Remembrance Day

Head of Faculty Operations (Medicine), Adrian Reyes-Hughes, writes about the origins of Remembrance Day, a doctor who pioneered advocating a humane approach to treating war neurosis, and the influence of war on developments in medicine.

Today, is Remembrance Day (also known as Poppy Day) – the 11th hour of the 11th day of the 11th month, a memorial day respected by Commonwealth Nations to remember those who died in the line of duty.

The first Remembrance Day was held after the First World War on the 11th November 1919. In many villages, towns and cities the names of the dead were read out during the service – this tradition still continues is some parts of the UK today. The Remembrance Service with its two-minute silence, prayers, traditional hymns, the wearing of a poppy and the reading of the fourth verse of Robert Binyon’s poem For the Fallen* is an important mark of respect for those lost sons, brothers, fathers and now days for lost daughters and sisters.

However, for decades some relatives would not attend such services or would stand outside the main gathering – they were relatives of soldiers shot-at-dawn for ‘cowardice’ (tried in inadequate courts with no real medical reports being put forward); many of those men and boys were suffering from ‘shell-shock’ (today we would call this PTSD – Post Traumatic Stress Syndrome).

It has been estimated that 40 per cent of casualties during the Somme Battle (1916) were suffering from ‘shell-shock’ (British casualty figure were circa 420,000). Not all soldiers with ‘shell-shock’ suffered the fate of a firing squad, many returned home to Blighty as ‘injured’. If they were part of a casualty group sent to Craiglockhart War Hospital near Edinburgh they would come into the care of Dr William H R Rivers (1864 – 1922) – a neurologist, psychiatrist and leading anthropologist (he had studied the islanders in the Torres Straits in the late 1890s).

Rivers developed a humane approach to treating ‘insanity’ in soldiers diagnosed with a wide range of conditions – temporary blindness, memory loss, mutism, uncontrolled crying, and limb paralysis – collectively described at the time as ‘war-neurosis’. Rivers approach was based on Freud’s theories and the practice of psychoanalysis. Within Pat Baker’s famous Regeneration Trilogy River’s approach is developed in the story line – the analysis of dreams, talking to patients to understand the origins of their trauma, one to one discussion to help overcome and adjust to the neurosis in order to maintain day-to-day life (or to enable calm existence).

Rivers was a pioneer of his day in advocating this treatment for war neurosis, this was against much criticism and resistance from other medical colleagues who believe in ‘corrective’ treatments (electric shock therapy to tongue and cheeks to ‘cure’ mutism) and against senior military opinion who just wanted large numbers of men on the battle lines. Further, in went against the grain of keeping the ‘stiff-upper-lip’, which was a strong human trait during this period. Two of Rivers’ better-known patients were the poets Siegfried Sassoon and Robert Graves – who recognised him as a compassionate and sympathetic doctor. His legacy remains today, The Rivers Centre in Edinburgh exist to care for patients with PTSD.

In 2006 the then Government passed an act to posthumously pardon men who had been executed for ‘cowardice’ – and in some cases pardoned soldiers have had the names added to a War Memorial. The Shot at Dawn Memorial was erect in 2001 in the National Arboretum in Staffordshire.

Rivers work is one of the many developments in medicine attributed to the influence and circumstance of war; history has shown that medical practice and research can refocus and innovate around specific conditions and injuries related to military action, which then benefit the wider population. Some readers may want to explore this further and I would recommend looking at the career of Sir Harold Gillies (1882 to 1960) and his amazing work around tubular pedicle grafting and reconstructive surgery, as a starter.

However, today I would suggest the thought is simple taking time to reflect on the cost of human conflict and remembering those who made the ultimate sacrifice for the liberties we enjoy today.

Adrian Reyes-Hughes

They shall grow not old, as we that are left grow old:

Age shall not weary them, not the years condemn.

At the going down of the sun and in the morning

We will remember them.

For the Fallen Poem by Robert Laurence Binyon (1869-1943) – published in The Times newspaper on 21st September 2014