This online edition is dedicated
by Mary Mark Ockerbloom at A Celebration of Women Writers
to Mary Houston (1888-1970), N/S, C.A.M.C.
"She Did Her Duty" 1916-1919

Royal Canadian Army Medical Corps Insignia

War Story of the Canadian Army
Medical Corps

Major-General G. L. Foster, C.B., Director General Medical
Services, Overseas Military Forces of Canada.

War Story of the
Canadian Army Medical Corps

BY
J. GEORGE ADAMI, M.D., F.R.S.,
(Temporary Colonel C.A.M.C.)
A.D.M.S. in Charge of Records, Office of Director-General,
Medical Services, O.M.F.C.

Volume I.
THE FIRST CONTINGENT
– (to the Autumn of 1915) –

PUBLISHED FOR THE CANADIAN WAR RECORDS OFFICE
BY
COLOUR LTD.,
53. VICTORIA STREET, WESTMINSTER, S.W.
AND
THE ROLLS HOUSE PUBLISHING CO. LTD.
BREAM'S BUILDINGS, FETTER LANE, E.C.

INTRODUCTION

BY
THE RT. HON. SIR ROBERT L. BORDEN, G.C.M.G., P.C., ETC.,
PRIME MINISTER OF CANADA

TO some the call of adventure, to others the fighting spirit of the race, but to most the duty of service appealed. Fresh from the avocations of peace and untrained at first in the art of war, they went forth strong, joyous, eager, confident. Valour and heroism were never more truly symbolized than in the story which their deeds have given to the world.

Such was the spirit of the Canadians in the battle line as I have seen and known them. One could not return from such a visit without renewed courage and strengthened determination. From the wounded in the hospitals one gained at least an equal inspiration in witnessing many a triumph of the spirit over the dull pain and monotony of long, weary months.

Let the Nation also give its tribute to those who consecrated their service to the care of the wounded; to the men who went forward through the battle storm with bullet-spattered ambulances to rescue those who had fallen; to the women whose first thought was of the helpless and suffering, when hospitals were bombed.

It is fitting that the story of the Canadian Army Medical Service should be told; and no one is more qualified for that purpose, whether by experience, by service, or by the truest ideal of duty, than he who has written the pages that follow.

16th August, 1918.

PREFACE

AN attempt is here made to record the outstanding facts bearing upon the activities of the Canadian Medical Service in such a form that the general reader may realize and become interested in the part played by medicine and surgery in modern warfare, while at the same time the professional reader may be given, as it were, a bird's eye view of the progressive development of military medicine in the great war as exemplified by the work of the C.A.M.C. How far the attempt has succeeded the reader must judge.

Based as the work is upon the official documents and the diaries of individual Medical Officers, the writer is only too well aware of its deficiencies. Official documents are apt to be painfully meagre in regard to the very matters which the historian needs for a full presentation of any particular happening: they may at times be wholly wanting. The Officer in the position to give the fullest details may constitutionally be unwilling to set pen to paper: may put down a line or two of bald official data, when for the credit of his unit and the officers and men under him, he should have set forth a detailed statement of events; on the other hand, some officer concerned in actions of subordinate importance may note these so clearly and interestingly that perforce the historian quotes at length from his description. If, therefore, too full credit is given to certain units and individuals, too little to others, the fault must to no small degree be attributed not to the historian, but to the material at his disposal. So also the limits set to the size of the volume have limited the publication of operation orders and the minutiæ of movements and activities of individual units.

The work will be of distinct service if, by calling attention to defects in the official records and that at a time not too distant from the events, it gives occasion to those actually concerned to afford the needed information and so prepare the way for a fuller and more accurate presentation of the facts at a later date. What has impressed the writer is the difficulty in securing accurate information even within a few months of the event: the difficulty, therefore, that must confront the historian who writes years after the event: the value of such a "contemporary history" as demonstrating to the officers in charge of units the importance of keeping adequate War Diaries.

So many of his colleagues have aided him that the writer finds it invidious to mention their names. He has studiously endeavoured throughout to acknowledge the sources of his information. One essential source has, however, been left out, and he would here call attention to the fact that for events in France as they affected the C.A.M.C. the underlying basis of his work has of necessity been the War Diary and reports of the A.D.M.S., First Canadian Contingent, now Major-General Foster, D.G.M.S. To General Carleton Jones and Colonel Lorne Drum he is indebted for much of the information upon which has been based the chapter upon the rise of the C.A.M.C.

London,
    August, 1918.

CONTENTS

LIST OF ILLUSTRATIONS

WAR STORY OF THE C.A.M.C.

CHAPTER I
THE RISE OF THE C.A.M.C.

WE are apt to forget how intimately the Army and the Army Medical Service are associated with the medical history of the Dominion. But so it is. For sixty years and more after the conquest, Canada was too poor and too thinly populated to be able to establish and support medical schools, or to attract well-trained doctors, either from the old country or from the States to the south. As a result, the surgeons who came over with the British regiments found their services in such request that many of them elected to remain when their regiments were recalled, and in all the older centres of population we meet with the same story: these old Army doctors became the recognized heads and leaders of the profession. Their connection with the Service gave them an immediate standing in the young community. They brought with them the old-world ideals of professional conduct, ideals strengthened, and indeed raised, by their military training and associations; and, as Major-General Fotheringham has well pointed out, ¹ it is largely owing to their influence that Canada has escaped the haphazard legislation, defective training and irregular medical practice which have cursed so many of the States of the Union to the south. When at last the population had increased sufficiently to maintain and justify the establishment of medical schools, we find that in Lower Canada two out of the four founders of the Montreal General Hospital and of the Medical School which in a few years became the Medical Faculty of McGill College, were old Army doctors; that another Army surgeon, Widmer, "scrupulously punctilious, and in every detail regardful of the proprieties of life," ² was the father of the profession in Upper Canada; a man of the very highest character, who did more than anyone else to promote the progress of the profession in what is now Ontario. Similarly in Acadia it was the old Army doctors, who in 1783 came along with the ship-loads of loyalist fugitives from the south, and formed the mainstay of the profession, while later, the British regiments at Halifax and elsewhere provided for two generations the foremost practitioners of Nova Scotia, and of New Brunswick, when in 1784 this was separated as a distinct province.

It is difficult for us, after fifty years of confederation, to realize that before that event there was no Canada proper, but a collection of separate provinces, which with difficulty had obtained something more than the status of Crown Colonies. So long as the Mother Country with its troops garrisoned and protected these, there was no urgent need for provincial militia. Militia regiments there were, it is true, here and there, but these existed more for ceremonial than for practical purposes; and their medical organization was the outgrowth of pre-Napoleonic conditions, when the regimental medical officer was still looked upon, along with the chaplain, as, if not the servant, certainly the nominee of the colonel of the regiment. Organized medical service was wholly wanting.

With Confederation, in 1867, the removal of the British troops necessitated that the new Dominion take some steps to establish a military system for itself. But it has to be acknowledged that Canada was not in a hurry to become a military power. It looked forward to a long era of peace. Can there be more striking evidence of the essentially pacific nature of the Anglo-Saxon peoples than the fact that the long-drawn line of boundary between the United States and Canada has no patrol? It was in June, 1914, a few brief weeks before the war, that the English speaking peoples celebrated the completion of a century of peace among themselves. We speak of the long frontier of some eight hundred miles that Russia had to protect against Germany and Austria: what is that to the three thousand miles of the Canadian frontier? Thus the Canadian Militia grew somewhat slowly. The Mother Country was most considerate; for strategic reasons it retained Halifax and Esquimalt for some forty years, until, under Admiral Fisher's naval scheme, Halifax, Esquimalt, Bermuda and St. Lucia were no longer employed as naval bases. As militia regiments were raised in each province, each had its surgeon-general chosen from among the local practitioners, but there was no Army Medical Service proper; nor was any course of preliminary instruction required for those who became Regimental Medical Officers. Gradually a small permanent medical force developed. Certain permanent military units had to be established at what may be termed strategic points – at Quebec, Kingston, St. John's, P.Q., Winnipeg, etc., and with the garrisons came the need for military hospitals and their personnel. In this way it came about that certain local practitioners obtained appointments over long years as medical officers to these garrisons, attending to the troops in addition to their private practice; but these rudiments of an Army Medical Service were for a generation so inconsiderable that there was no Director-General or Headquarters Medical Staff at Ottawa.

The Riel Rebellion in 1885 afforded Canadians their first independent experience of warfare since the campaign of 1812 (the Red River Expedition of September, 1870, was under British leadership; the Fenian Raid of 1875 was abortive and may be neglected); and here, while giving all credit to all actively engaged, it has to be confessed that the Medical Service was crude. There had been little or no preliminary organization. With the raising of the Field Force, it became essential to appoint a staff of medical officers. Dr. Bergin, M.P., of Cornwall, Ontario, was appointed Surgeon-General at Ottawa, there to control the medical branch and advise the Minister of Militia; Dr. (now Sir Thomas) Roddick, of Montreal, was made Deputy Surgeon-General, and directed to proceed at once to Qu'Appelle in the north-west and establish hospitals in such localities as the General in charge might designate; Surgeon-Major Douglas, V.C., who had been in the Imperial Service and on retirement had settled in Halifax ³, was appointed Director of the Ambulance Corps; Dr. (later the Honourable M.) Sullivan, Professor of Surgery in Queen's University, Kingston, was Purveyor-General; Dr. James Bell (later Professor of Surgery, McGill University) was appointed Surgeon, to take charge of one of the hospitals (the Field Hospital with General Sir F. Middleton's Division), and under him were six assistant surgeons; these in addition to the Regimental Medical Officers attached to each regiment, and a number of Toronto and Montreal medical students, who volunteered to go to the front as hospital dressers. There were only between four thousand and five thousand troops actively engaged in the field, and the preparations, therefore, had to be on a much smaller scale than we have become accustomed to in the great war. The campaign was conducted, it will be remembered, in a virgin country during the spring and early summer months, so that the amount of sickness was inconsiderable; there was an entire absence of typhoid, malaria and dysentery; even diarrhoea was almost unknown. Nor was the number of wounded such as to overtax the hospital accommodation provided at Saskatoon, Battleford and elsewhere. In other words, despite their lack of previous experience or previous training, the Medical Service rose to the occasion, which fortunately did not, medically speaking, become grave.

Following this little campaign there were those who urged the reorganization of the Service, with a Surgeon-General at Ottawa and Deputy Surgeon-General and staff in each province; but nothing was accomplished for many years to come, save that Dr. Bergin remained titular Surgeon-General, and three Deputy Surgeons-General were appointed: Drs. Roddick (Montreal), Ryerson ⁴ (Toronto) and Tobin (Halifax). But these all continued their civil practice, as did the whole service. The Regimental Medical Officers, it is true, were there, chosen by the officers commanding each militia regiment, and gazetted in due course as Surgeons-Major: that rank they retained whatever the length of their service. Not a few believed that they were ornaments to their regiments, and that they fulfilled all that in decency could be demanded of them if they appeared, in a uniform becoming progressively tighter, at each annual church parade. The only active members of the force were the semi-permanent officers, the local practitioners attached to the garrisons; these were, in general, appointed Principal Medical Officers at the annual camp of the district, and, as such, gave courses of instruction. There was, in fact, little or no organization. Between camps the permanent medical officers had no control over the regimental medical officers. Medical equipment for the annual camps, preserved between times at the District Medical Stores, were, to say the least, meagre.

