By Brian Roulston
The earliest record of nurses during war dates back to the American Revolution. Troops’ wives, daughters, and mothers accompanied them to care for the sick and injured. In 1775 Congress approved General George Washington’s request to provide one female nurse for every ten patients with pay $2 per month.
Florence Nightingale is credited with organizing and improving battle nursing during the Crimean War (1854-1856), modernizing military hospitals, boosting survivability and improving civilian care long after. Thanks to her and many dedicated war nurses, more soldiers were able to return home.
Called “Bluebirds” in Canada for their blue uniforms and white veils, they have a long history with Canada’s military, starting in the 1885 North-West Rebellion, where they provided crucial medical assistance. The Bluebirds also served in South Africa during the Second Boer War. The British and Canadian governments did not officially recognize their contributions.
1904, the Permanent Active Militia Medical Corps and the Militia Army Corps were established, later combined as the Canadian Army Medical Corps (CAMC) in 1919.
Unlike earlier wars with close combat, World War I saw soldiers exposed to long-range, high-explosive weaponry and continuous bombardment in trenches, significantly increasing injury rates. The use of machine guns, artillery, tanks, and chemical weapons (poison gas) resulted in unprecedented casualties and injuries. The CAMC evolved into a greater medical force to support our soldiers.
Nursing sisters established casualty clearing stations, typically two to three kilometres from combat. Not always safe, they provided primary medical services, delivering essential care to soldiers, prisoners of war, and occasionally civilians. To qualify women had to meet specific requirements: they needed to be British subjects, which most Canadians were, have a degree from a three-year nursing program, be single, healthy, and between the ages of 21-38 at the time of enlistment. Men were not allowed to be nurses.
Most nursing sisters came from middle—or upper-middle-class families. While educational requirements were strict, other rules were often ignored, some married women listed themselves as single and ages often lied about. Once in the CAMC, they were granted the rank of lieutenant, allowing them seniority over their patients and authority over hospital staff and assistants, officially designated lieutenant/nursing sister, captain/nursing sister etc. Canada was the only country that had commissioned women as officers. But they were commonly called “Sisters,” a nod to nursing’s historical ties to religious orders not implying religious affiliation.
In WW1, 2,845 nursing sisters served in various locations, including Canada, France, England, Belgium, Russia, and the Mediterranean. Assignments included casualty clearing stations, hospitals, hospital ships and hospital trains. Others worked in Convalescent Hospitals for soldiers recovering from illness or injury. Conditions near the frontlines were harsh. Provisions were scarce, and reliable access to potable water—especially in the Mediterranean—was a luxury. Some stationed in distant towns enjoyed some comforts such as heat, perhaps a warm shower. Those closer to the front lines initially endured canvas tents and later, makeshift wooden shacks or bombed-out buildings such as schools, churches, or community halls. Living conditions were further complicated by the prevalence of pests like fleas, ticks, flies, snakes, and venomous spiders.
Tragically, at least 58 nursing sisters lost their lives during World War I, with 21 dying due to direct enemy action. Fourteen nurses aboard the hospital ship HMCS Llandovery Castle perished when a German U-boat torpedoed it on June 27, 1918. The ship was carrying troops and medical personnel to the war front from Halifax to Great Britain. It was attacked 200 miles off the coast of Ireland. She had a large Red Cross on the bow and special lighting, required by hospital ships. The Red Cross, an internationally recognized symbol identified medical services and personnel protected under the Geneva Conventions during armed conflicts. German U-boat Captain Helmut Pazig had the authority to board the hospital ship, verify its credentials, and ensure no munitions were aboard before acting. Instead, he torpedoed the ship. Several lifeboats were launched from the Llandovery Castle. The U-86 surfaced, and Pazig began questioning survivors as they tried to get into their lifeboats or help others, all the while making baseless allegations that the hospital ship was carrying ammunition. The ship went down within ten minutes, suction drawing several survivors and lifeboats down with it. Pazig then ordered the submarine crew to go below deck. Once his crew was below, he and some commanding officers opened fire on the remaining survivors. They also charged at and rammed lifeboats to sink any evidence. One lifeboat with several nurses and crew members survived the attack.
Pazig threatened his crew and altered the logs to show he was not in the area during the attack. German forces eventually found out and court-martialed Helmut Pazig and his crew but they escaped custody. The most any crewman served was 4 months. Captain Pazig went on to command another U-boat during WWII.
Mae Bell Sampson, born in Duntroon, Ontario, finished her three years of training at Hamilton City Hospital Nursing School, at the corner of Barton and Victoria Ave in 1913. She became Hamilton’s first nurse to join and was among a group of 23 – the first Bluebirds to go overseas in 1914. Sampson was the only nurse from Hamilton who died. She was aboard the HMCS Llandovery Castle when it was torpedoed one hundred nights before Armistice Day and was posthumously awarded the 1914-1915 Star, the British War Medal, the Victory Medal, and a Memorial Cross.
In WWII, 4,480 nurses served in all branches of Canada’s armed forces as Allied forces swept through Italy, France, and Germany. The first nursing sisters and the No. 2 Canadian Air Force Mobile Hospital landed in Normandy 13 days after D-Day. Nursing sisters frequently faced enemy shelling and continuous air raids for hours at a time by the Germans against Allied Hospitals in England, the Western Front in France and Belgium, and the Mediterranean Front. A typical workday was about 18 hours, and often as long as 30 hours straight. In addition to long hours, nursing sisters and doctors frequently had to relocate hospitals whenever the front lines moved closer or further away, another layer of strain to their demanding roles. There were also times when there were weeks of inactivity, intermittently broken by the sudden influx of wounded soldiers requiring immediate care.
The toll on nursing sisters was substantial. Many suffered the same mental afflictions as many soldiers: mental exhaustion and the effects of war trauma, with diagnoses of “nervous debility” or “shell shock.” Standard treatment focussed on ample rest and nutrition. The harsh reality of their work involved not only confronting horrific injuries and comforting dying soldiers but also making difficult decisions triaging patients based on their chances of survival. Often their compassion—expressed through gentle words and a comforting touch—and rapport built through shared experiences were the only things that helped soldiers cope with their trauma. In one case, a group of injured soldiers gifted a nurse with a young dog from the trenches, in appreciation for the care she provided.
Nurses played a vital role in providing blood transfusions. They managed the logistics of blood supplies and set up and monitored blood transfusions to those severely wounded men. Their work in organizing and carrying out these life-saving procedures helped many soldiers survive on the battlefield.
In quiet moments, nurses often found solace in writing letters to the families of those who had died under their care, tending to their graves, and reflecting on the harrowing experiences they endured. They made friends among their ranks. Often those ended when they were transferred to other units. Despite intermittent quiet periods and occasional opportunities to travel, the weight of responsibilities and the trauma of witnessing the impacts of war remained ever-present.
Nursing Sisters are now officially called “Nursing Officers” in the Canadian Armed Forces. They care for soldiers in Canada and abroad. The title “Nursing Officers” was established in 2001, and the concept of having exceptional nurses known as Nurse Practitioners was accepted in April 2021. Essential in providing primary care in military clinics, field operations, on ships, in the air, and during international missions, they wear modern military uniforms with specialized medical insignias. They receive extensive training in medical procedures, combat first aid, tactical combat casualty care, avoidance of capture, map reading, and basic training.
On this Remembrance Day 2025, let’s remember the nurses who looked after our soldiers in the past and thank those dedicated to looking after our men and women in present and future military situations around the globe.
