A Question of Authority: the Management of Shell Shock at the Irish War Hospitals during the Great War by Peter Reid

In this month's blog post Peter Reid, MLitt research student at the Centre for the History of Medicine in Ireland (CHOMI), UCD, looks at the treatment of shell shock in Ireland during the Great War. He argues that the formation of a rational medical service for these soldiers in Ireland was undermined by the antagonistic relationship between military and civilian medical authorities.

Queen Street, Dublin.
Image provided courtesy of Peter Holder,
Irish Historical Picture Company

On 22 July 1929, John Kelly, an ex-British soldier, fell from a window of his residence in Dublin's Queen Street and later died from his injuries while being treated at the Richmond Hospital. His wife did not witness his fatal fall, but said that her husband, 'had been in ill-health since his discharge from the army in 1919, suffering from paralysis and shell shock.¹

Until recently, there had been relatively little research undertaken on the management of shell shock in Irish institutions during the Great War. In the case of Britain, Peter Leese has shown that army and military concerns dominated over those of civilian medical experts.² This post argues that a similarly asymmetrical relationship between asylum and military medical personnel was one of the key factors inhibiting the development of a well-coordinated shell shock treatment system in Ireland.

The Irish War Hospitals

The Richmond War Hospital, 1916-1919.
Image provided courtesy of the
National Archives of Ireland.

In Britain, by 1916, demand had overwhelmed the capacity of treatment facilities for shell shocked soldiers. From the summer of that year, the first treatment centres in Ireland, which would include two war hospitals, began to open in the main urban centres of Dublin and Belfast. The first of the war hospitals, a thirty-two bed unit, the Richmond War Hospital, received its first patients in June 1916. This hospital was a separate block within the grounds of Dublin's Richmond District Lunatic Asylum, allocated by the asylum's board of governance for this purpose. It admitted only British Expeditionary Force soldiers, that is, those soldiers who had served overseas at the Western Front. The main Richmond Asylum itself, however, admitted non-British Expeditionary Forces - the home troops. The army paid a generous stipend to the Richmond Asylum for the care of both categories of soldier.

Belfast District Lunatic Asylum.
Image provided courtesy of the National Library of Ireland.

In response to rising casualty numbers, the civil and military authorities agreed to relocate existing patients from the Belfast District Lunatic Asylum and use that facility as another war hospital. The Belfast War Hospital opened in May 1917 under the management of the existing District Lunatic Asylum Committee. It provided 500 beds for the use of both expeditionary and non-expeditionary British service personnel. Dr William Graham, the Medical Superintendent of the Belfast Asylum, remained in place as the medical authority running the new war hospital.

The evidence suggests that Dr William R. Dawson, already a leading figure in Irish medicine and highly regarded by the British army, played a key role in facilitating, if not initiating, both arrangements.

William R. Dawson, appointed by the War Office in 1915,
as a specialist in nerve disease to treat British service personnel in Ireland.
Image provided courtesy of the Royal College of Physicians of Ireland.

The Resident Medical Superintendents and the Royal Army Medical Corp

King George V Hospital, built 1902
(St Bricin's Military Hospital), Arbour Hill, Dublin.
Image courtesy of the National Library of Ireland.

Tensions in the relationship between the Richmond Asylum's Medical Superintendent, Dr John O'Conor Donelan, and his military counterpart, Lieutenant Colonel Hearn, Officer in Charge, George V Hospital, Central Military Hospital Dublin, quickly became apparent. Hearn instructed Donelan by letter that as Officer in Charge of Central Hospital that he, Hearn, was ultimately responsible for all soldiers in the asylum, 'until such time as they are invalided out of the army'.³ Three days later, Hearn again wrote to Donelan and firmly reiterated the point that 'should a man in your opinion require to be moved to the General Asylum [from the Richmond War Hospital] he still remains a soldier until finally discharged from the service by recommendation of the Military Board'.⁴ 

Dr John O'Connor Donelan, Resident Medical Superintendent,
Richmond District Lunatic Asylum, Dublin.
Image by kind permission of Dr Aidan G. Collins,
St. Vincent's Hospital, Fairview, Dublin 3.

The army's insistence on reserving the use of the war hospital solely for expeditionary soldiers, on prioritising their treatment over that of non-expeditionary soldiers, on maintaining their control over the admission and discharge of all military patients, and the complex bureaucratic needs of the military machine, served to insidiously undermine Donelan's authority. Donelan's dissatisfaction with the arrangement is evident in his asylum report of 1917 when he bemoaned the high number of discharges 'classified as only relieved'. He attributed this to 'the fact that a considerable proportion of these were soldiers under temporary treatment, who were removed by the Military Authorities to other asylums before recovery'.⁵ Donelan was implicitly criticising the military authorities for prioritising the needs of the army over the professional opinion of asylum medical officers, in particular himself.