This state of affairs persisted until 1896: until, that is, it so happened that a medical man, the late Sir Frederick Borden, became Minister of Militia. In this year a definite Medical sub-department of the Militia was created, with a Director-General at its head, having his headquarters in Ottawa. From 1896 dates thus the development of the Canadian Army Medical Corps. The first Director-General was Colonel Hubert Neilson. John Louis Hubert Neilson had not a little army experience. Born in Quebec in 1845, he received his training at the Army Medical School, Netley, and in 1869 became Medical Officer of the Quebec Garrison Artillery. He saw service during the Fenian Raid; acted as a Red Cross Surgeon in the Russo-Turkish war of 1878; was surgeon to the Canadian "voyageurs," called by Sir Garnet Wolseley after his Red River experience to aid in the Soudan campaign of 1884-85; was attached to the British Army for two years, making a tour of Europe and the United States to study army medical organization. Being largely independent of his practice, he accompanied his unit, the Garrison Artillery, when it was ordered elsewhere – to Victoria and Kingston. It was from Kingston that in 1898, after this preparatory study of army medical organization elsewhere, he was called to Ottawa as D.G.M.S. Here his headquarters were constituted by railing off the end of a corridor, and in this simple improvised room a single cupboard of no great size was sufficient to contain all the reserve stores of the Service!

But here was a beginning along modern lines, and the first important action of the D.G.M.S. was to take advantage of the carefully-thought-out new organization of the Royal Army Medical Service. He had himself already been attached to the R.A.M.C. at Aldershot, and now he persuaded the minister to send him, and with him several medical officers, to England, to follow courses of instruction there and thoroughly familiarize themselves with the working of the R.A.M.C. ⁵

The officers so trained were to be utilized as instructors of the new Canadian Medical Service which Colonel Neilson proposed to form. Lieutenant G. C. Jones had already been concerned in an important innovation, namely, in the formation of the first Canadian Bearer Company after the British model. This was before the Field Ambulance, as at present constituted, had been developed. The establishment of the Bearer Company arose out of an agreement with the Imperial authorities, whereby the Canadian Government supplied the medical personnel for the Halifax garrison and kept it at war strength, Great Britain supplying the equipment and Canada finding and supporting the officers and men.

Then in the autumn of 1899 Colonel Neilson drafted an all-important Order in Council, which was duly promulgated. Authority was granted by this for the formation of an Army Medical Corps consisting of six bearer companies and six field hospitals. The officers of the Corps were to be arranged in due Army order, were to hold substantive rank, and to receive promotion by seniority as vacancies should occur. The order recognized the regimental officers already existing, and formed these into a Regimental Medical Service, to include all medical officers appointed to regiments. These officers were to receive promotion not by seniority but by length of service, and to rise from the rank of lieutenant to that of major. It detailed, further, the relationship of the two services – the Army Medical Corps and the Regimental Medical Service – in the event of mobilization, and, what was of fundamental importance, laid down a course of instruction for those seeking to qualify as medical officers.

During the winter of 1899 and 1900 the Director-General visited the various main centres throughout Canada, explaining the scheme and calling for volunteers for the new Medical Corps with good success. The bearer companies were classed as "city units," and, in addition to their training during the winter in the armouries, were required to do three days' training in camp. The Field Hospital units were classed as "rural units"; they underwent twelve days' training in camp.

When, in September, 1899, the Boer War broke out and Canada spontaneously offered her First Contingent, the organization of the Medical Corps had not proceeded sufficiently far for the Dominion to send with it anything beyond the Regimental Medical Officers, and, it should be added, the regimental stretcher-bearers which were supplied from the personnel of the Halifax Bearer Company, the only body of trained orderlies in the Dominion. This was not due to the fact that the officers and men were lacking, but that organization was still far from complete. As a matter of fact, Canada did not send a division. It was merely an infantry battalion which composed the First Contingent to South Africa. After the departure of the First Contingent from Quebec, on October 31st, 1899, three Field batteries and two battalions of Mounted Rifles (the 1st C.M.R. and the R.C.D.) were enlisted, sailing in January, 1900, and in March the Strathcona Horse followed, and were succeeded later in the year by a large draft of Canadians to join the newly-established South African Constabulary (fashioned after the type of the famous North-West Mounted Police). But it was only in January, 1902, some six months before the end of the war, that the first Canadian medical unit, the 10th Canadian Field Hospital, was ready to leave Halifax, with the late Colonel A. Norris Worthington, M.P. for Sherbrooke, in command. ⁶ The equipment differed from that of the regulation British field hospital in that it was a combination of British and American usages. The Hubert tent (so-called after Colonel Hubert Neilson, who devised it) replaced the British hospital tent, and the wagons were lighter than the British model, being built upon the lines of a Canadian express wagon. It carried with it another innovation of Canadian origin – namely, a mobile acetylene gas plant. ⁷ Arriving at Durban, Natal, in February, the unit trekked up country through Laing's Nek and across the Orange Free State to the Transvaal, until it reached Valbank, where the larger part of the unit, under Colonel Worthington, became established as a stationary hospital, and, as such, was an important medical factor in the final decisive operations of the war. Under the command of Major G. C. Jones, a detachment became a mobile unit with Cookson's column in General Walter Kitchener's force on "trek," and took part in the operations in the Transvaal and Northern Cape Colony. This detachment never rejoined the unit, but had the good fortune to be present at the Battle of Hart's River or Buscbolt, along with the 2nd C.M.R. A bullet-marked Red Cross pendant from one of its ambulance wagons remains as a relic of this engagement in the office of the Director-General at Ottawa.

The Regimental Medical Officers saw abundant service. Three had accompanied the First Contingent, but only one – Captain Eugene Fiset ⁸ (of Quebec) – was present with the battalion during the greater part of its service in the field. Joining the contingent as Junior Medical Officer at the last moment before it sailed, he remained with it during its whole service, save when he was a prisoner. He received the D.S.O. for distinguished service at Paardeburg, an honour which also was gained by Major Keenan ⁹ (of Montreal) of the Strathcona Horse.

When, in June, 1902, the war came to a sudden end, preparations were made to hold a training camp in the autumn. As can easily be grasped, the war exposed the weak points in the militia medical system, and active efforts were made to remedy deficiencies. There was still no proper provincial or district medical organization; where there was stationed a permanent unit, its Regimental Medical Officer had been the natural channel through which the Director-General kept in touch with local needs. There were, however, large districts with no permanent units, and therefore with no local heads. Now a move was made in the first place to change this, and appoint Principal Medical Officers, who should supervise the medical units of their districts and keep Headquarters informed regarding matters of personnel and equipment. Subsequently on the formation of commands P.M.O.'s were appointed to the commands and Senior Medical Officers to the districts. After the war Lieutenant-Colonel Fiset, D.S.O., had taken a course of instruction with the R.A.M.C. Upon his return in 1902, he was appointed Staff Officer to the D.G.M.S., succeeding Lieutenant-Colonel Neilson as Director-General, when the latter officer retired in 1903.

Experience in South Africa had led the Imperial authorities to combine the old bearer company and field hospital into one unit, the Field Ambulance. The object of this step was to attain increased mobility at the front, and more particularly to combine under one command the two intimately related functions of collecting the wounded and affording immediate but temporary care of the same. It is interesting to note how, as the great war progresses and the scale of operations becomes increasingly vast, there is a tendency of necessity to resort to the old separation of these two functions; but undoubtedly, by the extent and variety of the duties imposed upon it, the Field Ambulance has become a most attractive and excellent training ground, affording a wider experience than does any other unit. The old Bearer Company, as the "Bearer Section," still remains the basis of the new organization; the Field Hospital is represented by the "Tent" and transport sections, but, shorn of its iron cots and heavy marquees, it has become more mobile, capable now of rapid movement. How necessary is this ease of movement has been abundantly demonstrated in this war, when one day a Field Ambulance may be running two or more Advanced Dressing Stations close to the trenches, the next day a Main Dressing Station three or four miles back of the line, and the third a Divisional Rest Station at "the back of the front." The first move of the new D.G.M.S. was to introduce the Field Ambulance unit into the Canadian Service, and this, not by combining rural "hospital" and city "bearer" units, but by expanding each of these units wherever possible into a full ambulance unit.

This expansion was of set purpose. The British Field Ambulance called for ten officers and 241 other ranks, of whom sixteen were to be non-commissioned officers of the rank of sergeant or higher. Colonel Fiset, in the Canadian establishment, called for the same number of officers and N.C.O.'s, but for only seventy-five other ranks – i.e., one-third the number. Where the British organization consisted of three sections, the Canadian provided but one full section, with the skeleton of the other two; the idea being that upon mobilization it would be easy to recruit the rank and file to full strength, and that here was a means of inducing the maximum number of civil practitioners to accept commissions and interest themselves in the Service. This policy has fully justified itself.

In the same year (1904) the officers and personnel of the permanent medical service were definitely banded together into a corps – the P.A.M.C.

To Colonel Fiset also belongs the credit of initiating the first movement in the direction of a well-ordered modern camp sanitation. The present war has proved most conclusively that the preventive and hygienic functions of the military medical service are of greater importance than the purely medical functions. But it has taken long years to dissipate the old idea that, a camp being only a temporary abode, filthy surroundings had to be put up with; and that if, as was noted in the Crimea for example, a horse happened to die in the lines, it might lie there and pollute all its surroundings, it being nobody's business to remove it. And Colonel Fiset began with the "slop sink." Until 1904 the removal of kitchen waste in camps was of the crudest. Pits were dug close to the cookhouse, and into these were dumped the kitchen refuse, fluid and solid. The refuse, exposed to air and sun, soon stank, and as one pit filled up it was replaced by others equally unsavoury, fly-infested and fly-blown. The D.G.M.S. showed that this nuisance could be effectually removed by pouring all the refuse into a box provided with holes in the bottom and a movable top, placed over the intersection of two cross trenches; the fluid drained into the trenches, and when the box became full, all that was necessary was to burn the contents in the kitchen fire. To Colonel Fiset, in short, is due the credit of having impressed upon the medical officers the fact that camp sanitation is more than a quartermaster's duty. It took some years, however, to impress this upon the camp authorities and regimental commanders, who, regarding the medical officers as "cure doctors" and not as "prevention doctors," held that their duties began after the series of sanitary defences had broken down and the men fell ill. Regarding sanitary matters as belonging entirely to the (lay) quartermaster, they were apt to regard recommendations by their medical officers concerning matters of hygiene as a rank intrusion, and to turn them down as a matter of principle. Remember that we deal here with the state of affairs as they were little more than a dozen years ago. Our camps were sanitary blots, nuisances which the old-timer in the militia, with nose and stomach hardened to the conditions, regarded as necessary evils. But already at this period the lines of the medical units, as a rule, were the bright spots in each camp. They were kept as hospitals should be kept – clean and fresh, and method after method which made for cleanliness was readily adopted; they were, in fact, the show places of the camp.

It is no exaggeration to declare that the main advance in the Canadian Militia from 1906 to the opening of the war was in the steadily increasing realization that where men are massed together their welfare and their effectiveness centre around the preservation of their health, and that sanitation is a matter that concerns all. And to the next Director-General fell the task of bringing about this realization and obtaining the co-operation of all the military authorities in the campaign of rationa1 hygiene. For in 1906, when Colonel Pinault, the Deputy Minister of Militia, fell ill, the duties of his office were taken on by the D.G.M.S. in addition to his own; and upon the death of the Deputy Minister, Colonel Fiset was appointed to the vacant position, and Lieutenant-Colonel G. Carleton Jones¹⁰, who had been Principal Medical Officer for the Maritime Provinces, was called from Halifax and made Director-General in his place.

