AT 9:00 P.M. , LIEUTENANT Colonel Frederick McKelvey Bell, assistant director of medical services (ADMS) for the Canadian military, dictated a confident telegram to St. John telling them that he would not need any more doctors. As the ADMS, the military hospitals—Camp Hill, Cogswell, and the destroyed Pier 2—were his priority, but they were filled with thousands of injured civilians and that made it his job to figure out how to treat them. In his uniform, McKelvey Bell appeared to be an ordinary enough man, a thirty-nine-year-old surgeon who in the first year of the war left the quaint houses of Ottawa to enlist. There was nothing outstanding in his features—his short stature, or barrel chest, nothing unusual about his heavy mustache or dark hair shorn into conformity—to indicate that he could lead an emergency medical team with unfailing optimism and organization. If there was something compelling about his face, it was his dark blue eyes. They drooped a little in the outside corners, creating an almost permanent sympathetic expression. “His ability to make people relax under conditions that tended to tenseness was unfailing.” But for all McKelvey Bell’s diplomacy, he was unsentimental, efficient, and prepared. His experiences in France could not have been better training for disaster work. On October 3, 1914, McKelvey Bell embarked with the No. 2 Stationery Hospital to France, the first temporary hospital set up by the Canadian Army Medical Corps in Europe. For two years he oversaw the treatment of thousands of wounded soldiers carted off the fields and dumped at his door. He stayed until 1916, when he was detailed back to Britain after developing a case of phimosis, a tightening of the foreskin, which left him hospitalized for a week in England. He shipped home in April 1916 and in 1917 was appointed ADMS, District No. 6. He was well familiar with triage and building temporary hospitals out of derelict buildings and boxes, although when he toured Richmond he told a reporter, “he had never seen anything on the battlefront equal to the scenes of destruction that he witnessed in Halifax today.”
McKelvey Bell had another unusual talent. He was a scribbler, a writer, a novelist, and an observer of subtle details in the midst of chaos. As a champion of the Canadian military, he was passionate about documenting and celebrating their work during the war. He crafted his experiences in France into a roman à clef that had been published earlier that year. It was already in stores—no doubt with a publisher dreaming of brisk Christmas sales.
McKelvey Bell had already autographed copies for readers. The First Canadians in France followed two friends, Jack and Reggie, who helped set up and run a hospital in a fishing village three hours outside of Boulogne. McKelvey Bell’s soldiers seemed to adjust to the war with great equanimity, tempered by alcohol and a jocular affection, although the French civilians were less accepting of the Canadians’ crude manners and the indignities of war. His descriptions of people fleeing the battle of Ypres could have easily described the people fleeing Richmond earlier that day. “Feeble old men tottering along, tearful women carrying their babes or dragging other little ones by the hand, invalids in broken down wagons or wheel-barrows, wounded civilians hastily bandaged and supported by their despairing friends hurried by in ever-increasing numbers. Some had little bundles under their arms, some with packs upon their backs—bedding, household goods or clothes, hastily snatched from their shattered homes. With white terror-stricken faces, wringing their hands, moaning or crying, they ran or staggered in thousands. Their homes destroyed, their friends scattered or killed, death behind and starvation before, they ran.”
He sent his first telegram to military headquarters in Ottawa Thursday night. He marked it urgent. “All hospitals filled to overflowing with wounded (stop) Interior Pier 2 Hospital Clearing Depot destroyed and useless (stop) Rockhead Hospital temporarily useless (stop) All other hospitals working well (stop) Every living man or woman being cared for (stop) Have brought in all available physicians, surgeons and nurses from outlying towns (stop) Plenty of medical supplies except antitetanic and anti-streptococcal sera (stop) Can you send two eye specialists from Montreal (stop) Approximately one thousand wounded in Military hospitals (stop) All going as well as can be expected.”
