Thousands of New Zealand men went through hell fighting for their country in World War I.

Fighting to keep them alive was a force of brave medics.

Doctors, nurses, stretcher-bearers, orderlies, ambulance drivers, chaplains, dentists and chiropodists risked their lives, often in appalling conditions, to care for the sick and wounded.

Veterinarians did the same for horses, donkeys, mules and camels that accompanied the soldiers onto battlefields.

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A new book, released as Armistice Day is marked today, is dedicated to the skill, compassion and courage of those Kiwi medical personnel.

"I really want readers to understand what an amazing job these people did," says Anna Rogers, author of With Them Through Hell: New Zealand Medical Services in the First World War.

"They're sometimes overlooked."

New Zealand sent around 100,000 men, about 9 per cent of our population at the time, to fight in the "war to end all wars".

They faced the horrors caused by sophisticated new artillery shattering bodies and minds, blinding and blistering by chemical weapons, deadly disease and gruelling trench warfare.

Around 18,000 of them died, and 40,000 were wounded or fell ill.

Paradoxically, from the hell of the "Great War" came groundbreaking medical advances such as widespread use of X-rays and more effective blood transfusion methods.

It also led to pioneering of plastic and facial reconstructive surgery, with New Zealanders Harold Gillies and Henry Pickerill at the forefront.

With Them Through Hell concentrates on telling the story of the men and women of New Zealand's medical services in their own words where possible, says Rogers.

The Christchurch author spent two years researching material for her book, including scouring diaries and letters at libraries and museums, old newspaper articles and soldiers' personal records.

"The thing that struck me over and over again is how young those guys were," Rogers says.

"And also the extraordinary courage of the people looking after them."

The battle wasn't over for many Kiwi soldiers when the war ended on November 11, 1918.

The barges carrying the Gallipoli wounded out to transports and, later, hospital ships were appallingly overcrowded and unsuited to taking stretchers. Photo / National Army Museum
The barges carrying the Gallipoli wounded out to transports and, later, hospital ships were appallingly overcrowded and unsuited to taking stretchers. Photo / National Army Museum

Sick and wounded still needed medical treatment, the permanently injured had to rebuild their lives.

When Armistice was declared, one nurse wrote in her diary she "did not know whether to laugh, shout or cry".

"There seems a short distance between laughter and tears."

War is about killing and being killed, about being wounded physically and psychologically, Rogers points out.

"But war is also about courage — the courage to continue working, in appalling, perilous conditions and for inhumanly long hours, to save lives — and it is about compassion."

The first group of New Zealand Volunteer Sisters to go overseas in October 1915. Photo / Alexander Turnbull Library
The first group of New Zealand Volunteer Sisters to go overseas in October 1915. Photo / Alexander Turnbull Library

Doctors used to treating patients in comfortable rooms found themselves in battleground trenches and dugouts.

Nurses went from calm wards to crowded tent hospitals full of severely hurt and dying men.

Clerks or shop assistants or students or farmers found themselves staggering through deep mud carrying stretchers while trying to dodge snipers' bullets.

Rogers wants readers to appreciate the bravery, skill and care of the New Zealand medical personnel in World War I.

"And I also like them to understand just what a terrible, terrible thing a war is."

The medic

Private Fred Crum served as a stretcher-bearer with the Mounted Field Ambulance, New Zealand Medical Corps (NZMC). He was fatally wounded in Palestine, aged 22.

From the book ...

Two NZMC men were killed and nine wounded in air raids at El Belah in May 1917.

One of those who died, on the 9th, was 22-year-old Private Fred Crum from Auckland, who was hit while grooming horses.

A few days later, his mate, Bugler Thomas Hartigan, wrote to Crum's family and paid a tribute to his "constant companion".

"The bomb dropped about 20 yards from him & one piece hit him in the arm. His first exclamation was, "Well, Tommy, I've got a backsheesh — one at last."

"I don't think he knew for some time afterwards that he had another and more serious wound [in the abdomen] and he was unconscious just before he passed away and his last words were of all our folks at home."

As his personnel file shows, Fred Crum was no angel.

He had abused an NCO, disobeyed orders several times and missed a roll-call.

But he wrote home faithfully to his family, enjoyed a joke and could not speak highly enough of the nurses who cared for him.