The co-operation above noted was obtained in a somewhat paradoxical manner. On first consideration it might be thought that the direct method would be most effective – namely, to endow the medical officers with greater powers. But to do this would mean divided authority in the unit and in the command. As a matter of fact, in what may for comparison be termed the pre-sanitary days, the responsibility for sanitation was placed upon the M.O. without, however, affording him the means to carry out his recommendations. On further consideration this will be seen to have been a shelving of responsibility by the officer to whom the duties rightly belonged. Camp sanitation is a matter of discipline, the discipline of cleanliness, and all matters of discipline are, and ought to be, in the hands of the Commanding Officer. The Militia Order issued in the spring of 1907 took the important step in advance of officially recognizing this. Henceforth the responsibility for sanitation was laid upon the O.C. If matters went wrong, upon him was to be placed the blame, and, as a result, he became bound to consult his M.O. and to follow his recommendations.

Colonel Jones's next move was to establish courses of lectures upon military medicine, and more particularly upon military sanitation, at each permanent station, to be given by the P.M.O. during the winter months to the permanent and active militia officers of the district. To these courses, and through the way in which they brought home to the medical officers the importance of hygiene, and to the working of the order just noted, must largely be ascribed the rapid improvement in the Service and its increasing influence. Plans were drawn up of the proposed sanitary lay-out of every unit with explanatory designs, and when, in the autumn of 1907, the annual camp of the Nova Scotia district was opened, the Camp Commandant held a meeting of the commanding officers and regimental officers at Camp Headquarters, when a model installation of all the sanitary constructions required for a battalion had been prepared. These were carefully explained, and the plans and instruction given out, and within three days a sanitary encampment on the new model had been achieved, with ablution tables, shower baths and other sanitary needs, and the new constructions were not only working smoothly, but formed a subject of enthusiasm and pride to their builders. This difference in the health and comfort of the troops here and at Petewawa, the artillery camp held a few months earlier, was very noticeable. Indeed, Petewawa materially strengthened the hands of the Director-General, for through the milk supply a small epidemic of typhoid fever broke out in this camp, and while this was rapidly suppressed, the widespread publicity given to it afforded the militia authorities the opportunity to institute a general reform of the whole sanitary arrangements.

Roughly, the main maxim of camp sanitation is to provide a billet for every bullet of dirt, and dirt is matter in the wrong place: the right place must be provided for it. And this right place is not where it is hidden. To hide it away means that proper arrangements have not been made for its disposal. Thus, contrary to preconceived notions of propriety, constructions in a camp which are apt from carelessness to become dirty are now placed, not in a retired spot, but wherever they are likely to be most exposed, and where any possible defects or careless usage are brought into the limelight, and, for the credit of the camp, relentlessly repaired.

Colonel Jones had early recognized the advantage of affording a meeting ground for, and of bringing together, the medical officers of the permanent force and the militia. In his first year of office he utilized the occasion of the meeting of the Canadian Medical Association in Montreal to call a gathering of officers and to found an "Association of Medical Officers of the Militia." The meeting next year was held under similar surroundings. In 1909 the association had proved its value, and was strong enough to hold a meeting of its own in February at Ottawa, with a good programme of papers and discussions. This annual meeting in the winter became a regular event and did much to promote a good service spirit, to bring the officers from the different divisions to know one another and to kindle enthusiasm. Another step in the same direction was taken at London, Ontario, in 1911, where, in place of medical units attending the annual camps of their districts or divisions, there was held the first full Army Medical Corps Camp. Medical units from different districts were here brought together for sixteen days' training. Beginning with a scheme of attack and defence, which called into play purely the work of the regimental officer with a battalion, next schemes calling into play the work of the field ambulance with the brigade, and, finally, the divisional co-operation of field ambulance and casualty clearing unit were worked out, and an insight given into the functions and inter-relationships of the different branches of the service that no local annual camp with the infantry and other arms could have supplied.

And now was published the "Manual of Establishment and Equipment of the Army Medical Corps, Canada," for peace and for war. This, it may be emphasized, was the first official publication on behalf of any department of the Canadian Militia, in which the word "war" was used, or the state of being at war clearly faced. The corps camp at London served to test, and, where necessary, correct, every detail of the establishment and equipment as drawn up during the preceding months – the constitution of the different units, the stores necessary for each, the number of transport wagons essential for each unit, their packing, the contents of the Field panniers, the number and contents of the boxes of drugs and apparatus. All this was put to a practical test, with the result that when the war broke out there was no confusion, and, so far as regards medical stores and equipment proper, the medical units accompanying the First Contingent were ready to start.

Each year, prior to the war, the D.G.M.S. conducted a course at Ottawa, in which, winter after winter, the medical history of one or other great campaign was carefully studied, and laboratory training given in sanitation and bacteriology, this latter course being under the supervision of the D.D.G.M.S., Major Lorne Drum. ¹¹ In short, so far as was possible with the framework of a regular army in place of a full regular army proper, the future administrative heads of such an army were given a thorough training; and they, in their turn, conducted courses of lectures and training during the winter months in their respective divisions, which all regimental medical officers were encouraged to attend. As a result, in 1914, the D.G.A.M.S. could call to the Service, not an untrained herd of general practitioners, but a group of officers keenly interested in their work, familiar with the problems and difficulties of the Service, and, what is more, familiar with the forms and administrative procedure of the A.M.C.: men who fell rapidly into line.

The main weakness of any permanent Army Medical Service is that in the long years of peace the officer whose duty it is to undertake the medical supervision, of a body of men in the prime of life obtains little opportunity for the performance of major surgical operations, little experience other than what may be termed minor medicine and surgery. The tendency is for the officer's professional capacity to become reduced in the same ratio as his administrative capacity becomes steadily raised. Now, admittedly, the ordinary medical man, working for and by himself, has not the stimulus to develop into a good administrator, and administrative ability is all-essential in dealing with large bodies of men. There is much to be said for the Canadian system, which provides a small nucleus of officers of the Permanent Army Medical Corps thoroughly trained in executive work, and a large body of medical officers conversant with the ordinary routine of Army Medical Service, who, at the same time, through their civil practice, have kept themselves thoroughly in touch with modern medicine and modern surgery.

In the seven years preceding the war other changes had taken place affecting the organization of the Canadian Militia in general. With the development of the North-West and growth of Alberta and Saskatchewan, it became necessary to modify the commands and districts, and with the medical organization of each the previous P.M.O.'s and S.M.O.'s were replaced by an Assistant Director (A.D.M.S.) in medical charge of each divisional area. ¹²

One other and outstanding feature of the C.A.M.C. remains to be noted, namely, the relationship and status of the nursing service. As a young country developing an army with no old traditions to hamper it, the logical course could be taken, rather than that which can be excused only on historical grounds. The British Army Nursing Service, it will be recalled, began by Sidney Herbert calling in the services of Florence Nightingale to mitigate the terrible condition of affairs in the hospital at Scutari during the Crimean War. One has but to read Sidney Herbert's "Life" to realize that, great and admirable as was this devoted woman, she was the despair of the official, making it impossible to incorporate her and the organization she controlled as an integral part of the Medical Service. Thus, from the Crimea onwards, the Nursing Service in the British Army, and other armies which have copied it, has been an auxiliary rather than an integral branch. Nevertheless, the nursing sisters have for long been an absolutely essential section of the Army Medical personnel; their work is performed under the control and direction of the medical officers. There is not one adequate reason why, as a body, they should belong to a separate organization – or to one of several separate organizations.

Thus it was that in 1906 the Minister deliberately created the Army Nursing Sisters as an integral portion of the Army Medical Service, under the command of a matron who, in her turn, is responsible to the D.G.M.S. Doing this, regulations were laid down as to the qualifications and course of training, and the fully qualified sister was given the relative rank of lieutenant. As distinguished from the nursing sisters of all other armies in the field, the Canadian Nursing Sisters have thus military status, and are under direct military control. This explains their uniform and their "stars," which apparently have given offence to the illogical.

Now, although this is a delicate matter to place upon paper, yet, with reference to this grant of relative rank, it is essential to call attention to certain facts. While the best are peers of the best, and there are English, Scotch and Irish nursing sisters not one whit behind their Canadian sisters in any respect, socially, as a body, the nursing profession in Canada has, in the first place, a higher status than it possesses in the old country. It attracts, in general, the daughters of professional men, and those from comfortable households. In a family of daughters, for example, it is quite the custom in Canada for the elder girls, when they have been "out" for three or four seasons, to realize that they have had their opportunity, and rather than be in the way of their younger sisters, to elect to become nurses. It is a rule that Canadian Nursing Sisters have had, not a common, but a High School education, or what corresponds thereto. And as nurses their training has been very thorough, with fuller courses of lectures on the basal subjects than is usual in Great Britain. As a result, a remarkably large proportion of the matrons of the great hospitals in the United States are of Canadian birth and training. Add to this that the Canadian nurse embarked on her profession is paid on a scale which in Great Britain would be thought extravagant. But then she is thoroughly competent, and this high recompense is found eventually economical. But just as at Oxford and Cambridge we may encounter those who do not attain to the quality which we associate with graduates of the older universities, so, among the Canadian Nursing Sisters, an occasional individual may be open to criticism; yet certainly as a body, for capacity, alertness and bearing, the Canadian sisters deserve, and more than deserve, the rank which has been given to them. And in this war they have abundantly "made good."

It should be emphasized that this step was taken on military grounds, and by the Ministry and Militia Council, not as the result of any agitation by the nursing sisters themselves – in fact, some years before the suffragettes became militant. The experience of the Canadian Army Medical Service has abundantly justified the innovation and proved it to be right and wise.

The first Matron to be appointed was Miss G. Pope, R.R.C., ¹³ who had been through the South African campaign as Matron. She was succeeded at the beginning of the war by Matron Macdonald,¹⁴ who, with the establishment of the Headquarters Staff in London, took charge there, under the D.M.S., of all matters connected with the nursing personnel.

CHAPTER II
THE ASSEMBLY AT VALCARTIER AND THE CROSSING

IT was on Saturday, August 1st, 1914, that Germany declared war on Russia; on Sunday, the 2nd, that France entered into the war; on Tuesday, the 4th, Great Britain.

On the 6th Canada took her first active step: By Order in Council His Royal Highness the Governor-General called out various corps upon active service; these including the Militia Council, the Permanent Staff at Militia Headquarters, Ottawa, and in the several divisional areas and districts all corps of the permanent force and various units in the different divisions. Among those called out were No. 7 and No. 9 Field Ambulances from Quebec and Charlottetown, Prince Edward Island, respectively.¹⁵ Subsequent orders in these first few days called out No. 1 Clearing Hospital (Toronto) and No. 18 Field Ambulance (Vancouver). Rapidly Canada's part in the war became determined, and on August 17th was published the Mobilization Order,¹⁶ the first important instructions for general guidance, by which it was directed that there be mobilized for service overseas a Canadian Expeditionary Force, consisting of one complete division (less a brigade howitzer artillery), along with certain units, such as the Princess Patricia Canadian Light Infantry, in excess of divisional requirements, the force to be equipped in a manner similar to that of the British Regular Army, to be Imperial and have the status of British Regular troops. Already the Minister of Militia had selected the plain at Valcartier, near Quebec, as the assembly place, and the order laid down that the troops should concentrate there,¹⁷ where final selection and acceptance for service would be determined and medical and veterinary equipment would be issued.

These were busy days for the Minister of Militia, and in nothing did his resourceful energy and initiative gain the whole-hearted admiration of the Dominion more than in the establishment of Valcartier Camp.

While fuller experience showed that it would have been less costly and more practical to have mobilized and selected the western troops at some central camp in the west, and Ontario troops at, say, Petewawa, and to have reserved Valcartier Camp for eastern troops only,¹⁸ it has, nevertheless, to be admitted that General Sir Sam Hughes's scheme appealed to the imagination. He came swiftly to the conclusion that an assembly camp was essential near to the port of embarkation, selected the ground at Valcartier, which was already under consideration for an artillery training ground; and realizing that this must be prepared immediately, without waiting for formalities, votes, tenders, etc., with the approval of the Prime Minister he secured the ground, and placed its preparation as a camp for twenty thousand men in the hands of the engineers and of large contractors whose capacity for rapid and effective work was known to him, these and the local arrangements being under the supervision of Captain W. Price (now Sir William Price and Honorary Lieutenant-Colonel), a leading citizen of and late Member of Parliament for Quebec, as his local representative. With Colonel Price were associated Lieutenant-Colonel H. E. Burstall (now Major-General Sir H. E. Burstall, K.C.B.), Colonel W. McBain, and others.

