“Real war at last. Can hardly wait. Here we go!”
[The first of six essays about the gallant nurses of World War I commemorating the centennial of America’s entry into the war on April 6, 1917. The outgrowth of these essays is the book, Easing Pain on the Western Front: American Nurses of the Great War and the Birth of Modern Nursing Practice (McFarland, 2020). Hear Paul Stepansky discuss the book with the editor of the American Journal of Nurse Practitioners in a special JAANP podcast.
It was the all-too-common story of the WWI nurses, the narrative thread that linked the vagaries of their wartime experiences. The war was to be the adventure of a lifetime. The opportunity to serve on the Western Front was not to be missed, not by hospital-trained nurses and not by lightly trained volunteer nurses. For both groups, the claim of duty was suffused with the excitement of grand adventure. Beginning in the spring of 1917, the war abroad was the event of the season. Julia Stimson, a Vassar graduate who, as superintendent of nursing at Barnes Hospital, led the St. Louis base hospital unit to Europe in May, 1917, was overwhelmed with the honor bestowed on her and the opportunities it promised. “To be in the front ranks in this most dramatic event that ever was staged,” she wrote her mother, was “all too much good fortune for any one person like me.” For 28-year-old Shirley Millard, a Red Cross volunteer nurse from Portland, Oregon rushed to a field hospital near Soissons in March, 1918, the prospect of nursing work at Chateau Gabriel, close to the Front, was a dream come true: “It is so exciting and we are all thrilled to have such luck. Real war at last. Can hardly wait. Here we go!” “I haven’t the least fear or worry in the world. Am ready for anything,” averred Minnesotan Grace Anderson, a reserve nurse and nurse-anesthetist who embarked from New York harbor in July, 1918. Serving in a base hospital or, more exciting still, in a field hospital or casualty clearing station only miles from the Front, was to be invited to the Grand Cotillion. Volunteer and army nurses alike were typically well-bred young women of substance, often upper-class substance. They were adventuresome and patriotic and given over to a sense of duty informed by literary culture, not battlefield experience. So they experienced happiness on receiving the call; they would make their families proud.
But their sense of exhilaration at being invited to the Patriotic Ball quickly gave way to stunned amazement at the “work” before them. The wounds of French, British, and, soon enough, American troops were literally unimaginable to them and then, in the fevered atmosphere of post-battle “rushes,” wrenchingly imaginable, indeed omnipresent. They grew familiar with the horrid stench of gas gangrene, which crackled beneath the surface of the infected body part or parts and almost always presaged quick death. Under the mentoring of senior nurses, the Sisters, young American women learned how to prep patients for surgery. In the process, they encountered cases in which “there are only pieces of men left.” And yet, having no choice, they quickly made their peace with the stumps of severed limbs and concavities of missing stomachs, faces and eyes and began to help clean, irrigate, and dress what remained, before and after surgery, if surgery could even be attempted. Like their seniors, they learned to remain unflinching in the face of the many soldiers who arrived “unrecognizable as a human being.” And they retained composure before soldiers as young as sixteen or seventeen — “children,” they would say — who arrived at Casualty Clearing Stations (CCSs) caked in mud and blood and covered with lice – children with three, five, nine, even eleven wounds. They learned to accept that many soldiers would die in a matter of hours or days, but to join this realization to an obligation to provide what comfort they could. They ended up working hard to keep the dying alive long enough to warm up and pass under morphine and chloroform, all the while holding their nurse-mother’s hand.
They could not operate on Rochard and amputate his leg, as they wanted to do. The infection was so high, into the hip, it could not be done. Moreover, Rochard had a fractured skull as well. Another piece of shell had pierced his ear, and broken into his brain, and lodged there. Either wound would have been fatal, but it was the gas gangrene in his torn-out thigh that would kill him first.”
Here is “a poor youngster with both legs broken, both arms wounded, one eye shot out and the other badly damaged,” there a “poor lad” who “had both eyes shot through and there they were, all smashed and mixed up with the eyelashes. He was quite calm, and very tired. He said, ‘Shall I need an operation? I can’t see anything’.” Within a week of arrival at her field hospital, Shirley Millard wrote of “bathing [a soldier’s] great hip cavity where a leg once was,” while “a long row of others, their eyes fastened upon me, await their turn. And she followed with the kind of litany offered by many others: “Gashes from bayonets. Flesh torn by shrapnel. Faces half shot away. Eyes seared by gas; one here with no eyes at all. I can see down into the back of his head.” Helen Dore Boylston, an MGH-trained nurse who served with the Harvard Medical Unit from 1915 on, presents an indelible image that affected her for life and affects us still:
There were strings of from eight to twenty blind boys filing up the road, clinging tightly and pitifully to each other’s hands, and led by some bedraggled limping youngster who could still see . . . I wonder if I’ll every be able to look at marching men anywhere again without seeing those blinded boys, with five and six wound stripes on their sleeves, struggling painfully along the road.
