Abstract
The popular ‘Happy – though Wounded’ image of First World War military patients is brought into question in Ana Carden-Coyne’s latest book on The Politics of Wounds: Military Patients and Medical Power in the First World War. While the author’s previous work Reconstructing the Body (2009) explored how the classical body was revisited in the aftermath of the First World War in an attempt to try and overcome the physical and psychological trauma, her new study returns to the origins of body-related interwar anxiety: the wounds themselves. This topic has been an increasingly popular object of historical enquiry since the turn of the century, and even more so with the centenary of the Great War, but Carden-Coyne’s richly illustrated book makes an original contribution to the cultural history of the period.
Drawing upon a wealth of primary sources, from personal diaries to reports, from canonical poems to photographs and sketches published in hospital gazettes, the author explores the medical, economic and social aspects of the experience of wounds and treatment, but she also convincingly demonstrates their political implications at a time when individual welfare and national victory were intimately connected. In this ambitious study, Carden-Coyne revisits the official history of wartime medicine and invites her readers to follow the journey on which the wounded from Britain and the British Empire embarked: from the moment of their injury on the battlefield all the way to hospitals and convalescent homes. This wider geographical scope and the length of her book enable the author to take further the study of British military patients and medical services than that found, for example, in Jeffrey Reznick’s Healing the Nation (2005). Carden-Coyne ambitiously sets out to capture the personal, intimate experience of wounds as well as their collective significance, thereby highlighting the sometimes contradictory impulses at play in an often civilian-staffed military medicine caring for a largely volunteer army.
The structure adopted follows the wounded on their journey, starting from the battlefield where the stretcher-bearers faced difficult decisions as to which men to take first. The first chapter considers logistical issues related to triage and transport on different fronts, as well as the ethical dilemmas arising from the seriousness of the injuries and the number of casualties. Carefully selected entries from diaries written by patients and medical officers – the latter sometimes in their turn becoming patients – offer a personal counterpoint to descriptions of the ‘medical assembly line’ and the ‘bureaucratization of the soldier’s body’ (73). Carden-Coyne shows that despite efforts to rationalize triage, early treatment and transport, the degree of pain and indeed the survival of the wounded varied greatly. This situation was influenced by many different factors such as the time of day, the casualty clearing station to which he was taken, the number of other casualties or the Medical Officer’s (MO’s) experience. MOs, often civilians themselves, had a power of decision over their patients, but Carden-Coyne shows how powerless they often felt, unable to save all and having to decide which cases to prioritize, while knowing that the men they strove to save would later be returned to the front. The problem of transport discussed in this chapter exemplifies the tension between the discourse found in the official propaganda and the actual experience of the wounded: despite the pain that this might cause to the patients, the emphasis was put on speeding up the transport in order to reassure the general public.
The second section, entitled ‘Surgical Wars: Wounds, Experiments, and Ethics’, importantly raises the question of ethics in wartime, in particular with regard to medical experimentation, pain and the patients’ voices, thereby emphasizing the ongoing debates taking place during the war, and which official postwar history often overlooked. These debates, Carden-Coyne contends, reveal the experimental nature of war surgery as well as the difficult question of the ethics of military surgery. The question of accountability of military medicine towards the public addressed in this chapter is central throughout the book, not least due to the civilian-dominated military medical world and to the greater availability of information. In this section Carden-Coyne besides revisits one of the key tropes of Reconstructing the Body, namely the tension between traditional and modern attitudes and practices with regard to surgery and prosthetics. The body of the wounded has become, she argues, a locus of experimentation despite efforts towards a standardization of treatment among Allied surgeons, such as the use of the Carrel-Dakin antiseptic method; the debates accompanying these experiments only served to increase the visibility of wounds, which had become ‘public and political’ (128).
The third chapter shifts the focus from the surgeon to the patient, whose point of view and role in the therapeutic process are here thematized. The surgeon, who is described as on occasion using the wounded body for personal gain and fame, can also be sympathetic towards the patients who see themselves as mere ‘guinea pigs’. Through a close examination of anaesthesia and pain relief, as well as other innovative procedures such as blood transfusion and resuscitation, Carden-Coyne emphasizes the uncertainty and mystery surrounding what was happening in the ‘theatre of dreams’. Resorting to public and private accounts, she discusses the issues shaping surgeons’ determination of the best course of action for each patient with limited knowledge of his condition, of the exact cause of his pain and of the time elapsed since his injury. In order to combat the feeling of powerlessness in the hands of the surgeon, patients developed what Carden-Coyne terms an ‘imagined therapeutic authority’, best seen in the images and stories they produced to mock the surgeon and thereby voice their anxiety and regain a form of control over the narrative of their therapeutic journey.