It is a striking story this, of the conversion as though by magic of a countryside largely unreclaimed into a busy city ready to receive twenty-five thousand inhabitants. The situation was admirable – a gently sloping ground, in the main sandy, with an abundant supply of water from the Jacques Cartier river, which ran through it, and at a day's marching distance from the port. Farm buildings were razed, crops harvested. Hundreds of acres of second-growth timber were attacked by field companies from Toronto, McGill and Queen's Universities, and, as Captain Curry puts it, "A patch of land that one day was covered with cedars, would next day be bare of all but the stumps, the brushwood blazing merrily in huge fires. Next day the stumps would be gone, and by evening the area would be covered with tents."¹⁹ Roads were made and bridges over the river; pavements built. Ditching machines, each accomplishing the work of fifty men, aided the speedy establishment of a drainage system, for which twenty-eight thousand drain-pipes were employed, and of a very complete camp water-supply. When Valcartier was taken over, Major H. M. Jacques,²⁰ of the office of the D.G.M.S., after inspection, reported that there were only two wells in the camp area in which the water was possibly fit for drinking purposes, and that there was pollution of the Jacques Cartier river higher up, so that its water could be employed with safety only after chlorination. The establishment of a proper system was placed under the medical control of Major H. A. Chisholm, P.A.M.C.,²¹ as Sanitary Officer, until Dr. G. G. Nasmith, of the Ontario Provincial Board of Health, was by the Minister appointed head of a special department in the Army, the Hydrological Service, with the rank of Lieutenant-Colonel, and placed in charge of the water-supply under the A.D.M.S., at the camp.²² Pumps drew the water from the intake on Jacques Cartier river above the camp to tanks and a chlorinating plant, where the water underwent repeated daily tests. From here miles of pipes carried the water to every part of the camp, so that every company had its own ablution tables and shower baths, every cook-house its own water-supply; in the horse lines troughs were supplied which filled automatically. Incinerators were built for the destruction of refuse. It is doubtful whether any camp in the Empire planned and improved over years of experience and deliberation, possessed a better sanitary system than did this mushroom growth of a fortnight. In addition, three miles of siding were laid down in connection with the Canadian Northern Railway, which skirts the camp; electric light throughout the camp was supplied from Quebec. The engineers installed a field telegraph and telephone system, and there was constructed a unique rifle range, three and a half miles long – the longest, it may be remarked, in the world, with targets at which men could practise by the thousand.

Of necessity, it was a tented camp, but large hutment buildings were rapidly raised for Headquarters' offices, pay, and other purposes, and for stores – ordnance, army service, medical, etc. – and dry canteens (for alcohol was rigorously excluded from the camp and district). It is interesting to note that of these more permanent buildings the first to be erected was the pathological laboratory, which immediately busied itself over the water-supply. Soon a bank and a moving-picture theatre made their appearance, and with these the camp reached the level demanded by modern civilization.

The response to the call for men was such that by the middle of August the number necessary to form a division had been exceeded by four thousand.

On August 17th, the day of the publication of the mobilization order, troops were already beginning to pour in. On that day there arrived 10 officers, 230 O.R., with 23 horses, of the 5th Field Ambulance from Montreal, followed rapidly between this and the 22nd by detachments from Nos. 1, 2, 3, 4, 7, 8, 9 and 10 Field Ambulances. On the 22nd there arrived 8 officers and 41 O.R. from No. 2 Clearing Hospital, Nova Scotia.²³ Day after day the sidings were filled with troop trains and freight cars. By the end of the month the camp was already over full.

At the beginning of September the total number of men under arms throughout Canada was 40,600; and after consultation with Colonel V. A. S. Williams, O.C. Valcartier, and his Staff, and the Os.C. of the various units, Colonel Sam Hughes approved of the reorganization of the camp and formation of a fourth brigade.

Besides the "Princess Pat's," the number of battalions outside the 1st Division had by now been swelled by the Royal Canadian Regiment (R.C.R.), two cavalry regiments, namely, the Strathcona Horse and the Royal Canadian Dragoons (R.C.D.), the Royal Canadian Horse Artillery (R.C.H.A.), and the 2nd Field Company Engineers. Early in September the War Office requested, in addition, the supply of Lines of Communication units, among which were included two General Hospitals, two Stationary Hospitals and a Casualty Clearing Station. And now the Dominion asked and received willing consent to furnish an additional ten thousand men, this number including the 4th Brigade and these additional units – a contingent of altogether 31,200 men with 7,500 horses, and the number still grew, until actually more than 32,000 men embarked in the Canadian Armada.

So large a camp of hastily organized units meant abundant work for the Medical Service. Lieutenant-Colonel H. R. Duff,²⁴ A.D.M.S. of the 3rd Division, was appointed A.D.M.S. of the camp. Unfortunately at an early stage he was thrown from his horse and severely injured, his place being taken on August 22nd by Lieutenant-Colonel J. W. Bridges,²⁵ A.D.M.S. 4th Montreal Division. Gathered together rapidly and enthusiastically from all parts of the Dominion, all who offered themselves for service were given clearly to understand that the personnel of the contingent would be decided at Valcartier. Thus at Valcartier each man had to undergo a careful physical examination before being definitely enrolled, or, on the other hand, rejected. The labour of examining, passing upon and filling up the medical papers of more than thirty-two thousand candidates may be imagined. It required the work from morning until night of a staff of some thirty officers and a hundred clerical orderlies,²⁶ the whole under the direction of Lieutenant-Colonel A. T. Shillington.²⁷

Further, all who had not already conformed to the regulations for the Expeditionary Force re vaccination against smallpox and inoculation against typhoid fever had to undergo the necessary treatment, and through the imperfection of many of the units this entailed an extraordinary amount of clerical work. There was no desire to submit those already inoculated to a second treatment; at the same time, it was essential for the safety of the force that none should go to the seat of war unprotected against what had been two of the greatest Army scourges. This work was under the control of Lieutenant-Colonel Hodgetts,²⁸ assisted by a corps of ten officers and some twenty N.C.O.'s and men.

It is not a little interesting that the introduction of inoculation against typhoid fever as a (practically)²⁹ compulsory measure was accepted without serious opposition. The practice was virtually unknown among the civil population of the Dominion. Nor had it before the war been introduced into the Militia. In the autumn of 1913 the D.G.M.S., Colonel G. C. Jones, had been in England at the same time as the Minister of Militia, and had brought to the notice of Colonel Sam Hughes the valuable work accomplished by Sir William Leishman, R.A.M.C., in perfecting the technique of the procedure, and the striking results gained in the British Army. Sir Almroth Wright, when Professor of Pathology at Netley, had originally introduced anti-typhoid inoculation as a voluntary method during the Boer war. In that campaign the losses from typhoid (or enteric) fever were appalling – one out of every eight of the British soldiers in South Africa went down with the disease. With Colonel Sir William Leishman's improved method of preparing the vaccine, inoculation had become as widely prevalent in the Imperial Army as the curious distaste which exists in Great Britain for compulsory measures of any order would allow, and this with such good results that the more autocratic United States had no hesitation in making it compulsory for their Army and Navy. Within a year typhoid fever was to all intents and purposes banished from the American forces. The Minister of Militia applied, therefore, to the War Office to be granted temporarily the services of Sir William Leishman, with the result that this distinguished officer of the R.A.M.C. visited Canada in the early spring of 1914, and, giving an admirable series of addresses at Ottawa, Montreal and Toronto, brought well before the Canadian medical and general public the advantages of the procedure. Thanks to this visit the country thus was well prepared to accept the innovation. We shall have later to demonstrate the remarkable results obtained.

As many of the troops arrived unprovided with regimental numbers, and were drafted from various regiments into units of the Expeditionary Force, the difficulty in tracing the papers and records of the individual seemed at times almost hopeless. But, over and above this, as drafts of various sizes came pouring in from all over the Dominion, each accompanied by its medical officer, the men had to be allocated to the battalion proper of the overseas contingent. It will be readily grasped that as each battalion is provided with one Regimental Medical Officer, where a battalion was made up from two or three militia regiments, this meant a considerable rearrangement of medical personnel. As many of these officers as could be spared were utilized for medical examination of the volunteers and for inoculation, but these were not adequate, and not a few of the medical officers of the First Contingent, including some of the most prominent, were members of units in Montreal and elsewhere who had not volunteered in the first place, but who had been summoned to Valcartier in order to aid in the medical examinations.

As a matter of fact, while by the mobilization order it was directed that medical units should mobilize at Valcartier and medical stores be issued there, this almost from the first was found impracticable. In the first place, as was foreseen, the Army Medical Service appealed to a very distinct and valuable element in the general population – to men who, while thoughtful, and, what is more, eminently patriotic, were not of the militant disposition, men who, in the absence of conscription and the long era of peace, had had no training as soldiers, to whom, before the full realization of what this war signified had been borne in upon us, the thought of the active destruction of their fellow-men, even for the sake of a great cause, was distinctly repugnant. Such men are no cowards, as has been abundantly proved by their devoted and fearless work as stretcher-bearers at the front, than whom none are more exposed to bodily danger, and as a body they have suffered heavily. Cowards! Not merely have they suffered heavily, but there has been a higher percentage of casualties among the personnel of the C.A.M.C. at the Front than in the infantry, or, indeed, any other branch of the Canadian Expeditionary Force. Your ordinary soldier during an engagement, save when engaged upon an advance, has a certain degree of protection in the trenches. He is not expected to move from his place save during that advance. The call to the stretcher-bearer demands that he moves irrespective of protection; his duty is to bring in the wounded. And nobly have our bearers worked in the open, retrieving their wounded comrades of other branches. Many have seemed to bear charmed lives, working in full view of the enemy under machine-gun and rifle fire, shell and shrapnel, working without haste, intent upon their mission of salvage. Many – alas, too many! – have fallen. But in loyalty and patriotic spirit the men of the C.A.M.C. are not one whit behind their comrades in the fighting line. It is merely that to men of this order the saving of life appeals more than does the taking. And they applied in great numbers to join the C.A.M.C.: so much so that one regiment alone in the middle west (the 48th Battalion) received no less than three hundred volunteers who, joining the C.A.M.C. in the first place, had to be transferred as being in excess of strength. And as the standards for eyesight, etc., are somewhat lower for the medical than for the militant branches of the Service, the country was saved the transport of a considerable body of men who might not have been found transferable at Valcartier.

And, in the second place, thanks to the organization before the war, the equipment and stores for the Field Ambulances had already been brought together to a very large extent in different Canadian centres, and the plan of local mobilization had already been worked out. It was, therefore, much more practical to mobilize a western medical unit at Winnipeg, an Ontario unit at Toronto, and an eastern unit at Valcartier.

Thus it was that the Officers and personnel of No. 1 Field Ambulance were drawn from medical units in Eastern Canada – i.e., the Maritime Provinces, the Province of Quebec and Ontario up to and including Kingston, and came under the command of Lieutenant-Colonel A. E. Ross,³⁰ the Senior Medical Officer in this area, who had been mayor of Kingston and Member of the Ontario Parliament. Major R. P. Campbell and his unit (No. 5 Field Ambulance) were at first attached to this, but later he and many of the officers and personnel were transferred to No. 1 General Hospital. No. 2 Field Ambulance was drawn from Central Canada – i.e., from Ontario, with the exception of the Kingston and Ottawa districts, Lieutenant-Colonel D. W. McPherson,³¹ of Toronto, being placed in command, while Lieutenant-Colonel W. L. Watt,³² of Winnipeg, commanded No. 3 Field Ambulance, which was mobilized at Winnipeg with officers and personnel drawn from Western Canada. This arrived at Valcartier on September 1st as a complete unit with stores and equipment.

