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v.4«j:\^i
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Politics and the
Canadian Army Medical Corps
A History of Intrigue, containing Many Facts Omitted from
the Official Records, showing how Efforts at
Rehabilitation were Baulked
By
HERBERT A. B^RUCE. M.D., F.R.C.S., (Eng.)
Colonel British Army Medical Service and C.A.M^C; Associate
Professor Clinical Surgery, University of Toronto ;
Surgeon to the Toronto General Hospital
With Introduction by
HECTOR CHARLESWORTH
WILLIAM BRIGGS
TORONTO
1919
Ca.577
Copyright, Canada, 1919.
by Herbert A. Bruce.
CONTENTS.
pagh:
Introduction 5
Author's Preface 31
My Original Commission and Report . . 37
Proposed Re-organization: Chain of Responsi-
bility 86
Acting Sub-Militia Council Considers and
Accepts My Report 91
Sir George Perley Intervenes . . . .114
My Efforts to Enlarge Babtie Board's Enquiry . 131
The Babtie Board's Findings .... 153
My Reply to the Babtie Board .... 188
The Unhappy Record of the Chairman of Sir
George Perley's Board .... 248
The Suppression of My Reply by Sir Robert
Borden 263
Dismissed from Office, but Denied Right to
Return Home 278
Later Suggestions for Improvement of the Cana-
dian Medical Service 280
Persecution of Lieutenant-Colonel Wilson . . 289
The Experiences of Doctors McMillan and
Moorhead 304
In Conclusion 317
M17BS&7
INTRODUCTION.
By Hector Chari^esworth.
After all wars it is customary to engage in stock-
taking; to canvass the mistakes that were made as
well as the results that were achieved. The custom
is salutary. It would be the most obvious folly in
any community to settle down complacently after a
period of stress and tolerantly dismiss any sins of
omission or commission that may have been com-
mitted, as but the evidences of a higher virtue. Peace
is the time for the restoration of clear vision and the
rectification of injustices perpetrated in the hurly-
burly of war. Therefore no apology need be made
for the man who with intimate knowledge of any
phase of Canada's war effort brings the facts to the
light of day.
The demobilization of Canada's Army which is
now making rapid progress rendered it inevitable
that many officers relieved of the obligations of Mili-
tary Service should become candid in ventilating
matters it had been the policy of administrators
5
POLITICS AND THE C.A.M.C.
to obscure or conceal. This is particularly true
of the Canadian Army Medical Service which for
nearly three years has been a subject of sporadic
criticism.
The medical service of any army is so vitally
connected with the efficiency of that army, its
responsibilities are so intimately related to the wel-
fare of the common soldiers, that its methods and
organization are second in importance only to the
conduct of officers and troops in the field of battle.
If its administration has been marked by blunders,
whether well-meaning or perverse, it is necessary and
just that after the smoke of battle has cleared away,
and the public morale can no longer be detrimentally
affected, the facts should be made known. It was
inevitable, in view of all the circumstances, that the
Canadian Army Medical Service should come under
review so soon as demobilization, especially of higher
officers with a close knowledge of our organization
overseas, was well under way. It is all the more
important, therefore, that Colonel Herbert A. Bruce,
M.D., the protagonist of the controversy with regard
to the Canadian Army Medical Service, should lay
all the facts before the public, and tell his own story,
supported by documentary evidence, in a manner so
clear that no politician can obscure the facts.
6
POLITICS AND THE C.A.M.C.
In the belief that it may assist the layman to grasp
at the outset the general outlines of the detailed
narrative which forms the main portion of the
volume, this introduction has been penned from the
standpoint of a detached observer. The writer has
read the original documents on which Colonel
Bruce's narrative is based, and can vouch for the
fact that he has not stated anything which he is not
in a position to prove. It has also been thought
advisable that one who was in a position to observe
political events in Canada during the long absence
of Colonel Bruce overseas — events which necessarily
had their reflex on the controversy in London —
should endeavor to place the story in perspective
from the standpoint of Canadians on this side of
the Atlantic.
The organization and system of the Canadian
Army Medical Service began to be the subject of
criticism within a few months after Canada's troops
became an actual factor in the prosecution of the war
by their glorious resistance in the second battle of
Ypres, April, 191 5. Criticisms became so cumula-
tive that in the spring of 19 16, the Government of
Canada was forced to give it recognition and decided
to send overseas Colonel Bruce, of Toronto, with
instructions to make a thorough investigation of the
7
POLITICS AND THE C.A.M.C.
work of the C.A.M.C. and formulate recommenda-
tions for its improvement. It is necessary at this
point to say a word as to the unquestionable qualifi-
cations of Colonel Bruce for this task. He had for
years been recognized as one of the most eminent
of Canadian surgeons. As a young man he had
succeeded in obtaining the very high honor which
everywhere attaches to the title, " Fellow of the
Royal College of Surgeons of England," and was
the second Canadian in the history of the institution
to win that distinction. He was, and is, one of the
Professors of Clinical Surgery at the University of
Toronto and Surgeon to the Toronto General Hos-
pital, which, it is perhaps unnecessary to say, holds
high rank among similar institutions throughout the
world. He was a Past President of the Toronto
Academy of Medicine, a Regent of the American
College of Surgeons, Washington, and a Fellow of
the American Surgical Association; and had held a
number of distinguished professional offices, includ-
ing that of Vice-President of the Congress of Clinical
Surgeons of North America and President of the
Ontario Medical Association in his native province.
He already held the rank of Lieutenant-Colonel in
the Canadian Army Medical Corps which had been
8
POLITICS AND THE C.A.M.C.
established some years before the outbreak of the
war, as a volunteer body.
Prior to receiving instructions to go overseas on
the mission outlined in the present volume, Colonel
Bruce had desired to give the Canadian Army the
benefit of such professional services as he could
render, especially in view of the fact that the events
following the first winter of trench warfare made it
apparent that the struggle was to be long and the
issue doubtful. Despite the vast claims of his pro-
fessorial duties and large private practice on his
energies, he went overseas at the close of the Aca-
demic year of 191 5 and offered his services to the
Canadian Army Medical Corps. Without going into
details which have no bearing on the purpose of this
volume it may be said that he found little disposition
on the part of the authorities to avail themselves of
his offer, even though it involved a very considerable
sacrifice on his part ; but he was for a time attached
to a hospital in France.
He therefore returned to Canada and it must have
been not a little gratifying to him, when, in the spring
of 19 16, he received notification from Ottawa that
the Government had decided to avail itself of his
services. He was shortly afterwards, appointed In-
spector-General of the Canadian Army Medical
9
POLITICS AND THE C.A.M.C.
Services overseas and his rank of Lieutenant-Colonel
in the C.A.M.C. was increased to that of full Colonel.
He at once made arrangements to suspend private
practice and embark and arrived in London in June
of 1916.
As a first step in his new duties he asked that he
be assisted by a committee of investigators who had
had experience of actual conditions, and on his
arrival he proceeded to make his selections for this
committee. In Colonel Bruce's own narrative the
high qualifications, from every point of view, of the
men he chose to assist him, are made clear. They
were officers of the most complete experience and
loyally gave their co-operation. From the outset the
newly-appointed Inspector-General had realized that
it was not a "one-man job" and he proceeded to sys-
tematize the work of collecting information and sug-
gestions, with the assistance of four Army Medical
men and one military layman. By dint of hard
work, which, in the latter stages of the enquiry,
sometimes involved sixteen hours of the day, a report
of a most comprehensive nature was completed in
the space of three months and presented to the Cana-
dian Government on September 20th, 19 16.
Of the many defects both in system and ad-
ministration which that report revealed readers of
10
POLITICS AND THE C.A.M.C.
newspapers already have a general idea, and in
Colonel Bruce's narrative they are now made the
subject of detailed permanent record. The defects
which the researches of the Inspector-General and
his fellow investigators had uncovered were so many
and serious that they felt compelled to recommend a
reorganization of the Canadian Army Medical Ser-
vice " from top to bottom." So far as possible the
investigators refrained from any attempt to censure
individuals, who, though conscientious in the per-
formance of their duties, were victims of the system
of which they formed a part. The main purpose was
to secure immediate remedies in a branch of the
Army on which the efficiency of the whole was so
completely dependent.
It cannot be too strongly borne in mind bv the
reader, that this report was intended to be confiden-
tial by Colonel Bruce and the associates who attached
their names to it. They had no wish to disparage the
public reputation, even of incompetents, and were
restrained by the established precepts of professional
etiquette in the phraseology of many of their find-
ings. Their wish was that reforms be effected not
through public protest but by thorough and deter-
mined administrative effort. Without their know-
ledge or consent the contents of the document were
11
POLITICS AND THE C.A.M.C.
made public in Canada and the " Bruce Report," as
it was called, became a football in political warfare,
not only partizan, but internecine within the ranks of
the dominant party in this country at that time. It
will be seen that this unfortunate turn of events was
the one thing needful for the men whose interest or
inclination it was to becloud the issues and cripple
the hand of the Inspector-General at the very incep-
tion of his proposed reforms.
Two chief subjects of controversy arose, and in the
turmoil of debate received little intelligent discussion,
based on a sense of the realities. One of these was
with reference to a recommendation in the " Bruce
Report " looking to the concentration of Canadian
hospitals in a centre easily accessible for inspection
and visitation. The Shorncliffe Area, which was
close to the chief points for the disembarkation of
wounded arriving from France, was suggested. The
condition which Colonel Bruce and his committee
had uncovered was that Canadian wounded had been
scattered at many points all over the British Isles
from the south of England to one almost inaccessible
spot in the north of Scotland, and even in Ireland.
The wounded men had time and again expressed
their dissatisfaction with this diffuse method of
handling them, and their desire to be ministered
12
POLITICS AND THE C.A.M.C.
to by doctors and nurses from their own land.
In fact the Canadian Government was familiar
with these causes of complaint prior to instruct-
ing Colonel Bruce to go overseas to report
on the general situation, but when he so promptly
diagnosed the condition affecting the disposal
of Canadian wounded on their arrival in Britain
and advised as a remedy their concentration,
so far as possible, in Canadian hospitals, he was
immediately accused of furtive designs upon the
unity of the Empire. Nevertheless the common
sense of Colonel Bruce's recommendation could not
be continuously ignored and his policy was adopted
even before the echoes of the clamor against his
proposal died away. We find that while the Babtie
Report, in 191 6, declared that " to separate the
(wounded) men who have fought side by side must
tend to undo the bond of brotherhood sealed in the
face of the enemy," the administration of the Cana-
dian Army overseas, in an elaborate review of its
war activities, laid upon the table of the House of
Commons by Sir Edward Kemp, Minister of Militia
Overseas, on May 12th, 19 19, confesses that it was
the later policy " to provide beds in sufficient num-
bers in Canadian hospitals in the British Isles to
meet the requirements of the casualties among the
13
POLITICS AND THE C.A.M.C.
Canadian troops in France." Thus the policy first
enunciated by Colonel Bruce early in 191 6 and con-
demned as unpractical and unpatriotic was put into
effect at the close of 191 8, when the flow of casualties
from France had all but ceased.
Another serious error in policy which the '' Bruce
Report " condemned was the action of the Canadian
Army Medical Service in taking over fifty-seven
small V.A.D. (Voluntary Aid Detachment) hospi-
tals in the ShornclifTe Area, at a time when the entire
Toronto General Hospital Staff was lying idle at
Shorncliffe. This staff could have taken care of over
1,000 patients, whereas in the V.A.D. group little
more than 500 Canadian patients were being cared
for in the 1,500 beds that they contained. The main
objection, apart from the waste of effort involved,
was that these V.A.D. hospitals were not equipped
to handle surgical cases from the battlefield. The
nurses, though devoted and enthusiastic, had had no
adequate training to deal with such casualties, and
the medical attendance was provided by local practi-
tioners of limited experience at a time when the
talents of eminent surgeons from Canada were lying
idle. Among the acts of ineptitude had been the
despatch by Surgeon-General Carleton Jones (head
of the C.A.M.C), of the Toronto General Hospital
14
POLITICS AND THE C.A.M.C.
Staff to Salonica, where belligerent action had been
indefinitely halted, while ignoring the needs of the
Canadian soldiers who were actually fighting in
France. The policy which sent eminent surgeons to
Salonica to treat malaria, dysentery and other ail-
ments which had lain outside the range of their
specialized practice at home was typical of a wasteful
distribution of talent that seems to have characterized
the whole administration of the C.A.M.C. This
unenlightened method of distribution had resulted in
the appointment of one eminent surgeon as O. C. of
a field ambulance, which called for no surgery
whatever, while in other instances physicians with a
very limited knowledge of surgery, were called upon
to perform delicate and hazardous operations. This
indiscriminate misuse of the abilities of the personnel
at the command of the Surgeon-General was found
to be prevalent rather than exceptional. With regard
to the sending of Canadian hospital units to Salon-
ica where physicians, rather than surgeons, were
needed. Colonel Bruce held that if there was a need
on that front, it could have been filled by withdraw-
ing British hospital units from among those who
were serving the Canadian troops in France and
replacing them with the idle Canadian units from
England.
15
POLITICS AND THE C.A.M.C.
Why, it may be asked, is a medical service
attached to an army? Surely, to look after the
needs of the army! That answer would appear
to be axiomatic; but the principle on which the
Canadian Army Medical Service was governed was
that it had no direct and primary function to per-
form with regard to the Canadian Army. Its heads
were always eager in proffers of surgical and medical
assistance to the Imperial, and even to the French
Governments, at a time when wounded Canadians
lacked proper surgical attention. It is not an unfair
inference that an appetite for titular honors and
other distinctions lay back of this policy.
Of the many other defects in administration which
the " Bruce Report " pointed out, and which could
not be defended on sentimental and other grounds,
it is not necessary to speak here. They will be found
in graphic detail elsewhere in this volume.
Though the War is over, there is one phase of
the maladministration which characterized the Cana-
dian Army Medical Service at the time when Colonel
Bruce made his effort at betterment which constitutes
a living issue. Owing to the diffuse and unintelligent
distribution of Canadian wounded in many parts of
Great Britain no proper records of casualties were
kept by the Canadian authorities and the Canadian
16
POLITICS AND THE C.A.M.C.
taxpayer will no doubt for many years to come be
mulcted for a pretty penny as a result of this short-
sighted policy. The importance of records in con-
nection with a proper and just administration of a
pension system cannot be over-estimated; but, be-
cause of the conditions described in the " Bruce
Report " these records are inadequate, and the gate-
way to misrepresentation in connection with pension
claims left wide open. There is no question but that
Canada will continue to pay heavily for the blunders
of the administration on this vital matter.
It may seem incredible that it should have been
possible for anyone to becloud the practical and
economic issues so clearly defined in the " Bruce
Report " by raising the issue of Imperialism ; but
this was precisely what happened. The name of old
Mother Britain was invoked to give a halo to incom-
petence, to clothe with a picturesque mist a quag-
mire of maladministration, and to punish and pursue
the men who had attempted to effect reforms. In
this tragic denouement candor compels the assertion
that the ministry of Canadian Forces Overseas,
which, just at this juncture, was established with
Sir George Perley, who had been acting High Com-
missioner in London, as incumbent, played a sinister
role. As a result " Argyll House," the headquarters
17
POLITICS AND THE C.A.M.C.
of this Ministry, has come to be used as a term of
reproach not only in connection with this but other
matters.
As was but just, Surgeon-General Carleton Jones
had been instructed to prepare a reply. Both docu-
ments were laid before the Sub-Militia Council, an
organization consisting of staff officers of the
Canadian Overseas Army which acted as a govern-
ing body of that force. In order to get the facts
before them in concise and legal form, they instructed
Major John Lash, Deputy Judge Advocate-General
of Canadian Forces in England, to examine both
documents and draw up a precis. Major Lash's
summary showed that Surgeon-General Carleton
Jones, though in virtue of his position responsible
for the abuses reported on, was in agreement with
Colonel Bruce in practically all the latter' s recom-
mendations; though naturally not with that which
called for a reorganization from " top to bottom."
The latter recommendation was of course the natural
sequel of the criticisms which the Surgeon-General,
by his agreement with them, tacitly admitted to be
just and right.
The Sub-Militia Council, in view of Major Lash's
summary, could adopt but one course. On motion
of Brigadier-General F. S. Meighen, seconded by
18
POLITICS AND THE C.A.M.C.
Major-General Sir Sam Steele (since deceased), it
gave Colonel Bruce as Inspector-General plenary
powers to proceed with the reorganization as pro-
posed. The Council was, however, anxious to deal
with Surgeon-General Carleton Jones as consider-
ately as possible, and decided to take the moderate
course of ordering him to return to Canada and to
report to the Adjutant-General. This was on motion
of Colonel Ashton, seconded by the late General
Steele. These decisions were reached on October
1 6th, 19 1 6, and the full minutes dealing with this
subject of the Sub-Militia Council's deliberations are
published herewith. Had these officers been per-
mitted to follow their own judgment they would
undoubtedly have succeeded in obtaining a really
effective reorganization of the /Medical Service.
Nevertheless, after the presentation of the " Bruce
Report " on September 20, 19 16, a tentative com-
mencement at reform had been made, which seemed
to promise excellent results. This was before the
appointment of Sir George Perley as Overseas
Minister.
In the meantime matters were transpiring in Can-
ada which were to have an unfortunate influence on
the course of events. As has been stated, the
untimely publication of what had been intended as
19
POLITICS AND THE C.A.M.C.
a confidential report had resulted in controversies, in
which the real issue — a more efficient organization
of the Canadian Army Medical Service — was ob-
scured. This had its reflex in Great Britain, where
it was made to appear that the " Bruce Report " was
a deliberate assault on the sacred cause of Imper-
ialism and an affront to the unselfish young women
who constituted the Voluntary Aid Detachment.
Nothing could have been farther from the truth;
but the misrepresentations were quickly turned to
advantage by those who would be affected by reor-
ganization of the C.A.M.C, or who imagined that
the road to social preferment lay in ardent lip-service
to the cause of the Empire. Of this latter coterie,
it is not wide of the facts to say Sir George Perley,
the Acting High Commissioner was the chief.
Owing to a decision of the Ottawa administration
to divide the Militia Department and create an
Overseas Ministry, Sir George Perley, at this critical
juncture, became clothed with power to take the
question of the Canadian Army Medical Service
under his own control. Practically his first official
act was to over-ride the decision of the Sub-Militia
Council and cancel the order for the return of Sur-
geon-General Carleton Jones to Canada. This arbi-
trary act was unquestionably due to the influence of
20
POLITICS AND THE C.A.M.C.
certain ladies who knew nothing of the grave prob-
lems involved, but were filled with hysterical
excitement on the subject of the V.A.D. hospitals.
Sir George's use of his powers to over-ride the
decision of the better-informed Canadian staff
officers, was the more extraordinary since it was
also a reversal of the declared policy of the Gov-
ernment at Ottawa, which had announced its em-
phatic support to the policy of reform and reorgani-
zation. In this matter Sir Robert Borden cannot
escape responsibility, since he allowed a member of
his Cabinet to check measures of immense impor-
tance to the welfare of Canadian soldiers, in
obedience to the outcry of a small, and relatively
unimportant social coterie in London.
In the meantime, however, Colonel Bruce, in his
capacity as Inspector-General, had rapidly proceeded
to lay the foundations of a new organization, but
the Canadian Government chose to take the position
that his Report, and the subsequent action of the Sub-
Militia Council, constituted a reflection on them-
selves. They adopted the unheard of and undignified
course of appointing a Board of Investigation to
investigate their own Investigator. This Board,
which was appointed on November 25th, 19 16,
was headed by Sir William Babtie, who had recently
21
POLITICS AND THE C.A.M.C.
been retired from the post of Chief of Medical Ser-
vices in India, pending investigation of the deaths
of many soldiers from lack of proper medical atten-
tion in the first Mesopotamian campaign. In this
volume will be found ample proof of the absurdity,
to use no harsher term, of such a selection, and also
evidence of the inferiority in experience of Sir
George Perley's hand-picked Board in comparison
with the experienced investigators who had assisted
the Inspector-General in compiling his original
Report.
It should here be said that Colonel Bruce was not
only prepared to welcome a further investigation of
the Canadian Army Medical Service, but in a volum-
inous correspondence published in this volume urged
it upon Sir George Perley; for evidence was still
accumulating to substantiate his findings. But,
having performed an unsought, difficult and unpleas-
ant duty to the best of his ability, he objected to the
appointment of a Board to investigate himself. That
the purpose of this Board was not merely to investi-
gate but, so far as possible, to discredit him, was
abundantly clear from the indiscreet utterances of
its members even before they commenced to hear
evidence. And in one or two instances it was fair to
assume that they had been selected because their
22
POLITICS AND THE C.A.M.C.
hostility to him was well-known in Canadian official
circles in London.
However, Colonel Bruce's protests and efforts to
obtain a really complete enquiry were of no avail.
The extraordinary methods which this " Hush "
enquiry — for it deserves no better name — pursued,
in its sittings and findings, are shown in the follow-
ing pages. The Babtie Board made its report on
December 21st, 19 16, and the published text, which
is included in this volume for purposes of record,
shows it to be a weak and unsatisfactory document
from every point of view. It discussed questions
of Imperial sentiment which had nothing whatever
to do with the issue, and, while agreeing in many
instances with the criticisms of Colonel Bruce, and
accepting his recommendations, it did so with bad
grace, and apparently in an apologetic mood because
it had failed to fit the facts to its inclinations. On
the whole the Babtie report was clearly a forced
attempt to whitewash the Canadian Army Medical
Service as constituted prior to September, 19 16.
It, however, was good enough to suit the purposes
of Sir George Perley, who sought to stifle public
criticism by issuing to the Canadian Press an alto-
gether misleading statement. The text of Colonel
23
POLITICS AND THE C.A.M.C.
Bruce's suppressed reply is now for the first time
placed before the Canadian public.
An ironical circumstance is that the Babtie Report
overshot its mark so far as to embarrass the Govern-
ment. Those Cabinet Ministers in touch with the
controversy had come to the conclusion that Sur-
geon^General Carleton Jones could not be retained
in that position. The Government apparently had
no intention of reinstating General Jones, and had
decided to appoint General (then Colonel) Foster in
his stead. The Babtie Report was, however, so
sweeping an exoneration of Surgeon-General Jones
that the Government, contrary to its intention, was
obliged to reinstate him temporarily. It was arranged
that he should hold the office for a few weeks, after
which he should return to Canada as Director of
Hospital Services in this country.
Though Sir George Perley had dismissed Colonel
Bruce from the post of Inspector-General, he chose
to invoke military regulations to restrict his activi-
ties and orders were secretly given to the military
embarkation officer at Liverpool that if Colonel
Bruce attempted to take ship for Canada he should
be arrested and sent back to London. It may seem
incredible that a surgeon of the highest standing,
who had committed no crime save that of honestly
24
POLITICS AND THE C.A.M.C.
carrying out instructions, and held distinguished
mihtary rank, should be the subject of such proposed
indignities, but these are the facts.
At the same time it was decided that while he was
to be compulsorily retained as an officer of the
Canadian Army Medical Service Colonel Bruce
should be excluded from participation in the duty of
caring for the Canadian soldier — the cause nearest
his heart. The British War Office having expressed
a desire to obtain his services, it was arranged that
he should be seconded to the Imperial Service. But
in permitting the transfer the Overseas Ministry
made the proviso that he should be excluded from
any area in which there were any Canadian hospital
or medical units. This policy of exclusion was
continued after Sir Edward Kemp succeeded Sir
George Perley as Minister of Military Forces Over-
seas, and until the conclusion of the war.
Is it not a cause for general indignation that one
who stood in the first rank of Canadian surgeons
should have been prohibited from ministering to
the soldiers of his native land — to those who natur-
ally had first place in his sympathies. That he
should be made to suffer this chagrin for the sole
crime of having executed too faithfully the duty he
was asked to perform! Twice afterward, Colonel
25
POLITICS AND THE C.A.M.C.
Bruce offered his services to Canada when the ever-
increasing number of Canadian wounded in need of
surgical care was apparent to everyone. In Decem-
ber of 19 1 7, he made such an offer to Sir Edward
Kemp, and in July of 191 8, to Sir Robert Borden.
No action was taken in either instance and until the
armistice was signed the prohibition against his
being permitted to serve in any area on the Western
Front, where the Canadians were engaged, was
maintained.
The same spirit also prevailed with regard to those
efficient officers who had assisted in the original
investigation and signed the Bruce Report. They
were given to understand that they had been " sent
to Coventry," and that the door of honor and pre-
ferment was closed to them. Particularly flagrant
was the treatment of Lieutenant-Colonel Wilson, of
Niagara Falls, details of which are given in Colonel
Bruce's narrative. Colonel Wilson was D.D.M.S.
at London when Surgeon-General Jones was rein-
stated, the second highest position in the C.A.M.C.
Both General Jones and his successor, Surgeon-
General Foster, sought to break Colonel Wilson
down by persecution. He was reduced from next
to highest to the lowest position in the Service and,
though a lieutenant-colonel in rank, was placed in
26
POUTICS AND THE C.A.M.C.
the trenches to perform the duties of a junior officer.
Finally he was shipped away to a Forestry Corps
camp in the Jura Mountains, although his surgical
and administrative abilities were unquestionably
high. There exists ample evidence to show that
Colonel Wilson was thus degraded by General
Foster, as a punishment for the assistance he had
given in connection with the investigations on which
the Bruce Report of September, 1916, was based.
Under circumstances of the deepest humiliation
Colonel Wilson bravely " carried on." Another
signatory of the Report, Major Charles Hunter,
who had been one of the leading physicians of
Winnipeg, and a man rarely endowed with special
medical knowledge, was also humiliated by being
assigned to subordinate duties.
In one sense Colonel Bruce may regard himself
as fortunate in having been seconded to the Imperial
Army. Though officially ostracized by the Canadian
Overseas Administration he received the most kindly
recognition in the Army Medical Service of Great
Britain. For two years he filled the important post
of Consulting Surgeon to that body in France. This
was professionally a position of exceptional honor,
since there were but twelve consulting surgeons with
Field Marshal Haig's vast Army. In February,
27
POUTICS AND THE C.A.M.C.
191 7, when Germany's ultimatum as to unrestricted
submarine warfare had rendered inevitable the
participation of the United States in the conflict,
Colonel Bruce received an invitation from Hon,
Newton D. Baker, U. S. Secretary for War, to visit
Washington and address the Council of National
Defense on the subject of medical organization.
This important body, consisting of members of the
Cabinet and various military, naval, financial and
industrial leaders of eminence, had been formed to
further " preparedness " in its every aspect. Colonel
Bruce accepted the invitation, and was able to give
the Council much valuable information and advice
on the problems that lay before the Army Medical
Service of the United States. In the summer of
1918 he was sent to represent Great Britain as
one of the delegation of three to attend the American
Medical Congress in Chicago, which was supple-
mented by a visit to the American Surgical Associa-
tion at Cincinnati. His associates were Sir James
MacKenzie, representing the medical profession in
England, and Sir Arbuthnot Lane, one of the Con-
sulting Surgeons of the British Medical Service in
England. Colonel Bruce- was selected for this mis-
sion from the Consulting Surgeons in France. On
the conclusion of the War he was on retirement.
28
POLITICS AND THE C.A.M.C.
gazetted a full Colonel in the British Army, in recog-
nition of his services. These facts are cited, not
for purposes of laudation, but merely to show the
standing of the man who now tells the story of his
•efforts to reform the Canadian Army Medical Ser-
vice, and who was cheated of his desire to serve the
wounded soldiers of Canada by a concerted policy
of ostracism and intrigue, because his proposals for
reform did not run on all fours with the views of
a coterie who placed social considerations above
efficiency.
In Colonel Bruce's chronicle he appears to have
endeavored to preserve chronological order so far
as was possible, and to cast it as nearly in narrative
form as the inclusion of a vast amount of documen-
tary material would permit. This documentary
material has rendered certain repetitions inevitable,
but it was necessary that it should be included, other-
wise the charge that Colonel Bruce had drawn on
his imagination for his facts would inevitably be
forthcoming. These facts are m themselves so
serious as to furnish complete justification for their
publication, if only in the interests of justice to
those men who performed an unsought but necessary
duty and whose reward was humiliation and perse-
cution. It is to be hoped also that the information
29
POLITICS AND THE C.A.M.C.
the volume contains of the subject of Army Medical
organization may serve, if not as a complete guide,
at least as a warning post as to what to avoid in
case Canadians are ever in the future called upon to
render service on the battlefield.
Viewing the narrative of Colonel Bruce from the
individual standpoint, altogether apart from the
Hospitals controversy, it is clear that some explana-
tion must be required of the Ministry of Canadian
Forces Overseas, and of the Prime Minister himself,
as to why antagonism to Colonel Bruce was carried
to the length of refusing his professional services
when twice offered. Relatives of the dead and of
the wounded are entitled to know why the abilities
of this experienced and able surgeon were expressly
denied to their near and dear ones, at crucial periods
when the Canadian Army was in need of all the
expert surgical assistance available.
.^0
AUTHOR'S PREFACE.
Returning to Canada I find much confusion exis^
ing as to the controversy which grew out of the
conditions disclosed in my Report to the Canadian
Government upon the administration of the Canadian
Medical Service Overseas, in September, 191 6. As
this confusion, and consequent misconceptions, have
arisen by reason of the refusal of the Ministers of
Militia to permit anything in the nature of criticism
of the Canadian Medical Services to reach the public,
I, having reverted to civilian life and being no longer
bound by the military obligations which sealed my
lips while I wore His Majesty's uniform, have
acceded to the request of hundreds of my fellow-
citizens to set down the history of and the facts
underlying that controversy. Since the armistice has
left me free to speak, it has been urged upon me that
for the public good, and in the interest of the Cana-
dian Army Medical Service, to which during the long
years of war Canadian medical practitioners and
Canadian nurses made such an unstinted, whole-
hearted and effective contribution of their energies
31
POLITICS AND THE C.A.M.C.
and abilities, I should not be accessory to the efforts
of the Militia Department in withholding this infor-
mation from the Canadian people.
My original Report was submitted as a confi-
dential document upon the instructions of the then
Minister of Militia. Copies of it were sent by me
only to the Prime Minister and others authorized by
the Minister of Militia to receive them, but shortly
afterwards a digest of my findings appeared in some
of the Canadian newspapers. This publication was
without my knowledge or sanction, but, as it gave
rise to a considerable amount of concern and uneasi-
ness in Canada as to the administration of the Army
Medical Service the Government, instead of facing
the situation and remedying the abuses disclosed,
resorted to the expedient of appointing a Board of
Inquiry. This Board, which was headed by Sir Wil-
liam Babtie, was instructed not to make another
investigation of the Medical Service, but simply to
review my Report, and this it did.
In due course the Babtie Committee issued its
finding. This was instantly communicated to the
press of London in a memorandum of Sir George
Perley, which was largely confined to those parts
tending to discredit my revelations. The publicity
which was accorded to the report of the Babtie
32
POLITICS AND THE C.A.M.C.
Board was denied to my Reply, although the latter
document was prepared and submitted upon the
authority of the same Overseas Minister of the Mili-
tary Forces of Canada, Sir George Perley.
In the following pages the reader will find a
resume of the main points in my own Report. The
Appendix, which contains a large amount of accum-
ulated evidence, upon which the text was based, is
omitted, as it seems unnecessary to reproduce it here.
The original Report and Appendix is to be found in
the files of the Militia Department at Ottawa. The
complete Report of the Babtie Board is given, as is
also that of my Reply, and I have included some
correspondence with Sir George Perley, covering
the various stages of the attempt at the reconstruc-
tion of the medical services overseas.
A perusal of these documents will afford the
reader some evidence of the difficulties involved in
the conduct of an investigation into the defects in
the organization and management of a permanent
Service, prejudiced by ancient traditions, and forti-
fied by autocratic powers conferred upon it by mili-
tary regulations. It will also reveal the harsh treat-
ment an individual may incur from a military
administration which one has sufficient courage to
criticize. In the great march of events of the past
33
3
POLITICS AND THE C.A.M.C.
five years few individual experiences are worth ink
and paper, and I have therefore endeavored to make
this record as impersonal as possible.
When after volunteering my services, the Govern-
ment accepted them and delegated to me the unpleas-
ant task of investigating and reporting upon what
is perhaps the most important Service in the Army,
I realized that a judicial and unbiased revelation of
the defects discovered might bring down upon me
the enmity of those whose regime I threatened to
disturb. But the members of my Committee were
one with me in the conviction that our obligation
to the Canadian soldiers far outweighed personal
considerations. Our work fortunately resulted in
more efficient and more generous treatment for the
sick and wounded and we are amply repaid.
An apparently deliberately-distorted statement of
my attitude towards the Medical Service, as the
result of my investigation of it, which was circulated
for political purposes and evidently with the object
of arousing antagonism against me, renders it neces-
sary that I should here reiterate that neither in my
original Report, nor in this volume, have I criticized
the medical men carrying on their professional
duties in the Canadian Army. My exposure was of
the administration of the service, and of the misuse
34
POLITICS AND THE C.A.M.C.
of its personnel. In my own experience of three
years I have never failed to express my unbounded
admiration and respect for these men, for the sacri-
fice they made and for their efficiency in the various
Canadian medical units in France and England.
Nor can the praise of the informed and discerning
be withheld from those members of the medical pro-
fession who carried on so ably and so uncomplain-
ingly at home.
To the medical officers serving with battalions I
have paid special tribute for their admirable work
under the greatest difficulties and hazards, and with
unfailing cheerfulness, and sympathetic helpfulness,
that gave moral support to the men. Their personal
exhibitions of courage were only second to those of
the stretcher-bearers, who displayed a heroism
beyond all praise. To the medical officers, working
in the field ambulances, casualty clearing stations,
and hospitals in France and England, I have also
paid homage for their splendid devotion to duty.
Indeed I have on many occasions remarked the unus-
ually high standard of professional qualifications
and aptitude existing in the Medical Service, the
general competence and zeal of the nursing stafif and
the fine spirit in which all " carried on," often under
adverse and trying conditions.
35
POLITICS AND THE C.A.M.C.
It was not permitted me to serve as I had hoped
to do, our own Canadian sick and wounded. Having
incurred the displeasure of those in authority be-
cause I refused to make my role of investigator a
travesty and complacently shut my eyes to the great
evils which menaced the comfort and well-being of
our troops, I was banished from the service in which
I had enlisted. As a consultant of the British armies
in France I found an opportunity for service to help
in the alleviation of the suffering and the physical
rehabilitation of many to whom it was my privilege
to minister. In consenting to permit the facts
which are contained in this book to be made
public, I consider I am discharging a duty and
a service to my country, for the reason that the
issues involved are living ones. Canada must
profit by the experiences of the late war, even
though in certain phases these experiences have
involved grave blunders and injustices. The day
is yet far distant when we can safely dispense
with a properly-organized Army Medical Service.
It is in the interest of everyone that this Ser-
vice should be conducted along efficient, economical
and truly national lines. This can only be accom-
plished by ending, and rendering impossible the
recrudescence of the evils of favoritism, promotion
36
POUTICS AND THE C.A.M.C.
by seniority, outside interference by irresponsible
persons, and other detrimental influences which have
tended to impair efficiency during the period of the
war. It must be clear to everyone who reads this
book that many of the mistakes of administration
are due to the lack of scientific professional know-
ledge in the executive of the service; and that its
purely administrative part should be divorced from
the professional side. One hopes that this proposal
has been duly emphasized in the ensuing pages. The
reforms outlined can only be accomplished by the
Government availing itself of the abilities of medical
officers of keen minds and outstanding ability who
have seen service in the various activities of the war.
Keeping this necessity in mind, it will be apparent
that the present volume is intended to be not merely
an indictment but has also a constructive purpose.
My Original Commission and Report.
Early in the spring of 1916 I was instructed by
the Hon. the Minister of Militia and Defence for
Canada, Lieutenant-General Sir Sam Hughes,
K.C.B., to make an investigation into the work of
the Canadian Army Medical Service Overseas, to
report upon its efficiency, and to make recommen-
dations for the improvement of the Service.
37
POLITICS AND THE C.A.M.C.
In July of that year I was appointed Inspector-
General of the Canadian Army Medical Service, and
upon my recommendation a Committee, consisting of
the following officers, was appointed to assist in the
investigation : —
Colonel Wallace Scott, C.M.G., F.R.C.S.,
C.A.M.C, Commanding Officer Moore Barracks
Hospital.
Colonel Walter McKeown, C.A.M.C, Surgeon;
President of a Standing Medical Board.
Lieutenant-Colonel F. W. E. Wilson, O.B.E.,
A.D.M.S., Canadian Training Division, Shorncliffe.
Lieutenant-Colonel Charles Hunter, C.A.M.C,
A prominent Winnipeg Physician, and Member of
a Medical Board, Folkestone.
Colonel Frank Reid, C.M.G., Director of Recruit-
ing and Organization, CE.F.
On the conclusion of a very careful and thorough
investigation of the Canadian Hospitals and Medical
Service in England, we presented a confidential
Report to the Hon. the Minister of Militia, and
through him to the Canadian Government. In the
necessary investigations and in the preparation of
38
POLITICS AND THE C.A.M.C.
this Report I was ably assisted by the Committee,
and the criticisms and recommendations contained in
it have been endorsed by each Member of this Com-
mittee. The following is a Summary of the Report :
Throughout the enquiry our motive was to ascer-
tain if everything possible, as regards medical and
surgical skill and nursing, had been and was being
done for the brave men who had been wounded or
had become sick while fighting in our cause, and to
whom we therefore owed the best and most efficient
service which it was in our power to give them.
Incidentally we also endeavored to ascertain if the
method of administration of the Medical Services
was such as would be likely to yield the best results
without waste of public money. I may at once state
that, in so far as the medical and nursing staffs were
concerned, we found that both the doctors and
nurses had discharged their duties in a most self-
sacrificing and exemplary manner. Therefore, any-
thing that we were compelled to say in criticism of
the administration and defects of policy must not be
interpreted as a reflection upon the personnel, who
had been most diligent in carrying out the duties
assigned to them. When members of the Medical
Staff are placed in positions in which they have no
39
POLITICS AND THE C.A.M.C.
opportunity of performing the duties for which their
previous training has especially fitted them, it is
perfectly obvious that their services are not being
used to the best advantage. At the same time, how-
ever, I should like to point out and to emphasize the
fact, which is equally patent, that the individual,
who is practically helpless in the matter, is not in
any way to blame for the consequent waste of good
material. The responsibility for this waste must be
laid at the door of the Director of Medical Services,
who, in too many cases, appeared to have ignored
special qualifications altogether, and had distributed
the personnel in the most haphazard manner.
At the outbreak of the war our medical organiza-
tion was a small one, and quite unprepared to cope
with the large problems created by the necessities of
a rapidly-increasing force. Making all due allow-
ance for these difficulties, it would naturally be
expected that some definite policy would have been
pursued to ensure that our men should receive the
best possible treatment. I take it that the first duty
of the Canadian Army Medical Corps was to the
sick and wounded of our Canadian Expeditionary
Force, and if this was so, a policy of concentration
of hospitals would seem to possess manifest advan-
tages. Instead of this, hospitals had been scattered
40
POLITICS AND THE C.A.M.C.
all over the country, rendering efficient control and
inspection difficult, and also entailing needless
expense in transporting patients to and from them.
More than a year before my investigation was
undertaken special arrangements had been made for
sending wounded Canadians to the Queen's Cana-
dian Military Hospital, Beachborough Park, and on
June i6th, 1915, it was suggested, in a letter from
Colonel Hodgetts, Commissioner of the Canadian
Red Cross, to Surgeon-General Carleton Jones, that
the War Office should be requested to make similar
arrangements in regard to the Duchess of Connaught
Hospital, Cliveden. This request was accordingly
made. The War Office acceded to it, and gave in-
structions that Canadian soldiers should be sent to
one or other of these two hospitals, and as a conse*
quence of this arrangement many more Canadians
found their way to them. In spite of the fact that
on December 17th, 19 15, in reply to representations
made to him to the effect that for Imperial consid-
erations it was advisable to spread the Canadians
throughout Great Britain, the Director of Medical
Services (Canadians) had expressed the opinion that
"it is conducive to the patients' well-being and com-
fort to be under our own administrative control,"
we find him, on February 2nd, 19 16, writing to the
41
POLITICS AND THE C.A.M.C.
War Office to ask that the instructions given in
regard to the two hospitals mentioned above should
be amended, and stating, in a further communication
dated March 25th, 19 16, '' that it is not now con-
sidered necessary, from a Canadian point of view,
to make any special arrangements at Southampton
for the collection of Canadian patients." No reason
is assigned for this complete change of attitude.
At the time of the publication of the Report we
had in Salonica, where there were no Canadian
soldiers, three hospital units, with a total bed capacity
for 2,800 patients.
Even should it have been found impracticable to
send Canadian patients to Canadian hospitals in
France, those proceeding from the Base in France
on hospital ships to England could easily have been
labelled " Canadian," and have been collected at the
point of disembarkation, from whence they could
have proceeded directly to a Canadian hospital. This
procedure would have been facilitated if we had had
a concentration of Canadian hospitals in some con-
venient area near the seaboard, such as that suggested
by me at Shorncliffe.
In this connection I should like to point out that
if we had had a concentration of primary hospitals
under our control it would have been possible to
42
POLITICS AND THE C.A.M.C.
secure the services of consulting experts in the
various departments, and have thus ensured the best
possible treatment for our men, whereas the policy
which had been pursued of scattering hospitals all
over the country made it impossible, under existing
conditions, to obtain the very large number of
experts which would have been required.
It had been stated to be desirable, from an Imperial
point of view, that our soldiers should mix in the
hospitals with those from other parts of the British
Empire. My experience with sick people leads me
to the conclusion that they prefer to be amongst their
relatives and friends, and I imagine that the feelings
of a sick soldier in no way differ in this respect
from those of a sick civilian. During the inspection
undertaken for the purposes of my Report we found
our Canadian soldiers stating that they wished they
had been sent to Canadian hospitals, where they
would have been under the care of doctors and
nurses from home, with whom they would naturally
have had more in common; and Canadian Medical
Officers complaining that, in consequence of the
existing conditions, they rarely had an opportunity
of treating a Canadian patient.
Further, as we shall ultimately be responsible for
pensions, I was very strongly of opinion that it was
43
POLITICS AND THE C.A.M.C.
imperative that we should ensure that our wounded
and sick soldiers were under the immediate super-
vision of our own Medical Service.
The Canadian Medical Service was criticised
under the following headings: —
I. Many Soi^diers w^re Arriving in Engi^and
FROM Canada Medicai,i,y Unfit; whu
SH0UI.D Never Have Been Enusted.
Many hundreds of soldiers, clearly medically
unfit for service overseas, had been sent from Can-
ada to England. This applied especially to the bat-
talions and drafts which arrived from Canada in
the second year of the war, and in consequence of
this an order was issued on March 9th, 19 16, that
all drafts should be medically inspected immediately
after their arrival in the Shorncliffe Area.
This medical examination of the newly-arrived
drafts showed that they included a large proportion
of unfit men; the Canadian Pioneer draft, which
arrived on June 29th, 19 16, being found to have
fifty-seven unfits out of a total number of 254 all
ranks, that is to say, 22.5 per cent, of unfits.
A large number of the men who had been dis-
charged from the Army had given a history of
asthma of long standing, many of them stating that
44
POLITICS AND THE C.A.M.C.
they had left England years ago because they were
unable to live in that country. Some of them had
exhibited marked symptoms of asthma at the time of
enlistment. In some cases the men had lived in
comparative comfort in Western Canada, but had
a recurrence of their old trouble on moving to
Eastern Canada with their battalions, and on
reaching England it had been found necessary to
discharge 'them.
Men suffering from tuberculosis had also been
allowed to enlist in the Canadian Expeditionary
Force. At the time of enlistment, although the
disease might possibly have been latent, owing to
the beneficial effects of previous treatment, there was
still evidence of the presence of old tubercular foci.
In the majority of these cases the men signed their
own death warrants on enlistment, and in addition
they were a constant menace to the troops with
whom they had been in close contact in crowded
huts and transports.
The following appear amongst a number of special
cases cited in the Appendix: —
Private R. Mick, 297454, enlisted with the 224th Battalion
on March 17th, 1916. He was sixteen years of age, weighed
eighty pounds only, and had suffered from infantile paralysis,
which left him with undeveloped and weak muscles in the
right hip and thigh. He was passed on two occasions as
45
POLITICS AND THE C.A.M.C.
medically fit. After arrival in England he spent most of his
time in hospital. He was still in England at the end of
August, 1916, although he had done no military duty since
coming over, and was of no military value.