A soldier with gangrenous wounds oozing everywhere might morph into a “mass of very putrid rottenness long before he died.” Such was the experience of Edith Appleton, who continued: “The smell was so very terrible I had to move him right away from everyone, and all one could do was dress and redress. Happily I don’t think he could smell it himself but I have never breathed a worse poison.”
All too soon after arrival, then, the cheery young American nurses beheld the fearless young soldiers – or remnants thereof – who came to clearing stations and base hospitals in funereal processions of ambulances. The fearless young men had become “wretched, restless beings.” For Shirley Millard, “The crowded, twisted bodies, the screams and groans, made one think of the old engraving in Dante’s Inferno. More came, and still more.” In Helen Boylston’s field hospital, a “rush” during the German offensive of late March, 1918 brought 1,100 wounded to her base hospital in 24 hours, with three operating teams performing some 90 emergency operations that night and the nights to follow. The operating room nurse, she recalled, “walked up and down between the tables with a bottle of aromatic spirits of ammonia in one hand and a bottle of brandy in the other, ready to pounce on the next person who wilted.” At Beatrice Hopkinson’s CCS 47, just outside Amiens, the situation was even worse. During the March rush many thousands of patients passed through the doors in only a few days and kept seven operating tables working day and night.
And so the narratives captured in these diaries, journals, and memoirs turn a corner into blackness, as the nurses themselves undergo a kind of existential decomposition. The volunteer nurses in particular, many little older than the combatants, became war-weary and war-wise in ways that choked off the childish exhilaration with which they had embarked. They found themselves at the threshold of their own nonnegotiable no-woman’s land. The nurse, wrote Mary Borden in The Forbidden Zone,
is no longer a woman. She is dead already, just as I am – really dead, past resurrection. Her heart is dead. She killed it. She couldn’t bear to feel it jumping in her side when Life, the sick animal, choked and rattled in her arms. Her ears are deaf; she deafened them. She could not bear to hear Life crying and mewing. She is blind so that she cannot see the torn parts of men she must handle. Blind, deaf, dead – she is strong, efficient, fit to consort with gods and demons – a machine inhabited by the ghost of a woman – soulless, past redeeming, just as I am – just as I will be.
Nurses bore up, but in the process many were ground down, their pre-war values pulverized into dust. Comprehending trench warfare in bodily perspective, they became freighted with the pointlessness of the horror, the multitude of mutilated, infection-saturated, and lifeless young bodies. It was, for Helen Boylston, less tragic than unutterably stupid.
Today a ditch is full of Germans, and tomorrow it is full of Englishmen. Neither side really wants the silly muddy ditch, yet they kill each other persistently, wearily, ferociously, patiently, in order to gain possession of it. And whoever wins, it has won – nothing.
They pondered the paradox of pain – the impossibility of knowing its nature in another along with the inability to nurse without imagining it. They grew into a capacity for shame – shame in their own strength, in their ability to stand firm and straight alongside a bedside “whose coverings are flung here and there by the quivering nerves beneath it.” They empathized with shell-shocked patients who, having endured the prospect of “glorious death” under the guns, were sent home “to face death in another form. Not glorious, shameful.” And finally there was the shame, thinly veiled, attendant to witnessing the unremitting pain of the dying. “No philosophy,” reflected Enid Bagnold, “helps the pain of death. It is pity, pity, pity, that I feel, and sometimes a sort of shame that I am here to write at all.”
And then, as hostilities drew to a close, there were the larger reflections, the alterations of life philosophy that grew out of nursing their boys. For Helen Boylston,
The war has done strange things to me. It has given me a lot and taken away a lot. It has taught me that nothing matters, really. That people do not matter, and things do not matter, and laces do not matter, except for a minute. And the minute is always now.
For Shirley Millard, Armistice Day and the immediate dismissal of her unit of volunteer nurses marked her epiphany:
Only then did the enormous crime of the whole thing begin to come home to me. All very well to celebrate, I thought, but what about Charley? All the Charlies? What about Donnelly, Goldfarb, Wendel, Auerbach? And Rene? And the hundreds, thousands of others.”
