should be seen as national liberation, not as an individual punishment. Advertising campaigns stressed that responsible young couples would naturally want to avoid bringing damaged babies into the world who would cost the state a fortune to sustain.

The German law clearly applied to each and every individual in the entire German population, presumably including members of the Nazi Party and the Hitler Youth! Thus its scope was much larger than the compulsory American sterilisation laws, which were most often applied only to inmates in psychiatric hospitals or prisons. And German practice differed from Swedish practice where, under Swedish law, no sterilisation would be carried out without the consent of the patient, or his/her parents.

There was another important difference. In Germany every undergraduate medical student was taught from films of feeble-minded, drooling and crippled children, and shown many films of sterilisation procedures. This was to familiarise them and involve them in the process, even before their medical careers started. In the USA and Sweden, only specialist practitioners were involved in the decision-making and in the surgical procedures.

Child candidates for compulsory sterilisation, waiting for the court's decision, 1934

A Law for the Prevention of Genetically Diseased Offspring via sterilisation became a German statute in July 1933. It demanded the compulsory sterilisation of any citizen who, in the opinion of a court, suffered from a list of specific disorders: congenital mental deficiency, schizophrenia, manic-depression, hereditary blindness or deafness, severe alcoholism, Huntington’s Chorea or hereditary physical deformities including epilepsy.

As the numbers of potential candidates for sterilisation grew and grew, it was feared that the ordinary court system would be clogged up with sterilisation cases. So a separate, dedicated court was established, to hurry cases through without the hassles of needing a qualified judge, trained lawyers and properly empanelled juries. Instead 200 Genetic Health Courts were established across Germany, with doctors inspecting the medical evidence and giving the final verdict. In total, these Genetic Health Courts ordered the compulsory sterilisation of just under 400,000 German children, teenagers and adults by the time war broke out in late 1939.

If the court decided that the person in question was to be sterilised, the decision could be appealed to a Higher Genetic Health Court where doctors and not judges also made all legally binding decisions. If the appeal failed, the sterilisation was to be carried out, with "the use of force being permissible".

One later amendment (1935) was very telling; it fined physicians who did not report patients who the doctors KNEW would qualify for sterilisation under the law. Teachers and kindergarten staff were encouraged to report their pupils for sterilisation, but were not fined if they failed to do so.

The UK tv series on Nazi Doctors (Oct 2009) reported three main outcomes, albeit unintended, that blighted The Genetic Health Courts programme:

1. The post-operative mortality and morbidity rates were higher than expected and were largely not reported. Bachrach recorded that as many as 5,000 patients died as a result of the surgery, most of them women.

2. The post-operative damage to the patients’ psychological health was much greater. This was true for all patients, of course. It was even more so for otherwise perfectly healthy people who would have loved to have had children, but were sterilised for a trivial reason eg distorted toes. Recently I saw the evidence given by elderly men and women who, sterilised in the 1930s, had been grief stricken all their lives.

3. The reputation of doctors was accidentally destroyed. They changed from being seen as healers to being seen as policemen, judges and punishment-inflicters. Families no longer trusted their own doctors, if and when their children became ill with ordinary childhood diseases.

I personally would add another important outcome. Even within the moral context of the 1930s science of eugenics, terrible decisions were made by the Genetic Health Courts. Either knowledge of genetics was not yet adequate, or it was adequate but political policy-makers overrode the medical decisions. Many people were forcibly sterilised for conditions that we (now) know are not genetically based. And as the programme didn’t continue for enough decades, I also wonder if the geneticists had any idea about how recessive genes could skip generations.

Read Susan Bachrach “In the Name of Public Health: Nazi Racial Hygiene”, in New England Journal of Medicine, 29th July 2004. And see Science and the Swastika 2001,  an analysis of science and morality during the Third Reich, especially (for the purpose of this post) the practice of eugenics and euthanasia.

The Great Silence, 1918-20

I came across the book called The Great Silence, written by Juliet Nicholson and reviewed in An Edwardian State of Mind. Nicolson’s title invoked the introduction of the two-minute silence on the very first anniversary of Armistice Day, a constant reminder in British Empire countries of the appalling sacrifices made by the war dead.

The years 1918 to 1920 were chosen by the author since this was the time between a] the last of the Great War battles in November 1918 and b] the internment of the unknown soldier in Westminster Abbey in November 1920. She avoided the historians’ techniques of analysing military and political narratives, and concentrated instead on the suffering of individual families.

My own grandfather was a soldier in WW1 who, although he returned to his family, had a bullet lodged in his kidney; he was in and out of hospital for the rest of his life. I know about family records, oral histories, photos, letters, diaries and financial crises!

Nicolson began with the armistice celebrations on 11th of November 1918. On one hand there was a huge national party, full of music, hugging men in uniform and eating whatever food could be placed on the trestle tables. On the other hand, the day was the start of a national agony for millions of ordinary citizens in Britain and the British Empire (and, I suppose, in the other countries who lost so many young men).

As Feminist Review noted, hostilities would fester for a lifetime for those who would never see their husbands, sons or fathers again. Even for those soldiers who returned home alive, the armistice offered little consolation to those who were marked by war forever, with their missing legs and their scared faces.

Some people tried very hard to avoid the ex-soldiers who clearly displayed the misery of war. We know, for example, some soldiers were so severely mutilated that passengers got out of their train seats and moved to other carriages. But it was everywhere - those physically damaged by the fighting could not be locked away in asylums or prisons. 

Some evidence in the book was very practical. I was particularly inspired by a heroic New Zealand plastic surgeon, Dr Harold Gillies, a man who had worked in France during the war with the Red Cross. With a team of artists and sculptors back in Britain, he developed many techniques of plastic surgery on 5,000+ soldiers with facial injuries. Gillies slowly and carefully rebuilt the human wrecks he met in his Queen Mary’s hospital, and gave them new lives.

Why were facial injuries so common and so awful? Apparently the government’s compensation scheme for lost limbs did not extend to anything above the neck; they didn’t acknowledge the paralysing emotional affects of facial disfigurement. Nor did they take account of men who had lost the ability to speak, swallow, see or even breathe normally through their facial injuries.

But in the end, it was not the practical responses that made the book special. It was the fact that Nicolson captured a grief that most ordinary citizens were unable to articulate in those early post-war years. The silence in the title, therefore, may refer not only to the official two minutes when people stood at attention and hung their heads in memory.

There was one major criticism that appeared in some of the reviews. Miranda Seymour noted that the author is the granddaughter of Vita Sackville-West, an aristocrat brought up in one of the grandest houses in England. This by itself is a good thing, but if many of Nicolson’s sources derived from her rather exclusive aristocratic world, the men from ordinary homes might have been covered with less energy than they deserved.

Limbless soldiers at London’s Roehampton Hospital
Photo published in NY Times, 15th July 2010

Perhaps in the end, nothing could make up for the wasted young lives, lost or maimed. As The Idle Historian so rightly noted: While the end of the war was framed by politicians as a great victory and final vindication of the just cause, ordinary families across the Empire were still filled with shock, disbelief and anger at the years of hardship and the slaughter in the trenches. And in the end, the War To End All Wars ... wasn't.