When the Lines of Communication units were authorized, those volunteering for service from the two clearing hospitals, No. 1 from Toronto, under the charge of Captain C. E. Cooper Cole, and No. 2 brought from Liverpool, Nova Scotia, under the charge of Major F. S. C. Ford,³³ were largely amalgamated (on September 3rd, 1914), and sent to the front as No. 1 Canadian Casualty Clearing Station, under the command of Major Ford, Captain Cole being transferred to No. 2 General Hospital. The necessary general and stationary hospitals were formed de novo from men who had volunteered from the various medical units throughout Canada. No. 1 General Hospital had as its basis the volunteers, officers and men from No. 5 Field Ambulance, Montreal, brought to camp by Major R. P. Campbell, who was given temporary charge of the unit until Lieutenant-Colonel Murray MacLaren ³⁴ was appointed O.C. The majority of the officers and men of No. 2 General Hospital, drawn from this general list were from Toronto and other parts of Ontario. At first, under the command of Lieutenant-Colonel Bridges, when this officer was appointed A.D.M.S. Valcartier, the command fell temporarily to Major R. L. Gardiner, of Ottawa, reverting to Colonel Bridges when the troops went overseas.³⁵ Similarly, as regards the stationary hospitals, the draft from No. 4 Field Ambulance from Montreal afforded a basis, with Major Hanford McKee³⁶ of that unit as O.C. No. 2 Stationary Hospital was brought together from the General List, and Major McKelvey Bell³⁷ was placed in temporary command, delivering up the position later to Lieutenant-Colonel Shillington.

There ensued, in fact, a period of rearrangement. Officers in the prime of youth belonging to the converted field ambulance units were transferred to their appropriate positions as Regimental Medical Officers: men of older standing who in their patriotism had accompanied the overseas drafts from their old regiments, found themselves removed to base hospitals units, where they would be of greater service. And when this had been accomplished, the modified units had to be trained, and as the particular aptitude of particular individuals – or want of aptitude – revealed itself, a process of culling and frequent rearrangement was undertaken with the object of garning the right man in the right place, and a maximum of efficiency. In this way members of medical units from all parts of the Dominion found positions, whether as Regimental Medical Officers or as members of the staffs of field ambulances of hospitals. Of the two field ambulances first called up, No. 9, from Prince Edward's Island, in command of Major Yeo, opened up an improvised camp hospital at Valcartier for the treatment of local sick. These two units having been called up and not having volunteered, when the camp became organized, the hospital was taken over by No. 5 Field Ambulance from Montreal, and this unit was returned to its base. The other, No. 7 Field Ambulance from Quebec, under Major Percy Wright,³⁸ which had been doing duty at Lever's Camp, volunteered almost intact.

THE CROSSING

To convoy across an ocean in one body an army of thirty-three thousand men was an undertaking of a magnitude greater than had ever hitherto been attempted. In the Crimea Great Britain at no time had more than twenty-five thousand men; France had a larger number, but these arrived piecemeal over safe seas without a sign of the enemy. In South Africa, similarly, troops arrived in detail from Great Britain and India, Australasia and Canada. Napoleon made preparations to convoy 100,000 men across the twenty-five miles which separate France from England, but never convoyed them; Trafalgar made him desist. The only comparable undertaking is the Spanish Armada three centuries and more ago, with 21,627 troops on board some 132 ships of a total of over 60,000 tons, for that period an adventure of even greater magnitude, but as disastrous as it was notable.³⁹

The Canadian Armada, on the other hand, was both notable and favoured by fortune. But it was an adventure on a huge scale, requiring ample and most careful preparation. To requisition and employ for one purpose thirty-two great ocean liners was in itself an indication of the resources of the Empire: to shepherd them in perfect order and without a mishap across three thousand miles of ocean speaks volumes for both the navy which marshalled them and the mercantile marine in charge of the individual ships. Even if at this early period of the war the seas had been swept clear of German warships (which was not the case), there was always the sudden peril of the mine and the submarine. The collection of the liners in Canadian waters had to proceed cautiously; the rendezvous could not be divulged, nor again the date of sailing, while in addition the Admiralty had to make the convoying arrangements. The wonder is that in the time afforded the arrangements were so perfect. With no advertisement throughout Canada, day after day during the last week of September, troops marched from Valcartier to Quebec in the order of their embarkation, they and their stores were expeditiously embarked, and liner after liner dropped quietly down the river to the place of rendezvous, until upon October 3rd each vessel had been given its appointed place in Gaspé Basin, and thirty-one vessels in all were collected, with five accompanying war vessels.

This, however, is not a general history of the war; these matters are but mentioned to indicate the profound impression made upon every medical unit that was privileged to be part of the great convoy. The many diaries that have come into my hands show that the two incidents which had the greatest appeal were the quiet assemblage of the liners in the beautiful Gaspé Basin, and the ordered departure from the bay.

The medical units accompanying the First Contingent were the following: No. 1 Canadian Field Ambulance, O.C. Lieutenant-Colonel A. E. Ross (of Kingston, Ontario); No. 2 Canadian Field Ambulance, O.C. Lieutenant-Colonel D. W. McPherson (of Toronto); No. 3 Canadian Field Ambulance, O.C. Lieutenant-Colonel W. L. Watt (of Winnipeg); No. 1 Canadian Casualty Clearing Station, O.C. Lieutenant-Colonel F. S. C. Ford (of New Germany, N.S.); No. 1 Canadian General Hospital, O.C. Lieutenant-Colonel Murray MacLaren (of St. John, N.B.); No. 2 Canadian General Hospital, O.C. Lieutenant-Colonel J. W. Bridges, P.A.M.C.; No. 1 Canadian Stationary Hospital, O.C. Lieutenant-Colonel L. Drum, P.A.M.C.; No. 2 Canadian Stationary Hospital, O.C. Lieutenant-Colonel A. T. Shillington (Ottawa).

Just as the D.G.A.M.S. in England, Sir Arthur Sloggett, found it essential to accompany the British forces overseas to Flanders, there to superintend an organization which had not been tested in any great war, so was it necessary for the D.G.M.S. Canadians to control the organization for which he had been so largely responsible, an organization which during the last seven years had been developed under his supervision. There was no other officer in the Service with the same intimate knowledge of the personnel of the various units and the capacity of individual officers; no one, again, so fully conversant with the medical staff at the War Office, and the methods of the Royal Army Medical Corps. It was far from being realized at this period what developments would take place, and that once overseas the expansion of the Service would be so great that a permanent Canadian Central Staff would inevitably have to be formed in England.

At Valcartier Colonel Jones, regarded as being in temporary medical charge of a division, reverted, when it was decided that he should accompany it overseas, to the status of A.D.M.S., with Lieutenant-Colonel G. L. Foster,⁴⁰ late A.D.M.S. 2nd District (Toronto) as D.A.D.M.S.⁴¹ Nevertheless, from the moment that Lines of Communication units were authorized, Colonel Jones had medical charge of more than a division, and the moment he reached England, dealing directly with the War Office, he had to assume the responsibilities of a Director of Medical Services. This was fully recognized by the authorities there, and, as a matter of fact, his promotion to Surgeon-General and appointment as D.M.S. was dated from September 1st, 1914. In the same order and from the same date Lieutenant-Colonel G. L. Foster, P.A.M.C., was appointed A.D.M.S. 1st Canadian Contingent, and Major H. A. Chisholm D.A.D.M.S.⁴²

In the absence of Colonel Carleton Jones, Major Jacques, of the P.A.M.C., was appointed Acting D.G.M.S. at Ottawa.

The passage was necessarily slow, the speed of the convoy as a whole being attuned to that of the weaker members, one or two of whom could with difficulty muster just under ten knots. To those accustomed to the Atlantic crossing the outstanding feature was the abundant exercise enforced – drills, games, marches and runs at stated periods. Thus, to quote the private War Diary of Captain P. G. Bell,⁴³ of the 3rd Field Ambulance, which crossed on board the Tunisian:

"28.9.14. Have moved down to Rimouski by easy stages.... Regular drills now at 10 a.m. and 2 p.m. with physical exercises, marches and runs about the deck. We have established our tent division on board and taken over the ship's dispensary. Sick parade 9 a.m., lectures to the men daily on First Aid, etc. Food is very good on board.

"30.9.14. Vaccination still in progress – did ninety-eight to-day myself. There are no 'conscientious objectors.'... Inoculation for typhoid was voluntary, but nearly all not already inoculated accepted it, the insertion of some five hundred million little corpses into their bodies apparently not worrying them very much.

"1.10.14. Several of us are making a practice of taking a mile run every night at 6 p.m. (fourteen times round upper deck). We come down and tumble into a hot bath before dressing, which is all very nice, and is gradually, I think, getting us pretty fit. I am getting infinitely more exercise than I ever did on shipboard before. The men are marched and doubled about the deck for an hour daily, as well as having physical exercises."

But otherwise on the whole the seas were quiet, and the voyage was singularly uneventful. Land's End was sighted and passed during the forenoon of the 14th, and that afternoon the transports, all in battle grey, and now in a double line, ran in to Plymouth Harbour, rounding the point and past the Hoe with its memories of Francis Drake and that other Armada of centuries ago, and so they moved up the river to Devonport, and that same evening found all moored two by two to buoys at the Hamoaze, over against Devonport.

And here in the Hamoaze there was for many eager spirits a painful pause, for Plymouth, while welcoming the Canadians with the utmost cordiality, was unprepared for an invasion upon so large a scale. As a matter of fact, Southampton had been the original destination, but rumours of submarines lying in wait off that port caused a change at the last moment. The dockage space was small, and much naval work was in progress which was imperative, and could not be interfered with. Many days elapsed before the last transport came alongside and discharged its contents. It was, for example, five days before the Tunisian, with the 3rd Field Ambulance on board, landed its troops, and a week before the 2nd Stationary Hospital found itself entraining at Plymouth for Lavington and Salisbury Plain.

SALISBURY PLAIN
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CHAPTER III
SALISBURY PLAIN

TO those Canadians who have not been overseas, Salisbury Plain, as seen from the uplands, may best be likened to the rolling, grass-covered country stretching around Calgary, at the foot of the foothills proper, that is, when seen with the back turned to the Rockies – for here are no distant, snow-clad peaks, but in every direction is a wide horizon. Descend into the valleys and a very different impression is gained. Here nestle little, old-world English villages, with elm-shaded thatched cottages, and even thatched farmyard walls built of clunch – i.e. of chalk some four feet or so in thickness, with strengthening courses of brick; old Queen Anne and Georgian manor houses which, were they in the eastern states, we would call colonial; old gabled inns with swinging signboards and low-raftered rooms – villages which are mellowing into a gentle decay. For Wiltshire is an agricultural county that has not kept up with the march of the rest of the world, and its agricultural labourers have had the reputation of being more poorly paid than those in any part of Great Britain. All lads of spirit have migrated to the towns or across the ocean, leaving behind the old and the very young, and those who find content in continuing ways of life that satisfied their forefathers. But each cottage has its little well-cared-for garden, and somehow the villages give the impression of the simple life rather than of poverty, or, if of poverty, then of a poverty that respects and will not flaunt itself. The plain is curiously old world. Nowhere, save perhaps in Brittany, are to be found more abundant prehistoric remains – dolmens and cromlechs, long barrows and round barrows, camps, earthworks, dykes and roads, remains of neolithic man, of Druids, Romans and Saxons. Stonehenge is but one of many memorials of a distant past.

