The impact of the first World War on hospitals and the medical profession in Ireland threw up challenges that, 100 years later, have contemporary echoes.
There were insufficient beds, a consequent urgent need for investment and, after it came, salary inflation among staff that all but wiped out the benefit of the additional funds that had been coming into the system.
Snapshots of the impact of the war on medicine in Ireland were given recently in Dublin, at the St Luke’s Symposium, which was hosted by the Royal College of Physicians of Ireland (RCPI). One, from Dr David Durnin of the Centre for the History of Medicine in Ireland, illustrated the problems that arose when the British army’s Royal Army Medical Corps (RAMC) decided that sick and wounded people would be brought home by hospital ships for longer-term care.
As a result, some 20,000 soldiers, primarily from Ireland in the first place, were transported home and distributed between several military hospitals in Dublin, Cork and Belfast. They were housed also in wards in civilian hospitals that were appreciative of the funding that came with them from the authorities in Britain.
“Ireland’s military hospitals were inadequately prepared to cope with the demands of war,” Durnin told the symposium. “Consequently, the RAMC authorised a complete overhaul of Ireland’s military hospitals. In addition, the RAMC reached an agreement with more than 40 civilian hospitals in Belfast, Cork and Dublin to provide accommodation and medical treatment for soldiers.”
Some 3,300 Irish doctors and medical students were involved in the war, of whom 243 died, explained another contributor, retired surgeon Joe Duignan. Many have no known graves.
First contingent
The first contingent of war wounded arrived in Cork, in October 1914 when the war was three months old, brought there by the hospital ship Oxfordshire.
Soon after, however, Dublin became, and remained, the main port of entry, drawn there partly by the opening in 1914 of the King George V Military Hospital at Arbour Hill, known now as St Bricin’s Hospital and run by the Defence Forces.
The King George had 102 beds but pressing needs saw a rapid expansion with provision for 300 more. “The remaining hospital accommodation for soldiers was primarily provided by civilian hospitals,” said Durnin. “This had a significant impact on the Irish civilian hospital system.”
These hospitals, relying mostly on State aid, charitable donations and bequests to pay their way, treated people free of charge but, in the early decades of the 20th century, their finances were precarious.
By the end of August 1914, the RAMC had contacted each one throughout the island asking could they take sick and wounded soldiers and, if so, how many beds would be available. Patient beds were financed through a subvention from the War Office and, after the war and into the 1920s, the Ministry of Pensions.
“The hospitals’ acceptance of returning soldiers prompted an immediate rise in income from donations from philanthropic groups,” said Durnin.
“Due to the considerable financial support from the British Red Cross and several prominent individual contributors, Dublin’s civilian hospitals experienced a revival in income during the first World War.
“Yet, this is not to say that the financial state of Ireland’s civilian hospitals improved during the first World War. On the contrary, while the admission of soldiers into the wards brought a significant rise in income, ultimately most hospitals suffered due to the rising costs associated with the conflict.”
The war and the consequential surge in hospital demand for food, light, heat, dressings, bandages, and medical staff led to rocketing overhead costs, part of the wider surge in inflation sparked by the war.
Impact on medicine
The conduct of the war had a profound impact on medicine, as was explained by Prof John Horne of Trinity College Dublin, who opened the symposium. That impact was felt in the fields of surgery, psychiatry and public health but also in the moral dilemmas underscored by the unprecedented scale of the conflict.
While battling to save lives and do the best for their patients, doctors and nurses “also helped keep the whole business going”, he suggested. “Their job was to cure the physically and psychically wounded so that they could return to battle or to a useful function on the home front,” he said.
The unprecedented carnage on the battlefield was caused by machine guns capable of firing 600 bullets a minute (as opposed to 15 by a rifle) and, above all, by high explosive artillery shells of different calibres, fired from well behind the front, which showered soldiers with lethal shrapnel.
Both of these were relatively recent inventions and both created casualties on an industrial scale. But medicine rose to the challenge, primarily through advances in surgery, and in the techniques and speed of medical interventions.
“Modern accident and emergency procedures owe everything to the systems of selection and intervention pioneered in battlefield surgery at the start of the Great War – including the term triage,” said Horne.
Lives were saved by battlefield surgery, including the guillotine-method amputations, the advent of blood transfusions and improved antiseptics.
The invention of the Thomas splint frame saw a reduction in femur fracture fatalities from 80 per cent to 15 per cent, Duignan noted. Huge advances were also made in skin grafting and in facial reconstructive surgery.
“One consequence of Great War surgery was the presence of disabled men in post-war society who, in earlier wars, would not have survived and who demanded aid and acceptance by right, not charity,” said Horne.
Both Horne and another speaker, Prof Brendan Kelly of UCD, drew attention to how battle trauma – “breakdown on a scale never seen before” as Horne noted – was dismissed initially as cowardice, sometimes with fatal consequences for sufferers, but came to be defined as “shell shock” and led to early understanding of post traumatic stress disorder.
Advances in epidemiology
The need to control diseases among mass numbers of troops, often living for long periods in deeply unsanitary conditions, led to advances in epidemiology. Soldiers in more advanced armies, Prof Horne said, were vaccinated en masse against tetanus and typhoid, and also protected against malaria.
Soldiers in other armies, notably those of Russia and the Ottoman Empire (Turkey), were, by contrast, ravaged by sicknesses. Thus, the war showed that mass inoculation could keep armies functioning longer under hostile conditions.
But, as Horne noted, many medics were “appalled by the contradiction between their professional purpose, which was to save life and restore health, and the destructive forces against which they battled, yet which arose from the same scientific and technical ‘progress’ that they associated with medicine”.
To coincide with the symposium, the RCPI published Healing Touch, an illustrated history of the college, from its foundation in 1654. Written by Alf McGreary, with illustrations edited by designer Wendy Dunbar, it is available from the college.
