Electrotherapy at Horton (County of London) War Hospital, Epsom, in WWI.

A shell-shocked soldier receives treatment from a nurse
A shell-shocked soldier receives treatment from a nurse.
The patient is in a Bergonic chair used for giving general electric treatment. c.1914-1918
Image Source US National Museum of Health and Medicine (ref Reeve 041476) via Flickr

In 1895 Sigmund Freud had reviewed electrotherapy, declaring it a 'pretence treatment'; charges of charlatanism persisted and the procedures retained a dubious reputation amongst members of the medical fraternity. Nevertheless, electro-shock therapy became the most notorious of shell-shock treatments during the Great War, causing disquiet not only from ordinary soldiers but amongst other doctors who worried that the over-use of simple electrotherapy would condemn patients to the care of untrained 'medical electricians'. Proponents of electric shock therapy argued that it worked and that it was not necessarily inhumane but soldiers were frightened of it and protests demonstrated the extent to which patients and the general public wanted to curtail the excessive power of wartime psychiatrists. Those suffering from 'shell - shock' were viewed with suspicion by the War Office, and by many doctors, who believed that it was a form of weakness or even malingering. Officers with the condition went to Craiglockhart where they were treated by psychiatrists whilst other ranks went to hospitals such as Netley, or were placed in asylums. Horton was a general hospital treating casualties with a wide range of injuries and illnesses. The over-riding priority was to restore as many men as possible for an early return to combatant service.

In the History of the Horton War Hospital, Epsom, Col. Lord, the Commanding Officer, remarked: -
'The electro-therapeutic department and massage corps were indispensable adjuncts to the work of the surgeons. . . . I always resisted the creation of a special massage department, my line of argument being that in a general hospital such treatment should not be severed from the immediate supervision of the sister and medical officer in charge of the case'.
During 1911, Noel Hawley Michael Burke (b. Galway 1885), was living with this mother, Mary, in 43 St. Dunstan's Road, London. At St Peter's Bournemouth on 3 February 1913 he married Mildred Ethel Finlay.

In Radiology and Electrotherapy, Vol. 22, No. 5, 1917, Noel H M Burke [1885 - 1964], M.R.C.S., L.R.C.P., Temp. Lieut. R.A.M.C.; Medical Officer in Charge of Electrical Department, Horton (County of London) War Hospital, Epsom, wrote about procedures adopted there in an article which included the following extracts: -
"The Horton Asylum, at Epsom, was converted into the Horton (County of London) War Hospital, and opened for reception of soldiers in May, 1915. The first convoy arrived direct from France on June 16th, 1915. There are 2,532 beds, of which half were filled by August, 1915, and most by September, 1915. During the first half of 1916 the hospital was only moderately full; since then it has been constantly above the 2,000 level. Besides general and mostly acute cases from the various fronts, the hospital is a centre for eye work and for ear, nose and throat patients, and deals with the sick from the Eastern Command.

The cases from Woodcote Park Convalescent Camp are sent to it for hospital treatment, and mostly reach the electrical department; latterly the neighbouring Manor War Hospital has sent over its electrical cases to Horton for examination and treatment. It will be seen, therefore, that there has been a large, and until this spring a fairly growing population from which the electrical department has drawn its material.

The work is done entirely by time table and appointment, so that confusion is avoided, patients are seldom kept waiting, and there are no periods of intense rush alternately with times of idleness. Special treatments, such as sinuses and open wounds, are carried out by the medical officer in charge; otherwise his time is fully occupied in seeing cases - new and old - keeping the notes and records in order, and controlling the work generally. All ordinary treatments are given by two male orderlies specially trained and under constant supervision.

Patients begin to attend at 8 a.m. and are all dealt with by 5 p.m. The rest of the orderlies' time is required for cleaning the instruments, delivering notes and reports, winding bandages, and so on. A third orderly keeps the rooms and fittings clean and does the dirty work generally.