"I always found him an upright chap," said Hartigan, "and although at times he had his little peculiarities, I shall always be proud to know that he called me Friend.

"Poets and others may rave about the glorious side of war, but when a chap is alongside his pal who has been so severely wounded that there is practically no hope for him, then there does not seem much glory about that.

"Believe me, these things hit a chap hard."

• Although injury meant pain and potential disability, even death, many men yearned for what they called a Blighty, a backsheesh or a buckshee — a wound bad enough to take them to hospital, or even home, without guilt about leaving the fighting, and their mates, behind.

The Gallipoli dentures

A dental inspection in France. Many recruits' teeth were in urgent need of attention before they could even depart for overseas service. Photo / Alexander Turnbull Library
A dental inspection in France. Many recruits' teeth were in urgent need of attention before they could even depart for overseas service. Photo / Alexander Turnbull Library

The poor state of many New Zealanders' teeth in 1914 meant hundreds of men were turned away from recruiting offices around the country and denied the chance to enlist.

Dental surgeries were set up at Army camps in New Zealand. From November 1915 to November 1918 dentists filled more than 220,000 teeth, performed almost 100,000 extractions and made 24,000 artificial dentures.

Four dental surgeons went to Gallipoli. A surgery was set up. It had 40 patients waiting the day it opened.

From the book ...

Among them was Yorkshire-born New Zealand signaller Bill Leadley, who had broken his bottom set of dentures on hard biscuits while sailing to Gallipoli.

Both these and the loathed bully beef were ruinous for teeth, real and false ...

Leadley had lost his upper set of teeth in a bayonet charge just after the landing.

By April 27 he was reduced to pounding the biscuits into a powder. By May 8 he was "feeling the effects of poor feeding, and had to drop out for a spell, as I was so weak".

His request to be sent to Alexandria for teeth was turned down.

On May 20, having heard that a dentist had arrived at Anzac, he found him on the beach and was told that his problem could be remedied as soon as the necessary dental instruments arrived.

As May became June, Leadley was "still persevering with powdered biscuits, but [feeling] awfully weak".

Finally, he had an impression taken on June 13 and received his top teeth a few days later.

Although they initially seemed a good fit, they soon made his mouth "rather sore, but [it] is better than being without any".

The Gallipoli dentures, which lasted for many years, were so tough that Leadley amused his children by bouncing them on the floor and catching them.

The nurse

Ethel Lewis was known for colossal courage and determination. Photo / Supplied
Ethel Lewis was known for colossal courage and determination. Photo / Supplied

Otaki-based Ethel Lewis, who was originally from Cornwall in England but came to New Zealand in 1912 in her early 30s, was affectionately known as The Little Nurse. She may have stood only 150cm tall, but she had colossal courage and determination, as shown during the great retreat from Serbia after it was invaded in 1915.

Later, while home on leave, she helped fundraise £700 to buy "an up-to-date motor ambulance" for Māori troops at the war front.

From the book ...

Former Otaki native health nurse Ethel Lewis was in England when war was declared.

Within a few days Lewis was nursing in a Belgian field hospital, then spent nine weeks in an Antwerp hospital until it was evacuated when the Germans arrived and she returned to England.

She then departed for Serbia. In the trenches on the Bulgarian frontier, she received a slight shrapnel wound to the shoulder and saved the life of a Serbian officer.

During the great retreat, Lewis and another nurse took 400 patients, none of whom survived, through the mountain passes of Albania, on foot, in knee-deep snow, eating a single slice of bread a day and often sleeping in pigsties.

Lewis carried one man on her back for two miles and was suffering from a frostbitten knee when the exhausted hospital staff finally reached safety.

King Peter himself would honour her brave contribution in Serbia.

After recuperating at Brockenhurst, Lewis "unfortunately broke her arm, causing some amazement amongst the staff by appearing for duty in that condition".

She returned to New Zealand on the Willochra in 1916 and joined the NZANS [New Zealand Army Nursing Service] the following year.

In 1918 she sailed back to Britain to work at Codford [New Zealand general hospital].

