Angles on Mons

‘The Angel of Mons’ by R. Crowhurst (UK National Army Museum)

I’ve been catching up on the BBC’s latest First World War documentary series, as the centenary approaches (that fact is not coincidental to my sporadic posting – day job and all). It’s actually pretty good, though I did catch a dodgy claim in the first episode. The redoubtable Mr Paxman, explaining the ‘defeat’ of the Battle of Mons and the famous story of angelic salvation, told us that;

“There was one simple explanation for the Angels of Mons: exhaustion”.

This is indeed a simple and plausible explanation for a bizarre story of angelic apparitions rushing to the aid of British Tommies. But it’s wholly unnecessary. The origins of the story as a piece of fiction turned folklore are well documented. Arthur Machen’s ‘The Bowmen’, written in faux documentary style, was modified to be more Protestant Christian (angels not unquiet dead), and embraced as genuine by Spiritualists, who then went hunting for/fabricated ‘evidence’. The rest is history.

If you’d like the real story, I recommend this article by the excellent David Clarke in the equally great Fortean Times, and, if you can access it, another of his from the journal Folklore. He went on to write a book on the subject. You can also check out this Skeptoid podcast. Another article by Steve MacGregor supports Clarke’s thesis, and focuses on the propaganda and recruitment value to the British government of this kind of story.

It does surprise me in the Age of Google, that no-one researching this series bothered to even read the Wikipedia page on the subject. I suspect, given the description of Mons as a ‘defeat’, that they chose to twist the tale to suit the narrative of exhausted, beaten troops. I don’t think they’ve entirely shed the ‘lions led by donkeys’ theme. In fact, as dire as casualties appeared at the time to a naive public, Mons was actually a very successful fighting retreat.

It’s a shame in another way too, because Clarke’s interpretations of the story are far more interesting. He casts the construction of the story as myth-making for the industrial era, and as a psychological coping mechanism for people on the home front to deal with the horror of modern war and mass casualties amongst their loved ones. To this I can perhaps add something to bring things full circle to the many soldiers who survived Mons. There actually is a direct relevance here that doesn’t rely on hallucination. Whether or not there were/are ‘no atheists in foxholes’, as the war progressed and the remaining soldiers of the professional army were joined by civilians, it appears that the number of believers in the supernatural also increased. Every soldier was issued a set of identity disks (later nicknamed ‘dog tags’), to be recovered in the event of their death. On these tags, alongside abbreviations like ‘CE’ for Church of England’ and ‘JEW’ for Jewish, was also stamped ‘SPIRI’, for ‘Spiritualist’. This reflects a booming recruitment period for that faith as people struggled to deal with the loss of sons, fathers, and partners. These soldiers and perhaps non-Spiritualists also, must have brought this civilian tale of an incident that never happened with them to the front, and carried that belief with them into battle. I may not believe it myself, sitting in the comfort of home, surrounded by my loved ones; but I cannot help hoping that it provided them some comfort.

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First World War Myths

Quite a brave article from the BBC after the recent hoopla from Michael Gove’s Daily Mail piece. Efforts by historians like John Terraine [thank you for the correction commenters – brain fart there I fear!] and Gary Sheffield have made little inroads into our Blackadder-tinted view of the Great War, so this is quite an encouraging bit of popular-level scepticism. It will be interesting to see which group of revisionists ‘wins’ the public perception war as the centenary nears.

The Great Homoeopathic War

Or; “Homoeopathy! Huh! What is it good for?”

If you do some Googling around the subject of First World War medicine, it won’t take long before you come across the subject of homoeopathy. One account is to be found on the venerable “Vlib” – here – but gets reproduced wherever there are homoeopaths hawking their wares (there’s an illustrated version here). It describes the work of the Anglo-French American Hospital in France during WW1. This actually happened, and the text is reproduced from a primary source.  Further, two out of five articles in the WW1 medicine section of Vlib deal directly with period homoeopathy, this being one. So did homoeopathy play a big part in WW1?

