Pod Insights Dan Snow's History Hit Surviving the Great War: Medics in the Trenches About this episode Warning: this episode contains graphic details of injuries.
The brutal nature of the First World War presented frontline medical personnel with an array of horrific and debilitating wounds, inflicted on a previously unimaginable scale. From gas attacks and bayonet wounds to rifle fire and artillery barrages, day-to-day life on the frontlines posed a serious risk to life and limb. The doctors and nurses responsible for medical care rose to the challenge, and the First World War saw a dramatic transformation in the provision of frontline medicine. Many more lives would be saved than lost due to the efforts of these 'lifesavers'. Focusing on the Canadian experience, Tim Cook, author of Lifesavers and Body Snatchers, explains just how important and innovative the work of frontline medical staff was, and reveals the more sinister side of how these advances were achieved.
Produced by James Hickmann and edited by Dougal Patmore.
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2:24 Dan Snow? Hi everybody, welcome to Dan Snow's History. My great-grandpa, Robert McMillan, was a doctor in the trenches of the First World War. He travelled from Canada, from rural Ontario, where he was the youngest of several children. He'd had to walk to school barefoot as a child, but he managed to achieve good marks. He managed to become a doctor in Toronto. But that career was cut short by the call of king and country. He got on a ship, went to Europe and served in the trenches. The things he must have seen are beyond all of our imaginings, perhaps thankfully. I never met him, he died before I was born, but my mum was something of a favourite of his. He would sit with her drinking sodas on a hot Canadian summer's day and he'd suddenly opened up.
3:09 Dan Snow? He would talk to my mum, his young granddaughter, and he would tell her all about life in the trenches and the things that he'd seen. And my mum was a kid and didn't write it down, didn't pay much attention really. She just has these fleeting memories of his description of the word going along the line that there was a gas attack, gas, gas, and they'd all thumble for their gas masks. It's one of her great regrets, my mum, that she wasn't a little bit older and able to really listen and remember and perhaps even write down these extraordinary stories from a distant battlefield. So First World War medicine is something I've always been fascinated by and it's why I'm so glad to have Tim Cook back on the podcast now. He's one of Canada's leading historians. He's the chief historian and director of research at Canadian War Museum.
3:54 Dan Snow? He's a great friend of this podcast, he's a true legend and we're honoured to have him on. He's written about First World War medics, but particularly First World War Canadian medics. So this book could have been written for me and my family and my mother's family, McMillan's, are very grateful and there are several copies of this book already flying around the family. He might be describing particularly the Canadian experience, but as you'll hear, this is a much wider conversation about medicine and its transformation in the First World War. Enjoy.
4:41 Dan Snow? Tim, great to have you back on the pod, man. Thanks for coming on.
4:45 Speaker 03 Thank you, Dan. Great to speak again.
4:47 Dan Snow? As soon as I heard that you were working in the area of Canadian medics in the First World War, I knew I had to talk to you because my great-grandpa was a, I have his sword hanging on my wall. He was a Canadian doctor in the war. But I mean, this is an area that just goes through a gigantic transformation, the First World War. But I guess particularly the Canadians, right? Because what would have been the state of Canadian military medicine at the outbreak of the war?
5:09 Speaker 03 Yeah, almost nonexistent, Dan. And that's the case for the Canadian permanent army. It was about 3,000 soldiers, so almost nonexistent, completely useless. And yet during the course of the war, as you and I have talked about in the past, just this incredible exertion from Canada, a country of about 8 million, a proud dominion as part of the British Empire, but 620,000 Canadians will serve. So about one in three adult males. And just with that incredible exertion, of course, you need a medical force to support them. So doctors are encouraged to enlist, like your grandfather, as you said there. So half of all Canadian doctors will serve in the war,
5:51 Speaker 03 a third of Canadian nurses. And I'm glad you mentioned the sword there, because I think it's important to remember, these were, for the most part, civilian doctors, but they're brought into a military environment. They're in uniform. And maybe that sounds simplistic to say, but these are men of medicine who are all of a sudden responsible for the horrendous carnage on the Western Front, but also disease prevention, which is absolutely crucial, but also for enforcing military discipline. And that didn't always sit easy with them, because it sometimes meant that they had to keep soldiers who were wearing down, who were on the verge of shell shock, for instance, in the line because they couldn't pull out everyone.
