The Shock of War | History | Smithsonian
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Most of the 9.7 million soldiers who perished in WWI were killed by the conflict's unprecedented firepower. Many survivors experienced acute trauma. (Hulton Archive / Getty Images)

The Shock of War

World War I troops were the first to be diagnosed with shell shock, an injury – by any name – still wreaking havoc

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In September 1914, at the very outset of the great war, a dreadful rumor arose. It was said that at the Battle of the Marne, east of Paris, soldiers on the front line had been discovered standing at their posts in all the dutiful military postures—but not alive. “Every normal attitude of life was imitated by these dead men,” according to the patriotic serial The Times History of the War, published in 1916. “The illusion was so complete that often the living would speak to the dead before they realized the true state of affairs.” “Asphyxia,” caused by the powerful new high-explosive shells, was the cause for the phenomenon—or so it was claimed. That such an outlandish story could gain credence was not surprising: notwithstanding the massive cannon fire of previous ages, and even automatic weaponry unveiled in the American Civil War, nothing like this thunderous new artillery firepower had been seen before. A battery of mobile 75mm field guns, the pride of the French Army, could, for example, sweep ten acres of terrain, 435 yards deep, in less than 50 seconds; 432,000 shells had been fired in a five-day period of the September engagement on the Marne. The rumor emanating from there reflected the instinctive dread aroused by such monstrous innovation. Surely—it only made sense—such a machine must cause dark, invisible forces to pass through the air and destroy men’s brains.

Shrapnel from mortars, grenades and, above all, artillery projectile bombs, or shells, would account for an estimated 60 percent of the 9.7 million military fatalities of World War I. And, eerily mirroring the mythic premonition of the Marne, it was soon observed that many soldiers arriving at the casualty clearing stations who had been exposed to exploding shells, although clearly damaged, bore no visible wounds. Rather, they appeared to be suffering from a remarkable state of shock caused by blast force. This new type of injury, a British medical report concluded, appeared to be “the result of the actual explosion itself, and not merely of the missiles set in motion by it.” In other words, it appeared that some dark, invisible force had in fact passed through the air and was inflicting novel and peculiar damage to men’s brains.

“Shell shock,” the term that would come to define the phenomenon, first appeared in the British medical journal The Lancet in February 1915, only six months after the commencement of the war. In a landmark article, Capt. Charles Myers of the Royal Army Medical Corps noted “the remarkably close similarity” of symptoms in three soldiers who had each been exposed to exploding shells: Case 1 had endured six or seven shells exploding around him; Case 2 had been buried under earth for 18 hours after a shell collapsed his trench; Case 3 had been blown off a pile of bricks 15 feet high. All three men exhibited symptoms of “reduced visual fields,” loss of smell and taste, and some loss of memory. “Comment on these cases seems superfluous,” Myers concluded, after documenting in detail the symptoms of each. “They appear to constitute a definite class among others arising from the effects of shell-shock.”

Early medical opinion took the common-sense view that the damage was “commotional,” or related to the severe concussive motion of the shaken brain in the soldier’s skull. Shell shock, then, was initially deemed to be a physical injury, and the shellshocked soldier was thus entitled to a distinguishing “wound stripe” for his uniform, and to possible discharge and a war pension. But by 1916, military and medical authorities were convinced that many soldiers exhibiting the characteristic symptoms—trembling “rather like a jelly shaking”; headache; tinnitus, or ringing in the ear; dizziness; poor concentration; confusion; loss of memory; and disorders of sleep—had been nowhere near exploding shells. Rather, their condition was one of “neurasthenia,” or weakness of the nerves—in laymen’s terms, a nervous breakdown precipitated by the dreadful stress of war.

Organic injury from blast force? Or neurasthenia, a psychiatric disorder inflicted by the terrors of modern warfare? Unhappily, the single term “shell shock” encompassed both conditions. Yet it was a nervous age, the early 20th century, for the still-recent assault of industrial technology upon age-old sensibilities had given rise to a variety of nervous afflictions. As the war dragged on, medical opinion increasingly came to reflect recent advances in psychiatry, and the majority of shell shock cases were perceived as emotional collapse in the face of the unprecedented and hardly imaginable horrors of trench warfare. There was a convenient practical outcome to this assessment; if the disorder was nervous and not physical, the shellshocked soldier did not warrant a wound stripe, and if unwounded, could be returned to the front.

