Contributions of the U.S. Army Nurse Corps in World War I

The Army Nurse Corps (ANC) was established in 1901 and was seventeen years old at the time the U.S. entered WWI on April 16, 1917. The Corps was small (403 nurses on active duty and 170 reserve nurses). At this same time, there were 8,000 nurses in the nursing service reserves of the American Red Cross.⁵

From 1914-1916 American civilian nurses volunteered with the American Ambulance Service in Paris and as nurses at a French Army field hospital in Belgium. American nurses also sailed to France with the American Red Cross “Mercy Ship” expedition in 1915. Some of these nurses returned to France again with the Red Cross or with the ANC in 1917- 1918 when America officially entered WWI. These forces had already been actively working in France for three years and had 900 or 1000 patients in each hospital.⁶

Vashti Bartlett sailed to France with the American Red Cross in March 1915 shortly after the outbreak of WWI. She worked in Pau at the foot of the Pyrenees as the head nurse and there she described treating the wounded soldiers so that they could return to the front: “If they are not so badly wounded we bring them back and heal them and send them forward again to the firing line that they may go through this agony once more- but such is the ….bravery of these ordinaryFrench men.”⁴ The idea of triage had been solidified in the American Civil War but nurses had to experience the idea of conserving the strength of the Army by first treating those who could continue the fight – something counterintuitive to nursing school lessons.

Nurses getting water at Base Hospital No.21, Rouen. This unit supported the British Expeditionary Force.

American reserve hospital units had been established across the nation in 1916, affiliating civilian hospitals with the Army. Red Cross nurses, doctors and medical corpsmen worked together at these hospitals and volunteered to work overseas in the event of war.⁸ By May 1917 the War Department called upon the American Red Cross to mobilize six of these base hospitals for immediate shipment to France to serve with the British Expeditionary Forces. Thus U.S. military and Red Cross nurses arrived in France before the American combat troops of the American Expeditionary Forces.^{6, 9, 3}

Nurses Qualifications

In the beginning U.S. Army nurses were U.S. citizens,⁵ female, unmarried, between 25 and 35 years of age, Caucasian and graduates of training schools offering theoretical and practical nursing⁸ As the war went on, some of these requirements were expanded. Before and during WWI, nurses were part of the Army, but were neither enlisted or commissioned personnel and they were not trained as soldiers. They were appointed by the Surgeon General with the approval of the Secretary of War.⁶ Nurses were not given military ranks at this time.⁷ There are diary accounts of how the enlisted men grew to appreciate and follow the instructions of these women without rank when it pertained to patient care, especially when the women exhibited stamina, creative problemsolving, and a sense of humor while suffering similar deprivations of war. The British and French governments requested that only graduate trained nurses be sent overseas as they did not wish for nursing aids to replace these nursing requirements.⁶

All nursingapplicants had to be individually considered especially regarding physical examinations before and after appointment.⁶  No member of the ANC, either regular or reserve, was assigned to overseas service against her will.⁶

Six months after the U.S. entered WWI nearly 1,100 nurses were serving overseas in nine base hospitals.⁸ One year later 2,000 Regular Army and 10,186 Reserve nurses were on active duty serving at 198 stations worldwide.³ By the end of the war the ranks of the Army Nurse Corps would swell to 21,480 with over 10,000 having served overseas This was an increase of 3800% from before the war.^{7, 9, 3, 1}

Scope of Practice

Nurses were intended to work in the rear and not face dangerous conditions near the battlefield. However, the plans had to be discarded when new medical groups were organized. Surgical and gas treatment teams were organized to take specialty care closer to the patients; nurses were key elements of those teams.⁶ These female nurses challenged conceptions of how close women could be to battle and how they could face danger.²

There were two American organizations providing medical care in France during WWI; the American Red Cross had been working since 1914, and continued working during American belligerence. Plans envisioned the Army having the primary responsibility for patient care in the forward areas, but on a number of occasions Red Cross hospitals also worked in the forward areas.  Both the Army and the American Red Cross provided patient care in the rear areas. Sometimes these hospitals were equipped by the Red Cross but controlled by the Army; other times under control of the Red Cross they cared for all allied wounded.  Some of the U.S. nurses also worked in French hospitals, and some cared for civilians within the war zone.⁵ These two groups gave nurses some flexibility. During the war, Julia Stimson was both Chief Nurse of the American Red Cross in France (from April 1918) and the Director of the Nursing Service of the AEF (from November 1918). She wrote “the freedom of the chief nurse, American Red Cross, who at the same time was a chief nurse of the ANC and thus functioned in a dual capacity, made it possible for her to meet emergencies with both American Red Cross and ANC personnel in a way that prevented loss of time and duplication of effort”⁶ … “emergency detachments [of nurses] were authorized to move on French military papers obtained by the Red Cross which added greatly to the efficiency of this service, moving them on authority obtained through our Army channels would have caused greater delay.”⁶

Mobile Hospital No. 2 training at Auteuil, Paris, 1 July 1918. Doctors, nurses, and enlisted men had to train on new equipment before going into action.