6:36 Dan Snow? Tim, you and I have talked about this before. It's kind of frustrating for historians of the First World War. It's seen as a time of complete stasis, of conservative thinking, of backwardness. And yet, even leaving aside infantry tactics, armor, aircraft, all that kind of stuff, artillery, just in the area of medicine alone, there can't have been many four-year stretches in the history of the world where medicine was transformed as radically as 14 to 18.
7:00 Speaker 03 Yeah, you're exactly right. It's strange because medical historians often write about the evolution of the practice and treatment, of course, but they almost leave out the two world wars where, as you rightly say, there is this radical transformation. And I think during the war, the Canadian Medical Corps, we can just talk about them, but they were deeply attached to the British Royal Army Medical Corps and transferring doctors back and forth, sharing lessons. There's this continual learning process that is carried on behind the lines, which I found fascinating. This is my 14th book, so I'm not exactly new to the Great War. And yet, of course, I've written about the evolution in artillery tactics, or infantry,
7:42 Speaker 03 or combined arms, but there was an evolution in medical treatment. And how couldn't there be, right? I mean, the wounds and the carnage were unbelievable. And Dan, we've talked about this. I know the eyewitnesses to history are so important to how you talk about history and how we learn about history. For me, I've had the pleasure, and sometimes the horror, I guess, of reading thousands of letters and diaries and memoirs. And it's there where these poignant accounts come across the doctors who are just seeing these unbelievable wounds from shrapnel, from machine gun bullets, tearing bodies apart, destroying organs, shattering bones,
8:23 Speaker 03 chemical weapons, burning out lungs and blinding soldiers. And all of this, of course, it was up to the doctors and the nurses to care for these young guys.
8:33 Dan Snow? Yeah, Tim, obviously, I've got a personal interest here. My great-grandpa apparently came back from war. He's pretty difficult. And he was a difficult father to my grandpa. They didn't get on. And I think a lot about the things he would have seen. And he was behind the lines in Cambrai, I know, and various other places. Like, were they able to segment that? Were they able to, say, take a professional detachment to it all? Or was it could be as traumatic as being on the front line?
8:56 Speaker 03 I think it was as traumatic as being on the front lines and many medical officers were on the front lines. Each battalion had a medical officer. So a battalion was about 850 men at this point. And that medical officer was like a general practitioner. He was to keep the soldiers healthy. Generally didn't engage in the complicated surgery that we see further behind the lines. But there was an emotional toil or emotional burden that all of the doctors and nurses had to carry. And you see it in their diaries and letters, they're wearing out the horror that they are seeing and experiencing. And yet, they were probably better than most, at least equipped to maybe compartmentalize some of
9:36 Speaker 03 that. And you see it, I think, in the evolution of treatment. And that's one thing where not only are these young guys coming into them, torn apart with bones protruding from flesh, with entrails falling out of their stomach cavities, chest cavities. And yet they are continuing to treat them methodically. They introduced triage, although that too came with an emotional burden. Because triage, as we who have lived through COVID now have a better sense of this, involved deciding who would be treated first, who could be pushed to the side and treated later, and frankly, who was too badly wounded and had
10:17 Speaker 03 to be left to die. And the doctors and nurses write about this, quite frankly. And I think about that emotional burden that weighed on them. And frankly, soldiers understood this was happening too. In the book, I wanted to make sure that the soldiers' voices are there. Too often in medical histories, it's almost like the war is happening somewhere over the horizon. But in fact, no, we know it was thousands or tens of thousands of young men fighting their way forward. And during the course of the war, as the evolution in tactics changes, as weapons change, as the tank is introduced in 1916, as chemical weapons become more frequent in 16 and 17, the nature of wounds change. And so the doctors
11:00 Speaker 03 need to address this. And there is this tremendous evolution. The introduction of blood Transfusions, the use of the X-ray, radical surgery, because Dan, this is the age before antibiotics. And so almost every wound was infected. And that's something that your grandfather would have encountered that would have been entirely radical to what civilian doctors had seen. These soldiers are coming in and because of the soil in France and Flanders, which had been impregnated with human and animal feces for centuries, almost every wound was infected. And so they had to find ways to treat that, which was often a radical procedure of simply
11:41 Speaker 03 cutting out great swaths of flesh and muscle. And so all of this is to give a brief glimpse into this evolution of treatment, which I think is important to say, because as I've talked to people about this, I think there's a sense that the medical treatment was perhaps something more akin to the American Civil War of the 1860s, where, where doctors are lopping off limbs, left, right, and center. Amputation, of course, happened during the war, but it's a much more sophisticated form of treatment that evolves, as you said, over the four years.
