Book Review: The Backwash of War

In 1915, Ellen N. La Motte arrived in Europe as one of the first American volunteer nurses to work in the field hospitals of World War 1. She was specialised as a Tuberculosis nurse, a keen observer and a writer unafraid of judgment. And she wrote.

The Backwash of War: The Classic Account of a First World War Field-Hospital has her observations of working in a Belgian field-hospital. And she spares nobody. Surgeons, Generals, orderlies, fellow nurses, patients, patients’ wives, and the very foundation of war-time policy – all are scrutinised under her eagle’s eye.

“Much ugliness is churned up in the wake of mighty, moving forces, and this is the backwash of war.”

And truly, there is nothing pretty about these stories, which is probably why it was considered “bad for the morale of the troops” not long after it was first published. But in a way that is a breath of fresh air in the face of the many narratives that attempt to find glory, or at the very least sentimentality, in tales of wartime.

Even though I knew there would be nothing pretty about these narratives, part of me kept waiting for that one happy moment, a silver lining if you will. And even though you will still look for it, I’ll tell you now that there isn’t one. And rightfully so. La Motte makes it her job to convey the atrocities of war as she witnessed it.

I read one review that stated that La Motte was so dispassionate that the reviewer would not want to be a patient under her care. I have to strongly object to this point of view. La Motte is exactly the kind of nurse you want in your quarter. I am sure she is scary as heck, and that she would be one of those nurses feared by medical students and surgeons alike, but she is hyper-aware. She is empathetic, not sympathetic. She allows room for growth, and for change in her own opinions, which we witness in at least two vignettes.

“And there were many people there to wait upon him, but there was no one there to love him.”

I felt a kind of solidarity with La Motte, perhaps because South African hospitals are very often described as a war zone, given the amount of crime and gang wars we see, combined with the omnipresent lack of resources. I have often found myself pondering the same things La Motte pondered nearly one hundred years ago – about worth and dignity, the motives of surgeons and the justifiability of certain health policies.

She illustrates what it is like to work in a time and place of crisis: how you have to let go of the dreams of holding your patient’s hand while lovingly listening to his life story, because you have to get work done. How you have to let go of all of the romanticisms of your profession because reality is uglier, and demands action.

La Motte is also an expert in irony. I thoroughly enjoyed her musings on war, the enemy, family, and under-resourced healthcare, and the fact that she does not feel the need to explain her use of irony. Reading her feels like a stimulating intellectual conversation.

I should add that the actual medical aspect of these vignettes is very interesting, especially to me having just recently done Surgery. Gas gangrene, penetrating abdominal wounds, brain injuries… on the background of medicine 100 years ago, when recovery from penetrating bowel injury was nearly unheard of.

backwash quote


A relatively quick read, written with great style and composure. Recommended to nurses, nursing students, surgeons, medical students, anybody interested in healthcare, history buffs, war buffs, people who enjoy short stories and anybody interested in general.

I received this book from the publishers via NetGalley in exchange for an honest review.


  1. harveylisam says:

    This sounds like something I’d love to read! I love reading honest accounts of this kind of atmosphere, not just the silver linings or the glory. That’s not as real. Thanks for sharing!

    1. It’s a fantastic book. I think you would like it – I mean, even though it’s quite horrifying sometimes.

  2. Natasha says:

    It sounds so sad and interesting at the same time!

    1. It really is both of those. And quite jarring!

  3. I’ve never heard of this book but it sounds amazing – so awesome it’s out there!

    1. Yeah! I loved it. Hope you get to read it.

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