Authors: Anne Melville
On the Western Front the enemy was the German; in the Dardanelles it was the Turk; in Serbia it was the louse. Its killing power took Kate by surprise, and the battle against this unexpected adversary began almost from the first moment of her arrival in Serbia.
The journey across a continent disrupted by war had been long and uncomfortable. Kate and her fellow-doctor applied themselves to the Serbo-Croat dictionary and by the end of the journey had at least mastered the difficulties of the Cyrillic alphabet. But this achievement proved to be of only limited use. Now they could read and pronounce words in the unfamiliar letters, but they had yet to learn what the words meant.
Communication was the first problem to confront them when at last the party of doctors and nurses stepped off the train at Kragujevatz. They had been invited to come here and they were expected â a reception committee was waiting for them at the station. But their first impression, gained from an interpreter whose English was almost as incomprehensible as the Serbo-Croat of his companions, was that the British team were not wanted in the town. Women in the medical world were so often under-valued that it was easy to see slights even perhaps where none was intended; but to Kate, tired after the journey and still disappointed that she had not been sent to France, the impression that they were being turned away came as a last straw. To keep her temper under control she supervised the unloading of the expedition's stores while the senior doctor, Dr Muriel Forbes, established that she and the Serbs could converse, after a fashion, in German.
âThe reason why they're suggesting we should establish ourselves away from the town is that the arsenal is here in Kragujevatz and there are regular bombing raids by Taube aircraft,' Dr Forbes reported when the situation had been explained to her. âIt doesn't mean that they don't need or want us. Far from it! Twenty-one of their own doctors have died in the past five weeks.'
âFrom the bombs?' asked Kate incredulously.
âNo. From typhus. There's an epidemic raging. They've had four thousand civilian deaths in this town alone and nobody knows how many are dying in the villages. As well as the regular military hospital here, there's an emergency building filled with men wounded in the campaign. That's where they'd expected us to work, but the typhus is spreading through there as well.'
âIf we split into two teams, could they give us orderlies?' Kate asked.
Muriel's smile showed that she had been thinking along the same lines. âYes. I asked that question, and the answer was that with the greatest of ease and pleasure we could be provided with as many Austrian prisoners of war as we needed.'
âIs that safe? I mean, would they have to be under military guard all the time?'
âI gather that they're only Austrians in the sense that they were conscripted into the Austrian Army because they lived in land under Austrian occupation. They're Serbs by race â Bosnians â and delighted to have been captured â in fact, it sounds as though most of them deserted. They'd work as volunteers.'
âThen we ought to establish a separate hospital for the typhus victims,' said Kate. âUnder tents, if possible, and a little way out of town.'
The two women were so closely in agreement that there was not even any need to discuss where each of them should go. Muriel, the elder, was a surgeon and volunteered at once to care for the wounded soldiers who could not be housed in the main military hospital.
Three days later Kate's tented hospital received its first patients. Those of the British team who stayed with her had been allocated their own spheres of responsibility â for nursing, the kitchen, the dispensary and the stores â and had set to work at once to train the Serbo-Austrian orderlies allotted to them. Kate herself had grasped the greatest nettle of all, that of sanitation and disinfestation. She was only twenty-four years old and all her training had been done in teaching hospitals run with an almost military discipline along lines laid down many years earlier â establishments whose methods of organization could not even be queried by a junior doctor, much less completely re-thought. But her recent work at Blaize had provided useful experience of organizing a hospital almost from scratch, and from her father she had inherited the ability to be definite, taking responsibility and giving firm orders even when she lacked the experience to be sure that the effects would be as she hoped. From her mother, too, she had from childhood absorbed the principles of community hygiene. Lydia's battle in Jamaica had been against the mosquitoes which carried malaria and yellow fever and against the the insanitary habits which made dysentery endemic. With the same singlemindedness Kate declared war on the lice which carried typhus and on the polluted water which spread the equally dangerous typhoid fever.