12:17 Dan Snow? You're listening to Dan Snow's history hit, talking about the medics of the First World War. More coming up.
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14:50 Dan Snow? You know, as you're talking, I'm very struck by the fact that if you need to train up infantry leaders, you can do that. It takes a while, and it's a difficult process. You can train up engineers, you can train up aviators, but you can't actually just create these doctors out of nothing, right? So I'm suddenly thinking this great expansion that occurs... So you mentioned the Canadian Army was 3,000 strong in 1948, which is crazy. You know, what is it by 1918? And I guess the one specialism you can't just will into being is medics.
15:28 Speaker 03 That's right. They go from 3,000 to 620,000, of which about 450,000 serve overseas. And you need a medical force to, of course, care for that mass of soldiers. And as you rightly say, you can't really train them up during the course of the war. So basically, Canada is taking almost every single doctor of military age. In fact, trades what they called during the war, a doctor famine in Canada, because all of the rural doctors who would have been treating large communities enlist. And so it becomes a great problem on the home front. But this was part of serving king and country. And what I found really interesting is that all of the major Canadian universities,
16:11 Speaker 03 like McGill, like University of Toronto, like Queen's in Kingston, they basically take their whole medical faculties and send them overseas. And they create these hospital units. So there is this great mobilization of the medical men. In the end, as I've said, half of all Canadian doctors and those who were left behind were largely over military age. And they go overseas and they're continually learning. And I found that fascinating. Just as there was ongoing training of infantry tactics during the course of the war, or as the artillery and the gunners became more effective in counter battery work or all manner of artillery tactics, there was this learning behind the lines.
16:56 Speaker 03 And one of the things they were really focused on then was preventive medicine. And as I said, this is my 14th book. I've been in the archives. I love the archives. I know you've been there. You know, I don't want to sound sappy here, but there's something really special about being there and reading through the official records that often no one has looked at since 1919. Reading those letters and diaries. And what I found were this constant lecture series behind the lines on how to better treat wounds. Venereal disease was a great concern, of which the Canadians and Australians were very randy. And about 15% of the force contracted a venereal disease. So the various treatments there.
17:38 Speaker 03 How to deal with chemical weapons, completely brand new? What do you do with brain wounds? Abdominal wounds in 1915 are at death sentence, but by 1918, they're regularly saving soldiers? This is just part of that evolution. But preventive medicine is also really crucial. And as I said, Dan, I hadn't really thought about this before, but all history books have their own history. And I began writing this in April of 2020, and you'll remember that time. Second month of COVID, really, a time of great terror, isolation, lockdown. We were talking about masking and social distancing and vaccinations.
18:18 Speaker 03 And as I was reading some of the archival material, there's a great vaccination debate that goes on the Canadian forces, where the Canadian doctors say, "We must have forced vaccination." And they do. And in fact, in the British Army, they don't. It happens later in the war and is significantly contributing to the reduction of disease. But this is just one of those preventive medicines or treatments that doctors are responsible for to ensure that something like a typhus outbreak doesn't wipe out these armies that are living in cesspools along the Western Front with the dirt and deprivation and the rats and the lice and really vectors of disease with latrines and other things.
19:02 Speaker 03 And so that was, I found really interesting, the fact that preventive medicine is absolutely crucial. And there's at least one doctor who writes about this, and I cite in my book where he says, "That's the most important role that we carry out in the war. It's not one that would immediately have come to mind." But just to get back to the idea of learning, I see in the medical war, a war of contradictions. And we've touched upon that a bit. These civilian men of medicine who come into the military and now they're forced to ensure that discipline is there, to keep soldiers in the line. They were often the gatekeepers. And yet there are other contradictions as well. Doctors and surgeons caring and saving soldiers.
