Notes from a Field Hospital

Two days ago I came across A Surgeon in Belgium at gutenberg.org. It was written by Dr. Henry S. Souttar about his work at a Belgian hospital as the German army invaded in 1914, and evidently published before the end of the war. Its tone is oddly light at times -- e.g. "The wards were full when we arrived, and I had a wonderful opportunity of studying the effects of rifle and shell fire." -- and the descriptions of Antwerp and its history feel out of place. The ugliness and seriousness of the war have clearly not sunk in yet, and he still seems to find a thrill in it. But he is passionate when he describes the burned-out Belgian villages and shelled churches and fleeing peasants -- also when he theorizes about the Teutonic character with predictably unflattering conclusions and predicts the triumph of the British side in the emotional and dogmatic jargon that I already know from the fiction of the time. What interested me most, since I find medicine fascinating, were his medical observations:

- In the Antwerp hospital where he worked, many soldiers arrived whose wounds were infected by the filth of the fields where they had been fighting. But the bacteria to which they were exposed in the countryside were less dangerous than those in the city. The medical staff dressed the wounds fairly lightly and treated them with solutions of oxygen, and in the worst cases wheeled the patients out into the fresh air. Even gangrenous injuries healed satisfactorily, because the oxygen was so effective. And there were no cases of tetanus.

- Among the most problematic injuries were those where bones were severely broken and even blown away. But a new approach that worked reasonably well was to replace the bone with steel plates. Concerns that the screws which fixed the plates to the bones might come loose did not seem justified. [N.B. Opapa had trouble with such a screw, though, I think, and had to have it operated out.]

- Apparently there is no need to extract bullets from a body -- unless they are pinching a nerve or causing other discomfort, and then preferably only when the wound has healed -- because, if any infection exists, it is only exacerbated when the bullets are removed. [I don't understand how bullets can be infectious, since the act of firing presumably makes them hot enough to sterilize them. On the other hand, since they might do damage if they get into the bloodstream, it seems best to me to remove them routinely as soon as the wound has healed.]

- A practice of which the two sides in World War I accused each other was removing the hard nickel tips of bullets to make "dum-dum bullets." Without the casing tip, the bullet spreads out when it hits its target, and causes severe damage where it would otherwise make a fairly clean perforation.

- A person who has alcohol in his bloodstream does not take chloroform very well.

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Last February I also read Notes on Nursing (1860) by Florence Nightingale, the pioneer of modern nursing and hospital sanitation. In her book, which is not a training manual but a guide for the general public, she explains her ideas about nursing and tries to dispel the myths. She stresses hygiene above everything; a sick-room must be scrupulously well-dusted, well-aired, neat and clean. As a part of this, she refutes the idea that night air is harmful, by pointing out that the day air in cities is a polluted brew upon which the night air is a decided improvement; therefore it is good for patients, provided that they are properly tucked in so that the cold does not affect them.

Her model nurse is stereotypically efficient; she must be clear and firm in her voice and step, inform the patient accurately about her comings and goings so that he can trust her, keep good records so that someone else can take her place at any time, observe well, and report facts and not opinions to the doctor. But she should also be considerate . . .

. . . as well-meaning visitors often are not. Florence Nightingale lists rather awful instances of common thoughtlessness: plunking down on the patient's bed without thinking that it can jar him, bringing flowers with overpowering scents, speaking from angles at which it's difficult for the patient to see one properly, lecturing the invalid about his illness and airing conspiracy theories or raising false hopes, etc. It's exaggerated, of course -- clearly not all visitors are so insensitive, and all patients so sensitive -- but I'm sure that almost everyone does one or two things that prove, on reflection, to be thoughtless and perhaps unkind.

An underlying idea to Florence Nightingale's rules is that the nurse should devote considerable time and thought to each patient, and not be content with superficial observation. For example, a patient may appear to have eaten food when he has really scraped it politely into the garbage. And, if he refuses to eat the food, he does not necessarily have no appetite, but maybe the food came at a bad time or wasn't prepared properly. Besides, she argues against hastily assessing a patient's well-being; redness or paleness have many causes, for instance, and she recommends that decisions about a patient's state of mind be made only after the nurse has had a lively discussion with him for an hour or more, and preferably also after the following night's sleep. I don't know if nurses have the time and energy to take all that trouble, but it makes sense.

Her view of the patient is quite respectful. She points out that a patient can know his own body better than the nurse. For instance, some patients ask for food (fruit, pickles, jams, gingerbread, bacon or ham, cheese, butter or milk, etc.) which it doesn't seem wise to eat but which has no bad effects after all. The times when the invalid wants to sleep, and when he wants to eat, must be accommodated; and even apparently trivial annoyances, whether the cause is a colour or a noise or something else, should be treated considerately.