When the Belfast War Hospital opened in May 1917, it was initially managed by the existing District Lunatic Asylum Committee. However, as Lieutenant Colonel J.B. Buchanan, Officer-in-Charge of Holywood Military Hospital, noted in 1919, 'this plan did not prove satisfactory'. When the Resident Medical Superintendent, Dr William Graham, died suddenly in November 1917, the Belfast War Hospital came under the direct control of the War Office.⁶

Consequences of an unsatisfactory relationship

Between 1916 and 1919, the Dublin and Belfast Irish war hospitals treated 1,577 soldiers. However, there were never enough beds in Ireland for emotionally traumatised soldiers such as John Kelly and, by 1921, the 'South Ireland Pension Area' - Ireland exclusive of the province of Ulster - had the longest waiting list in Britain and Ireland for treatment.⁷ The antagonistic relationship between medical and military actors was one factor contributing to this unfortunate situation.

Contemporary relevance

In a report issued in July 2015, the Mental Health Commission identified that a lack of cohesion and 'deep disharmony' between clinicians and managers had undermined clinical governance in Carlow/Kilkenny and South Tipperary and, in early 2014, was associated with a 'spike' in suicides in the region.⁸ This reflects the continuing importance not only of independent surveillance by bodies such as the Mental Health Commission and the Health Information and Quality Authority, but also of managerial and clinical relationships in the delivery of contemporary mental health services in Ireland.

Peter Reid completed a MA in the Social and Cultural History of Medicine at the Centre for the History of Medicine in Ireland (CHOMI), UCD, in 2014. The title of his MA dissertation was, 'The Institutional Management of Soldiers with Shell Shock in Ireland, 1916-19'. In September 2015, Peter will be commencing a MLitt at CHOMI, investigating the treatment of children with disability in early twentieth-century Ireland.

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1 Irish Times, 24 July 1929.^↩
2 Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War (Basingstoke and New York, 2002), 54-6, 98.^↩
3 Letter to Resident Medical Superintendent, Richmond Lunatic Asylum from Lieutenant Colonel Hearn, King George Fifth Hospital, 1 August 1916, Richmond War Hospital Admission and Discharge Book, BR/Priv 1223, NAI.^↩
4 Hearn to Resident Medical Superintendent, Richmond Lunatic Asylum, 4 August 1916.^↩
5 Richmond Asylum Joint Committee Minutes, 1917, 17, BR/Priv 1223, NAI.^↩
6 Medical History of the War: Report in Compliance with War Office Letter No. 24/General Number/6978 (A.M.D.2) 18 October 1919, WO 35/179.^↩
7 Joanna Burke, 'Effeminacy, ethnicity and the end of trauma: the suffering of "shell-shocked" men in Great Britain and Ireland, 1914-39, Journal of Contemporary History, 35, no. 1 (2000), 69.^↩
8 Irish Times, 22 July 2015.^↩

Irish Doctors in the First World War by David Durnin

‘The absence of conscription in Ireland leaves it open to young Irish practitioners to profit by the military service of English, Scottish and Welsh doctors and set up practice in the homes of the absentees to their obvious hurt. How does the British Medical Association hope to deal with that? Nay, to put it more fairly, how can we hope that the British Medical Association can right this wrong?’ 

 On 20 January 1917, the British Medical Journal published the above letter sent by an unidentified Captain in the Royal Army Medical Corps – the British Army’s medical division. The letter highlighted underlying feeling among some British doctors that Irish medical personnel, rather than participating in the First World War, travelled to Britain to occupy jobs left vacant by medical men serving with the British Army. In response, Dr Maurice Hayes, a graduate of the Catholic University of Ireland, argued that the Irish medical profession, without compulsion, had ‘provided a steady flow of volunteers to the British Army’. From 1915 to 1919, Hayes acted as Honorary Secretary of the Irish Medical War Committee – a group of leading medical professionals, responsible for encouraging Ireland’s doctors to enlist in the British Army. Prominent members of the committee included Ephraim Cosgrave, President of the Royal College of Physicians of Ireland; D.J. Coffey, President, University College Dublin; A.F. Dixon, Dean of Faculty of Physic, Trinity College, Dublin and F. Conway Dwyer, President, Royal College of Surgeons Ireland. The group, through letters and newspaper advertisements, appealed to Irish medical professionals to volunteer for war service. Their appeals were successful. From the outbreak of war in 1914 to the end of hostilities in 1918, Irish doctors enlisted in the British Army medical services.