The plain covers a stretch of country some twenty-five miles from east to west, by fifteen miles from north to south. It is watered, and poorly watered at that, by five streams⁴⁴ which, distributed like the fingers of the outstretched hand, converge and join at or near Salisbury, which thus is the natural capital of the district, the centre to which all the main valleys trend.

The rolling downs, devoid of fields and fences and the diminishing population, make this an ideal ground for camps and army manoeuvers and exercises, and as such they have of late years been employed by the British Army. There is a pre-war cavalry school at Netheravon, and the least populated district to the north has been employed for artillery, with heavy gun and other ranges. It was in this area that the Canadians were camped.

Yet it has its disadvantages, as our Canadians were soon to experience. This undulating "down" country is, geologically speaking, situated upon the chalk, a formation of which we have little or no knowledge in Canada. Perchance it was useful for us to become accustomed to it, since the formation extends over southern and eastern England, from Wiltshire on the west and Cambridgeshire to the north, across the Channel over northern France down to the Somme and the Champagne district. It makes for thin if not poor soil; the chalk is covered by a clayey compost from eight to eighteen inches in depth, with intermingled fragments of flint, and this pulverizes into abundant whitish dust in dry weather, and in wet weather, since the water does not permeate the underlying chalk, it forms, when "puddled" by the feet of marching men, a most appalling quagmire – a mud through which one sinks it may be up to the knees, until brought to by the terra firma of the underlying chalk. That mud will remain a memory with the men of the First Contingent until their dying day – will, in fact, be the main memory of Salisbury Plain.

Most of the Canadians arrived at Lavington or Patney, or other stations on the outskirts of the Plain, in the early hours of the morning, and marched thence into camp through darkness. There at West Down North, in the reserved artillery area, medical units found the tents already pitched, put up by the British Army Service in expectation of their arrival. And now followed a winter of steady training – and yet more steady raining.

As for the training, the men were drilled, weather or no; were given route marches, even though the Canadian pattern army boot had not been built in anticipation of British rain and Wiltshire mud; they took part in concentration schemes, bivouacs and manoeuvers, now here, now there, over the plain. The Field Ambulance units went through the familiar routine in unfamiliar surroundings. There was not an officer of the three units who was not a trained member of the C.A.M.C., conversant with the field exercises of the annual camps. The same was true of most of the non-commissioned officers and of a large number of the rank and file. The personnel had been carefully selected. Now they found themselves, tent, bearer and transport sections, drilled and exercised and route-marched here and there over the Plain – marching to Salisbury with transport and equipment, the bearers acting as patients; or, again, they marched to Black Copse supposedly with the advanced guard, and the bearers were sent forward with their stretchers; an Advanced Dressing Station was opened up, and the tents pitched by the tent division as a Main Dressing Station further back; the cooks, too, being exercised, taking out the field kitchen and feeding the unit. In each camp to which they were attached they ran a Medical Detention Room in two or three hutments, for the treatment of mild and transient cases – cases under suspicion, or not deemed sufficiently serious to be sent to the main military hospital and struck off the strength.

The original arrangement with the Imperial authorities had been that the latter would care for cases of serious sickness and casualties occurring in the contingent, either in the Military Hospital at Tidworth, on the eastern border of the Plain, or in the General Infirmary at Salisbury to the south. This plan was defeated by the heavy influx of wounded from Flanders after the First Battle of Ypres. Like all the other large hospitals in the south of England, Salisbury Infirmary had little accommodation to spare. It was decided, therefore, to utilize one of the Canadian General Hospitals as a camp hospital, only the most serious cases being sent to Tidworth and Salisbury, infectious cases to the Salisbury Isolation Hospital, and mental cases to the district asylum. No. 2 General Hospital, which had been the first to arrive on the Plain, had opened a camp hospital in the tents provided immediately upon arrival at West Down North, utilizing equipment lent by the 3rd Field Ambulance, their own stores being still at Plymouth. In the last week of October this was taken over by No. 1 and greatly enlarged.⁴⁵ In a week the marquees were full and more accommodation was needed. Next, owing to the wet and inclement weather, every endeavour was made by the camp authorities to get the patients under shelter. Several houses were secured along the valley of the Avon: Bulford Manor, a fine old seventeenth century mansion; three commodious cottages, just completed for the use of officers of the Bulford Camp, and Ablingdon House, the residence of General Vaughan, which was most generously placed at the disposal of the Canadian authorities by that distinguished officer. Many Canadians have grateful recollections of the care and attention bestowed upon them by Mrs. Vaughan. Somewhat later Figheldean House was taken over for convalescent patients.

It was on November 6th that Bulford Manor became the Headquarters of No. 1 Canadian General Hospital. Here was accommodation for sixty cases, under Lieutenant-Colonel K. Cameron,⁴⁶ head of the Surgical Service, with two rooms admirably adapted for surgical operations and preparation for the same. The accommodation soon became taxed to the utmost; one of the cottages was used as a residence for the nursing sisters, the other two for medical patients under the charge of Lieutenant-Colonel F. G. Finley. ⁴⁷ In one of them rooms were set aside for the laboratory. On the Bulford cricket ground adjoining tents were erected, their number being augmented from time to time.

With this rapid enlargement and increase in the scope of the camp hospital, the personnel of No. 1 General was reinforced by a few officers and almost all the N.C.O.'s and men of No. 2 General. A few officers, N.C.O.'s and men remained in charge of a small hospital at Lavington on the western border of the Plain, but the greater number of the officers of this unit proceeded to France, there to be distributed amongst the British hospitals until such time as the unit as a whole should become established there.

With the appearance of sporadic cases of cerebro-spinal fever one of the commodious cottages was taken over by No. 1 General as an isolation hospital, and, as the condition demanded every care, the laboratory was installed in the adjoining cottage, with Captain A. Rankin⁴⁸ and Captain A. W. M. Ellis⁴⁹ in charge, working in co-operation with Dr. Arkwright, of the Lister Institute. Next, early in December, Figheldean House was taken over as an auxiliary hospital. At Christmas the number of patients under treatment exceeded one thousand. But, in six weeks, what with the flooded condition of Bulford and the increase in the number of cases, the accommodation provided proved inadequate, and the main hospital was moved to the Cavalry School at Netheravon, leaving the venereal section at Bulford. By the beginning of February the hospital had charge of twelve hundred patients. Altogether while on Salisbury Plain No. 1 General Hospital received and treated 3,993 patients, of whom 1,249 were venereal and 46 cerebro-spinal fever, with a death-roll of 69, one-third of which was due to cerebro-spinal fever.⁵⁰ Seven deaths had been from a virulent form of broncho-pneumonia, of which there had been fifteen cases.

With the Canadian troops scattered across the Plain from Pond Farm and West Down North on the west to Tidworth in the east, and the hospital detachments and auxiliaries similarly scattered in different villages over an area some nine miles across, not only were the administrative difficulties very great, but the admission and evacuation of patients was a constant source of great trouble. The number of ambulances was restricted, and of the three at the disposal of the unit, owing to the wretched state of the roads brought about by the heavy motor-lorry traffic and the continued wet weather, it generally happened that two were under repair. But for the co-operation of the Divisional Ammunition Park at Netheravon, and the motor transport afforded by them, it would not have been possible to "carry on." Despite all these difficulties, the unit under Colonel MacLaren worked with a will and proved itself most effective.

As for the raining – there was a downpour so persistent that the oldest inhabitants remembered nothing to compare with it. The brooks overflowed and ran surly down the valley roads, expanding here and there into lakes; the tent floors were morasses; it was impossible to keep dry. The rainfall for the month of December was the highest in fifty years, namely, 6.34 inches. The nearest approach was 6.25 inches in December, 1876. Colonel Bridges informs me that out of seventy-five days, there were only five upon which it did not rain. If our officers found that rubber boots rising over the knees did not always protect them, the predicament of our nursing sisters passing over the quagmire from tent to tent, or from tents to quarters, was at times piteous. But the extraordinary part was that the troops appeared, despite the discomfort, to thrive upon it. The whole contingent, one would have thought, ought to have been down with rheumatic fever: but rheumatic fever was almost unknown. The open-air life, good food and abundant exercise kept the men in excellent health, until, after some six weeks, the discomfort of tent life and the increasing cold of winter induced the authorities to replace the tents by hutments, and then promptly influenza and throat troubles spread through the contingent. I cannot in this respect do better than quote from the report of a Regimental Medical Officer, Captain H. E. MacDermot,⁵¹ M.O. 1st Reserve Ammunition Park:

"Our stay here lasted nearly six months, and in that time we lived under very varying conditions. But the most marked feature was the extremely heavy and persistent rain, which lasted from November to March with practically no intermission. The consequent discomfort was all that might be expected, especially during the first six weeks when we were housed in very poor tents. In November our unit was moved into wooden huts and conditions were then a little better, but the encampment was still in process of building and so was very incomplete.... The food was always good and plentiful, and canteens for extras were within reach. There were, however, very few, if any, means of recreation, and this aggravated the tendency to excess of one or other order.... It is a little remarkable that under the conditions of wet and exposure there was no serious impairment of the health of the men. But I believe that the explanation of this lay partly in the exposure itself. It is noteworthy and beyond question the case that what illness there was increased at once and rapidly when the men moved into huts, with the attendant evils of accumulation of dust and insufficiency of fresh air. The huts, too, for a good portion of the time were overcrowded, and the comparative segregation of illness provided by the tents was largely lost by the crowding together in one hut of a number of men previously scattered through five or six tents.

"As might have been expected, the illnesses of the men were chiefly in connection with the respiratory system. A type of influenza developed, the worst feature being an extremely persistent and troublesome cough. There would be fairly high temperature, pains in the back and limbs and general malaise; but this stage usually passed in three or four days, leaving the cough, which often lasted for weeks....

"The one case of cerebro-spinal meningitis which occurred in the Park (it terminated fatally) developed in Tidworth Barracks a couple of months after we had moved there from the huts at Sling Plantation, where the epidemic of this disease amongst the surrounding battalions was at its worst. All precautions for isolation of the 'contacts' of this case were taken, and bacteriological examinations of their nasal passages were made. Three of the men so examined proved positive for the germ of the disease for a time, and were isolated and treated until their throat passages were found free from the germ.

In view of the publicity already given to these subjects, it is necessary to note in fuller detail two matters connected with the health of the Canadian troops at Salisbury Plain – namely, the outbreak of cerebro-spinal fever and the veneral situation.

Cerebro-spinal fever (epidemic cerebro-spinal meningitis, or spotted fever) is a disease which, only recognized for the last hundred years or so, has been characterized by appearing in an epidemic form at irregular intervals. Years may elapse during which in any given city not a case is reported, and then the disease may carry off large numbers of young children, together with occasional adults. This may continue for one, two or more years, generally dying down until again no more cases are reported, or a very occasional sporadic case. What is remarkable is that the disease has broken out among the soldiery in every modern war, as again that local epidemics have frequently been recorded in barracks in times of peace.