The impact of wounds on masculinity and the expectations of stoicism, also discussed by Julie Anderson (2011), are touched upon in the third section but developed in greater details in the subsequent chapters. In chapters 4 and 5 Carden-Coyne explores relationships between patients, staff, visitors and locals, and she offers a thorough analysis of the negotiations between gender and class in the unique setting of the war hospital. ‘Provocative wounds’ examines the community created in the hospital and the sometimes ambiguous and sexually charged interaction between the different members. In particular, the presence of visitors is discussed and the contact between women at times fulfilling traditional motherly and wifely roles, but also taking control over men. The author convincingly argues that wounds were a source of pain as well as of opportunity, and that behaviours that might be frowned upon in another context, such as promiscuity with female visitors and nurses, could be interpreted as signs of recovery. This chapter compellingly demonstrates the social value of wounds and the blurring of boundaries between the public and the private spheres, and in terms of gender roles they triggered. Carden-Coyne heavily emphasizes the impact of wounds on gender identities and the remasculinization of patients through vocational training and, ultimately, marriage.
The last section, entitled ‘Silent Wounds: Coercion, Brutality, and Resistance in War Hospitals’ stands in stark contrast with the previous chapter, which highlighted the sociality and intimate relationships that were both a result and an alleviating factor of the men’s suffering. This final chapter highlights the coercive dimension of treatment in wartime hospitals, the author showing how the official ‘culture of compulsory cheerfulness’ (280) differed from private accounts. If the ‘happy though wounded’ image was often accepted and reinforced within the wards, resistance and conflict could also be observed, as well as distrust and even defiance towards medical authorities. Gender roles were questioned as their female carers no longer fitted with the conventional description of motherly or wifely functions, but rather were feared. Likewise, relationships among patients were not always harmonious and the author joins Joanna Bourke in noting that encounters between men from different national origins and social backgrounds led masculine identities to be questioned, reinforced and sometimes reinvented. In this thought-provoking final section, Carden-Coyne also explores the sensory world of the war hospital, in particular its noises and silences, and the crucial importance of touch. If the sensory dimension of pain has recently been a focus of scholarly attention (The Birkbeck Pain Project; Bourke, 2014; Moscoso, 2012), this aspect has been little-researched in the field of First World War studies. Carden-Coyne’s work contributes to bridging a gap in our understanding of war combatants’ sensory – sometimes even sensual – experience of war. Although the focus is here on patients being brutalized by masseuses, by nurses and by doctors, the author evokes the medical touch as a source both of pleasure and pain. Through these ambiguous, on occasion disempowering, circumstances patients developed what she calls ‘cultural agency’: through their gazettes and journals they expressed their complaints, their anxieties and their – feigned or real – cheerfulness, while avoiding the discipline and moral judgement that would accompany the expression of such ideas elsewhere.
In this book, Carden-Coyne delivers a carefully crafted study of the intimate, yet very public experience of wounds during the First World War. The Politics of Wounds draws upon existing works, for example, by Julie Anderson (2011), Joanna Bourke (1996, 2014) and Jeffrey Reznick (2005), and unpublished private archives. Some readers may find that casualties from the empire are discussed in less detail. If Carden-Coyne helpfully examines some of the differences – observed or imagined – between British and empire combatants, she also underlines that exchanges were frequent in wartime medical practices. This book is about people’s perspectives, and more specifically the wounded’s point of view. The ‘medical power’ embodied to a certain extent by surgeons and nurses, is shown to be at times insensitive and selfish but also troubled and helpless. The patients themselves appear not as passive victims of their wounds and of their treatment, but as agents in their own recovery.
The author engages with a wealth of sources (which could sometimes have been analysed in more detail) and she delivers an original and timely analysis of an experience shared by millions of servicemen across Britain and the empire. The Politics of Wounds will be of interest to cultural historians as well as medical and military historians, who will find in this study a new insight into the ‘matter’ of the war. Gender studies and social history specialists will also appreciate Carden-Coyne’s demonstrating how different classes, genders and nations were brought together in the war hospital for a brief but intense period, and how the expected and observed reactions differed depending on the patients’ background and origins. The sense of uncertainty felt by the wounded and those who cared for them alike was accompanied by greater demands for public accountability; in this respect this study contributes to our understanding of post-First World War political and social changes. Carden-Coyne, however, manages to avoid generalizations and paints a nuanced portrayal of combatants and doctors that stands out for its careful attention paid to individual journeys as well as larger trends. But one of the greatest achievements of this book is perhaps the insight it gives in the powerful yet elusive sensory dimension of the experience of wounds and treatment; Ana Carden-Coyne’s willingness to engage with this aspect makes The Politics of Wounds an enlightening read for those interested in history but also in the phenomenological enquiry into war and pain.