Tag Archives: American nurses in WWI

Remembering the Nurses of WWI (VI)

[The sixth and final essay about the gallant nurses of World War I commemorating the centennial of America’s entry into the war on April 6, 1917]

PLAGUE

Influenza.  The Plague. The Great Pandemic of 1918.  The Spanish Flu, which, as best we can determine, originated not in Spain but in Camp Funston in northeastern Kansas and Camp Oglethorpe in northwestern Georgia in March and April, 1918.  From there it spread to other army camps, then to France via troops disembarking at Brest, then to the rest of Europe, then to the rest the world.  By the time the epidemic had passed, world population was reduced by 50 to 100 million, or from 3% to 5%.[1]  

During 1918 and 1919, 47% of all deaths in the United States were from influenza and its complications, with over 675,000 deaths in all.   The first wave of the disease in March and April 1918 was relatively mild, as the virus learned to adapt to humans via passage from person to person.  But the second wave, which began in August, was deadly.  Philadelphia officials foolishly refused to cancel a Liberty Loan Parade scheduled for September 28.  Within three days, every hospital bed in the city’s 31 hospitals was filled; within 10 days the pandemic exploded to hundreds of thousands ill, with hundreds of deaths each day. By October 12, 4,500 Philadelphians had died from the flu; a few weeks later the total was nearly 11,000.  Neighboring New York City lost over 21,000 during the same period.

One characteristic of the Spanish flu was that, unlike typical influenza, it targeted younger victims, aged 20-40.  The fault was in their very youth, as   their immune systems mounted a massive response to the virus, filling their lungs with so much fluid and debris that the exchange of oxygen became impossible.  Victims lapsed into unconsciousness and drowned on their own internal secretions.  Others remained alive long enough to have bacteria swarm into their compromised lungs and compound viral infection with bacterial pneumonia; the result was either death or a lengthy convalescence.

The American Expeditionary Force (AEF)consisted of healthy young men.  Influenza hit them hard.  At home, things grew desperate in army training camps and cantonments.  It was the first and only time the number of seriously ill soldiers exceed the military’s total hospital capacity; the army had to take over barracks and use them as hospitals.  It was no better overseas, where the virus took advantage of the conditions of trench warfare to evolve into its lethal form.  By the U.S. War Department’s own reckoning, the flu eventually sickened 26% of the AEF – over a million men – and accounted for  82% of the army’s total deaths from disease.[2]

Influenza patients at a naval training station in California, 1918

The serious shortage of nurses to care for stricken soldiers spurred the American Red Cross to action.  It struggled to ship out the 1,000 nurses a week requested by the army. On the home front, it set aside its policy of racial exclusion and enrolled African American nurses for “special service.” In early December, two emergency detachments of nurses of color set out for army hospitals at Camp Sherman in Ohio and Camp Grant in Illinois, respectively. There they were assigned to general wards filled with white soldiers.  To the surprise of skeptical white chief nurses, their service was exemplary, whatever the drudgery assigned them.[3]

******

The story of the pandemic of 1918 is the story of modern medicine not yet modern enough to identify and treat viral infection. Researchers of the time were bacteriologists but not yet virologists.  Operating within the scientific paradigm of their time, they were consigned to search for a bacteriological culprit, and they thought they had found one.  Plausibly but erroneously, they believed the Spanish Flu was caused by the Bacillus influenzae discovered by the German bacteriologist Richard Pfeiffer in 1892.  But they were wrong. Their bacteriology and the laboratory technologies that supported it could not test for a filterable virus.  Bacteriology circa 1918 might be adequate – barely – to the secondary bacterial infections (especially pneumonia) that followed the weakening of the immune system caused by the virus.  But in the face of the virus itself, it was helpless.  It was only in 1934, when a new flu epidemic raged in Puerto Rico, that Thomas Francis of the Rockefeller Institute, utilizing a technique for viral transmission in animals developed by his colleague, Richard Shope, isolated the Type A influenza virus.

If the warring armies of 1918 were hit hard by the flu, it was often the nurses, no less than the infected soldiers, who took it on the chin. This included the nurses of the Allied Expeditionary Force.  During the initially mild phase of the epidemic, ignorant of what was to come, overseas nurses were content to add the flu to the list of infections they combatted and to which, often enough, they fell victim.  Being bedridden themselves was simply a vicissitude of the job – a cost of the business of frontline nursing.  “It’s not that I mind being in bed,” wrote Helen Boylston in February, 1918.  “I don’t even mind having flu and trench fever.”  Two months later, she recorded that the flu was back again, “and everybody has it, including me.  I’ve run a temperature of one hundred and two for three days, can hardly breathe, and have to sleep on four pillows at night.” But she kept her suffering to herself and soldiered on:  “But I’m not talking about it, because I don’t want to be sent to Villa Tino[for rest and treatment].”   Of course, when the influenza struck in full force in the fall of 1918, nurses, whatever their resolve, were not spared.  In the U.S., 127 army nurses died from flu, and an untold number, probably another 100, died in Europe.  Katherine Magrath, the chief nurse of Base Hospital 68 in Nièvre in central France, buried 12 of her nurses in a single month. After each funeral, she avoid looking at the faces of her surviving nurses lest she wonder “which would be the next to be absent from the dismal scene.” [4]

