SIX

Toronto, Canada, and Cambrai, France, 1917–1918

THE CASUALTIES OF WORLD WAR I WERE OF A SORT AND A SCALE never before seen. For the first time, dogfights screamed through the skies, filling them with fire and smoke, and on the seas German U-boats quite literally undermined the superlative British fleet. The war introduced tanks and dirigibles, machine guns, blinding chemical gas, and long-range guns, including the biggest in the world, a howitzer named Big Bertha. And it killed profligately. Great Britain and its empire lost over 1 million soldiers; France, 1.3 million; Russia, 1.7 million; Germany and its allies, 3.5 million. During the fighting, the loss of life per day exceeded five thousand souls. To replenish its devastating losses, Britain passed five versions of the conscription act, each one broader than the previous one until the last, when they were calling up all men, married or unmarried, of any profession, from the ages of seventeen to fifty-one. For nearly three devastating years America claimed political neutrality, watching the carnage from across the Atlantic (while manufacturing weapons and selling them to the Allies).

Advances in military technology had far outstripped the advances in medical technology. Injuries were of a type that doctors had never seen: bones pulverized into unrecoverable shards, a profusion of disfiguring facial injuries, and a mysterious new condition called shell shock. The terrible destructiveness of the new weaponry, coupled with the revoltingly unhygienic environment of the trenches, made for an acute need for medics and more medics on the battlefield.

England had sent out the call and Canada responded. The University of Toronto’s Medical School reorganized and condensed the curriculum of the fifth and final years of training of the class of 1917 so that its members would be graduated a year early and sooner sent overseas. Upon graduation, the entire class of 1917 enlisted in the Canadian Army Medical Corps (CAMC). Practically speaking, their final credits were to be earned in the trenches. In 1917 the population of Toronto was nearly 90 percent Anglo-Celtic. “God Save the King” was the Canadian national anthem. The Union Jack figured prominently on the Canadian Red Ensign national flag. A half million Canadian soldiers fought in Europe, and more than sixty thousand of them died.

Frederick Banting, a mediocre student in the class of 1917, was among the first to volunteer. It was the third time he had tried to enlist. He first appeared at the army recruitment center on August 5, 1914, the day after Canada entered the war, but his poor eyesight prevented his enlistment. He tried again in October and was again rejected. By December 1916, his medical training, coupled with the desperation born of the terrible loss of life, made possible what had not been possible before. It would be one of many experiences in Banting’s life where he succeeded by persistence through repeated failures and against compelling evidence and poor odds.

Banting was of Scottish and English descent. His family had come to Canada in the middle part of the nineteenth century. Banting was born to Margaret and William Banting in 1891 on a farm in Alliston, Ontario; he was the youngest of four. He had one sister and three brothers (a fourth brother died as an infant); the sibling nearest in age to him was his sister, four years his senior. Fred was especially close to his mother, Maggie.

As each of the Banting sons turned twenty-one, his father gave him a horse, a harness, a buggy, and $1,500, which he could spend any way he chose. All three of the older Banting boys used their money to establish farms. Fred spent his money on education.

When he entered Victoria College at the University of Toronto, he had no definite objective in mind. Like the parents of Charles Evans Hughes, Banting’s parents hoped he would pursue the ministry. Although he maintained the habit of attending church every Sunday through his college years, it was largely to please his mother. He was interested in art and had a fine baritone singing voice. He was athletic and played football and baseball. Although Banting enjoyed college life, his grades were not especially good. He had to repeat English composition and struggled with spelling throughout his life, but he persevered, spurred by the understanding that if he failed he would have to return to cleaning out henhouses, threshing wheat, and mending fences.

According to one story, Banting’s interest in medicine came about as the result of his witnessing an accident one day in which two workmen fell from a scaffold and appeared to be seriously injured. Fred ran for the doctor. He was impressed by the effect the doctor’s arrival had on the crowd that gathered around the men. They were immediately relieved and stood at a respectful distance to watch as the doctor set to work with steady and sure hands.

Edith Roach was part of Banting’s plan to improve himself. They met in the summer of 1911 when Edith’s father, a Methodist minister, moved his family to Alliston. She was also a student at Victoria (with a scholastic record considerably better than Fred’s). The last thing Lieutenant Banting did before leaving Toronto in late February 1917 was to give Edith Roach a ring and ask her to wait for him.