The experience of being exposed to blast force, or being “blown-up,” in the phrase of the time, is evoked powerfully and often in the medical case notes, memoirs and letters of this era. “There was a sound like the roar of an express train, coming nearer at tremendous speed with a loud singing, wailing noise,” recalled a young American Red Cross volunteer in 1916, describing an incoming artillery round. “It kept coming and coming and I wondered when it would ever burst. Then when it seemed right on top of us, it did, with a shattering crash that made the earth tremble. It was terrible. The concussion felt like a blow in the face, the stomach and all over; it was like being struck unexpectedly by a huge wave in the ocean.” Exploding at a distant 200 yards, the shell had gouged a hole in the earth “as big as a small room.”

By 1917, medical officers were instructed to avoid the term “shell shock,” and to designate probable cases as “Not Yet Diagnosed (Nervous).” Processed to a psychiatric unit, the soldier was assessed by a specialist as either “shell shock (wound)” or “shell shock (sick),” the latter diagnosis being given if the soldier had not been close to an explosion. Transferred to a treatment center in Britain or France, the invalided soldier was placed under the care of neurology specialists and recuperated until discharged or returned to the front. Officers might enjoy a final period of convalescence before being disgorged back into the maw of the war or the working world, gaining strength at some smaller, often privately funded treatment center—some quiet, remote place such as Lennel House, in Coldstream, in the Scottish Borders country.

The Lennel Auxiliary Hospital, a private convalescent home for officers, was a country estate owned by Maj. Walter and Lady Clementine Waring that had been transformed, as had many private homes throughout Britain, into a treatment center. The estate included the country house, several farms, and woodlands; before the war, Lennel was celebrated for having the finest Italianate gardens in Britain. Lennel House is of interest today, however, not for its gardens, but because it preserved a small cache of medical case notes pertaining to shell shock from the First World War. By a savage twist of fate, an estimated 60 percent of British military records from World War I were destroyed in the Blitz of World War II. Similarly, 80 percent of U.S. Army service records from 1912 to 1960 were lost in a fire at the National Personnel Records Office in St. Louis, Missouri, in 1973. Thus, although shell shock was to be the signature injury of the opening war of the modern age, and although its vexed diagnostic status has ramifications for casualties of Iraq and Afghanistan today, relatively little personal medical data from the time of the Great War survives. The files of the Lennel Auxiliary Hospital, however, now housed in the National Archives of Scotland, had been safeguarded amid other household clutter in the decades after the two world wars in a metal box in the Lennel House basement.

In 1901, Maj. Walter Waring, a distinguished officer and veteran of the Boer War and a Liberal MP, had married Lady Susan Elizabeth Clementine Hay and brought her to Lennel House. The major was in uniform for most of the war, on duty in France, Salonika and Morocco, and it was therefore Lady Clementine who had overseen the transformation of Lennel House into a convalescent home for neurasthenic soldiers. The daughter of the 10th Marquess of Tweeddale, “Clemmie,” as she was known to her friends, was 35 years old in 1914. She is fondly recalled by her grandson Sir Ilay Campbell of Succoth and his wife, Lady Campbell, who live in Argyll, as “a presence” and great fun to be with—jolly and amusing and charming. A catalog of Lady Clementine’s correspondence, in Scotland’s National Archives, gives eloquent evidence of her charm, referencing an impressive number of letters from hopeful suitors, usually young captains, “concerning their relationship and possible engagement.”

Generally arriving at Lennel from treatment centers in London and Edinburgh, convalescing officers were received as country house guests. A handsome oak staircase dominated Lennel’s entry hall and led under an ornate glass dome to the upper floor, where each officer found his own pleasant bedroom, with windows opening onto the garden or with views of the woodlands and the Cheviot Hills beyond; there appear to have been only about a dozen residents at any one time. Downstairs, the private study of Major Waring had been appropriated during his absence to the war as an officers’ mess, while his paneled library was available to the bookish: Siegfried Sassoon, who was to emerge as one of the outstanding poet chroniclers of the war, found here “a handsome octavo edition” of a Thomas Hardy novel, and spent a rainy day carefully trimming its badly cut pages. Meals were presided over by the officers’ hostess, the beautiful, diminutive Lady Clementine.

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