Private Wenrow, No. 412252, 39th Reserve Battalion, aged
34; enlisted February 8th, 1915, and was discharged on May
8th, 1916, having done very little work since enhstment, and
being unfit for marching, owing to severe bunions on both
feet, which had been there on enlistment.
Private Alert, No. 417943, 23rd Reserve Battalion, enlisted
July 2ist, 1915, and was discharged July 18, 1916. At the
time of enlistment he had partial paralysis of the whole of the
left side of his body.
A more carefu! and rigid examination by compe-
tent medical officers was recommended.
2. That th^ Syste:m o^ Distribution of
Casualties from the; Front to Impe:rial
Hospitals in England, Scotland, Wales
AND Ireland is Extremely Unsatisfac-
tory.
At the time of the pubHcation of my Report a
Canadian casualty arriving from the front was sent
indiscriminately to a hospital in England, Scotland,
Wales or Ireland. On August i6th, 1916, there
were only 1,612 Canadian overseas patients in Cana-
dian primary hospitals, whilst 5,135 were in British
hospitals, scattered over a wide area in England,
46
BRITISH HOSPITALS IN WHICH CANADIAN PATIENTS ARE SITUATED
'SUTTOM V£NI
FOVANT O
SOUTHAKPTOM
Map No. i
POLITICS AND THE C.A.M.C.
Scotland, Wales and Ireland. At this time a com-
plete inspection of Canadians in Imperial hospitals
had not yet been made. Subsequently, when this
was completed by inspectors appointed by me, it was
found that Canadian patients were accommodated
in no less than eight hundred different hospitals,
scattered throughout the length and breadth of the
United Kingdom. ( See Map No. i ) .
The conditions found in seven of these hospitals,
situated in the London Area and at Aberdeen, Scot-
land, may reasonably be taken as typical of those
which obtained in the others. In these hospitals 248
Canadian patients were examined by our inspectors.
It was found that of this number 116 ought to have
been evacuated to Canadian convalescent hospitals,
fifty-two discharged as permanently unfit for active
service, and thirteen who were suffering from
venereal disease, should have been cared for in a
venereal area of our own. That is to say that of the
248 Canadian patients examined, 171 should not
have been in these hospitals at all, and twenty per
cent, of them ought to have been previously evac-
uated to Canada as permanently unfit.
It was recommended that steps be taken to secure
authority fron the War Office for the collection of
Canadian casualties at the base in France, so that
47
POLITICS AND THE C.A.M.C.
they might subsequently be directed to Canadian
hospitals in England. It was also recommended
that active treatment hospital accommodation, suffi-
cient to take care of all Canadian casualties from the
Front, should be provided in a concentrated area in
England, and the use of British hospitals for Cana-
dian patients discontinued as much as possible.
3. Thk PrKse:nt Method of Having Hospitals
Scattered Over a Wide Area is Most
Objectionable.
A glance at Map i illustrates this very clearly.
Buxton, for instance, which had recently been taken
over as a Canadian hospital for patients suffering
from rheumatism, was 236 miles from Folkestone.
Argument is unnecessary to show that the wider the
area of distribution of patients, the more difficult
becomes efficient administration, supervision and
inspection. A further and no less important point
is the cost of transporting patients these great dis-
tances and back again to convalescent hospitals.
Map 2 illustrates the proposed concentration
scheme. It was impossible to make this an ideal one,
owing to the fact that large sums of money had been
spent by Canada upon hospitals in various localities,
and that it was necessary to make use of these hos-
pitals, if possible. .,.
POLITICS AND THE C.A.M.C.
4. There was Unnecessary Detention in Hos-
pitals. There Had Been No Medicaid
Inspection by the Canadian Medical
Service oe Canadian Soldiers in Imperial
Hospitals, and There Had Been No
Eeeicient Medical Inspection oe Cana-
dian Hospitals, in Consequence oe
Which Canadian Soldiers Were Re-
tained IN Hospitals in Great Britain,
Many oe Whom Should Have Been
Returned to Canada, Where They
Could Have Been More Economically
AND Eeeiciently Treated. The Lack oe
System Permits the Aimless Moving oe
Patients from Hospital to Hospital.
The treatment of Canadian sick and wounded
soldiers had not been such as to ensure either the
earHest possible return of convalescents to the fight-
ing unit or Base duty, or the prompt discharge from
the Service of the medically unfit.
Until July ist, 19 16, when Lieutenant-Colonel
Finley was appointed Consulting Physician, no
experienced medical man had been employed to exer-
cise a general supervision over the medical treatment.
There was still no Consulting Surgeon, although the
49
POLITICS AND THE C.A.M.C.
necessity for such an appointment was urgent.
Owing to the lack of efficient supervision, soldiers
were sometimes allowed to remain in hospital for
weeks, or even months, after they were fit for train-
ing, or at least for base duty, or when they were
clearly cases who should have been discharged from
the Service. During the inspection several cases
were met with who had been detained in hospital
for over a year after they should have been
discharged.
Patients had been transferred aimlessly from one
hospital to another, with no satisfactory records of
their condition accompanying them. The informa-
tion acquired at the first hospital, had therefore to
be elicited again, before the medical staff of the
second hospital could begin successfully to treat the
patients.
In the Recommendations the urgent need for a
Consulting Surgeon was strongly emphasized, as well
as the necessity for co-ordination of the Service in
England, Canada and France. It was also recom-
mended that the personnel of hospitals should be of
a more permanent character than heretofore, and
that there should be periodical inspection of all cases
in hospital, to ensure their not being detained for
an unnecessarily long time. Suggestions were made
50
POLITICS AND THE C.A.M.C.
which it was estimated would effect a thirty-three
per cent, reduction in the number of Canadian casual-
ties in hospitals in Britain. These included measures
to prevent the enlistment of unfit men and of those
who obviously could never be trained successfully
for overseas service.
5. The Use by the Canadian Medical Service
o? Voluntary Aid Hospitals was Most
Undesirable, as They WerE Ine^f^icient,
Expensive and Unsatisfactory.
Most of the Voluntary Aid Detachment hospitals
were formerly dwelling-houses, roughly adapted to
serve as hospitals. In most of them there was no
proper operating-room; in some, operations were
performed in a recreation or other unsuitable room,
whilst in others any patient requiring an operation
had to be removed to another hospital for it.
In spite of the lack of the necessary equipment
and personnel, a considerable number of these hospi-
tals received wounded and sick directly from the
Front. There were, no doubt, isolated instances of
V.A.D. hospitals, e.g., St. Anselm's Hospital, where
the building, equipment, and medical and nursing
staffs were all that could be desired. There is no
doubt, too, that at the beginning of the war these
51
POLITICS AND THE C.A.M.C.
hospitals served a most useful purpose, and were, in
the absence of military hospitals, practically indis-
pensable. In the emergency, the hearty welcome, the
will to serve, largely made up for the absence of
trained skill and surgical appliances. But there was
no question that at the end of the second year of
the war the continued use of V.A.D. hospitals by
the Canadian Medical Service was undesirable. In
the Shorncliffe Area alone there were fifty-seven of
such institutions, with a total capacity of over three
thousand beds. They were scattered over a wide
area, and were in many instances inaccessible by rail,
factors which undoubtedly increased the cost and
difficulty of administration. In addition the medical
staff consisted of civilian practitioners, often with no
surgical experience. Under these conditions it was
obvious that the greatest care was necessary in select-
ing suitable cases for admission to these institutions,
in the supervision of the surgery, and in careful
inspection of the patients, with the object of ensuring
that they were not detained in the hospitals for too
long a time.
(In this connection it should not be forgotten
that practically all the military hospitals through-
out Great Britain had subsidiary V.A.D. hospitals
52
POLITICS AND THE C.A.M.C.
attached to them, to which, of necessity, many of our
Canadian patients found their way.)
It is a grave indictment of the Canadian Medical
Service to say that a fair proportion of the patients
in these V.A.D. hospitals at this time should never
have been sent there; that inspections by competent
Canadian medical officers were scandalously infre-
quent; and that quite twenty-five per cent, of the
patients were retained in hospitals for weeks or
months after they should have been discharged.
Owing to the fact that the hospitals were under the
charge of civilian medical men, with no military
experience, the importance of the early return of
soldiers to their units, or at least to base duty, was
in many cases entirely lost sight of, the result being
that the discipline and morale of soldiers, who had
long been ready for the hardening influence of the
training camp, were impaired by the enervating
effects of an unduly prolonged stay in hospital.
A constant effort seems to have been made to keep
these institutions filled, and in at least four cases
agreements were in force for some considerable time,
under which the Canadian authorities agreed to pay
for ninety per cent, of the beds in the hospitals,
whether those beds were filled or not.
53
POLITICS AND THE C.A.M.C.
It was recommended that the use of Voluntary-
Aid Detachment hospitals by the Canadian Medical
Service be discontinued.
(During the final weeks of the war the last rem-
nant of the V.A.D. hospitals was being disposed of
by the Canadian authorities. In the meantime, of
course, Canada has paid the price for her tardiness
in adopting the recommendation on this subject made
by me in 1916. An editorial, dealing with the British
Voluntary Aid Detachment hospitals, which ap-
peared in the British Medical Journal some consider-
able time after the publication of my Report, entirely
supported my attitude in the matter.
I wish to emphasize the fact that in what was said
in my Report I intended no disparagement whatever
of the service of the Voluntary Aid Detachment
nurses. On the contrary, I expressed my apprecia-
tion of the self-sacrifice and devotion displayed by
those nurses, and of the splendid services which they
had rendered to the sick and wounded, and further
stated that there was plenty of work which these
partially-trained nurses were capable of doing in var-
ious capacities. After two years' experience in the
British hospitals in France, I feel that I cannot speak
too highly of the value of the splendid work which
they have so unselfishly and cheerfully performed.
54
POLITICS AND THE C.A.M.C.
Far from intending to criticize the Voluntary Aid
Detachment nurses, I had in view, at the time I made
my Report, their employment in the Canadian Ser-
vice, and during the early period of my reorganiza-
tion took up the question with the Matron-in-Chief,
who I found very much opposed to the idea. If I
had continued my work of reorganization, I should
have insisted upon the employment of a large number
of Voluntary Aid nurses in all our hospitals, as
many splendid young women in Canada had offered
to give their services, and I was convinced that their
work would have been of the greatest value, and inci-
dentally would have effected a very considerable
saving to the Canadian Government.
My policy was to adapt to military conditions the
system which prevails in civil hospitals at all times,
whereby a certain percentage of novices perform
duties which require no special skill or nursing exper-
ience. In the civil hospital, beginners perform these
services as the initial part of their training for the
nursing profession, at little or no expense. It
occurred to me that by a process of diluting the staffs
of trained nurses in Canadian military hospitals
with V.A.D. nurses, the same system would be
attained with a resultant economy of expenditure.
It would also have enabled the Canadian Army
55
POLITICS AND THE C.A.M.C.
k..
Medical Service to avail itself of the energy of many
patriotic Canadian girls without training who were
eager to serve as volunteers in any capacity without
remuneration. Canada, indeed, was practically the
only country in the war which made no use of such
available material. British experience showed that
with a few months' practise, V.A.D. nurses be-
came capable of performing a large share of the
work of caring for the patients. At the end of
eighteen months to two years their ability to serve
the sick and wounded was undistinguishable from
that of the regularly trained nurse. What a great
opportunity Canada has lost in not having employed
this voluntary aid. If she had done so we would
now have available a large force of trained 3^oung
women, who would be able to assist in handling the
extra burdens thrown on our country in the care of
the disabled soldiers; a force which would be an
invaluable asset in the case of such an epidemic as
that of the influenza which occurred last autumn and
winter. The British Medical Service followed a
system of employing about forty per cent. V.A.D.
nurses in co-operation with sixty per cent, trained
nurses and from my two years experience in British
military hospitals, I can say that the quality of the
nursing was not diminished thereby, but was quite
56
POLITICS AND THE C.A.M.C.
up to the high standard found in Canadian miHtary
hospitals where only graduate nurses were employed.
My purpose was that so soon as the more pressing
reforms in the Medical Service were completed to
initiate this system of employing V.A.D. nurses.)
6. The: Administration of the; Group of Fifty-
SEVEJN Voi^UNTARY AlD HoSPlTAI^S UndKR
-Shornci^iffe: Miutary HospiTAi, BY the:
Canadian Medicai, Se:rvice: was Unsatis-
factory AND ExPE:NSIV^.
On July 22nd, 191 5, the Shorncliffe Military
Hospital and its subsidiaries were handed over by
the Imperial Government to the Canadian Medical
Service for administration. 'Most of these subsidiary
hospitals were Voluntary Aid Detachment hospitals.
When this arrangement was made it was agreed that
the Canadians should supply the working staff for
the Shornclifife Military Hospital, and should take
over all the duties of transfers, returns, the outfitting
of overseas patients with clothes, equipment, etc.,
for which the Imperial authorities had previously
been responsible. The agreement further specified
that the Shorncliffe Military Hospital was to be used
for Canadian and Imperial soldiers, both cases occur-
ring locally and those transferred from overseas.
57
POLITICS AND THE C.A.M.C.
The Shorncliffe Military Hospital is an old build-
ing, inconveniently located and most difficult to
administer. At the very time that the arrangement
referred to was made the personnel of No. 4 Cana-
dian General Hospital was at Shorncliffe, and not
being used for any purpose whatever. If, instead of
taking over the Shorncliffe Military Hospital group,
this hospital unit, with equipment and staff for taking
care of 1,040 patients, had been installed in a new
general hospital building, a costly and disastrous
mistake would have been avoided. In the Report a
detailed statement is given, showing the cost to the
Canadian Government of the administration of this
group of hospitals for purposes other than Canadian.
The amount given in the Report is rather over
$113,000.00 per annum, but it was subsequently
found that certain items, bringing the total amount
up to $160,000.00 per annum, had been omitted.
At the time when my investigation was made the
Shorncliffe Military Hospital and its subsidiary hos-
pitals were taking care of only 558 Canadian
patients. This total number included 113 venereal
cases, who should have been provided for in an area
of their own. The remaining 443 cases could quite
well have been accommodated in one stationary
58
POLITICS AND THE C.A.M.C.
hospital, and therefore this item of $160,000.00 a
year can be regarded as wasted.
7. Thk Method of Operating Jointi^y With
THE Red Cross Certain Hospitai^s Buii^t
AND Equipped by Them was Unsatisfac-
tory. Such Duai, Controi, was Unde-
SIRABI^E.
The system of dual control in these hospitals had
undoubtedly given rise to a certain amount of diffi-
culty, with no advantages to counterbalance it. It
was therefore recommended that the Red Cross Hos-
pitals be placed in the same relation to the Canadian
Medical Service as the Ontario Military Hospital at
Orpington; that is to say that the hospitals, when
built and equipped, should be taken over and man-
aged by the Canadian Medical Service,"
8. Impropriety of Detaining Canadian Army
Medicai^ Corps Personneiv to Imperiai^
Hospitals and Stii^i, Retaining Them on
Canadian Pay Roi^ls.
In the section of the Appendix dealing with the
administration of the Shorncliffe Military Hospital
Group there will be found a nominal roll of C.A.M.C.
personnel employed in V.A.D. hospitals in the
Shorncliffe area, together with the cost to the
59
POLITICS AND THE C.A.M.C.
Canadian Government per month of such personnel.
Even though this may be adjusted later on, when the
question of reciprocal service has to be considered,
the matter will present many complications, and
entail considerable difficulty.
9. Unsatis:pactory Si'tuatign at Shorncuf:^E,
Due: to Assistant Director o^ Me:dicai,
Services Being A1.S0 A.D.M.S., Dover
District (ImpEriai,).
The occupancy by a Canadian officer of a position
under two different administrations has not proved
satisfactory. As A.D.M.S. Dover District he re-
ceived repeatedly Army Council instructions, which
clashed with his instructions as A.D.M.S. Canadians,
and it was therefore clear that a good and satisfac-
tory A.D.M.S. Dover District could not make an
equally satisfactory A.D.M.S. Canadians.
It was recommended that this dual position be
abolished, and that the Imperial authorities take over
the A.D.M.S. Dover Area.
10. No Attempt Had Been Made to Restrict
THE Earge Number of Operations Pro-
ducing No Increased Miutary Effi-
ciency.
No instructions of any kind had apparently been
issued dealing with the above subject. The only
60
POLITICS AND THE C.A.M.C.
military justification for operations for minor dis-
abilities is the resulting improvement in the efficiency
of the soldier, and after two years of war, definite
conclusions ought to have been reached in regard to
the desirability of many operations which were still
frequently performed. Such operations include those
for varicocele and varicose veins, for haemorrhoids,
dislocated semilunar cartilage, mastoid disease and
hernia. !
It was recommended that operations on Canadian
soldiers for minor disabilities be restricted to those
which improve military efficiency, and be performed
only by medical officers possessing sufficient skill and
practical experience.
II. The InstaIvIvATion oi^ An Expensive PIvAnt
AT Ramsgate Was Inadvisable, as a
Large Number oe the Cases Treated
There Should Have Been Sent to
Canada egr Treatment.
At the Granville Canadian Special Hospital,
Ramsgate, were treated joint injuries, nerve lesions
and contractures, shell-shock and neurasthenia. Am-
putation cases were also transferred to this hospital
to await the application of an artificial limb.
As regards equipment, one cannot help being
sceptical as to the military value of much of the
61
POLITICS AND THE C.A.M.C.
elaborate installations for baths of all kinds and
electrical appliances, calculated though they may be
to impress the casual visitor.
It was highly desirable that soldiers who were
permanently unfit, or who at the most could only
be fit for base duty, should be returned to Canada
as soon as they were able to travel without detri-
ment to their health. This especially applied to
amputation cases, both for the sake of the man him-
self, and from an economic point of view.
Amputation cases waited in England to be fitted
with an artificial limb, necessitating a stay of six
months on an average after healing of the stump.
During the weary months which elapse before the
artificial limb can be worn and freely used, func-
tional and professional re-education should be begun,
either simple training in the man's old occupation
or the teaching of some new line of work. Lack
of occupation and of some incentive tends to prolong
indefinitely the actual medical treatment of convales-
cent patients, occupation having a curative effect in
the later stages of treatment. Re-educative measures
had been undertaken to a limited extent at the Gran-
ville Special Hospital, but as arrangements had been
made by the Hospitals Commission to deal with
62
POLITICS AND THE C.A.M.C.
these cases in Canada it was not necessary to retain
them in England.
From the economic standpoint it may be said that
in France it is estimated that about one per cent, of
the wounded will require artificial appliances of some
kind, and that the life of an artificial limb is only
from three to five years. This being so, there is no
doubt that in the future there will unfortunately be a
great demand for the manufacture and repair of arti-
ficial limbs, and the Canadian Government has very
wisely established a factory for this purpose in
Canada.
In the course of the investigation we came across
this very curious anomaly. Although the artificial
arms were manufactured in and obtained from
America, our men were detained in England until
these could be brought across the Atlantic, the
authorities, apparently, being totally oblivious of the
fact that they would be nearer the source of supply
after they returned to Canada, and in one case of
which we have records the soldier was brought back
from Canada to be fitted with an artificial arm which
came from America.
Cases of nerve and joint injury, in which it is
obvious that very many months must elapse before
the man can again be of any military value, should
63
POLITICS AND THE C.A.M.C.
also, as a rule, have been returned to Canada. The
necessary nerve and orthopaedic operations, which
usually have to be delayed until some time after the
wounds have healed, are better undertaken where it
is intended to carry out the after-treatment and re-
education measures.
The location of this hospital was unfortunate,
especially for neurasthenic and shell-shock cases,
owing to the frequent visits of Zeppelins to the area
in which it was situated.
After careful consideration we came to the con-
clusion that if this hospital was transformed into an
active treatment hospital, no less than forty-one of
the paid civilian personnel could be dispensed with,
thus effecting a saving of $14,877 per annum.
It was recommended that the hospital be used as
an active treatment hospital for the reception of
cases direct from the Front, the amputation, nerve
and joint cases being in future returned to Canada.
(It may be of interest here to mention that the
unsuitability of this site for a hospital of this kind,
for the very reason given above, was subsequently
abundantly demonstrated. But, although my warn-
ing was given in September, 19 16, the hospital was
not abandoned until April, 19 18, after considerable
loss of life and destruction of property had been
64
POLITICS AND THE C.A.M.C.
caused by bombs during an air raid. The hospital
was then removed to Buxton, where its character was
largely changed, as a result of the adoption of the
recommendation for sending the class of cases which
had been previously treated in it, to Canada).
12. The: Estabushme:nt at Buxton o? a SpEciai,
Hospital for the Treatment oi^ Rheu-
matics Was IivIv Advised, as the Majority
OF Rheumatics WilIv Not Be Fit Again
FOR Active Service, and Could Be Better
AND More Cheaply Treated in Canada.
In June, 191 6, a Canadian Red Cross special
hospital was opened at Buxton for the treatment of
rheumatism and allied conditions. This hospital was
165 miles north-west of London and 236 from
Folkestone, and therefore a long distance from any
other Canadian hospital, rendering the cost of trans-
portation to and from it excessive.
As severe rheumatism is practically certain to
recur under such conditions as obtained in the army
in England and overseas, it seemed to me that it
should be regarded as sufficient ground for discharge
as permanently unfit, and that all the chronic cases
should be returned to Canada. The slighter ones
could have been perfectly well treated in any of the
65
5
POLITICS AND THE C.A.M.C.
Canadian primary hospitals. The same remarks
apply to severe cases of shell shock, which were also
being treated in this hospital, and in which recovery,
from a military point of view, is always incomplete.
We came to the conclusion that it was a mistake
ever to have established a special hospital in Eng-
land for the treatment of rheumatism, and it was,
therefore, recommended that its use for this purpose
be discontinued.
13. PRi:sEN'r Systi^m of Handling Canadian
Vknkre:ai. Patients Was Strongly Con-
demned.
On account of the extreme urgency of the venereal
situation a memorandum was submitted by me to
the Hon. the Minister of Militia and Defence on
September 5th, 1916, to the following effect: —
That no satisfactory arrangement had yet been
made for dealing with venereal cases, and no special
place provided for them until the Elham House
property was secured a short time before my investi-
gation was undertaken. The buildings on this pro-
perty were quite as good as those in any modern
hospital, and were in every way suitable for a prim-
ary hospital for the reception of wounded direct from
the Front. As we were at the time in urgent need
66
POLITICS AND THE C.A.M.C.
of primary hospitals it seemed a needless extrava-
gance to put venereal cases in such a splendid insti-
tution, and the use of huts in a venereal area was,
therefore, recommended.
The objections to treating these cases in hospital
were pointed out. In civil life this is never done,
except for a complication of the venereal disease,
the patients carrying on their ordinary avocations
during the course of treatment. The method of
dealing with the situation was placing a premium
upon the contraction of the disease, as it meant
that the soldiers were relieved from duty for long-
periods of time, and that when they left the hospital
they were flabby and demoralized, and required a
long course of training before they were fit for
service. If they were given regular exercise and
light training while they were being treated for the
disease they would be discharged in good physical
condition to the Command Depot, and only require
a short period of training before they became fit to
rejoin their units.
It was recommended that the course suggested in
the last paragraph should be adopted. It was pointed
out that the time during which the services of the
men would be lost would thus be considerably
reduced and, in addition, the country would be
67
POLITICS AND THE C.A.M.C.
saved a large amount of unnecessary expenditure.
It was also recommended that the building occupied
by the venereals should be evacuated, and that a
certain area should be acquired for their use. This
would have immediately liberated a first-class hos-
pital, which could have been used as an active
treatment hospital for our overseas casualties.
14. FauIvTy Syste^m o^ Handling Ini^Ectious
Dise:ases.
Up to this time cases of measles had usually been
sent to Moore Barracks Hospital, and those of other
infectious diseases to the Folkestone Isolation Hos-
pital. In many ways this arrangement was not
very satisfactory. There was no resident physician
at the Folkestone Isolation Hospital, and the medical
officer paid only occasional visits to the institution.
Patients were received at a rate of so much per
patient per day.
As the arrangement which had been made for
treating cases of infectious diseases occurring
amongst the Canadian troops in institutions not
under our own control had been found to be a most
unsatisfactory one, it was recommended that in
68
POLITICS AND THE C.A.M.C.
future Canadians should look after these cases
themselves, and place them under the best possible
conditions for appropriate treatment.
15. Me:dicai, Boards to R^gui^ate the CivASSiFi-
CATION OF CaSUAIvTIES WhEN CoNVAI.e:S-
CDNT, Had Not Be:e:n Adequate:i,y Pro-
vide:d For.
The Medical Board situation was a disgrace to
the Canadian Medical Service, and was largely
responsible for excessive wastage of the Canadian
Expeditionary Force and for the unsatisfactory
estimation of pensions. There was no central
control; no uniformity of standard amongst the
different Boards ; no supply of an adequate, perma-
nent and efficient personnel for the Medical
Boards; no records of a satisfactory nature avail-
able regarding very many of the casualties, and no
instructions regarding pensions. The importance
of efficient Medical Boards and a proper classifica-
tion of casualties had never been appreciated by the
authorities. Medical officers, frequently new arrivals
from Canada, often young men with little experi-
ence, and ignorant of the elements of the work
required, were sometimes hurriedly brought together
to form a Medical Board, and allowed to classify,
69
POLITICS AND THE C.A.M.C.
without supervision, casualties for duty, training,
base duty or discharge. Naturally enough no
uniform standard of fitness had prevailed amongst
the different Boards, composed, as they were, of
these shifting elements, and independent of each
other. Hence had arisen contradictory findings on
the same casualty, and Medical Board work had
often degenerated into a farce.
The different Boards at Folkestone, Bramshott,
London and Havre were not co-ordinated in any
way. Thus, in August, 19 16, of iii cases which
were boarded at Havre, and considered there to be
fit only for permanent base duty, nearly 50 per cent,
had been previously passed by the Medical Boards
in England as fit for duty at the Front in from four
to six weeks. Of 226 cases which were returned
from France as permanent base duty men on July
1 6th, 19 1 6, about a quarter were passed by the
Medical Boards in England as fit for full duty in
four weeks.
As regards the boarding of officers, no general
policy had heen determined on, and there was no
agreement between the Boards at London and Folke-
stone, the result being that dozens of officers were
retained in England who might, with advantage to
the country, have been discharged from the service.
70
POLITICS AND THE C.A.M.C.
The question of casualties m England appeared
to have been largely regarded as an isolated problem,
and no co-ordination with Canada had been
attempted, though the time was ripe for such co-
ordination.
The appointment of an Assistant Director of
Medical Services Invaliding was recommended, for
the purpose of securing co-ordination between the
Medical Boards in England and France, and co-
operation with the Claims and Pensions Board in
England and the Military Hospitals' Commission
in Canada, together with complete re-organization
of the Medical Boards. The imperative necessity
of regarding casualties in Britain and Canada as
one problem only, and not as an isolated one in
each country, was emphasized, and it was pointed
out that this was especially important in view of the
re-education work which was being undertaken in
Canada.
The appointment of Standing and Travelling
Medical Boards, the personnel of which should be
permanent, and the members of which should
possess, if possible, a certain amount of military
experience, was recommended. These Boards would
not deal with discharges and permanent base duty
71
POLITICS AND THE C.A.M.C.
men, but their function would be to see periodically
all soldiers, other than those in 'hospitals, not classi-
fied as fit for full duty, with a view to placing them,
if considered advisable, in a higher category, and
thus reducing the wastage of man power in the Army.
The Board of Medical Officers inspecting the
Canadian troops at the base in France should be
composed of men thoroughly conversant with the
work of the Travelling Medical Boards in Britain
and interchangeable with the members of these
Boards. This was the only possible way of securing
the necessary uniformity of standard.
1 6. Satisfactory Records Re:garding Individuai,
Casuai^ties We:re: Not Avaii,abi,e:.
The records of the sick and wounded were found
to be hopelessly bad, patients very rarely bringing
with them any written information from France,
and very insufficient and unsatisfactory records
being kept in England. The entry on the medical
history sheet (the only record in most cases) was
made, as a rule, by the registrar of the hospital, who
knew nothing whatever about the patient, saw him
only on admission and discharge, and blindly copied
the diagnosis already entered on the medical history
72
POLITICS AND THE C.A.M.C.
sheet at the previous hospital, or jotted down what-
ever the patient stated to be his disability. As a
result of this, when the patient ultimately came
before a Medical Board all previous records had
usually been lost, with the exception of such brief
— and often misleading — entries on the medical
history sheet.
The following recommendations were made : —
A nominal roll of all Canadian soldiers, specify-
ing their disabilities, should be forwarded to the
Canadian Records Office every week, and a certified
entry made at once on the medical history sheet of
each patient. A similar weekly return should be
made to the Records Office by Canadian hospitals
at the base in France. After the facts had been
carefully entered on the medical history sheet at
the hospital to which the soldier was sent any
documentary evidence from France should be sent
to the Records Office, and not retained in the
hospital. The importance of the medical history
sheet in hospitals in Britain was emphasized, as also
was the necessity of this document accompanying
the soldier from one hospital to another.
7Z
POLITICS AND THE C.A.M.C.
17. The: Exceedingly Important Question of
Pensions, Which W11.1. Invoi^ve the
Expenditure of Large Sums of Money
BY Canada Annuai^i^y, Had Been Neg-
I.ECTED BY THE Canadian Medicai. Ser-
vice.
The importance of pensions had not been recog-
nized in any way. Canada will have to pay in
pensions millions of dollars annually for the next
fifty years. It may be^ safely assumed that the
country is anxious to do full justice to all claims
for disabilities resulting from, or aggravated by,
military service. To be scrupulously fair to the
individual soldier, and to give him the benefit of the
doubt when such exists, and yet to protect the State
against unjust claims for compensation, was the
bounden duty of the Medical Service.
In order to ensure full justice to the individual
soldier and protection to the State the following
precautions were absolutely essential : —
(a) Some means of identification.
(b) Reliable records and first-hand documentary
evidence, as far as is possible.
74
POUTICS AND THE C.A.M.C.
(c) A final examination before discharge made
by medical men who have every facility for
thorough medical examination, and whose
professional standing would render it diffi-
cult to subsequently successfully attack their
conclusions.
Judged by this standard, the Canadian Medical
Service had failed to an almost criminal degree : —
(a) Insufficient precautions had been taken to
secure ready identification.
(b) The records were hopelessly bad.
(c) There had been only two permanent mem-
bers — one of them of junior rank — on the
two Boards dealing with discharges. The
personnel had been constantly changed, and
medical officers of little professional ex-
perience and no knowledge of the special
problems involved had been attached for a
few weeks, giving place to men of the same
calibre.
Re-organization was suggested on the following
lines : —
(a) Steps should be taken to secure adequate
means of identification.
75
POUTICS AND THE C.A.M.C.
(b) Careful records should be kept.
(c) There should be thorough medical examina-
tion by a competent and permanent Medical
Board.
It was recommended that when the soldier finally
appeared before the Medical Board a short history
of the essential facts of his case should be written,
read to him, and signed by him in the presence of
witnesses.
The medical examination of officers for discharge
on account of physical disability had been perfunc-
tory and inadequate, and it was recommended that
this should be made more satisfactory from the
point of view of pensions.
So far as could be ascertained, no special con-
sideration had then been given in Canada to the
very important question of aggravation of pre-exist-
ing disability by active service. The desirability of
definite rules for the guidance of the Medical Boards
in estimating such disabilities was emphasized.
76
POLITICS AND THE C.A.M.C.
i8. Lack of Co-Ordination in the Canadian
Medicai, Service: Between Canada, Eng-
land AND THE Front.
The investigation revealed a lack of adequate
co-ordination between the Canadian Army Medical
Corps in Canada, England and France. This was
noticeable ( i ) In the examination of the men, and
(2) in the administration of the Canadian hospitals
in France.
As regards the examination of the men, there was
no common standard. It sometimes happened that
a man, who apparently had had no difficulty in pass-
ing a Medical Board in Canada, was, on his arrival
in England, found unfit for service at the Front.
Furthermore, as has been previously mentioned, a
man who had been passed by a medical officer in
England as fit for service at the Front, was fre-
quently retained at the base in France as unfit to
proceed to the trenches.
In regard to the Canadian hospitals in France, so
far as we could discover, the only function per-
formed by the Director of Canadian Medical Services
(London) with reference to such units was the
control of promotions; their location, movements,
patients treated, and all such matters of general
77
POLITICS AND THE C.A.M.C.
administration, being controlled by the British
Director of Medical Services, Lines of Communica-
tion. The return of Canadian medical officers
required in the Canadian Medical Services in Eng-
land was, therefore, a matter of considerable diffi-
culty which could be accomplished only by a cir-
cuitous correspondence with the War Office.
19. Canadian Army Medical Corps Personnel
IS Not Being Used to the Best Advantage.
It was understood by the majority of the officers
of the Canadian Army Medical Corps when they
enlisted for overseas services that they were intended
to serve, primarily, Canadian sick and wounded sol-
diers, but it was found on my inspection that the
personnel of the C.A.M.C, with a few exceptions,
had not been engaged in the care of the Canadian
sick and wounded. A special illustration of this
was the fact that a Canadian personnel of about
900, with subsequent reinforcements of at least half
that number, belonging to three stationary and two
general Canadian hospitals, had been despatched to
the Mediterranean, although no Canadian troops
were serving with the Mediterranean Force. In
France, C.A.M.C. units, including six general hos-
pitals, four stationary hospitals, and three casualty
78
POLITICS AND THE C.A.M.C.
clearing stations, were not serving, except in a very-
small proportion of cases, the Canadian sick and
wounded. The same applies to England, where the
staffs of the Shorncliffe Military Hospital, the
Ontario Military Hospital, Orpington, and the
Duchess of Connaught Red Cross Hospital, Taplow,
were serving from 70 to 80 per cent. Imperial
patients. Thus it was very evident that the C.A.M.C.
personnel was not fulfilling the purpose for which
it was originally designed; that is, attendance on
the Canadian sick and wounded.
There was no doubt that each of the Canadian base
and stationary hospitals in France at this time could
have doubled their bed capacity without increasing
the medical personnel, and very slightly — if at all —
increasing the nursing staff. Therefore, if it was
intended that the bed capacity of these hospitals
should remain as it was, then the number of medical
officers serving in them should have been consider-
ably reduced.
A survey of the duties which were being per-
formed by the officers of the C.A.M.C. in England,
France and the Mediterranean disclosed the fact
that there were many square pegs in round holes.
In other words, the officers were not given the duties
which their qualifications, training, and previous
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POLITICS AND THE C.A.M.C.
experience rendered them most competent to per-
form. The reason for this, apparently, was that
the hospital units had been mobilized in Canada, and
there seemed to have been a great objection on the
part of the officers commanding these units to
exchange a man whose talents would have been of
more use elsewhere.
20. The: Poucy 01^ the: Departme:nt Had BttN
Opposed to the: Use op Experienced
Medical and Surgical, Consulting
Specialists.
Although from time to time a number of promi-
nent medical and surgical specialists had offered
their services to the Department, the Director of
Medical Services had consistently refused to avail
himself of them. Why a consulting specialist, who
has proved himself of so much use in civil life,
should not be equally useful in military practice is
difficult to understand.
It was recommended that a certain number of
physicians and surgeons of recognized professional
standing be appointed as consultants to our Expe-
ditionary Force.
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POLITICS AND THE C.A.M.C.
21. DiscoNTi:N'r Concerning Promotions,
EsPE^ciAivivY IN Regard to RegimentaIv
MedicaIv O^i^icers Serving at the Front.
Discontent, naturally impairing efficiency, existed
on the subject of promotions, and in many instances
there was no relation between the length of service
and professional ability of the medical officer on the
one hand and his rank on the other. The raising
of local hospitals and other medical units in Canada
had led to the promotion of doctors, who, arriving
overseas, compared very unfavorably with many
of their juniors in rank.
It was recommended that promotion of medical
officers be made on merit; length of service, pro-
fessional ability and organizing capacity being the
criterion. Rapid promotions in Canada should be
discontinued, and if fresh medical units should be
raised in Canada their command should be given
to medical officers who had already served overseas.
It was pointed out that deserving medical officers
of battalions and field ambulances, who had served
overseas, would be of the greatest value in England
on Medical Boards, on the staffs of convalescent
hospitals and in brigades, and that their services
should be recognized by suitable steps in rank. It
6 81
POLITICS AND THE C.A.M.C.
was also recommended that acting rank be given
to medical officers temporarily employed on duties
demanding the same.
22. The C.A.M.C. Training School Had Never
Been Properly Organized, Although
o^ THE Greatest Importance to the
Canadian Medical Service.
The C.A.M.C. Training School was for officers,
N.C.O.'s and men of the C.A.M.C. for the entire
Canadian Expeditionary Force overseas. It was,
further, a reserve depot for all C.A.M.C. units
overseas. The importance of the work done by this
training school had not been recognized or appre-
ciated.
It was recommended: —
1. That the Canadian Training School should be
given an authorized establishment sufficiently
liberal for its necessities.
2. That the officers selected to staff it should be
the best obtainable.
3. That permanent quarters should be at once
supplied for its location.
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POLITICS AND THE C.A.M.C.
22^. In the: Operation of the Me:dical Service:
Sufficient Attention Had Not Been
Paid to Economy in Management.
It will be apparent from what has been stated
that there seemed to be a lack of attention by the
Medical Service to the important question of
expense. Owing to lack of time it was impossible
for us to get a complete statement in regard to
expenditure, but I may here again direct attention
to the unnecessary expense incurred in the admini-
stration of the V.A.D. hospitals, an item amount-
ing to $160,000.00 annually, and the equally
unnecessary outlay on the equipment of the Gran-
ville Special Hospital. Under the heading of
" Unnecessary Detention in Hospitals," a number
of instances have been given of men being detained
in hospitals for long periods, although physically
fit to be returned to their units. In the time at our
disposal we were unable to compute the loss in
fighting efficiency and money which this had
entailed, but we know that both must have been very
considerable.
The following recommendations were made for
re-organizing the Canadian Medical Service: — *
*In subsequent pages it will be seen that most of these
recommendations were adopted.
83
POLITICS AND THE C.A.M.C.
1. That the Canadian Medical Service be re-
organized from top to bottom.
2. That the medical arrangements in Canada,
England and overseas be co-ordinated, so
that the special qualifications of each medical
officer be used to the best advantage.
3. That Canadian casualties be, as far as pos-
sible, treated in Canadian hospitals, the first
duty of the Canadian Army Medical Corps
being to the Canadian sick and wounded.
4. That there be a concentration of Canadian
hospitals, and that the use of voluntary aid
hospitals for Canadians be discontinued.
5. That we discontinue the present arrangement
with the Red Cross in so far as the operation
of hospitals jointly with them is concerned,
and that in future we take over from them
for administration any hospitals which they
procure and equip.
*6. That, as soon as suitable accommodation
can be provided in Canada, soldiers who are
*A reference to the report of the Minister of the Overseas
Military Forces, 1918, submitted by Sir Edward Kemp, states
on page 384 that: —
84
POLITICS AND THE C.A.M.C.
obviously incapacitated for any further
active service be returned to Canada when
they are fit to travel without detriment to
their health, their further medical treat-
ment and necessary re-education to be carried
out in Canada.
7. That immediate steps be taken to provide
hospitals in Halifax, Montreal, Toronto,
Winnipeg and Vancouver, together with a
smaller one in Ottawa, and that these have
suitable accommodation for a limited num-
ber of officers.
8. That a certain number of Canadian medical
officers who have had experience at the
front be detailed for duty in Canada to assist
in the organization of these hospitals.
9. That all ranks, before leaving Canada, be
examined by an independent Medical Board
to ensure the weeding out of unfits, and that
a sufficient number of Boards for this pur-
pose be established throughout Canada, to
"The Medical Service returned to Canada in the year 1917
9,000 patients for further treatment, and in the year 1918
there were returned 13,481 patients,"
which is possibly one of the best examples of the effective
action which followed Colonel Bruce's investigation.
85
POLITICS AND THE C.A.M.C.
be under the direction and control of an
A.D.M.S. Embarkation.
10. That the establishment of the A.D.M.S.
Embarkation at Bath be abolished.
11. That the three Canadian hospitals now-
stationed at Salonica be immediately recalled
for duty in England if they can be spared
by the Imperial authorities.
12. That, in future, no medical units be organ-
ized in Canada for overseas duty.
13. That there be established in Canada a suffi-
cient number of well-equipped C.A.M.C.
depots for thoroughly training the personnel.
14. That the re-organization scheme herewith
attached be adopted.
PROPOSED RE-ORGANIZA TION : CHAIN
OF RESPONSIBILITY^
A proposed scheme of re-organization of the
Canadian Medical Services is herewith attached.
This was essential in order to carry out the primary
function of the Canadian Medical Services, e.g., the
care of Canadian sick and wounded. The Canadian
*See chart attached, marked No. 2.
86
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POLITICS AND THE C.A.M.C.
To have directly under him the D.D.M.S.,
England; D.D.M.S., Lines of Communication,
France; and the D.D.M.S., Canadian Army
Corps, France.
Deputy Director of Medical Services, England.
To have the responsibility of the Canadian Medical
Services in England. Directly associated with
him shall be a Consulting Surgeon, a Consulting
Physician, and a Consulting Sanitary Officer.
His immediate staff to be five Assistant Direc-
tors of Medical Services, and the Assistant
Directors of Canadian Training Divisions shall
be responsible directly to him.
Deputy Director of Medical Services, Lines of Com-
munication, France.
This officer shall have the responsibility to as
great an extent as possible (pending arrange-
ments with the Imperial authorities) for the
control of the Canadian hospitals in France.
It shall be his object to as much as possible
centralize the hospitals, so that they can the
better perform their duty of gathering together
the Canadian sick and wounded for transport
to England. He shall, with an Assistant
Director of Medical Services, have control of
88
POLITICS AND THE C.A.M.C.
the examination of men arriving as reinforce-
ments from England, and to him shall be given
the responsibility of classifying casualties com-
ing back from the Front as to their disposal
either on base duty in France or to be returned
for disposal in England. He shall further have
control of a C.A.M.C. depot in France, where
C.A.M.C. officers and other ranks shall be
available for reinforcements in France. In
this way an easy interchange of officers and
men between England and France, it is hoped,
will be brought about.
Deputy Director of Medical Services, Canadian
Army Corps, France.
This officer will be responsible for the Medical
Services of the Canadian Army Corps, with an
A.D.M.S. for each division in the corps.
Assistant Director of Medical Services, Embarka-
tion, Canada.
There shall be an A.D.M.S. Embarkation in
Canada, who shall be held responsible for the
sending forward to England of fit men. He
shall also be held responsible that the troops
embarking in Canada for England shall be as
free as possible from infectious and contagious
89
POUTICS AND THE C.A.M.C.
diseases, and shall take measures to prevent the
spread of such diseases as much as possible
on shipboard. (Under the conditions which
obtained at the time of my investigation each
unit arriving from Canada was a hotbed of
contagious disease for the first three months of
its stay in England. It was hoped that such an
officer would prevent this state of affairs.)
Assistant Director of Medical Services — Personnel
and Nursing Service.
This officer shall have charge of the personnel
of the C.A.M.C. in the Canadian Expeditionary
Force, including personnel records and qualifi-
cations of all ranks. In this Department shall
be included promotions, ranks and postings of
officers, nursing sisters and men, establishment
of units and corps orders.
Assistant Director of Medical Services — Records.
This officer shall have charge of casualty and
medical historical records, statistics and war
diaries; returns from hospitals, location and
movement of patients, and enquiries concerning
the same.
Assistant Director of Medical Services — Invaliding.
This officer shall have control of Invaliding
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POLITICS AND THE C.A.M.C.
Boards. That is, he shall select the personnel
of Boards, arrange for the instruction of
officers in Board work, promulgate rules and
regulations with reference to Boards, compile
statistics in reference to the same, and control
the movements and location of Medical Boards.
Assistant Director of Medical Services — Supplies.
This officer shall have control of supplies and
equipment for the Canadian medical units,
medical stores, claims and accounts.
ACTING SUB-MILITIA COUNCIL CON-
SIDERS AND ACCEPTS MY REPORT.