Context is vitally important here, and the author of the “editor’s note” at the start of the article has attempted to provide it. Unfortunately it is entirely credulous and lacking in supporting references. It’s written by a Dr M. Geoffrey Miller – a proper doctor, who seems to have a soft spot for the brave homoeopaths prepared to take on actual diseases armed only with a small phial of water (if you’re thinking “huh?”, read on).Miller seems to take the view (here also) that in a context where conventional medicine couldn’t help and might even hinder, some kind words and a placebo were exactly what was called for. He doesn’t appear to be a proponent of modern day homoeopathy, but like some of his colleagues and many members of the public, he misunderstands what it actually is. He says;

“ Homeopathy (or Homoeopathy) is the treatment of disease by diluted drugs that in a healthy person would produce symptoms of that disease.”

This is, frankly, bollocks. Treatment of a healthy person with a homoeopathic preparation would NOT produce symptoms of anything. This is because by definition, any truly homoeopathic treatment is so diluted as to contain not even one molecule of the “drug” it is meant to contain!  Let me put this as simply as possible:

Homoeopathy is NOT herbal medicine – it contains no herbs.

Homoeopathy is NOT medicine – it contains no active ingredient.

Homoeopathy is water. Magic water.

Or sometimes a magic sugar pill.

You know what other “treatment” is provided in the form of a sugar pill with zero medicinal content? That’s right, a PLACEBO. And that’s exactly how homoeopathy “works”. Now, there’s not necessarily anything wrong with  exploiting placebo effects to ease suffering. But all it’s doing is playing with the patient’s perception of how unwell they are. So any claims of patients recovering because of homoeopathy should be treated with great scepticism.

What of the results given in the essay? Aren’t they suggestive of some working treatment? Well, no. 10 patients had typhoid – all survived. Must be down to the homoeopathy, right? Nope. Typhoid, untreated, has a 10 – 30% fatality rate. For none out of ten patients to die is fortunate, but hardly evidence of effective treatment.

This is irrelevant, since for a treatment to be worth anything, it must produce reliable results, and must be distinguishable from natural recovery (aka regression to the mean). No scientific studies have shown homoeopathy to be better than placebo. This is, in fact, because it IS placebo. The Neiully homoeopathic “hospital” was in fact a convalescent ward for non-critical patients.

Predictably, bound up with the talking-up of homoeopathy, is the  doing-down of conventional medicine (or “allopathy” in the homoeopaths’ cultish newspeak):

…because orthodox management of disease frequently cause iatrogenic illness from the toxic effects of drugs that were commonly prescribed and which were not particularly effective in any case.

Bzzt! Let’s play homoeopathy bullshit bingo! Homoeopaths and their fans are always on about “iatrogenic illness” – this is the harm done by drugs with side-effects, misdiagnosis, and medical incompetence. All of which are possible because conventional medicine ACTUALLY DOES SOMETHING. Homoeopathy, which DOES NOTHING, is free from such complications. In a WW1 context, critics have much more of a point than they do now – with penetrating traumatic injury and far from ideal conditions in many hospitals, infection and disease were much harder to control by any means. Thus harmless quacks could be let loose on people that might recover given time and relatively sanitary conditions, or might not. But the failings of early 1900s medicine are not positives for homoeopathy – it must stand on its own as an effective method of treatment. And even 80 years later, it simply does not. Further complicating any meaningful assessment of this hospital is that it appears to have employed conventional medicine also. How are we to disentangle the effects of a) homoeopathy, b) “allopathy” and c) people getting better on their own? Needless to say, this situation allows the homoeopath with rose-tinted glasses to credit homoeopathy with all the successes and to slate conventional medicine’s “toxic effects“.

This is a common tactic of today’s homoeopaths – how else would you persuade people to lay aside proven treatment and drink magic water?

The author also states that;

“It would be true to say that very few medications of the WW1 period were truly effective, certainly not in the way that modern medications are today.”

