First, Michael asks Professor John Oxford about the impact of influenza on the Armistice:

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Michael Palin: How significant was the influenza outbreak on the casualties at the end of the First World War?

Professor John Oxford: In the American Army it was hugely significant. I mean more American soldiers died of the influenza than died from German action.

Michael Palin: So how did it begin?

Professor John Oxford: We think it began in the great Army camps on the Western Front. The biggest one was Etaples. They had everything there that we now know could engender a new virus, a new bird virus to appear. And it was a bird virus, it was overflown by migrating ducks and geese, and we now know that those animals, those birds carry these viruses. We’ve got samples from the lungs of people from, certainly from 1918. I mean, for example, this little box, I mean surprisingly there’s a sample here of a lung from a young person who died.

Michael Palin: Oh, wow.

Professor John Oxford: It’s dark because in those days there was so much pollution around there. So what we do is we take a little scalpel, chop off a little piece, and they’re very precious because people risked their lives to get these samples, to get a piece of lung of a person who died of influenza in 1918 you risk your life getting it, and when you examine that and do the analysis you find out that it’s a bird virus. It’s not H5N1, it’s what we call H1N1.

Michael Palin: What did they know about the epidemic at the time and how did they, were they able to contain it successfully?

Professor John Oxford: The first indications I think they had, and I’m full of admiration for them I must say, was in the Royal Army Medical Corps, 1916, in the great camp at Etaples, they were worried, they’d always been worried about infection in the First World War because in every previous war more soldiers had died of infection than had died of bullets or shell wounds. But the First World War they seemed to have got away with it up until 1916, and then suddenly in Etaples and Aldershot Barracks the soldiers began to die in the camps of a respiratory infection. That really got the alarm bells ringing.

Michael Palin: What measures could they take or did they try to take to contain it?

Professor John Oxford: They could do quite a lot. Strangely now we’re learning, I’m glad we are, we’re learning from what they tried. They were really struggling, and they must have had huge commitment. I mean those nurses there, they were nursing soldiers who were dying in Etaples of influenza, they realised if they caught it they could die. 50% chance. They did not make a run for it. So they were putting effort in I think to try and contain it. They used masks, they tried to do a bit of social distancing, you know, move yourself away, but if you’re nursing someone how can you do that. They had to get pretty close. And they used hygiene. Wash your hands. And we now know scientifically those three things can have some effect, so we are learning from the events on 1916-17-18. In an unprecedented way they published, they were allowed to publish in 1916-17 about this outbreak, and then by 1919, this is The Lancet 1919, and they produced their kind of classic work.

Michael Palin: And what are these?

Professor John Oxford: This is the important pictures.

Michael Palin: What do these signify, someone in this ...

Professor John Oxford: They signify a typical soldier, a young person, you know, this is youth here. So there’s an infected soldier, flushed, headache, aches and pains, tightness across the chest, ill in bed, you know, probably will survive. As they move down to the next bed and they see someone, a soldier who’s already had this and has moved on, when they see that, this is this ...

Michael Palin: Yes, a sort of grey pallor.

Professor John Oxford: Yes, it’s called, a heliotrope cyanosis it was called, and heliotrope is a kind of lavender colour. You could go into a ward, they could go into a ward, Dr Abrahams, he could go into a ward, he looked round the ward and said look, how many soldiers are coloured like that, they’re going to die, you can get ready for the next soldier to take their bed. Because he’d look at them and say they will die. And the same with this. This soldier will die, blue lips, blue ears, their oxygenation is so poor they will die.

Michael Palin: At that stage was there anything they could do, do they have any vaccine?

Professor John Oxford: No, there is nothing they could do. The big thing that gave that virus its opportunity to spread was the Armistice. You know, all those millions of young, including my own father, including your father, they were all going home from the Western Front and they were unfortunately carrying these viruses with them, and they would go to every spot of the British Empire. They went home, their parents would call a little party, their son had come home from the War, bring in the neighbours from ten miles around, get in there and get infected and they’d die. That was the biggest outbreak.

Talking to Doctor Andrew Bamji, Michael discovers what medical conditions were like for the injured of 1918:

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Michael Palin: What sort of injuries were you seeing coming into Queen Mary’s at the very end of the War, the Armistice time?