My Report on the Medical Service and the
Interim Reply of General Jones, which he subse-
quently stated he wished to be regarded as his final
reply, were considered at a meeting of the Acting
Sub-Militia Council for Overseas Canadians, held
at the offices of the Department of Militia and
Defence, Cleveland House, St. James's Square,
London, on October 6th, 191 6. There was also
submitted a letter from Major Lash, the Deputy
Judge Advocate-General, giving a comparative
statement of the remarks made in the Report and
those in General Jones's Reply. The following
officers were present at the meeting : — >
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POLITICS AND THE C.A.M.C.
Major-General Sir J. W. Carson, C.B. (in the
chair).
Major-General Sir S. B. Steele, C.B., M.V.O.
Major-General J. C. MacDougall, C.M.G.
Brigadier-General R. G. E. Leckie,. C.M.G.
Brigadier-General F. S. Meighen.
Colonel W. J. Neill (Now Brigadier-General).
Colonel A. D. McRae (now Major-General).
Colonel Frank A. Reid, C.M.C.
Colonel E. C. Ashton (now Adjutant-General,
Canada).
Lieutenant-Colonel James G. Ross (now Brigadier-
General) ;
and
Major B. M. Greene (now Lieutenant-Colonel),
Secretary to the Council.
In addition to the Report and Reply referred to
above, there was submitted to the meeting by
General Jones a further Report from his Assistant
Director of Medical Services, Shorncliffe area,
which will be found to be an illuminating document.
It is as follows: — i
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POLITICS AND THE C.A.M.C.
From : —
Assistant Director of Medical Services,
Canadians, Shorncliffe Area.
To:—
Director of Medical Services, Canadian
Contingents, London.
" Referring to my Report to you under date of
September 25th, 1916, in reply to your D.M.S.,
17. 10.7, of September 23rd, 1916, asking for my
comments on sections of the Report of the Board
of Inquiry held on the administration of the Cana-
dian Army Medical Corps in this area, I wish to
state that my reply had to be prepared in a great
hurry, and without a copy of the Board's report to
go upon. Colonel Bruce forwarded me a copy,
which I now have. I am, therefore, now in a better
position to make comments on same, being able to
review the Report as a whole instead of sections of it.
" The administration of the Shorncliffe and
Dover area has been carried out by the A.D.M.S.
Canadians, acting under the direct instructions of
the D.M.S., Canadian Contingents, London.
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POLITICS AND THE C.A.M.C.
''CANADIANS SHOULD BE IN CANADIAN
HOSPITALS.
" The A.D.M.S. Canadians suggested to the
D.M.S. that all Canadians should be taken care of,
if possible, by Canadians in Canadian hospitals. . . .
"At this time Moore Barracks Hospital (the only-
Canadian hospital) was being remodelled. It could
not take care of all the Canadian patients from local
Canadian troops in this area, and the A.D.M.S.
Canadians suggested to the D.M.S. that No. 4
Canadian General Hospital, which had then arrived,
be opened up as a general hospital with 1,040 beds.
The D.M.S.' reply was that this hospital's equipment
was at Southampton, and could not be used except
for overseas duty. The A.D.M.S. Canadians sug-
gested that other equipment be sent, and when No. 4
Canadian General Hospital had to go overseas
another unit might take its place. This suggestion
or procedure the D.M.S. did not care to adopt, but
as the Shorncliffe Military Hospital had mostly
Canadian patients, the D.M.S. took the same over,
and with the Shorncliffe Military Hospital all the
Imperial military and Voluntary Aid Detachment
hospitals under the administration of the Dover
command had also to be taken over.
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POLITICS AND THE C.A.M.C.
" If a Canadian general hospital had been opened
up, this work for the Imperials would not have had
to be done by the Canadians, and it zvould not have
been necessary to transfer Canadians to Imperial
Voluntary Aid Detachment hospitals, where their
treatment could not he carried on as satisfactorily as
if treated in a general hospital.
" No. 4 Canadian General Hospital was put in
charge of the Shorncliffe Military Hospital, but was
soon sent overseas to be replaced by another Cana-
dian unit. On account of these frequent changes it
was pointed out by the A.D.M.S., Canadians, to the
D.'M.S. that it was absolutely unsatisfactory to
administer the command, and a permanent establish-
ment was asked for for this hospital, which was only
given a short time ago, and, although repeatedly
asked for, this establishment has not yet been author-
ized. Things are more satisfactory at this hospital
since the change has been made, but not so satisfac-
tory, as far as the Canadians are concerned, as if a
Canadian general hospital had been opened in this
area, and all Canadians handled by Canadians, which
would have put a stop to the unnecessary transferring
of patients to so many hospitals as has been the case
in the past — in many instances the patients going
95
POLITICS AND THE C.A.M.C.
from one hospital to another in a circle, and on some
occasions landing up in the same hospital from
whence they started.
" This idea of not opening up a Canadian general
hospital made the Shorncliffe Military Hospital
very hard to administer, as I had to train up officers
for this special staff, and officers for inspecting the
numerous Imperial and Voluntary Aid Detachment
hospitals, and when they were trained in these impor-
tant duties they were often removed without warn-
ing by theD.M.S., on consultation with the A.D.M.S.,
Canadians. I have drawn the attention of the
D.M.S. to this on a number of occasions, and pointed
out that I must, in order to have proper administra-
tion, have properly trained inspecting officers, who
would be permanent, in order to properly carry on
the administration; as I have pointed out to the
D.M.S., at times there were not sufficient officers in
this district to carry out the duties, as the D.M.S.
had either sent them overseas or to other areas ; as a
consequence patients were allowed to remain in
hospital longer than they should.
" Even with this extra accommodation, small as it
was, it was not found sufficient, and small Canadian
convalescent hospitals (so-called Voluntary Aid
96
POLITICS AND THE C.A.M.C.
Detachment) had to be opened to take care of the
transfers from Moore Barracks Canadian Hospital
and the Shorncliffe Military Hospital. These so-
termed Canadian Voluntary Aid Detachments are
managed by Imperial ladies, and are Canadian hospi-
tals only in name. If^ as was suggested by the
A.D.MS., Canadians, No. 4 Canadian General Hos-
pital had been opened up, this state of affairs would
have been entirely avoided, and it would not have
been found necessary to open these small convales-
cent hospitals, all of which, at the time, had served
a useful purpose.
" The A.D.M.S., Canadians, had to administer
the Shorncliffe area on the lines as laid down by
the D.M.S., Canadian Contingents, London, and did
the best he could with the material that he had avail-
able. Even Moore Barracks Canadian Hospital was
opened too soon; as was pointed out by the
A.D.M.S., Canadians, when it opened to receive
patients satisfactory arrangements had not been
made to treat the cases. This could all have been
avoided if a Canadian hospital of 1,040 beds, under
canvas if necessary, had been supplied, as was asked
for by the A.D.M.S., Canadians.
97
POLITICS AND THE C.A.M.C.
"A.D.M.S., Canadians, and A.D.M.S., Dover
District (Imperial).
" The dual position had to occur when the Shorn-
cliffe Military Hospital was taken over, with the
numerous military and Voluntary Aid Detachment
hospitals of this area; but if the Toronto General
Hospital or a Canadian general hospital had been
opened, as was requested by the A.D.M.S., Cana-
dians, this would not have occurred. It is quite true,
as stated in the Bruce Report, that the A.D.M.S.,
Canadians could have easily administered all the
Canadian hospitals, as well as the Canadian Army
Medical Corps Training School.
'' REGISTRAR'S DEPARTMENT SHORN-
CLIPPE MILITARY HOSPITAL."
" The same answer applies here — that as the
D.M.S. directed the taking over of these Imperial
hospitals, consequently an increased staff had to be
taken on, but the cost of the same could be easily
chargeable to the Imperials and the Canadians. This
also would not have occurred if a Canadian general
hospital had been opened in this area for the
reception of Canadian patients."
98
POLITICS AND THE C.A.M.C.
''C.A.M.C. PERSONNEL EMPLOYED IN
V.A.D. HOSPITALS,''
" When it was directed by the D.M.S., Canadian
Contingents that Imperial and Voluntary Aid Detach-
ment hospitals had to be taken over for administra-
tion, it was found when the A.D.M.S., Canadians,
made his inspection of these various hospitals that
in order to handle Canadian or Imperial patients
some of the staff employed were not sufficient to give
the proper care and attention to patients that might
be entrusted to them ; also in the matter of discipline,
some of these hospitals zvere found to he very lax.
These matters were brought to the attention of the
D.M.S., London, and on his authority the A.D.M.S.,
Canadians, was allowed to send doctors in some
instances, and in others nurses and orderlies, so that
it would be ensured that patients in these hospitals
would receive the proper attention. This also
would have been avoided if a Canadian general
hospital had been opened up in this area for Canadian
patients.
" In regard to the work in these Voluntary Aid
Detachment hospitals not being carried out satisfac-
torily to the A.D.M.S., Canadians, I took the oppor-
tunity to point out to theD.M.S., London, personally,
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POLITICS AND THE C.A.M.C.
at different times, my views on the subject, and also
by letters to the D.M.S., Canadians, and the Eastern
command. A copy of the letter referred to in my
former communication, dated i6th June, 191 6, is
attached hereto, which clearly shows the views taken
by the A.D.M.S., Canadians, in regard to Voluntary
Aid Detachment hospitals, and the handling of
surgical cases as well as operations in general.
AMBULANCE SERVICE.
" The same remarks apply here. If a Canadian
general hospital had been opened in this area for the
reception of Canadian patients, the transferring of
patients to a very large extent by motor ambulances
would not have occurred, but as this has occurred
the proper charges for this service could be easily
made against the Canadians and Imperials.
*' Unsatisfactory Situation at Shorncliffe due to the
A.D.M.S., Canadians, being also A.D.M.S.,
Dover District {Imperial).
" / quite agree with the Report of the Bruce Board
in regard to this dual position, to which I have
referred before; but the dual position could not be
avoided when the A.D.M.S., Canadian Contingents,
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POLITICS AND THE C.A.M.C.
directed that the Shorncliffe Military Hospital, with
its subsidiaries, should be taken over by the
A.D.M.S., Canadians, for administration.
"If the expenses have increased, those belonging
to the Imperials should be charged to them.
" Faulty System of Handling Infectious Diseases.
" The D.M.S., Canadian Contingents, was quite
aware of the way in which infectious diseases were
being handled in this area under his administration,
and / quite concur with the Report of the Bruce
Board that it would he far better if all Canadian
patients were treated in Canadian institutions and
handled by Canadian staffs; but, unfortunately, with
the limited accommodations in Canadian hospitals
in this area the arrangements which have been
carried out in the past had to be made.
" I feel sure that if the criticisms of the Bruce
Board and their recommendations, as outlined in
their exhaustive and most complete Report, on the
Canadian Medical Service, are acted upon it will
help greatly to improve the Canadian Medical
Service as a zvhole.
(Signed) G. S. Rennie/'
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POLITICS AND THE C.A.M.C.
This interesting statement from a member of
General Jones's own staff corroborates those made
in my Report in criticism of the conditions found in
the Shorncliffe area.
The letter from Major J. F. Lash to the Deputy
Minister of Militia and Defence, which has been
previously referred to, was as follows : —
" I attach herewith copy of the general recommendations
contained in the Report on the Canadian Army Medical Ser-
vice, made by the Committee of which Colonel H. A. Bruce
was Chairman, each recommendation being followed by the
remarks on it contained in General Jones's reply.
" It will be seen that the first recommendation is not con-
curred in, and that the fourteenth recommendation is not fully
concurred in. The third recommendation is concurred in,
but difficulties and large expenditures are anticipated in carry-
ing it out. With the remaining eleven recommendations
Surgeon-General Jones is in concurrence, or sees no objection
to their being carried out."
The various documents which have been referred
to were submitted to, and considered by, the Acting
Sub-Militia Council, and after consideration of the
whole situation the members of the Council unani-
mously approved of my report and recommenda-
tions, and advised that the necessary re-organization
of the medical service should be proceeded with in
accordance with the recommendations.
102
POLITICS AND THE C.A.M.C.
The following resolution was then moved by
Brigadier-General F. S. Meighen, and seconded by
Major-General S. B. Steele: —
" Resolved that the Report of Colonel Bruce's Committee
and the recommendations therein made be approved, and that
the Council advises that the necessary re-organization of the
medical service be made to give effect to these recommenda-
tions forthwith."
It was then moved by Colonel (now Adjutant-
General) E. C. Ashton, and seconded by Major-
General S. B. Steele :— -
"That whereas the investigation into the affairs of the
Canadian Medical Service carried out by the Committee of
.which Colonel Bruce is Chairman has already seriously inter-
fered with the due administration of the Canadian Army
Medical Corps under the command of Surgeon-General G. C.
Jones; and whereas the Council has advised that the recom-
mendations contained in the report of the said committee be
put into effect under the administration of someone in com-
plete accord therewith; and whereas in order to make the
Canadian Medical Service in England and France effective
and efficient the service in Canada must closely co-operate;
and to this end it is essential that someone thoroughly
familiar with the conditions here go to Canada to co-ordinate
the work. Therefore, the Council recommends that Surgeon-
General Jones proceed to Canada with a view to co-ordinating
the services, and that Colonel Bruce be appointed Acting
Director of Medical Services, C.E.F."
A poll was taken on this question, with the result
that all the members voted in favor of the motion,
103
POLITICS AND THE C.A.M.C.
with the exception of Brigadier-General Leckie,
who refrained from voting for personal reasons.
/The various resolutions of the Acting Sub-Militia
Council were cabled to the Minister of Militia, and
at a subsequent meeting, held on October 13th,
1916, the Chairman of the Council read the follow-
ing cable, which he had received from Lieutenant-
General Sir Sam Hughes : —
" Kindly carry out recommendations of Sub-Militia Council
and let Surgeon-General Jones return to Canada to carry on
work proposed. Further let Colonel Bruce continue his present
mission and also supervise medical service meantime."
The Minutes of the Acting Sub-Militia Council
also contain the following letters from Lieutenant-
General Sir Sam Hughes : —
To:-
" The Chairman of the Council.
"Kindly give the necessary authority to Colonel Herbert
A. Bruce, Special Inspector-General, Medical Services, C.E.F.,
to proceed with the re-organization of the medical services as
recommended in his special report to me, copy of which is in
your possession, and in harmony with the Sub-Militia Council
and the Department of Militia and Defence."
To:—
The Secretary of the War Office.
" Sir,—
"After a searching investigation it has been found necessary
to re-organize our medical service, and I am instructing
104
POUTICS AND THE C.A.M.C.
Colonel H. A. Bruce, my Special Inspector of Medical
Services, to undertake and effect this re-organization under
the direction of my Overseas Sub-Militia Council.
" In connection with this re-organization Colonel Bruce will
find many matters which it will be necessary to take up with
your medical department, and it would be much appreciated
if you would arrange so that his needs may receive prompt
attention, and that he be granted from time to time the
necessary authority to enable him to promptly effect the
re-organization of our Canadian Overseas Medical Service,
which is so much needed."
The work of re-organization of the medical ser-
vice was proceeded with by me in accordance with
these instructions, and at my request Colonel
Murray McLaren was made Acting Director of
Medical Services as a temporary measure until a
suitable man could be found. At no time did I
occupy this post, nor had I any intention of so
doing, as may be seen from a communication sent
by me to Sir George Perley, Overseas Minister for
the military force of Canada. During my re-organi-
zation I had prepared a scheme for an advisory
medical board, upon which it was my hope to serve
in a professional capacity as soon as the work of
reorganization was completed.
At a meeting of the Council, on October i8th,
191 6, I submitted a report upon the progress of
re-organization, and urged the necessity of providing
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sufficient Canadian beds in England for the require-
ments of the Canadian Expeditionary Force. I then
indicated how this accommodation could be secured,
my proposals including the addition to the Ontario
Military Hospital at Orpington of a thousand beds,
which had been promised me by the Ontario Govern-
ment. It was pointed out that the adoption of my
recommendation to return to Canada all the perma-
nently unfit, as well as all those who were likely to
require six months' treatment before they would
again be fit for service, would release about four
thousand of the beds which were now occupied.
I further reported that I had made the following
requests of the War Office : —
( 1 ) " That Canadian sick and wounded, upon
arrival in England, should be directed to Canadian
hospitals if there were beds available, and if not,
should be sent to British hospitals in a circumscribed
area."
(2) " That they take back the administration of
the A.D.M.S., Dover, and the ShornclifYe Military
Hospital Group."
(3) "That a D.D.M.S., Canadians, Lines of
Communication, France, be appointed."
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POLITICS AND THE C.A.M.C.
(4) " That Canadian primary hospitals be
centraHzed in the Shorncliffe Area."
At a meeting of the Sub-Militia Council, held on
October 27th, 19 16, the subject of physically unfit
soldiers was brought up for discussion by the Over-
seas Deputy Minister of Militia and Defence. Sta-
tistics were submitted, showing that in twelve
battalions which had recently arrived from Canada
there was an average of more than sixteen per cent,
of unfit men, the great majority of whom ought
never to have been enlisted. The total number of
unfits in these units was 1,367. It included men
who were under age, men over age, men who were
immature, men with defective feet, defective legs,
and weakness of the heart. The following resolu-
tion was moved by Brigadier-General Meighen, and
seconded by Colonel Ashton : —
" That whereas the number of soldiers arriving in England
from Canada physically unfit for service at the Front is steadily
growing, and in the case of twelve battalions recently arrived
has reached the serious proportion of over sixteen per cent;
and whereas the medical examination of these men has shown
that the great majority of them have for a long time been
suffering from obvious physical disabilities and should never
have been enlisted ; and whereas such unfits, by reason of their
disabilities, form an undue proportion of the patients in
hospitals in England, thus placing a heavy strain on the
Medical Service; and whereas these unfits present a very
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serious question from the pensions point of view, owing to
the very great difficulty of establishing the facts as to whether
the disabilities were the result of or aggravated by military
service; and whereas these men, who are not suitable for
active military service are nevertheless capable of productive
work in Canada; and whereas practically all of such men
were taken from productive work in Canada and enlisted into
military service, for which they are useless, at enormous
expense to the Government, so that not only has the value
of their labor been lost to the country, but they have been
a heavy charge during their period of service without giving
any return.
" Be it therefore resolved that the Acting Overseas Sub-
Militia Council hereby recommends that men presenting them-
selves for enlistment be subjected to a much more stringent
medical examination, and that only those fit for active service
at the Front be accepted; and further recommends that all
soldiers, prior to embarkation for England, be given a further
rigid examination, and only those who are then found fit for
service at the Front be permitted to proceed to England."
At a meeting held on November 3rd, 19 16, at
which Sir George Perley, K.C.M.G., was present, I
submitted the following report : —
On October 27th there were 20,256 sick and
wounded in England, of which only 9,272 were in
Canadian hospitals. The total Canadian bed
capacity in England was 11,084, and the number of
extra beds required to provide for the Canadian sick
and wounded at this date was therefore 9,172.
Negotiations had been commenced for the taking
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over of the Canadian Red Cross hospitals by the
Canadian Medical Service.
I reported to the Council that an officer had been
sent to France to investigate the conditions in regard
to Numbers six and eight, Canadian General Hospi-
tals. Number six Canadian General Hospital, which
was staffed by the Laval unit, had, on October 28th,
19 1 6, the following personnel: —
Officers 37
Nursing Sisters 70
N.C.O.'s and men 199
306
This hospital unit was organized a year before this
investigation, and had been stationed in Paris since
July, 19 1 6, but had received no patients, for the
reason that no buildings had as yet been provided
Some of the officers, three nursing sisters, and all
of the non-cc«nmissioned officers and men, were
encamped at Gravelle, eight miles east of Paris,
awaiting the erection of a hospital. One cannot
well imagine a more unsatisfactory state of things,
and Colonel Beauchamp, the O.C., told our inspector
that both he and his staff were absolutely discour-
aged with their past experience and future prospects.
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POLITICS AND THE C.A.M.C.
It certainly seemed unfortunate that the personnel
of a 1,040 bed general hospital, together with the
necessary supplies and equipment, should have been
allowed to lie idle for a whole year, while we were
so urgently in need of their services elsewhere.
In order to clear up the situation, in so far as
Numbers six and eight Canadian General Hospitals
were concerned, I placed the facts before Sir Alfred
Keogh, Director-General of the British Medical Ser-
vice, asking him to make an investigation, and he
accordingly appointed a Court of Inquiry, consisting
of the following officers: —
President— Colonel G. H. Barefoot, C.M.G.,
D.D.M.S., Lines of Communication, France.
Members — Lieutenant-Colonel (now Lieutenant-
General) T. H. Goodwin, C.M.G., D.S.O., (now
Director-General British Medical Service), Major
R. B. Black, D.A.D.M.S., R.A.M.C.
After making an investigation, the Court of
Inquiry issued a report in which it was stated that
the officer in charge of the stores of the hospital (No.
6), reported that there was complete medical and
ordnance equipment for a hospital of 1,040 beds,
and that these stores appeared to be well cared for
and in good condition. The Commanding Officer
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brought the following facts to the notice of the
Court :—
(i) The daily expenditure amounted to £200
per day (practically $1,000).
(2) The discipline was beginning to suffer, owing
to the enforced idleness of the personnel.
(3) In regard to the establishment of buildings
for the hospital, the only step taken during the
previous five months appeared to be a preliminary
survey made by an architect sent by the Canadian
Red Cross Society.
Subsequently the French military authorities
placed at the disposal of the unit a building at
Troyes, sufficiently large to accommodate a thousand
patients. It was therefore decided that the unit
should move into this building, and carry on its
work there until the new buildings at Joinville,
which were being put up for it by the Canadian Red
Cross, were completed. Actually these buildings
were not occupied until June, 19 18.
During the first six months (July, 19 16, to Janu-
ary, 19 1 7), this hospital unit did absolutely no work,
owing to the fact that the head of the medical ser-
vice had not provided in advance a building for
them, and for the next eighteen months it occupied
a building in a remote district, where they got only
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slightly wounded cases, and were therefore not
carrying on their full functions, which means that
their services were largely unutilized. One might
reasonably ask for an explanation as to why this
hospital unit was hurriedly rushed to France on
July 6, 1916, and kept there without doing any duty
whatever for six months at a cost to the Canadian
Government of a thousand dollars per day, and for
a further period of eighteen months, during which
it performed not a third of the duty of which it was
capable ?
The attention of the Deputy Overseas Minister of
Militia having been called to the unsatisfactory situa-
tion in regard to the absence of a common standard
of medical fitness in France, England and Canada,
he submitted the following particulars for the con-
sideration of the Council : —
There was found to be no standard generally
accepted by the medical officers at the Front, the
base, and in England. As a result of this men who
had been sent out from England to France as physic-
ally fit for service were not infrequently returned
from the base as unfit. An investigation of the
situation at the Front showed that the A.D.M.S. of
a division had of necessity to permit the medical
officers of battalions to evacuate men on their own
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responsibility, and it appeared that these medical
officers to a great extent adopted their own standards
for evacuation. It was even reported that the free-
dom which they enjoyed in this respect was some-
times made use of to get rid of men who for some
reason were objectionable to the battalion, but other-
wise physically fit for service.
It was recommended that a conference should be
held between the Deputy Director of Medical Ser-
vices, Corps, and the Assistant Directors of Medical
Services of each training division, with the object of
agreeing upon a uniform medical examination and
a definite standard of fitness for service, which
should be accepted by the medical officers of the'
training division, those at the base and those at the
Front. It was also recommended that this standard
of fitness should be used in Canada.
At a meeting held on November 9th, 19 16, in view
of my report in regard to the advisability of the
return of Canadian casualties to Canada, a resolution
was passed by the Acting Overseas Sub-Militia Coun-
cil to the effect that casualties, the medical treatment
and supervision of which were not likely to reach a
state of finality in less than three months, should be
sent to Canada as soon as the patient was fit to
travel.
8 113
POLITICS AND THE C.A.M.C.
The work of re-organization was proceeding most
satisfactorily along the lines indicated, and a consid-
erable amount had already been done, when Lieuten-
ant-General Sir Sam Hughes, the Minister of Militia
and Defence for Canada, resigned his portfolio.
Closely associated with this event was the appoint-
ment of Sir George Perley as Overseas Minister for
the military forces of Canada, and one of his first
official acts was the cancelling of the arrangement
made in regard to the return to Canada of Surgeon-
General Jones.
Sir George Perley Intervenes.
At this time I had a great many interviews with
Sir George Perley in connection with medical mat-
ters, but more especially in regard to my report,
which he seemed determined to discredit. In one
of these interviews he said that he understood that
I had told someone that he had condemned this
report without having read it. I replied that this
was not quite correct, and that what I had said was
that either he had not read the report at all, or that
if he had done so he had not read it intelligently,
as he was evidently not familiar with its contents.
In order to give the reader some idea of the difficulty
which I had in continuing my work I will here
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insert the correspondence which passed between me
and Sir George Perley at this time.
On November 2nd, I received a telephone message
from Sir George Perley, asking me to cancel all the
arrangements which I had made with the War Office
in connection with my scheme of re-organization.
When he made this request I pointed out that one
of these arrangements which would effect a saving
to Canada of $160,000 a year, was about to be com-
pleted, namely, the taking over by the Imperial
authorities of the administration of the A.D.M.S.,
Dover (57 V.A.D. hospitals), and on November 5th
I wrote him as follows : —
" Dear Sir George :—
" On instructions from you I wrote to the War Office on
November 3rd, asking that the various requests which had
been made by me in conformity with the re-organization scheme
should be left in abeyance for the present. As some of these
matters were, in my opinion, of a very necessary and urgent
character, as they had been the subject of negotiations for
some weeks, and as we had had from the War Office a notifi-
cation that one of our requests would be put into effect in a
day or two, namely, the taking over of the A.D.M.S., Dover,
together with the Group of fifty-seven V.A.D. hospitals, I
think it is necessary for me to have my position clearly
defined.
" Some two weeks ago I was asked by General Carson to
re-organize the medical service according to the recommenda-
tions made in my report, which report had been adopted. He
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stated that I was to have general supervision of the medical
service. He then told Colonel McLaren that it was my wish
that he should take the position of Acting D.M.S. I under-
stood that General Jones was asked to proceed to Canada to
re-organize the medical service there, so as to make it co-or-
dinate more closely with the service in England and overseas.
In accordance with these instructions I have proceeded upon
a plan of re-organization, as outlined in my report.
" One of the first necessities in re-organization was to
increase our bed capacity in England to a sufficient number
of beds to give us accommodation for all our Canadian sick
and wounded. On the 27th of October we had 20,256 in
hospitals in England. Our total bed capacity in England is
11,084. The number of extra beds required to provide for our
sick and wounded in England is therefore 9,172.
" The plan proposed by me for the care of our venereal
cases, amounting at this date to 1,239, and which was sug-
gested six weeks ago, was placing these patients in a battalion
area, and the Westenhanger area had been arranged with the
Adjutant-General for this purpose. This would liberate for us
a special hospital at Etchinghill, which now takes care of
three hundred patients, and which, with slight alterations,
would provide excellent accommodation for eight hundred
active treatment cases ; that is to say, by this move we should
gain 1,700 beds. The Red Cross is fitting up St. Lawrence
College at Ramsgate, with a bed capacity of one thousand.
It then occurred to me that we might very well get additional
accommodation of one thousand beds at Orpington at very
much less cost than building another hospital of this character,
in consequence of the fact that practically all of the expensive
part of this hospital would not have to be duplicated, such
as operating rooms, admitting rooms, laboratories, kitchens,
etc. Further, the medical staff is quite sufficient to take care
of this additional number of patients. A slight increase in
nurses and orderlies would probably be required. This,
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therefore, would be the most economical way of securing this
additional accommodation.
" I then cabled to Mr. Hearst, asking him if his Govern-
ment would feel disposed to give this additional accom-
modation, pointing out that it could be done for a much less
sum than the original cost of the hospital.
" After looking over the Duchess of Connaught Hospital
at Taplow I had an interview with Major Astor, and asked
him if he, as the owner of the property, would object to this
hospital being extended by five hundred beds. He said he
was quite willing. I then saw Colonel Hodgetts, and asked
him if the Red Cross would be willing. I think it is likely
they will agree to this.
" Another recommendation was the return to Canada for
active treatment there, as soon as they were able to travel, of
patients either permanently unfit, or who would require many
months of active treatment. I have three or four officers
now working at one hospital examining and boarding men,
and they report to me that they will have three hundred
ambulatory cases ready to leave in a week's time. H this
work is continued amongst our other wounded I am satisfied
we shall find that from three to four thousand can be
invalided immediately to Canada. I have had a man looking
for a building at lyiverpool, with accommodation for about
350 patients, the money for it having been given us by Mr.
Harold Kennedy, of Quebec. This will provide suitable
accommodation for patients in transit. The additional accom-
modation necessary could be secured by renting two or three
hotels in some area now occupied by us.
"Another request to the War Office was that a D.M.S.,
Lines of Communication in France, should be appointed. This
officer would be in charge of the Canadian hospitals at the
base in France. It is also requested that he should have under
him an Assistant Director of Medical Services, who will have
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the control of the examination of Canadians arriving as
reinforcements from England, and the responsibility of classi-
fying casualties filtering back from the Front or to be
returned to England. He would further have control of a
C.A.M.C. Depot in France, where C.A.M.C. officers and other
ranks would be available for reinforcements in France. In
this way it is hoped that an easy interchange of officers and
men between England and France will be brought about.
" I should like now to briefly refer to my position in
regard to the question, which was introduced into the London
Press by Lady Drummond, namely, that I believe that the
first duty of the Canadian Army Medical Corps is to the
Canadian sick and wounded, and that we should have our
hospitals centralized in different areas. In the practical carry-
ing out of this scheme we must, of course, have regard to the
hospitals which we have already estabhshed. These hospitals,
as you know, are situated in the neighborhood of London, in
the Shorncliffe area, and in the neighborhood of Ramsgate,
and we shall shortly require further hospital accommodation
in the neighborhood of Brighton. This grouping of our
hospitals will enable us to have a number of consulting experts
in the various districts. We should, therefore, request the
War Office to issue instructions to the disembarking officers
at Dover and Southampton as follows: —
1. " Canadians shall be directed to Canadian hospitals,
provided beds are available.
2, " If no beds are available in Canadian hospitals, they
shall be directed to Imperial hospitals in certain specified
areas.
" Such an arrangement would be entirely satisfactory to
the Medical Service, and I believe would meet all the objections
that are now being raised.
" As, owing to military conditions, even though we provide
sufficient beds for our patients in England, they will never
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be entirely occupied by Canadians, a considerable number of
the patients — twenty-five to thirty per cent. — will always be
British. Under these conditions, a corresponding number
of our patients must go to Imperial hospitals. FaciHties should
of course be given us for inspecting Canadian patients in
Imperial hospitals.
" I may say further that certain necessary changes have
been made in the personnel with the one object of increasing
the efficiency of the medical service, and that I have asked
some prominent surgeons to come from Canada to assist us
here.
" I have thought it desirable to give you a brief outline of
the work which has been done and that I propose to do in the
process of re-organization. In conclusion I may say that I
should like to, receive definite instructions from you before
proceeding further as to my present status.
(Signed) "Herbert A. Bruce."
This letter will give some idea of the large amount
of work which had already been done in the short
time which had elapsed since the commencement of
re-organization, and of how many further schemes
were in process of realization.
The following letter was written to Sir George
Perley on November 7th : —
" Sir,-^
" I beg to call your attention to a number of important
changes urgently needed in the Canadian Medical Service,
which require prompt action, and which cannot be carried
through without your co-operation in conference with the War
Office.
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" May I ask for your assistance in securing the necessary
authority to go on with this work from the War Office?"
" Venereal Situation. The venereal situation in the whole
Canadian Expeditionary Force in England has reached a most
acute point. Men are lying about the floors of the Shorncliffe
Military Hospital suffering from venereal disease. The
brigade hospitals in Shorncliffe are taking care of their own
venereal cases, which are being isolated in huts in the lines of
the battalions. There is absolutely no place to send these
cases, and it is now many weeks since the Westenhanger
proposition was put before the Council, and yet nothing has
been accomplished. Certain alterations will be necessary in
the huts to make them suitable for treatment. The authority
to alter these huts will have to be obtained from the War
Office. I would, therefore, ask your assistance in obtaining
the necessary authority.
" Canadian Officers' Hospital. The early installation of a
Canadian Officers' Hospital is very necessary. Canadian
officers are distributed all over England at the present time,
and it is difficult to get them back promptly. Many cases have
come to my attention where officers have been kept in English
hospitals much longer than is necessary, probably chiefly
because there was no one in immediate authority over them
to have them medically boarded and returned to us for further
duty, or to be invalided as unfit for further service to Canada.
New Zealand has, within a short distance of London, an
officers' hospital, where their officers are taken as soon as
they are fit to travel. They have here their own Medical
Board.
" We had on October 27th, 505 officers sick and wounded
in England. We have been given, free of cost, a hospital of
150 beds at Yarrow, near Ramsgate, which was formerly used
as a children's hospital. It is beautifully situated, and we are
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staffing it, with the expectation of using it as a surgical
hospital for officers. * * * *
" Standard of Unfits. Early steps should be taken to co-
operate with Canada with reference to the arrival in England
of unfit men. I would urge that no time be lost in carrying
out this recommendation. * * *
" It is essential that a common standard of fitness between
England, Canada and France of men for the trenches should
be decided upon. This matter can be best decided by the
sending forward of a competent medical officer, who shall
be known as an Inspector of Drafts, and who will proceed to
the Canadian Army Medical Corps in France to investigate
the needs of the situation, re-organize the medical arrangements
at the Canadian base at Le Havre, and finally be responsible
for the fitness of the drafts of men which are sent from
England to France. This officer should have the privilege of
free passage between France and England. In this way the
matter of the large percentage of troops from England, con-
stantly being held up at the base in France on account of the
difference in standard between England and France, will be
obviated. * * *
" Btchinghill. * * As this is a matter of great urgency, I
would ask that it be taken up immediately with the War
Office, and the necessary authority obtained, so that our own
Canadian Engineers can proceed with the work.
"Reinforcements Canadian Army Medical Corps.
" Some little time ago we asked the War Office for the recall
of the three hospital units now located in Salonika, but our
request was not granted. I have recently learned from our
officers who are on leave from Salonika that at the present
time there is ample hospital accommodation there, and under
these circumstances it would seem likely that if the request
was again put to the War Office these units would be returned
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to us. We have the further reason that these units have now
served a year in the trying climate of Greece, and on this
account alone should be relieved.
(Signed) " Herbijrt A. Bruce;."
On November 8th Sir George Perley replied as
follows : —
" Dear Colonel Bruce, —
" I am in receipt of your letter of yesterday, and in the
first place wish to state definitely that I am prepared at once
and at any time to take up and decide any questions which
are imperative and require prompt action. At the same time I
would call your attention to the fact that a recognized channel
exists through which all matters in the medical department
should be taken up. Under the present arrangements a report
should be made by you through the Acting Adjutant-General
to the Acting Sub-Militia Council, so that proper discussion
and consideration can take place, but of course you will always
be afforded an opportunity of appearing there and giving all
explanations. Not only that, but I shall be glad at other times
to see Colonel Reid and yourself, and talk over any of the
more important and urgent questions, but when it is necessary
for me to do this you will readily see that I should have the
files before me, with all the requisite reports and recommen-
dations, to enable me to form a proper judgment.
"You have enumerated some matters, which you say
require prompt action. You have been attending to the affairs
of the Medical Service for some time now, and it seems to
me that some of these questions might well have been settled
before this, but I am ready to take them up for immediate
consideration. * * * *
" The venereal situation is certainly urgent, and I cannot
quite understand why your action regarding it has been so
long delayed. The question of a common standard for unfits
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necessitates action in Canada, and I am sending a communi-
cation about it to the Government at Ottawa.
" I have taken the time to write you thus fully in answer
to your letter, but I cannot always manage to do this. I am
sure you will agree with me that any questions which need
to be discussed had better be brought before me in the usual
departmental way. It saves a great deal of time to simply
talk these matters over with all the papers before me, when
decisions can be arrived at without correspondence.
(Signed) "George; H. Parley.''
It will be seen from the last paragraph of the
above communication that Sir George Perley, while
admitting the urgency of the case, proclaimed his
devotion to red tape, which would ensure needless
delay.
On November 20th, I replied to this letter as
follows : —
"Sir,—
"Referring to your communication of the 8th inst. in reply
to my letter of the 7th, in which I placed before you matters of
great urgency in regard to the Medical Service, which can only
be accomplished by securing the co-operation of our superior
authorities with the War Office.
" I did not reply to your letter before, in consequence of
your asking me not to write you letters, but to take such
matters up in a departmental way. In the early part of your
letter you point out the channel through which matters should
be taken up. I may at once state that I was previously well
acquainted with this procedure, and my excuse for departing
from the usual rule in this particular instance was that you
had recently been appointed Overseas Minister, and I desired
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to make you conversant with certain urgent matters which had
been under consideration for some time, and which I had
repeatedly and vainly brought to the attention, both in writing
and verbally, of the Sub-Militia Council and the responsible
heads. I therefore wrote to you, knowing that the improve-
ments desired could be accomplished immediately with your
support, and could not be carried through without it.
" May I further point out that all I can do in the way of
re-organizing the medical service is to make known the
requirements to those in authority over me, and to suggest
the most effective way of carrying them out, leaving to those
authorities, whose province it is, the duty of taking the neces-
sary steps to put these recommendations into effect. The
whole matter of providing hospital accommodation is in the
hands of the Quartermaster-General.
" I note that you agree that the venereal situation is urgent,
and say that you ' cannot quite understand why my action in
regard to it has been so long delayed.' May I at once state
that action on my part in this matter was not delayed, but
that on the contrary I placed it before the Sub-Militia Council
in Reports submitted on four separate occasions, i.e., Septem-
ber 8th, October i8th, November 3rd and November 15th. In
these reports I pointed out the serious situation which had
arisen in consequence of the unsatisfactory — and in my opinion
improper — method which had obtained in dealing with
venereal patients.
" Before submitting these reports to the Sub-Militia Council
I had, on August 26th, written a letter on the subject to the
Quartermaster-General, in which a request was made that a
battalion area be set aside for this purpose. A copy of this
letter is enclosed herewith. This matter was dealt with fully
in my report, which was submitted to the sub-Militia Council
for their consideration on October 6th.
" At the present moment the situation is most serious, and
is daily becoming more so. Every arrival of troops from
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Canada means an addition to the number of venereal cases,
and as we have not sufficient accommodation for the cases
already here, it is obvious that the difficulty of the situation
is continually increasing.
" There is no arrangement for venereal cases in any Cana-
dian area in England at the present time. To-day, for instance,
there are ninety-seven men being treated in the battalion lines,
a most serious and improper state of affairs. The Acting
D.M.S. is to-day asking the War Office, through the Adjutant-
General, if we may, as a temporary expedient, have accommo-
dation for four hundred patients to enable us to get the
venereals out of our battalion lines.
" In regard to the administration of the A.D.M.S., Dover,
you state that the ' facts regarding this matter have never been
placed before you.' May I point out that this matter is fully
dealt with in my Report, a copy of which is in your possession.
" In conclusion I may add that I shall, of course, continue
to make it a rule to take the various matters up with you in
the usual departmental way by bringing the files for your
information and approval.
(Signed) "Herbert A. Bruce."
I should add that three days previously, on
November 17th to be exact, I had written the
following letter to Sir George : —
" Dear Sir George;^-
"You will recollect that about a fortnight ago I spoke to
Sir Thomas White, and subsequently to you, in regard to the
suggestion that at the time I made my report I might have
a desire to become D.M.S. , when I stated that I had no
thought or wish at that time, nor have I any desire at the
present time, to secure this position ; in fact, as I stated to
you, administrative work of this character is distasteful to
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me, and I should very much prefer being engaged in my
regular surgical work.
(Signed) *' Herbe^rt A. Bruce."
On November 23rd Sir George Perley sent the
following reply to this letter: —
" Dear Coi^gnee Bruce,
" I beg to acknowledge your letter of the 17th inst. in
regard to the suggestion that you might have had a desire
to become D.M.S., and I note that you prefer regular
surgical work rather than administration.
(Signed) "George H. Perley/'
On November i6th, 19 16, Sir George Perley gave
instructions to the Acting Adjutant-General for
Canada in the following terms: —
" Sir —
" Will you please arrange at once for a Board of Inquiry,
to which shall be referred: —
1. " Report on the Canadian Army Medical Service by
Colonel Herbert A. Bruce, dated 20th September, 191 6.
2. " Interim Report of Surgeon-General G. C. Jones, in
reply to the Report on the Canadian Army Medical
Service by Colonel Herbert A. Bruce.
" The Board shall report as quickly as possible to me on
the following points : —
" (a) The criticisms made by Colonel Bruce, as to whether
they are justified, in whole or in part.
" (b) The recommendations made by Colonel Bruce, as to
whether the Board endorses and concurs in them; if
not, in what respect does the Board differ from
Colonel Bruce and its reasons therefor.
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" The Board will be constituted as follows : —
'' Pr^^trf^w/.— Surgeon-General Sir William Babtie, K.C.M.G.,
C.B., V.C.
"Mm&^rj.— Colonel E. C Ashton, G.O.C, C.T.D., Shorn-
cliffe.
Colonel J. T. Fotheringham, C.M.G., A.D.M.S.,
2nd Canadian Division, B.E.F.
Colonel A. E. Ross, C.M.G., A.D.M.S., ist
Canadian Division, B.E.F.
Lieutenant-Colonel J. M. Elder, No. 3 Canadian
Hospital, Boulogne.
" For your information, the above officers have all been
notified informally, but you will, of course, officially notify
them as required by the Regulations.
" I would point out that I wish the Board to assemble
immediately, and to make its report with the utmost possible
despatch.
" The Board will, of course, hear such evidence as it may
think necessary to enable it to make its findings, but in any
case I consider it essential that the evidence of both General
Jones and Colonel Bruce should be taken. You will please
have the President of the Board notified to that effect.
(Signed) "George H. Peri^ey.''
This meant that my confidential Report was to
be investigated and reviewed, and on November
1 6th, 19 1 6, I sent the following cablegram to the
Prime Minister at Ottawa: —
" To-day's orders announce new Minister has appointed
Board of Inquiry on my report and on Jones's reply. Would
point out that report and reply were considered by Acting
Sub-Militia Council, consisting of five generals, with General
Steele senior, and five colonels, approved by them, and a
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recommendation made that the Medical Service be re-organized
along the lines of report. I was subsequently informed by-
General Carson that he had received authority from Canada
to have me proceed with re-organization, and I have been
proceeding by authority with this work for about four weeks.
Board ordered is headed by Imperial general. Consider his
selection unfair to Canada in view of one of the recommenda-
tions, namely, that Canadian patients should, as far as
possible, be treated in Canadian hospitals. Three of the four
other members are on duty in France, where they have been
from beginning, and are unfamiliar with conditions in Eng-
land, with which my report only deals. It would appear that
Minister intends to whitewash effect of my report instead of
facing issue. If this Board as constituted stands, I ask to be
relieved of my position here so that I may at once return to
Canada."
I received no acknowledgment or other reply to
this cablegram.
On November 17th I sent the following telegram
to Sir George Perley: —
" Must protest against Fotheringham being member of
Board. He has expressed himself openly and bitterly, and
placed his attitude definitely on record, and is therefore
already prejudiced. Also consider larger proportion of Com-
mittee should be composed of men familiar with conditions
in England, as this is the only part of the service reported
upon."
On November 21st Sir George Perley wrote as
follows : —
" Dear Colonel Bruce, —
" On my return from France I find your letter of the i8th
inst. awaiting me, enclosing copy of a cablegram which you
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sent to the Prime Minister. In view of the controversy
which had arisen both here and in Canada regarding some
matters in your Report, I feel that it is absolutely necessary
in the public interest that they should be settled by a properly-
constituted professional Board. There is no question which
comes closer to every Canadian than the proper treatment of
our wounded, and all we want to do is to make sure that
the best is done for them in that respect. You have no
grounds for suggesting that I wish to * whitewash the effect
of your report.* I have chosen a most capable Board of
professional men simply to advise me regarding these matters,
of which I have little personal knowledge. When I was in
France I got your telegram protesting against the appointment
of Colonel Fotheringham as a member of the Board, because
you considered him prejudiced.