To save the wounded soldiers in the town from further infection, Muriel would direct typhus patients to the tented hospital at once. Even though she expected this, Kate was not prepared for what she saw as she stepped out of the staff tent at six in the morning. A row of carts stretched from the perimeter of the camp back along the road until it disappeared behind the brow of a hill. There were ox wagons and donkey carts and occasionally a smaller vehicle â hardly more than a platform on two wheels, pulled between the shafts by the mother of the child who lay on it. Old men carried babies in their arms;
exhausted women slept on the verge. There was no noise, no jostling for position; the line of sufferers waited patiently until someone was ready to help them.
Kate was already dressed in the costume which she had designed for everyone concerned in the reception of new patients. It was not beautiful, and only time would tell whether it was effective. She had rubbed her body all over with paraffin and was now wearing a one-piece garment tightly strapped round her neck, ankles and wrists. One of her first actions when she realized the dangers had been to cut off most of her thick tawny hair so that the short crop which remained could be easily contained inside a rubber cap. Long boots and rubber gloves completed the outfit.
Careless of the impression she must make, she called for stretcher bearers and hurried to the head of the queue. A tall man with only one arm jumped down from the front of the first ox wagon and led her round to the back. He pulled the canvas aside to reveal more than a dozen children. All were between the ages of three and ten and all were either asleep or unconscious. Their hair was dirty and their clothes ragged, but that was of no importance. What made Kate stare in dismay was the state of the little girl nearest to the light. Her leg rested on a pad of folded sacks but there was no flesh on the bone of the foot and the gangrene was spreading above the knee. Several weeks must have passed since she survived the first onslaught of the typhus and it was clear that in all that time she had received no medical attention.
The one-armed man was saying something, presumably in Serbo-Croat. Kate shook her head to indicate that she did not understand and he made a second attempt in a language equally unfamiliar to her. She put up a finger to silence him as she made a quick count of the children. Three were in need of immediate surgery, five were in the semi-comatose stage of typhus which suggested that they were approaching the point of crisis, two others â
awake now and moaning for water â showed the brown blotches on their skins which were the earlier signs of infection, and three were already dead. Only one little girl appeared to be free of typhus and her state was the most serious of all, for it was clear that she was suffering from diphtheria and that an immediate tracheotomy was essential.
Kate pointed out this child and two of the gangrene cases to be the first to go to the special admission tents, where they would undergo a routine of cleansing and disinfecting before being admitted to the ward tents. As she turned away, realizing that all the reception arrangements must be multiplied, she had to fight down a sense of panic. In the weeks of waiting she had done her best to fill the gaps in her experience, but even then she had been part of a team and had never been required to attempt the most dangerous operations. She had had some surgical experience as a medical student, but she was not a qualified surgeon. Beatrice, allowing her to join the unit, had expected her to act only as Muriel's assisstant in this field. But to put a child who was already almost dead from diphtheria back on to a jolting wagon in order that she could be entrusted to Muriel's safer hands would be a risk too great to take. From now on, Kate realized, everything she did would be a question of life or death for someone. This was the moment in which the sentimental disappointment she had felt in being unable to work with British soldiers fell away from her mind and never returned. The need for a doctor here was as great as it could be anywhere else in the world. Within a short time she would have a little girl's life in her hands, and it was a life just as important as that of a soldier in Flanders. To be a doctor, nationality must never be of any importance.
The one-armed man made a third attempt to communicate with her and this time he spoke in French. Kate had learned the language only from books, but she had a
natural talent for languages and could both understand what he said and answer him. Recognizing the anxiety in his voice, she paused for a moment to answer although there was so much to do.
âCan they be saved?' he asked.
âThree are already dead. We will do our best for the others. But the gangrene is very serious. Why were they neglected for so long?
âThey are not my children,' said the tall man. âThey are orphans. All of them: no mother, no father. I am a Russian. My name is Sergei Fedorovich Gorbatov. A woman gave me shelter on her farm. When she died, there was no one left alive on the farm except her son there.' He pointed to a three-year-old whom Kate had already marked out as the most likely survivor of the wagonload. âI heard of your hospital and set out to bring him here. All these others I have found on the road as I came, or they have been brought out of their houses by neighbours. Their fathers killed in the army, their mothers dead of disease. Who will look after them?'