He had grossly underestimated the numbers of injured. There were over 1,400 patients at Camp Hill alone. The Cogswell was full. The USS Old Colony, an American passenger steamer that the U.S. Army had acquired for the British Navy, converted itself into a hospital ship with the help of the USS Tacoma, the ship that turned to Halifax upon hearing the noise. The Tacoma arrived at 2:00 p.m., and after a brief visit with the authorities, its captain ordered his medical officer and his staff to take all their supplies and report to the Old Colony. The Tacoma crew scoured the city for supplies, taking enough equipment from a Coast Guard cutter, the USS Morrill, the Victoria General Hospital, the remnants of the Pier 2 Naval Hospital and their own ship, the Tacoma, to assemble two temporary operating rooms. Fifty-four wounded were brought aboard throughout the day. Seventeen died by midnight. At 11:00 p.m., two hours after McKelvey Bell turned down St. John’s offer to send more medical staff, he changed his mind and asked for more volunteers and supplies. Telegrams rocketed back and forth between McKelvey Bell and the offices of the Adjutant General in Ottawa. In Montreal, Toronto, and St. John, orderlies, military nurses, and blankets were packed onto trains with boxes of food and cooking supplies. Others, including the whole 159th Battalion, who were waiting to go overseas, were on standby orders, ready to take the first train east, but it was not an easy decision. Whoever he brought to the city needed housing and food, and the shortage of both was acute. There was another complication. A navy ship was headed to Halifax with a cargo of one thousand wounded Canadians, which meant that he had to get the civilians out of the hospitals by the time the ship docked.
Colonel Thompson was also worrying about the shortage of personnel. His soldiers had spent the day trying to keep citizens calm, first sending out blankets and then sending out men to disperse the people who had evacuated their homes, reassuring them that there would be no second explosion. He had also bought up the whole stock of tarpaper to prevent profiteering. Most of the soldiers he did have were still at work in Richmond, searching for survivors. He was understaffed and, with the windows and doors blown out of stores as well as houses, he was worried that the looters would show up after dark. “The whole city was open and our men were exhausted.” He was at his desk trying to think of a solution when Rear Admiral Chambers, followed by two American officers, walked through the door. Chambers introduced Captain Moses from the Van Steuben and Captain Symington of the Tacoma. Symington stepped forward.
“Is there anything we can do?”
“Can you give me any men to patrol the streets?”
“Can you give me two hundred and fifty?”*
Thompson sat back in his chair, relieved that his men could get some sleep. They would need it with the amount of work they would be called on to do over the coming days. Outside, the temperature was dropping fast, and the staccato rhythm of hammering echoed through the streets as people rushed to cover their windows. In the North End, searchers bent low to shine their torches over the frozen basements filled with wreckage, but without proper light and equipment it was useless. “There were still moans and cries from shattered houses but there were little means of reaching the victims lying underneath.” At 2:00 a.m. the rescue operation was called off. Aside from ambulances, soldiers, and sporadic snowflakes, the streets were deserted. The blighted city tried to rest as American soldiers patrolled the streets of Halifax.
AT 8:00 THURSDAY NIGHT, the phone rang at Dr. William Edwards Ladd’s office in Boston. James Jackson, the division manager of the Boston Metropolitan Chapter of the Red Cross, identified himself and then asked Ladd to head up a hospital unit destined for Halifax on Friday. Ladd had been trained as a gynecologist, but since his graduation from Harvard in 1906, he had earned his reputation as a surgeon and had privileges at three hospitals, surgeons then keeping private independent offices and popping in and out of different hospitals depending on the day. “A very unsatisfactory arrangement.” He would have preferred to dedicate himself to one institution and one set of patients rather than run between three at the behest of other doctors who made the diagnoses. In 1910 when Ladd began volunteering at the Children’s, he knew where he wanted to work full time. “The Children’s was my very first and most permanent love.” Ladd came to believe that many of the children he saw were neglected not only by society, and often by their parents, but by the medical community as well. Even small surgical interventions could effect positive results in both the child and later in the adult. He was particularly soft on the children with facial deformities, such as a harelips; he saw no reason why they had to go through life disfigured when surgery could reduce both the deformity and the stigma. He determined that as soon as possible he would devote himself to Boston Children’s
Hospital. Boston Children’s was a progressive institution founded by four doctors who, after serving in the CivilWar, were each introduced to specialized children’s hospitals inNewYork and Europe. Specialization was a new approach; more commonly children were treated as adults, if they were treated at all. These new institutions tailored not only their medicine but their whole establishment to the children’s needs, right down to pint-sized furniture, an approach that the doctors believed was missing from Boston’s medical network. Certainly, many of the children’s diseases in Boston could be prevented if the hygiene in crowded, ill-ventilated slums was improved, but the doctors identified another problem. More often than not, both parents of underprivileged children worked. If their children fell ill, the parents could not attend to their health. Put simply, the poor children needed a place to go if they caught something serious, which, because of where they lived, they most likely would. Founded in 1896, Boston Children’s tried to accommodate their young patients in any way they could, and were unafraid of trying unconventional approaches to problem solving, such as keeping a herd of cows on the front lawn to ensure their children drank tuberculosis free milk. It was the ideal place for an ambitious young surgeon.
