Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting them on Wednesdays to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The narrator of All Quiet on the Western Front, the famous, semi-autobiographical novel of the First World War by Erich Maria Remarque (1898 – 1970), states that by 1918 war had come to seem so perpetual, so inescapable a fact of existence, that it was just another cause of death, “like cancer or tuberculosis or influenza or dysentery.” As to the latter, the German soldiers were so accustomed to it by the end of the war that they thought it was not worth pulling up their trousers; and the shirt tails of their Russian prisoners of war were stained with blood.

There are several hospital scenes in the book. Near the beginning a soldier in the narrator’s company, called Kemmerich, has been wounded. His companions visit him in the clearing station where he suffers phantom limb pain:

“How’s it going, then Franz,” asks Kropp.

Kemmerich’s head drops back. “OK, I suppose. It’s just that my damned foot hurts so much.”

We glance at his bed-cover. His leg is under a wire frame, which makes the coverlet bulge upwards. I kick Müller on the shin, because he would be quite capable of telling Kemmerich what the orderly told us before we came in; Kemmerich no longer has a foot. His leg has been amputated.

Nevertheless, his life has not been saved; he is clearly dying. He is so close to death, in fact, that his companions have already forgotten what he looked like when he was healthy. Müller is interested in his excellent boots for which, unlike Müller, he no longer has a use. Müller is not callous or unprincipled; he would never dream of taking the boots if Kemmerich still had a use for them; but Müller is anxious that the ward orderlies will appropriate them first if he does not preempt them. The war strips away all superfluous refinement of feeling, turns everyone into a raw utilitarian and makes survival the highest good.

Towards the end of the book the narrator is wounded and is sent to a hospital run by Catholic nuns. He is so exasperated by the sound of their prayers that he throws a bottle at the wall and it smashes. One of the other patients owns up to this breach of discipline because he bears a certificate of head injury saying that his behaviour might become erratic and is therefore to be excused.

When patients in the hospital are certain to die they are taken to the Death Room which, however, is not large enough to contain them all. New wounded arrive constantly:

Our room gets two blinded soldiers. One of them is very young, a musician. The nurses never use knives when they feed him; he’s already grabbed one once out of the nurse’s hand. In spite of these precautions, something still happens. The sister who is feeding him one evening is called away, and leaves the plate and fork on the side table while she is gone. He gropes across for the fork, gets hold of it and rams it with all his force into his chest, then grabs a shoe and hammers on the shaft as hard as he can.

Doctors are not heroes to the narrator; “there may be good ones,” he says sceptically, but many of them simply do the military’s bidding and, as in George Grosz’s famous picture, declare the crippled and the skeletal to be A1, that is, “Fit for active service.”

How many of us have the strength to resist the pressure of authority?