Finally, she made a reflection that is as relevant today as ever: medicine should not be expected to take the place of letting the body do its work, or of proper diet and care.

* * *

. . . and a non sequitur at the end:

“The truth which makes men free is for the most part the truth which men prefer not to hear.”

-- Herbert Agar (American journalist, 1897-1980), A Time for Greatness
(Quoted in Oxford Dictionary of Quotations, rev. 4th ed.)

Musicking, Novels, and Trivia

When I woke up incredibly late at around 4 p.m., I had already been awake for fleeting minutes intermittently, and through involuntary eavesdropping had the cheerful feeling of being well-informed about everyone else's comings and goings. T. had returned from her work in a school cafeteria, and was talking with Papa and Mama in the corner room; J. had gone to the BVG building to see about his transit tickets, because he had lost the jacket which contained them, but he had also thrown away an old backpack which contained his student identification card, for which stroke of genius I laughed at him later; Gi. and Ge. were holed up in their respective rooms as usual.

So, after conversation and a shower, I read news articles on my laptop and then, when it was occupied by other persons, played the piano. As usual, I am conflicted about whether my playing is good or not, which I find absurd objectively because I am playing for my own amusement anyway. But my slipshod technique and practicing habits do make it less amusing. Anyway, on the programme there was Chopin (Military and Heroic Polonaises, the latter of which went extremely slowly, and a waltz and nocturne or two), Schubert (Sonata D958, Mvt. 2 and 3; Sonata D959, Mvt. 2 and 3; Sonata D960, Mvt. 1 and 2), movements from Beethoven's earlier sonatas (including the short Mvt. 1 and 2 of the Moonlight Sonata), Bach (Italian Concerto and a Goldberg variation). J. came in part-way through, so we played a duet and then he read out a page of a story by Gottfried Keller, where a cook discusses with an innkeeper what food will be prepared for a guest, making funny errors on account of the Gothic script. Lately I haven't minded assisting J. with homework and such things, though a month ago I usually had a startlingly ferocious reaction to his requests for help that was not unlike that of Bilbo Baggins when he wants to snatch Frodo's ring in a certain film.

As for my reading, I have finished the online fiction oeuvre of Rafael Sabatini -- who wrote comparatively good and intelligent, though violent, historical novels -- and now I have arrived at the oeuvre of Charles Alden Seltzer, who wrote westerns. The first book in the list is The Boss of the Lazy Y. I've realized this time that it is over-written to the point of seeming like a parody; the last times I read it I skipped the descriptive paragraphs at the beginning as usual (at university I made an art of reading only the essential passages of books, so that I could go through three or four novels in an evening, though now I tend to conscientiously read them in their entirety), but this time the purpleness of the prose sank in. The hero is described as the quintessence of morose, forbidding virility, and the parallels of his character to the harsh but grand desert environment around him are hammered into the reader's brain with a blacksmith's subtlety. A Mexican eagle, whom the hero promptly addresses with one of the racist epithets that unfortunately litter old westerns, flies overhead; a rattlesnake threatens to strike but is shot by the hero, who surveys the corpse and remarks that it is "man-size." Anyway, I find it funny.

And, last of all, I checked my answers for the King William's College quiz yesterday. It's given out at the end of every year in the Guardian (though I couldn't find it there this year, and had to go to the school website for a PDF copy of it), and it's "fiendishly difficult." The questions are phrased oddly but cleverly, and each set of questions has a theme, like duelling or pirates or places in London. One can usually answer at least two questions if one has a reliable knowledge of Sherlock Holmes, the works of John Buchan, and other English classics that the quizmaster happens to know; but the majority of the questions are, I think, about obscure historical events. This year I had thirteen questions right, which pleased me greatly.

The Vital Virtue, and Other Tales

The New Year has thus far proved drowsy and unproductive for me. Apart from our New Year's Eve celebration, walks to the Volkspark and to the Kleistpark amid the snow, and a visit to B. and A. in Prenzlauer Berg for a small family gathering before G. and N. flew home, I have done very little.

