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The centennial of the Armistice – the end of the First World War – was marked by solemn ceremonies across Canada and around the world.

As we donned poppies and lowered flags, there was also much reflection on how, in the wake of the “war to end all wars,” Canada became more of a country than a colony.

But, in a country where medicare is virtually the national religion, there has been surprisingly little acknowledgment of how the health system we have today had its roots in a conflict that ended a century ago.

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Prior to The Great War, the health-care system was quite rudimentary. Physicians tended to the ill, often making house calls, and they were paid out-of-pocket.

Hospitals were, for the most part, charitable religious institutions that provided little more than prayer and comfort, because few effective treatments were available

In the prevaccination era, hospitals had large wards to tend to victims of outbreaks of infectious diseases like measles, mumps and diphtheria, most of them were children.

In Canada in the early 20th century, one in five children died before the age of five.

There was no health insurance, private or public, other than a few co-operative ventures, mostly within the nascent union movement.

The warfare of the First World War was barbaric. Bullets and bombs rained down as soldiers hunkered down in trenches infested with rats and fleas; infectious diseases spread quickly in such insalubrious conditions.

Among the 600,000 who served in uniform during the First World War (including 424,000 overseas), 66,000 died, and another 172,000 were wounded.

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Carnage on this scale was unprecedented, and so was the medical response. A total of 21,453 people served in the Canadian Army Medical Corps as physicians, nurses, stretcher-bearers and orderlies.

More than half of all of Canada’s physicians and nurses at the time served overseas; almost all of them volunteered, and many sacrificed their lives. The skills they acquired would forever change medicine.

Canada alone operated 10 large hospitals in England and France to tend to its wounded, along with 10 stationary hospitals and four casualty clearing stations. Back home, the federal government also took control of 11 hospitals for the care of returning soldiers, and built the first state-run hospital.

The Conscription Crisis of 1917 – which threatened to tear the country apart – ended when the government agreed to provide free medical care for all veterans. That was the beginning of the medicare system we have today, which provides “free” hospital and physician care.

The fallout of the First World War led to the creation some of the first patient advocacy groups.

The War Amps was founded to help the 3,461 soldiers who returned home as amputees.

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Similarly, the Canadian National Institute for the Blind was formed to tend to hundreds of soldiers who lost their eyesight in battle, as well as the staggering 850 people left blind by the Halifax Explosion of 1917.

While the battlefields of the First World War were deadly, the deaths and suffering did not stop after the Armistice.

As wandering soldiers returned, rates of venereal diseases soared; in the preantibiotic era, those infections could be debilitating, and even deadly.

About 9,000 Canadian soldiers were listed as having suffered “shell shock,” what today we would call post-traumatic stress disorder (PTSD). That was almost certainly a gross underestimate.

In the wake of the war, newspaper obituaries routinely featured veterans who died by suicide, the most infamous of which was lieutenant-colonel Sam Sharpe, a sitting member of Parliament, who jumped to his death from a window of the Royal Victoria Hospital in Montreal.

Then there was the so-called Spanish flu, which killed more people than the war – with estimates ranging from 50 million to 100 million, including more than 50,000 in Canada.

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The lethality of the flu, combined with already epidemic levels of tuberculosis, sparked a renewed interest in public health and led to the creation of the federal Department of Health in 1919.

It also fuelled political debates about the need for a “national sickness plan,” to extend public health insurance beyond veterans. This, in turn, led to a handful of provincial health insurance plans that would morph into what we now know as medicare after the Second World War.

So, as we remove our Remembrance Day poppies for another year, it is worth remembering that the sacrifices of veterans continue to resonate to this day in programs like Medicare, a source of pride and healing born of war.

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