Ultimately, U.S. nurses worked on surgical teams, hospital trains, hospital ships, and in all sorts of hospitals: field hospitals, mobile units, base hospitals, evacuation hospitals, camp hospitals and convalescent hospitals.^9,3,2 The formula of nurses required for war time had stayed unchanged since the American Revolutionary War at one nurse for every ten hospital beds^5,6 At first, the Army estimated that 10,000 nurses would be needed, but by the end of March 1918 the surgeon general asked for 40,000 nurses.⁵

The first Army nurses in France worked in the six hospitals of the British Expeditionary Forces, and nine additional base hospitals arrived in France within six months after the American declaration of war. Serving with the British presented some difficulties as the nurses needed to acclimate to both the American Army and the British Army way of providing healthcare – two cultures to be assimilated simultaneously (the currency they were paid in, expectations of the job, air raid drills, nature of injuries and illnesses). Even with this build-up of medical care, by midsummer 1918, allied casualties hadgreatly increased and a shortage of nurses resulted because shipping was used for combat troops rather than medical personnel; there was no shortage of volunteers. At one hospital 70 nurses cared for 5000 patients.⁵ It was common for the nurses working in the AEF to work 14-18 hour shifts for weeks at a time. Base Hospitals were designed as five hundred-bed hospitals and they were to provide definitive treatment for patients transported from the field and evacuation hospitals. 46 female nurses were originally thought to be sufficient for staffing.⁵ An example of what actually happened was that Base Hospital #10 received 1400 patients during its first week of operations with most of them being surgical patients and mustard gas cases.⁵ Emma Elizabeth Weaver worked at Base Hospital #20 where “the maximum number of patients in the hospital at one time was 2275 [in a hospital staffed for 500 beds]... Grand total of patients admitted was 8703.¹

Nurses made key contributions, including anesthesia, in the operating room. This group is working at Hospital Unit No. 116, Aulnois-sous-Vertuzey (near Commercy, Meuse) on 15 June 1918.

Nursing experience and skills in the administration of anesthesia, psychiatric nursing and orthopedic work was especially needed.⁶ Anesthesia nursing gained recognition as a valuable resource when the Army realized nurses could supplement the medical officer’s efforts. Anesthesia nursing was one of the first domains for nurses to expand their practice and be recognized within the scope of nursing.⁵ American nurses served on shock, gas, orthopedic and surgical specialty teams where they could be moved to the front lines in groups of five or six. These teams could help stabilize soldiers who otherwise would have to endure long evacuation processes to reach this type of care. Shock teams administered whole blood and fluids; surgical teams included neurosurgical, orthopedic, chest and maxillofacial specialties.  Gas teams were also sent to care for patients at the front lines.²

WWI introduced the terror of chemical weapons; in the AEF 31.49 % of all casualties were related to gas exposure.¹ Common nursing therapies aimed at treating the symptoms of chemical gases whether they were mustard, phosgene or chlorine. Nursing activities included decreasing patient activity, giving oxygen by face mask, keeping the environment free of dust and smoke, providing liquid diets, preserving body warmth and helping with oral hygiene for those with lung irritants. Nurses cleaned vesicants from the skin, and protected intact skin from any exudate, especially from the blisters that would open. They irrigated patient’s eyes and gave them eye shades. The gas specialty teams that traveled to the front lines gave supportive care as well to include rest, oxygen, morphine and stimulants. Vomiting was used to remove lung exudates, as were benzoin steam tents which helped with coughing and prevented pneumonias.^5,2

Irrigation of patient wounds to prevent infection.

Emma Weaver described “All day long from morning until night I went from bed side to bed side doing dressings. I had an orderly to assist me. ….strenuous days. These patients were rushed directly from the front. I always dreaded removing bandages for fear of hemorrhage. I never knew what I was going to find, there were many missing limbs, horrible deep wounds. The Carrel Dakin sol[ution] played a very important part in the treatment of these cases. The results were excellent, a wound healing in 3 weeks less time than without. Dr. Alex Carrel French & Dr. Drysdale Dakin discovered this solution of hypochlorite of soda which killed microbes or bacilli in wounds, the wounds always having to be kept wet with same. Dr. Carrel made a clever arrangement of tubes which run down to the wounds from a jar filled with the sol[ution] which hung above the patient’s bed. Every two hours a nurse goes around the ward & lets the solution run into the wounds thru the tubes.”¹

Ward of Evacuation Hospital No. 20, showing Balkan frames and Carrel-Dakin solution bottles and tubing.

