By Michael O'Leary; The Regimental Rogue
"The total number of cases receiving hospital treatment up to August 31, 1919, was 539,690 of which 144,606 were battle casualties and 395,084 of disease."
Official History of the Canadian Forces in the Great War; The Medical Services, by Sir Andrew McPhail, 1925 (emphasis added).
Canada sent a total of 418,606 troops overseas in the First World War. In comparison, the number of hospitalizations reached 539,690 (or 129 % of the number of deployed troops) in the Canadian Expeditionary Force (CEF). This number is further divided into 144,606 battle casualties and 395,084 soldiers being hospitalized for various diseases. While these numbers do not include minor illnesses that were treated by unit medical officers, they do include multiple hospitalizations for many individuals. These statistics do, however, emphasize the seriousness of disease and sickness on the battlefield of the First World War, in an era before the use of effective antibiotics. Illnesses that might be considered minor today (or almost eradicated in the Western world by improved diet and medicine) could hospitalize a man for weeks or months before he returned to duty on the front lines.
This article will look at some of the causes of the frequency of wounds and types of illnesses that affected Canadian soldiers of the First World War. Researchers examining a soldier's service record are reminded that consideration must be given to the era, the state of development of medical care and the unavailability of many of the diagnostic tools and treatment methods that might be found in a modern doctor's office or hospital.
The Official History of the Canadian Forces in the Great War; The Medical Services provides the following statistics. The source, printed in 1925, also notes that figures are subject to technical revision. Discrepancies in classification of individual cases initially recorded as "killed accidentally, "suicide", or other causes can be adjusted following review giving different number depending on source and date of publication.
|Cases of disease||19,100||375,984||395,084|
|Died of Disease||175||3650||3825|
|Percentage of deaths by disease to number of cases of disease||.91 %||.97 %||.96 %|
|Cases of wounded||6347||143,385||149,732|
|Died of wounds||819||16,363||17,182|
|Percentage of deaths by wounds to number of cases of wounds||12.90 %||11.41 %||11.6 %|
|Disease and other causes||297||4663||4960||8.75 %|
|Killed in Action||1776||32,720||34,496||60.92 %|
|Died of Wounds||819||16,363||17,182||30.33 %|
In summary, less than 1% of soldiers hospitalized for sickness died of their disease; and of those sent to hospital wounded, only 11.6% later died of their wounds.
The following table from the Official History of the Canadian Forces in the Great War; The Medical Services shows the distribution of wound types experienced by officers and other ranks of the CEF:
|Head and neck||907||21,377||22,284|
|Wounded, remained at duty||904||6698||7602|
|Effects of gas fumes||368||10,988||11,356|
Further detail is provided on the numbers of amputations performed:
The Official History of the Canadian Forces in the Great War; The Medical Services offers details of the following diseases which afflicted the soldiers of the Canadian Expeditionary Force:
During the First World War, shell-shock became the catch-all term for a wide variety of nervous conditions which, at various times were identified as ranging from "cowardice" to "maniacal insanity." While modern medicine is no more certain of effective diagnoses and treatment, the medical system of the Great War was not prepared for the range of possible symptoms or the reactions of patients or commanders to shell-shock. The medical system also found itself in the unenviable position of certifying men who appeared well enough at the time of examination to be fit to stand trials for cowardice, which in some cases led to their executions.
Identification and treatment of psychological illnesses was outside the experience of most of the medical officers in the front lines, who had to deal with cases as they appeared. Later, with the realization that shell-shock was a disease, or perhaps better described as a range of diseases and medical conditions, it was categorized as "shell-shock," "hysteria," or "neuresthenia." The growing readiness of the medical system to treat shell-shock patients with care was countered in 1917 by orders that attempted to quash the diagnosis (because it was suspected as a malingerer's choice of malady to fake). Those orders read:
In no circumstances whatever will the expression "shell-shock" be made use of verbally or be recorded in any regimental or other casualty report, or in any hospital or other medical document except in cases so classified by the order of the officer commanding the special hospital for such cases." (Report O.M.F.C. 1918)
Wounds of the eye, in themselves, were not common because they were usually associated with more significant trauma to the head, resulting in death. Within the CEF, 66 cases of blindness were recorded, with a further 476 men losing one eye. Ten others lost an eye as part of more general injuries, and there was one case of a man wilfully blinding himself. Cases of diseases of the eye totalled 6547 members of the CEF, but no deaths were recorded from this cause.
Men who lost their sight were treated at St. Dunstan's Hostel, where they were trained to live without their sight and were also taught a trade if they so desired.
