Brana Dimitrijević

The 9th Circle of Pirot (Serbia)

In the small town of Pirot a ward for tetanus patients was founded during the fall of 1914. This was recorded by Dr. Milutin Velimirović, a medical student at that time*. He was the eighth child of the Priest Miloš Velimirović. He spent his childhood and early youth in Pirot and finished his medical studies in Prague, Czechoslovakia, in 1921 and was not destined to ever again return to Pirot.

Velimirović cherished tender memories of Pirot, but as the Great War gathered momentum, his recordings became more austere. The church bells announced many deaths every day, it rained non-stop, and Belgrade fell. Refugees were arriving in great numbers. Bulgaria's attack was imminent according to a newspaper acquired from Caribrod.

From the beginning of the war the elementary school in Pirot was turned into a hospital, which admitted tetanus patients. Velimirovic writes that tetanus was a terrible disease which couldn't be treated with a serum (they did not have it at that time, anyway). Tetanus developed because of injury, no matter how small. But the cause can be found in mud, dust and animal feces. Continuous battles took place in the vicinity of the Sava and Drina rivers. These areas were already notorious for tetanus infection. It is strange that tetanus did not manifest itself on an even greater scale.

When tetanus-infected wounded started to arrive at this hospital, the two volunteering nurses stopped working. They were not afraid of tetanus, because the infection is not contagious, but they could not stomach the horrific appearance of the patients. This was due to spontaneous muscle spasms provoked by toxins that tetanus bacteria had caused in the nerves. Every wounded soldier had a firmly shut mouth and a sardonic, or satanic. smile on his face. Their jaws were so spasmodic that it was impossible for them to take a teaspoonful of water. But if they did, it would result in even stronger spasms of the entire body. Spasms were also caused by the slightest throb or rustle or someone's entering the room talking a bit louder. Some patients would react in such a way that their body would twist in the form of an arch. The doctors practically never visited these patients, not only because of the horrible sight, but also because their inability to help them. From time to time, only the director of the hospital would pay them a visit, giving brief instructions to Velimirović. The only support Velimirović had came from his former teacher, Dara, and a high school student, Momčilo. Although it was insufficient, the assistance was more than welcome. Velimirović was overworked, agitated and brokenhearted. Nothing ever left a more profound scar on the 21-year old. Nothing ever had such an impact on him, not even the typhus epidemic that occurred during the winter and spring of 1915—when the improvised hospitals in Pirot, situated in the town's largest buildings, became massive centers of death.

Pirot was located far from the front lines and the Serbian Army Medical Corps decided to station tetanus patients there for no other reason than their negative influence on the whole medical staff. Velimirović recalls that his small team worked day and night, but in spite of that more than half of these patients died within several days. Those who succeeded in staying alive had an extremely difficult and slow recovery. They were totally stiff, getting spasmodic contractions and convulsions at the slightest noise. Once, Velimirović remembers, foreign doctors came to observe this unprecedented sight. They stopped at the door of a dimly-lit room—daylight causes a tetanus patient's entire body to spasm—and they speechlessly observed the victims for a while before leaving, never to return again.

Translated from Serbian by Emilija Kićović
Originally published in Medicus 11/2007, #22:18, Belgrade

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[1] Archives. SANU. 14.325