" I do not know what your ground is for suggesting this,
but the standing and professional reputation of Colonel
Fotheringham is such that I am sure he will consider all the
questions at issue with an open mind, and with a sole thought
to the best interests of the medical service. We all have the
welfare of our wounded very much at heart, and I shall
expect both General Jones and yourself to appear before this
Board and give them the full benefit of your knowledge and
professional experience in this matter.
(Signed) "George H. PerlEy.''
It will be seen that Sir George Perley took the
ground that the public interest would be better
served by investigating the investigator than by open
steps to better the Service, which my Report had
shown to be so much in need of reform.
On November 23rd I wrote the following letter
to Sir George Perley: —
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POLITICS AND THE C.A.M.C.
" Sir —
" I have the honor to advise you that I have just received
a copy of your letter to the Acting Adjutant-General, dated
i6th November, directing that a Board of Inquiry be held
for the purpose of considering my Report.
" I desire to point out that the recommendations made as
the result of my inquiries were concurred in by the Sub-
Militia Council, who so advised the Government at Ottawa,
and asked for authority to have the recommendations carried
out. The Minister of Militia gave instructions that they were
immediately to be put into effect, and I was ordered by the
Sub-Militia Council to do so. I have been acting on these
instructions, and now find myself in the embarrassing position
that, as I read your letter of instructions, the Board of Inquiry
is to determine whether the recommendations already approved
of at Ottawa, and in part carried out, are proper.
" It must lead to confusion to put into effect a poHcy which
may be the subject of immediate change, and then uncertainty
created by this new inquiry must be hurtful to the objects
which we all have in view. I can give no more striking
illustration of this than the disturbance caused by the sus-
pension of the arrangements we had come to with the War
Office to relieve us of the administration of the A.D.M.S.,
Dover area, and the fifty-seven Voluntary Aid hospitals con-
nected therewith.
" It is the recommendations in the report that are most
essential for consideration and adoption, and these have been,
in all material particulars, concurred in by Surgeon-General
Jones.
(Signed) "Herbert A. Bruce;."
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POLITICS AND THE C.A.M.C.
MY Bf PORTS TO ENLARGE BABTIE
BOARD'S ENQUIRY.
Here it should be pointed out that all my efforts
at this time were directed toward securing permis-
sion to bring immediately before the Babtie Board
evidence that had accumulated during my term
of office as Inspector-'General subsequent to the
presentation of my Report in September, 19 16, and
which gave strong confirmation of my findings.
There were also matters that demanded immediate
action, and I was anxious that the powers of the
Babtie Board be sufficiently enlarged to enable them
to consider and pass upon these questions. Sir
George Perley's attitude, as will be seen from the
correspondence, was ever one of obstruction, at first
concealed by evasion, but at last when driven to a
decision he rules against any admission of new
revelations which might still further discredit the
Service. On November 24th I wrote the following
letter to Sir George Perley: —
" Sir —
" Now that I have had an opportunity of carefully con-
sidering the letter containing your instructions to the Board
of Inquiry, I see that my Report is to be the sole subject
matter for consideration. Since such is the case I feel it
my duty to put in writing the protest that I made to the
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Prime Minister, and verbally to yourself, as to the constitution
of the Board.
" The high standing of the President, Sir William Babtie,
and his distinguished services in the various appointments
he has held in India and the Mediterranean, entitle him to the
respect of the members of the profession. Whilst no one will
dispute this, I should like to point out that this inquiry has
to do with a Canadian question, affecting hospitals which
are entirely staffed by Canadians and under the control of
the Canadian Medical Service ; and, further, that its recom-
mendations must deal with the larger question of the care
of the Canadian sick and wounded, not only in England, but
also with their return to Canada for a continuation of active
treatment there.
" The training and experience of Sir William Babtie has
been wholly that of an officer of the regular Imperial Army,
which will make it extremely difficult for him to take the
point of view that should be taken when considering a matter
affecting a civilian force such as Canada has sent. Admittedly,
under these circumstances, there must come up in contrast
the question of administration and treatment by British
medical officers trained in the regular Army, as opposed to
the administration of Canadian medical officers familiar with
advanced hospital methods.
" It seems singular that when it was thought necessary to
appoint a Board of Inquiry to consider the matter dealt with
in my Report, men famihar with hospital conditions in Eng-
land were not selected. Instead of this, three officers have
been appointed, whose work has from the beginning been
carried out entirely in France. Colonel Ross, A.D.M.S., First
Division, and Colonel Fotheringham, A.D.M.S., Second
Division, have been engaged at the Front from the date on
which their respective divisions went overseas until the
present time, and have rendered distinguished services of the
very greatest value, both to our own and to the Imperial
forces. It is scarcely necessary to say that these services are
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a matter of pride to every Canadian. At the same time it
should be remembered that the work of an administrator at
the Front is of entirely different character from hospital work
in England, and the knowledge required in doing such work
is not helpful in solving the problems with which we have
to deal in England. In addition I may say that information
which I have of opinions expressed by these officers upon
the subject of my Report shows that they have already
formed a judgment upon it, and makes it quite clear that
they cannot be expected to approach this question with an
unbiased mind.
" Your letter of instructions directs the Board to hear
evidence. May I, without appearing to wish to interfere
with your discretion as to the conduct of the inquiry, suggest
that the Board be directed personally to visit the hospitals
to which our Canadian soldiers have been sent, and especially
to enquire into the facilities provided for treatment in the
various Voluntary Aid hospitals?
" In my opinion the inquiry ought not to be limited to the
consideration of facts in my Report, but its scope should be
extended to cover the conditions which a continuance of my
investigation subsequent to the publication of the Report has
brought to light. I would, therefore, suggest that supple-
mentary instructions be given to the Board to enquire into
and report upon the chaotic conditions found at No. 6 Cana-
dian General Hospital, Paris, and the unsatisfactory state of
affairs at No. 8, Canadian General Hospital, Paris; and also
to report upon the serious situation discovered at the Duchess
of Connaught Hospital, Taplow, and to place the responsibility
for the maladministration upon the guilty parties.
" I would suggest that you send a copy of this letter to the
secretary of the Board for its consideration.
(Signed) "Herbert A. Bruce/'
I subsequently received the following letter from
Sir George Perley, dated November 25th: —
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POLITICS AND THE C.A.M.C.
" Dear Colonel Bruce, —
" I beg to acknowledge receipt of your letters of the 23rd
and 24th instant. You asked me to send a copy of the last
one to the secretary of the Board of officers for their con-
sideration. As I placed this matter in their hands, I would
suggest that it would be better to put your views before them
yourself, as you will, no doubt, have an opportunity to do so.
*' In your letter of the 23rd instant, you refer to the sus-
pension of arrangements made with the War Office in regard
to the administration of the Dover district. It is true that
on the 2nd instant I asked you to let this question stand in
abeyance for a few days, as I wished to have an opportunity
of talking it over further with you. On the 7th instant you
wrote me that you had received a notification from the War
Office that they would take over the administration on the
6th instant, and that you thought it unfortunate that this
should be held up for any great length of time. On the 9th
instant I telephoned you to carry out the proposal, and
arrange for the War Office to take over that district. It does
not seem to me that the suspension of these arrangements for
those few days could have caused any serious disturbance.
(Signed) "George H. Perley."
As a matter of fact the administration of the
Dover district was not taken over until thirteen
months later.
In reply to this letter I wrote, on November 30th,
the two following letters to Sir George Perley : —
" Sir —
" In reply to your letter of the 25th inst., regarding the
suspension by you of arrangements made with the War Office
for taking over the administration of the A.D.M.S., Dover, I
may say that this concession was obtained by me from the
War Office after several weeks' negotiations. They wrote,
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stating that on the 6th November they would take over this
administration, and on this date an Imperial officer went
to Shorncliffe where he remained until recalled in conse-
quence of the arrangements being cancelled.
" By your direction, I subsequently asked the Adjutant-
General to request the War Office to take over this adminis-
tration, but they have not yet done so.
" It is scarcely necessary for me to point out that the
delay in this regard has already cost the Canadian Government
rather more than $7,000.00.
(Signed) "H. A. Bruce."
" Sir,—
" Your letter, dated the 25th of November, was delivered
to me by hand late in the afternoon of November 29th.
** In answer to my request that you should send a copy
of my letter of November 24th to the secretary of the Board
of Inquiry for its consideration, you suggest that it would
be better to put my views before this Board myself. As I
asked that the scope of the inquiry be enlarged, so as to
include an investigation into the conditions found at Nos. 6
and 8, Canadian General Hospitals, Paris, and the Duchess
of Connaught Hospital, Taplow, may I point out, what must
be apparent, that this Board has no power to enlarge the scope
of its inquiry, which is strictly limited to the terms of refer-
ence.
*' I take it that the chief function, if not the only excuse,
for the establishment of such a Board of Inquiry, is to deter-
mine the exact situation which obtains in the Canadian
Medical Service. Under these circumstances I do not see
how you can refuse to enlarge the scope of the inquiry; in
view of the serious situation at these hospitals, which has
already been brought to your notice.
(Signed) "Herbert A. Bruce.''
I received the following reply to this letter, dated
December ist: —
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POLITICS AND THE C.A.M.C.
" Dear Colonel Bruce, —
" In reply to your letter of the 30th ult., I may say that
it was not my intention to have the Board of officers go into
all the details of the Medical Service in this particular inquiry,
but if fresh information is available which casts further light
on the matters referred to in your Report, and the questions
at issue before the Board, it seems to me that such facts
might be helpful in enabling them to make their report. I
am, therefore, sending them copies of your correspondence
for such action as they may think advisable.
(Signed) "George H. Perley/'
On December 4th I replied to this letter as fol-
lows : —
" Sir —
" I now have your letter of the ist inst. in reply to mine
of November 30th, in which you say that it was not your
intention to have the Board of officers go into all the details
of the Medical Service in this particular inquiry, but that
if fresh information is available, you think that such facts
might be helpful in enabling them to make their report.
" I desire to call your attention to the wording of your
order of the i6th November, 1916, appointing the Board of
Inquiry, and specifying the special matters referred to it,
which are as follows:—
1. ' Report on Canadian Army Medical Service by Colonel
Herbert A. Bruce, dated 20th September, 1916.
2. * Interim Report of Surgeon-General G. C. Jones, in
reply to the Report on the Canadian Army Medical
Service by Colonel Herbert A. Bruce.
* The Board shall report as quickly as possible to me on the
following points: —
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POLITICS AND THE C.A.M.C.
' (a) The criticisms made by Colonel Bruce ; as to whether
they are justified, in whole or in part.
' (b) The recommendations made by Colonel Bruce; as to
whether the Board endorses and concurs in them;
if not, in what does the Board differ from Colonel
Bruce, and the reasons therefor.'
" I take it that the Board will be limited by the terms of
that order, and would be justified in rejecting any matters
which are not specifically referred to in my Report or the
Interim Report of Surgeon- General Jones, in reply to it.
" The matters which have been the subject of discussion
between us, and are referred to in our correspondence, as
contained in my letters to you of the 23rd and 24th November,
and your replies of the 25th November and 1st December,
are not specifically dealt with in my Report or the Reply of
Surgeon-General G. C. Jones, and, therefore, without definite
instructions from you, as Minister of the Overseas Military
Forces of Canada, the Board of Inquiry would have no
authority to deal with these matters.
" The matters which I refer to, and which are dealt with
in the letters mentioned in the preceding paragraph, viz.:
the condition of affairs which I found in the Canadian General
Hospitals, Nos. 6 and 8, Paris, and the Duchess of Connaught
Hospital, Taplow. These matters are of such a serious nature,
and involve questions of public importance, not only from the
standpoint of maladministration, but also by reason of the
waste of public funds, that I think it desirable, in the public
interest, that the present Board should report on the result
of my investigation into the above matters.
" I do not wish to go before the Board as you suggest,
and be met with the answer that the subject of my further
investigations is 'not within the scope of the inquiry,' or
* that the evidence which I propose to offer in regard to these
other matters throws no light on the matters referred to in
my Report of September 20th.' Nor do I wish to have any
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POLITICS AND THE C.A.M.C.
misunderstanding in regard to the position which I take in
reference to the same.
" I therefore wish to place myself on record by a definite
and final request to you to issue a further order enlarging
the scope of the inquiry of the Board appointed by your
order, dated the i6th of November, 1916, so as to include an
inquiry into the conditions which I have found to exist in
the Canadian Military Hospitals, No. 6 and No. 8, Paris, and
the Duchess of Connaught Hospital, Taplow.
"May I ask for your immediate decision on this matter?
(Signed) "Herbert A. Bruce.''
The following letter, dated December 5th, 19 16,
is from Major Thompson, Secretary to the Board
of Inquiry : —
" Dear Colonel Bruce, —
" General Babtie directs me to enclose you copy of a letter
I received from Sir George Perley, dated the ist of December,
enclosed with which are copies of correspondence Sir George
had with you.
" General Babtie directs me to say that the Board would
like to hear any statement you might like to make with refer-
ence to this on Wednesday, the 6th, at 10.30 a.m.
(Signed) "J. Thompson.''
To this letter I replied as follows on December
5th:-
" Dear Sir,—
" The matters which have been the subject of discussion
and correspondence between Sir George Perley and myself
related to facts which came to light after the making of my
Report, and are therefore not strictly within the scope of
your inquiry, and I have no desire to give evidence on matters
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POLITICS AND THE C.A.M.C.
that might be regarded as irrelevant or not pertinent to the
same,
"If you would allow me to make a suggestion, I would
ask your Board to join me in the request I have already made
to Sir George Perley, to enlarge the scope of the inquiry so
as to include the evidence which I desire to give, and deal
with the same as if it formed part of my Report of September
20th. If this is done I shall be glad to supplement the evi-
dence already given, but unless this is done it appears to
me that giving evidence on matters beyond the scope of the
inquiry would accomplish no useful purpose.
"I might also add that I Have partially completed an
inspection of Canadians in Imperial hospitals, and while I
realize that your inquiry does not embrace this phase of the
situation, I mention it in case you thought it well to suggest
to Sir George Perley to widen the scope of the inquiry so
as to include this branch of my investigations also.
(Signed) "Herbert A. Bruce.''
The following letter, dated December 7th, is a
reply from Sir George Perley to my letter of
December 4th: —
" Dear C01.ONEL Bruce, —
" I duly received your letter of the 4th inst. As I ex-
plained to you in my letter of the 21st ultimo, I found when
I assumed the duties of Minister of Overseas Military Forces
of Canada that I would have to deal with the controversy
which had arisen both here and in Canada regarding some
matters in your Report and in the Reply made to it by
Surgeon-General Jones. In order to arrive at a correct con-
clusion I felt it absolutely essential in the public interest to
have the benefit of the considered opinion of professional men
on both your Report and the Reply to it. The present Board
was constituted for this purpose, and I did not expect it to
go into all the details of the Medical Service in this particular
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inquiry. Such a course would require the Board to continue
its sittings for an indefinite period, which would keep its
members too long from their own important duties, and
cause delay in bringing in their Report. I am, however,
anxious that they should have an opportunity of considering
any information casting light on the criticisms or recom-
mendations which appear in your Report, and as I wrote you
on the 1st inst, I sent them at that time copies of your
correspondence, and I suggested that any facts regarding the
conditions which a continuance of your investigation sub-
sequent to the publication of your Report had brought to
light might be considered by the Board. I have a letter
from the secretary of the Board telling me that you discussed
this subject before them yesterday, and that they asked you
to furnish them with general statements of the points which
you wished to bring forward, and that they were very anxious
to hear anything that you might have to say that would have
any bearing on the terms of reference. I think you might
very well avail yourself of the opportunity thus given by
placing before the Board such further facts as you may need.
" You ask me to enlarge the scope of the inquiry to include
the conditions at the two military hospitals in Paris, and at
the Duchess of Connaught Hospital, Taplow. The situation
at the latter hospital has already been fully investigated by a
Board of officers of which you were a member, and I under-
stand that the recommendations of that Board have been
carried out, so that there is nothing further to be done about
it so far as the military authorities are concerned, unless
you have some fresh information of which I am not cognizant.
" You have already had someone in Paris looking into the
situation at the Canadian hospitals there, and I do not feel
that I would be justified in retaining the present Board to
make a full report about that. These men are very busy
with their own various important duties, from which they
cannot be spared for a very long time. If you thing it neces-
sary, I shall be prepared to consider a recommendation
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from the Medical Department that we should send over a
couple of medical officers of good standing to look into the
position there and make a full report.
" I could not, however, very well enlarge the scope of the
present inquiry without asking the Board to visit other
hospitals than those you mention, and to go into the various
details of the Medical Services. It does not seem desirable
that these particular officers, holding such important positions,
should do that at this time, and therefore I feel that it is
not practicable to enlarge the scope of the inquiry as you
suggest. I am anxious, however, that they should hear every-
thing that would help them in their consideration of your
Report, and the Reply of Surgeon-General Jones, and I think
you should place before them all the information in your
possession which will enable them to come to a correct con-
clusion and make their report as soon as possible,
(Signed) "George Perlky."
In consequence of Sir George Perley's suggestion
of a reference to the Chairman of the Board, on
December 7th I wrote the following letter to Sir
William Babtie: —
"Dear Sir —
" I have considered your suggestion, vis. : that I should
submit a statement to your Board outlining the evidence that
I am in a position to give relating to the matters which have
been investigated by me subsequent to the making of my
Report of September 20th. In the first place, I do not wish
to be understood as concurring in the appointment of the
Board of Inquiry into my investigations, nor am I receding
in any way from the position taken in my letters to Sir
George Perley, or in the verbal protests made to him in
connection with the same.
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POLITICS AND THE C.A.M.C.
"I do not wish, however, to be understood as in any way-
hampering your Board in their inquiries, as I think it is in
the public interest that these matters be fully investigated
and reported upon.
" My position has been fully explained to Sir George
Pcrley, and I think justifies the position which I now take,
as appears from our correspondence, which has, I understand,
been placed before your Board.
" The condition of affairs which I find exists in the Paris
Hospitals 6 and 8, I have not formally reported upon, but
I am of the opinion that these matters should be investigated
fully, but inasmuch as my Report does not deal with them
specifically, they could only be enquired into by your Board
as corroborating my Report on the heading of ' Economy
of Managenrent.'
" The same observations apply to the conditions which I
find to exist at Taplow, but these conditions have been the
subject of special inquiry, and the evidence taken is, no
doubt, available. The evidence which I am now prepared to
give does not relate specifically to any of the special matters
referred to in my Report, but only as corroborating the find-
ings in general, and strengthening, if possible, the opinions
that I have formed.
"As far as the investigation in regard to Canadians in
Imperial hospitals is concerned, the result of my further
inquiry only confirms the opinion which I formed at the time
of making my Report, and if any doubt exists in the mind
of the Board as to the desirability of continuing the present
system, they are welcome to the result of my further
investigation. At the same time, I adhere to the views already
expressed as to the necessity of widening the scope of the
inquiry if your investigation is to be conducted along proper
lines, and you are desirous of getting the whole truth.
" You are now enquiring into my Report of September
20th, and, therefore, limited by the four corners of that
Report. Matters subsequent thereto might be considered
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POLITICS AND THE C.A.M.C.
irrelevant, as I have not reported on the same. If what I
suggest be done, the whole matter will be thrown open, and
all the evidence that I have subsequently collected will be
relevant and available for your consideration, to enable you
to report upon the whole situation.
" I do not want to be understood as wishing to hold back
anything; in fact I am desirous of giving the full result of
my investigations to a Board properly constituted, with full
powers to consider and deal with the same, but I do not
want it said hereafter that the evidence which I wish to
submit had no bearing on the special matters referred to
your Board.
(Signed) "Herbert a. Bruce."
On December 8th I wrote the following letter to
Sir George Perley, in which I recapitulated my
reasons for protesting against the constitution
of the Board and urged an enlargement of its
powers : —
"Dear Sir George,—
"I duly received your letter of the 7th inst. in reply to
mine of the 4th inst., and in view of the very full and frank
statement made, I desire in reply to set forth my position with
the same frankness.
"As you are aware, I was asked to make a Confidential
Report to the Minister of Militia in my capacity as Inspector-
General of the Canadian Medical Service, and in accordance
with that request I prepared and handed in a Confidential
Report to the Minister, of which copies were sent by his
instructions to Surgeon-General Jones, to the Deputy
Minister of Militia, and to the Premier.
"About the middle of the month of November I was
handed a copy of a letter, said to have been signed by you,
and addressed to the Acting Adjutant-General, asking him
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to arrange for a Board of Inquiry to consider the terms of
my Confidential Report and the Reply of General Jones, and
asking that Board to report to you as quickly as possible
on certain points. Your letter also states how that Board
will be constituted.
" In the first place I am not aware of any provision which
authorizes you to appoint a Board of Inquiry to report on
a Confidential Report, and when I learned what was proposed
I immediately entered a verbal protest against this being done.
" I further protested against the constitution of the Board.
Three of the members of the Board had openly expressed
themselves as antagonistic to the whole scheme of re-organ-
ization as outlined in the Report, and this before they had
ever read my Report. So that even if a Board of Inquiry
is justified, under these circumstances it is unquestionably
prejudiced before entering upon its duties.
" I further wish to point out that whereas I can take no
objection to a Court of Inquiry being assembled by you to
enable you to arrive at a correct conclusion on any subject
upon which it may be expedient that you should be informed,
this Board is authorized to report to you as to whether my
criticisms and recommendations * are justified in whole or
in part,' and as the Report may affect my character and
reputation as Inspector-General, I should have had a full
opportunity of being present throughout the entire inquiry.
This, I desire to point out, I have not had.
"As I said before, the majority of the Board were
prejudiced against my Confidential Report from the outset,
and in my opinion could not approach the subject with an
open mind, and as the object of the Board, as stated in your
letter to the Acting Adjutant- General, was to report to you,
as Minister of the Overseas Military Forces of Canada, it
occurred to me that if the Report is to be of any value, those
who are to make the report to you should approach the
subject with an unbiassed mind.
" Further, I suggested to you that this Board of Inquiry,
or Court of Inquiry, if the object of appointing the same
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POLITICS AND THE C.A.M.C.
was to assist you in arriving at a correct conclusion in regard
to the medical situation in England and France, should not
limit itself to criticizing certain items of my Report, but
that the whole subject should be thrown open, and that you
should have the benefit of their report and advice upon the
medical situation generally.
" I trust I have made my position clear to you, namely,
that if this Board or Court of Inquiry was appointed for the
purpose of criticizing my recommendations and criticisms,
then I was entitled to be present throughout the entire inquiry.
If, on the other hand, the Board or Court of Inquiry was for
the purpose of advising you on the medical situation generally,
then I will be only too glad to appear before it as witness,
and give it all the information upon every subject upon
which I have informed myself.
" Further, I have very good reasons for stating that
efforts have been, and are being made to influence the Board
of Inquiry to bring in a finding adverse to my Report, and
I would particularly call your attention to an article which
appeared in the British Medical Journal on the 25th November
last, and which was evidently inspired by someone, or was
a reflection of views expressed by some of the members of
the Board before they had had an opportunity of consider-
ing my Report or the evidence before them. I cannot resist
quoting one sentence from the article referred to: —
"'We fully believe that the tenor of the Report will be
such as to lead to the re-instatement of Surgeon-General
Jones and to justify Sir William Osier in withdrawing his
resignation.*** ' ^'^
" In conclusion I desire to state that my sole object in
accepting the position of Inspector-General was with the idea
of giving my services and the result of my experience to the
Canadian Government, in the hope that I might better the
situation as existing at the time in the Canadian hospitals in
Great Britain and France. My Confidential Report has set
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POLITICS AND THE C.A.M.C.
forth fully and fairly the conditions which I actually found
to exist, and my criticisms thereon were honest, and
the recommendations which I made will, if carried out,
undoubtedly benefit, not only the unfortunate wounded, but
also effect a large saving in expense to the country. If, how-
ever, you come to the conclusion that my criticisms are not
justified, and that my scheme for re-organization is im-
practicable, then I can only say that my efforts to correct
the abuses which I found are futile, and I will willingly hand
over the task of re-organization to whoever you may select,
because I cannot but think that you will agree with me that
re-organization is sadly needed.
" I do not wish you to understand me as being antagonistic
to you in this matter. My desire will be to help and guide
you if given an opportunity of doing so. But to have a Court
of Inquiry appointed to consider a Confidential Report with-
out my being allowed to be present throughout is a matter
which I justly resent, more especially after my scheme for
re-organization had been approved by the Minister, and I
had had the same under way for some weeks before the
Court of Inquiry was authorized.
" Major Lash called upon me this morning, I assume
under your instructions, and I discussed the situation very
fully with him. But in order that there may be no misunder-
standing, I have taken the opportunity of answering your
letter, and explaining my position to you as fully as possible.
(Signed) *' Herbe^rt A. Bruce.''
The following letter was written by me to Sir
George Perley on December 9th : —
" Dear Sir George, —
" In writing you yesterday I overlooked calling your atten-
tion to the official announcement said to have been issued
from the office of the High Commissioner for Canada, and
appearing in the British Medical Journal for November
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POLITICS AND THE C.A.M.C.
25th, 1916, under the heading of * Canadian Army Medical
Service.'
" The announcement states that for the purpose of obtaining
an authoritative finding upon the. issue which has arisen out
of the recent Report on the Canadian Army Medical Service
by Colonel Herbert Bruce, and the reply thereto by Surgeon-
General Jones, Sir George Perley has constituted a board of
inquiry, with instructions to report as quickly as possible upon
the criticisms made in Colonel Bruce's report, and whether they
are justified in whole or in part; also upon the recommen-
dations made in Colonel Bruce's report, and whether the
Board endorses and concurs in them, and if not, in what
respect does the Board differ in opinion, and its reasons
therefor.
"Am I to understand from this that the report of the
Board is to be considered as an authoritative finding on my
Confidential Report? The letter from you to the Adjutant-
General, which I referred to in my letter of yesterday, rather
gives one the impression that the decision in this matter rests
with you, but the official announcement can hardly be
considered as consistent with this idea.
" I would be glad if you would let me know the exact
meaning of the words used in the official announcement,
because I am to-day writing the British Medical Journal with
reference to the article, which is both unfair and unjust, and
unless they consent to at once correct the inaccuracies, and to
withdraw certain statements therein, I propose to submit the
matter to my solicitors, for the purpose of taking the advice
of counsel with regard to the same.
(Signed) "Herbert A. Bruce."
The following letter, dated December 9th, was
written to me by Major Thompson, Secretary to
the Board: —
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POLITICS AND THE C.A.M.C.
" I am directed by the Board of Inquiry to inform you
that the Board informed Sir George Perley of your interview
with them on the 6th December, and sent him a copy of your
letter of the 7th.
" Sir George Perley has sent the Board copies of your
report dealing with the conditions that existed at the Duchess
of Connaught Hospital, Taplow, and also a report by Lieuten-
ant-Colonel McKeown regarding the Canadian hospitals at
Paris. Sir George adds that these may possibly help the
Board in making its report, and says that he thinks the Board
might hear what you and General Jones have to say about
them. If you wish to give evidence on these points, I will
be glad to arrange a meeting.
(Signed) ''John Thompson."
On December 12th I replied to this letter as
follows : —
" I have to acknowledge your letter of the 9th inst. and
note that you have reported the result of my interview with
your Board to Sir George Perley, and that he has sent the
Board copies of my report dealing with the conditions that
existed at the Duchess of Connaught Hospital, Taplow, and
also the report of Lieutenant-Colonel McKeown regarding the
Canadian hospitals at Paris.
"In reply, I beg to say that I made no report on the Duchess
of Connaught Hospital, Taplow, but was a member of a
Board that made inquiries; and would suggest that you get
the full report of the investigations which were made as a
result of the report, and of the findings of the Court which
made the investigations. I also note that Sir George Perley
adds that these may help the Board, and thinks that the Board
might hear both my evidence and that of Surgeon-General
Jones. As to my giving any further evidence, I beg to refer
you to a letter written to Sir George Perley dated December
8th, of which you no doubt have been furnished with a copy,
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POUTICS AND THE C.A.M.C.
and which fully explains my position. In case you have not
a copy, I am herewith enclosing one,
" In your letter you make no mention of my request to
give you further information in regard to Canadians in
Imperial hospitals. I should be glad to give you the result of
my inquiry in this regard, if the scope of your inquiry will
permit you to receive it as a part of my report.
(Signed) " Herbert A. Brucic."
Ultimately having refused to enlarge the scope
of the enquiry Sir George Perley announced his
intention of ending further correspondence on the
subject, in a letter dated December 13th, 1916, as
follows : —
" Dear Colonei. Bruce, —
" I beg to acknowledge your letters of the 8th and 9th
instant, which reached me in due course. While I certainly
could not agree to some things in them, I believe I have
already explained matters fully in my previous letters, and I
really think that nothing can be accomplished by any further
communications between us on this subject.
(Signed) " George H. Perley."
This letter did not prevent my calling Sir George's
attention to the facts contained in the following
letter to him dated December 20th: —
" Dear Sir George, —
" My attention has just been called to a memorandum on
the medical service, said to have been issued by Colonel J. T.
Fotheringham, C.M.G., A.D.M.S., Second Canadian Division,
and dated the i8th day of November of this year.
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POLITICS AND THE C.A.M.C.
"This memorandum was apparently circulated throughout
the battalions of the Second Canadian Division at the Front,
but I cannot find that it ever appeared in Divisional Orders,
and just how it came to be promulgated I am at a loss to
understand.
" You will observe that the memorandum is dated
November i8th, 1916, two days after your letter of the i6th
November to the Acting Adjutant-General, appointing Colonel
J. T. Fotheringham a member of a Board to enquire into my
Report and the Interim Report of Surgeon-General Jones in
reply thereto. The memorandum contains the following: —
"3. Relations with: —
(a) Canadian Medical Service in London.
(b) British Medical Service.
(a) No occasion has arisen by any lack of confidence in
the policy of administration of the D.M.S. in London.
Evidence has arisen of what one may term over-
engrossment in their own affairs of the Canadian
Medical Service in England, and failure fully to
appreciate the fact that we at the Front are the main
item of importance.
(b) As to our relations with the British Medical Service,
nothing in our war experience could be more pleasant
than the generous goodwill with which our efforts
have been met, and appreciated and helped by every
officer and unit of the R.A.M.C., from the D.G.M.S.
and his staff at G.H.Q. to the casualty clearing
stations and field ambulances with which we are
associated at the Front. There has never been any
approach to disharmony. Duties are exchanged; each
cares for the other's sick and wounded as required,
and co-operation in the common interest is complete.
Nothing that could disturb this desirable state of
things should be tolerated for a moment. The
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POLITICS AND THE C.A.M.C.
situation is clearly set forth in the dispatch of the
G.O.C.-in-C, General Sir Douglas Haig, on May 19,
1916, in which he selects the Canadian Medical Ser-
vice for special mention among the medical services
in the following terms: —
'As part of the medical services, the Canadian Army
Medical Corps has displayed marked efficiency
and devotion to duty.'
" We wish no further recognition, and desire nothing that
will segregate us from the rest of the medical services of the
Empire.
" I think you will agree with me that, in view of the fact
that Colonel J. T. Fotheringham had just been appointed a
member of a Board to enquire into these very matters, the
publication of a memorandum containing the above was — to
say the least of it — indiscreet, and fully justifies my objection
to his being appointed a member of the Board.
" In calling this to your attention, I desire that inquiries
should be made as to whether this memorandum was published
or promulgated with the authority of the Officer Commanding
the Second Canadian Division, or whether any authority was
given to Colonel Fotheringham to distribute this memorandum
among the battalions.
(Signed) " Herbert A. Bruce/'
I will refrain from further comment on the pro-
priety of General Fotheringham' s consenting to .sit
as a member of a Board of Enquiry on a question
which he had already prejudged.
The enquiry, as it ultimately took place before
a hand-picked Board, bore no resemblance to the
proceedings of any properly constituted civil or
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military court. The well-recognized rules of evi-
dence and of practice with regard to the examination
of witnesses were habitually disregarded. The
principle of British fair play which prevails in
courts of justice and which demands the presence
of both the complainant and the accused was absent.
This Star Chamber policy of secrecy and injustice
was continued even to the length of denying me a
copy of the evidence on which my Report was con-
demned. These statements will explain the allusions
in the following communication.
On December 28th I wrote the following letter
to Sir George Perley: —
" Dear Sir George, —
" I have applied to the Secretary of the Board for a copy
of the evidence taken before the Board of Inquiry, but he
informs me that he is not permitted to give me a copy with-
out your permission. Will you kindly instruct him to have
a copy of the evidence for my perusal?
(Signed) "Herbert A. Bruce/'
On December 30th Sir George Perley replied as
follows : —
" Dear Colonei, Bruce, —
'* I duly received your letter of the 28th inst., and I now
enclose herewith a copy of the Report made by the Board of
officers. I have not yet received the evidence, but in any case
I do not intend making that public, though I will, of course,
send a copy of it to the Government at Ottawa.
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POLITICS AND THE C.A.M.C.
" It seems to me that at present there is no further need
of a Special Inspector-General of Medical Services, and I have
therefore decided to relieve you of the duties of that office,
to which you were appointed by the Honorable Sir Sam
Hughes, K.C.B., when he was Minister of Militia and Defence.
I have also decided to withdraw at the same time the authority
given to you through Major-General J. W. Carson, under
which the management and control of the medical services
were handed over to you, and the Acting D.M.S. was to take
his instructions and orders from you. Will you kindly hand
over the books and papers connected with your office to
Colonel Murray McLaren, Acting D.M.S.
" I am sending a copy of this letter to Major-General
Turner for his information.
" Thanking you for the attention which you have given to
your duties.
(Signed) " George H. Perley.''
THE BABTIB BOARD'S FINDINGS.
As I have previously said, from the beginning
Sir George Perley was most definitely and decidedly
hostile to my Report, and in casting about for some
avenue of discrediting it he hit upon the by no means
original expedient of appointing a Board of Inquiry
for the purpose. The very personnel of this Board
made its purpose apparent because no one was
appointed to it, with the exception of Colonel
Ashton, who had not openly opposed my recom-
mendations and who was not on record as being
unsympathetic to the reforms I had so earnestly
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POLITICS AND THE C.A.M.C.
advocated. Indeed, one of the members of this
Board, before leaving France to take part in the
enquiry remarked that no more than a week v^ould
be required to dispose of the Report, and even from
the High Commissioner's Office there emanated the
opinion that when this Board had completed its task
Surgeon-General Jones would be reinstated and I
should be on my way back to Canada. Neither of
these forecasts were entirely correct, however, as
the Board of Inquiry, under the chairmanship of
Sir William Babtie, spent more than a month in
considering my Report, and examining witnesses in
camera, (So far as I was able to observe the pro-
cedure of the Board in the examination of witnesses,
it was far from what one would expect in a judicial
body constituted under Army Regulations to conduct
an impartial investigation. The whole tenor of the
questions put to me reflected the prejudices of the
examiners and an answer inconsistent with their
conclusions often brought about a heated argument.)
I was only permitted to be present at the sittings
of the Babtie Board when I was called to testify.
When my evidence was concluded, I was dismissed.
Not only did the Court fail to accord me the oppor-
tunity of hearing all the evidence, but upon those
occasions when I was called in for examination I
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POLITICS AND THE C.A.M.C.
was made to feel the Court's antipathy toward my
Report and myself.
The official report of the evidence upon which the
findings were supposed to be based was not complete,
as certain important details of my evidence were
deleted. As I had only been allowed to attend the
sessions of the Babtie Board when my evidence was
being taken I wrote to Sir George Perley, after its
report was issued, requesting a copy of the evidence,
but this was refused, and I was therefore in the
dark as to the evidence upon which the Babtie Board
based its report.
The following is the text of the finding of the
Board : —
Sir :
The Board having assembled in accordance with War
Ofifice Letter number i2i/medical/2893 A.M.D. i, dated 25th
November, 1916, proceeded to consider the Report on the
Canadian Army Medical Service by Colonel H. A. Bruce, the
Special Inspector-General appointed by Major-General Sir
Sam Hughes, and a reply thereon by Surgeon-General G.
Carleton Jones, then Director Medical Services, Canadian
Expeditionary Force. Both officers have been examined by
the Board, and in addition, evidence from the officers and
other enumerated in appendix No. i was heard. A report
of the evidence taken and copies of various documents sub-
mitted to the Board are annexed to this report. The Board,
in preparing its report, has not only taken into account the
evidence submitted to it, but has ventured to incorporate into
some of its recommendations its own knowledge of conditions
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POLITICS AND THE C.A.M.C.
so far as they affect the efficiency of the Canadian Army
Medical Service.
In making this report, the Board has constantly kept in
view, not only the welfare of the sick and wounded of the
C.E.F., but the interests of the Government and the people
of Canada, and has been especially careful in its comment
upon the work of the Director of Medical Services, whose
administration has been so severely criticized by the Inspector-
General in his Report and in his evidence.
It will be convenient to summarize here the principal
points emerging from Colonel Bruce's Report. These are : —
(a) The concentration of Canadian sick and wounded in
Canadian hospitals.
(b) The suitability of V.A.D. hospitals for the care and
treatment of Canadian soldiers.
(c) The system of medical boards.
Before offering any general remarks on these topics, the
Board thinks it right to explain that up to February, 1916,
the accepted policy was to provide special hospital establish-
ments for Canadian patients; that about that date, owing to
various considerations, practical and sentimental, it was deter-
mined, with the consent of the War Office, to deal with Cana-
dian patients in the same fashion as British patients are dealt
with, that is, by distributing them throughout the United
Kingdom to the great series of central hospitals, each with
its group of affiliated auxiliaries.
In the report of the Special Inspector-General, the latter
system is condemned, and a return to the policy of Canadian
hospitals for Canadian sick and wounded advocated. The issue
is a fair one, for there is much to be said on both sides, but
the Board, after very careful consideration, has come to the
conclusion that, the policy therein recommended is not only
unwise, but impracticable, having regard to the amount of
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POLITICS AND THE C.A.M.C.
accommodation that would be required owing to the increase
of Canadian troops in Europe.
The arguments for and against are set forth under the
headings into which this report is divided, but it will be
convenient to consider here the principal reasons that have
led the Board to the opinion that a reversion to the original
scheme of concentrating Canadian sick and wounded in
Canadian hospitals is impossible.
All through the report of the Inspector-General the dom-
inating idea is a conception that the Canadian Expeditionary
Force is something separate and apart from the Imperial
Army, a conception that may be summarized as the "water-
tight compartment " policy in matters medical. The Board
is of opinion that as long as the Canadian Expeditionary
Force forms an integral part of the Imperial Army, such a
view is no more possible in the United Kingdom than it is
in France, and so long as Canadian troops continue to
operate under the command of the Commander-in-Chief,
British Expeditionary Force, it must continue to be impossible
to discriminate in the medical arrangements of Canadian and
British troops. The personal experience of the majority of
the members of the Board, amply confirms this view, so far
as the arrangements at the French Front and at the overseas
bases are concerned, and the Board has satisfied itself that
it would be inadvisable to attempt separation on the return of
the sick and wounded to the United Kingdom.
It appears to the Board that to separate, on their return
to England, men who have fought side by side, must tend
to undo the bond of brotherhood sealed in the face of the
enemy. The Board is aware that these considerations of high
policy do not strictly come within its purview, but cannot
refrain from adverting to this aspect of the matter, because
it would almost appear as if the report under consideration
was based upon the conception that the Canadian Forces had
a similar relation to the British Armies as that held by the
Allied Nations.
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POLITICS AND THE C.A.M.C.
The policy that the Board ventures to attribute to Colonel
Bruce would have prevented the use of Canadian medical
units in the Mediterranean, because Canadian troops did not
happen to be employed in that theatre of war, and the sending
of Canadian hospitals to Paris for the use of the French sick
and wounded. Indeed, the sending of Canadian medical units
to the Mediterranean is criticized from this very point of
view in the report of the Inspector-General. Again, and for
similar reasons, the Board is in profound disagreement with
the view that Canadian Army medical corps personnel should
not be associated with the British service in scientific enquiries
and in other work; on the contrary, it is of opinion that such
participation is both desirable and necessary in the best
interests of the two services. The Board, too, is at variance
with the contention that the services of the Canadian Army
Medical Corps should in the main be confined to Canadian
troops; field ambulances serve primarily the Canadian forma-
tions, but in the case of the Line of Communication units,
their work must, of necessity, be largely with other than
Canadian troops. This aspect of the case, it is fair to say,
was repudiated by the Inspector-General when placed before
him.
The Board feels bound to place on record that in some
of the opinions expressed by Colonel Bruce he is misled by
a lack of intimate knowledge of army organization and of
the inter-relation of the various branches of the service, as, in
some of his criticisms he has failed to make allowance for
the sudden expansion of the army and for the unavoidable
want of specialized training in its auxiliary services. Such
imperfections as have existed are rapidly being remedied, and
it is plain truth to say that in no war history has sickness
been so well controlled or the sick and wounded so well cared
for. The Board, relying on its own observations and the
evidence laid before it, is abundantly satisfied that the Cana-
dian sick and wounded have been thoroughly well cared for,
not only in the central hospitals, whether British or Canadian,
158
POLITICS AND THE C.A.M.C.
but in the Voluntary Aid hospitals, which Colonel Bruce
criticises. These latter hospitals are the outcome of a mobili-
zation of the medical resources of the United Kingdom, and
in them Canadian soldiers are not only well cared for pro-
fessionally, but are comfortable, happy and at home. The
Board desires to emphasize its dissent from the criticisms
of these institutions, which it believes to be unjust and
undeserved.
The other principle raised in the report of the Inspector-
General, the system of Medical Boards, is dealt with in detail
hereafter, and the Board agrees that there is much justice
in the criticisms levelled at the complicated arrangements that
have been permitted to grow up. With the re-organization
proposed the Board is unable to concur, and has ventured, as
the^result of the combined experience of its members, to
suggest a system that it believes to be simple and likely to
be practical in operation.
The Board does not concur in Colonel Bruce's view that
a complete re-organization '' from top to bottom " of the
Canadian Army Medical Service is necessary. In its opinion
•the reforms he suggests would not remedy the defects he
deplores, which are not due to the system but to inexperience
on the part of officers, military and medical, and to faults
in administration, which are commented upon in the detailed
criticisms that the Board has felt it its duty to record.
The Board cannot conclude this general review of its
findings without adding that the Report of the Inspector-
General ignores the good work done by Surgeon-General
Jones and his staff under circumstances of novelty and great
difficulty. The Board has not hesitated to criticise those
matters, wherein, in its opinion, the Director of Medical Ser-
vices has failed, but does so with great reluctance, for it is
satisfied that much of what has been accomplished has been
the result of his zeal and industry, while the good relations
of the Imperial and Canadian services are largely due to the
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POLITICS AND THE C.A.M.C.
tactful performance of the many delicate duties that fell to
his lot.
The Board would also* point out that the lack of an organ-
ized Canadian staff was a very serious handicap to the
Director of Medical Services in his dealing with the important
subject of non-effective troops.
/. SOLDIERS ARRIVING IN ENGLAND FROM CAN-
ADA MEDICALLY UNFIT.
The Board is agreed that large numbers of soldiers have
come, and continue to come, from Canada who are unfit for
service at the Front. The cases come under two main
headings : —
1. Men who do not comply with the recruiting standards
as regards age.
2. Men who are unfit by reason of physical disability.
The first class is the more numerous; of one series of
cases submitted to the Board, 849 out of 1,366 were unfit by
reason of being under or over age. The Board understands
that the recruiting medical officer is not required in his exam-
ination to consider the apparent age of recruits, and this being
so, the charge as regards the Canadian Army Medical Corps
narrows itself down to the second class.
The Board is satisfied that there have been large numbers
of men passed who ought not to have been passed by the
medical officers, but it was perhaps inevitable under the cir-
cumstances of raising the Canadian Expeditionary Force that
examinations could not be conducted with all the care neces-
sary. This it believes to have been due partly to inexperience
on the part of examining medical officers, partly to hurry,
partly to carelessness, and lastly, in some instances, to the
opinion of the examining medical officer being over-ridden
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POLITICS AND THE C.A.M.C.
or ignored by commanding officers. These defects in recruit-
ing continue to exist, despite medical examinations by recruit-
ing medical officers, by battalion medical officers on joining
units, and before sailing for the United Kingdom. The
remedy lies in a more stringent examination and better organi-
zation of recruiting methods in Canada. Examining medical
officers should be responsible, as in the British service, that
a recruit's apparent age corresponds with his declared age;
there should be inspectors of recruiting familiar with the
requirements of the army in the field, and no soldier should
be permitted to cross the seas without having been classified
by a Medical Board as fit for general service.
