PRIVATE PAIN AND PUBLIC DISPLAY: THE ANZIO BEACHHEAD
During the winter of 1943-4, Allied troops came to a halt in their advance up Italy on the Gustav line, which included the slaughter point of Monte Cassino. In an attempt to outflank this line, American and British troops landed 50 miles north on the beaches of Anzio in January 1944. They landed successfully on the coastal strip but were trapped when the Germans regrouped in the hills. It took until May 1944 before there was a break-out and Rome was captured. During this time, the Allied troops' lines hardly moved and they suffered heavy casualties, mainly from persistent artillery fire.
Harry K. Beecher was the medical officer admitting casualties to one of the few hospitals on the beachhead. He was later to become a leader in the new clinical research on pain as professor of anaesthesia at Harvard. His concern for humanity reflected that of his ancestor, Harriet Beecher Stowe, author of Uncle Tom's Cabin. Every wounded man who could speak was asked the same question: 'Are you in pain? Do you want something for it?' All of these men were seriously wounded as they had already been sent back after first aid in advanced medical posts. Some of these men were in an exalted state, recognizing their near brush with death. Beecher collected the answers and was astonished that 70 per cent of the men answered no to both questions. When the war was over, Beecher asked the same questions to an age-matched group of civilian men who had been operated on at the Massachusetts General Hospital in Boston; 70 per cent answered yes to both questions.
Beecher reasonably concluded that something about the situation in which the tissue damage was inflicted influenced the amount of pain suffered. Beecher had a theory about what was the crucial difference in the two situations. To be wounded on the Anzio beachhead had a positive biological advantage over not being wounded. This paradoxical statement needs explanation. To be wounded and to reach hospital at Anzio implied a good chance of evacuation and survival. To remain in the line unwounded implied a serious risk of being killed. Of the 767 men in the American Rangers battalion who attacked in the attempted break-out on 30 January only six returned. Beecher proposed that the men he questioned in Anzio were pain free because they were in an exalted state in the expectation of survival with honour. Therefore, he suggested there are rare circumstances in which wounding is advantageous, and those wounds are pain free. I doubt this reasoning, but there is no doubt that he observed numbers of seriously wounded men who were not in pain.
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