19:46 Speaker 03 And yet there is this medical mystery that I Talk about in the book and it's the second part of the title called Body Snatchers. And Dan, for about 15 years now, I have been researching this mystery, looking for the evidence because about 15 years ago, I came across a reference to Canadian doctors conducting autopsies behind the line. And I thought, isn't that interesting that they had time to conduct autopsies? And they were doing that, of course, to learn from the dead to try to better treat the living. And yet in those records 15 years ago, there was a reference to a doctor removing a soldier's body part.
20:27 Speaker 03 And I thought, well, that can't be right. And so I've spent years researching at the National Archives. And eventually I found the files. And indeed, they revealed that Canadian doctors were part of a British Imperial program, willingly part of it and enthusiastically in part of it, to harvest the body parts of slain soldiers.
20:49 Dan Snow? Um, why? For what purpose?
20:54 Speaker 03 That was my question. Why were they doing this? How were they doing this? Um, they were trying to learn from the dead. And so if they had a soldier with a bullet wound through his brain, they cut open his cranium, they remove the brain, they stabilized it and stored it and they sent it back to London to the Royal College of Surgeons. And this was happening along the Western Front. If there was a soldier coughing up his lungs from mustard gas, wheezing and choking to death and finally dying in agony, they would cut open his chest, remove his spongy mustard gas corrupted lungs, and send it back to London.
21:38 Speaker 03 And this was a program that began in May of 1915 and the Canadians were a part of it. Eventually about 4,000 soldiers' body parts, British, Canadian, Australian, are sent back to the Royal College of Surgeons. And then it was shocking to me, shocking to read this, shocking to think that these soldiers, young men serving king and country, fighting in what they were told was a just war, were not only supposed to serve at the front.
22:10 Speaker 03 But they were to serve beyond death with their body parts becoming medical specimens for other doctors to learn from what killed soldiers on the Western Front.
22:23 Dan Snow? Did the men know this at the time? Did this become a bit of a thing? There was this issue between the men and they were like, "Hey, doc, don't chop my arm off and send it back to London."
22:31 Speaker 03 It's a great question because I looked for references and I've read thousands of letters and diaries of soldiers. Never once have I come across a reference to this. I don't think they knew about it. I don't think the poor bloody infantry, as they were called, understood that if they were killed and if they died and made their way to a hospital, so if they died en route, or if they died on the surgical table, or if they died of infection, that they would be a candidate for a surgeon to open them up and to harvest a body part. There was no consent, of course. Consent is a modern concept. And in fact, when the Canadian soldiers, like the British soldiers, attested, when they signed up, their body
23:13 Speaker 03 was in effect controlled by the army. And of course, this is the war where we shot soldiers for running away from the front. It's a challenge for the historian, I think, to apply modern day sensibilities, the horror of soldiers, in my mind at least, of having their body parts harvested. And one of the things the historian has to do, as you know too well, is to try to situate it in the time. And so I understand why doctors were doing this. They're doing this because they need to learn from the slain. And there are cases where doctors are recommending in 1916, for instance, that soldiers need a helmet because there's so many head wounds coming in. I understand that. And yet, what fascinated me was that
23:57 Speaker 03 these body parts go back to London where they're on display, and then they go back to Canada. Eight hundred body parts. And this, nobody has written about. And this, of course, happens in 1919, after the war is won. The horrible, bloody, costly war. Seven hundred and fifty thousand British dead, sixty-six thousand Canadian dead. It's a time of mourning and grief. It's a time of commemoration, of building thousands of memorials. I know, Dan, you've been to the Vimy Memorial and Thibault Val. These great constructions to mark the sacrifice.
24:34 Speaker 03 And yet, at the same time, there are 800 body parts of Canadian soldiers back at McGill University in Montreal as medical samples. And to me, that's another one of these contradictions that's really difficult to get one's head around.
24:53 Dan Snow? You mentioned that people getting shot and a lot of the executions that the British Army carry out are connected now, people think with stress, trauma, shell shock, we might call it. How did doctors come to terms with this, well, I don't know how new it is, but certainly this phenomenon of mental trauma that could sit alongside the physical trauma they were treating?