In this context, he’s almost right. We’re pre-antibiotics here. But it would be even truer to say that NO homoeopathy is “truly effective”. The reality here is not that homoeopathy was able to step in where conventional medicine failed, but that precisely because there was (and is) no active ingredient in homoeopathic medicine, a facility based around its use would at worst do no harm. Read between the lines of this statement;

nearly all the medical complaints were incurable by the orthodox treatments of the time and all would fare as well as they would if they were admitted to the orthodox General Hospitals.

Then there’s this bit;

Many would do better because of care that they were given by the dedicated nurses and doctors.

In other words, given a less crowded and lower pressure environment, the staff would be able to offer personal attention to patients and a better bedside manner, thereby enhancing the placebo effect. Making people feel as though they were getting better, as if the medicine were working.

Every single non-surgical case referred to constitutes a self-limiting illness that would have got better on its own. If it hadn’t, it wouldn’t have been selected for inclusion in this article! The second half of this screed deals with surgical patients (a majority) who were simply in recovery for, or being cared for prior to, surgery at an ACTUAL hospital – in this case the American Ambulance Hospital, also at Neuilly:

“In the later months of the work at Neuilly the cases were increasingly surgical. Altogether they totaled one hundred and twenty-two. Many of these had been operated on at the base hospitals, cases of fracture having received the requisite surgical first-aid, and bullets and shrapnel fragments having mostly been extracted. Here the process of healing merely required watchful safeguarding, and the concussion injuries and contusions without open wound also required no active surgical interference.”

We are not told of most patients’ fates. Though conventional medicine could do little for infection, there is no evidence here, nor anywhere else, to suggest that homoeopathy could either. In fact bearing in mind its proposed mechanism – magic water – there is no possible way it could have.

Essentially it appears that this “hospital” was used as convalescent bed-space, and not for terribly long either. As the homoeopaths could do no active harm, and had at least one surgically trained doctor on staff as well as professionally trained nurses, they were permitted to go ahead and try their luck (and my patience). This is further evidenced by the comment;

“The War Office and Admiralty respectively had ultimately accepted the offer of beds made by British Homoeopathic institutions early in the war, and an increasing number of patients from the Army and the Fleet were being sent to the Homoeopathic hospitals in England.”

They accepted because bed space is the #1 commodity in healthcare, especially in time of war. The vast majority of patients were (and to an extent still are) recovering on their own under observation by others. And those observers, the nurses, would have been just as professional and experienced as at any similar institution not employing dubious treatments.

As for why this hospital lasted less than 18 months, the author cites pressure on homoeopaths at home (to administer the aforementioned beds, as well as thinking they were also treating patients), many homoeopaths called to service in the RAMC, and (more importantly!) the fact that the landlord wanted them out. The place had been a sanitorium before, and as it was again by 1934, we might speculate at the reasons for eviction.

The article gives us a total of 122 patients in the 15 months that the hospital was in operation, with 11 nurses on staff according to an article on the Royal College of Nursing site. The number of doctors isn’t clear, but it appears to have been a handful. This is typical of an Auxiliary Hospital of the time, and in fact, that’s what this place was.

Auxiliary Hospitals were vital but non-critical establishments intended to allow long-term sick and post-operation patients to convalesce.This is not to do-down their role, just to belie the implication of the article that this was some frontline hospital (note that this stresses a location as close to the front as possible).

What of the wider context claimed here? That homoeopathy was;

…widely practiced during WWI…

First – blood-letting was widely practiced in medieval times – this is not an endorsement of its efficacy. Second, what does “widely” mean? Where are the numbers? What other hospitals were there? What studies and results are cited? Bugger all, that’s what. And there’s nothing on the WWW, nothing on Pubmed,  and nothing in the JSTOR journal archive to even suggest this. The only possible source of enlightment in this regard is an article locked behind a pay wall at Sciencedirect. So, a homoeopathic gold bar to anyone that can show me evidence that justifies this claim (use the comments section below).

Til then, it’s just self-aggrandising hot air.

Last word goes to the “Quackometer”, which awards the article 4 “canards” out of 10…

For more on homoeopathy, see the excellent Bad Science blog, run by the Guardian’s Dr Ben Goldacre.