Book Review: Paxton on Carden-Coyne, The Politics of Wounds - Military Patients and Medical Power in the First World War

Paxton on Carden-Coyne, 'The Politics of Wounds: Military Patients and Medical Power in the First World War'

Ana Carden-Coyne. The Politics of Wounds: Military Patients and Medical Power in the First World War. Oxford: Oxford University Press, 2014. xii + 382 pp. $110.00 (cloth), ISBN 978-0-19-969826-4.
Reviewed by Jennifer Paxton (Texas Tech)
Published on H-War (July, 2015)
Commissioned by Margaret Sankey
All wars are traumatic. All wars result in damaged and devastated bodies, traumatized minds, and terrible tragedy. However, as described by Ana Carden-Coyne in her book The Politics of Wounds, World War I proved itself particularly horrific in this respect, as men in incredible numbers bore the wounds of new, more scientific, more industrialized warfare. It is these men, their wounds, and their pain which form the subject of The Politics of Wounds. Carden-Coyne seeks to give a voice to a group which has frequently been voiceless in the historiography of World War I, the wounded British or colonial soldier himself; simultaneously, she probes the meaning assigned to his experiences, his suffering, and his attitudes by military and political forces.
Carden-Coyne emphasizes the fundamental tension between individual, often suffering, human beings, and a vast industrialized war machine and the industrialized war in which it fought. Thus, The Politics of Wounds is both intensely personal, filled with individual experiences and individual reactions, and deeply rooted in the realities of industrialized society, and focuses on the interaction and tension between the two. To this end, she draws extensively and powerfully upon both published and unpublished primary sources: diaries and ephemera (such as hospital gazettes), cartoons, poems, photographs, and the like, allowing the reader, as far as possible, to see the personal experiences of the wounded. In particular, Carden-Coyne uses these sources to reveal the “soft resistance” which allowed these men, in an environment which apparently stripped them of all agency, to actually retain a measure of autonomy and, at least perceived, power over their lives. Refusing operations, complaining in the pages of official hospital gazettes, expressing their feelings in the private pages of diaries—all these, according to Carden-Coyne, could provide space for soft resistance, and thus the refusal to be merely a cog in a machine.
The Politics of Wounds is divided into five chapters, each focusing on a particular aspect of a wounded man’s experience (and following his personal progress through the system: the battlefield, treatment, redeployment, and postwar life). First, Carden-Coyne describes the process of medical evacuation, by which the wounded made their way from the battlefield, through a sometimes bewildering and often inefficient process of transport and triage, and ultimately to a hospital. She effectively emphasizes the conflicts between military needs—speed, efficiency, and return of soldiers to the front lines as quickly as possible—and medical needs, and how the immense scale of the conflict often led to inefficiencies, breakdowns in organization, and prolonged delay in aid reaching the wounded. These men, Carden-Coyne argues, often continued to feel like cogs in a machine, or perhaps goods on an assembly line, as shown in a darkly humorous cartoon drawn by a soldier for a hospital gazette (p. 86). Chapter 1 also notes the ethical dilemmas faced by medical personnel, forced by the realities of warfare to balance the needs of good care and military necessity. Carden-Coyne clearly has considerable sympathy for the often impossible positions in which doctors and medical officers found themselves, but also admits that this did not much comfort their patients, who frequently felt ill-used by the system.
Chapters 2 and 3 examine the dynamics of surgery. Carden-Coyne notes that in wartime, surgeries must necessarily take place under less-than-ideal circumstances, and are often hurried, experimental, and improvised. Moreover, arguments and scandals arose over the number of amputations, public outcries over tetanus and gas gangrene, deaths due to misuse or overuse of anesthetics, and the proper use of antisepsis and asepsis. According to these chapters, physicians again found themselves forced to balance military needs with humanitarian ones, while also dealing with debates within their own profession. In general, Carden-Coyne again displays great sympathy for the physicians and surgeons (generally portraying them more favorably than the military system they interacted with, revealing a possible bias on her part), whom she describes as doing their utmost to help patients and carry out their ethical responsibilities, while also making life-saving advances in surgical techniques; however, as she describes in the next chapter, this did not prevent their treatments from being frequently painful and not always effective, and certainly did not always result in a particularly favorable impression of them among their wounded patients. She argues that while experimental surgeries and new treatments might have saved lives, botched surgeries, unnecessary amputations, and deaths from anesthetic misuse certainly did not, and led to deep anxiety and lack of confidence on the part of patients. This anxiety sometimes revealed itself, as Carden-Coyne clearly demonstrates, in the form of “soft resistance”: refusing operations, gallows humor, drawings and poems, and more.
The final two chapters, and perhaps the most interesting in the book, deal with life in military hospitals. On the one hand, Carden-Coyne asserts, these hospitals were sites of shared suffering, deep connection between people, and an almost familial atmosphere, in which emotional needs as well as physical ones could be addressed. She reveals how romances and sexual liaisons, as well as deep friendships, formed between the wounded and their caregivers or visitors, and dismissed patients sometimes maintained affectionate contact with their hospital “family.” Hospitals were also the subjects of propaganda, as the image of the heroic soldier cheerfully recovering from his wounds served to defuse some public discontent over the treatment of the wounded. The wounded soldier, as Carden-Coyne emphasizes particularly effectively here, was not only a wounded man; he was a patriotic symbol, and also a military asset intended to be returned to the front lines with all possible speed. His body was not only a wounded body in pain; it was a social symbol, as well as part of a war machine. And, as discussed in chapter 5, this fact led to the darker side of hospital life: the looming reality of painful treatments (such as massage or orthopedics), followed by the mandatory return to the front lines, and possible further damage or death. Soldiers reacted to this reality with gallows humor, malingering, public complaints in the hospital gazette (which, Carden-Coyne argues, actually served as a safety valve, and may have prevented more forceful resistance), and the like. As Carden-Coyne clearly demonstrates, the military hospital was the site of tension between pain and comfort, as reflected in the varying patient responses to it.
The Politics of Wounds is a complex book, addressing many facets of a complex issue, and is wisely organized into chapters which are linked both chronologically and thematically. However, its very complexity may be its greatest weakness: it addresses issues of medical ethics, military ethics, social perceptions of masculinity and patriotism, tension between public and private spheres, concepts of the body, the tension between masculine soldiers and “feminized” convalescents, the interaction between military and civilian politics, and (in the epilogue) the definition of a “good” or “worthy” recipient of a pension. Consequently, the book can at times seem to attempt too much: in the effort to address all of these interlocking issues, The Politics of Wounds can at times seem confusing and scattered. However, it insists upon allowing the wounded soldiers of World War I their agency and personalizing their suffering, and it accomplishes this goal powerfully. Carden-Coyne places the wounded of Britain and its empire within their extremely dehumanizing, depersonalizing context, while simultaneously intensely personalizing them and, even more importantly, describing how they personalized themselves.
Printable Version:
Citation: Jennifer Paxton. Review of Carden-Coyne, Ana, The Politics of Wounds: Military Patients and Medical Power in the First World War. H-War, H-Net Reviews. July, 2015.