[2] The SS Letitia made her maiden voyage from Glasgow to Quebec and Montreal and kept sailing on that line until the outbreak of the First World War.

The Hospital ship conducted her first rescue at sea when she came across the sinking SS City of Birmingham on 27 November 1916 some 90 nautical miles (170 km) south east of Malta.

[5] The Letitia was relocated from the Mediterranean to the Atlantic in 1917 and her new task consisted of bringing wounded Canadian soldiers stationed in the United Kingdom back to their homes in Canada.

[6] HMHS Letitia set sail from Liverpool in late July 1917 for its ninth run with a full crew of 137 men, 74 hospital staff (including 12 nurses) and 546 wounded Canadian soldiers onboard.

The visibility was reduced to near zero, but Lt. Col. David Donald continued on his course and posted several crew members to listen for whistles, buoy bells or foghorn blasts, to avoid hazards including the dangerous shoals that flank the entrance to Halifax Harbour.

[6] The captain had used the navigational method of dead reckoning to estimate his position when he heard a whistle of an approaching pilot boat.

[6] All passengers and medical staff were saved, but there was one fatality among the crew, a stoker who was accidentally left on the ship and who drowned while trying to swim ashore.

[6] The wreck of the Letitia remains near the entrance to Halifax Harbour just south of Portuguese Cove at a depth of 37 metres (121 ft) and is a popular recreational dive site.