The Adventure of Death

Thursday, 07 November 2013


From 1900 to 2100

Medico-Chirurgical Hall

Refletions on palliative care, death and dying in the First World War.

Dr Sally Lawton - Senior Lecturer in Palliative Care - Roxburgh House

Notes

Minute of meeting of Aberdeen Medico-Chirurgical society held in the Society's Hall, Foresterhill on Thursday 14th November 2013.

The President, Dr Colin Hunter, presided.

The President presented the award of the Strachan Bursary to Miss Victoria Campbell.

The President then introduced the evening's speaker, Dr Sally Lawton, senior lecturer in Palliative Medicine who spoke on The Adventure of Death: Reflections on Palliative Care, Death and Dying in the First World War.

Dr Lawton described her early training as a nurse and then at university doing a degree in English and history. She specialised in palliative care and her interest was enhanced by finding a book by McKenna (The Adventure of Death) when she was moving the Roxburgh House library. Her specific interest in palliative care in WW1 was triggered by finding a book by Florence Farnborough Nurse on the Western Front which described nursing in WW1.

Dr Lawton described the organisation of medical and nursing care in WW1 when the RAMC itself had over 1000 personnel killed. They had to 'triage' and evacuate casualties back from the front to prevent them getting in the way and get them back to fighting, but if they were deemed too severely injured to survive, then they were of little value. She gave figures relating to troops and causalities, for example there were 1,295,583 solders at the front in 1916. There were 651,662 battle casualties and an almost equal number of non battle casualties. Of the half million taken to hospital, 7% died, 33% returned to duty and 57% were evacuated overseas.

Regimental first aid posts transferred casualties back to advanced dressing stations, then to field ambulance dressing stations, casualty clearing stations and then to hospitals distant from the front. Forward stations had symptom relief including morphine. Dr Lawton showed the medical record cards in use at the time, which although small, contained all the important information, but there were complaints at the time about information not following the patient.

During her talk, Dr Lawton drew comparisons between the present day and WW1, triage and poor communications being the first two. Bed shortages also featured then.

Little was written about the care of the dying in those days although soldiers often saw colleagues being killed. In wards, the dying were often put in isolation, often near the door, often behind screens - another parallel with today, although Dr Lawton wondered if this behavior was more to do with medical/nursing staff discomfort than that of other patients.

She spoke about some ethical issues including using morphine for euthanasia - she wondered if that coloured our present reluctance to use morphine. Doctors then were often reluctant to use high doses (another parallel with today). Dr Lawton poignantly told of a patient called Rossa who had shot himself but the staff were instructed to do their best to keep him alive so that he could be court martialed and probably shot. She is writing a novel based on this story.

She then turned to the role of the media, quoting from, amongst others, Rupert Brooke. She said that the truth was often vilified with the press not necessarily reporting the reality. Another parallel with today.

Turning to the nurses, Dr Lawton spoke of the straight discipline and staffing problems. The chief nurse at the time insisted on having trained nurses at the front with unqualified staff being looked down upon. The fifth parallel with modern times.

The Red Cross did get passes for some families to visit soldier who were dying if time permitted and doctors, nurses and chaplains all wrote to families with a tendency to glorify the dead. She made her final parallel with today.

Dr Lawton finished her talk with a quotation from a poem by Winifred Letts, a volunteer nurse.

After some question, the President thanked Dr Lawton for her insightful, informative, well researched and often poignant talk.

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