Banting’s ship crossed the Atlantic, landing in the CAMC depot at Westenhanger, in Kent, the southeasternmost county in England. From there he went to Granville Canadian Special Hospital at Ramsgate, where he worked with Dr. Clarence Starr, a highly respected orthopedic surgeon from Toronto who would play an important role in his future. Although such an arrangement was excellent training for a newly minted surgeon, Banting was anxious to get into the action. He would soon be afforded the chance.

The medical corps suffered more battle casualties than any other arm of the service. On the Western Front, stretcher bearers, ambulance drivers, and doctors fell beneath the same shells as the soldiers whose wounds they were charged with dressing. In the winter of 1917, Banting was sent to replace a doctor who was killed by shrapnel while looking out a window in a shattered home at Cambrai.

Cambrai is roughly a hundred miles north of Paris and a hundred miles southwest of Brussels. During the Great War, it was in enemy hands and deemed the key position on the German front line. Although the battlefields of Cambrai are today among the least visited of the Western Front battlefields of World War I, the fighting that began there in November 1917 is well remembered in the annals of military history. It was the first instance of a revolutionary method of attack—a mass assault using both tanks and aircraft. The routed Germans studied this method and later developed the blitzkrieg methods that the German army successfully employed in World War II.

As a medical officer of the 44th Battalion Banting served with the 13th Field Ambulance, stationed at a place called Lilac Farm, near Cambrai. The 13th Field Ambulance was commanded by Lieutenant Colonel W. H. K. Anderson. Banting’s immediate superior was the second in command, Major L. C. Palmer, an able surgeon who, like Starr, would play an important role in Banting’s future medical career. Fred was popular among his comrades, joining in soccer and volleyball games during the brief respites from duty. He was cool under pressure, and courageous, too. According to an oft-repeated apocryphal tale, he once walked into an enemy dugout, armed with nothing more deadly than a swagger stick, and emerged with three German prisoners whom he immediately put to work. The official history of the unit contains the following paragraph:

Captain F. G. Banting, Medical Officer of the 44th, goes forward with the attack—and, with his medical detail, establishes the first dressing station in Drury Quarry. His work is beyond praise. Pressing into service a captured German medical detail he worked incessantly throughout the operations—clearing hundreds of wounded in addition to the men of his own unit.

Dressing stations were ad hoc operating theaters, which were set up in any available structure, such as a barn or farmhouse or even a primitive dugout. The wounded were evacuated from the battlefield by horse- drawn ambulances. Human stretcher bearers transferred wounded men from the ambulances to the operating tables in the dressing station and back to the ambulances for transport to the casualty clearing stations farther from the front.

At Lilac Farm the dressing station was a partly wrecked barn, not far behind the firing line, and Captain Banting often came under heavy German fire. Many of the wounds to combatants were catastrophic, and surgical decisions had to be made in seconds. Amputations were common. In this era, before the introduction of sulfa drugs, infection was a primary concern among wartime surgeons. When faced with a choice between dressing a potentially infected wounded limb and a sanitary amputation of that limb, the latter was often preferred. The soldier’s chances of survival were better with amputation.

While everyone at the front could hear the distinctive long whistle of an incoming shell and know that it would end in an explosion, one man in Banting’s unit, an Italian stretcher bearer, had trained his ear to discern the difference between an “overhead,” in which one should remain standing, and a “ground burst,” in which it was better to lie flat. At the first scream of an incoming shell, everyone in the unit would look to the Italian, who would signal whether the incoming round was “overhead” or “ground burst.” Much to Major Palmer’s amazement, Fred Banting had trained his ear to hear nothing at all. Occasionally Palmer would find Banting studying a pocket anatomy textbook with such concentration that he seemed oblivious to the shells screaming all around him.

On September 28, 1918, Banting was operating at his dressing station at Lilac Farm. As a result of several casualties, Palmer and Banting were the only officers at the station. That morning, the Germans were using “whizzbangs,” which were shells that had no incoming scream and could be heard only seconds before landing and exploding. These confounded even the Italian stretcher bearer.

The Germans were in retreat, but firing furiously as they went. A Canadian artillery officer set up an eighteen-pounder in the barnyard and aimed it over the ridge at the Germans. The Germans were determined to put this gun out of action, and the whizzbangs pelted the farm with such intensity that both the Canadians and their German prisoners were taken aback. One of the prisoners, a German major, ventured out onto the steps of the farmhouse to admire the storm of shrapnel and was promptly decapitated where he stood.