Dr Andrew Bamji: I’ve got a set of notes here of a chap who was admitted here just before the Armistice in fact, and his name is Thomas of the 1st Cheshires, and you can see that the whole of the side of the face has been literally just taken off.

Michael Palin: Yes, just ripped out.

Dr Andrew Bamji: Yes.

Michael Palin: And yet he was still alive.

Dr Andrew Bamji: He was still alive, and conscious.

Michael Palin: One wouldn’t have thought that was possible. And conscious, yes.

Dr Andrew Bamji: Well as long as it doesn’t take off a major artery then he’s not going to bleed to death.

Michael Palin: Yes. So when we were these pictures taken, how soon after the injury?

Dr Andrew Bamji: This was taken about two weeks after the injury, and this is actually dated 6th November, and so we know he would have been here at the time of the Armistice itself.

Michael Palin: Yes.

Dr Andrew Bamji: And as you go through looking at the reconstructions, first of all you can see here that they’ve allowed everything to settle and heal back leaving a very huge defect. Now as we go through these and just watch the dates, we’re now into 1921 and a whole series of tubes and flaps are being raised, and then when we get to August 1922 we’ve recreated the upper lip and then you bring down a last flap to recreate the nose. This is a forehead flap obviously. You then actually cut off the bits you don’t want and send it back. And at the very end this is what you end up with. Our guy is now presentable.

Michael Palin: Yes, put his face really.

Dr Andrew Bamji: Yes. What a lot of people don’t realise is that during the first two years of the war, or the first year and a half, you didn’t have a steel helmet, you just wore a soft hat.

Michael Palin: Oh really? So these were developed halfway through the war?

Dr Andrew Bamji: So these were coming in halfway through the war.

Michael Palin: Really? Yes.

Dr Andrew Bamji: But of course, by protecting the head you hadn’t protected the face so the number of facial casualties went up because, of course, you didn’t get your head injury so you didn’t die, you got your facial injury as well but that was now an injury that wasn’t going to be fatal.

Michael Palin: Right. So for the wounded it was more, you could get more disfigured perhaps than ...

Dr Andrew Bamji: Yes, indeed.

Michael Palin: But more likely to survive.

Dr Andrew Bamji: Yes. So here’s another piece of shrapnel of the sort of that might fly through the air and catch you across the face. And if that came at you edge on it’s going to make a hell of a wound in your face.

Michael Palin: Yes. What did they do to sort of keep them kind of going? Did they, they obviously had no injections or nothing, was there morphine, and they could they give them morphine?

Dr Andrew Bamji: Yes, you had morphine. I mean your chap himself would have a wound pack. Now this is actually ...

Michael Palin: Your chap, the soldier would be issued with these? Yes.

Dr Andrew Bamji: This is your ordinary soldier, yeah. So this would be clipped onto your belt and in it is a little tin which is actually just like a sardine can, and in this is your wound dressing. So if you were fit enough you’d peel open the can and slap the dressing on, or get one of your mates to do it, and hopefully that would staunch the blood. The first point of call for medicine would be the Regimental Aid Post with your Regimental Medical Officer. This was the kit of Sidney Roberts who was an RMO, and this is sort of basic medical kit that he would have. I won’t recommend you take the scalpels out because I’ve cut myself on them before. So this will enable you to do very basic stuff. Now, the other things that would happen perhaps on the front line ...

Michael Palin: So this would be, he’d be almost – would he be under fire while using these?

Dr Andrew Bamji: Yes, yes, he’s up in the front line, or just behind it.

Michael Palin: Yes.

Dr Andrew Bamji: This is a tourniquet, and the idea of this is that if you have a major arterial wound in a limb then you’d strap this around the limb. You’ve got a nice bit of wood tucked in here which acts as a pressure point over the bleeding point. You place that over the top, strap it up and then you twist it even tighter to cut off the blood supply, so you put it over the bleeding point and then hopefully the bleeding will stop. Tie it on, then the patient’s stable and ready to go back to the next step.

Michael Palin: What do you feel about the way the wounded and that side of War is seen?

Dr Andrew Bamji: It’s neglected. Perhaps one of the things that really bothers me about the way that we look at war, and perhaps even the First World War in particular, is we only focus on the glorious dead and in a sense we’re not allowed to see the people who have been disfigured in the way that Private Thomas was disfigured. And if we don’t look at that sort of thing how can we possibly understand what war is really all about?