Unable to treat the flu at its source, the nurses did what they had grown accustomed to doing for the desperately ill:  They bore witness to suffering and tried to ease it.  Their witnessing was different from that of the doctors.  In their diaries, for example, they record the sensory experience of hands-on care of those who grew sicker and then died.  Influenza cases had swamped the nurses, wrote Shirley Millard at the beginning of April, 1918. And the soldiers, “When they die, as about half of them do, they turn a ghastly dark gray and are taken out at once and cremated.”  Forty of 160 patients had the flu, and the staff was coming down with it  So reported Hoosier nurse Maude Essig from Base Hospital 32 in the French resort town of Contrexéville in November.  “The odors,” she added, “are bad.”[5]

Treatment of the flu-ridden called forth everything in the nurses’ toolbox. They quickly learned the course of the illness, and they took from the toolbox everything they had to strengthen the heart, ease respiration, and attenuate suffering.  If they could not tame the virus, they could, with luck, keep patients alive long enough for their immune systems to rally and join the struggle.  During the early days of the pandemic, Beatrice Hopkinson wrote in her diary how flu-ridden patients were stripped of their clothing in one tent, bathed in disinfectant and distributed among different wards.  But disinfectants, she and others quickly learned, were unavailing.  Patients who were very ill often died from pneumonia within days, Hopkinson found.[6]  For those whose fate was not sealed, the trick was to bring down their high fevers with alcohol baths and to keep their hearts beating and their lungs exchanging oxygen and carbon dioxide.  Here is how nurses coped with a signal corps switchboard operator – one of the first “Hello Girls” – stricken with influenza on board the transport ship Olympic in September 1918:

Risking their own lives, nurses placed warm mustard packs on her chest to dilate the capillaries, stimulate her nervous system, and help her cough up the mucus that could drown her.  They aspirated her lungs, sponged her body with alcohol, applied camphorated oil every hour, gave  her salt-solution enemas, and spoon-fed her concoctions of milk, eggs, and whiskey.  The first week, Conroy received four hypodermic injections of digitalis to control her pulse and strengthen her heartbeat.[7]

None of these ministrations attacked the virus, but they kept Conroy alive, and after 17 days her fever finally broke.  She, no less than the nurses who saved her, went on to contribute to the war effort in France.

In 1916, prior to the epidemic, nurses who began to feel “influenza-ish” might resort to brisk walks and a “good hot mustard bath.”  But when they took ill after the epidemic set in, they resorted to large doses of quinine and aspirin or, alternatively, to quinine and “a stiff dose of whiskey” to keep going.[8] By the fall of 1918, their wards had become “influenza departments,” and they wondered how long they could resist infection.  Inevitably, nurses became patients, taking to their beds to await transfer to nearby convalescent homes set aside for them, referred to colloquially as “Sick Sisters,” for treatment and recuperation.[9]  For some, only physical collapse on the wards could remove them from the second battlefield.

The flu paid no heed to the Armistice that ended hostilities on November 11, 1918.  It raged on in base hospitals. It subsided in intensity in the final month of the year only to  return with renewed virulence in the new year. The nurses, for their part, remained in base hospitals throughout France and Belgium, serving not only bedridden soldiers but the local populace as well.  Then, pooling their efforts with the women physicians serving in American Women’s Hospitals (AWH) sponsored by the Medical Women’s National Association, they fanned out from northern France and Belgium to Serbia, the Near East, and even Russia.  Working hand in hand with medical colleagues, the nurses established public health programs for civilian populations that had gone without medical, surgical, dental, and nursing care since 1914.  Divided into mobile units, AEF nurses and AWH physicians established weekly house call and dispensary routes that took them to battle-scarred villages throughout the regions they served.  During the seven months that AWH No. 1 was based in Luzancy in northcentral France, for example, its units  made 3,626 house calls to the 20 villages on their regular schedule and to 45 outlying villages as well.  In virtually every village, chronic disease management shared center stage with dental and gynecological care.  And among the diseases with which nurses and physicians continued to do battle, typhoid fever and influenza had pride of place.[10]

We have considered the manner in which nursing interventions could become curative by simple dint of their frequency and intensity  – not to mention the confident bravado with which they were administered.  No where was this in greater evidence than with the soldiers and civilians stricken with virulent flu in the fall of 1918 and winter of 1919.  Nurses in the Allied Expeditionary Force, no less than their sisters-in-arms in the British Expeditionary Force, stayed on and nursed on, no matter the  apparent inevitability of death.  There was this implicit hope that caring interventions could at any point turn the tide, if only in the sense of gaining a brief reprieve during which the body’s depleted healing resources might rally.