A piece of shrapnel tore open Banting’s sleeve and chewed into his right forearm. It was a deep wound, and the ragged metal severed the interosseous artery. Palmer took Banting by the shoulder and guided him to the shelter of a brick wall. There he quickly tied a tourniquet above the elbow, removed the fragment, and applied a dressing.

Palmer ordered Banting to the casualty clearing station and pointed to a waiting ambulance. Until this moment, Banting had accepted his superior officer’s help without protest, but now he looked in the direction of the abandoned dressing station and begged to stay near the action, where he was clearly needed. The shells were crashing down around them. There was no time to argue. Just as Palmer was about to say so, a runner arrived with a note: Cambrai had been taken by the Allies and they needed a new dressing station there immediately. Palmer hesitated, considering whether to take Banting along. Then Palmer decided to go ahead to Cambrai, taking some sergeants with him to dress the wounded. He ordered Banting to the ambulance and left.

At Cambrai, the tanks had torn and churned the earth together with the rain so that it was nearly impossible to find a place to set up the dressing station. Then there was a sudden and fierce counterattack, and the Germans retook the town. As the German infantry flooded into the area, Palmer hid in a cellar, where he could hear the German boots on the floorboards overhead. It seemed that he crouched there for hours, barely breathing, hoping none of the soldiers would think to explore the cellar. Around midnight, the British again advanced and the Germans again retreated. Back at Lilac Farm, the wounded continued to arrive in a steady stream. Banting took care of them as quickly as he could, dressing them and dispatching them to be transported to the same casualty clearing station to which he himself had been ordered hours before. Each time a stretcher arrived, he told himself that this would be the last one, or that as soon as there was a break in the shelling, he would report to the casualty clearing station to get his arm checked. The shells continued to rain down, and the wounded continued to arrive. Hours passed. Whenever Banting decided that it was time to go, he would look down at the young man on the table before him and ask himself if this was the face he would walk away from. The answer was always no; the next would be the one. By the time Major Palmer made it back to Lilac Farm after his ordeal, it was four o’clock in the morning. He was stunned to see Banting standing at the table, just as he had left him seventeen hours before.

At the moment of Palmer’s arrival Banting was trying to force his stiffened fingers to scissor open a blood-soaked pant leg. Palmer gazed beyond Banting to the far wall, where the bodies of those who would not be moving on to the casualty clearing station had been laid side by side under a drape of filthy cloth. Palmer grabbed Banting by the left shoulder and directed a hard glare at the surgeon’s grimy, blood-spattered face. Banting met his gaze without malice or fear.

“Which one should I have left, sir?” he asked. Banting nodded to the soldier bleeding before him on the stretcher. Palmer looked down. It was the Italian stretcher bearer. The left side of his jaw was torn away, and the pulpy tissue of his face was spattered over his shirt like a bloody bib. The tissue was flecked with small white chips of bone. His left eye was swollen shut, but his right eye stared up at Palmer, wide with terror. Without another word, Palmer walked away.

When Banting had patched up the Italian and sent him on to the casualty clearing station, Palmer returned and put his hand on Banting’s neck and walked him to the ambulance. Haggard with fatigue and weak from the loss of blood, Banting did not resist. Banting eased himself into the seat next to the driver, and within seconds his chin had dropped to his chest. Palmer tapped the roof of the vehicle and it hurtled off over the muddy, shell-pocked field with the sleeping officer.

At the casualty clearing station Banting was given morphine and told that he would be evacuated to England. The next thing he knew he was at the Number One General Hospital in Manchester, and his wound had been debrided.

Banting sent word to Dr. W. E. Gallie whom he knew from Toronto. Permissions were promptly secured, and Gallie was soon in Manchester, examining Banting’s arm. He determined that the wound on the dor- sum of the forearm was infected and there was a slight ulnar nerve lesion. Banting remained at the hospital in Manchester for two weeks, at the end of which he took a turn for the worse. He was transferred to Buxton, where there was discussion about amputating his arm. The surgeons told him he had a choice between losing his arm and losing his life if the infection persisted. It was an argument that Banting had made to others, but he had never been on the receiving end of it. He would have none of it, arguing with such force and irascibility that no one dared to cross him. Further, he insisted that he and only he should direct his care. Ultimately he prevailed. The resident surgeons left him alone to take his chances. No doubt some were surprised when the infection cleared up.

Banting’s refusal to comply with military orders won him the Military Cross. His refusal to comply with medical advice won him the use of his right arm. With this arm he would save the lives of millions of diabetic children. His would be the medical breakthrough that Dr. Frederick Allen had so long believed was imminent.