Anyway, here are some of the past week's amusements:

Television: Live and Let Die, Vienna Philharmonic New Year's Concert, The A-Team, sundry crime shows
YouTube: Roman Holiday, Notorious, To Catch a Thief, Spellbound, The More the Merrier, parts of Charade and Rebecca; Royal Canadian Air Farce
New Yorker, Guardian, Globe and Mail, and New York Times articles

Papa, Mama and I watched the New Year's Concert yesterday. In the second half the usual depressing feeling that all waltzes and polkas sound alike did descend on me; but this was temporary and I even enjoyed the "Blue Danube" and "Radetzky March," which I have heard approximately nine-hundred-and-ninety-nine times. It was not as embarrassing to watch the conductor as it often is; though he didn't glower impressively like Zubin Mehta or Valery Gergiev, neither did Georges Prêtre assume a theatrical air of absorption or indulge in giddy mannerisms as his colleagues all too often do. He lightly waved the tempo here, and wiggled his fingers there, mouthed "stop" at the end of the odd phrase, smiled often and evidently enjoyed the concert greatly. I felt that he brought a welcome lightness, but not superficiality, to the music. Besides, I liked the camera direction; not distractingly fanciful, it permitted satisfying views of the musicians, the audience, the flowers and the ladybug ornaments (which did not, I believe, contain chocolate) among them, and the Musikverein building.

My favourite films among the ones that I watched on YouTube are To Catch a Thief and Spellbound. The first is a well-known Hitchcock film where Cary Grant plays a retired jewel thief who is wrongly suspected of returning to his old work. He wants to clear his name, so he obtains the addresses of people who have valuable jewels that might be stolen, and hopes to trap the real thief at one of these places. One of the rich targets is an American woman (Jessie Royce Landis, who played Cary Grant's mother in North by Northwest) and her daughter (Grace Kelly). I like the Monegasque scenery, the brisk but leisurely pace of the plot, the characters, and the care with which the film was made. Its atmosphere is not as tinged with cynicism and darkness as Charade, for instance, is (in my opinion), nor is it too fluffy. Spellbound is another Hitchcock film, about a psychoanalyst, Dr. Constance Petersen (Ingrid Bergman), who works at a mental hospital. The head of the hospital, Dr. Murchison, is to be replaced by Dr. Edwardes. But it turns out that the man who shows up as Dr. Edwardes (Gregory Peck), is not Dr. Edwardes at all but an amnesiac who has assumed that identity. Dr. Petersen, who loves the impostor, does what she can to cure the amnesia and to find out what happened to the real doctor. The plot is melodramatic, but the quality, taste and seriousness of the acting and direction redeem it, I think. I also like how the parallels between detective work and psychoanalysis are worked out; one collects the data, searches out the clues, and tries to decode and synthesize them to find the solution of a problem. And, realistic or not, I like the film's implied assumption that there is no problem that cannot be rationally explained and solved.

As for my New Yorker reading, I found this week's article on Rudy Giuliani especially good and amusing. I much enjoyed the anecdotes that were skillfully employed as needles to puncture the balloon of political oratory. For example, in one chapter of his book Leadership, "Loyalty: The Vital Virtue," Giuliani records how he appointed Robert Harding to be New York's budget director, even though he was criticized for patronage because Mr. Harding's father, as the chairman of the New York State Liberal Party, had secured political support for the mayor. “I wasn’t going to choose a lesser candidate simply to quiet critics,” he wrote. Elizabeth Kolbert (who wrote the article) responds: "This self-praise is particularly noteworthy, since Giuliani also appointed a second Harding son, Russell, to lead the New York City Housing Development Corporation. Russell, a college dropout with no experience in the housing field, embezzled more than four hundred thousand dollars from the agency, and was eventually sentenced to five years in federal prison."

Besides, I've been re-reading the works of Edward P. Roe on Project Gutenberg. This time their kitsch has been sadly apparent, but I find Miss Lou and An Original Bellevery good in their meticulously researched descriptions of the American Civil War. Mr. Roe had served during the war as a chaplain, and he clearly still read and thought about, and discussed, it long afterwards. The second book portrays not only the war itself, but also the riots that broke out in New York City in July 1863, after President Abraham Lincoln declared a draft. Mobs marched through the streets, murdering black people and police officials in the streets, attacking newspaper offices and other buildings, and looting the houses of the rich. (One of the virtues of Mr. Roe is that he is quite unprejudiced about race and national origin; he only indirectly mentions that most of the rioters were Irish.) The army was called in to help the outnumbered police fight the mob, because the city militia had been sent off to fight in Pennsylvania. The police superintendent, Thomas Acton, had already ordered his men to shoot to kill and take no prisoners. Despite his clerical calling, Mr. Roe approves of this course and calls him "courageous," but I find the superintendent's commands unnecessarily violent. Anyway, I had never heard of the riots before I read this book, but the author's description is interesting and most detailed. It reminds me of the looting in New Orleans after Hurricane Katrina, because it also shows how thin the veneer of civilization can be, especially in turbulent times.