In the early years, when Ladd volunteered at the hospital, children in other hospitals were still considered undesirable patients because, more often than not, they died. “Tuberculosis, osteomyelitis, syphylis, yellow fever, typhoid, malaria, and many bacterial infections were rampant and without good means of management. There were few useful drugs beyond digitalis, aspirin and the opiates. Insulin was unknown.” Over the previous
few decades, pediatricians had gained some acceptance with both patients and the medical community, but pediatric surgery was still controversial. In 1910, the survival rate of sick children was dismal; in surgery it was pathetic. “Surgery was limited by the fact that intravenous fluid therapy was not yet understood and that there were no blood transfusions. When surgery was performed, speed was essential. Drainage of abscesses was the most frequently used procedure, although resections of tumors, hernia repairs, appendectomies and other operations were well established.” Well established perhaps, but hardly successful. In 1910, appendicitis was the fourth-highest cause of death among children under twelve. “In most hospitals, the mortality rate for a simple colostomy was in the range of 90%.” Doctors’ inability to control the intravenous fluid therapy, also known as the fluid balance, was one of the most pernicious problems. A child’s intake and excretion of fluids—primarily water, potassium, and sodium—was so delicate that a few drops either way could result in dehydration or shock, both of which resulted in death. No one understood how precise the fluid and electrolyte balance was in an infant’s tissue. Instead, surgeons based their calculations on adult formulas, an approach that Ladd realized was hazardous for two reasons. The first was that the proportions were not the same in adults and children, much as a recipe for a cake for two and a cake for forty were not the same. The second was that babies needed precise measures of fluid. An adult could give or take a pint of blood without much distress. For an infant who weighed six pounds, that translated to a tablespoon. Even several extra drops of blood loss quickly became a severe health risk. Too much fluid created a similar risk. “The smaller the baby, the bigger the problem. The younger the baby, the narrower the tightrope.” Without any means to control the fluid balance, surgeons were forced to work with greater speed, less accuracy, and, almost always, worse results. When by chance, skill, or luck a young patient survived a surgical procedure, the patient often succumbed to infection during recovery.
Ladd perceived other problems with childhood surgery. Even diagnosing a child required a different skill set. Children could not articulate their symptoms verbally, through inability, fear, or both. “The physical signs alone may be all that is available. . . . must be able to gain the child’s confidence or acquire the knack of performing the physical examination with sufficient gentleness to avoid frightening the small patient and thereby making his examination almost valueless.” Surgeons needed to rely heavily on their own senses—smell, touch, and sight—to diagnose children and discover what the child could not describe. Ladd also complained that general surgeons took too many cases. If children’s surgery were specialized, it would allow those surgeons a wider range of child patients with the same disease, giving them the opportunity to learn more about childhood diseases. Sometimes, Ladd saw only two or three cases of the same disease over ten years, too small a sample to draw uniform conclusions. Furthermore, adult-sized surgical tools were unsuitable for children, most being too bulky for precise work, especially on helpless, exquisite creatures such as infants.
Early on, Ladd suffered setbacks. After operating on three infants with intussusception, a painful condition in which one part of the infant’s intestine blocked another and which usually resulted in death, Ladd returned to the pathology lab. “The autopsy table was his library.”Working with his former Harvard embryology professor Dr. J. L. Bremer, Ladd examined the infants’ colons to find a solution. They did. In his 1913 paper in the Boston Surgical Journal, Ladd reported that he and his chief surgeon Dr. J. S. Stone had cured ten times as many children with intussusception as had been cured in the five years before, dropping the mortality rate from 90 percent to 45 percent. Through pathology, Ladd recognized that diseases themselves were different in children, having not reached the later stages more familiar to the general surgeon. A child, Ladd later concluded, was not just a “diminutive man or woman” and that “the adult may safely be treated as a child but the converse can lead to disaster.”