The Board has come to the conclusion that this important
matter has not received the attention it deserves, and that
the authorities have failed to make adequate representations
regarding a condition of affairs that must severely handicap
the C.E.F., both as regards organization and training in the
United Kingdom, and efficiency in the field.
What share in this responsibility lies with the D.M.S.?
The Board is not prepared to say, as the A.G. branch of the
staflf, to which the subject appertains, does not appear to have
been represented in England until recently, but the Board
believes that in the absence of the A.G.'s branch, it was the
duty of the D.M.S. to represent, as often as was necessary, to
all sources open to him the fact that large numbers of men
were arriving here who were unfit for general service.
//. and III. DISTRIBUTION OF CASUALTIES AND
CONCENTRATION OF HOSPITALS.
Colonel Bruce's objections to the present system of treating
a moiety of Canadian patients in Imperial hospitals distributed
throughout the United Kingdom, and his advocacy of the
policy of concentrating them in purely Canadian hospitals,
are interdependent. The Board, therefore, proposes to
consider sections II and III together.
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II
POLITICS AND THE C.A.M.C.
As regards distribution, it is recognized that the Canadian
soldier returning to England from France is not in the same
position as the British soldier so returning, but, despite this
important difference, the Board is of opinion that, practically
speaking, a system of distribution which is satisfactory in the
case of the British soldier, need not be inefficient in the case
of the Canadian.
What is required to meet the special circumstances of the
Canadian soldier is an extension of the system of Canadian
convalescent hospitals, and organized co-operation as regards
inspection between the Canadian and Imperial services. The
Board is satisfied that considerable difficulties must arise in
the collection and distribution of Canadian invalids to Cana-
dian hospitals, because the problem begins at the Front, and,
from the personal experience of the majority of the members
of this Board, it believes that it is quite impracticable to
earmark and collect Canadian casualties at the base in France,
and that it would be difficult and inconvenient to direct
them solely to Canadian hospitals in England.* Special
*Conipare this statement with the confession of an absolute
reversal of this policy contained in the " Report of the
Ministry, Overseas Military Forces of Canada, 1918," sub-
mitted by Sir Edward Kemp on May 15th last (page 391).
" So far as was practicable and possible, too, the Canadians
evacuated from France were distributed to Canadian hos-
pitals. In times of stress, however, mainly to meet the
exigencies of ambulance railway transport in England they
had, of necessity, to be distributed to both British and
Canadian hospitals. That, after seve're fighting, was inevit-
able ; but every effort was bent towards placing Canadians
in Canadian hospitals, and how successful was this endeavor
is evident in the expansion of Canadian bed capacity alone.
Where it was necessary, owing to the demands of the
moment to place Canadians in British hospitals, the British
authorities were prevailed on to place Canadians in hospitals
in areas most easily accessible to the Canadian authorities
and to the Canadian patients' relatives and friends."
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POLITICS AND THE C.A.M.C.
arrangements for their despatch would be necessary and, while
the Board has it in evidence from the principal embarkation
medical officer that the difficulties are not insuperable, they
are sufficient to enhance the complexities of an already
complex problem. The administrative difficulties in this
respect would, the Board believes, be found in practice, ser-
ious, and would necessarily involve the provision of clearing
hospitals, at, or near, the ports of England. Even if the
difficulties of collection in France could be got over, it would
necessitate the holding of Canadian patients in France until
a sufficient accumulation occurred to justify special arrange-
ments for distribution on arrival in England. This policy
the exigencies of war would be bound to frustrate. If, how-
ever, this proves to be possible, the difficulties of distribution
to Canadian hospitals in England would disappear.
But the present system must hold the field if it is found
impracticable to find suitable hospital accommodation for the
whole of the Canadian sick and wounded in the Shorncliffe
area and its neighborhood, to which it is important that any
such scheme should be confined. The establishment of Cana-
dian hospitals in England, even if all were situated south of
the Thames, would not meet the requirements, but might even
accentuate the difficulty of distribution, and, in either case,
the Board is satisfied that the policy of centralisation would
be unwise and expensive and impracticable.
The Board considers it to be unwise on broad grounds
of policy, believing that it is to the best interests of both
British and Canadian soldiers that they should meet one
another, and, as illustrative of Canadian sentiment in this
matter, would remark that the Canadian hospitals at Beach-
borough, Taplow and Orpington are governed by explicit
provisoes on the part of the donors that they are not to be
confined to the treatment of Canadian sick and wounded.
That such a policy would be expensive is certain, for
houses suitable for hospitals are not to be found near Shorn-
cHfTe, and great difficulties would be experienced even in
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POLITICS AND THE C.A.M.C.
the larger area mentioned. The probable outcome would be
the necessity of the erection of hut hospitals, at large cost
and with much delay, and the Board is of the opinion that
such expenditure would not be justified without very grave
and urgent necessity. The Board does not believe that any
such necessity exists, for, after conversation with many
Canadian soldiers in different hospitals and with officers and
others familiar with the working of the present system, it
has failed to discover any general sentiment among Canadian
troops in favor of their exclusive treatment in Canadian
rather than in British hospitals. The present system permits
the individual Canadian soldier to select, subject to adminis-
trative convenience, the neighborhood to which he would
desire to be sent, and, while there is evidence that from time
to time Canadian soldiers ask to be sent to a particular
locality or transferred from one hospital to another, the
reason generally given is to be near relatives in the United
Kingdom, and is not generally associated with their treatment
and comfort in Imperial hospitals.
The Board does not suggest that the existing Canadian
hospitals in England should be given up and does not object
to a reasonable extension of these hospitals, but, even without
extention, there is no reason why any wish on the part of a
Canadian soldier to be treated in a Canadian hospital should
not be met, just as the desire to go to a particular neighbor-
hood in Great Britain is gratified whenever circumstances
permit.
Even if sufficient separate accommodation could be pro-
vided for all Canadian casualties in one area in England, it
would either be necessary to retain a large number of empty
beds to meet the eventualities of war, or, if these were utilized
for British patients, as Colonel Bruce suggests, then they
would not be available for Canadian patients when the Cana-
dian Corps was heavily engaged. In the opinion of the
Board, such a policy must, of necessity, break down under
the stress of war.
164
POLITICS AND THE C.A.M.C.
The special advantages that Colonel Bruce claims for a
policy of concentration can be attained with existing arrange-
ments, which are sufficiently extensive to permit of the utilisa-
tion of the special skill of Canadian physicians and surgeons
in all branches of medicine and surgery.
There are twenty thousand Canadian soldiers in hospital
in the United Kingdom to-day, and the provision of special
Canadian hospitals for them all would necessitate additional
accommodation for nine thousand, and even this would not
allow a margin for battle casualties. Of this number, the
Board is informed that between two and three thousand are
being provided for by special arrangements with the Ontario
Government and the Red Cross, and there is a large number
of patients now in the United Kingdom who the Board agrees
should be returned to Canada, as they are unlikely to be fit
for general service within a reasonable period. This number
Colonel Bruce estimates at between two and three thousand,
and with this estimate the Board concurs. Deducting both
classes, there would remain about four thousand additional
beds to be provided, involving a capital expenditure of
approximately one million dollars if buildings had to be
erected, which is believed to be inevitable.
This question of cost cannot be considered apart from
that of the existing arrangements whereby Canadian soldiers
are subsisted in Imperial hospitals, whether military or V.A.D.,
at a cost of three shillings per head per day, whereas the
average cost to the public of Canadian soldiers in Canadian
hospitals, as of British patients in British hospitals, is from
six to seven shillings per head per day. The difference is
due to cost of personnel and equipment. It is right to state
that similarly British patients are maintained in Canadian
hospitals at the same charge of three shillings, but obviously
the balance of advantage is in favor of the Canadian Govern-
ment, and if Colonel Bruce's policy were adopted, the many
advantages of this reciprocal agreement would be very much
diminished.
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POLITICS AND THE C.A.M.C.
Although these questions have been considered on a money
basis the Board believes that, if it could be established that
the Canadian soldier suffered from being treated in Imperial
hospitals, the Canadian Government would not consider the
cost in any v^ay, but there is ample evidence that Canadian
soldiers have not suffered from being treated in Imperial
hospitals. ' iH I
This important subject has been dealt with at some length,
because the chief consideration in the reorganization sug-
gested by Colonel Bruce is a policy of preferential treatment,
which the Board considers impracticable in its application,
and which it believes to be unwise and opposed to Canadian
sentiment.
IV. UNNECESSARY DETCXTION IN HOSPITALS,
ETC.
The Board cannot agree that there is a lack of efficient
medical inspection in hospitals, but, while not reflecting on
the efficiency of these inspections, the Board agrees with
Colonel Bruce and Surgeon-General Jones that additional
inspection of Canadian hospitals, and of Canadian patients in
British hospitals throughout the United Kingdom, is desirable
from the Canadian standpoint. There is evidence that the
desirability of special inspections of Canadian patients in
British hospitals was not fully recognized by the then D.M.S.
until July of this year, but the Board is of the opinion that
this policy, with which the Board is in complete sympathy,
should have been initiated at an earlier period.
From early in the war the Canadian Red Cross had organ-
ized a system of visits to Canadian patients in British hospitals
throughout the United Kingdom, and the valuable information
collected in this fashion was available to the D.M.S. and
frequently utilized by him.
The Board agrees with Colonel Bruce and Surgeon-
General Jones as to the desirability of additional consultants
166
POLITICS AND THE C.A.M.C.
being appointed, and thinks that there is ample scope for a
consulting surgeon, as well as a consulting physician, in
Canadian hospitals in the United Kingdom. It is not to be
supposed, however, that Canadian hospitals have not had
the advantage of the advice of experienced consultants; for
the late Lieutenant-Colonel Sir Frederick Eve (whose death,
which the Board laments, denied them the advantage of his
experience), was one of the consulting surgeons for the
Eastern Command and visited then the Canadians in hospital
from time to time. The Board would venture to suggest,
however, that it would be better if Canadian consultants were
appointed to the Imperial Army, instead of their services
being confined to Canadian hospitals, and if this policy is
adopted it might apply not only to the United Kingdom, but
to France. The Board think it right to refer to the allegation
that there have been many errors of diagnosis and treatment.
The Board is decidedly of the opinion that there is no cause
for alarm on this score, as such errors as have come to
notice are incidental to the exigencies of active service, and
believes that they do not prevail to as great an extent as in
the ordinary course of practice in civil hospitals, whether in
Europe or Canada.
In opposition to the views of both Surgeon-General Jones
and Colonel Bruce, the Board is of opinion that it would be
preferable that the head of the Medical Service should remain
in Ottawa as the principal medical adviser of the Government
upon all questions, such as the medical examination of
recruits, the organization of new units, selection of medical
officers for commissions, and other questions upon which the
Government in Canada might desire the advice of a senior
and responsible officer, matters which, in the opinion of this
Board, are intimately bound up with the success of the Force
in the field.
The Board is agreed that there is a considerable accumu-
lation of convalescent Canadian patients in Imperial hospitals,
and that this is due to the insufficiency of accommodation at
167
POLITICS AND THE C.A.M.C.
present in Canadian convalescent hospitals. The Board is
also satisfied that there are in the United Kingdom a large
number of Canadian invalids who ought to be sent back to
Canada, but whom it has been impossible to repatriate because
the available accommodation in Canada has been insufficient.
Unless a very large increase in the rate and number of
patients evacuated can be accomplished, it will, in the opinion
of this Board, be necessary to increase materially the accom-
modation in the Canadian convalescent hospitals in the
United Kingdom. As soon as there is sufficient convalescent
accommodation for Canadians, so soon will many of the
difficulties experienced by Colonel Bruce in inspecting
Canadian patients in British hospitals disappear.
The Board attaches the greatest importance to the early
provision of sufficient e^ccommodation for returning invalids
to Canada, which is a matter, the importance of which this
Board cannot over-emphasize.
In this connection the Board would wish to direct attention
to the fact that all invalids returning to Canada have so far
been conveyed in returning transports or passenger steamers.
In view, however, of the increased number of Canadian troops
in Europe, and the growing number of serious cases, who, it
is generally agreed should be sent to Canada at an earlier
stage, tlie Board would suggest that the provision of a regular
hospital ship should be considered.
V. USB OF V.A.D. HOSPITALS.
Colonel Bruce's recommendation that the use of V.A.D.
hospitals by the C.A.M.C. be discontinued is not concurred
in.
The Board offer the following remarks on some of the
points raised in Colonel Bruce's indictment of a system that
has done much to link up the military medical service with
the civil population: —
POLITICS AND THE C.A.M.C.
I. Inefficiency. It is not agreed that, as a class, the V.A.D.
hospitals are inefficient, and the evidence which, to
Colonel Bruce, indicated inefficiency, was really due
to defective classification, whereby some V.A.D. hos-
pitals which were not equipped for all purposes occa-
sionally contained patients for whom treatment
should have been prescribed in a hospital of a higher
scale.
Even in such cases facilities for the transfer of such
incidental admissions to primary hospitals were always
available, and in no case did the Board find that faulty
treatment could fairly be attributed to the V.A.D.
system.
2. Expense. As already stated, the charge for a patient in a
V.A.D. hospital never exceeds three shillings a day,
and the Board has it in evidence, and is satisfied,
that the cost per patient in a military hospital is at
least six shillings per day.
3. Unsatisfactory. Colonel Bruce's point of view appears to
be that those hospitals which are the inevitable out-
come of a general mobilisation of the medical
resources of Great Britain, are unsatisfactory from
an administrative and professional point of view, but
the Board is satisfied that in no other way could the
situation arising out of the war have been met, nor
could it be altered now without vast and unjustifiable
expenditure.
Colonel Bruce mentions, among other points, the following
as evidence of the unsatisfactory nature of these institutions :—
(a) Inconvenient location. This is, in many instances,
inevitable, as accommodation had to be made use of
wherever available. The inconvenience is largely
minimised by the system of classification of patients,
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POLITICS AND THE C.A.M.C.
by ample facilities for transportation, and by periodic
inspections by Imperial and administrative officers.
(6) Medical Staff. The medical staff is generally found
from the local practitioners who nearly all give their
services gratuitously, and make large sacrifices in so
doing.
The investigations of this Board do not support these alle-
gations of inefficiency. The standard of professional efficiency
naturally varies, but there is no ground, even in the special
reports made by Colonel Bruce's direction, for the grave
indictment contained in his report, *' a good deal of the surgery
is bad," and if patients have been retained in these hospitals
too long it has been caused by the insufficiency of accomrno-
dation in Canadian convalescent hospitals and delays in con-
nection with the C.C.A.C. in England.
(c) Nursing Staff. In all hospitals there is a nucleus of
trained nurses (ten per cent.), whose work is supple-
mented by the devoted efforts of the Voluntary Aid
Detachments, the members of which have undergone
courses of instruction in first aid and home nursing,
and who, after two years of hospital work, are many
of them so efficient that the Imperial Government has
not hesitated to send them to France and the Medi-
terranean. In no case, has the Board had reason
to be other than satisfied with the nursing in these
institutions.
The comments made in Colonel Bruce's report on the
V.A.D. hospitals have been widely resented, and this Board
is of opinion that these strictures are unjustified and
regrettable.
While the Board agrees with Colonel Bruce that patients
could sometimes be more advantageously treated in, and
more speedily evacuated from large military hospitals, the
advantages of the V.A.D. system should not be overlooked in
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POLITICS AND THE C.A.M.C.
this regard. In these hospitals the Board found the Canadian
patient well fed, comfortable and happy, and receiving an
amount of care that is only possible in institutions organized
on the lines of " the home." This has been an enormous
asset in the case of soldiers widely separated from their
kith and kin.
VI. ADMINISTRATION OF SHORNCLIFFE GROUP OF
V.A.D. HOSPITALS.
V.A.D. hospitals are affiliated in groups to central military
hospitals, which are responsible for their administration, and
special and frequent inspections are arranged by the A.D.M.S.
of areas and D.D.M.S. of commands. The V.A.D. system is
general throughout the United Kingdom, and, as stated, is
believed to be economical and satisfactory.
When the Canadian medical service took over the Shorn-
cliffe Military Hospitals, which was a central hospital, and
when the A.D.M.S., Canadians, was appointed A.D.M.S. of the
Dover area (an Imperial appointment), the administration of
these institutions necessarily devolved for the most part upon
the Canadian Medical Service. At the time that these arrange-
ments were made, the necessity for additional accommodation
for Canadian patients was pressing, and advantage was taken
of the opportunity to hand over the administration to the
Canadian Service, as being that which could most conveniently
supervise these institutions, which were likely to be largely
used by Canadian sick and wounded.
As to the detailed criticisms made by Colonel Bruce, the
Board is of opinion that, while the system is an economical
one under which we administer a large number of auxiliary
hospitals, the Canadian staffs employed in connection there-
with have been larger than necessary. This is especially so
in regard to the Registrar's Department at the Shorncliffe
Military Hospital, upon which expert clerical evidence has
been obtained.
171
POLITICS AND THE C.A.M.C.
Members of the C.A.M.C. have been employed in V.A.D.
hospitals, just as the R.A.M.C. are similarly employed, but
in every case there have been advanced good reasons for their
use, such as the maintenance of discipline and special nursing
and care in exceptional cases of illness.
The Board cannot agree that the employment of C.A.M.C.
personnel should be confined to purely Canadian institutions,
or that the Canadian ambulance service should not be used
for Imperial patients, and if adjustment is required in these
regards it should be dealt with when reciprocal services
are under consideration.
In all these points the Board is opposed to the policy
suggested by Colonel Bruce, and in agreement with that
carried out by General Jones.
VII. RBLATIONS WITH RED CROSS.
The necessity for a continuance of the past harmony
between the Red Cross, both British and Canadian, and the
medical service, is unquestioned, and the Board is of the
opinion that the discovery of admitted irregularities at one
place (Taplow) does not vitiate the policy and relations hith-
erto obtaining. The Board does not propose to enter in
detail into these questions, which, as regards one hospital,
have been the subject of special inquiry and a court martial,
but while rumors of irregularities were widespread they did
not apparently reach the ears of the D.M.S., and it feels
bound to add that glaring departures from accepted service
methods of administration passed unnoticed at General Jones's
inspections.
VIII. DETAILING OF C.A.M.C PERSONNEL FOR
IMPERIAL SERVICE.
The Board disagrees with Colonel Bruce, and is strongly
of opinion that the forces and resources of the Empire must
be pooled to the utmost in this struggle, and that therefore
172
POLITICS AND THE C.A.M.C.
interchange of personnel is desirable and necessary in the
interests of both services.
The very instances quoted by Colonel Bruce seem to the
Board to prove the desirability of such interchange, and the
advantage to the Canadian forces of the participation of its
officers in special investigations, such as those conducted at
Hampstead, is too obvious to require justification by it.
The Board believes that the policy adopted by Surgeon-
General Jones will commend itself to the authorities, for
which there is abundant precedent in other branches of the
IX. SITUATION AT SHORNCLIFFB.
A.D.M.S., Canadians, being also A.D.M.S., Dover {British).
The Board, both from its own observation and experience
and from the evidence submitted, is opposed to the opinion
expressed in Colonel Bruce's Report. The statement that
" from many points of view the interests of the two services
clash," is contradicted by the evidence, and is, in the opinion
of the Board, incorrect.
The D.D.M.S., Eastern Command, on whose initiative the
appointment was made, states that " Colonel Rennie is one
of the best A.D.M.S.'s in the Eastern Command."
The Board is satisfied that this arrangement has been, and
is, a good and satisfactory one as regards both Canadian and
British interests.
X. SURGICAL OPERATIONS NOT TENDING TO
INCREASE MILITARY EFFICIENCY.
The Board agrees with Colonel Bruce that much surgery
that is fitting in civil life is not advisable in military practice,
and has evidence to the effect that efforts have been made
to induce the newly-commissioned medical officers to regard
physical unfitness from a military point of view, and that
experience has effected marked improvement in this respect.
173
POLITICS AND THE C.A.M.C.
The appendix to this section (p. 145 of the Report) men-
tions twenty-one cases '' ad hoc." One at least of these cases
came under the attention of the Board. The hospital records
of that case (No. 66242, Private Downs, M.), are incorrectly
reported by Colonel Bruce ; the man did not suffer from the
disability stated; the operation performed was not as stated,
and the mention of the surgeon's name (Lieutenant-Colonel
D. Armour, R.A.M.C.) accentuates the grave nature of the
criticism. The Board of course concurs in the recommendation
on page thirty-five of Colonel Bruce's report.
XL and XII. SPECIAL HOSPITALS,
In the opinion of the Board, a special hospital, such as
that at Ramsgate, is essential ; as if treatment had to be
delayed until the patient could be sent to Canada — even if
sufficient facilities existed there — the beneficial results of early
treatment would not be attained.
At the same time, the Board appreciates that many cases
have been admitted and detained there whose immediate
transfer to Canada was desirable, and this remark applies in
a special degree to cases of amputation.
The Board, however, has it in evidence that the facilities
that exist in Canada are not as yet sufficient to meet the
requirements of the Canadian Expeditionary Force in this
respect.
With regard to the ** Arts and Crafts Department," the
Board fully recognizes that trades should not be taught in
England, but believes that there is a distinct therapeutic value
in work of this sort for selected cases. Much of special
equipment already existed in the building now used as a
hospital, and the cost of the additional installation has been
met by private benefactors, and has not fallen on the
Canadian Government.
The value of the institution in fitting men to return to
duty is shown by the report of the O.C., which states that
sixty per cent, of the patients were discharged to full duty.
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POLITICS AND THE C.A.M.C.
The remarks made in regard to Ramsgate apply equally
to the Buxton Hospital, and Colonel Bruce admitted that his
criticism had reference to its use for cases of chronic rheuma-
tism, and the Board is in agreement with his views in this
respect. It was explained to the Board that shell shock cases
were only sent there because of lack of sufficient accommo-
dation at Ramsgate. Lieutenant-Colonel Finley, the Consult-
ing Physician, reports that seventy-one per cent, of all the
cases that have been treated at Buxton returned to full duty.
It should be added that in the staff are included two
officers with neurological experience. The Board holds that
this hospital serves a useful purpose.
XIII. VENEREAL SITUATION.
The Board recognizes that the question has been a vexed
one ever since an army took the field. The evidence shows
that soon after arrival in England the D.M.S. tried to secure
adequate provision for these cases, and that his efforts were
not invariably supported by higher authority. Proper accom-
modation was not provided as asked for; as a result, the
discipline and control, which are essential in this class of
case, were not secured.
The recommendation that a battalion of a combatant type
be organized, with a special medical staff, is not concurred
in ; the men must be regarded as sick and be placed in various
grades determined by the stage of their affection and remain
under medical control. A solution can only be reached by
co-operation between the Medical Service and the Adjutant-
General's branch. The Board concurs with the view that
segregation of all such cases in an area by themselves, under
special arrangements for treatment and discipline on the
lines of a convalescent hospital, which combines treatment
and training, is essential,
175
POLITICS AND THE C A.M.C.
XIV. INFECTIOUS DISEASES.
The system of utilising the isolation hospitals of local
authorities is that generally adopted by the British service
whenever possible. As it has been found to be economical
and convenient, we recommend no change in that respect
at Shorncliffe. ^
The calculation respecting the cost of providing a Cana-
dian Isolation Hospital is incomplete, and the comparison
made so fallacious as to be misleading, as the estimate does
not allow for the cost of buildings and equipment. The
present charge of four shillings per patient per day is, having
regard to all the circumstances, a most moderate one.
The introduction of the C. A.M.C. into the isolation hos-
pital was, in the opinion of the Board, fully justified under
the special circumstances of an outbreak of cerebro-spinal
meningitis.
The two cases of diphtheria, quoted as having been unduly
detained in hospital, have been satisfactorily explained to the
Board, which is satisfied that the course pursued was the
right one.
XV. MEDICAL BOARD SITUATION.
With reference to the remarks of Colonel Bruce that "the
present Medical Board situation is a disgrace to the Canadian
Army Medical Corps," and that " Medical Board work has
often degenerated into a farce," the Board thinks it right
to begin its comments on this section by remarking that, on
examination. Colonel Bruce agreed that the use of the words
first quoted were unjustifiable, and had little or no application
to the part taken by the Canadian Army Medical Corps in
carrying out the procedure prescribed for them.
The Board agrees that there is a necessity for reformation
in the Medical Board situation and in the classification of
casualties, and is of opinion that an easy solution of the
176
POLITICS AND THE C.A.M.C.
problem would be the adoption of the British system so far
as applicable.
In order to obtain uniformity in the classification of the
various degrees of fitness for soldiers, the Board recommends
that the categories defined in A.C.I. 1023 of 1916 be adopted
in the C.E.F., and adhered to on all occasions, the use of the
term " permanent base," " light duty," being abolished.
There are two main classes of cases which may call for
the intervention of Medical Boards: —
(i) In the case of soldiers evacuated to the United Kingdom
from France returning to the Front.
(2) In the case of soldiers (a) who for any medical reason
are regarded as unfit for full duty at the Front;
(b) whom it is considered desirable, for any medical
reason to return to Canada.
In the first class, the intervention of a Medical Board
should rarely be necessary; the second should invariably be
decided by a Medical Board. In the opinion of this Board it
would add greatly to simplicity and directness of procedure
if the services of any Board, Imperial or Canadian, as the
case might be, could be utilised.
The first principle involved is that no soldier should be
sent out of Canada who is unfit for general service, and, to
ensure this, all drafts or units should be examined, and only
men passed by a Board as " fit for general service " should
be permitted to embark.
Thereafter, the principle should be recognised that a sol-
dier can only be reduced from this category by the finding
of a Medical Board, and that soldiers so reduced may be
raised in category, by the medical officer of a hospital or
of a unit, on becoming fit for it. For example: a soldier
is slightly wounded in France, and at the general hospital at
the base in France becomes fit for duty at the Front, the
decision of the officer commanding the hospital suffices to
return him to duty with his unit. If, in a more serious case,
12 177
POLITICS AND THE C.A.M.G.
the soldier returns to England and there becomes fit for full
duty, a similar simple procedure should suffice; but, if the
soldier is incapacitated to such an extent as in the opinion
of the officer commanding the hospital renders him unfit for
general service, this opinion should be confirmed by a Board,
which could recommend the man for garrison service in
England or France or for invaliding to Canada. In the last
case, this Board should prepare all medical documents neces-
sary. Similarly, in the case of any soldier, in or out of
hospital, becoming unfit for his category, he should be brought
before a Medical Board.
It is the opinion of the Board that the procedure outlined
above should suffice to invalid a soldier to Canada, with the
proviso that the authorities there will adopt whatever pro-
cedure may commend itself to them in dealing with the
discharge, or otherwise, of the invalided soldier and his claim
to pension. The Board is strongly of the opinion that pension
claims should not be dealt with at an oversea base, except
in the case of men taking their discharge in the United
Kingdom.
The recommendation on page 52 of Colonel Bruce's Report
is concurred in. All Boards should, as far as circumstances
permit, be constituted on the lines therein suggested, and
this Board would emphasise that in all cases one member
should be a medical officer with knowledge and experience
of active service conditions.
The work of Medical Boards can be standardised only
in a general way, by adherence to general principles laid,
down from time to time.
As regards the lack of supervision alleged in Colonel
Bruce's Report, the existing system of placing the responsi-
bility on the administrative medical officer under whose orders
the Board is constituted should be sufficient, if adhered to,
as has not invariably been the case.
The Director of Recruiting and Organisation should, in
the opinion of this Board, have no control over Medical
178
POLITICS AND THE C.A.M.C.
Boards, which should be ordered by, or through, the Adjutant-
General's branch of the staff and constituted by the A.M.O.
concerned. The boarding of officers should, in the opinion
of this Board, follow the general Hnes indicated in the case
of other ranks.
The invaliding of the Canadian soldier should only be
conducted at Canadian, or other hospitals, where suitable
facilities for special examinations exist.
As regards co-ordination with Canada, if the scheme above
commends itself to the responsible authorities there should
be little difficulty in this respect.
With respect to the re-organisation suggested by Colonel
Bruce, the institution of a special A.D.M.S. charged with the
supervision of invaliding would, in the opinion of the Board,
tend to divorce the D.M.S., and the A.D.M.S. of formations
and areas from their responsibilities in this respect, and is
not recommended. The higher supervision of invaliding is
a primary duty of the D.M.S., who should, by inspection and
precept, secure such uniformity in method as is necessary
and desirable.
In order that close touch may be maintained in the case
of Boards conducted by Imperial officers, the D.M.S. should
be in communication with the D.G.A.M.S. who exercises
similar functions for the Imperial Army.
Under the procedure outlined, there would be no presi-
dent of a Medical Board occupying a preferential position,
and, in any case, this paragraph of Colonel Bruce's Report
and that which precedes it (A.D.M.S., Invaliding), on page
52, are inconsistent.
As to the other suggestions made by Colonel Bruce as to
re-organisation, the Board has already dealt with and con-
curred in some of them, and considers the others complex
and difficult to carry out in practice. The procedure on the
discharge of a soldier from hospital should, it is considered,
follow closely that recently adopted in the Imperial service
under A.C.L., 1910, under which a soldier discharged from
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POLITICS AND THE C.A.M.C.
hospital to duty is recommended for (i) full duty, (2) com-
mand depot, (3) employment, i.e., base duty.
In the opinion of this Board, many of the complaints and
much of the difficulty experienced as regards the invaliding
and return to duty have been due to the inability of the
Canadian casualty assembly centre to handle the large and
increasing number of casualties, which it is called upon to
deal with, under the existing organization.
In the event of men of the lower categories being returned
to Canada as surplus to requirements, it would be desirable
that the first two pages of A.F.B. 179 be completed by a
M.O. before embarkation, so that any claim against the
public might be safeguarded and recorded. All such records
should be attested by the soldiers' signatures.
XVI. RECORDS.
The criticisms made by Colonel Bruce are generally
agreed to by the Board, which, however, would point out
that they are of universal application, and apply to all medical
services in all wars.
The desirability of improvement in medical records has
not been lost sight of, and all available information is the
subject of special investigation and record by the Medical
Research Committee, which was entrusted with this duty by
the War Office at the beginning of the war.
As regards the individual casualty; there has often been
a lack of sufficient information accompanying the patient
from hospital to hospital, but this is now in course of being
remedied, and it has been arranged that field medical cards
and hospital reports, including X-ray photographs, and any
other essential information, shall accompany the patient from
stage to stage. Every effort is made in the Record Office
to keep the medical history sheets complete, and, to make
them available for use in hospital, Surgeon-General Jones
early arranged for a duplicate sheet to be maintained by the
officer i/c records.
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POLITICS AND THE C.A.M.C.
Much of the information which has accumulated will
ultimately be brought together and should be available when
the final estimation of a soldier's pension is under considera-
tion. The Board understands that all pensions in the first
instance are temporary in character.
In conclusion, the Board cannot agree that the defects
in the system are attributable to the C.A.M.C, or that the pro-
posals of Colonel Bruce are practicable, while it is satisfied
that Surgeon-General Jones has done a great deal towards
the establishment of a better system than has hitherto been
available in armies of the field.
XVII. PENSIONS.
The importance of the question of pensions is recognised
by the Board, but primarily it is not a duty of the Canadian
Army Medical Corps. It is the duty of the Medical Service
to assist the pension authorities by complying with all reason-
able directions as to the preparation of the medical reports,
upon which claims are adjudged; but it is obvious that the
Medical Service is not responsible for the absence in invalid-
ing forms of special means of identification, such as "thumb
prints," nor is that Service in any way concerned with " dead
or missing" men. In this section, as elsewhere. Colonel
Bruce has confused the duties of the Medical Service with
those of the Adjutant-General's branch, and there is no
ground, in the Board's opinion, for a charge of neglect to
an " almost criminal degree."
It is only fair to Colonel Bruce to note that in his evidence
he withdrew the remarks to which attention has been drawn
above.
The Board is of opinion that the ultimate investigation
of pensionable cases should take place in Canada, where
special Boards can be convened and special methods of
research be employed, for it is not at the base of an army
in the field that these questions can be deliberately determined.
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POLITICS AND THE C.A.M.C.
XVIIL CO-ORDINA TION.
Many of the matters dealt with here have been referred
to by the Board in its comments on the first section of Colonel
Bruce's Report.
The adoption of identical standards of fitness, however
theoretically desirable, is, in practice, impossible, as officers
will judge " fitness " by the conditions that appeal to them
at the moment. For example, a soldier that would be considered
quite fit for a summer campaign will frequently be rejected
when it comes to a question of his doing duty in the trenches
in the winter; similarly, while men may be enlisted up to a
certain age, it may be that the general officer commanding a
force in the field will not, under special circumstances, accept
men of the maximum age.
The only course is the enforcement of a stringent
examination on enlistment, and adherence to whatever
standard of fitness may be laid down in regulations from
time to time.
As to questions raised as regards quarantinable diseases,
such as trachoma, the Board agrees with Colonel Bruce that
special action should have been taken to obtain sanction for
the return of such cases to Canada.
XIX. C.A.M.C. PBRSONNBL NOT USED TO
ADVANTAGE.
The Board disagrees with the contention that underlies
Colonel Bruce's Report that the services of the Canadian Army
Medical Corps officers and other ranks should be confined to
Canadian troops, and the case quoted where Canadian medical
units were sent to the Mediterranean to service with an
Imperial force that did not include Canadian troops, seems
to this Board to illustrate the " water-tight compartment "
conception that in the early part of this Report has been
commented upon as mischievous and erroneous.
The statement that certain medical units are " not serving,
except in a small proportion of cases, the Canadian sick and
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wounded in France," is not true so far as the thirteen field
ambulances referred to are concerned, while, as regards the
casualty clearing stations and stationary and general hospitals,
it is obvious that their employment on the line of communi-
cation necessitates their being used for all troops using that
line.
As to the unsuitable allocation of duties, the Board is of
opinion that the need of trained experts at the base and in
casualty clearing stations is not appreciated by Colonel Bruce,
while a specially trained practitioner who can efficiently
command a field ambulance is, as a rule, of more value at
the Front than he would be as a specialist in a general hos-
pital.
It would be easy to controvert the instances mentioned by
Colonel Bruce, but it does not seem to the Board to be
necessary to enter into the personal qualifications of par-
ticular officers.
With regard to the Nursing Service, to which Colonel
Bruce refers in this section, it must be borne in mind that
the hospitals in England are, in effect, training schools and
depots, and that the requirements of the hospitals at the
Front must have preference.
As to the allegations of unfitness among officers selected
for commissions in the Canadian Army Medical Corps, from
over-age, addiction to alcohol and other drugs, etc., this Board
deprecates such unqualified statements.
Had Colonel Bruce added what must have been within
his knowledge, as it is of this Board, that the proportion
of undesirables in this corps is at least as low as in any other
branch of the service, there would have been no objection
to his criticism.
With reference to the A.D.M.S., Embarkation, Bath, the
Board is agreed that the multiplication of staff officers with
the status and pay of A.D.M.S. is undesirable.
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POLITICS AND THE C.A.M.C.
XX. CONSULTING SPBCIAUSTS.
The Board is agreed as to the desirability of appointing
civil practitioners of eminence as consulting physicians and
surgeons to the Canadian hospitals in England, but thinks
that the appointment of consultants to the Expeditionary
Force is a matter for the decision of the Imperial authorities.
The question has been discussed by this Board in its
comments on section XV.
No evidence was adduced by Colonel Bruce that a number
of medical and surgical specialists either offered their ser-
vices or were refused by the D.M.S., but General Jones
stated in his reply that up to July there was " a large pro-
portion of men of consultant rank in the several units, but
as the service developed the situation became modified, and
consultants have since been employed as required." Up to
this date, only one, lyieutenant-Colonel Finley, has been
appointed.
The recommendation of Colonel Bruce, on page 68, is
concurred in, but the Board has already expressed its opinion
that the appointments should be to the Imperial Army.
XXI. DISCONTENT AS TO PROMOTION.
Interest in this topic exists in all armies in the form of
the desire for promotion and the accompanying increase of
pay and allowance. Evidence that this is abnormal in the
Canadian Army Medical Corps was not produced. The Board
is of opinion that the initial error lay in giving no lower
rank than that of captain to officers on joining the Canadian
Army Medical Corps. It is plain that majors and lieutenant-
colonels can be employed only in small numbers, and that
under present conditions most of those who began their
service as captains will conclude their service in this war
with the same rank.
The Board regrets that it cannot concur in the recom-
mendation that steps in rank should be given to *' deserving
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POLITICS AND THE C.A.M.C.
medical officers of battalions and field ambulances who have
served overseas," in order that their services may be utilised
on Medical Boards and in hospitals in England, as promotion
cannot fairly be made irrespective of the rights of all others
in the same rank.
This Board recommends that the ordinary rules of pro-
motion be observed, and the senior officer be selected for
promotion, provided he has all the necessary qualifications,
and that all future first commissions be in the rank of
lieutenant.
XXIL C.A.M.C. TRAINING SCHOOL.
The Board agrees with Colonel Bruce's statement that the
Canadian Army Medical Corps Training School has never
been properly organised. It has not yet been given an estab-
lishment, and only recently suitable accommodation. As the
Training School is, in effect, the depot of the Canadian Army
Medical Corps overseas, it is of particular importance that
it should be fully organised under an officer with practical
experience in the field.
From the evidence it is clear that efforts were made by
the D.M.S. from time to time to get a suitable location
allotted to this unit, and, in the view of the Board, no
responsibility attaches to him, as he did not receive assistance
or support from the authorities.
The Board recommends that this important question
receive early consideration.
XXIII . ECONOMY IN MANAGEMENT.
The Board cannot agree that in the operation of the
Medical Service sufficient attention has not been paid to
economy in management; on the contrary, the various
arrangements that have come under its knowledge have been
generally most advantageous to the Canadian Government.
It need only add as an example, the maintenance of Canadian
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patients in V.A.D.'s and Imperial hospitals at three shillings
per day. ' i*'|j
The Board would refer to the findings of the Special
Board, presided over by Lieutenant-Colonel Harold Machen,
from which it will be seen that the service has been managed
with a due regard to economy.
(Signed) W. Babtie, Surg.-General, President
of the Board.
(Signed) Ernest E. Ashton, Colonel;
(Signed) J. T. Fotheringham, Colonel;
(Signed) A. E. Ross, Colonel;
(Signed) J. W. Elder, Lieutenant-Colonel;
Members of the Board.
Dated at London, England,
December 21st, 1916.
On January ist, 19 17, following the announce-
ment in the London Times, Sir George Perley
handed to the London correspondent of the Cana-
dian Associated Press a lengthy summary of the
Babtie Report, which was published on January 2nd,
in the leading newspapers of Canada, and in which
emphasis was given to any points of disagreement
with my Report. This summary was prefaced by a
statement credited to Sir George by the Canadian
Associated Press and designed to prejudice Cana-
dian opinion against my Report and generally
mislead the public. For instance Sir George stated :
" The Board was thus composed of eminent
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POLITICS AND THE C.A.M.C.
officers of wide experience and the highest profes-
sional standing who had actual experience and
intimate personal knozvledge of the requirements of
the Medical Service."
The facts were that not one member of the Babtie
Board had actual experience and intimate personal
knowledge of the conditions which I had investigated
and revealed, and which during the brief period
allowed me to re-organize the service, as Inspector-
General, I had done my best to remedy.
In the next paragraph of his statement to the
Canadian Press Sir George said: —
" The people of Canada will, above all, be much
relieved and pleased to know that the Board, relying
on its own observations and on the evidence before
it, is abundantly satisfied that the Canadian sick and
wounded have been thoroughly and well cared for.
The Board disagrees with Dr. Bruce's criticisms
and recommendations except in one or tzvo minor
instances, particularly with reference to the concen-
tration of Canadian sick and wounded in Canadian
hospitals."
This statement was evidently designedly mislead-
ing, the Board having actually been compelled by
the evidence to acquiesce in many of the essential
criticisms and recommendations of my Report.
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POUTICS AND THE C.A.M.C.
Moreover, as is elsewhere shown, the personal
observations on which the Babtie Board relied were
singularly incomplete, less than three days having
been devoted to actual observation of conditions. No
evidence was cited in the text of the Report which
might sustain and justify its findings, nor was any
printed with that document, to show how far these
findings were consistent with the evidence. It will
thus be seen that ever since January 2nd, 19 17, the
Canadian public has been left with an erroneous
impression of the nature of the Babtie Board's
Report, and has been given no information as to the
investigations made and the evidence taken on
which it is presumably based.
MY REPLY TO THE BABTIE BOARD'S
FINDING.
Immediately upon the publication of the Babtie
Board's finding, and although I had not then nor
have I to this day been favored with a copy of the
evidence on which it was based, I prepared a reply,
which I forwarded to Ottawa. That reply was
suppressed by the Canadian Government, even
though repeatedly asked for on the floor of the
House of Commons, and is now for the first time
given to the public.
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POLITICS AND THE C.A.M.C.
The Memorandum of Coi^onEIv Herbert A.
Bruce, C.A.M.C, Formeri^y InspEctor-GenErai,
OF THE Canadian Army Medical Service, Upon
THE Report of the Board of Inquiry Appointed
BY Sir George PerlEy, Minister of Miutia,
Overseas, on November i6th^ 1916, to Report
Upon.
(a) " The Criticisms Made by C01.ONE1.
Bruce'^ (Upon the Canadian Medical
Service Overseas) '' As to Whether
They are Justified, in Whole or in
Part.''
(b) "The Recommendations made by Colonel
Bruce; as to Whether the Board
Endorses and Concurs in Them ; if
Not, in What Respect does the Board
Differ from Colonel Bruce and its
Reasons Therefor."
Submitted to The Honorable Sir Edward
Kemp, Minister of Militia and Defence,
Canada, May i8th, 19 17.
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POLITICS AND THE C.A.M.C.
MEMORANDUM OF
COLONEL HERBERT A. BRUCE, C.A.M.C.
The report of the Babtie Board of Inquiry upon
the result of my investigation into the Canadian
Medical Service overseas, which I undertook in the
latter part of 1916, on behalf of the Canadian
Government, was made public in London on
January ist, 191 7. As the result of this publication
controversy ensued which interfered with and
delayed the adoption of the urgent reforms which
I had earnestly and conscientiously advocated in
my Report. Subsequently Sir George Perley,
Minister of Militia, overseas, at my request, gave
me permission to reply to the findings of the Babtie
Board. I hesitated to take this course, because my
original Report was prepared and submitted as a
confidential and official communication to the
Government, but inasmuch as it was not so treated
I have decided to avail myself of the permission
given me to reply.
I have been relieved of my duties, and the office
of Inspector-General abolished, and as I am entering
upon another appointment overseas, but still having
the welfare of the sick and wounded in our Cana-
dian Contingents at heart, I now beg to submit
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POLITICS AND THE C.A.M.C.
the following memorandum, which in my present
unofficial capacity I respectfully and with deep
feeling urge upon the consideration of the Govern-
ment.
My one regret is that after five months of
incessant effort, the task undertaken for the better-
ment of the Canadian sick and wounded in England,
has ended, not in action, but in controversy, although
the re-organization under way when I was removed
from office gave every promise of success.
The broad difference between my finding and
that of the Babtie Board is that my Report was
based on a personal scrutiny of actual existing con-
ditions in the Medical Service, whereas the Babtie
Board was content with the evidence of those
identified with the service, the Board's only intimate
enquiry being confined to a tour of the Shorncliffe
area, occupying three days. Unlike the Babtie
Board, I had.no preliminary report with which to
theorise, but the more laborious, and in the end
more satisfactory, task of ascertaining actual con-
ditions as they existed.
The opening statement of the Babtie Board
intimates that it was appointed by the Imperial War
Office. In fact the Board was appointed by Sir
George Perley in a letter dated November i6th,
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POLITICS AND THE C.A.M.C.
19 1 6, instructing the Canadian Adjutant-General
to convene a Board of Inquiry, and specifying its
constitution and duties. The Canadian members
of the Board were not selected by the War Office,
but were the appointees of Sir George Perley,
although the President, Sir Wm. Babtie, was chosen
after a conference with the British Director-General
of Medical Services.