Portion of a battle line, outlining casualty clearing stations 

Source: Wellcome Images, L0027194, Wellcome Library 

 On 18 August 1914, the first contingents of Irish medical personnel travelled to France; No.1 Stationary Hospital, No.1 General Hospital and No.13, 14, and 15 Field Ambulance Divisions departed Dublin for Le Havre. On the same date, No. 16 and 17 Field Ambulances departed Cork for Saint-Nazaire. Initial reactions to the wartime setup varied among the contingent depending on their assignment. In 1914, RAMC Command implemented an intricate casualty clearing process on the Western Front. Significant numbers of medical personnel occupied the roles at each stage of this process and Irish physicians and surgeons were among them. Stretcher-bearers collected injured soldiers from the combat zone and carried them to the nearest Regimental Aid Post – a zone occupied by RAMC MOs, normally located in shell craters or building ruins – before transporting the wounded to Advanced Dressing Stations. Here, injured soldiers had their wounds dressed and were then transported via Field Ambulance – horse-drawn carriages or motor vehicles – to a Casualty Clearing Station (CCS). RAMC medical personnel in the CCS dealt with injuries requiring immediate treatment and conducted numerous surgical procedures. Ambulance cars and trains then transported the wounded, fit for transportation, to nearby hospitals established by the RAMC or voluntary groups, like the Red Cross. Hospitals were located close to battlefields. MOs also identified wounded men better suited to treatment in hospitals on the home-front and recommended these men be moved, via hospital ship, back to domestic hospitals in Britain and Ireland. 

Photograph showing a ward, with patients either in bed or on chairs, c.1915 

Source: Wellcome Images, L0060826, Wellcome Library 

The majority of hospital ships arriving in Ireland docked in Dublin and contained an average of 400 soldiers. From 1914 to 1918, approximately 70 institutions located throughout Ireland provided facilities for the treatment of 16,000 returning sick and wounded. These included auxiliary wards and hospitals and a number of specialist institutions established by RAMC Command (Ireland) for the treatment of specific diseases. In 1915, for example, the War Office appointed Lieutenant-Colonel William Dawson, Inspector of Lunatic Asylums in Ireland, as RAMC (Ireland) specialist in nerve diseases. On 16 June 1916, Dawson took charge of the Richmond War Hospital, located in Dublin’s Grangegorman Asylum. The Richmond War Hospital catered for 32 soldiers suffering from mental disorders. From the date of opening till its closing on 23 December 1919, the Richmond War Hospital treated 362 cases, of which two-thirds were discharged to friends or ordinary military hospitals, two returned to duty and 31 sent directly to civil asylums. While the institution was helpful in the RAMC’s attempts to provide treatment for mental cases, it was undeniably small. Therefore, in October 1916, the War Office requested Dawson to facilitate them by placing an asylum with 500 beds at the disposal of the RAMC. Similar arrangements had been managed successfully in Britain. In Ireland the vastly overcrowded asylums made this an unlikely prospect. Yet, in April 1917, the War Office acquired Belfast’s Civil Lunatic Asylum and incorporated it as part of the Belfast War Hospital. The hospital received Irish men suffering from mental illness during active service and also treated men, not of Irish birth, who belonged to Irish regiments. The first military cases arrived on 15 May 1917. Staff consisted of men who had enlisted in the RAMC for the duration of the war and who had previous experience working in asylums. Between the opening of the hospital and its closing on 15 December 1919, 1,193 cases were admitted; 772 were discharged into the care of their family or friends and 103 transferred to other hospitals more suited to their treatment needs. 

This post has given a brief overview of Irish medical involvement in the First World War and using the small example of Irish asylums, has highlighted the impact of the conflict on Irish medical infrastructure. In future pieces, I will profile some of the Irish doctors who participated in the First World War and, using details gathered from diaries and letters, detail their roles and experiences on various fronts. As a PhD student researching Irish medical personnel in the First World War, I am always pleased to be contacted with details of new source material. If you are in possession of diaries, letters or postcards of Irish medical personnel who participated in the First World War, please get in touch – David “dot” Durnin “at” ucd.ie 

David Durnin is an Irish Research Council Doctoral Scholar, at the Centre for the History of Medicine in Ireland, University College Dublin. For more information on his research, click here.