When Ladd later presented these views at the Boston Surgical Society, the most prominent surgeon of the day, the revered Dr. Edward Churchill, stood and sneered.
“Anyone who can work on a bunny rabbit can operate on a child.”
Ladd never forgot the slight. Despite his affable manner, he was intensely competitive. During his studies, he rowed with the Harvard crew and his love of the sport and competition was so strong that he continued overseeing Harvard’s training for four years after his graduation to ensure that they continued to beat Yale. Under his tutelage, they did not lose one race to their rivals. For the rest of his life, he kept a long oar above his bed. Ladd maintained his own physique long after he left Harvard. He stood six-foot-three, was slight but muscular, with “iron gray” hair and dark brown eyes. His voice was low and modulated, betraying the understated confidence of wealth—he arrived at work each day by limousine—but the attribute people usually noticed were his hands. “He’d pick up a baby and it fit right in his hand.” “His hands were so large you could not imagine them inside a child.” By the time Jackson of the Red Cross called Ladd’s office on December 6, 1917, Ladd had risen from volunteer to the secondhighest rank on staff.
The afternoon papers were full of the explosion. Thursday night’s Boston Evening Record headline ran in large bold type: “U.S. Powder Ship Blows Up in Halifax Harbor; parts of City in Flames; Many Dead.” In New York, the stock market closed weak, partially spooked by the news that the war had taken its first casualties in North America. Jackson explained the situation to Ladd in case he had not read the papers, and asked him to head a Red Cross relief expedition. Ladd agreed, asking what he needed to do. Jackson told him to round up thirty volunteer doctors and fifty nurses to to leave for Halifax the next morning. He promised to take care of supplies if Ladd came up with the staff, but Jackson did not think finding people would be a problem. The Red Cross had “an embarrassing numbers of letters from the Boston people ready to go anywhere or do anything.” Jackson told him that the first group of Red Cross workers was leaving with the Committee on Public Safety even as they spoke.
THAT NIGHT TWO PULLMANS, a baggage car, and a buffet car pulled alongside the Boston platform. It was cold and the travelers bundled themselves up for what would prove to be a long train ride. Colonel William A. Brooks had gathered together thirteen medical professionals, members of the Massachusetts State Guard. The Red Cross, which had been working with the committee since its inception on a War Services program— exhibiting Red Cross films, war films, conservation messages, and organizing sing-alongs on the Boston Common—called Ratshesky and requested that six of its representatives, all experienced disaster workers, be allowed to join the train. Otherwise, they would have to wait for the train that Jackson was arranging for Ladd. Ratshesky invited them. After all, John Moors had been named head of both the American Red Cross in Halifax and part of the Aid Division of the Public Safety Committee. Four railroad officials showed up as well as five reporters from the Boston Globe, the Associated Press, the Boston American, and the Boston Herald.
The train pulled out of the station at 10:00 p.m. All along the East Coast, to Portland, Maine, Ratshesky wired Halifax without receiving a response, and settled instead for the tidbits of information railmen gleaned from the telegraphs. The train was on schedule throughout the night until thirteen miles outside of Waterville, Maine, at Burnham Junction, where it slowed to a stop. Ahead of them, men were cleaning up downed telegraph poles and a heap of wreckage where five freight cars had derailed. They waited for over an hour.
Over fifteen hundred miles away, off the coast of North Carolina, a heavy arctic wind was driving the warm Carolina air out to sea, where it met the Gulf Stream. The collision of warm and cold turned the wind into an enormous, fast-paced, low-pressure swirl that was gaining speed and moisture as it followed its usual route up the coast toward Nova Scotia. Meteorologists had two names for this winter-weather phenomenon. Some called it a Hatteras Low. Others called it an Eastern Seaboard bomb because, when it hit, it dropped so much snow so fast. With the telegraph line in the hands of the censor and the city services devastated, no one bothered to check with the weather bureau.