Diseases of the ear accounted for 5708 hospital admission, of which 19 resulted in fatalities.
The CEF recorded 729 cases of self-inflicted wounds of which six were by officers. The determination of the chain of command to prevent these instances was so strict that any medical officer identifying a possible case of self-inflicted wound was required to report it, and the patient was immediately placed under arrest awaiting court martial.
An excerpt from the War Diary of The Royal Canadian Regiment, showing the entries for 27 and 28 March 1916. The entry on 28 March notes the self-inflicted wound of 477130 Private T.H. Burdett.
The Official History of the Canadian Forces in the Great War; The Medical Services describes how a soldier intending to inflict a wound upon himself might do so:
" A man would fasten his rifle in a fixed position, discharge it, and observe where the bullet struck. He would then place the least serviceable part of his body in the line of fire and discharge the rifle again."
An excerpt from the Part II Daily Orders of The Royal Canadian Regiment, showing the entry for the Court Martial of 814480 Private H. Barre for a self-inflicted wound.
There was another, less easily detected, type of "self-inflicted wound" that might ensure a man spent lengthy periods in hospital instead of in the front line trenches …
The Official History of the Canadian Forces in the Great War; The Medical Services states the following for the incidence of venereal disease:
In the Canadian army overseas during the period of the war there were 66,083 cases of venereal disease, of which 18,612 were syphilis; this yields a rate of 158 per thousand, and for syphilis alone 4.5 per cent or 45 per thousand."
In an attempt to curtail the incidence of venereal disease, soldiers of the CEF forfeited 50 cents per day of their pay plus field allowances while in hospital for treatment of sexually transmitted diseases.
An excerpt from the Part II Daily Orders of The Royal Canadian Regiment, showing the entry for the Hospital Stoppages (of Pay) for two soldiers during their hospitalization for venereal disease.
The use of poisonous gasses is one of the strongest images we have been left with of the First World War. The Official History of the Canadian Forces in the Great War; The Medical Services gives the figure of 11,356 for the number of wounded suffering from effects of gas fumes. This is 7.85 % of the total number of wounded. The volume doesn't provide a number for deaths directly attributed to gas, but infers that the progress of counter-measures and strict adherence to anti-gas drills effectively countered the enemy's progress in use of gas types and quantities.
The Official History; The Medical Services offers the following points on these principal gas types and their effects on soldiers:
An excerpt from the Part II Daily Orders of The Royal Canadian Regiment, showing the recording of the "Died of Wounds 'Gassed'" death of 440081 Private L.F. Mason at No. 14 General Hospital.
Soldiers who survived hospitalization would be subjected to medical examinations for the purpose of determining their fitness for duty. Although the intent of the system was to return every capable soldier to his front line unit, the medical system categorized soldiers according to the nature of duties they were fit to perform. The receipt of a medical category could then lead to reassignment to a new trade and to a new unit for further service. Alternatively, it might lead to discharge and return to civilian life.
The following excerpt from Official History of the Canadian Forces in the Great War 1914-1919; The Medical Services outlines the medical categories assigned to soldiers in the First World War. The volume was published by Authority of the Minister of National Defence under direction of the General Staff. The excerpt can be found on pages 211-212 of the volume, formatting in bulleted lists has been added for clarity:
"For the purpose of ascertaining the physical condition of each soldier and his value as a reinforcement a system was established early in 1917 by which men were assigned to groups according to their fitness for service. Five medical categories were created, A, B, C, D, E, to include, respectively, men who were fit for general service; fit for certain kinds of service; fit for service in England; temporarily unfit but likely to become fit after treatment; and all others who should be discharged.
"Category A was divided into four classes 1, 2, 3, 4, which contained respectively:
"Category B was likewise subdivided into four groups, to include men:
"In Category C were placed men fit for service in England only."
"In Category D were all men discharged from hospital to the command depot, who would be fit for Category A after completion of remedial training; and there was a special group to include all other ranks of any unit under medical treatment, who on completion would rejoin their original category."
"Category E included men unfit for A, B or C, and not likely to become fit within six months. It was a general rule that a soldier could be raised in category by a medical officer but lowered only by a board."
"A commanding officer could, however, raise a man in Category A from second to first group, since training alone and not medical treatment was involved. All soldiers of low category were examined at regular intervals and new assignments made."
"It was the function of the medical services to assign recruits and casualties to their proper categories. In April, 1918, when the demand for men became urgent, an allocation board was set up for the duty of examining all men of low category, and assigning them to tasks that were suitable for their capacity."
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