Described by and named after the American physician Jacob Mendes Da Costa, as he studied the effects of combat on Civil War soldiers, cases of Da Costa’s syndrome surged during the First World War as scores of traumatised young men, whose nerves had quite literally been shot to pieces, returned home. Believing the syndrome to be caused by ‘the irritable heart of the soldier,’ Da Costa observed that while symptoms varied, heart palpitations and significant cardiac pain were almost always present; this led to it being commonly known as ‘Soldier’s Heart.’
Writing about the physical effects of Soldier’s Heart in his 1918 monograph The Soldier’s Heart and The Effort Syndrome, the cardiologist Thomas Lewis noted that fatigue, shortness of breath and dizziness were also reported. In many cases, physical exertion was liable to bring about an attack, and as Lewis explained, ‘because these symptoms and signs are largely, in some cases wholly, the exaggerated physiological response to exercise’ thus, he christened it ‘the effort syndrome.’
From 1914 to 1918, up to 60,000 British soldiers were diagnosed with Effort syndrome with as many as 44,000 being discharged from the Armed Forces as a result. Many of those who suffered with this debilitating and often distressing affliction, contributed to the pioneering research undertaken by Lewis at The Military Hospital, in Hampstead. Lewis was joined there by the Canadian cardiologist, Thomas Cotton and a number of other highly eminent physicians, including Sir William Osler, Sir Thomas Clifford Allbutt, Sir James Mackenzie, Jonathan Campbell Meakins, John Parkinson and A. N. Drury.
The Military Hospital was originally founded as the North London Hospital for Consumption and Diseases of the Chest, work began on the site at Mount Vernon, Hampstead in 1880, with the building’s design adopting a French Renaissance style. The following year, the Western Block which contained 34 beds was built; by 1893 this number had grown to 80 after the Central Block was finished, yet five years later only 60 of these were occupied. In 1901, the hospital was renamed The Mount Vernon Hospital for Tuberculosis and Diseases of the Lungs and two years later, the Eastern Block was finally completed.
By early 1914, financial difficulties forced the sale of the hospital to the Medical Research Committee and Advisory Council. After the outbreak of war, Mount Vernon was offered to the War Office, who initially suggested that it be used as the No. 1 Canadian Stationary Hospital. However, the building required many adaptations in order to fulfil its new role. In March 1915, the hospital changed hands again, after it was granted to the British Army and became known as The Military Hospital, Hampstead.
The Commanding Officer placed in charge was the Boer War veteran, Colonel Reid, with wards the responsibility of Dr Chapple, a Liberal M.P. who held the temporary rank of Major. Matron Amy Willes headed the nursing staff until 1916 when she was transferred to the Connaught Hospital, Tidworth and awarded the R.R.C., 1st Class in June of that year. In addition, there were 6 sisters and 8 Voluntary Aid Detachment members, including the distinguished stage actress, Olga Nethersole. Indeed, so moved was Nethersole by her time at the hospital that she would go on to establish the People’s League of Health in 1917, which sought ‘to raise the standard of health of the British nation.’
Several weeks after The Military Hospital opened its doors to the wounded, an article about the importance of its work featured in The British Journal of Nursing. Marvelling at the hospital’s transition, it was noted how the ‘entrance hall and wide corridors are dominated by men in khaki, sergeant-majors, hospital orderlies, and a passing medical man, while up and down the corridors pace the convalescent soldiers in smart brand new hospital uniforms of blue coat faced with white, trousers to match, and scarlet tie; the distinctive red cape of the Army Sisters and the grey cape with red border of the Military Nursing Service Reserve, are also in evidence.’
Hampstead residents were keen to show their appreciation to the men who were ‘heroes all’ with convalescents not only enjoying ‘the bracing air of Hampstead’ but also ‘the admiration of the neighbourhood.’ Remarking upon how they had been ‘sent useful gifts’ by grateful civilians, Sister Willes further appealed to their generosity, adding that she would welcome ‘some bed-tables on castors, made to slide over the beds, and some flower-pots for the plants which decorate the wards.’
In May 1915, a correspondent for the Evening Post also paid a visit to the hospital, during which time many being treated were casualties of the Battle of Neuve Chappelle. One resident had been struck in his left arm by a splinter of shrapnel, which tore through the bone before entering his chest, breaking his collarbone and finally settling in the wound. It was thought that removal would be comparatively easy, although psychologically harmful for the soldier, ‘whose nervous system is so shattered by the ordeal of Neuve Chappelle.’ Nevertheless, the injured soldier felt buoyed by the sense of camaraderie he had felt both at the front and at the hospital, commenting, ‘Oh, they stuck it lovely, our fellows did; yes, they did, they stuck it lovely. And all our mates lying dead. The General gave us the order to stop firing, but we didn’t want to, seein’ our mates lying there. They stuck it lovely, they did.’
Mount Vernon became The Royal Flying Corps Hospital in 1917 and the specialist heart unit was transferred to Sobraon Barracks Military Hospital in Essex. New recruits underwent thorough medical examinations, with cardiovascular debility being cited as a recurrent reason for rejection. It was also decided by an Air Medical Investigation Committee, that the hospital should focus upon complaints uniquely seen among pilots, for example, anoxaemia, a deficiency of oxygen in the blood usually caused by high altitudes. One of the most well-known patients to be treated at the The Royal Flying Corps Hospital, was Captain Arthur Roy Brown, the Canadian flying ace credited with shooting down the infamous ‘Red Baron,’ Manfred von Richthofen.
Brown’s brief stay at the hospital in May 1918 coincided with the appointment of W. H. R. Rivers as its Chief Psychologist. Rivers, who is largely known for his work with the war poet Siegfried Sassoon and with soldiers suffering from shell shock, was able to draw upon his time as RAMC Captain at the Craiglockhart War Hospital, Edinburgh to help Brown. Despite protestations to his father that ‘all that is really the matter is that I am just tired out’ Brown had in fact been suffering from severe war neurosis. By June, Brown was sufficiently rehabilitated to be posted as an instructor to the No. 2 School of Air Fighting, but he was again hospitalised after a crash in July, and returned to Canada in 1919 after leaving the RAF.
It was also in 1919, that Mount Vernon ceased to be used as a hospital, instead becoming an outpost of the National Institute for Medical Research and it was there that the Influenza virus was first identified in 1933. The grand building has now been converted into luxury flats, but its impressive façade still alludes to its illustrious history, as a staging post in the treatment of the neurological and psychological damage that can accompany the stress of combat. Shortly after it was taken over by the military, a visitor recalled hearing a service held by the hospital chaplain and vividly remembered the sound of men singing loudly in unison:
‘The Son of God goes forth to war
A kingly crown to gain;
His blood red banner streams afar:
Who follows in His train?
Who best can drink his cup of woe
Triumphant over pain,
Who patient bears his cross below,
He follows in His train.’