Kate was already sufficiently dismayed by the enormity of the medical task which she faced. This was no time for her to consider how a ruined social order should rebuild itself. She repeated her promise to do her best before turning away more decisively to make the necessary new arrangements.
âMay I give you help?' Sergei was at her side as she crossed the field. He made a gesture towards the empty sleeve of his shabby military coat. âI'm no use to any army now, praise be to God. But I can work as a nurse or a messenger. As your orderly, I could help with any problem of language, between French and Serbo-Croat or German. If you will teach me a little English as well, you will find I learn quickly.'
Kate had been too greatly concerned with the children to pay much attention to their escort. Now she looked at him more closely. His tangled beard had given the
impression of an older man, but he might not be more than thirty. His eyes, unnaturally bright, glittered out of a face which was too pale, almost grey. His clothes were ragged and he himself was dirty. Nevertheless it was immediately clear that he was not a peasant, but an intelligent and perhaps even an educated man.
His offer was tempting. Kate had known even before she arrived that she would not be able to communicate in Serbo-Croat, but she had not realized what a disadvantage her lack of German would be. So many of the Serbs had lived under Austrian rule that this was their second or even their first language. Without Muriel, problems of interpretation could arise with an irritating frequency. Kate's knowledge of the political situation in the Balkans was too vague to explain why a Russian should be here. Perhaps he had deserted and now saw the hospital as a kind of shelter. But it was true that his amputated arm must have turned him into a non-combatant, and he had shown compassion by accepting responsibility for so many sick children. It was time to make another quick decision.
âYou may stay as long as the children you have brought are patients here,' she said. âFirst you must move your wagon from the road. Then present yourself at the admission tent. Your beard must be shaved. You will have to be stripped and bathed and rubbed with paraffin and given new clothes before you may go near the other tents and if you leave the compound at any time after that, you may not come back.'
Had she spoken in such a way to an Englishman he would not have been able to believe his ears, but Sergei saluted her now in a manner which was not a correct military gesture but was clearly intended to be admiring rather than mocking. The small incident was reassuring, re-emphasizing her discovery that if she was decisive enough about giving orders, even men would obey promptly.
Sergei made himself so useful that there was no further
mention of the suggestion that he should leave with the children. During the next four months at least a hundred thousand Serbs died in the typhus epidemic, and in the whole of the country fewer than a hundred doctors remained alive. Some deaths took place in Kate's hospital, for many patients arrived too ill to be saved. But her sanitary barriers proved effective and there were no cases of cross-infection. Even dysentery was kept at bay in spite of the lack of plumbing. She also found time to organize dispensary teams to go out to the villages so that when a second epidemic began â this time of diphtheria â its victims could be treated with serum in their own homes.
Kate had been taught that typhus was a cold-weather disease and as the summer sun grew hotter it did indeed seem that the plague was coming to an end. Fewer new patients were brought to the hospital and, now that the sides of the tents could be tied up to let the breeze blow through, those who remained made a faster recovery. For the first time since her arrival there were moments â even half-hours â when Kate could feel herself off-duty. Sergei, quick to pick up a little English, insisted on teaching her Russian in return. Kate protested laughingly that of all the languages in the world Russian was the one least likely ever to be of use to her, but was disarmed by his sweeping assertion that to acquire useless knowledge was the mark of the civilized person. Her good ear for both languages and music enabled her quickly to acquire a conversational vocabulary. Learning to read and write was more difficult, but there was an attraction in finding a use for her previous study of the Cyrillic alphabet, and the unavailability of any other books gave her an incentive to master those which formed Sergei's only luggage. Welcoming the necessity to clear her mind of medical problems for an hour or so, she enjoyed her lessons and made good progress. Like a dutiful schoolgirl she studied grammar and was rewarded by poetry.