25:16 Speaker 03 Yeah, and that is a part of the book Mental Trauma and Shell Shock, as it was called, Battle Stress in the Second World War, A Stress Injury Today, or Mental Injury, An Invisible Injury. We have a much greater sense, Dan, I think, of post-traumatic stress disorder, and certainly in Canada with the war in Afghanistan and Canadian soldiers coming back with invisible injuries, and in fact, what has been called an epidemic of suicide among many veterans. This is much more prominent, I think, in Canadian society. It wasn't at the time. There has always been invisible wounds. We've seen it in other wars, called different things, and yet, the war on the Western Front, the static war, the
25:57 Speaker 03 war of unbelievable high explosive bombardments, of the stress and the strain, ensured that there would be these invisible wounds. And I think we know about them from much of the literature. And in fact, shell shock is one of those tropes, or narratives, or stories that's often woven through, you know, histories and films and plays when we talk about the Great War. In my book, I address that, but also, how did the doctors treat it? How did you go from being a civilian doctor, working in a rural community where you probably delivered babies most of the time, or removed tonsils or appendixes, to the incredible carnage on the Western Front and seeing soldiers collapse from the mental strain? And so, the treatment ranged from
26:43 Speaker 03 Quite gentle and benign treatment, talk therapy, injured soldiers being sent to basically spas to rest and recuperate, to much more brutal treatment, including electric shock therapy. And one of the aspects of shell shock was mutism, the inability to speak, or paralyzed limbs. And this electric shock therapy could be quite brutal. I addressed that and the evolution of treatment. And one of the things I found interesting in the book is that many of the doctors were quite humane in their treatment. It's come down through films and plays that the doctors were part of the medical system and all too eager to shock these soldiers, or force them back into the line, or take part in some of the firing squad ghastly episodes.
27:28 Speaker 03 In fact, the doctors were quite sympathetic, to the point where the high command began to wonder if the doctors had been compromised, if in fact, the doctors were not doing their full job in keeping these soldiers in the line. So that too, I think, is a fascinating part of this war of new experiences. And one of the parts I found most interesting, and I think it connects to the invisible wounds, is the doctors, again, half of whom served on the Western Front, how they then returned to Canadian society, bringing back the hard lessons of war, and coming back to your initial point of, was there ever a period, a four-year period, where we learned so much about medicine?
28:11 Speaker 03 And I don't think there has ever been. And these Canadian doctors are bringing back new surgical techniques. They're bringing back blood transfusion, which they are using on burn patients in Canada and cancer victims. They're bringing back X-rays to assist Canadians with tuberculosis, which is the great killer of Canadians under the age of 45. We sometimes forget the white death. But maybe the most important element of the lessons of the Western Front with all of its brutality and death and carnage is a new movement in public health. And I found that fascinating. They're talking about vaccinations and how we need to vaccinate
28:56 Speaker 03 Canadians against disease. There's a new movement of maternal health to save babies who are being born to replace the fallen soldiers from the Western Front. And I think, again, the contradictions of war. No one went to war in 1914 to save babies in 1922. And no one was studying the evolution of surgical care in 1916 to ensure that Canadians were better vaccinated in the 1920s. And yet, these are the lessons of war. And Dan, you and I have talked about this. You've studied war enough to know every war comes with its unintended lessons. And the war you think you're going to get is not the
29:41 Speaker 03 one that you do get.
29:42 Dan Snow? Well, that's never been more true than the quick, easy war launched. Well, now I'm about to apportion blame for its start, Tim. I'm about to make the ultimate mistake. Thank you very much for coming on the show. Tell everyone the name of the book.
29:55 Speaker 03 The book is Lifesavers and Body Snatchers: Medical Care and the Struggle for Survival in the Great War.
30:03 Dan Snow? As Tim said, he's written several other books. So make sure you go and check out all Tim Cook's other books. But also, he's the chief historian at the Canadian War Museum, which is one of the best. And your online presence is just fantastic. So if you want to know anything about the First World War, let alone Canada's role with it, you've got to head over to the Canadian War Museum. They're the best. Thank you very much, Tim Cook, for coming back on the pod. Good to see you, buddy.
30:23 Speaker 03 Thanks, Dan.
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