The Army Medical Organization
In addition to civilian practice and research, doctors and other medical practitioners were needed in the Army. By the end of the European war, 34,786 personnel had served in the Royal Canadian Army Medical Corps (RCAMC), including 3656 nursing sisters, and the Corps suffered 107 fatal battle casualties.
In choosing to enlist, medical personnel were subject to the sort of regimentation one would expect from the army. The Field Ambulance was the organization responsible for evacuation and treatment of casualties forward of the Casualty Clearing Station (CCS). Field Ambulance units were assigned to support specific brigades, for example No. 14 Canadian Field Ambulance worked with 7th Canadian Infantry Brigade, No. 22 with 8th Brigade, and No. 23 treated 9th Brigade’s casualties. Assault sections of these three Field Ambulance units landed with the infantry on D-Day. From the battlefield, a wounded soldier was moved by stretcher-bearers to his unit’s Regimental Aid Post, from which he was evacuated by ambulance. The RAP was set up in haste to deal with the wounded as quickly as possible, so only very basic treatment was available. It was sometimes bypassed and a casualty taken directly to a Casualty Clearing Post, where he might receive blood products or morphine. The entire chain of evacuation to this point was within range of enemy fire, so removal of casualties further to the rear as quickly as possible was obviously of extreme importance. The next step was evacuation to a Field Dressing Station, where intermediate treatment could be offered before transfer to a Casualty Clearing Station, a basic hospital for surgery and short-term convalescence.
This system was modified in Northwest Europe. In order to get the wounded into surgery faster, Field Dressing Stations (FDSs) came to be combined with Field Transfusion Units (FTUs) and Field Surgical Units (FSUs) to form Advanced Surgical Centres (ASCs). The Casualty Clearing Station-which otherwise performed surgery-was not considered suitable as a basis for the ASC because it had insufficient personnel to adequately support two FSUs (each of two surgical teams). The ASC operated closer to the front while the CCS came to be responsible more for convalescence further back.
Treatment of the wounded in forward areas was the responsibility of male medical personnel, but the contribution of nursing sisters to post-operative care of wounded soldiers cannot be understated. Nursing sisters were usually attached to a General Hospital or CCS, but arguments were made for their employment further forward with FSUs because their role in monitoring patients following surgery not only aided recovery, it also made the surgeon’s job easier.
The final step in the evacuation chain was transfer to a General Hospital for cases requiring further care. In the early stages of the Normandy campaign this was done primarily by ship to England, although air evacuation of casualties had also been done since the Sicilian campaign in 1943. There were more than 20 Canadian General Hospitals, most of which were attached to army formations and thus moved to follow the army’s advance. No. 1 Canadian General Hospital, for example, opened in early 1941 near Birmingham with 600 beds but moved, beginning in December 1943, to various locations in Italy to support 1st Canadian Corps. It was ultimately joined in the Mediterranean by Numbers 3, 5, 14, 15, and 28 Canadian General Hospitals. Meanwhile, in the UK, preparations for the invasion of Northwest Europe led to the designation of groups of transit, coastal, and base hospitals. Transit hospitals received casualties brought by train from south coast ports, while coastal hospitals took casualties transported in vessels not part of the regular evacuation chain. After treatment at these centres, patients would be transferred to base hospitals. By July 1944, a number of Canadian General Hospitals were concentrated at Bayeux, Normandy as part of the 21st Army Group medical centre, and No. 6 CGH had moved to Douvres-la-Délivrande. As the Allied armies advanced, Canadian hospitals moved to the Rouen and Dieppe areas, later to Antwerp and Germany.
The need to treat the wounded as close to the front as possible meant that working conditions were seldom optimal. Besides coping with enemy fire and air raids, medical facilities also had to deal with the pernicious dust and flies that were ubiquitous in Normandy:
Most camp sites were in or adjoined apple orchards, in which apples rolled on the ground in thousands. Bodies of horses, cattle, sheep and men lay rotting and unburied over Normandy. Consequently, fly control was an impossibility. In addition dust rolled over the area in billowing clouds, penetrating everything and probably acted as an additional source of infection. (52 Mobile Field Hospital, Operation Record Book, June and July 1944, quoted in Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 204).
Medics occasionally found themselves right in the thick of the fighting, as during the assault on Walcheren Island in the autumn of 1944. John Hillsman, with No. 8 FSU, described the situation immediately following the amphibious landings on the 1st of November:
We had to crawl two hundred yards on our bellies with the exploding ammunition [from a stricken assault vehicle] shooting at us from one side and the Germans from the other. We finally reached the [No. 10 FDS] tent and found that the Staff Sergeant had organized a rescue team and was going down in that blazing mess and bringing out the survivors. One of the medicals went inside of an exploding Alligator to reach a wounded Commando. He was blown half in two by a mortar bomb. For the next half hour we lay on our faces in the sand dressing wounds, stopping hemorrhages and splinting fractures. Constant explosions were blowing sand over us as we worked. Our heads were retracted down in our helmets until the edge of the damned things almost reached our shoulders (John Hillsman, quoted in Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 211).
Two days passed before 8 FSU was able to properly set up and care for casualties.
What kinds of injuries did medical personnel have to treat? The proportion of various casualties reported by No. 15 Field Ambulance of 4th Canadian Armoured Division in September 1944 was representative of the Army as a whole: 10% of wounds were caused by rifles, 17.5% by machine guns, 14.5% by mortars, and almost 43% by artillery; about 27% of casualties had multiple wounds. Although these proportions would vary depending on the nature of the campaign being waged, artillery remained the main killer throughout the war. Nonetheless, a few statistics testify to the advances that had been made in battlefield medicine. The mortality rate among the wounded dropped to 66 per thousand from 114 per thousand in the Great War, and thanks to improved sanitation, hygiene, and treatment methods, less than 1% of fatalities were due to disease.