The first intimation I had of the personnel of
this Board was from the notice communicated by
Sir George Perley to the London Times. I pro-
tested against the constitution of the Board to the
Minister and by cable to the Prime Minister of
Canada, for the reason that at least three of the
Canadian members of the Board had already
criticised openly and bitterly the recommendations
contained in my Report, and because it was obvious
to those of us who had been engaged in the investi-
gation of the gross abuses which we had
exposed that the members of this Board had been
selected with the object of white-washing the Ser-
vice and those responsible for its shortcomings.
On November 1 8th, two days after being appointed
a member of this Board, Colonel Fotheringham
issued a memorandum expressing his opinion that
no occasion had arisen " for any lack of confidence
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POLITICS AND THE C.A.M.C.
in the policy of administration of the Director of
Medical Services in London," and further, that we
" desire nothing that will segregate us from the
rest of the Medical Services of the Empire." This
memorandum was distributed to medical officers of
certain battalions at the Front, and was of itself
sufficient to justify the protest as to his prejudice,
and to create pardonable surprise at his willingness,
under the circumstances, to serve on the Board.
The British Medical Journal, in its issue of
November 25th, the day upon which the Board
convened, announced that there was reason to
" believe that the tenor of the report will be such
as to lead to the reinstatement of General Jones."
It was not difficult for this journal to prophesy the
result of the enquiry, for in the Canadian colony
in London, and particularly in official circles, there
existed, as was natural from the expressed attitude
of Colonel Fotheringham and others in high
authority, advance information that the Babtie
Board would ultimately reinstate General Jones,
and would, as far as possible, discredit the recom-
mendations which were the unanimous expression
of all who had been engaged with me in probing
the abuses existing in our Medical Service.
13 193
POLITICS AND THE C.A.M.C.
In view of the unanimity of my confreres who
contributed in so important a measure to my Report,
may I briefly outline their eminent qualifications
for the unpleasant but necessary task which they so
cheerfully and ably performed?
COLONEL REID, whose post as Director of
Recruiting and Organization, had placed upon him
the responsibility for the disposition of all our
Canadian casualties for over a year, and was,
therefore, able to give us important information,
supported by records in regard to unfits and the
conduct of other branches of the service.
COLONEL WALLACE SCOTT, a Fellow of
the Royal College of Surgeons of England, and
formerly a teacher in surgery in the University of
Toronto. After fifteen years' previous military
training he joined the First Contingent at Valcartier
and has been in the Medical Service overseas since,
and is now in charge of a thousand-bed hospital at
Shorncliffe.
LIEUT. -COLONEL P. W. E. WILSON, ior ten
years in the CANADIAN ARMY MEDICAL
CORPS, had been an administrative oflicer in the
Shorncliffe district for a year and a half, and was
Deputy Director of Medical Services for England
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POLITICS AND THE C.A.M.C.
during the re-organization, which post he held until
removed by General Jones upon the latter's return
to office.
LIEUTENANT -COLONEL WALTER
McKEOWN^ chief surgeon of St. Michael's Hos-
pital and a professor of clinical surgery in the
University of Toronto, for the last year and a half
president of a Medical Board in the Shorncliffe
area, during which time thousands of cases have
passed through his hands.
MAJOR CHARLES HUNTER, of Winnipeg,
as president for a year and a half of a Medical
Board examined thousands of casualties, and is
admittedly the foremost expert in Medical Board
matters.
The standing and experience of these two last-
mentioned officers makes them eminently qualified
to give an authoritative opinion upon the Medical
Board situation, and incidentally in its relation to
pensions.
May I here again state that my Report was con-
curred in by every member of this Committee?
The president of the Babtie Board is an Imperial
officer of high standing, who has been engaged in
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POLITICS AND THE C.A.M.C.
administrative work in India and elsewhere during
the whole of his professional career.
COLONEL ASHTON is a combatant officer, the
G.O.C. of the Shorncliffe area, and although a
physician by profession is not a member of the
C.A.M.C, and has been continuously engaged as a
combatant officer since going to England.
COLONEL FOTHERINGHAM AND
COLONEL ROSS were administrative officers at
the Front, being in charge of the field ambulances
practically since entering the overseas service.
LIEUTENANT-COLONEL ELDER, a sur-
geon of high standing in Montreal, has been engaged
in surgical work in France since going over from
Canada.
To the military and medical standing of the
members of the Babtie Board no one could be more
ready to extend due credit than myself, but wide
as had been their general experience in other phases
of the Army Medical Service, the problems upon
which they were supposed to express an opinion
were essentially new to them and presented diffi-
culties which no serious investigators could under-
stand except by personal contact. The work of an
196
POLITICS AND THE C.A.M.C.
administrator at the Front, whose whole object is
to facihtate the movement of the wounded with the
least delay to the army hospitals, demands unique
and outstanding abilities, but it furnishes no pre-
paration for the administration and care of patients
in hospitals where a finality of treatment is aimed
at. In making this statement I am emphasizing
the vitally important difference in the value of my
Report as compared with the findings of the Babtie
Board — one was the product of the careful research
of competent officers, thoroughly trained in the
duties which they undertook, the other the product
of a casual examination by officers — equally com-
petent, perhaps, in their respective fields — totally
unfamiliar with the underlying difficulties of the
task assigned them.
Although by the terms of reference to the Babtie
Board to report upon " the criticisms made by
Colonel Bruce " and " the recommendations made
by Colonel Bruce, as to whether the Board endorses
and concurs in them," myself and my Report were
on trial, I was barred from being present at the
sittings of the Board, except when called upon to
attend as a witness — this despite the provision of
the King's Regulations that when an enquiry affects
the character and military reputation of an officer
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POLITICS AND THE C.A.M.C.
or soldier *' full opportunity must be afforded the
officer or soldier to be present throughout the
enquiry." My exclusion from the hearing was
accompanied by the persistent refusal by Sir George
Perley of my request to have the scope of the enquiry
enlarged to permit of the submission of additional
evidence of grave irregularities discovered subse-
quent to the publication of my Report of the serious
nature of which the Minister was fully cognisant.
The temper of the communications of the Minister
in reply to my protests and the hostile attitude of
the Board towards me was sufficient evidence that
the early information of the treatment that was to
be accorded my colleagues and myself and our
Report, was not without foundation.
The chief criticism levelled at myself at the time
was my lack of military experience, although the
situation upon which I had been asked to report
involved matters of hospital rather than military
administration, and was, in fact, a business with
which a large part of my professional life had been
concerned.
The members of the Babtie Board reported that
they found three principal points emerging from
my Report —
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POLITICS AND THE C.A.M.C.
The concentration of Canadian soldiers in
Canadian hospitals;
The suitability of the Voluntary Aid hospitals,
and
The system of Medical Boards.
These are far from being the outstanding features
of my Report, which was an unbiassed and unin-
spired statement of the grave abuses which had been
revealed by our painstaking investigation of concrete
cases. But there was a motive which impelled the
Babtie Board to project subordinate issues into the
leading place in its Report, and thus dwarf and
becloud the revelations and recommendations con-
tained in my finding. I did strongly urge the
concentration of Canadian soldiers in Canadian
hospitals, but it was never intended by me that the
Canadian hospitals should be reserved exclusively
for the care of the Canadian sick and wounded.
What I asked for in this connection was that instruc-
tions should be given to the embarkation officers at
Southampton and Dover that: —
(a) Canadians be directed to Canadian hospitals
if there are beds available.
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POLITICS AND THE C.A.M.C.
(b) If no beds are available in Canadian hos-
pitals, that they should then be directed to
Imperial hospitals in a specified area.
Even if this system were in force, owing to the
exigencies of war, we should probably only be able
to get a preponderance of Canadians in Canadian
hospitals, and should always have a certain propor-
tion — a quarter or a third — of British and other
Imperial patients.
The recommendations contained in my Report on
the subject of the concentration of our soldiers
in Canadian hospitals were so distorted that the
majority of the Canadian people have yet to learn
their real nature, but the policy itself had actually
been adopted by General Jones towards the end of
191 5, and though later abandoned, its merits are
still advocated by him in his reply to my Report.
It was General Jones who contributed to the dis-
cussion of the subject the term " segregation," which
is not used in my Report, and certainly does not
represent my policy in this regard. It may be
pertinent to quote the passage in which this term is
first used, as in the same paragraph, which is from
page 4 of the Interim Report of Surgeon-General
Jones in reply to my Report, is contained some of
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POLITICS AND THE C.A.M.C.
the reasons why my recommendations of concentra-
tion were so fiercely attacked and why the poHcy
was abandoned: —
" The poHcy of segregating Canadians/' writes
General Jones, " was changed in February of this
year, owing chiefly to the strong stand of the Acting
High Commissioner, Sir George Perley, who held
that Canadians should mix with the other soldiers
of the Empire, in hospital. I was further informed
by Sir George Perley that persons in very high
positions thought strongly on this matter, and con-
sidered that in the interests of the Empire there
should be no segregation of the Canadians in hos-
pital. My policy of segregation was, therefore,
receded from."
On the subject of concentration the Babtie Report
states that up to February, 19 16, the accepted policy
was to provide separate hospital accommodation for
Canadian patients, although it was only in October,
19 1 8, that an arrangement was made by the War
Office, in response to a request from the Director
of Medical Services, to send Canadian patients to
the Duchess of Connaught's Hospital, Taplow, and
the Central Military Hospital, Shorncliffe.
In January, 19 16, a meeting was arranged by Sir
George Perley at his office, as High Commissioner
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POLITICS AND THE C.A.M.C.
for Canada, at which Lady Drummond, General
Jones, and others were present, when it was urged
by Lady Drummond (and supported by Sir George
Perley) that there should be no attempt to separate
Canadian and British patients. General Jones, who
had previously advanced excellent reasons in favor
of the concentration of Canadian patients, then
acquiesced in Lady Drummond's suggestions and
receded from his own policy of " segregation."
Later, the Babtie Board found that the concentra-
tion of Canadians in Canadian hospitals was " not
only unwise, but impracticable," and its Report
speaks of the ** water-tight compartment policy" and
the separation " on their return to England of men
who have fought side by side " as tending to ** undo
the bond of brotherhood sealed in the face of the
enemy." These are high-sounding phrases, but they
are not entirely fact. Our four divisions are fight-
ing as a corps in France, as part of the Imperial
army. On both sides they are in contact with the
British forces, and there is some intermingling, but
the fact is that we are holding as a unit a certain
portion of the line. Our soldiers are not interspersed
among the British soldiers in the manner indicated
by the Babtie Board, and Canadian sick and
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wounded on the completion of their hospital treat-
ment go to Canadian training centres and Canadian
reserve battalions.
The Babtie Board states that the separation of
Canadian casualties from British casualties is
'' impracticable and impossible," but for three or
four months last winter our sick were actually
being separated upon their arrival in England and
sent to Canadian hospitals. Further, the Board
heard — and ignored — the evidence of Surgeon-
General Donovan, the chief embarkation officer in
England, on this point, who stated that such a
separation could be accomplished, if it was desired.
I may mention here that, subsequent to the
publication of my Report and before the appointment
of the Board of Inquiry, Lady Drummond, in a
letter to the London Times, objected to the section
of the Report which dealt with the concentration
of Canadians in Canadian hospitals, which she
described as " segregation." This letter gave rise
to a certain amount of controversy, to which, being
an officer, I was unable to reply.
The inquiries which were carried out during the
course of my re-organization, in regard to Canadians
in Imperial hospitals, gave sufficient evidence of
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POLITICS AND THE C.A.M.C.
the desirability of their being concentrated in hos-
pitals in definite areas. The following is a summary
of the reports of the inspectors: —
The Canadian patients were scattered from
Aberdeenshire in the north of Scotland to the
extreme south of England, and were also found in
hospitals in Ireland at distances of from five to
fifty miles from the base hospitals in Dublin, Cork
and Belfast, and even the Isle of Guernsey claimed
one Canadian patient. It was, therefore, obvious
that, under the existing arrangements, satisfactory
systematic inspection of Canadians in Imperial
hospitals was quite impossible.
The majority of these men stated that they would
have preferred being sent to a Canadian hospital,
not because they had any complaints to make in
regard to the treatment they received in British
hospitals, but because they would have preferred to
be amongst their own people. Judging from the
individual reports and from interviews with the
inspectors, I was satisfied that the Canadian sick
and wounded in British hospitals were being well
looked after, and receiving every kindness from the
doctors and nurses. It was of interest to note that
one of the inspectors stated that a large number of
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POLITICS AND THE C.A.M.C.
the Canadians in Scotch hospitals were of Scotch
extraction, and had been given a choice, when cross-
ing the Channel, as to where they wished to be
sent. This being so, there would seem to be no
difficulty in carrying out the recommendation made
by me, vis. : that Canadians should, as far as pos-
sible, be sent to Canadian hospitals.
Of the 7,216 cases seen by the inspectors, 2,313
were ready to go to convalescent hospitals, or nearly
one-third of the total number of 7,216. Army
Council instructions specified that Canadians in
Imperial hospitals should be transferred to Canadian
convalescent hospitals when " convalescent," and
569 of these cases had already been notified to the
Canadian authorities as awaiting such transfer.
Lack of accommodation in Canadian hospitals, how-
ever, prevented the transfer of these cases. This
needless delay, when the men ought to have been
in our convalescent camps undergoing physical
training and preparation for duty, in the first place
interfered with the keeping up of reinforcements,
and in the second place entailed unnecessary expense
to Canada.
Nearly a quarter of the patients seen — 1,660 out
of 7,216 — were suitable cases to be sent for further
treatment to Canada, either immediately or within
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POLITICS AND THE C.A.M.G.
a month or so, and 44 more were considered as
likely to be suitable for such transference after they
had had some months of further treatment in
Britain. Thus more than half of the patients seen
in Imperial hospitals should either have been in a
convalescent camp or on their way to Canada.
The usual arrangement in the British Service
was to have central military hospitals, with a large
number of auxiliary or V.A.D. hospitals attached
to them, some of them having as many as sixty of
these auxiliary hospitals, which were not infre-
quently many miles from the central hospital and
accessible only by motor car. One of the inspectors
stated that to " inspect the auxiliaries to the Edmon-
ton Central Hospital, which were 58 in number, or
to the Chatham Military Hospital, which were 67
in number, would require the use of a motor car,
and at least ten days' time."
Another inspector stated that " two cases in the
extreme north of England could not be seen at all,
as to do so involved motoring over a hundred miles,
or spending parts of two days in the train."
Owing to the great difficulty of inspecting
patients in these out of the way hospitals they were
liable to be retained in them much longer than was
necessary, resulting in a loss of man-power to our
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army in the field. Many of these hospitals had no
proper facilities for operation or X-ray examination,
and if these were required the patient had to be
transferred to another hospital, often at some con-
siderable distance.
The results of this inspection made it perfectly
clear that systematic inspection of Canadians in
Imperial hospitals was quite impossible under the
existing arrangements.
The adoption of the policy of concentration would
not prevent the use of Canadian medical units in the
Mediterranean, or the sending of Canadian hospitals
to Paris, or the use of Canadian medical units else-
where, when we could spare them.
My criticism of the despatch of No. 4 Canadian
General Hospital to the Mediterranean was based
upon the then deplorable lack of hospital accom-
modation for Canadians in England. Colonel
Rennie, in General Jones' Reply, states that upon the
arrival of No. 4 Canadian General Hospital in
England, in June, 19 15, he suggested to General
Jones that it be used to staff a general hospital of
1,040 beds. Had this excellent suggestion been
adopted, it would not have been necessary to take
over the group of 57 Voluntary Aid hospitals in the
Shorncliffe area, the suitability of which for our
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purposes it became my duty later to criticize and
condemn.
The first obligation of the Canadian Medical Ser-
vice is to the Canadian sick and wounded, and after
the performance of this primary duty, it is our duty
and privilege to supply as many additional medical
units as the resources of Canada will permit.
I have not lost sight of the " High Imperial
Policy" mentioned by the Babtie Board in its report,
and by Ivady Drummond in her letter to the London
Times, which appears to have originated the " segre-
gation " controversy. I am personally of the opinion
that our soldiers, who have left their homes to join
the colors, and who, as a part of the Imperial Army,
are fighting our battles in the cause of freedom and
right, have surely proven that they are imbued with
true Imperial instincts, and that when they return
wounded or sick to England, after having shown
their willingness to make the supreme sacrifice, they
do not need to pass through a kindergarten of Im-
perialism in the hospitals.
VOLUNTARY AID HOSPITALS.
As a rule patients are well cared for, comfortable,
and enjoy their stay in Voluntary Aid hospitals, as
is evidenced by the difficulty of getting them out of
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these hospitals, and I should like here to express my
appreciation of the self-sacrifice and devotion dis-
played by the V.A.D. workers, and of the splendid
services which they have rendered to the sick and
wounded. There is plenty of work which these par-
tially trained nurses are able to do in different
capacities, and I would be the last to disparage such
valuable services, but in our hospitals we provide
thoroughly trained, graduate nurses, and our soldiers
when requiring active treatment should have the
advantage of the highest technical training.
The duty of our Medical Service was to provide
sufficient beds for Canadian patients requiring
active treatment, in a concentrated area, rather than
being dependent upon the widely scattered Volun-
tary Aid hospitals. I impressed upon Sir George
Perley, both by interviews and letters, the urgent
necessity of increasing the hospital accommodation
without avail. Negotiations with the War Office
were entered into for the acquisition of the Kitch-
ener Hospital at Brighton, and if my efforts in this
regard had been backed by Sir George Perley, this
hospital, in my opinion, could have been acquired
months ago. During my term of office arrangements
were made to increase the accommodation of the
Duchess of Connaught Hospital, Taplow, by 500
209
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POLITICS AND THE C.A.M.C.
beds, and with Mr. Harold Kennedy's agents, for
the acquisition of a building at Liverpool with ac-
commodation for 350, with the object of using it
as a rest hospital for patients in transit. A cable
was sent by me to the Ontario Government, asking
whether, in view of the necessity for further hos-
pital accommodation for Canadians in England, they
would increase that at Orpington by 1,000 beds,
and this was ultimately done.
No criticism whatsoever was made in my report
of the mobilization of the medical resources of the
United Kingdom by the British Medical Service.
Such resources have been and are being tried to the
utmost, and every ingenuity had to be employed in
the organisation of the system best suited to the
purpose, and the objections to the use of V.A.D.'s
by us do not in any way apply to the use of these
hospitals by the British Service. We do not require
Voluntary Aid hospitals. The criticism in my re-
port dealt with the absence of a policy which would
enable us to handle our casualties most efficiently
and economically in a centralized area, for it must
be remembered that the Canadian authorities alone
are responsible for keeping our divisions up to
strength, and if this is to be done without great
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waste we must have a system of handling our cas-
ualties such as that proposed in my Report.
It should not be forgotten that, with the exception
of a few Voluntary Aid hospitals, especially
equipped to receive direct convoys from the Front,
the great majority are utilized for the care of two
classes of patients:
1. Convalescent soldiers.
2. Chronic cases, who have passed the acute stage
in an active treatment hospital, but still
require prolonged medical treatment.
While Voluntary Aid hospitals are very properly
used by the Imperial Service to take care of those
two classes of cases, the necessity for their employ-
ment by us is obviated in consequence of our sol-
diers, when convalescent, being transferred to
Canadian convalescent hospitals and by the adoption
of my policy of returning to Canada the second
type of case.
The Babtie Board reported that " there is a
necessity for the reformation of the Medical Board
situation," and General Jones, in his reply, accepts
practically all of my recommendations for re-
organisation, but although this and ten other of my
211
POLITICS AND THE C.A.M.C.
fourteen recommendations are concurred in by
General Jones, the official summary of the Babtie
report given to the press by Sir George Perley, con-
tained the statement that except " in one or two
minor instances," the Board did not agree with my
criticisms and recommendations.
In my Report I paid tribute to the high quality
of the service which I found being performed in the
Canadian hospitals, in these words :
" Insofar as the medical and nursing staffs are
concerned, I find that both the doctors and nurses
have discharged their duties in a most self-sacri-
ficing and exemplary manner, and that their work
has been beyond all praise."
The Babtie Board, in reviewing my Report, found
that I had ignored the results obtained by General
Jones. As an investigator appointed to ascertain
and remedy any defects which might exist in our
Medical Services overseas, I deemed it my duty to
state clearly my conclusions without regard to per-
sonal considerations. Lieutenant-General Sir Sam
Hughes, who was then Minister of Militia, informed
me that if the Medical Service could be made more
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efficient he would immediately take steps to put any
necessary changes into effect. No one had a better
opportunity than myself to realize the difficulties
with which General Jones had to contend, but my
investigation began after two years of war and when
the correction of outstanding defects in the system
should not have required the services of an outsider.
In writing my report, I had in mind that a great arm
of our military service, responsible for the care of
thousands of our sick and wounded, should not
suffer neglect because of consideration for a single
individual, however prominent his position in that
organization might be, and however great the social
influence exerted in his behalf. That I was not
tempted to unduly exaggerate the situation should
be apparent from a perusal of the Reply of General
Jones, who concurs in eleven of my fourteen recom-
mendations, and also with another, but raises the
question of expense — differing only in the remaining
two, which have to do with re-organisation. It is
difficult to reconcile this discrepancy of view between
General Jones and the Babtie Board on the essentials
of the medical situation with the Board's most favor-
able estimate of General Jones himself. The radical
recommendations made by me, in which General
Jones concurs, would obviously be unnecessary if
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POLITICS AND THE C.A M.C.
my criticisms were not justified. General Jones'
reply to my Report is sufficient proof that he recog-
nized the gravity of the criticisms by his concurrence
in the bulk of my recommendations.
General Jones either did or did not understand
the necessities of the medical situation. If he did,
then his concurrence in practically all of my recom-
mendations justifies in the main the criticisms upon
which they are based. If he did not understand the
needs of the situation, as the Board implies by its
dissent from my recommendations, although con-
curred in by General Jones, how then can their very
favorable estimate of his administration be justified ?
A summary of the recommendations in my Report,
and of the remarks on them in General Jones' reply,
is given herewith :
Recommendation i.
That the Canadian Medical Service be re-
organised from top to bottom.
General Jones does not concur in this.
Recommendation 2.
That the medical arrangements in Canada, Eng-
land and overseas be co-ordinated, so that the
special qualifications of each medical officer be
used to the best advantage.
General Jones concurs in this.
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Recommendation 3.
That Canadian casualties be as far as possible
treated in Canadian hospitals, the first duty of
the Canadian Army Medical Corps being to the
Canadian sick and wounded.
General Jones concurs in this, but adds that it
would be expensive to provide the additional
hospital accommodation required.
Recommendation 4.
That there be a concentration of Canadian hos-
pitals, and that the use of Voluntary Aid
hospitals for Canadians be discontinued.
General Jones again calls attention to the expense
of this, but states that if it is otherwise con-
sidered advisable, there are no medical reasons
why this policy should not be adopted.
Recommendation 5.
That we discontinue the present arrangement with
the Red Cross in so far as the operation of
hospitals jointly with them is concerned, and
that in future we take over from them for ad-
ministration any hospitals which they procure
and equip.
General Jones does not object to this if it can be
arranged with the Red Cross Society.
215
POLITICS AND THE C.A.M.C.
Recommendation 6.
That as soon as suitable accommodation can be
provided in Canada, soldiers who are obviously
incapacitated from any further active service
be returned to Canada when they are fit to
travel without detriment to their health, their
further medical treatment and necessary re-
education to be carried out in Canada.
General Jones concurs in this.
Recommendation 7.
That immediate steps be taken to provide hospitals
of 1,000 beds in Halifax, Montreal, Toronto,
Winnipeg, and Vancouver, together with a
smaller one in Ottawa, and that these have
suitable accommodation for a limited number
of officers.
General Jones concurs in this.
Recommendation 8.
That a certain number of Canadian medical
officers, who have had experience at the front,
be detailed for duty in Canada to assist in the
organisation of these hospitals.
General Jones concurs in this.
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POUTICS AND THE C.A.M.C.
Recommendation 9.
That all ranks, before leaving Canada, be ex-
amined by an independent Medical Board, to
ensure the weeding out of unfits, and that a
sufficient number of boards for this purpose be
established throughout Canada, to be under the
direction and control of the A.D.M.S., Em-
barkation.
General Jones concurs in this in general.
Recommendation 10.
That the establishment of the A.D.M.S., Embarka-
tion, at Bath, be abolished.
General Jones concurs in this.
Recommendation 11.
That the three Canadian hospitals now stationed
at Salonika be immediately recalled for duty in
England, if they can be spared by the Imperial
authorities.
General Jones concurs in this, and states that re-
quests for the return of medical units sent to
the Mediterranean as soon as possible were
made to the War Office some months ago.
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POLITICS AND THE C.A.M.C.
Recommendation 12.
That in future no medical units be organized in
Canada for overseas duty.
General Jones concurs in this.
Recommendation 13.
That there be established in Canada a sufficient
number of well equipped C.A.M.C. depots for
thoroughly training the personnel.
General Jones concurs in this.
Recommendation 14.
That the re-organization scheme herewith attached
be adopted.
General Jones does not fully concur in this.
The several headings of my Report, which in the
light of the subsequent controversy appear to call
for comment, are mentioned herewith :
I. Soldiers Arriving in Engi^and From Canada
Me;dicai,i,y Unfit.
Many soldiers are arriving in England from
Canada medically unfit, who should never have been
enlisted.
The Babtie Board agrees that this has occurred
without vigorous protest from the then Director of
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POLITICS AND THE C.A.M.C.
Medical Services. It has resulted in enormous ex-
pense to Canada, and in serious blocking of the
hospitals, owing to the prolonged retention of such
unfits in England.
The Board states that these cases come under
two main headings:
1. Men who do not comply with the recruiting
standards as regards age.
2. Men who are unfit by reason of physical dis-
ability.
The Babtie Board stated that the " Recruiting
Medical Officer is not required in his examination
to consider the apparent age of recruits," and fur-
ther on says that " the remedy lies in more stringent
examination and better organization of recruiting
methods in Canada," and that the apparent age of
the recruit should correspond with his declared age.
This is a recommendation in my Report. The Board
considered that as the regulations do not require the
Medical Officer to know the apparent age, no charge
should be made against the Medical Service; but
surely when this defect in organisation was first
discovered, it was the duty of the Director of Medi-
cal Services to impress upon the Canadian authori-
ties the necessity of ascertaining that the apparent
age of the recruit corresponds with his declared age.
, 219
POLITICS AND THE C.A.M.C.
In regard to the second group of medically unfit
men, the " Board is not prepared to say that the
responsibility lies with the Director of Medical Ser-
vices," as this belongs to the Adjutant-General's
branch of the Service. It further states that it
" believes, in the absence of the Adjutant-General,
that it was the duty of the Director of Medical Ser-
vices to represent, as often as necessary, to all
sources open to him, the fact that large numbers of
men were arriving here who were unfit for general
service."
The presumption is therefore that he did not do
so. As this neglect is responsible for the presence
in England of thousands of unfits, at present, repre-
senting a useless expenditure of millions of dollars,
and enormous wasted effort, and as since the
beginning of the war there have been many more
thousands of this class, the responsibility for this
must rest somewhere. If, as it appears, the Director"
of Medical Services failed to notify the Government
promptly in regard to this situation, he must accept
at least some responsibility. If, on the other hand,
the Government exonerates him from all responsi-
bility, then the Government itself must be held
responsible. Further, as the Board points out, this
condition of affairs has severely handicapped the
220
POLITICS AND THE C.A.M.C.
Canadian Expeditionary Force, *' both as regards
organisation and training in the United Kingdom
and efficiency in the field." The heavy increase in
our pensions consequent on the enlistment and re-
tention of unfits will amount to millions of dollars
annually.
II AND III. Distribution of Casuai^ties and
Concentration of Hospitai^s.
Let me briefly state my position on the distribution
and concentration of Canadian casualties in hospitals
in England, as my attitude on this subject has been
very much misrepresented. I feel strongly that it
is the duty of the Canadian Government to provide
sufficient hospital accommodation for all our
patients. In spite of extra accommodation for two
thousand, arranged by me, we still require four
thousand beds. In profound disagreement with the
Board, I must emphasize my belief that we can best
show our patriotism, not by sentimental disserta-
tions, but by providing sufficient accommodation for
our own sick and wounded, instead of sponging on
the Imperial authorities as at present, even though
the Board considers that we are saving money by so
doing.
221
POLITICS AND THE C.A.M.C.
The Board states that it is " difficult " and " im-
practicable " to collect and distribute Canadian
invalids among the Canadian hospitals. It seems
strange that this statement should be made in view
of the evidence given by the principal Imperial Em-
barkation Medical Officer, who stated that, far from
its being impossible, these cases could be earmarked
on the ships coming to England, and if they arrived
in considerable numbers could easily be despatched
to any Canadian hospital. If they arrive in small
numbers at Southampton, they could be sent to the
British Clearing Hospital now at Eastleigh, and des-
patched to a Canadian hospital a few days later with-
out our having to provide a clearing hospital. Simi-
larly, cases arriving at Dover in small numbers could
be sent to Moore Barracks Hospital, and later des-
patched to any other Canadian hospital in which beds
were available.
Officers of the Royal Flying Corps are earmarked
and sent to a special hospital in London without any
difficulty, and the same applies to members of the
Household Cavalry. An arrangement is also in
force whereby Territorials may be sent to a hospital
in their own neighborhood. New Zealanders are
directed, by Army Council instructions, " to be con-
centrated in as few hospitals as possible," and
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POLITICS AND THE C.A.M.C.
Australians are sent to certain districts. In fact,
all British sick coming across the Channel are given
a choice as to the locality in the British Isles to
which they prefer to be sent.
The Babtie Board is of opinion that the policy
of centralization is unwise, expensive and imprac-
ticable. It has been shown that it is neither
expensive nor impracticable. The Board holds that
it is " unwise on broad grounds of policy," and gives
an illustration of Canadian sentiment in this matter
by remarking that the " Canadian hospitals at
Beachborough, Taplow, and Orpington are governed
by explicit provisoes on the part of the donors that
they are not to be confined to the treatment of
Canadian sick and wounded."
Queen's Canadian Hospital^ Beachborough.
In General Jones' report, the A.D.M.S. of the
Shorncliffe area states that the only thing Cana-
dian about this hospital, to which a large amount of
Canadian subscriptions were devoted, is the name
" Canadian," and that it has nothing to do with the
Canadian Army Medical Corps, but only with the
Imperials. At the time of my inspection there were
only twelve Canadian patients in the hospital. We
223
POLITICS AND THE C.A.M.C.
provide the hospital with a quartermaster and with
fifteen other ranks at a cost per month to the Can-
adian Government of $450.00.
Duchess of Connaught Hospital, Taplow.
As far as I have been able to ascertain, there was
no objection on the part of the Canadian Red Cross
or of Major Astor, to this hospital being used for
Canadians only. The most convincing proof of this
is the fact that for some months during last winter
Canadians were directed specially to this hospital.
I have been told on the authority of Major Astor
himself that there was no objection to the arrange-
ment suggested by me.
Ontario Military Hospital, Orpington.
As there is doubt in my mind whether the donors
made any explicit proviso as to its use by Canadians
and Imperials conjointly, as stated in the report of
the Board, I would suggest that the matter be cleared
up by reference to the Ontario Government.
As regards the preference of our Canadian sol-
diers for a Canadian hospital, I may say that of
eight thousand Canadians in Imperial hospitals, who
were questioned by inspecting medical officers, more
224
POLITICS AND THE C.A.M.C.
than half expressed a preference for Canadian hos-
pitals, in spite of the fact that a very large number
of the First Contingent were British-born. Captain
W. C. Arnold, C.A.M.C, who returned on the
steamship Scotian, arriving in St. John on February
5th, in charge of invalids, at my request made a
canvass of one hundred of these for the purpose of
ascertaining what their wishes would have been if
they had been given an opportunity of choosing be-
tween an Imperial and a Canadian hospital. Of one
hundred men questioned, about half of whom were
British-born, ninety-one expressed themselves as
being strongly in favor of being sent to a Canadian
hospital. With two exceptions all these men had
had experience with several hospitals in England.
The reason given by the majority of the men for
their preference was that the surroundings would
be more congenial, due to the fact that the patients
and personnel were Canadians who would under-
stand them better, and that they would likely meet
with friends from Canada and from their own units.
The Board states that " there is no reason why any
wish on the part of a Canadian soldier to be treated
in a Canadian hospital should not be met." This
appears to at once dispose of their argument in
opposition to my recommendation, as this is all that
I asked for. ^^^
225
15
POLITICS AND THE C.A.M.C. -
The Board brings forward no argument which
disproves my contention that in order to make use of
the services of a number of skilled Canadian special-
ists to the advantage of our sick and wounded, some
scheme of centralization is imperative.
IV. Unnecessary Detention in Hospitals, Etc.
The Board states that it does not agree " that
there is a lack of efficient medical inspection," but
at the same time is of opinion that " additional in-
spection of Canadian hospitals, and of Canadian
patients in British hospitals throughout the United
Kingdom," is desirable. It further says that the
" desirability of special inspections of Canadian
patients in British hospitals was not fully recognized
by the then Director of Medical Services " until a
very short time before the making of my Report,
and apparently anticipating its appearance. The
first partial inspection of Canadian patients in a few
Imperial hospitals was made in September, 191 6,
by the D.M.S. office.
Arising out of this criticism was the recommenda-
tion that large hospitals for active treatment and
re-education be established in Canada, a policy first
proposed by me. The necessity for such a policy
should have been manifest to the Director of Medical
226
POLITICS AND THE C.A.M.C.
Services two years ago. This recommendation was
one of the prominent features of my Report, and,
recognizing its urgency, I placed it before the Can-
adian authorities some weeks before my Report was
issued. The Board's full concurrence in this
recommendation is not consistent with the statement
in the official report given to the press that they
disagree with the recommendations, except in a few
minor instances.
(Even before my Report was finished, it was
quite clear to me that many thousands of Canadian
wounded in England ought to be immediately re-
turned to Canada, and I sent a telegram in August,
19 16, to the Minister of Militia, which was
forwarded by him to the Prime Minister of Canada,
urging the importance of immediately constructing
hospitals, each with a capacity of a thousand beds
at Halifax, Montreal, Toronto, Winnipeg and
Vancouver, together with a smaller one at Ottawa.
These, hospitals were intended to represent merely
a nucleus, as it was perfectly evident that it would
be necessary to make large additions to them as the
number of our wounded increased. Had the Cana-
dian Government acted upon this advice, there would
not subsequently have been such a great deficiency
of accommodation for the wounded. In addition I
227
POLITICS AND THE C.A.M.C.
suggested to the Minister of Militia that hospitals
should be built similar to the one built by the Ontario
Government at Orpington, a copy of the plans of
which I secured for him.)
It is interesting to note that the Board agrees
that " there is a considerable accumulation of con-
valescent Canadian patients in Imperial hospitals."
As a matter of fact, my inspection of Canadians
in Imperial hospitals showed 2,500 patients suitable
for transference to our convalescent hospitals. But
only about 500 of these had actually been earmarked
by the Imperials for transference, the remaining
2,000 justifying my contention that there is unneces-
sary detention in primary hospitals.
Our ten thousand Canadians were distributed in
over eight hundred Imperial hospitals, some of which
were quite inaccessible by rail, and others only with
great loss of time. The difficulty of reaching these
patients was so great that more than 1,600 of them
were not found at all. This was due to the fact that
they were distributed in a number of small hospitals
in various parts of the country, and also were fre-
quently transferred from one hospital to another.
Two Canadians in a remote district in Scotland, a
hundred miles from the central hospital, were not
visited, owing to the two days' trip involved.
228
POLITICS AND THE C.A.M.C.
This work was done by eighteen inspectors, and
was commenced on November i8th, 19 16, the in-
spection not being completed until January ist, 191 7.
If this inspection is to be of value it must be done
in a limited period, say two weeks, and to accomplish
this would require the services of twenty- four
experienced medical officers, and then it would be
necessary to provide them with the free use of motor
cars for the purpose. Even under these circum-
stances it is clear from our experience that we would
miss a certain proportion of Canadian patients.
The reports of these inspectors were given to this
Board, but it has evidently chosen to entirely disre-
gard them. In the course of the inspection it was
found that 2,500 patients were unfit for further
service, or would require more than six months'
active treatment. The Babtie Board attach con-
siderable importance to the " early provision of
sufficient accommodation for returning invalids to
Canada." This statement is made as if it originated
with the Babtie Board, the fact being completely
ignored that it embraces Nos. 6 and 7 of my recom-
mendations, and that this policy was suggested by
me to the Canadian Government at the end of
August, and that in accordance with it the first
consignment of invalids was sent to Canada on. the
1 8th December, 19 16. 229
POLITICS AND THE C.A.M.C.
I wish to emphasize the fact that the whole
criticisms under this heading was based on actual
knowledge of conditions, and was fortified in my
Report by an appendix, giving details of i66
patients carefully examined, which prove conclu-
sively the accuracy of this criticism. Specific cases
cannot be answered by high-sounding platitudes.
V. Use 0^ V.A.D. Hospitai^s.
In addition to my general remarks on this subject,
I should like to refer to a specific instance, further
proving the unsatisfactory nature of at least one of
our Canadian V.A.D.'s, where some fifty Canadian
soldiers are being cared for. An investigation dis-
closed debts amounting to $7,500.00, which had been
incurred to tradespeople for supplies. Ultimately
a deed of settlement was entered into, whereby an
agent, acting for the creditors, is placed in control,
and can at any time take over the management of
this hospital. It is stated that credit was given,
owing to the belief that the Canadian Government
was responsible.
This unfortunate situation, which could not help
but bring discredit to Canada, would not have hap-
pened had there been any adequate system of inspec-
tion of hospitals by the Director of the Canadian
Medical Services. 230
POLITICS AND THE C.A.M.C.
VI. Administration of Shorncuff^ Group of
V.A.D. H0SPITA1.S.
This entails a cost to us of about $160,000.00 a
year, with no corresponding advantage. If, as has
been stated, the necessity for additional accommoda-
tion for Canadian patients was pressing, the Director
of Medical Services should have utilized the per-
sonnel of No. 4 Canadian General Hospital, who
were then idle at Shorncliffe, and secured a building
which would have accommodated a thousand. The
additional accommodation obtained by the taking
over of these V.A.D. hospitals only increased our
bed capacity by about 500. In my Report I stated
that the cost of this administration was $113,000.00
a year, but certain items were omitted, which bring
it up to $160,000.00.
I had made an arrangement to hand back the
administration of this area to the War Office, and
on November 6th an Imperial officer went down to
take it over. He was subsequently recalled, as Sir
George Perley countermanded the arrangements I
had made with the War Office, with a view to the
saving of this very unnecessary expense. The con-
tinuance of this office since that date until the
present time has cost the Canadian Government over
$93,000.00. It ill becomes the Babtie Board, while
231
POLITICS AND THE C.A.M.C.
objecting to our having sufficient hospital accom-
modation for Canadian patients because of the
expense entailed in securing such accommodation, to
condone this large expenditure, unnecessary as far
as our Medical Service is concerned.
VII. ReivATions With Red Cross.
The present method of operating jointly with the
Red Cross certain hospitals built and equipped by
them is unsatisfactory. Dual control is undesirable.
It is not for a moment suggested that there should
not be a continuance of the happy relationship which
has existed in the past between the Red Cross and
the Medical Service. The Red Cross has its func-
tion, and, as everybody knows, it has discharged
it nobly. But the conditions which I found to exist
at the Duchess of Connaught Hospital, Taplow,
which resulted in a local scandal and brought con-
siderable discredit upon Canada, were, in my
opinion, partially due to a system of dual control
which existed there.
232
POLITICS AND THE C.A.M.C.
VIII. De:taii,ing 01^ C.A.M.C. Personneji, i^or
Imperiai, Service:.
The Babtie Board does not deal quite fairly with
this question, as my chief criticism was in regard to
the large number of C.A.M.C. personnel employed
in the Voluntary Aid hospitals in the Shorncliffe
area, a list of whom is given in the appendix to my
Report under the Shorncliffe hospital group, pages
136 to 144; inclusive. I approve of detailing officers
under certain circumstances for special scientific
investigation with the Imperials, and told the Babtie
Board so.
IX. The: Combination of the Canadian and
Imperiai, A.D.M.S. Offices at Shorn-
cuFFE IS Unsatisfactory.
The A.D.M.S., Colonel Rennie, in his letter
incorporated in Colonel Jones' reply, states his
disapproval of the course pursued by General Jones
in taking over the Voluntary Aid hospitals instead
of utilizing No. 4 Canadian General Hospital, the
personnel of which was then available and idle. The
opinion of this officer is ignored by the Babtie Board.
233
POLITICS AND THE C.A.M.C.
X. No Atte:mpt Has Been Made to Restrict
THE Large Number of Operations
Which Produce No Increased Miutary
Efficiency.
The general statement made by the Board denying
the justice of this criticism is in direct conflict with
the concrete cases quoted in my Report. No orders
were promulgated by General Jones nor did he
appoint a consulting surgeon. Although twenty-one
examples were given, the Board refers only to one,
that of Private N. Downes, 86243, the hospital
records of which they claim are incorrectly reported
by me. I based my report upon the official record
of the Medical Board which examined the man for
discharge from the service, and which also had at
its disposal the official medical history sheet, which
accompanied him from the hospital. Those
documents are now available at the Canadian Record
Office in London and in Ottawa. The man, after
discharge in England, returned to Canada and was
admitted to the Convalescent Home in Toronto, and -
the records of this institution show that he was then
suffering from the disability reported by me. A
further operation was performed at the Toronto
General Hospital on July 18, 19 16, to relieve this
disability, and he was discharged from the hospital
234
POLITICS AND THE C.A.M.C.
on August 4. On October 23, 19 16, he was
examined by a Medical Board and discharged as
medically unfit, on account of the disability given
in my Report. The record in the General Hospital
states that, apart from .this trouble, he was in
*' the best of health." I understand that this
surgeon, before the Board, did not deny hav-
ing operated upon this man, but stated that the
operation was of a different character to that
reported by me. In my report I do not state the
nature of the operation, but simply that an operation
was performed, which was followed by incontinence.
The subsequent history of the case confirms the
accuracy of my original report.
In quoting cases in my Report, I adopted the
practice of suppressing the names of the doctors in
each case, and it was through an inadvertence
that I greatly regretted that this surgeon's
name appeared. Although I gave evidence
before the Babtie Board for the greater part of
three days, I was not asked regarding this case, and
I was not aware that doubt was thrown upon the
accuracy of my report until I read the Babtie Report.
235
POLITICS AND THE C.A.M.C.
XL The InstalIvATion of an Expensive Pi^ant
AT Ramsgate was InadvisabIvE, as a Large
Number of the Cases Treated There
Should be Sent to Canada for Treat-
ment.
The Board agrees that many cases have been
admitted and detained at Ramsgate which should
have been immediately transferred to Canada. If,
as the Board agrees, these cases are better treated
in Canada, I submit that the Director of Medical
Service a year ago should have asked the Govern-
ment to provide such a hospital in Canada instead
of establishing it in England. We should now have
hospitals of this character in several of the larger
centres, especially Montreal, Toronto and Winnipeg,
all of which possess skilled specialists ready and
willing to contribute their services, which undoubted
advantage would be supplemented by the home
environment of the patients.
236
POLITICS AND THE C.A.M.C.
XII. The Estabushme:nt of a Special Hos-
piTAi. AT Buxton for the Treatment of
Rheumatics was IivIv-advised, as the
Majority of Rheumatics will not be
again Fit for Active Service, and could
BE More Efficiently and More Cheaply
Treated in Canada.
The Board states that it is in agreement with my
views in this respect, but when it mentions that this
hospital takes care of shell-shock cases, and there-
fore serves a useful purpose, it entirely loses the
point of my criticism, namely, that this hospital was
established at Buxton because of its medicinal
springs for the specific purpose of treating rheuma-
tism.
XIII. Present System of Handling Canadian
Venereal Patients is Strongly to be
Condemned.
The Board agrees with the criticism, and in the
main with the new method suggested by me of deal-
ing with these cases, namely, to combine a treatment
with training and discipline.
237
POLITICS AND THE C.A.M.C.
XIV. Faulty System of Handling Infectious
Diseases.
Despite the Board's defence of the existing policy
it is admittedly unsatisfactory; even if the Board
is correct in its estimate that it would be more
expensive to care for these cases ourselves, we
should not be prevented by this consideration from
doing what is obviously the best for our patients.