The McKay artificial arm

Prosthetics, such as the one worn by this wounded New Zealander, were essential in giving men some chance of a partly normal post-war life. Photo / William Yates Album, Feilding Library
Prosthetics, such as the one worn by this wounded New Zealander, were essential in giving men some chance of a partly normal post-war life. Photo / William Yates Album, Feilding Library

Hundreds of Kiwi troops had limbs amputated due to the terrible effects of shellfire and gas gangrene.

Artificial limbs were made in England, both at hospitals and by commercial companies and, from mid-1917, at a Wellington factory built up by Gerald Tolhurst, himself an amputee.

From the book ...

New Zealand had its own prosthetic invention.

In June 1917, J Wiseman & Sons Ltd in Auckland was sure that "Disabled soldiers who have returned from the front, and their relatives will be interested in the demonstrations of the McKay Artificial Arm that are to be given at the Surgical Appliance Department".

When Peter McKay of Collingwood near Nelson had had his left hand blown off by gelignite some three-and-a-half years earlier, the expensive American artificial arm he ordered proved useless, so he invented, and patented, his own.

Made of aluminium, the arm was operated by a strap attachment to the shoulder.

A "simple movement" of the shoulder muscles made the fingers of the artificial hand open and close, allowing the wearer to write, light and smoke a cigarette, hold a knife and fork, and drink "almost gracefully" from a glass of any size.

Other attachments enabled the wearer to "drive nails, [and] use an axe, a brace and bit, and other tools in a thoroughly effective manner".

As the Wiseman advertisement explained, McKay was shortly leaving for England "at the instigation of the Dominion Government, to demonstrate his invention to the Home authorities".

The McKay arm became widely known and used.

Pioneers of plastic surgery

Henry Pickerill, fourth from left, second row from front, with staff and patients of the first NZ plastic surgery unit. Photo / Hocken Collections
Henry Pickerill, fourth from left, second row from front, with staff and patients of the first NZ plastic surgery unit. Photo / Hocken Collections

Shell fragments and shrapnel, and bullets fired from low-velocity rifles at close range, left soldiers without jaws and noses.

Kiwi ear, nose and throat surgeon Harold Gillies convinced British military authorities to open, first, a face and jaw unit, and then a purpose-built 1000-bed hospital at Sidcup in Kent.

One of the surgeons was another New Zealander, Henry Pickerill, who had been the first director of the Otago University Dental School.

The work of these two men established them as pioneers of plastic and facial reconstructive surgery.

From the book ...

A lively, engaging and idiosyncratic man, "who called everyone, man or woman, 'my dear' or 'honey'", according to Juliet Nicholson's book The Great Silence 1918-1920, Gillies was keen not simply to mend wounds but to improve appearances.

He would show his patients photographs of handsome young men and ask them to choose the chin or nose they might like.

"Broken and septic teeth were removed, dentures fitted, broken bones reset and skin-grafting carried out to reconstruct noses and jaws," Kevin Brown wrote in Fighting Fit.

Eye sockets were filled, too, and ears replaced.

Gillies and his team also salvaged poorly treated cases, where terrible wounds had been closed by stitching without the lost tissue being replaced.

Originally Gillies followed the established method of using a pedicle flap, where a piece of healthy skin, usually from the chest, was sutured to the wounded area to provide new grafted skin.

The other end remained attached to the source, thereby providing a blood supply.

These pedicles, particularly the longer ones, tended to curl inwards, like paper.

Gillies told biographer Reginald Pound it was his inspiration to realise: "If I stitched the edges of those flaps together, might I not create a tube of living tissue which would increase the blood supply to grafts, close them to infection, and be far less liable to contract or degenerate as the older methods were?"

The insight came during an operation in October 1917, and Gillies immediately stitched the curling flaps into what he called "tubed pedicles".

With Them Through Hell by Anna Rogers (Massey University Press, $65) is out now.

New Zealand in World War I

• About 100,000 men served overseas from a population of just over one million. Around 18,000 died and 40,000 were wounded or fell ill.

• 846 were killed or fatally wounded at Passchendaele on October 12, 1917.

• More than 3600 male medical personnel served overseas and 662 died; 550 nurses served and 16 died.

• Up to 430 of New Zealand's approximately 700 registered doctors served overseas.

• Around 10,000 horses were sent to war. Only four came home.