Now cerebro-spinal fever was reported from several parts of Canada in the autumn of 1914; four cases occurred at Valcartier in September, and despite all care there in isolating those who had come into contact with the patients, three cases showed themselves on the convoy; two were soldiers, the other a ship steward's clerk. After arrival, seven cases were reported up to November 24th, scattered through the different battalions at Bustard Camp and West Down South, but there was no spread; on the contrary, for a period of three weeks, up to December 13th, not a single case was reported. Evidently the life in the open all day and in tents through the night arrested the disease. With the transfer to huts early in December it broke out again; there were fourteen cases in the second half of December, and ten of the fourteen were fatal. At this period every detail of happenings at Salisbury Plain was cabled to Canada, and when towards Christmas time reports of death from meningitis appeared in all Canadian journals day after day, the impression spread abroad that there was a grave epidemic; as a matter of fact, thanks to the precautions taken, the total number of cases in the thirty-three thousand men of the First Contingent from the time of its arrival to its departure from the Plain, did not exceed thirty-nine, though of these twenty-eight were fatal cases.⁵²

With great willingness the Lister Institute placed one of its experts, Dr. Arkwright, at the disposal of the Canadian authorities. In the first week of January a laboratory fully equipped was established in a cottage at Bulford, and here a staff of well-trained Canadian Medical Officers assisted Dr. Arkwright in making a thorough bacteriological study of the cases – and, what is equally important, of the contacts. It has been proved that when the disease becomes epidemic, certain individuals, themselves showing no indication of the disease, may harbour the meningococcus (the causative agent) in their throats for a year and more, and may thus be the innocent instruments of conveyance of the disease to others, in whom the organisms no longer multiply passively on the moist surface of the throat and upper nasal passages, but gain admission to the tissues and body fluids, take an active growth and set up the disease. It is necessary, therefore, to detect these "carriers," for by isolating them as well as those succumbing to the disease, the spread can be arrested.

Now here are the interesting points about the Salisbury Plain cases. In barrack epidemics which have been studied in Germany, as many as ten carriers have been found among sixteen soldiers occupying the same room, and forty-two carriers among 485 men in the same battalion; indeed, it has not been uncommon to find from ten to thirteen per cent. of "carriers" among soldiers occupying the same room.⁵³

The cases on the Plain, on the other hand, were widely scattered. Of the forty, ten are recorded as occurring at Sling Plantation, ten at Lark Hill, four at Bustard Camp, two at West Down North, five at West Down South, and others elsewhere. Eighteen different units contributed cases, the highest number contributed by any one unit being six in the 17th Battalion. In this battalion alone was there anything that could be said to approach a regimental epidemic; but even then these six cases all occurred during the second fortnight of December: there were no further cases; the resolute precautions taken stopped the spread. As a matter of fact, all the evidence at our disposal shows that we had not to deal with the usual room infection. Dr. Arkwright pointed out in his report to the D.M.S. that of 349 "contacts" examined (sisters who had nursed cases, men who had slept in huts along with a recent case of meningitis, etc.), 345 afforded a negative result, and only four a positive; that is to say, afforded growths of meningococci from their throats – a percentage of 1.12. Actually a higher percentage was obtained from the throats of non-contacts.⁵⁴ "The low proportion of carriers detected at Bulford would suggest that the cases of meningitis did not, as a rule, result from infection in the sleeping room, but from carriers with whom the case of meningitis came into contact elsewhere." At most, the transfer to huts with their poorer ventilation predisposed the men to infection. It is not improbable that the crowded canteens were implicated, and that the disease was conveyed through partially rinsed mugs and glasses. I am informed by Lieutenant-Colonel Armstrong, the Director of Canadian Dental Services, that at Witley Camp there has been a striking reduction in the number of cases of another infectious disorder known as Trench mouth (ulcerative stomatitis), since the order was put into force that in public drinking places every glass or mug after use has its edge dipped momentarily into boiling water, and this in the presence of the customers. This order is enforced not only in canteens, but in the inns and bars of the neighbourhood, such drinking-places as have not installed the simple apparatus necessitated being placed out of bounds. Food utensils also are now well sterilized, and this, too, must exert a good effect.

What, for Canadian amour propre, is more irritating is that coincidentally "spotted fever" was reported as breaking out in other parts of England. It was natural that the ordinary public should jump to the conclusion that the First Canadian Contingent had introduced the disease, and was responsible; it is regrettable that the Special Advisory Committee by the unhappy wording of their report should without adducing adequate evidence seem to support this suggestion.⁵⁵

For what are the facts? Cerebro-spinal fever had been setting up minor epidemics for some years, more particularly in southern and south central England; in Ireland, at Belfast (1906-08) there had been a severe epidemic. In 1910 there was an outbreak in the Nottingham district; six out of eleven cases studied in the city and suburbs of Nottingham itself were shown to be "spotted fever" by the recognition of the organisms in the spinal fluid.⁵⁶

And the disease was spreading, so that in September, 1912, cerebro-spinal fever was at last added to the list of compulsorily notifiable diseases in every sanitary district of the British Isles,⁵⁷ and from September 1st to the end of the year 104 cases were notified, in 1913, 305, and in 1914, 315.

Coming to 1914, in the autumn cases were being reported as follows: ⁵⁸

ENGLAND AND WALES

Number of cases notified each week (not including patients from overseas):

CEREBRO-SPINAL FEVER

There had thus been more than a dozen cases of cerebro-spinal fever reported in the month before the contingent set foot on British soil, or could possibly have communicated the disease; and the first case developing at Salisbury Plain (on October 18th) coincided in point of time with the first case notified among the Imperial troops. There is absolutely no evidence that the Canadian troops are responsible for the spread of the disease in the Eastern command and elsewhere in England. The fact is that when the disease is already present in a country and the weather is raw and damp, there is certain to be an outbreak among the troops unless those precautions be taken which the experience of the last four years has shown to be effective.

Regarding the venereal situation, old-established reticence makes it difficult to state in plain terms the exact state of the case, and that although the Times at last has escaped from circumlocutions, and allows the term "syphilis" to appear upon its pages, and a Royal Commission upon Venereal Diseases and its conclusions have been extensively commented upon in the public Press and wherever thoughtful men and women are congregated.

The writer himself has for years taken the stand that the proper way to deal with this problem is by perfect openness.⁵⁹ But he appreciates the patriotic way in which many of the clergy and others who hold opinions diametrically opposed to his, have consented not to make this matter of the venereal problem in the Army a live issue during the course of the war. Were he in an official publication to give, he would not say his own views, but those of the heads of the medical corps and of the Service in general, or were he merely to give detailed statistics, and that without comment, he would by either act open the flood-gates of discussion and invite such criticism as for the good and efficient working of the Army is best delayed until the conclusion of hostilities. Later, this matter of the methods of control and suppression of venereal disease in Canada and among Canadians must be taken up by the Dominion, the military situation being but one part of the greater problem.

This much, however, may be said: from the Canadian corps in the field venereal disease has been almost eliminated. In the Army at large the incidence of the disease is much less than in any previous campaign, less even than in civil life.⁶⁰ Public opinion must be educated in future to deal with this subject, as it has been educated to accept vaccination against small-pox and inoculation against typhoid. By such means it is not too much to hope that the graver malady will disappear as effectually as these other two diseases.

With reference to the medical units other than the field ambulances and No. 1 General Hospital, and their activities during the period of training; to No. 2 Stationary Hospital was granted the distinction of being the first of all Canadian units to place foot upon French soil. This unit, under Lieutenant-Colonel Shillington, after the inspection by Their Majesties the King and Queen two days previously, left the Plain on November 6th, 1914. At Southampton the O.C. was detained by arrangements concerning the nursing sisters, and thus it devolved upon Major H. C. S. Elliot,⁶¹ the second in command, to take the unit across the Channel to Havre. For a few days it was billeted at Boulogne. On November 27th it opened up the well-known Hôtel du Golf at Le Touquet, on the dunes near Paris Plage, as a hospital of three hundred beds – the first of a series of Canadian base hospitals along the French coast between Boulogne and Dieppe.

No. 1 Stationary Hospital was detained in England, with the intention that it should open up as a base hospital in the immediate neighbourhood of London. For this purpose a new and admirably situated hospital, St. Vincent's Hospital, at Mount Vernon, Hampstead, was allotted to it by the Imperial authorities; the unit was transferred there and immediately set to work to transform this into a military hospital. But, on further consideration, the authorities found that this would better subserve other purposes.⁶² And so, on February 2nd, 1915, No. 1 Stationary Hospital followed No. 2, and was dispatched to Boulogne, where it opened up at Honeault Camp, Wimereux. Early in August, at the request of the War Office, Major Handford McKee took his unit to the island of Lemnos, off the mouth of the Dardanelles, there to participate in the Gallipoli campaign.

Of No. 1 and No. 2 General Hospitals the story has been given in the preceding pages.

No. 1 Casualty Clearing Station, after six weeks of field training, was sent to Taplow, where Major Waldorf Astor had generously placed the closed tennis court in his beautiful grounds at Cliveden at the disposal of the Canadian authorities, to be used as a hospital under Canadian control. That hospital has grown greatly since those early days, so that the spacious wards in the tennis court form now but an inconsiderable portion of the great Duchess of Connaught's Canadian Red Cross Hospital, or, as it is now known officially, No. 15 Canadian General Hospital. But to Major (now Colonel) Ford and his staff belongs the credit of establishing those first wards. At the beginning of February, 1915, a special staff was appointed under the late Lieutenant-Colonel Gorrell (of Ottawa), and in the first week in March, after some three weeks spent in a rest camp at Graville, No. 1 Canadian C.C.S. found itself taking possession of the old historical military prison, Fort Gassion, on the banks of the Lys, outside the fine old town of Aire, some seventeen miles behind the firing line, there to remain for many months.

It was in February that the main body of the First Contingent, now the 1st Canadian Division was transferred to France. The "Princess Pats" which were not divisional troops, had left the Plain early in December. His Majesty the King made a last inspection of the division on February 4th,⁶³ and the following day it marched off the Plain, and by the middle of the month the last transport reached St. Nazaire, leaving behind in England five unhappy battalions to form the base brigade of the division. These were moved later to Shorncliffe to form the Canadian Training Depôt, the nucleus of the Canadian Training Division.

No. 1 General Hospital being responsible for its patients, could not leave with the division, but remained on the Plain. Figheldean House was closed in the middle of February. At the end of the same month the reinforcements from No. 2 General Hospital were returned to their unit at Lavington Manor. In the first week in March the evacuation of patients from Netheravon was completed. Only upon May 5th was the evacuation for all patients from the unit accomplished, when the last batch of venereal patients in the tent hospital at Bulford was transferred to Shorncliffe, and on May 13th the unit entrained at Amesbury for France.

Shorncliffe now replaced the Plain as the reserve and training camp for Canadian troops, although, for valid reasons, the Director of Medical Services, along with the Pay and Record Departments, established their headquarters in London.

CHAPTER IV
WITH THE B.E.F., FRANCE

THIS is not the full and final history of the C.A.M.C., with all documents provided and every move of every unit carefully traced and recorded. Rather it is, to employ Lord Beaverbrook's phrase, a "contemporary history," the first object of which is to recall to those interested the good work accomplished by the Army Medical Service, before through the lapse of time their interest has been dulled. It is not the intention, therefore, to note every detail connected with each unit of the C.A.M.C and its doings. I imagine that to most of us our past lives are not recalled as a steadily moving procession of events, but as a series of vignettes, those events standing out well and sharply which affected us most acutely, whereas the intermediate days and months have left upon us little or no impression. It will serve best in such a contemporary history to dwell upon the great moments of the war, and the participation in them of the Canadian Army Medical Service, taking care at the same time to do justice to those units which, not immediately involved in actual warfare, have done valuable work upon the Lines of Communication, at the "base" in France, Mudros and Salonika, in England and in Canada. Doing this, more particularly the endeavour will be made to follow the progressive development of the various orders of units and their modification in response to the novel conditions which distinguish this from all previous wars.

This may safely be said, that Salisbury Plain, with all its training and hardships and inconveniences, had converted the 1st Canadian Division, under General Alderson, into well-seasoned soldiery. When, in February, 1915, it reached Flanders, it was in so good a condition that rapidly it fell into place. Winter, it is true, accompanied it, with snow and sleet and slush; but this was as nothing. At last it was at the seat of war and part of the British forces under the supreme command of Sir John French.

