The impact of war on medicine

College of Physicians and Surgeons of Alberta CPSA, Messenger

An Alberta physician and veteran reflects before Remembrance Day

By Lieutenant-Colonel William Patton

Nov. 11, 2018 will mark the 100th anniversary of the armistice that brought World War One to its end. As the grandson of a veteran of the Great War, I grew up in its shadow. I remember elderly men with rows of burnished medals on their chests, stiffening to attention during bitterly cold Remembrance Day ceremonies, wiping tears away from rheumy eyes, their thoughts focused on memories from long ago. My grandfather never spoke of his time as a fighter pilot on the Western Front, or his experiences as a prisoner of war. When asked about his memories, he would cheerfully try to change the subject, or remark “they were good times indeed”. As a young boy, I kept his medals in a purple Crown Royal bag in my dresser—the British War Medal, with its curiously naked Saint George atop a horse trampling a Prussian eagle, and the Victory Medal with its hopeful proclamation “The Great War for Civilization”. The bag also contained the Memorial Cross of his older brother, tragically killed during the Battle of Amiens, so close to the end of the war.

Past and present: Lt. -Col. Patton's medals alongside his grandfather's.

The Great War represented the end of a military epoch and a harbinger of what would come. At the start of the war, the cavalry still charged across the battlefield with lances and the infantry advanced in rows: the British in soft caps, the French in blue jackets and red pants. Four years later, the world had witnessed the horrors of technological warfare, with barbed wire, the machine gun, poison gas, the tank and the aeroplane.

During the Great War, 619,636 Canadians served with Canadian Forces and 59,544 died, with an additional 172,000 wounded. Hippocrates may be known for his oath, but he also wrote, “He who wishes to be a surgeon should go to war”. Nearly 21,000 men and women served in the Canadian Army Medical Corps, which suffered 1,325 killed and three of its members awarded the Victoria Cross. Extraordinarily, in 1918, 216 of Alberta’s 400 physicians stepped forward to serve in the military. They embraced their wives and children one last time and joined their fellow Canadians fighting overseas, away from their families for years at a time, some never to return.

When conflict brings change

Wars advance medicine. The recent wars in Iraq and Afghanistan brought us damage control resuscitation and surgery, the renewed use of the tourniquet and massive transfusion protocols. We owe the Great War for similar advances, including wound irrigation, debridement and packing, the Thomas splint, the tetanus vaccine (developed by the University of Toronto’s Connaught laboratories) and the birth of plastic and burn surgery. We owe a far greater debt, however, to the regimental medical officer and his stretcher bearers, who shared in the dangers and filth of the trenches, who searched the battlefield under artillery bombardment, machine gun fire and poison gas to find the wounded and carry them back to medical care. We owe a similar debt to the hospital staff, who faced numbers of casualties unimaginable in our civilian systems, often within range of shelling and attacks from the air.

Sadly, the First World War would be followed by the Second and all the horrors of total war. Canada would soon find itself in Korea, in UN peacekeeping and NATO peacemaking missions throughout the world and most recently, in Afghanistan. Nearly 40,000 Canadians served in that war—159 were killed, over 2,000 were wounded and many more bear the invisible scars of depression, PTSD and substance abuse. As a veteran of that conflict, I witnessed the toll that mission took on our hospital staff and the lives damaged, both visibly and invisibly. But I also witnessed the incredible strength, dedication and moral fortitude of Canadian soldiers and their capacity for post-traumatic growth.

Canadian medics serving in Afghanistan carry a fallen fellow medic during a ramp ceremony (2008).

One hundred years after my grandfather’s war, my own medals now lie in that same purple bag, joining my grandfather’s and those of my great-uncle. I also find myself trying to change the subject when asked about my experiences and brushing questions aside with the same “they were good times indeed”.

I write with a challenge to my fellow Alberta doctors: This Remembrance Day, attend a cenotaph ceremony in your local community and when you see a young veteran with a medal on their chest, stiffening to attention at Last Post and immersed in memories of not-so-long ago, please walk up to that veteran, extend your hand, look them in the eye, and thank them for their service.

Lieutenant-Colonel William Patton currently practices at Edmonton’s University Hospital and serves with the Canadian Armed Forces Reserves. Since joining the Canadian Armed Forces in 2000, Lt.-Col. Patton has completed several tours around the world, including a deployment to Afghanistan in 2008. There, he was responsible for running the multinational NATO combat hospital for southern Afghanistan and served with CPSA Registrar Dr. Scott McLeod.