Orthopedic injuries needed Bradford frames and extension devices for tractions. Julia Stimson, Chief Nurse at Base Hospital #21, described “our surgical hut looks like a carpenter shop. We have about ten beds under a wooden canopy frame to which poor shattered legs of our blown-to-pieces men are fastened. When a leg is broken in half a dozen places and there are several gaping infected wounds besides, it is something of a trick of carpentry and mechanics to make the poor fellows comfortable, put on extension so the legs won’t contract, and yet make it possible to irrigate the wounds….”⁵

Life for Nurses

Environmental and logistical factors could make life difficult for Army nurses working in France. The cold, damp weather, mud, wound drainage, and blood mixed with the scarcity of clean, hot water and laundry

Frequently nurses had to launder their own uniforms in addition to caring for patients. These nurses, at an unknown hospital, at least had good weather for this washing.

facilities made wearing the white, cotton, starched duty uniform impractical. The nurses switched to a gray crepe and then a gray jersey dress in order to have a warmer more durable uniform. Lighting was also difficult to maintain for work or recreation especially when long periods of enforced blackouts were needed.^{5, 6} In the summer of 1918 members of the ANC were given War Department authority to wear wound and service chevrons under the same conditions as officers, field clerks, and enlisted men.⁶

No U.S. Army nurses died as a result of enemy action, three were wounded by shellfire and 272 died of disease (primarily tuberculosis, influenza, and pneumonia).^{1, 3} Members of the ANC who died during their Army service were buried with military honors.⁶

Nurses’ Impact

Julia Stimson's medals, and her later rank in the Army, were symbols of military recognition of the contribution and importance of nurses. Here she receives the U.S. Distinguished Service Medal from Gen. Pershing, Tours, France, 5 June 1919.

The U.S. nurses who served in WWI proved they could save lives and make a difference in patient care close to the battlefield. They proved skilled nursing care improved patients morbidity and mortality. Women could not only handle adverse conditions but that they were necessary, and the Army recognized that with medals and rank. After the war, Julia Stimson was the first woman to achieve the rank of major in the U.S. Army.² Nurses were among the first women to receive military medals,

Ward at Mobile Hospital No.2 damaged by shellfire on the night of 17/18 July 1918, Bussy-le-Chateau, Marne. The hospital’s chief nurse was decorated for leadership in guiding personnel to safety.

recognizing their performance of skilled nursing care in war time environments.

France bestowed the Croix de Guerre on 28 American nurses for their service in WWI.^{1, 8, 5}

Great Britain awarded the British Royal Red Cross to 69 American nurses and the Military Medal to 2 of them.^{8, 5}

The U.S. awarded the Distinguished Service Cross (the second highest gallantry medal) to 3 nurses and the Distinguished Service Medal (the highest decoration in noncombat) to 23 more.^{8, 3, 5}

Julia Stimson summed up the perseverance she saw:  Nurses “at the front are having such wonderful times. They are working terribly hard, sleeping with helmets over their faces and enamel basins on their stomachs, washing in the water they had in their hot-water bags because water is so scarce, operating fourteen hours at a stretch, drinking quantities of tea because there is no coffee and nothing else to drink, wearing men’s ordnance socks under their stockings, trying to keep their feet warm in the frosty operating rooms at night, and both seeing and doing such surgical work as they never in their wildest days dreamed of, but all the time unafraid and unconcerned with the whistling, banging shells exploding around them. Oh, they are fine! One need never tell me that women can’t do as much, stand as much, and be as brave as men.”²

The women who served in the Army Nurse Corps “rendered service ‘beyond expectations’ at a time when women were not even allowed to vote” in the U.S.¹

References

¹ http://www.armyheritage.org

² Budreau, Lisa M., and Prior, Richard M. Answering the Call, The U.S. Army Nurse Corps, 1917- 1919, A Commemorative Tribute to Military Nursing in World War I. Falls Church, VA: Office  of Medical History, Office of the Surgeon General, United States Army. 2008.

³ Feller, Carolyn M., and Cox, Debora R. Highlights in the History of the Army Nurse Corps. Washington, D.C.: U.S. Army Center of Military History, 2000.

⁴ http://nursing.jhu.edu/news-events/news/archives/2003/Vashti_Bartlett.html

⁵ Sarnecky, Mary T. A History of the U.S. Army Nurse Corps.  Philadelphia, PA: University of Pennsylvania Press, 1999.

⁶ Stimson, Julia C. The Medical Department of the United States Army in the World War. Volume  XIII, Part Two, The Army Nurse Corps. Washington, D.C.: U.S. Government Printing Office, 1927.

⁷ http://www.wisvetsmuseum.com

⁸ http://www.womensmemorial.org

⁹ http://www.womensmemorial.org/H%26C/History/wwi%28nurses%29.html