Those forces held at that time a front of less than thirty miles, stretching from Ypres on the north to Givenchy. It was organized into two armies. Of these, the First, or Southern,⁶⁴ covering the ground from Nieppe, near Armentières, to Estaires and Givenchy, was under General Sir Douglas Haig; the northern,⁶⁵ from the Bailleul area to Ypres, was under General Sir H. Smith-Dorrien. The Canadian Division consisted of three brigades⁶⁶ (to each of which was attached a Field Ambulance) Colonel G. L. Foster (now Major-General, D.G.M.S., O.M.F.C.) was in command of the Divisional Medical Corps as A.D.M.S.

It was at this point that the first grave administrative difficulty became obvious. There could be no question of running the medical, or any other section of the First Contingent as a body independent of the British authorities; the terms of Canada's offer to Britain precluded that. The Contingent was to be part and parcel of the British Regular troops and the British Army. But the personnel, and to no small extent the medical supplies, of the Canadian Division came from Canadian sources, and to this extent the A.D.M.S. remained dependent upon his Canadian superior, the D.M.S. With this, at the front he was under the D.D.M.S. of the corps to which the division was attached, and of which it formed a part; the Canadian Casualty Clearing Station was under the D.M.S. of the Army, and the Canadian Stationary and General Hospitals under the D.M.S. Lines of Communication, but more directly under the A.D.M.S. or S.M.O. of the district in which they found themselves. For the D.M.S., Canadians, General Carleton Jones, to have become attached to the staff of Sir Arthur Sloggett, D.G.M.S. in France, would have placed him immediately in an anomalous position. By British Army procedure he would have had no right to enter the territories of other D.M.S.s; those officials had complete control over the units in their respective areas; nor could divided authority be countenanced, and yet it was essential that he should keep in close touch with each Canadian medical unit. The Imperial Army regulations, indeed, had never contemplated this state of affairs.

It was equally essential that he should keep in close touch with Canada, with the Reserve and Training Division in England, and with the D.G.A.M.S. in Great Britain, Sir Alfred Keogh, who was in control of medical arrangements there. To carry on in these circumstances needed an intimate knowledge of British Army procedure, an intimate personal acquaintance with the heads of the British Army Medical Service, and tact. And the D.M.S. possessed these attributes.

What has proved a "common sensible" compromise was rapidly reached, and the good spirit and friendliness of all parties concerned has caused it to work without serious friction. It was decided that the D.M.S. Canadians should have his headquarters in London, but that he should be at liberty to cross to the seat of war whenever necessary, under and with the authority of the D.G.M.S. overseas, to visit the Canadian Medical units in the various areas, and, conferring with the D.M.S.s of these areas, through them and through the D.G.M.S. (Sir Arthur Sloggett) to initiate such changes in distribution of the units and personnel as should mutually be agreed upon.

After a short stay, mustering and training behind the lines, with the beginning of March, 1915, the Canadians moved to the front west of Estaires, Sailly and Laventie, and south of Armentières, as part of the first British (Sir Douglas Haig's) Army. And here within a very few days it participated, although only as little more than an onlooker, with but an occasional casualty, in the Battle of Neuve Chapelle. The Canadian trenches, in fact, adjoined those of the British troops to the south concerned in the action of March 10th. Had the day gone otherwise, our men would have been called upon to take part in the advance, and they were all prepared. But Neuve Chapelle taught us that it is not the first but the second and third lines of the enemy that count; that it is not sufficient for the artillery to prepare the way for entrance into the first line of trenches; there must be fire of such intensity as to render at least the third line and its communications untenable. And in those days the British artillery and the amount of ammunition at its disposal were inadequate to accomplish this. But here, at a bound, the Canadians saw battle.

The only Canadian unit that actually participated in the Battle of Neuve Chapelle was the 1st Canadian Casualty Clearing Station. On March 8th, two days before the battle, Lieutenant-Colonel W. D. Ford had brought his unit to Aire, some seven miles behind the front. Aire, on the winding Lys, is a delightful little old-world town, possessing one of the finest churches in French Flanders, with a tower curiously reminiscent of English early Perpendicular architecture.⁶⁷ The town walls, with their bastions and three gates, were razed as late as 1893.

Like the whole of this countryside, Aire has seen much war.⁶⁸ It was besieged and taken by Philip IV. of Spain in 1641, and certain stately old houses in the town, with their richly decorated fronts, still bear witness to the years of Spanish occupation. Philip it was who built Fort St. Francis, now known as Fort Gassion,⁶⁹ a quarter of a mile outside the St. Venant Gate, and built it in orthodox seventeenth century fashion, octagonal, with large bastions and a surrounding moat and drawbridge with strong gate and gate-house. Recaptured by the French in 1676, the fort, nevertheless, in its day, with its twenty-five guns and outworks, was a formidable protection to the town and obstacle to the enemy, as Marlborough found to his cost in the campaign of 1710. With the able defence of de Guebriant and Fort St. Francis, and the marshes and inundations, the town only capitulated in November, after a ten-weeks' siege,⁷⁰ too late in the season for its capture to be of service, and at too great a cost; for the Flanders rain and dysentery caused the loss of many hundreds of the English troops. Those were the days when opposing armies retired to winter quarters.

To-day moat and bastions have followed the fortifications of Aire and are no more; but the thick encircling walls of the fort remain, and the bridge and old-world gateway and gate-houses with the barrack-like buildings within. For years it had been used as a military prison, and here rumour has it Captain Dreyfus was confined for long months.

It was to Fort Gassion that the 1st Casualty Clearing Station was detailed on the Saturday. They found a motor ambulance convoy and a motor transport unit still in occupation. These were given no time to put matters in order, but received orders leave forthwith. The old prison was, in fact, in a filthy condition, and as warning had been given to prepare for the forthcoming engagement, there ensued a period of feverish activity. The Army Service Corps came to their aid; equipment was unpacked; the bigger rooms cleaned to act as wards; and, losing not a minute, on Monday, March 10th, the day the battle opened, the unit began admitting patients. That first day they had 50 patients, on Tuesday 150, and on Wednesday 350, the great majority of these being stretcher cases. And their work was urgent and necessary. In the spring of 1915 the First Army possessed altogether six casualty clearing stations; to-day it has sixteen. At the time of the battle there were only two of these nearer to the front – at Merville. The prompt readiness and capacity of the unit received the special commendation of Surgeon-General W. G. Macpherson, D.M.S. First Army, and led in June to the award of the C.M.G. to Lieutenant-Colonel Ford.

The stay of the Canadian First Division with the First Army was of brief duration. Arrangements had been made with the French to extend the British line a few miles to the north, and the Canadians were selected to take over from the 11th French Division – the "Division de Fer" – the trenches protecting the northern sector of the Ypres salient. And so it was that on April 7th the 1st Canadian Division was transferred to the Second Army under Sir H. Smith-Dorrien, marching out of the Estaires region northwards, Colonel Foster, A.D.M.S., moving his quarters from Estaires to Oxelaere. Ten days later the 2nd and 3rd Brigades took over from the French the line north-east of Ypres, the 1st remaining in reserve.

"The French Medical Officers whom we relieved were very courteous, and explained to us how they had carried on while they had been stationed there during the winter months. They explained that each French regiment of three battalions had three M.O.'s and three assistants (who were usually students), and they worked together. The senior officer in this was a major, and was in charge of the medical work for the regiment. This system seems to work out very well and is more congenial for the M.O.'s.... The trenches were in very bad shape, and working parties, under guidance of the engineers, were working each night strengthening the parapets, building traverses, deepening the trenches, erecting parados and putting out wire entanglements. There were many bodies buried at the bottom of the trenches, so the work was frequently very unpleasant and required a good deal of chloride of lime to keep down the smell of decay. This work, although not completed when the attack was launched, helped very greatly in resisting the assaults of the enemy."⁷¹

In order to understand the happenings of the following days from a medical point of view, let us at this point describe the disposition of the medical units, so that the organization for the rapid disposal of the wounded as carried out in the British forces at this period may be clearly grasped.

The Regimental Medical Officer accompanies his men into the trenches, and, as against an attack upon those trenches, his duty is to select behind the line some spot well protected from shell fire, and as far as possible equi-distant from each of the companies at the front, there to establish his Regimental Aid Post (R.A.P.). For prompt evacuation of the wounded this should not be too far back. The approaches to it, also, should be screened from shell fire and snipers. He is provided with sixteen well-trained stretcher-bearers whose duty, as their name implies, is to convey the wounded back to the R.A.P. As a matter of fact, and as was discovered at Ypres, they are of greater service remaining in the trenches and affording first aid to the wounded, and as a body they develop into extraordinarily capable and expert dressers. In consequence, it is becoming more and more the habit during any heavy action to retain these men for the more urgent work of dressing the wounded, and to employ other men detailed from the platoons to act as stretcher-bearers. If the R.A.P. is unduly distant from the front line, the return of the wounded is delayed by the length of the carry. The R.A.P. is, in short, the regimental collecting post to which all wounded, whether walking or stretcher cases, make their way. During an action, the duty of the Regimental M.O. is not to be in the trenches, but at the R.A.P. There, with his N.C.O. and one or two orderlies, he attends to the wounded as they walk in or are brought back by the stretcher-bearers, and sees that each is given a tag, attached to a button of his tunic, giving his name, number, nature of wound, etc., prior to departure as a walking case, or removal by the bearers of the Field Ambulance.

1. In an action the first object is to remove out of the fire zone all who are no longer of service, and this as rapidly as possible. Thus the R.A.P. is not a surgery: it is at most a casualty ward. First-aid dressings are given, wounds are bandaged temporarily; splints, when urgently needed, are provided for fractured limbs; bleeding is arrested; morphia injected where injuries are painful, or strychnine where there is collapse.

2. From the R.A.P. those of the wounded who can walk make their way on foot to the Advanced Dressing Station (A.D.S.) of a Field Ambulance, which is situated within the fire zone at some roadside point up to which, if not always during the day-time, certainly at night the ambulances (usually horse ambulances) can be brought. The more seriously wounded are removed on stretchers from the R.A.P. to the A.D.S. by men of the bearer section of a Field Ambulance. In the course of a heavy action this duty also can only be undertaken in the dark.

3. The next stage of the journey towards the base is, in general, performed in motor ambulances.⁷² The greater number of cases are conveyed to the Main Dressing Station (M.D.S.) of a Field Ambulance. Here they undergo classification. The gravest cases are operated on immediately, and are kept at the M.D.S. until they are fit to be transferred to the Casualty Clearing Station. Mild cases also are given rest and treatment for a few days, until fit to return to duty, or if there be a rest camp in the neighbourhood, they may be sent there to recuperate. Every man saved from proceeding further to the base means a saving of many days' loss to his company. Other cases are sent to railhead with instructions, some for treatment at the Casualty Clearing Station, others for transfer to one or other special hospital (infectious cases, eye cases, graver dental cases, etc.). The majority of those admitted leave the M.D.S. within twelve hours, the object being to evacuate as rapidly as possible.

4. In the early part of the war Red Cross ambulances, army transport, motors and motor-omnibuses, as they could be obtained, were employed for the conveyance of patients from the Field Ambulances to the Casualty Clearing Station. These developed into a well-organized and most efficient motor transport corps, under the Army Service Corps.

5. The Casualty Clearing Hospital or Station is the next relay point. This is always situated in the vicinity of railhead, and, as its name implies, is the great forward clearing depot. Its first function is to accommodate the wounded for a few hours until, after their wounds have been cared for and suitably dressed, they can be placed in an ambulance train and sent to the base. But it is well behind the firing line, only within range, that is, of long distance guns, "Jack Johnsons"