The enormity of the crime and the absurd reasoning that justified it coalesced in the wartime essays of Ellen LaMotte and Mary Boyden, one recurrent theme of which is the impossibility of a good death in war, where the very effort to “restore” bodies and minds that are shattered, literally and figuratively, becomes oxymoronic. War, they insist, occurs in an alternate universe where any claim to morality is, from the standpoint of ordinary life, self-willed delusion. In this universe, surgeons function as cavalier automatons and even life-saving surgery is specious, because the lives saved, more often than not, are no longer human lives, psychologically or physically. In this alternate universe, death withheld, ironically, is the ultimate act of inhumanity.
What makes the nurses of World War I gallant is that so many of them were able to bracket their encroaching horror, with its undercurrents of anger, depression, and numbing – and simply care for their patients. They were able to function as nurses in a nurses’ hell. Military directives pushed them to an even lower circle of the Inferno, since the nurses’ primary task, they were told over and over, was to get injured troops back to the Front as soon as possible. They were to fix up serviceable (and hence service-able) soldiers so that they could be reused at least one more time before breakdown precluded further servicing and the soldier’s obligation to serve further.
But the nurses knew better and unfailingly did better. Nursing practice, it turns out, had its own moral imperative, so that military directives were downplayed, often cast to the wind. As the nursing historian Christine Hallett observes, the emotional containment nurses provided for suffering and needy soldiers did not – indeed could not – preclude caring. In essays to follow, I hope to explore further the remarkable elements of this caring, which blurred the boundary between comfort care and healing and took nursing practice into the domains of emergency medicine, infectious disease management, surgery, and psychotherapy. It is as agents of care and caring that the nurses of World War I rose to the status of gallants. Flying in the face of military priorities and surgical fatalism, they bravely dispensed cure in a manner true to the word’s etymology, the Latin curare, a taking care of that privileges the patient’s welfare above all else.
 Julia, C. Stimson, Finding Themselves: The Letters of an American Army Chief Nurse in a British Hospital in France (NY: Macmillan, 1918), 3-4.; Shirley Millard, I Saw Them Die: Diary and Recollections, ed. E. T. Gard (New Orleans: Quid Pro, 2011), location in Kindle edition (loc), 388; Shari Lynn Wigle, Pride of America: The Letters of Grace Anderson, U.S. Army Nurse Corps, World War I (Rockville, MD: Seaboard, 2007), 9.
 Agnes Warner, ‘My Beloved Poilus’ (St. John: Barnes, 1917), loc 75; Beatrice Hopkinson, Nursing Through Shot & Shell: A Great War Nurse’s Story, ed. V. Newman (South Yorkshire: Pen & Sword, 2014), loc 1425; Helen Dore Boylston, Sister: The War Diary of a Nurse (NY: Washburn, 1927), loc 463; Enid Bagnold, A Diary Without Dates (London: Heinemann, 1918), 125: “Among his eleven wounds he has two crippled arms.”
 Ellen N. La Motte, The Backwash of War: The Human Wreckage of the Battlefield as Witnessed by an American Hospital Nurse (NY: Putnam’s, 1916), 51-52.
 Edith Appleton, A Nurse at the Front: First World War Diaries, ed. R. Cowen (London: Simon & Schuster UK, 2012), 138, 161; Millard, I Saw Them Die, loc 428; Boylston, Sister, loc 463.
 Dorothea Crewdson, Dorothea’s War: A First World War Nurse Tells her Story, ed. Richard Crewdson (London: Weidenfeld & Nicolson, 2013, 2013), loc 1189; Appleton, Nurse at the Front, 189.
 Crewdson, Dorothea’s War, loc 1192; Millard, I Saw Them Die, loc 388; Boylston, Sister, loc 1101; Hopkinson, Nursing Through Shot & Shell, loc 1719, 1780.
 Mary Borden, The Forbidden Zone, ed. H. Hutchison (London: Hesperus, 1928/2008), 44.
 Boylston, Sister, loc 648.
 Bagnold, Diary without Dates, loc 25, 104; LaMotte, Backwash of War, 139.
 Boylston, Sister, loc 1373.
 Millard, I Saw Them Die, loc 1562.
 All the brief essays in LaMotte’s The Backwash of War and Borden’s The Forbidden Zone circle around these and related themes. Among them, I was especially moved by LaMotte’s “Alone,” “Locomotor Ataxia,” and “A Surgical Triumph,” and Borden’s “Rosa,” “Paraphernalia,” and “In the Operating Room.”
 Christine E. Hallett, Containing Trauma: Nursing Work in the First World War (Manchester: Manchester University Press, 2009), 177.
Copyright © 2017 by Paul E. Stepansky. All rights reserved.