Saturday, May 18, 2013

The Great Fly-Killing Competition: Sudan 1941

A recent edited volume of primary documents, Combat Stress in the 20th Century is an excellent addition to the literature on psychiatry at war.  Editors Terry Copp and Mark Humphries have selected a broad range of articles from medical journals, archived reports, and accounts by medical officers and laymen alike which show the development (or some would say lack thereof) of military thought on mental breakdown and treatment in the commonwealth armies.

For those of more eccentric historical taste (you've come to the right place!), there are plenty of accounts of the more extreme sides of the subject, including electroshock therapy, barbituate sedation, or insulin shock therapy.  On the scale of strange, however, it is hard to top the account of FM Richardson's competitive health preservation.  It seems that to remove the risk of malaria and the sheer annoyance of the omnipresent fly, all Second World War British officers needed to do was start counting:

In a camp in Sudan where fly infestation was very bad and made life intolerable despite intensification of all the usual measures and the efforts of a strong daily fly-swatting patrol almost unbelievable results were achieved in little over a month by a fly-killing competition.  The unit was divided by tents and other convenient groups into teams of ten to twelve men and a running total of the number of flies killed by each team was published weekly.  A standard tin of which the fly content was known was kept by the G.M. Havildar to whom the teams brought their daily bag to be counted, recorded and burned.  The results soon became apparent and it was not long before the 100,000 mark was passed.  The I.H.C. sepoy would do a lot for a few rupees and a good curry bat, and enthusiasm soon rose so high that the best hunting grounds had to be allotted on an official programme like the blocks in a shooting jungle.  Finally the few remaining flies were being stalked by the more resolute competitors and one could see none where recently they had been swarming.
Allied Advances in the East African Campaign. Image by historicair
 This may all sound rather ridiculous but I was later discussing it with a man who had lived in Rumania, where, he said, flies had been innumerable.  A similar competition on a village basis for big money prizes was organized by the Government, and the results, he assured me, were so remarkable that flies virtually disappeared from the country and the disposal of the rubbish which the flies would have eaten became quite a problem.  I accept no responsibility for this statement which may have been merely a dramatic way of emphasizing the success of the scheme, but it is a stimulating thought for medical entomologists.  (FM Richardson, "Competitive Health Preservation in the Army", text of a presentation at the USAREUR and Seventh Army Medical Surgical Conference at Garmisch, Germany, 18 May 1981.)
In civilian life, cold hard cash was necessary to promote fly-killing! 
 Mansfield Advertiser, Mansfield, Penn., June 24, 1914
via State Library of Pennsylvania via
 Questionable Advice and Advertisements
Richardson is best known for his work Fighting Spirit which is a socio-psychological look at men in combat.  He suggested applying the  health competition to battle exhaustion cases.  This seems like a questionable cure for the malady.  If soldiers took the competition seriously, and paid attention to the publicized battle exhaustion rates of various competing units and formations, they would condemn those with symptoms of breakdown.  Hence, it is more likely that those suffering from combat stress would be under even more pressure from their peers, complicating their malady further.  In consideration of how important acceptance by the group is to soldiers, letting their unit down further in the competition may have increased their shame, reducing the already low chances of rehabilitation and return to unit.

Wednesday, May 15, 2013

The poor to the madhouse, the rich to the spa: Neurasthenia in the 19th Century

The history of mental illness and psychiatry is a fascinating field that is always generating interest.  One would only need to glance at the program for the recent University of Calgary Conference "History of Medicine Days", to find new research on asylums, psychiatric pharmacology, or combat stress.  On this last topic, Terry Copp and Mark Humprhries' 2010 work Combat Stress In the 20th Century: The Commonwealth Perspective, compiles an impressive collection of primary sources from the archives and medical journals which outline the development of an understanding of mental breakdown on the battlefield.  Their introduction to the first chapter, "From Railway Spine to Traumatic Psychosis: Doctors Confront Trauma in the Modern Age, 1865-1918", shows how class and gender affected early thought on mental illness.

In the nineteenth century, public asylums could resemble medieval dungeons more than places of recuperation and rest.  Those committed to them were largely the impoverished, homeless cases deemed unstable and disruptive.  More affluent families with any compassion for a relation would certainly attempt to avoid incarcerating them here.  Instead of diagnosing these patients as insane, doctors would allow them to be classified as having "nerves".  As Copp and Humprhies write, "nerves allowed those with enough money to pay for treatment and a respectable diagnosis to wrap many of the more common mental illnesses in a linguistic cloak thus avoiding the stigmitization of the asylum". (p. 4)
Opening in 1247, London's St Bethlehem Hospital or "Bedlam"
 as it was known was the first dedicated strictly  to those with mental disorders.

Insanity was considered to be inherited, yet nervous disorders were thought to be acquired, and thus these were socially acceptable conditions.  Insanity reflected poor blood, while a nervous disorder may have just been reflective of being in the wrong place at the wrong time.  Psychiatrists, alienists, and neurologists were happy to be able to escape the practices of the asylum, and so by classifying the nervous disorders into neurasthenia, hysteria and traumatic neuroses, they looked forward to private practice with more well-heeled patients.
“Mistress and her maid,” by Jean Louis Forain.
University of Virginia Art Museum.

Neurasthenia was thought to be a loss of nerve substances from the body.  Modernity, with its  railroads, electrification, and mechanization was thought to increase this dissipation of "nerve force".  While veterans of the American civil war were first to diagnosed, medical culture soon began to associate it with those who were on the cutting edge of the latest technologies.  Copp and Humpries record, "...a diagnosis of neurasthenia was often quite fashionable because it indicated that one was engaged with the modern world.  It grew in popularity so quickly that soon the link between veterans and the diagnosis was all but forgotten."  (p. 5)
Charcot demonstrates a case of 'hysteria' c. 1885

Hysteria was a condition that was hard to distinguish from neurasthenia, and carried negative connotations with its diagnosis.  By the late nineteenth century it had become associated with undue sensitivity, moral weakness, and impulsiveness.  "Although it was similiar clinically to neurasthenia, hysteria resulted from the patient overexciting their own nerves through some specific idea or act.  Masturbation, obsession with romantic relationships, grief, and worry were all thought to unnecessarily tax the nervous system and sap the energies of the patient and, in extreme cases, produce a shock which resulted in the more pronounced hysterical symptoms like paralysis, blindness, and mutism." (p. 5)  With this contrast, it is clear which diagnosis was preferable for the patient!

The authors' note that it was the patient's class and sex that differentiated the two conditions to most doctors.  Patients from the upper class, of course, had "superior moral constitutions" and were less likely to succumb to the temptations which would bring on hysteria.  Women, however, thought to have less willpower and tendencies towards emotional outbursts, were also thought to be at risk.  It appears that wealthy women could turn a doctor's diagnosis in the favourable direction, as "...women of means were often able to find a doctor willing to label them neurasthenic." (p. 6)

Copp and Humprhies emphasize that after the Civil War, nervous disorders were increasingly accepted as a "more benign form of mental illness." They note that it was the pace of modernity that many blamed on the acute manifestation of these disorders:
At the heart of the diagnosis of neurasthenia was the notion that modernity itself was traumatic.  The mechanized, industrial slaughter of the Civil War and the hurdling pace of modern life were symptomatic of the trials and triumphs of the modern age and it was to be expected that man's feeble body would recoil in horror as it was further disconnected from an agrarian, rural past.  In the decades after the Civil War, doctors on both sides of the Atlantic were increasingly faced with victims who suffered from the after-effects of these head-on collisions with modernity. (p. 6)