And having regard to the fact that a number of the
medical units which come over are frequently dis-
engaged, I do not agree that it would be more costly.
XV. Medical Boards Have Not Been
Adequately Provided For.
It is significant that while the Board agrees that
" there is a necessity for the reformation of the
Medical Board situation," General Jones accepts
practically all of my recommendations for re-organ-
ization. As the Medical Boards are under the
control of the Director of Medical Service, it is
difficult to see how responsibility for their unsatis-
factory condition, at the end of two years of
operation, can be evaded.
238
POLITICS AND THE C.A.M.C.
XVI. Satisfactory Records Regarding
Individual Cases are Not Available.
In this instance I offered practical suggestions
which would effect a marked improvement in the
records of our sick and wounded — records which
were admitted by all to be most unsatisfactory.
XVII. The Exceedingly Important Question
OF Pensions, which will Involve the
Expenditure of Large Sums of Money
BY Canada Annually has been Neg-
lected BY THE Canadian Medical
Service.
The all-important fact is that Canada has not
been safeguarded in the matter of pensions, and will
pay millions of dollars for such neglect.
Obvious precautions for the identification of
soldiers have not been taken, the records of medical
cases are hopelessly bad, and competent Medical
Boards have not been provided. The history of the
causation of the disability is based entirely on the
applicant's unsupported statement. It was the duty
of the Medical Service to emphasize the necessity
for a workable scheme of identification when the
absence of any such precaution was so apparent.
239
POLITICS AND THE C.A.M.C.
The Board of Inquiry's disclaimer of the responsi-
bility of the Medical Service in this matter will
afford little comfort when the liabilities incurred are
better appreciated.
The Board emphasizes its agreement with me that
each Medical Board dealing with discharge cases
involving pensions should include one surgeon of
experience, one physician of experience, and one
medical officer of good judgment, who has seen
service at the Front. This concurrence on the part
of the Board entirely justifies my criticism in regard
to pensions and Medical Boards.
XVIII. Lack o^ Co-ordination in the: Canadian
Medical Service Between Canada,
England and the Front.
Thousands of unfits arrived in England, and the
Director of Medical Services there failed to impress
this abuse upon the attention of the Government. A
number of men passed as fit according to our
standard in England, and sent to France as re-
inforcements, are being turned back as unfit, and as
is pointed out elsewhere, failure to take adequate
steps to prevent this has caused considerable loss.
240
POLITICS AND THE C.A.M.C.
XIX. C.A.M.C. Phrsonne^i, is Not Being Used
TO THE Best Advantages.
My contention is that the first duty of the Cana-
dian Army Medical Corps is to the Canadian sick
and wounded, and when these are thoroughly pro-
vided for, I entirely approve of hospital units
and medical and nursing personnel being supplied
to the limit of our resources to assist the Imperial
Army or our Allies. My criticism in regard to the
sending of medical units to the Mediterranean was
that at the time No. 4 Canadian General Hospital
was sent to Salonika, according to the Director of
Medical Service there was urgent need of additional
hospital accommodation for our own sick at Shorn-
cliffe. Instead of taking over the group of fifty-
seven V.A.D. hospitals, scattered widely over the
County of Kent, the Director of Medical Services
should have secured a building which would give
the needed accommodation, where the services of
No. 4 Canadian General Hospital could have been
utilized. The work of this hospital at Salonika,
while of the greatest value, was largely, in fact
almost entirely, of a medical character and entailed
a waste of the services of a number of skilled
surgeons, who were urgently needed elsewhere.
16 241
POLITICS AND THE C.A.M.C.
XX. Consulting Specialists.
The Babtie Board further " agrees with Colonel
Bruce and Surgeon-General Jones as to the desira-
bility of additional consultants being appointed."
The intent on the part of the Board evidently is to
make it appear that General Jones held this view,
whereas he was distinctly opposed to it until very
recently. This is obvious from the fact that
although the advisability of appointing consultants
was repeatedly put before him, the first appointment
he made was as recent as July, 19 16. What struck
me most forcibly at the outset was that the Medical
Service was organized on purely administrative
lines, and that the Director of Medical Services had
for two years failed to gather around him in an
advisory capacity leading Canadian physicians and
surgeons, who were readily available. The lack of
this Advisory Board of Medical Consultants was
made evident in the general unsatisfactory hospital
situation, which it was my duty to emphasize.
The policy of the D.M.S. was opposed to the use
of consultants. I might here cite the case of Dr.
Clarence L. Starr, one of the leading orthopaedic
surgeons of Canada, who tried for over a year to
get a position in the Canadian Army Medical Corps
overseas, which would enable him to utilize his
242
POLITICS AND THE C.A.M.C.
special knowledge. Ultimately he offered his ser-
vices to the Royal Army Medical Corps, and was
immediately asked to go overseas. Hearing of his
arrival in England in November, I sent for him
and was fortunate in getting him to take a position
with us as a consultant in orthopaedic surgery, with
the rank of lieutenant-colonel. We were urgently
in need of his special services and already they have
been of great advantage. As soon as I began to
re-organize the Medical Service I recommended
and secured the appointment of Dr. George E.
Armstrong, professor of surgery, McCill University,
Montreal, as consulting surgeon, and Major John
Amyot as consulting sanitary officer, and also recom-
mended the immediate appointment of two more
consulting physicians and another consulting sur-
geon. There can be no gainsaying the fact that
with such consultants available for our hospitals
the standard of efficiency would be very much
increased.
XXL DlSCONTi^NT AS TO PROMOTIONS.
The Board's attitude towards promotions is hide-
bound by the old fetish of seniority. Such seniority,
acquired during many years of peace, has been made
the bar to rapid promotion by merit, to the detri-
ment of the Service.
24^
POLITICS AND THE C.A.M.C.
XXII. The C.A.M.C. Training School has
Neve^r Been Properly Organized.
This criticism is concurred in, but the Board
claims that efforts were made by the Director of
Medical Services to secure a suitable location. Such
suitable location was secured by me within three
weeks of beginning re-organization.
XXIII. In the Operation of the Medical Ser-
vice Su:^FiciENT Attention has Not
Been Paid to Economy in Management.
The Board cannot agree with this criticism, but
states that the arrangements which have come
within its purview have been satisfactory to the
Canadian Government.
This seems an incomprehensible statement, in
view of the fact that evidence was given before the
Babtie Board of the waste of money involved in the
enforced idleness of No. 6 Canadian General Hos-
pital, Paris, for a period of six months. This
hospital at the repeated request of General
Jones, was sent to France on the ist of July, 191 6,
although he had made no provision for a hospital
building. The personnel of three hundred and six
officers, nursing sisters, N.C.O.'s and men, were
244
POLITICS AND THE C.A.M.C.
located in huts and tents, in which they remained
until the middle of January, 191 7, without having
attended a patient, for the reason that no hospital
building was provided.
I received information of difficulties arising in
connection with our hospitals, No. 6 and 8, Paris,
which caused me to send a medical officer to Paris,
(Lieutenant-Colonel McKeown) to look into their
affairs. His report, which is herewith appended,
caused me to ask the War Office to appoint a Board
of Officers to make an investigation of the affairs
of these hospitals, and their report is also appended.
From Colonel McKeown's report it will be seen
that when he visited No. 8 Canadian Hospital they
had only accommodation for 306, and had only 282
patients, with a personnel of 273 — an absurdly
large staff for the number of beds available — mean-
ing a considerable waste of money.
The British Board of Officers' report that the
personnel of No. 6 Canadian General Hospital cost
the Canadian Government £200 ($1,000) per day,
which means for the six months during which
they were in idleness a waste of over $180,000.00.
Although evidence was given as to this to the Board,
the careful limitation of the scope of the inquiry
evidently enabled them to entirely disregard it.
245
POLITICS AND THE C.A.M.C.
When looking into the affairs of No. 6 and 8
Canadian General Hospitals, there seemed to be a
great deal of confusion as to whether the French
Government or the Canadian Government were
responsible for the provision of buildings and other
matters. I was not able to find any agreement in
the Director of Medical Services' office, but did find
a letter from the French Government which clearly
indicated that they had no intention of supplying the
buildings for Nos. 6 and 8 Hospitals. I then made
frequent requests of the High Commissioner,
through the Secretary of the Sub-Militia Council,
for the production of an agreement, if such existed,
but was not able to secure one. It seemed to me
incredible that some business agreement was not
entered into between the French Government and
the Canadian Government setting forth the terms
upon which this unit was sent to France.
Under this heading I should like again to call
attention to the expenditure of $150,000 a year
for the administration of the A.D.M.S., Dover
(Imperial), which, so far as the Canadian Service
is concerned, is not required.
Recent investigation by me of a home supposed
to be used for convalescent officers, and accepted
as such in June, 1916, by General Jones, with an
246
POLITICS AND THE C.A.M.C.
agreement for payment of $1.75 per patient daily,
showed that no hospital returns were made, and
that, consequently, it was impossible to check the
accounts submitted some months later. This estab-
lishment was used mainly as a home for officers
considered temporarily unfit for service, though
requiring no special medical, or surgical attention
The Government has never given authority to use
public funds for this purpose. The accounts sub-
mitted by this home amount to about $7,500.
DUCHBSS OF CONN AUGHT CANADIAN
RED CROSS HOSPITAL, TAP LOW.
In my Report of September 20, 19 16, I did not
deal with the condition of affairs found by me at
this hospital, as my investigations were not con-
cluded. After some preliminary inquiries I asked
that a Board of Officers be convened for the purpose
of inquiring into the affairs of this hospital. The
investigation showed that the sergeant-major was
improperly profiting from dealings with certain
firms and other irregularities which ultimately led
to his being court-martialled and sentenced to penal
servitude. This Board of Officers reported that
proper inspections of the hospital were not made
247
POLITICS AND THE C.A.M.C.
either by the Director of Medical Services or by
officers acting for him. They state : '* Had a reason-
able supervision been maintained by the Director of
Medical Services, the situation at this hospital
would have been remedied months before, its repu-
tation re-established in the community and the
system of irregularities and frauds so long con-
tinued, should have been impossible." At the
beginning of the investigation into the affairs of
this hospital I was met with the assurance that there
was nothing wrong. However, the investigation
was proceeded with, with the result that a disgrace-
ful state of things was disclosed. Under my super-
vision re-organization was accomplished, and the
new order of things established here will soon wipe
out the stain and obliterate the memory of what
went on before.
THB UNHAPPY RECORD OF THE CHAIR-
MAN OF SIR GEORGE PERLETS
BOARD OF INQUIRY.
The hostile attitude of the members of the Board
is not surprising when we consider its composition,
which made it clear that the members of it had been
most carefully selected by Sir George Perley, un-
questionably with the object of ensuring that its
248
POLITICS AND THE C.A.M.C.
findings should be such as would accomplish the
desired result, vi:s., the discrediting of my Report.
An Imperial officer, Sir William Babtie, was
appointed Chairman of the Board, although he was
wholly unfamiliar with the conditions in the Cana-
dian Service. But, on the other hand, he was
keenly interested, from an adverse point of view,
in one of the questions dealt with in my Report,
namely, the Voluntary Aid Detachment hospitals,
owing to the fact that, as a member of the British
Medical Service, he shared the responsibility for
the employment of many thousands of these hos-
pitals by this Service, in which, at the time, they
played an important part. As he was, therefore,
prejudiced in regard to an important section of
my Report, I considered his appointment an unfair
one. His incompetence to judge of the efficiency of
any Medical Service was subsequently abundantly
proved by the fact that he was censured in the
Report of the Board of Inquiry on the medical
arrangements in Mesopotamia after an investigation
which revealed the most terrible neglect of the
wounded and sick. In addition, I had a strong
objection to an Imperial officer sitting in judgment
over matters which were purely Canadian in char-
acter, more especially as he was prejudiced
249
POLITICS AND THE C.A.M.C.
against some of the criticisms made by me; for
instance, those in relation to the V.A.D. hospitals
and the administration of the A.D.M.S., Dover,
because they affected — directly or indirectly — the
Service with which he himself was connected.
In the summer of 19 17, a few months after the
issue of the Report of the Babtie Board, the Report
of the Commission appointed to inquire into the
conditions in Mesopotamia was published. This
Report, which a leading article in the Times
describes as " one of the most distressing documents
ever submitted to Parliament," horrified the British
public by its revelations of culpable mismanagement,
more especially as regards the Medical Service.
Several Government officials were censured by the
Commission, amongst them being Sir William
Babtie, who was at the time Director of Medical
Services for India. The Report showed that there
had been a frightful amount of preventable suffer-
ing amongst the sick and wounded in Mesopotamia,
due largely to the lack of suitable transport and of
medical and surgical supplies and personnel.
The intense sufferings that were caused to British
troops through the inadequate medical arrange-
ments in connection with the first Mesopotamian
250
POLITICS AND THE C.A.M.C.
Campaign, for which General Babtie was respon-
sible, are also emphasized in a book, *' The Long
Road to Bagdad," recently published by Edward
Candler, the famous Oriental traveller who accom-
panied the expedition.
These deficiencies were from time to time brought
to the notice of the higher medical authorities by
General Cowper and Major Carter, but these
authorities, instead of taking action upon this
information with a view to remedying the defects,
threatened Major Carter with the consequences,
i.e., loss of position and of preferment if he per-
sisted in making such representations. (It is worth
noting that in my case also a similar course was
adopted, the authorities doing their best to discredit
the revelations made, instead of endeavoring to
remedy the abuses revealed.)
In his evidence before the Commission, Major
Carter gave a vivid and harrowing account of the
sufferings of the sick and wounded in their passage
down the Tigris after the battle of Ctesiphon. He
states that when the steamer (the Medjidieh) was
about three or four hundred yards off, it looked
as if she was festooned with ropes. The stench when
she was closer to him was quite definite and unmis-
takable, and he found that what he had mistaken
251
POUTICS AND THE C.A.M.C.
for ropes were dried stalactites of human excreta.
The patients were so huddled and crowded together
on the ship that they could not perform the offices
of nature clear of the edge of the ship, and the
whole of the ship's side was, consequently, covered
with excreta. A certain number of men were
standing or kneeling on the immediate perimeter
of the ship. He found a mass of men huddled up
anyhow — some with blankets and some without.
They were lying in a pool of dysenteric excreta.
Major Carter says : — '' With regard to the first man
I examined, I put my hand into his trousers, and
thought he had a haemorrhage. They were full
almost to the waist of something warm and slimy.
1 took my hand out, and thought it was blood clot.
It was dysenteric excreta. The man had a fractured
thigh, and his thigh was perforated in five or six
places. He had apparently been writhing about the
deck of the ship. Many other cases were almost as
bad. There were a certain number of cases of
terribly bad bed sores. * * * j found men
with their limbs splinted with wood strips from
* Johnny Walker ' whiskey boxes, * Bhoosa ' wire,
and that sort of thing."
This account of the appalling state of things
must have reached the Indian Government officials,
252
POLITICS AND THE C.A.M.C.
but in spite of this the following reassuring telegram
was sent to the Secretary of State for India in
England : —
" Wounded satisfactorily disposed on. Many likely to
recover in country, comfortably placed in hospitals at Amara
and Basra. Those for invaliding are being placed direct on
two hospital ships that were ready at Basra on arrival of
river boats. General condition of wounded very satisfactory.
Medical arrangements under circumstances of considerable
difficulty worked splendidly."
The Report of the Commission says that " the
officer directly responsible for the deficiencies of
medical provision in Mesopotamia was the Director
of Medical Services for India, which appointment
was held at the beginning of the war by Surgeon-
General Sir William Babtie. The Commission also
says that " the numerous sanitary and precautionary
requisitions of Colonel Hehir," Sir William Babtie's
successor in office, " are a measure of Sir William
Babtie's omissions." These requisitions included
sun-glasses, antitoxin, mosquito-nets, spine-pads,
etc. Sir William Babtie was also severely censured
for giving unsuitable rations to the Indian troops
in Mesopotamia, although, with his experience of
India, he must have known how very liable such
troops are to scurvy. The result was a very
serious outbreak of scurvy amongst them, which
253
POLITICS AND THE C.A.M.C.
was definitely ascribed by the War Office Sanitary
Commissioners to deficiencies in the Indian rations.
But the gravest criticism made in regard to Sir
William Babtie is that, although he knew perfectly
well that the medical equipment, including personnel,
hospitals, field ambulances, river hospital steamers,
and the special comforts for the wounded which
were imperatively necessary in such a climate as
that of Mesopotamia, were lamentably deficient, he
made no adequate efforts to improve these de-
ficiencies in such a way as to equip the Mesopotamia
Expedition in a suitable manner from the medical
point of view.
At the conclusion of his evidence before the Com-
mission, Sir Alfred Keogh, the then Director-
General of the British Army Medical Services,
made the following very strong statement in regard
to the Indian Medical Service: —
" I have no hesitation in saying that the medical arrange-
ments connected with the army in India have been for years
most disgraceful. I say this with a full sense of responsibility.
I have served many years in India. T have not been there
for some time now, but in my opinion things are not better
than they were. Anything more disgraceful than the care-
lessness and want of attention with regard to the sick soldier
in India it is impossible to imagine."
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POLITICS AND THE C.A.M.C.
The reassuring telegram sent to the Secretary of
State for India in regard to the medical arrange-
ments in Mesopotamia, and in fact the whole situa-
tion, shows a close analogy to the Report of the
Babtie Board in regard to my criticisms of the
Canadian Medical Service, and also shows the
astuteness of Sir George Perley, whose obvious
object — as has been pointed out — was to discredit
my Report, in selecting as Chairman of the Board
of Inquiry a man who was found to be responsible
for a Medical Service which was so strongly con-
demned, not only by the Mesopotamia Commission?,
but also by the Director-General of Medical Ser-
vices, who declared it to be the worst and most
" disgraceful " Medical Service of which he had
any knowledge. To a man with Sir William
Babtie's antecedents, any Medical Service, in com-
parison with the one with which he had been so
intimately associated, and according to the Com-
mission " responsible " for, must have seemed more
or less perfect.
On the appearance of the Mesopotamia Report,
the House of Commons appointed a Committee to
investigate the degree of culpability of the officials
censured in that Report, and during the sittings of
this Committee Sir William Babtie was relieved of
255
POLITICS AND THE C.A.M.C.
his duties at the War Office, where he was at the
time holding an important appointment, but it seems
that the Army Council subsequently accepted his
explanation of his conduct, as he was reinstated.
That his reinstatement in office was not accepted
by the British public without criticism, however,
appears from a paragraph which was published in
the London World, the leading social weekly of
Great Britain, on October 23rd, 19 17. It reads as
follows : —
"Five days after my announcement in The World comes
the official notification that Sir William Babtie has resumed
his position as Assistant Director of Medical Services, 'the
Army Council having received and accepted his explanation
of his conduct with regard to the medical breakdown in
Mesopotamia.' In view of the publicity given to the Meso-
potamia Report, in which the Commissioners passed the
strongest censure on Sir William Babtie, surely the British
public is entitled to know what his explanation was, and to
pass their own judgment upon it? One would have thought
that the Commissioners themselves would have insisted on
this, as the reinstatement of Sir William as it stands consti-
tutes a grave reflection on their findings. At present the
whole procedure is a nauseous farce. A scandal occurs — a
Commission is appointed to enquire into it. Considerable
expense is involved, and much valuable time is occupied.
And when at length the findings are published, any which
happen to be unfavorable to highly-placed personages are
unceremoniously set at naught."
The following article on this subject appeared in
the Toronto Saturday Night on July 7, 191 7: —
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POLITICS AND THE C.A.M.C.
"A curious reflex in connection with the Babtie Report on
the Canadian Army Medical Service, which excited so much
controversy a few months ago, comes from the Report on
the first Mesopotamia Campaign, recently published in Great
Britain. The Royal Commission confirms an earlier investiga-
tion into the breakdown of the Medical Service in Meso-
potamia, made by Vincent Bingley. It is declared that
from an early stage in the campaign the sick and wounded
underwent great suffering, which was aggravated after the
defeat at Ctesiphon, and culminated during the Kut Relief
operations, when there was a complete breakdown in medical
arrangements. The Times summary says : — ' Surgeon-General
Babtie, Director of Medical Services in India, is blamed for
the serious faults of his administration, which he made no
adequate effort to improve.' It is further stated that the
Commission condemns the attempts which were made to
conceal medical deficiencies, and the issuance of official
reports, at the time when things were going from bad to
worse, to the effect that the wounded were satisfactorily
disposed of.
" It is thus quite clear that when Surgeon-General Babtie,
who, after the Mesopotamia disaster, had been brought back
from India, issued a white-washing report in connection with
the Canadian Medical Services, he was seriously in need of
white-washing himself. It will be remembered that after
Colonel Bruce made his investigation last summer, and put
in an Interim Report recommending immediate reforms,
including the retirement of Surgeon-General Carleton Jones,
the friends of the latter secured the appointment of a Com-
mission to investigate Dr. Bruce's charges, and that this
Commission almost completely negatived every assertion that
the latter had made. So sweeping were its refutations that
they defeated their own ends, and the Report was never
seriously regarded as a vindication by those who took the
trouble to inform themselves. This Committee, it will be
remembered, was presided over by Surgeon-General Babtie,
17 257
POLITICS AND THE C.A.^TC.
who was called in as an outsider, and who it was supposed
would be impartial. It is now quite clear that, to say the
least, the chairman of the Commission was incompetent for
his task, and as a man whose own errors in India were under
investigation, was likely to be more than disposed to take
a lenient view of any faults that might be discovered in the
administration of the Canadian Army Medical Service. It
is, then, quite clear that the Babtie Report was not worth
the paper it was written on, and by induction the Mesopotamia
revelations are a vindication of the Bruce Report."
In the autumn following the publication of the
Mesopotamia Report troops were sent from England
to Italy, and a notice appeared in the Press to the
effect that Sir Wililam Babtie was to be put in
charge of the medical arrangements there. Public
opinion in England, however, refused to tolerate
such an appointment after the grievous consequences
of his failure elsewhere, and the criticisms of it in
the London papers were so severe that, although
Sir William Babtie had already proceeded to Italy
to take up the duties of his new post, the Govern-
ment was compelled to recall him by telegram. He
was subsequently disposed of, so far as the British
Army Medical Service was concerned, by giving
him as a sinecure a wandering commission as an
inspector, which practically deprived him of all
authority and influence. It is customary in the
British War Office when it has been decided to part
258
POLITICS AND THE C.A.M.C.
with the services of an officer regarded as no longer
competent for his duties, but whose shortcomings
have not warranted court-martial proceedings, to
salve his feelings by giving him a step in rank. Such
a system is not without its uses in facilitating
necessary changes. In this case Sir William Babtie
became a lieutenant-general.
It may be interesting here to reproduce two
editorials by Horatio Bottomley, a member of the
British House of Commons and the editor of John
Bull^ generally recognized as the paper of the
masses, which appeared in that paper, the first of
December ist, 19 17, and the second on April 27th,
1918. The first is entitled " The Greatest Scandal
of the War," and the second "Rehabilitating the
Scrapped and Incompetent." They are as follows : —
"Since our recent revelations as to the way in which
Surgeon-General Babtie — the Mesopotamia culprit who was so
severely castigated by the Commission of Inquiry — had been
quietly restored to his former post, other journals, including
the Times and the Daily Mail, have taken the matter up.
whilst it has been a matter of general discussion throughoyt
the medical profession. But the grave indictment we print
below, by one of the very foremost doctors of the day, whose
name is known throughout the world, reveals such amazing
further scandals that the nation will undoubtedly insist upon
an explanation from the Government of what, on the face of
it, looks like a most wicked, callous and shameful flouting
of the public conscience, and at the same time a grave insult
259
POLITICS AND THE C.A.M.C.
to our troops, whose fate — this time on the Italian Front-
has once again been entrusted to such an incompetent. It
must not be! Babtie must be recalled. Read the indictment:
— ' Widespread Indignation. With regard to Sir William
Babtie, you voice the sentiments and the indignation of the
vast majority of our profession — probably of every single one,
whether civiHan or military, who knows the facts. I have
talked with many, both among the seniors and the juniors,
and have not found a single one who does not consider
Babtie's reinstatement preposterous, and the explanation
tendered in the House of Commons ridiculous. Of course
it is due entirely to the determination of his friend. Sir Alfred
Keogh, to continue to play the part of the autocrat, as he
has done ever since the war started, and to treat with con-
tempt all criticism or suggestion. How can such a charge
be justified? Simply by the fact that Sir Alfred has failed
to call together the Advisory Board, with which he is pro-
vided by the constitution of his department, and has refused
to convene it in spite of the fact that it is still carried in the
army list, and the salaries of its civilian members are still
paid by the State. This, again, is preposterous, and questions
have been asked in the House of Commons, but the only
answer vouchsafed is that Sir Alfred consults the individual
members of the Board when he sees fit, and does not consider
that a meeting of the Board as such is required.
" Grave Charges. Mesopotamia, where the medical break-
down is clearly found by the Commission to be due to the
want of prevision, energy and adaptability of this very man,
Sir William Babtie."
" Babtie's New Post. Whatever will you have to say when
you know of the egregious appointment of Sir William Babtie
to Italy, to represent our Army Medical Service? What
verdict will you and the public pass upon the appointment,
during the last few days, of this very man. Sir William Babtie
260
POLITICS AND THE C.A.M.C.
— who was proved to have failed so egregiously to rise to the
duties of his post when Director of Medical Services in India
— rto the very important job of Medical Director of our Army
in Italy? Yet that is what has actually taken place, and a
more preposterous bit of bluff was never tried. At Adastral
House, serving as second in command to Sir Alfred Keogh,
Sir William Babtie has made himself notorious to our pro-
fession for rudeness and tyranny — surely, just the very
qualities which will do the maximum of harm, both pro-
fessionally and internationally, in Italy. While such appoint-
ments in face of dereliction are permitted, we can scarcely
claim to have begun even to deserve to win this war."
(Note by Editor of John Bull.) — "As regards the threat
of proceedings against us, whether under the Defence of the
Realm or any other Act, it leaves us quite cold. Why not
start them at once — with a dozen maimed and wounded sol-
diers from Mesopotamia as jury? Surely, however, both Sir
William Babtie — and also his patron-chief, Sir Alfred Keogh
— know by this time that threats of legal action have no
terror for us, when we are conscious that we are protecting
the public and are sure of our facts. Wherefore we await
developments with composure, should the authorities be ill-
advised enough to commence proceedings."
In view of the gross mismanagement — to say the
least — of the medical arrangements in Mesopotamia,
for the the glaring defects in which, together with
their lamentable and tragic consequences, the Com-
mission had no doubt whatever that Sir William
Babtie must be regarded as at any rate partially
responsible, it seems incredible that this man should
have been selected as a suitable person to sit in
261
POLITICS AND THE C.A.M.C.
judgment on my Report, as President of the Com-
mittee appointed to consider it. This last-mentioned
Report deah entirely with, questions concerning
medical organization, and medical organization was
precisely what Sir William Babtie was found to
have failed in so grievously in Mesopotamia.
So much for the President of the Board of
Inquiry. As regards the remainder of the personnel,
three of the members were medical officers who had
been serving in France, and, consequently, knew
nothing whatever of the conditions which obtained
in the hospitals in England, as pointed out in my
original protest to Sir Robert Borden. One of
them stated as his reason for objecting to my Report
that he resented the fact that a civilian surgeon,
without military experience, should presume to
report upon and criticize a Service, the ramifications
of which — it was assumed — it was only possible to
understand after many years of military training,
and it would seem fair to assume that they were all
influenced by this reason. One of the members of
the Board — Colonel Ashton, a combatant officer-
had also been serving on the Overseas Sub-Militia
Council at the time when it expressed unanimous
approval of my Report and Recommendations. As
a matter of fact, he was the mover of the resolution
262
POLITICS AND THE C.A.M.C.
that General Jones should return to Canada, and
that I should be put in charge of the Medical Ser-
vices at the D.M.S. Office in London. What induced
him to sanction, when a member of the Babtie
Board, the expression of opinions which were
diametrically opposed to those he had apparently
held when serving in his former capacity is not
quite clear.
THB SUPPRESSION OF MY REPLY BY
SIR ROBERT BORDEN.
My Reply to the Report of the Babtie Board was
inquired for on several occasions by members of
the Canadian House of Commons, but the Govern-
ment persistently refused to lay it on the table of
the House. Ultimately the Prime Minister, Sir
Robert Borden, gave his reasons for not doing so
in a speech, which appeared in the OrOers of the
Day in Hansard on August 27th, 19 17, and which
I should like to reproduce here. It is as follows : —
'* On various occasions some honorable gentlemen
have expressed their desire that a memorandum
made by Colonel Bruce with respect to matters set
forth in a Report of the Commission of which
General Sir William Babtie was chairman, shall be
263
POLITICS AND THE C.A.M.C.
laid upon the table of the House. I have given the
matter the best consideration that I could, and I do
not think it is a document which ought to be laid
on the table of the House by the Government. It
is not an official Report, as Colonel Bruce was not
requested or empowered by any competent authority
to make the memorandum in question. That fact
is further established by the circumstance that, as
I am informed, he sent a copy of it to some .honor-
able members of this House, which certainly he
would not have done if he had believed it to be an
official Report in the ordinary sense.
" There is also the further consideration that he
has been seconded to the Royal Army Medical Ser-
vice, and I am informed that the memorandum
which he has prepared deals with the administration
of that Service. It seems, therefore, that the War
Office ought to be consulted before any document
of that kind put forward by an officer of the British
Service was laid on the table of this House by the
Government.
*' I should also like to correct a misapprehension,
which, if I understand correctly, has arisen with
regard to his opportunity to be heard before the
Babtie Commission, of which Sir William Babtie
was chairman, and four very eminent Canadian
264
POLITICS AND THE C.A.M.C.
surgeons, whose names I have already given to the
House, were members. The proceedings of the
Board show that Colonel Bruce was called as a
witness on November 27th, 19 16, recalled on
November 28th, and again on the 6th December,
on which date he was heard twice, and also on the
1 6th December. A memorandum has been placed
in my hands, containing an extract from a statement
by the Secretary of the Board, in the following
words : —
' The Board directs me to say that neither General Jones
nor Colonel Bruce asked to be allowed to be present through-
out the inquiry being made by the Board.' "
Sir Robert then read a telegram which he had
received from Sir George Perley, but I will- omit
it here, as the substance of it appears in a letter
which I wrote to the Prime Minister after my
return to Canada in March of the present year,
when, having been demobilized, I was free to speak.
The text of that letter was as follows : —
"Toronto, March 10, 1919.
" Dear Sir Robert, —
" You will perhaps think it strange that at this
late day I should advert to a speerb made by you
w^ith reference to my still unpromulgated Reply to
265
POLITICS AND THE C.AM.C.
the Babtie Report so long ago as August, 1917;
and which I regret to say contained several state-
ments that were erroneous. My excuse is that until
within the past few days I have been in service; and
now take the first opportunity since my return to
Canada and subsequent demobilization to place
before you facts as to which you were evidently
misinformed. So long as I was in uniform there
existed grave doubts as to the propriety, or even the
legality, of my making a reply to statements made
by you in your official capacity as leader of the
Government of Canada, but even had I been free
to speak I would have hesitated to do so in view
of the political situation in Canada during the latter
part of 191 7; — a situation which rendered it desir-
able that nothing should be said by anyone, under
whatever provocation, which could by any perver-
sion be twisted into an argument that might
conceivably divert Canadians from the solemn pur-
pose of prosecuting the war to the full extent of
their powers. From first to last in my relations
with the Canadian Army Medical Service I was
actuated by one thought, to promote by my humble
efforts the highest efficiency in Canada's conduct of
the war — in connection with which the C.A.M.C.
held a very important function. Now that the war
266
POLITICS AND THE C.A.M.C.
is over and I am out of uniform, I feel that I cannot
longer, in justice to myself and to the eminent and
able officers who assisted in the preparation of my
original report, permit the erroneous implications
of your speech to go unchallenged and uncorrected.
" Hansard reports you as having said : —
1. " Colonel Bruce was not requested or empowered by
any competent authority to make the Memorandum in ques-
tion."
'' This is incorrect. Sir George Perley, the Over-
seas Minister of Militia, authorized me to make this
Reply, and promised that it would receive the same
publicity that was given to the Babtie Report.
2. " You give as a further reason that : —
" Colonel Bruce has been seconded to the Royal Army
Medical Service, and that you are informed that the
Memorandum which he prepared deals with the administra-
tion of that service, and that, therefore, the War Office
should be consulted before any document of that kind put
forward by an officer of the British Service was laid on the
table of the House by the Government.'
" The information on which you spoke was
entirely incorrect, and as the statement might pre-
judice me with the British Service, I must ask you
to do me the justice of an immediate and public
correction. Indeed, I feel that the mere making of
such a statement on information which the most
267
POLITICS AND THE C.A.M.C.
cursory examination of the reply in your hands
would have discredited, is an injustice to which you
should not have exposed me.
" There is no reference in my reply to any part
of the work of the British Medical Service. There
is a negative statement that the objections to the
use of Voluntary Aid Detachment hospitals by me
does not apply in the case of the British Service,
but nothing more.
3. " You also state that you wish to correct a misappre-
hension in regard to my not having had the opportunity of
being heard before the Babtie Commission."
" No claim or complaint of this kind was made
by me. It is stated in my reply that I gave evidence
before this Commission for the greater part of three
days. The complaint is that I was not given the
opportunity of attending the meetings of the Com-
mission throughout the entire inquiry. I may re-
mind you that the military procedure in a case
similar to my own would be to inform the individual
of the place, date and time of the commencement of
the sittings of the Board, and to give him permission
to be present throughout the inquiry. THIS WAS
NOT DONE IN MY CASE. The first intimation
I had of the place of meeting was a notification to
attend as a witness at a certain hour. After my
268
POLITICS AND THE C.A.M.C.
evidence had been taken, I was dismissed by the
chairman. On one occasion I waited outside for an
hour before being admitted to the meeting of the
Commission. At the conclusion of the sittings of
the Commission, I requested Sir George Perley to
furnish me with a copy of the evidence taken, but
this he refused. It is a well-known fact that the
meetings of the Commission were held in secret.
The statement that neither General Jones nor myself
requested to be present throughout the inquiry is
simply an attempt to evade the issue; the true posi-
tion is that, contrary to military etiquette, neither
General Jones nor myself were given an opportunity
to be present.
" May I venture to hope that you will give the
same publicity to the correction of the above mis-
statements as the misstatements themselves received ?
" On the same occasion you submitted a telegram
from Sir George Perley, dated August 23rd, 1917.
This telegram is set out below, with my comments
in a parallel column.
Prime Minister, Ottawa. Colonel Bruce' s Comments.
The Director of Medical
Services submits the follow-
ing:—
Department is receptive of
suggestions, irrespective of
269
POLITICS AND THE C.A.M.C.
their source. All suggestions
and recommendations are
carefully considered, and if
deemed advisable, are put
into effect. Following are
some improvements effected
in this service since January
I, 1917:—
I. Systematic routine in-
spection of Canadians in
hospitals in United Kingdom
to select cases requiring
further treatment in Canada.
I. This is a recommenda-
tion made in my Report, and
it was put into effect by me
on November 16, 1916, when
eighteen inspectors were
started on this work.
2. Establishment of a 1,300-
bed hospital at Liverpool to
assemble patients for Canada
and facilitate prompt em-
barkation. Arrangements to
be made for assembling
insane patients for Canada at
Mental Hospital near Liver-
pool for convenient embarka-
tion.
2. This was initiated dur-
ing the period of my re-
organization in November,
1916.
3. Provision for a hospital
ship service from Liverpool
to Canada for invalids.
3. Suggested by me during
re-organisation.
4. Hospital accommodation
in England has been ex-
panded by over 5,000 primary
beds to adequately meet Cana-
dian requirements. Arrange-
ments completed for further
270
4. This is carrying out one
of the most important recom-
mendations in my Report.
Much work was done in this
connection by me during re-
organization, and some of
POLITICS AND THE C.A.M.C.
expansion that will provide
sufficient hospital accommo-
dation for all tuberculous and
venereal patients.
5. Arrangements made by
which War Office provides
reliefs for Canadian medical
units in Mediterranean, these
units returning for duty in
England.
6. Greater economy in the
use of personnel by deciding
number requisite for each
medical unit and adhering to
such limitation.
7. Completion of consultant
and inspection service on
systematic basis. All patients
in Canadian hospitals in-
spected semi - monthly and
routine inspections of Cana-
dians in British hospitals.
8. Improved system of
controlling movement and
prompt evacuation of patients
in hospitals.
the accommodation secured,
notably the addition of 1,040
beds to the Ontario Military
Hospital at Orpington. Build-
ings had been secured and
plans completed to provide
adequate accommodation for
our venereal patients in
November, 1916, but were
lost to us because of lack of
support from Sir George
Perley.
5. This was urged by me in
my Report. It was taken up
by me with the War Office
in September, 1916, and the
arrangement would have been
completed if Sir George
Perley had supported it.
6. A recommendation in my
Report.
7. Recommendation in my
Report. I secured the appoint-
ment of the first consulting
surgeon, Lieutenant-Colonel
Armstrong, in November,
1916.
8. A recommendation in my
Report.
271
POLITICS AND THE C.A.M.C.
*9. While segregation of
Canadians in Canada hos-
pitals is impracticable and in-
advisable, arrangements have
been made whereby those sent
to British hospitals are dis-
tributed to hospitals readily
accessible to Canadian inspec-
tors and convenient for final
disposition.
9. The practicability of
sending Canadians to Cana-
dian hospitals is clearly
established by the testimony
of Sir William Donovan,
Chief Embarkation Officer,
who arranges for the trans-
portation of wounded sol-
diers, on arrival in England,
to hospital.
To deny the desirability of
this course (unless for senti-
mental reasons, which, at
best, can be given a secondary
place) is inconsistent with
the principles approved by the
Director of Medical Services,
and set out in Sir George
Perley's cable, such as Clause
I (Inspection for return to
Canada), 7 (Inspection of
Canadians in hospital) and 8
(Improved system of evacua-
tion), A policy which defeats
in any degree these important
objects could never be said
to be "desirable." These
objects outweigh any con-
ceivable sentimental gain.
*Compare this with Sir Edward Kemp's report, page 391,
in which he says that " it was the policy of the Canadian
authorities to provide beds in sufficient numbers in Canadian
hospitals to meet requirements of Canadian casualties . . .
and every effort was bent towards placing Canadians in
Canadian hospitals."
272
POLITICS AND THE C.A.M.C.
10. Systematic inspection
and control of hospital and
medical records to ensure
completeness and accuracy
of same.
11. System for strict con-
trol of laboratory service.
12. Improved system of
controlling hospital food sup-
plies to ensure economy.
The arrangement for Cana-
dians to go to British hos-
pitals in a circumscribed area,
for convenient inspection, was
urged by me in November,
1916.
10. A recommendation in
my Report.
11. Some improvement in
this direction was desirable.
12. This matter was under
consideration during my re-
organization.
13. Abolition of dual con-
trol of Shorncliffe Military
Hospital by arranging with
military authorities to resume
their control and administra-
tion. The A.D.M.S., Cana-
dians, Folkestone, at request
of British authorities, carries
out administration of this
group, and reports direct to
British authorities on all
matters pertaining thereto.
13. This was a recommen-
dation in my Report, but it
was not carried into effect
until December 12th, 1917,
when it was ultimately
adopted, but only after the
strongest pressure had been
brought to bear upon the
Director of Medical Services
by the officer commanding
the Shorncliffe area. Colonel
Smart.
In October, 191 6, I had
made arrangements with the
War Office for their resump-
273
18
POLITICS AND THE C.A.M.C.
tion of control of the Shorn-
cliffe group of V.A.D. hos-
pitals. On November 6th,
1916, an officer was sent to
Shorncliffe for the purpose
of taking over control of
this group. Sir George
Perley cancelled my arrange-
ment with the War Office,
and consequently this officer
was recalled. The action of
Sir George Perley in this
matter cost the Canadian
Government $175,960.00.
14. Abolition of dual con-
trol of Red Cross hospitals
by C.A.M.C. taking entire
control.
14. This was a recommen-
dation in my Report. An
agreement in regard to this
was entered into by me with
the Red Cross in November,
1916.
15. Abolition of purchasing
bureau for medical supplies
and equipment.
15. This was recommended
during my period of re-
organization.
16. Establishment of cen-
tral medical stores, where all
medical supplies are received
and carefully checked for dis-
tribution.
16. This was made neces-
sary by the adoption of
clause 15.
17. Improved control of
expenditure of medical stores
and supplies by more strict
and systematic checking of
indents from units.
17. It was with the expecta-
tion of effecting this that
clause 15 was adopted.
274
POLITICS AND THE C.A.M.C.
i8. Decentralization of
Medical Boards and improve-
ment of control through care-
ful routine inspection and
uniform standardization.
i8. This was initiated dur-
ing my re-organization, and
Medical Boards were formed
at Taplow, Orpington, Rams-
gate, Shoreham and Hastings
in December, 1916,
19. Improved Medical Board
form for the purpose of
meeting provisions of Cana-
dian pension laws.
19. A recommendation in
my Report, and the Improved
Medical Board form was
drawn up and actually adopted
during my re-organization.
20. Standardization of fit-
ness of soldiers according to
physical grades, with system
of control to provide uniform
classification throughout the
20. This was the outcome
of a meeting arranged and
held while I was Inspector-
General, during my re-organ-
ization.
21. Improved system of
dealing with officer and nurs-
ing sister casualties, by which
convalescence is spent in hos-
pital instead of on leave,
thus controlling and shorten-
ing period of non-effective-
ness.
21. The system of dealing
with officers and nursing sis-
ters was severely criticized
by me, and some better pro-
vision for their treatment was
urged upon the Overseas
Minister of Militia.
22. Adoption of complete
and systematic measures for
prevention and spread of
communicable disease.
23. C. A. M. C. Training
School re-organized on proper
22. The old system was
criticized in my Report, and
a new method was recom-
mended.
23. This was a recom-
mendation in my Report.
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POLITICS AND THE C.A.M.C.
basis and staffed with per-
sonnel trained at the Front ;
an improved syllabus of
training adopted based on
experience gained in present
24. Fair and definite policy
adopted for promotion of
officers and other ranks.
24. A recommendation
my Report.
25. Definite policy of giv-
ing officers overseas service,
which recognizes prior rights
of those who have served
longest in England ; provision
for return of officers of ex-
perience from overseas to
serve in England and Canada.
25. A recommendation
my Report.
26. More complete co-or-
dination with services in
France and Canada,
26. A recommendation
my Report.
27. More complete co-or-
dination with exchange of all
ranks between Canadian corps
and medical units on lines of
communication and at base.
28. Arrangement for tem-
porary expansion of army
medical units at Front during
time of action by detail of
personnel from medical on
lines of communication and
at Base.
2.y. Was a recommendation
in my Report.
28. This was initiated, not
by the Canadians, but by the
Royal Army Medical Corps.
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POLITICS AND THE C.A.M.C.
29. The majority of these
improvements have been noted
in monthly progress reports.
" From the above it will be seen that 23 out of
the 28 improvements, stated by the Director of Medi-
cal Services to have been effected in the Service,
were due to the adoption of recommendations in my
Report, or the continuation of reforms instituted
during my term of office as Inspector-General, while
re-organising the Service, and that one other of the
improvements mentioned by him was not initiated
by the Canadians, but by the British Medical Service.
*' It is most creditable that, in spite of the fact
that the Babtie Board disagreed with my recom-
mendations and criticisms, these reforms should
have been continued or instituted by the Director
of Medical Services, but it is at least strange that he
should have reported them in a way that seemed to
claim the credit for them.
*' As the recommendations were made for the
purpose of correcting certain abuses set forth in
my Report, it must be admitted that the Director of
Medical Services, in adopting these recommenda-
tions, confirmed the accuracy of the criticisms.
" Yours faithfully,
(Signed) " HERBERT A. BrucE,
" Colonel A.M.S."
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POLITICS AND THE C.A.M.C.
It would thus appear that aUhough the Babtie
Board of so-called experts, employed by the Govern-
ment for reasons which are abundantly clear, stated
that my criticisms were unfounded and my recom-
mendations unnecessary, yet the Director of Medical
Services, who succeeded Surgeon-General Jones,
nevertheless put into effect practically all of these
recommendations.
DISMISSED FROM OFFICE BUT DENIED
RIGHT TO RETURN HOME.
