General view of operating room on board H.M.C.S. PUNCHER showing Surgeon Lieutenant Commander J. Calder giving anaesthetic while Lieutenant W. James Hart begins minor operation, 31 May 1944. Photo by Leslie F. Sheraton. Department of National Defence / National Archives of Canada, PA-142458.

The expansion of the RCN meant that there were not enough medical officers (doctors) to have one on each of the ships used to escort convoys; smaller ships like corvettes and minesweepers usually had only a sick berth attendant (SBA), who was in effect forced to assume similar responsibilities but often with not more than one or two years' training. One RCN Surgeon Lieutenant-Commander described typical working conditions when he wrote that a given "assignment may entail long periods with a small body of normally healthy men, and one may feel that his professional knowledge is not being adequately utilized." Then,

without warning, disaster is upon them and the medical officer has every opportunity to test his ability and ingenuity. He is on his own, without the service of a consultant. A medical officer at sea, may, in addition, be called upon to minister to a patient in another ship of the convoy. The hazardous trip in a small boat from ship to ship in a heavy sea is long to be remembered (W.C. Mackenzie, November 1942, quoted in Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 166).

To further complicate their jobs, ships' medical personnel could only treat the sick and wounded with whatever supplies and resources had been embarked before sailing, so additional help in an emergency could be as far away as the next port. Medical officers and SBAs had no choice but to do their best, though procedures often had to be carried out under primitive conditions. One survivor from the sinking of HMCS Regina off the English coast in 1944, for example, "was in a badly shocked condition with a severely mangled left leg below the knee. Both the tibia and fibula were fractured and protruding through a large gaping wound. The main arteries were severed. He was treated for shock and given morphine, it being recognized that an amputation would be required." The surgeon, who had himself been rescued, performed the surgery "on the rolling deck" despite suffering from broken ribs. "A large shot of brandy and a padded stick for the patient to clench his teeth on, served in the absence of an anaesthetic. The stump was dusted with sulfanilamide, shell dressings were applied and tightly held in place with bandages" (S.T. Richards, quoted in Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 168-169).

Besides the direct danger posed by enemy fire, sailors also had to face the possibility of their ship sinking in the North Atlantic. Survivors plucked from the water were frequently covered in the oil that leaked out when a ship was torpedoed. "Caking a crewman's skin, it could only be stripped and scraped away with difficulty-and much tenderness if the attendant was to avoid adding injury in the process; swallowed, it could release toxins into the body, an attack that proved fatal in many cases" (Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 169). Because survivors of sunken ships often spent hours in frigid water before being picked up, "immersion foot" was another condition requiring special treatment. Similar to the "trench foot" of the First World War, it was caused by prolonged exposure to icy water. Treatment required some delicacy

Survivors of the torpedoed minesweeper H.M.C.S. CLAYOQUOT rescued by H.M.C.S. FENNEL near Halifax, 24 December 1944. Photo by Ernest Campbell. Department of National Defence / National Archives of Canada / PA-141316.

When survivors are picked up, the cold extremities should be kept cool and only allowed to thaw or warm up extremely slowly, while heat is applied to the rest of the body. It should be remembered that bad results have followed heating extremities before a galley stove. In the case of one frozen foot, the unaffected limb should be immersed in hot water to produce reflex dilatation in the affected limb; if both feet are frozen, the arms should be placed in hot water. Extreme care should be exercised in handling such a limb while it is still numb so that local injury may be avoided. Friction should not be employed at any time. The skin should be kept clean and, in severe cases, sterile. It is recommended that the limb may be placed in dry cotton wool and pressure points carefully avoided (Proceedings of the First Meeting of the Subcommittee on Surgery, 16 February 42, quoted in Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 170).

In addition to wounds similar to those suffered by soldiers caused by gun fire and high explosive, navy "medicals" thus had some peculiar problems to solve. So, too, did doctors in the air force.