Types of Cases Seen, Methods, and Results.
1. Peripheral Nerve Injuries. - These constitute about a half of the cases dealt with.
A. Testing is done by the old-fashioned faradic and galvanic method; the condenser responses are noted as well in nearly all cases. Less reliance is placed on the latter than was the case a year or so ago. No diagnosis is attempted without a second thorough examination after an interval of three or four weeks of treatment; much importance is attached to the result of stimulating the nerve trunks above and below the lesion. Some 85 cases have come to the operating theatre, and in most of these the exposed nerve trunks have been electrically tested by a sterilizable electrode.
B. Treatment follows no hard and fast line, but is prescribed according to the special requirements of each case. For instance, in a case of nerve concussion, compression by scar, or after operation, a galvanic current is passed through the seat of trouble to improve the local nutrition and help absorption of inflammatory products.
For maintaining muscular tone and the general nutrition of the limb, some form of rhythmically varying current is used - sinusoidal, faradic, or condenser discharges.
The old and somewhat unproven theory that muscular contraction must of necessity be produced is not followed at this hospital. The use of the sinusoidal bath is instituted by Lewis Jones, at St. Bartholomew's Hospital, has shown conclusively that excellent results follow treatment whereby no visible contraction is produced, and similar methods are employed at Horton with equally good results. For circulatory disturbances, especially in cases complicated by ligature of vessels and for neuritic pain, the eau courante [spouting jet bath] has proved its value many times. These methods are used in conjunction, of course, with the necessary mechanical support to weak muscles, and in most cases massage is also employed. The results are very satisfactory; trophic ulcers are very rare, pain is greatly relieved in nearly all cases, and return of function occurs in all cases that can be followed for a reasonable length of time.
2. Scars, causing limitation of movements, have been treated with chlorine ions, high frequency, or whirlpool baths, immediately followed by massage, and good results recorded.
3. Stiff joints have yielded well to galvanic currents, and to whirlpool baths.
4. Pain
(a). Neuritic -There have been excellent results of eau courante [spouting jet bath] treatment in acute traumatic neuritis; other cases have responded better to salicyl ions.
(b) Crushed backs after burial have received most benefit from salicyl ions.
(c) The painful shins of trench fever have done very well with rhythmic sinusoidal baths.
(d) Chronic sciatica, lumbago, and other vague and probably rheumatic conditions, have shown somewhat disappointing results, largely in proportion to the previous duration of the ailment.
5. Trench Feet
In 1915-16 these were unsatisfactory, as there was then no sinusoidal, high frequency, or eau courante [spouting jet bath] treatment available; in the winter of 1916-17 they did well, with the greater choice of method at the disposal of the department. The painful type did best in baths giving ionisation with sodium salicylate, for the circulatory type rhythmic sinusoidal and whirlpool baths were about equally useful; while in a few cases, where the presence of gangrenous patches contraindicated a wet method, encouraging results followed exposure to the effleuve of the high frequency vacuum electrode. Altogether two-thirds of the cases treated in the recent season were benefited, one-third were not classified, and none were definite failures.
6. Chronic wounds and sinuses have been readily healed by ionic, or by Russ' methods, and occasionally by high frequency. When bone has been involved no definite improvement has been obtained by any electrical method....
23rd June, 1915, to 30th June, 1917
Patients seen and discharged

(a) in first 11 months, 270, who had had 3,473 treatments.
(b) Patients seen following 7 months, 277, who had had 11,339 treatments.
(c) Patients seen following 6 months, 328, who had had 6,736 treatments...."
Of the 456 patients classified on discharge it was claimed only 23 had not been improved by their treatment but the basis of that assessment was not disclosed.
Noel Burke was promoted Temporary Captain, RAMC, 18 June 1917. On 26 April 1919 he relinquished his commission and in 1923 was resident at 65, Cheyne Walk, Chelsea, SW3. By 1925, however, he was employed as a Physician in The Ministry of Pensions Hospital, Orpington, Kent. This had been No. 16 Canadian General Hospital demobilised on 20th September 1919, when it came under the control of the Ministry of Pensions. It then provided treatment and care for 1000 disabled ex - servicemen and was staffed by the Ministry of Pensions Nursing Service (MPNS). Eventually the establishment became the Orpington municipal general hospital.

His wife, Mildred Ethel Burke, died at 31 The Avenue, Lewes, Sussex, on 27 August 1960.

The career of Noel Hawley Michael Burke, who in 1954, had been awarded an Order of the British Empire in the Queen's Birthday Honours, is described in an obituary which appeared in the British Medical Journal for 1964: -
"N. H. M. BURKE, J.P., O.B.E., M.R.C.S. L.R.C.P., D.P.M., D.M.R.E.
Dr. N. H. M. Burke, formerly medical superintendent of Cell Barnes Hospital, St. Albans, Herts, died on 4 September aged 79. He was a Fellow of the British Medical Association. Noel Hawley Michael Burke was born on 11 December 1885 of a military family, and after studying medicine at King's College Hospital qualified M.R.C.S., L.R.C.P. in 1914. After military service in the R.A.M.C. he took the D.P.M. in Psychiatry in 1924 and another D.P.M. in Mental Deficiency in 1928. In 1927 he took the DAM.R.B. After gaining a wide experience in psychiatry Dr. Burke was appointed deputy medical superintendent to the Fountain Hospital and in 1932 medical superintendent to Cell Barnes Hospital. He occupied this post with distinction until he retired in 1953. For many years he had given valued service to the local Branch and Division of the B.M.A., and was elected chairman of the Division for 1946-7. He also held important office in the Royal Medico-Psychological Association, and had served as president of the St. Albans British Legion. A chapter on mental deficiency from him forms part of Geoffrey Evans's Medical Treatment (1951). During the second world war Cell Barnes became an Emergency Hospital to which part of St. Bartholomew's Hospital was evacuated. This came under Dr. Burke's shrewd, successful, and harmonious administration. He took great pleasure in his duties as a magistrate, and few people could have been better qualified for this responsible office. His outstanding quality was finally given official recognition on his appointment to the O.B.B. The most outstanding thing about Dr. Burke was his intense sympathy and feeling for both patients and their relatives. Mental deficiency was his chosen specialty, and nobody was better suited for such a service. His feeling for his staff was almost paternal, and there are many still who regard him with great affection. Nobody could work under him without being greatly influenced. His own personal standards, his high integrity, his forward-looking policies, and his great friendliness endeared him to all his colleagues. In the last 25 years few people have done more to improve the lot of the mental defective. He strove for improved diagnostic, therapeutic, and educative techniques and was always ready with advice and guidance for less experienced practitioners. With his passing a great figure is removed from the psychiatric scene. His wise counsel, sound judgement, and burning enthusiasm will be sorely missed and can never be fully replaced. As recently as July 1964 Dr. Burke took up residence in Canada with his daughter and her family. She also qualified from King's, and to her is extended sincere sympathy in her great loss.
G. S. M."

Brian Bouchard, July 2016