It will be remembered that in a letter, dated
December 30, 19 16, Sir George Perley dismissed
me from the office of Inspector-General of the Can-
adian Medical Service, and requested me to hand
over all letters and papers connected with that office
to Colonel Murray McLaren, the Acting Director
of Medical Services. In compliance with this re-
quest, I sent in my resignation, asking that it be
immediately accepted. The Overseas Minister,
however, refused to accept my resignation, although
urged by me on several occasions to do so, in spite
of the fact that no offer of any other position in the
Canadian Medical Service was made to me.
At this time I had several interviews with Sir
George Perley, and it may be of interest to mention
278
POLITICS AND THE C.A.M.C.
that on one occasion he produced a statement, which
he had had drawn up, and which he asked me to sign,
possibly with a view to future publication, to the
effect that I did not mean certain things which I
had said in my Report, one of these being the recom-
mendation for the concentration of Canadians in
Canadian hospitals. It is scarcely necessary to say
that I declined to sign this document, on the ground
that what was said in the Report exactly expressed
my views in regard to these various matters.
Subsequently Sir George Perley, at the instance,
I understand, of the British War Office, asked me if
I would be willing to accept a position as Consulting
Surgeon with the British armies in France. He re-
peated this request on several occasions, but at the
time I refused to accept this position, believing that
by returning to Canada I could do more to further
the interests of our Canadian wounded soldiers. As
I was unable, in spite of repeated efforts, to get my
resignation accepted, I obtained a passport from the
War Office, and booked my passage to Canada. I
was subsequently informed by the officer in charge
of embarkation at Argyll House, that acting under
orders from his superior officers, he had requested
the Port Embarkation Authorities at Liverpool to
intercept me there and prevent my sailing in the
event of any attempt on my part to return to Canada.
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POUTICS AND THE C.A.M.C.
I ultimately came to the conclusion that in view
of the confirmed antagonism of Sir George Perley,
backed up by the Canadian Government, further
efforts on behalf of the Canadian sick and wounded
on my part would be futile ; and I therefore decided
to accept the offer of service with the British War
Office, which would enable me to make use of my
experience as a surgeon, and was shortly afterward
appointed consulting surgeon to the British Armies
in France.
LATER SUGGESTIONS FOR IMPROVE-
MENT OF THE CANADIAN MEDICAL
SERVICE.
Although I had for some considerable time ceased
to belong to it, and was now in the British Army
Medical Service, my concern for the welfare of the
Canadian Medical Service, was still active, and on
the 9th of September, 19 17, I wrote to Sir Edward
Kemp, Minister of Militia, urging the appointment
of an Advisory Medical Board. The letter was as
follows :
" De:ar Sir Edward, — ■
*' At the time I was dismissed from office while
engaged in the work of re-organization of the Can-
adian Medical Service Overseas, I had just com-
pleted a plan devised for the purpose of ensuring the
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POUTICS AND THE C.A.M.C.
better use of the special qualifications of the medical
personnel, so that our sick and wounded should
receive the best possible treatment. This was not
presented to the Minister for the Overseas Military
Forces of Canada, as his general attitude was un-
friendly, and it would only have been a waste of
time to have discussed the matter with him. How-
ever, as I still have very much at heart the welfare
of our Canadian sick and wounded, I am taking the
liberty of outlining to you the scheme which I
contemplated asking to have put into effect at that
time, and which is as follows :
" The appointment of an Advisory Board of five consul-
tants, consisting of two surgeons, two physicians and one
sanitary officer, to deal with and be responsible for all the
purely professional matters involved in the treatment of the
sick and wounded. This Board to be given full authority
in regard to the disposition of the medical and nursing
personnel. The D.M.S. to be in charge of the purely
administrative work of the Medical Service and to put into
effect the recommendations of the Advisory Board, of which
he would be an ex oMcio member.
" May I here point out that the American Medical
Service is arranged along these lines, and that in the
hospitals which it has sent to France a prominent
civilian surgeon has been appointed as Medical Dir-
ector, charged with the entire responsibility for the
281
POLITICS AND THE C.A.M.C.
treatment of the sick and wounded, and with full
power in regard to the medical and nursing
personnel.
'' The commanding officer of the hospital is a
member of the permanent United States Medical
Service, and has a purely administrative position.
This arrangement would effectually remedy one of
the important criticisms in my Report, vis., the
misuse of medical personnel.
** I desire to respectfully submit this for your con-
sideration, and to emphasize the great importance of
the subject and the urgent necessity for early
action.
. (Signed) " H. A. Bruck"
In answer to this I received a reply from Sir
Edward Kemp, dated September 26th, 191 7, in/
which he said that he had referred the matter to Sir
George Perley. After waiting some months, and
hearing nothing further in regard to it, on the 12th
of April, 191 8, I wrote the following letter to the
Prime Minister, Sir Robert Borden:
" Dear Sir Robert, —
"On the 9th September, 1917, I wrote to Sir
Edward Kemp, Minister of Militia, in regard to the
282
POLITICS AND THE C.A.M.C.
appointment of an Advisory Medical Board, which
I had decided was essential during my re-organisa-
tion of the Canadian Army Medical Service. In
his reply he promised to refer the matter to the
Overseas Minister, but no action has resulted. . . .
" At this time of national peril, when every effort
is being put forth to keep our divisions up to
strength, the supreme importance of an efficient
Medical Service, which will conserve our man-
power, must be abundantly apparent. Under these
circumstances I need make no apology for again
bringing this matter to the notice of the Canadian
Government, and do so in the hope that it will now
receive the consideration which its importance
merits.
(Signed) "H. A. Bruce."
CANADIAN DIRECTOR OF MEDICAL
SERVICE, FRANCE.
It might be interesting to give a brief account of
the medical situation in France, where, a few months
ago, we had four casualty clearing stations, six
stationary hospitals and six general hospitals.
These Canadian hospitals were distributed over a
wide area, and none of them were arranged with a
view to their serving the Canadian troops. It is a
283
POUTICS AND THE C.A.M.C.
well-known fact that casualty clearing stations
are constantly being moved at the Front, and while
there might have been a little difficulty in arranging
for all of them to have been constantly in the rear of
the Canadian troops, two of them at least might
have been so placed as to be always available for the
Canadian wounded. Had there been a competent
responsible head to the Canadian Medical Service
in France, it would have been clear to him, long
before this late period in the course of the war, that
our hospitals would have been more easily managed
and more efficient if they had been grouped in one
area. If our stationary and general hospitals had
been thus concentrated, it would have been easily
possible to have sent large numbers of Canadian
wounded in hospital trains direct to such an area.
During periods of lesser activity the Canadian
wounded would have had to be distributed through-
out the various British hospitals, but as hospital
trains were constantly moving, both from the front
to the base, and between different points along the
base, it would have been possible to have subse-
quently collected these casualties in the Canadian
area. If a Director of Medical Services in France
had been appointed early in the war, much of the
confusion and difficulty in dealing with hospital
284
POLITICS AND THE C.A.M.C.
affairs in France would have been avoided, the ex-
pense of carrying on the Medical Service greatly
reduced, and a more efficient Service provided. In
addition to these advantages, there would have been
another very important one, viz., that Canadian
doctors, nurses and personnel would have been able
to take care of their own Canadian wounded.
It was announced in November, 19 18, that the
Canadian authorities had adopted this recommenda-
tion, and had created a new post at the Canadian
Headquarters in France, namely, that of a Director
of Medical Services, France. This post was given
to Colonel A. E. Ross, who had been promoted to
the rank of Brigadier-General. Strange to say, this
is the identical Colonel Ross who, as a member of
the Babtie Board, agreed with the disapproval of
my recommendation that a Deputy Director of
Medical Services, France, should be appointed.
The tardiness of the Overseas Minister and of the
Canadian Headquarters in London in recognizing
the desirability of the creation of this post — although
it was recommended by me more than two years
before — must have resulted in great injury to Can-
adian interests during this long period.
Though employed with the Imperial Army, senti-
285
POLITICS AND THE C.A.M.C.
ment naturally made the welfare of my fellow-
Canadians my first thought, and prompted by this
feeling I offered myself to Sir Edward Kemp, who
had succeeded Sir George Perley, as Minister of
Overseas Military Forces for Canada in December,
191 7, for service with the Canadian Army Medical
Corps. This offer was declined.
During the summer of 19 18, Sir Arbuthnot Lane,
Sir James Mackenzie and I, at the request of the
British Government, went to America as delegates
to the meeting of the American Medical Associa-
tion. On my return to London I found that some
of the senior men had returned to Canada, and I felt
it my duty to again offer myself to the Canadian
Government, and for this purpose called upon Sir
Robert Borden, who was then in London. The offer
then made to Sir Robert was confirmed in the fol-
lowing letter, dated the i6th of July, 191 8: —
" De:ar Sir Robert, —
" Following up our conversation of yesterday,
and in order that you may not misunderstand my
position or misinterpret the object of my visit, I
think it better to confirm what I said in writing.
" As I told you, I have now given up a year and
a half of my time to the British Medical Service,
and have no reason to complain of their treatment
286
POLITICS AND THE C.A.M.C.
of me. In fact they have shown me the greatest
kindness and consideration, and I am thankful to
say that my work for the British sick and wounded
has met with the approval of those in charge of that
Service. But, as I told you, I have made up my
mind to resign in the autumn and return to Canada,
because I feel that I have sacrificed all that I can
afford for the British Service. At the same time, I
am always willing to make further sacrifices in the
interest of our Canadian sick and wounded, and I
therefore wish to offer my services to Canada.
'' Please do not think that I am writing this letter
with the idea of embarrassing you or your Govern-
ment — nothing is further from my mind.
(Signed) " H. A. Bruce:.^^
To this letter Sir Robert Borden replied as fol-
lows on July 1 8th: —
" Savoy Hotel, London.
'' Dear CoIvOnel Bruce, —
" Thanks for your letter of the i6th inst. I
thoroughly understand and appreciate the spirit in
which you placed your situation before me. The
subject will be discussed with Sir Edward and with
General Mewburn as soon as the latter returns from
France.
287
POLITICS AND THE C.A.M.C.
" In the meantime pray accept my thanks for your
patriotic offer of further service with the Canadian
Forces.
(Signed) "R.L.Borden."
But despite this suggestion of consideration of my
offer to again volunteer in the service of Canada,
I heard nothing more from the Canadian authorities
from that day to this. My desire that the Govern-
ment would enlist my services was ignored, and that
not very courteously. Then I determined that 1
would ask to be transferred — instead of seconded —
to the British Service, and moved to another area.
Accordingly I applied to the British authorities and
was informed by an officer of high rank that when
I was given this appointment, a stipulation was made
by the Canadian Government that I be sent to an
area in France where I should not come into contact
with any Canadian hospitals, as the Canadian Medi-
cal Service did not wish to have anything further
to do with me. He added that, although he had no
personal feeling in the matter, and should like to
grant my request, under the circumstances he pre-
ferred to " let sleeping dogs lie." He was afraid
he said that if my request was granted, it would
offend the Canadian Government. This episode,
taken in conjunction with earlier experiences on
288
POLITICS AND THE C.A.M.C.
which I need not dilate, produced a very strong
impression on my mind that at the very outset of my
entering the British Service an effort had been made
to discredit me with that Service. This attempt
I was easily able to overcome. At the time of my
accepting the British appointment, Sir George Perley
had seemed eager that I should do so, and undoubt-
edly he welcomed it as a solution of the difficulty
presented by my request to return to Canada, a
contingency he was willing to go to extreme lengths
to prevent.
Persecution of Lieutenant-Colonel Wilson.
The treatment of Lieutenant-Colonel F. W. E.
Wilson, one of the most efficient officers of the
Canadian Army Medical Corps, affords an illustra-
tion of the extent to which " Prussianism " has been
carried by Sir George Perley and those in charge
of the Medical Service. There is no doubt what-
ever that this treatment was meted out to him be-
cause he had served on the committee which assisted
me in my Investigation and Report. There is
absolute proof of the fact that Sir George Perley
was not only cognizant of the treatment which was
to be accorded to Colonel Wilson, but was entirely
in agreement with it. After the appointment of Sir
289
19
POLITICS AND THE C.A.M.C.
Edward Kemp as Overseas Minister, I wrote to him
the following letter, dated December 28th, 191 7,
which explains itself: —
"A.P.O., No. i,B.E.F.,
" France.
" De)ar Sir Edward, —
" I desire to call your attention to the very unfair
treatment given to Lieutenant-Colonel F. W. E.
Wilson, of the C.A.M.C, by General Foster, the
Director of Medical Service, and Colonel Ross,
Deputy Director of Medical Service, Canadian
Corps, France.
" This officer came to England as second in com-
mand of No. 2 Canadian Casualty Clearing Station
in April, 19 15, and in June of the same year was
appointed D.A.D.M.S., Shorncliffe, and in May,
1916, A.D.M.S., Canadian Training Division,
Shorncliffe. In November, 19 16, on the reorganiza-
tion of the Canadian Medical Service by me, he was
appointed Deputy Director of Medical Service for
England, which office he held until January, 191 7,
when, upon the reinstatement of General Jones, he
was dismissed from the office of the Director of
Medical Service. On March 3rd, 19 17, he was
sent to France by General Foster, then Director of
290
POLITICS AND THE C.A.M.C.
Medical Service, who personally assured him that
he would receive a position in France in accordance
with his rank and experience. Instead of this he
was sent over as ordinary C.A.M.C. reinforce-
ments, and was ordered to report to the A.D.M.S.,
4th Canadian Division, by whom he was sent to an
advanced dressing station of the 12th Field Ambu-
lance to work under a captain. Ten days later he
was made Medical Officer to the 50th Battalion, a
position usually filled by a captain. He held this
position for two months, and worked in the trenches
during the Battle of Vimy Ridge. At the end of this
time he was attached to No. i Casualty Clearing
Station as a supernumerary. Three weeks later,
without any previous warning, he was, at eleven
o'clock at night, ordered to report forthwith to No.
II Canadian Field Ambulance. As this unit was
already at full strength, and was not serving the
front line at the time, his sudden movement from
the casualty clearing station can only be explained
as an attempt to further humiliate him. On June
26th he was sent to the Jura Mountains as Medical
Officer of the Canadian Forestry Corps, relieving a
captain, who had been in the Medical Service about
six months. Lieutenant-Colonel Wilson still holds
this position.
291
POLITICS AND THE C.A.M.C.
" As he is one of the best administrative officers
in the Canadian Medical Service, and of the highest
integrity and abiHty, and was so regarded by prac-
tically everyone in the Canadian Medical Service,
his degradation from the second highest position
in this Service to the lowest position in it can only
be explained in one way, viz., as a punishment for
his courage in speaking the truth when a member
of the committee of which I was chairman, which
reported upon the condition of the Canadian Medical
Service Overseas.
" It is surely time that the Prussian methods of
those in authority in the Canadian Medical Service
be investigated, and justice done to an officer who
has been punished for having at heart the interests
of the Canadian sick and wounded, and because he
had sufficient courage to point out defects in the
Service which interfered with its efficiency.
" I appeal to you with confidence, feeling satis-
fied that it is only necessary to bring the facts to
your attention, and that under the circumstances you
will take the necessary steps to reinstate Lieutenant-
Colonel F. W. E. Wilson in a position commen-
surate with his great ability, not only as a matter of
justice, but with the object of improving the Medical
292
POUTICS AND THE C.A.M.C.
Service. May I suggest that he be given a position
as an A.D.M.S., v^ith a step in rank?"
(Signed) "H. A. BrucK."
On January 5th, 19 18, Sir Edward Kemp repHed
to this letter as follows : —
" Dear Coi.one;i^ Bruci:^ —
" Your letter of the 28th ult. was duly received.
" Respecting Lieutenant-Colonel F. W. E. Wilson,
I may say that in August last information came to
the Headquarters Staff that Colonel Wilson was
doing excellent work in the position which he held
at that time, and that he was satisfied with his
appointment in connection with the Forestry Corps,
and was satisfied to continue in the same.
" I am informed that Colonel Wilson holds the
rank of Lieutenant-Colonel, the same as when he
went to England. If, however, he has any complaint
to make with respect to his treatment since he went
to France, I should be very pleased indeed if you
would request him to write a letter addressed to
myself, over his own signature, setting forth his
position and what he desires, and I will see that the
same has most careful attention.
(Signed) "A. E. Kemp.^'
Upon receipt of this letter I wrote to Lieutenant-
Colonel Wilson, enclosing Sir Edward Kemp's
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POLITICS AND THE C.A.M.C.
letter, and asking him to reply to it, and the follow-
ing is a copy of his letter :
" Personal.
'' Jura Hospital,
" Canadian Forestry Corps,
" U Jeux.
" i8th January, 1918.
'' To Sir Edward Kemp, Overseas Minister of
" Militia, Oxford Circus House, London.
" My Dear Sir Edward, —
" In a note which you recently addressed to
Colonel H. A. Bruce, a copy of which he was kind
enough to send to me, I note that you suggest that
I should write to you direct concerning the treat-
ment received by me as an officer of the Canadian
Army Medical Corps during my ten months in
France.
'' Before briefly stating my case, let me preface
by saying that I have made no formal complaint
for the following reasons: First, It is against mili-
tary usage for an officer to complain; he should
obey orders and go where he is sent. Second, As
long as Sir George Perley was Overseas Minister
of Militia, I was sure, on account of the prejudiced
294
POUTICS AND THE C.A.M.C.
stand against the Bruce Report, taken by him, that
justice would not be meted out to me inasmuch
as I had been a member of the Bruce Committee.
Third, I considered that an appeal to the present
Director of Medical Service, General Foster, would
be unavailing for the reason that when he sent me to
France he assured me that I would receive no degra-
dation here, but a position in keeping with my rank
and experience; my treatment immediately on ar-
rival in France shewed me without a shadow of a
doubt that the D.D.M.S. (Colonel Ross), Canadian
Corps, France, had received no such instructions
from General Foster, and I have every reason to
believe that he was instructed to serve out to me
the continuously degrading treatment which I have
received. Fourth, I have a distinct unwillingness to
* squeal/
" Also let me speak of the statement of Colonel
White, Deputy Director of the Canadian Forestry
Corps in France, that * Colonel Wilson was satis-
fied .... and satisfied to continue in his present
position.' I told Colonel White that I had no com-
plaints to make; Colonel White was a Forestry
officer, in no way connected with the Canadian Army
Medical Corps. I remember assuring Colonel White
that I had been most courteously treated since I
295
POLITICS AND THE C.A.M.C.
came to the Forestry Corps, and was satisfied with
my treatment here. I was told by Colonel White
that Sir George Perley was anxious to have me
satisfied, and I remarked at the time to Colonel
White : ' Sir George would no doubt prefer to keep
me satisfied provided that I am well out of the way!
To state that I was satisfied with the treatment by
the Director of Medical Service (General Foster)
and the D.D.M.S. (Colonel Ross), would have been
to declare myself a fool, for I am now filling
the position of a Medical Officer in the Forestry
Corps after having been displaced from the position
of Deputy Director of Medical Service, England,
the second highest position in the C.A.M.C. in Eng-
land — to be * satisfied ' under such circumstances
would be an obvious absurdity.
" My whole story resolves into this : I was ap-
pointed a member of the Bruce Committee, and I
agreed with the findings of that Committee. Subse-
quently, on the re-organization of the C.A.M.C, I
was appointed D.D.M.S., England. Previous to
this, I had been A.D.M.S. of the Canadian Training
Division at Shorncliffe; before that D.A.D.M.S.,
Shorncliffe, and still earlier Second in Command of
No. 2 Canadian Casualty Clearing Station. As far
as I know, nothing against my personal or military
296
POUTICS AND THE C.A.M.C.
character or my efficiency as an administrative
officer has been said or written. I doubt that if
my enemies make any such claim against me; in
fact, my continued and uninterrupted advancement
would naturally make one take an opposite view.
What then was my crime? — Obviously my connec-
tion with the Bruce re-organization. But, in justice
to me, let me remind you that I was not alone in
believing in the Bruce Report; General Carleton
Jones, the most criticized official in the Report,
declared over his own signature his agreement with
practically all the reforms suggested in the Report.
As you are probably aware, the bulk of these changes
have since been brought about by the Director of
Medical Service (General Foster), who was ap-
pointed by Sir George Perley after the Babtie Board
had condemned the Bruce Report. If the late Dir-
ector of Medical Service agreed with the bulk of
the Report (as can easily be proved), and the present
Director of Medical Service, in spite of the Babtie
Board condemnation, has carried out the majority
of the reforms suggested, why in the name of all
that is just should I be punished because I was a
party in the compilation of the Bruce Report?
" Since my arrival in France, I have received
practically the same treatment as I would have
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POLITICS AND THE C.A.M.C.
received if I had been a new graduate from a
medical college and had been recently gazetted an
officer in the C.A.M.C. As a matter of fact, when
the war broke out I had been a major in the Cana-
dian Militia for some two or three years and had
fifteen years' successful civil practice to my credit.
Since my coming to France my career has been as
follows: For two months as regimental medical
officer in the trenches; two wrecks in a casualty
clearing station ( from which I was rudely removed
without a moment's warning), upwards of a month
as an extra officer to a field ambulance with abso-
lutely no duty, and the rest of the time medical
officer in the Jura Mountains with the Canadian
Forestry Corps (relieving, when I came here.
Captain Locke, a young graduate with only a few
months' experience in the C.A.M.C).
" It is apparent that the treatment received by
me showed markedly an anxiety on the part of those
in control to squeeze me out of the Service and,
failing that, to locate me as far as possible from
London. It is quite apparent. Sir Edward, that the
C.A.M.C. even in this, the fourth year of the war,
is headed by men who dislike officers with ideas
and who have the courage to express those ideas.
Let me remind you. Sir, that I was peculiarly fitted
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POUTICS AND THE C.A.M.C.
to have views on Canadian Army Medical Corps
subjects, having been a D.A.D.M.S. and later on
Assistant Director of Medical Service of a division
which at times had a strength of 45,000 men; I was
in consequence intimately acquainted with many of
the more difficult problems which have cropped up
in this war.
" Either the Canadian Army Medical Corps is so
rich in valuable officers that it can afford to throw
aside to a minor position a man of my experience,
or I am being definitely persecuted for my connec-
tion with the Bruce Report.
" In conclusion, allow me to remind you, that
since the Bruce Report, investigations and changes
have been the order of the day in all branches of
the British Army. The appointment of Colonel
Goodwin over the heads of all the senior officers
of the British Medical Services has swept away the
chief grievance of the Bruce Report ; it was said of
Colonel Bruce that he was a surgeon and not suffi-
ciently senior or experienced in military matters to
be capable of investigating, suggesting changes, and
later re-organizing the Canadian Army Medical
Corps. The main fault with the Bruce Report, to
my mind, was that it was too advanced for the type
of man such as Sir William Babtie (who himself
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POLITICS AND THE C.A.M.C.
has, since presiding on the Babtie Board, been pub-
licly censured for his part in the Mesopotamia
scandal) and the men who sat with him, were. They
seemed unable to look past the hard-shelled con-
servative ways of ante-war red tapeism and recognize
the real needs of the Canadian Medical Services.
Subsequent events are rapidly providing, in spite of
the unfair interference of Sir George Perley and the
blanket opposition of the Babtie Board, that the
Bruce Committee findings zvere largely correct.
" With best wishes and kindest regards to your-
self and family,
*' I remain,
" Yours truly,
(Signed) "F. W. E. Wilson,
" Lt.-Col."
'' PS. — A personal interview with you on the
subject of Medical Services would give me an op-
portunity of going over many matters concerning
which you would be doubtless interested. I have,
therefore, applied to-day for special leave to Eng-
land, which I hope to procure within the next ten
days; would it be too much to ask you to advise as
to your probable whereabouts, and if I can have the
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POLITICS AND THE C.A.M.C.
favor of a personal interview some time, probably
next week?"
The persecution of Lieutenant-Colonel Wilson
was unparalleled in its vindictiveness. After assist-
ing me in obtaining the evidence upon which the
findings of my Committee were based, he was,
during the progress of my re-organization, appointed
Deputy Director of Medical Services, England.
Previous to this he had been Assistant Director of
Medical Services at the Canadian Training Division
at Shorncliffe, and was generally recognized to be
the most efficient administrator in the Canadian
Medical Service.
The work of the Babtie Commission was so
thoroughly done, that the public were led to believe
that no fault could be found with the former admin-
istration of the Canadian Medical Service, and to
strengthen this impression it became necessary to
reinstate General Jones. The disingenuousness of
this action by Sir George Perley will be appreciated
when it is pointed out that General Jones was told
at the time he was reinstated that he would only
retain his former position for a few weeks, after
which he would be replaced by Colonel (now
General) Foster. As Lieutenant-Colonel Wilson
had occupied a prominent place during my period of
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POLITICS AND THE C.A.M.C.
administration, General Foster, after a conference
with General Jones, decided to dismiss him from his
position as Deputy Director of Medical Services,
England, and to punish him for his association
with me, by sending him to France to occupy a
very junior position. Accordingly, he was sent to
France on the 3rd of March, 19 17, and there
received the disgraceful treatment which has just
been recorded.
What crime had Lieutenant-Colonel Wilson com-
mitted which deserved to be punished in this way?
Merely the crime of having served as a member of
a Committee which pointed out abuses discovered in
the Management of the Canadian Army Medical
Corps. But Lieutenant-Colonel Wilson and the other
members of the Committee were not by any means
alone in declaring their belief in the accuracy of the
Bruce Report. We find General Carleton Jones, the
former Director of Medical Services, who in that
capacity was himself responsible for many of the
defects disclosed by this Report, declaring over his
own signature his agreement with the desirability
of practically all the reforms suggested in my
Report. General Foster also, in a statement which he
submitted through Sir George Perley to the Prime
Minister, and which was communicated by the latter
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POLITICS AND THE C.A.M.C.
to the House of Commons on August 27th, 19 17,
gives a list of the improvements which he claims to
have effected in the Canadian Medical Service since
he assumed the control of it. An analysis of his
statement shows that the great majority of these
improvements represented either the carrying out
of recommendations in the Bruce Report, or were
initiated by me during the period of re-organization.
If General Jones, the former Director of Medical
Services, agrees in the main with the recommenda-
tions in the Report, and General Foster, the present
Director of Medical Services, in spite of the con-
demnation of the Report by the Babtie Board, has
adopted, on his own showing, most of the reforms
suggested, what justification could there possibly
be for the punishment of Lieutenant-Colonel Wilson,
whose only fault was that he assisted in the work
of the Bruce Committee? Was the Canadian Medi-
cal Service so abundantly supplied with capable
officers and administrators that it could afford to
waste in a subordinate position the services of a man
of such exceptional experience and ability as Colonel
Wilson?
Although Colonel Wilson for some months has
been doing work in connection with the Canadian
Forestry Corps ordinarily done by an A.D.M.S.,
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POLITICS AND THE C.A.M.C.
and although he was recommended for this post
with a step in rank, he was neither given the post,
nor was he given the step in rank. He was regarded
by the British Medical Service as a man of unusual
administrative ability and accorded the highest
praise. Yet he received no recognition of his ser-
vices and recently returned to Canada with the same
rank he held in 19 16, when he was a member of
my Committee. If he had been performing the
same service for the British he would undoubtedly
have received recognition; but unfortunately it was
necessary that any recommendation for honors
should come through the unit with which he was
connected, in his case, the C.A.M.C.
The Experience of Dr. R. J. McMillan, a Noted
Specialist in Anesthetics, and Dr. A. S. Moor-
head, a Prominent Surgeon^ both of Toronto.
The letters of Doctors McMillan and Moorhead,
which constitute this chapter, require neither elab-
oration nor comment. They tell their own story of
the unselfish determination of two outstanding
members of the Canadian medical profession, to
dedicate their services to those from whom at that
time the call was most urgent, " the British sick and
wounded'*; of the humiliating treatment accorded
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POLITICS AND THE C.A.M.C.
them; of their final admission to the British Medical
Service in the face of many obstacles. Of the great
work which they later performed in France there has
been no lack of testimony from their associates and
superiors in the British Medical Service. Once they
were permitted to carry out their mission, Doctors
McMillan and Moorhead labored faithfully and with
distinction during the exceptionally trying period
which marked the climax of the war and after the
armistice, remained at their posts in France until
they were no longer needed.
When they decided to respond to the appeals
for reinforcements for the British Medical Ser-
vice, Doctors McMillan and Moorhead, both of
whom then held military rank (Doctor McMillan
having been an officer of the Canadian Militia
for many years, although not on the active
list), made the usual formal application to the
Adjutant-General at Ottawa for permission to
travel abroad. To these gentlemen, as to most
officers in the Canadian Militia in pre-war days,
or those not then recruited for overseas service,
this had always been considered a somewhat per-
functory proceeding and the regulation that officers
should receive official sanction before leaving the
country, so far as the medical members at least were
305
20
POLITICS AND THE C.A.M.C.
concerned, was honored more in the breach than in
the observance. For this reason neither Captains
McMillan nor Moorhead were surprised when they
received no reply to their communications and they
proceeded overseas at their own expense. Instead
of receiving the welcome to which their position in
the medical world and their fine spirit entitled them,
they were, as will be seen by their letters, forced
into irksome and humiliating professional idleness
and to the necessity of despatching expensive cables
to influential friends in Canada to assist them in
overcoming the obstacles which stood between them
and their objective. This was during a period in
which the Canadian forces in France were heavily
engaged in the operations of Passchendaele. The
heavy casualties resulting from these operations
were for the most part treated in the British hos-
pitals in France, which were over-worked and under-
staffed, and which would have been inestimably
aided had the services of Captains Moorhead and
McMillan been available to them. The medical auth-
orities at Ottawa, however, preferred rather than
permit them to render service which meant not only
the alleviation of suffering but the actual saving of
lives, to regard these two officers as proteges of mine
and therefore dangerous to the existing order. The
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POLITICS AND THE C.A.M.C.
record of conditions in several hospitals in France
at that time is sad proof of the need for just such
men. As I have said, these officers were deliberately
thwarted in their efforts and but for their persist-
ence and the influence of their friends in Canada,
they would have been deported for a technical
infraction of a military regulation. Their wasted
months in Britain when there was much need of
them in France were due to the cable messages sent
from Ottawa, of which they both make mention.
In the light of their experiences, as related by
themselves, it is interesting to note the treatment
accorded two other Canadian medical officers.
Captains E. Hodgson and A. Mowat McCormick,
who went to England by the same boat as Captains
McMillan and Moorhead under identical conditions
so far as permission to leave Canada was concerned,
but who were taken on by the British Medical Ser-
vice at once and without any opposition from the
Canadian authorities. There must have existed
some reason for the difference of treatment accorded
these officers, whose position in regard to the cir-
cumstances under which they went overseas was
identical, and it lay in the publication in the Can-
adian press on the occasion of their departure from
Toronto, of an unauthorized and unfounded rumor
21 307
POLITICS AND THE C.A.M.C.
that " Captains McMillan and Moorhead are pro-
ceeding to France to join Colonel Bruce." That the
newspapers publishing this paragraph may have had
some ground for their belief in its authenticity is
indicated by a reference' to the case of these two
officers by General J. T. Fotheringham in a letter
to a relative of one of them, which was : " About
Captain Moorhead's case. He and McMillan were
unfortunate enough to listen to unofficial communi-
cations from Bruce." The cables from the Can-
adian to the British medical authorities barring
Captains McMillan and Moorhead from the British
Medical Service, which are contained in the corres-
pondence following, were the outcome of this
misconception of the situation and of the policy of
the Canadian Medical Service at that time.
These letters of Captains McMillan and Moor-
head explain themselves : —
" From Captain R. J. McMillan, C.A.M.C,
" To Sir Robert Borden, K.C.M.G.,
" March 30th, 19 18.
/ " No. 2 General Hospital,
" B.E.F., France.
" 30th March, 1918.
308
POLITICS AND THE C.A.M.C.
" The Rt. Hon. Sir Robert Borden, K.C.M.G.,
" Prime Minister of Canada, Ottawa.
" Dear Sir Robert, —
" I practice medicine in Toronto, and am an officer
in the Canadian Army Medical Corps. As I was
not being employed by the C.A.M.C, and having
heard from friends that our Service had more
officers overseas than they required, and being
anxious to help in the common cause, I decided
to offer my services to the Royal Army Medical
Corps.
" At the request of the British Medical Service,
in June, 19 17, the Canadian Director of Medical
Services, London, agreed to my transfer to the
R.A.M.C.
" Early in July I applied to the Adjutant-General,
Ottawa, for leave of absence, and advised the Assist-
ant Director of Medical Services, No. 2 Division,
Toronto, and General Fotheringham, of my inten-
tion to join the R.A.M.C. The A.D.M.S. gave me
a certificate to assist in getting a passport.
" I did not wait for a reply to my application for
leave, as I was advised that it was a purely formal
matter and that many months might elapse before a
reply would be received, and further, that it was
customary for officers to leave Canada for service
309
POLITICS AND THE C.A.M.C.
abroad without waiting for such permission.
x\ccordingly, on August loth, 191 7, I left Toronto
for England, although I had not received an answer
to my request for leave.
" When I reported to the British Medical Service,
England, I was told that they would take me on
at once if it were not for a cablegram received from
Ottawa, as follows : —
" Captain R. J. McMillan, being an officer in the C.A.M.C,
left for France to join the R.A.M.C without permission, at
the instigation of Colonel H. A. Bruce."
" The statement ' at the instigation of Col. H. A.
Bruce ' is absolutely false, as the only action Colonel
Bruce took in the matter was to give me a recom-
mendation to the British authorities, which I asked
him to do.
" I then called upon the Adjutant-General, Can-
adians, London, who informed me that he knew
nothing about the matter and could not understand
any interference with my joining the British Ser-
vice, as I was not required in the C.A.M.C. I was
asked to wait until a cable was sent to Ottawa for
instructions. At the end of three weeks I received
instructions to proceed to the camp at Shorncliffe,
where I remained doing minor duties until Novem-
ber 22nd, 191 7, when I was permitted to join the
British Medical Service.
310
POLITICS AND THE C.A.M.C.
" Doctors Hodgson and McCormick, of Toronto,
officers in the C.A.M.C, came over on the same ship
with me to join the R.A.M.C. with the knowledge
of the mihtary authorities in Canada, and although
they had not received permission to leave the Can-
adian Service, were immediately taken on by the
British Medical Service. Doctor Simpson of
Toronto, an officer in the C.A.M.C, came to Eng-
land two months previously and joined the British
Service without having obtained permission from
the Canadian authorities.
*' The only reason I can see for being in this way
singled out for punishment was that some of the
Canadian newspapers reported that I had left Canada
to join Colonel Bruce, and evidently this annoyed
some person in authority in the Canadian Medical
Service.
" I came over to England to help during this great
crisis at much personal sacrifice, inasmuch as I left
a wife and family and a good practice although not
in a financial position to do so.
** I received no pay of any kind between August
loth, 1917, and November 22nd, 1917. I have
asked the Canadian authorities for the pay of my
rank, with separation allowances for this period, and
this has been refused me. This I consider a great
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POLITICS AND THE C.A.M.C.
injustice, for if the Canadian authorities had not
interfered, the British Medical Service would have
paid me from the time I left Toronto.
" Under these circumstances, I appeal to you as
the highest authority in Canada, with every con-
fidence that you will see that justice is done.
" I have the honor to be,
" Your obedient Servant,
(Signed) ^^ R. J. McMii.i.an,
" Capt. C.A.M.C.
" Seconded to the British Medical Service."
" From Captain A. S. Moorhead, C.A.M.C.
'' To Sir Robert Borden, K.C.M.G.
" April 24th, 1918.
"Army Post Office No. i,
" B.E.F., France.
"24th April, 1918.
'' Sir Robert Borden, K.C.M.G.,
''Prime Minister of Canada, Ottaiva.
*' Dkar Sir Robert, —
*' I feel it my duty to call your attention to a
matter which I believe to be of public importance,
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POLITICS AND THE C.A.M.C.
inasmuch as it shows the high-handed methods
employed by your MiHtia Department, which inter-
fere with our efficient prosecution of the War.
" I was an honorary officer in the Canadian Army
Medical Corps, doing work for the Hospitals Com-
mission in Toronto, which duty I performed for a
year and a half, and for the Pensions Board for two
months, without pay from the Militia Department.
"Knowing of the great shortage of medical
officers in the Royal Army Medical Corps in
France, and also being aware of the fact that the
Canadian Medical Service was well supplied with
doctors, I decided to offer my services to the British
War Office, as a result of which the War Office
in June, 191 7, asked the Canadian Director of
Medical Services, London, if I could be sent to
them, and on receiving a reply in the affirmative,
asked the Canadian Director of Medical Services
to request the Canadian authorities in Canada to
send me over.
" On August 8th, as I had not heard from Ottawa
in the matter, I decided to proceed to England at
once and informed the Assistant Director of Medical
Services at Camp Borden, who replied it was all
right, and he filled my place on the Pensions Board
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POLITICS AND THE C.A.M.C.
next day. He had previously sent a certificate
enabling me to get my passport in Toronto.
" I left Toronto on August loth, 19 17, arriving
in London on September 2nd, and immediately
reported to the War Office, where I was told that
they needed me and would take me on at once were
it not for a cablegram which they had received from
Ottawa, which was as follows: —
" Captain A. S. Moorhead, an officer in the C.A.M.C, has
left for France to join the R.A.M.C. without permission, at
the instigation of Colonel Bruce."
** The latter part of this cable which refers to
Colonel Bruce is untrue, as he did not directly or
indirectly influence me to join the R.A.M.C.
" I then saw the Adjutant-General, Canadians,
who promised to cable to Ottawa, and after waiting
in London for three weeks was sent to the C.A.M.C.
depot at Westenhanger.
" Colonel Chisholm, at the Canadian Director of
Medical Services' Office in London, told me that I
was not needed in the C.A.M.C, as they had plenty
of officers, which statement was corroborated by
the fact that I found from fifty to seventy medical
officers taking drill at one time at the medical depot,
314
POLITICS AND THE C.A.M.C.
and was told that there were over 400 super-
numerary medical officers attached to various hos-
pitals in England awaiting appointments.
" I remained idle at the Canadian depot at Westen-
hanger until November 22nd, when, on being per-
mitted to join the R.A.M.C., was immediately sent
to France.
"As the Canadian authorities prevented me from
joining the R.A.M.C. during all this period, I con-
sidered that they should pay me, and accordingly
sent a statement of claim to the Paymaster Canadian
Overseas Forces. I received a copy of a letter from
the Adjutant-General, Militia Department, Ottawa,
stating that I had no claim whatsoever against his
department. I think you will appreciate the unfair-
ness of this decision.
" I gave up a busy practice in Toronto because
I was aware of the great shortage of medical men
in the British service in France, and wished to give
my services where they were most needed.
" During the three months I was kept in idleness
in England because of red tape or stupidity in the
Canadian Medical Service, very hard fighting was
occurring in France, in which our Canadian troops
took part, and not only was the shortage of medical
men felt by the British wounded, but also by our
315
POLITICS AND THE C.A.M.C.
own Canadian wounded, in consequence of the
practice of sending them into any British hospital
available.
" I consider, therefore, the action of the Canadian
medical authorities in this matter was an injustice
to the wounded, as well as to me, whereby I was
prevented from doing a service which I made every
effort to perform.
" Yours faithfully,
(Signed) "A. S. Moorhejad,
"F.R.C.S.
" Captain, C.A.M.C,
" Seconded to the R.A.M.C."
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POUTICS AND THE C.A.M.C.
IN CONCLUSION.
My colleagues and I entered upon our investiga-
tion without prejudice or bias, determined only to
prepare an honest and impartial Report, based solely
upon the conditions actually prevailing. I had
scarcely commenced my work, however, when
pressure was brought to bear upon me by friends
of those who might be affected to influence me in
the investigation and findings.
The treatment later meted out to myself and
some of the members of the Committee which acted
with me was certainly not such as to encourage in
future an honest expression of opinion from Boards
of Inquiry in any branch of the Service. While
military discipline in the fighting forces may be —
and undoubtedly is — absolutely necessary to secure
that cohesion and unified action which is so essential
in military movements, there does not seem to be the
same necessity for it in the Medical Service, which
has to do with the care and treatment of the sick
and wounded. Insistence on this too rigid discipline
results in the suppression of any criticism which
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POLITICS AND THE C.A.M.C.
might lead to an improvement in the Service. The
fact that all honors are bestowed on the recom-
mendation of the head of the Service tends to dis-
courage individual initiative, and to make the work
done by the members of such a Service little better
than that of automatons. It was not uncommon
for medical men, who, in civil practice, exhibited
initiative and were accustomed to express inde-
pendent opinions of their own, to completely lose
their individuality after becoming members of a
medical military organization. At first sight it
seems a little difficult to understand, but on a little
reflection it becomes easy to see the reasons. In my
opinion the following are some of the more
important ones: —
These men, after leaving their homes, and decid-
ing to give their services to their country, are very
soon forcibly impressed with the fact that they must
carry out any orders given them without question.
If they wish to make any communication to the
authorities it cannot be made direct, it must proceed
through regular channels, which involve intermin-
able and hazardous delays. That is to say, if a
medical officer in a hospital is dissatisfied with the
situation in that hospital, and sees things there which
he is sure should be and could be improved, he must
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POLITICS AND THE C.A.M.C.
write a letter, and hand it to his commanding officer,
who is at liberty either to pigeon-hole the com-
munication or forward it to the Assistant Director
of Medical Services of the area in question, from
whom it goes to the Deputy Director of Medical
Services, ultimately reaching the Director of Medical
Services. At any stage of its progress, however, it
may be disposed of, and even if it does finally reach
the Director of Medical Services, it often occurs
that no notice is taken of it. The individual who
has suggested the improvement is, in the first place,
discouraged, and if he persists is soon regarded as
a nuisance, and becomes unpopular with his superior
officers. A similar routine has to be gone through
in regard to recommendations for promotion or
honors. It follows that if a man has ambitions he
is much more likely to realize them if he is some-
thing of a " time-server," and that if he has ideas
which indicate initiative and originality he is likely
to become unpopular with those who are placed in
authority over him. Things being as they are in
this respect, one can readily understand that a
medical officer would hesitate to say anything to
those above him in criticism of the conditions in his
hospital, however unsatisfactory these conditions
may be, for fear that such presumption may be
319
POLITICS AND THE C.A.M.C.
punished by dismissal from his post. He realizes
that if he is dismissed the Service, he goes home, to
a certain extent in disgrace, although his only crime
may have been the pointing out of certain abuses in
that Service to those responsible for its efficiency.
Also, whilst he remains in the Service he is
absolutely prevented, by the rules of military dis-
cipline, from publishing any criticism of it. It is
not surprising, under such circumstances, that the
ultimate result of these restrictions is that every-
thing in the shape of healthy criticism is effectually
suppressed. In other words, the strict enforcement
of military discipline in a Medical Service places
tremendous power in the hands of the executive of
that Service, more especially as they possess auto-
cratic control over the whole system of rewards and
punishments. Such power as this can only be placed
with safety in the hands of a man of exceptional
probity and good judgment, and of sufficient
strength of character to do what is just and right,
irrespective of selfish or partisan considerations. If
these qualities are wanting in the head of the
Medical Service one can readily appreciate what
injustice is likely to be done.
In conclusion, after nearly two years in the British
Service, I should like to say that during the time
320
POLITICS AND THE C.A.M.C.
that I held my post in France the traditional British
qualities of fair play have resulted in my receiving
from Sir Arthur Sloggett, the Director-General of
Medical Services, and his officers the very kindest
treatment, and have been made to feel very much at
home amongst the officers of the British Medical
Service. I should like to pay a tribute to the very
excellent work which has been done by the doctors,
nurses, members of the Voluntary Aid Detachment,
stretcher-bearers and orderlies in that Service, to
which every word which I have already used with
regard to the members of the Canadian Army
Medical Service applies.
Let me again emphasize the fact that my Report
was not in any sense a criticism of the work of the
doctors serving with the Canadian Army Medical
Service, for whose untiring devotion to duty and
spirit of self-sacrifice I have the utmost admiration.
The individual work of the medical officers was
worthy of the highest praise, and as a fellow-Cana-
dian has filled me with pride in my countrymen and
my profession. It is against the administration of
that Service, its policy of drift and lack of intelligent
foresight that my criticisms were aimed.
321
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THE UNIVERSITY OF CALIFORNIA UBRARY