Nurses were great naturalists.  Fevers might break.  Hearts might resume normal rhythms.  Lungs might expel enough infectious matter to resume respiration. To be sure, the worst of the influenza victims almost always died.  But then so did the worst of the postsurgical patients, the worst of the gassed patients, the worst of the soldiers with multiple injuries and multiple amputations. It mattered not.  Nursing professionals professed an ethic of caring grounded in, but not limited by, the scientific medicine of the time.  When all else had failed, when surgeons and physicians had given up on a patient, nursing care could still be a clinical tipping point that loosened the grasp of the grim repeater.  Always the nurses gave it their all.  Bits from the wreckage might still be saved despite the “unutterable woe.”[11]  Let one nurse, Britain’s Kate Luard, distinguished recipient of the Royal Red Cross Medal and Bar, speak for all in a diary entry from the fall of 1916:

There is no form of horror imaginable, on any part of the human body, that we can’t tackle ourselves now, and no extreme of shock or collapse is considered too hopeless to cope with, except the few who die in a few minutes after admission.[12]

__________________

[1]There is abundant secondary literature on the Great Pandemic of 1918.  An excellent, readable  overview is John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (NY: Viking, 2004).  Those interested in the pandemic’s impact on the American Expeditionary Force and the war in general should begin with Carol R. Byerly, Fever of War:  The Influenza Epidemic in the U.S. Army during World War I (NY: New York University Press, 2005).  A lively account of the search for the virus that caused the pandemic in the decades after the war is Gina Kolata, Flu:  The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It (NY: Farrar, Straus and Giroux, 2011).

[2] Cited by Byerly, Fever of War, 6.

[3] Lavinia L. Dock, et al.,  History of the American Red Cross (NY: Macmillan, 1922), 404-410.

[4] Helen Dore Boylston, Sister: The War Diary of a Nurse (NY: Ives Washburn, 1927), loc 694; Mary T. Sarnecky, A History of the U.S. Army Nurse Corps (Phila:  University of Pennsylvania Press, 1999),  121.

[5] Shirley Millard, I Saw Them Die: Diary and Recollections (New Orleans, LA: Quid Pro, 2011), loc 472; Alma S. Wooley, “A Hoosier Nurse in France:  The World War I Diary of Maude Frances Essig” ( https://scholarworks.iu.edu/journals/index.php/imh/article/view/10683/15077), entry of October 7, 1918.

[6] Beatrice Hopkinson, Nursing through Shot & Shell: A Great War Nurse’s Story, ed. Vivien Newman (South Yorkshire: Pen & Sword, 2014), loc 1999.

[7] Elizabeth Cobbs, The Hello Girls:  America’s First Women Soldiers (Cambridge:  Harvard University Press, 2017), 134.

[8] Edith Appleton, A Nurse at the Front:  The First World War Diaries, ed. R. Cowen (London:  Simon & Schuster UK, 2012), 102; Maude Essig, “World War I Diary,” entry of October 27, 1918; Boylston, War Diary, loc 1348.

[9] Dorothea Crewdson, Dorothea’s War: A First World War Nurse Tells her Story, ed. Richard Crewdson (London: Weidenfeld & Nicolson, 2013), loc 5344, 5379.

[10] On the role of American women physicians in WWI and its aftermath, see Ellen S. More, “’A Certain Restless Ambition’: Women Physicians and World War I,” Amer. Quart., 41:1989, 636-660; Lettie Gavin, American Women in World War I  (Niwot, CO: University Press of Colorado, 1997), 157-178; and Kimberly Jensen, Mobilizing Minerva: American Women in the First World War (Urbana:  University of Illinois Press, 2008), 77-97. Statistics on AWH No. 1’s service while based in Luzancy are given in Jensen, Mobilizing Minerva, 110.

[11] [Kate Norman Derr], “Mademoiselle Miss”:  Letters from an American Girl Serving with the Rank of Lieutenant in a French Army Hospital at the Front, preface by R. C. Cabot (Boston:  Butterfield, 1916), 21.

[12] John & Caroline Stevens, eds., Unknown Warriors: The Letter of Kate Luard, RRC and Bar, Nursing Sister in France, 1914-1918 (Stroud: History Press, 2014), loc 1277.

Copyright © 2017 by Paul E. Stepansky.  All rights reserved.  The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

 

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Remembering the Nurses of WWI (IV)

“Mustard gas burns.  Terrific suffering.”

 [The fourth of a series of essays about the gallant nurses of World War I commemorating the centennial of America’s entry into the war on April 6, 1917]

Now, sadly, chemical weapons are back in the news.  But large-scale chemical warfare  reaches back over a century.   In WWI, Germany released 5,730 cylinders of chlorine gas across a four-mile stretch of no-man’s-land into the Allied lines during the Second Battle of Ypres in April, 1915. Thus the birth of chemical warfare.  Britain replied in kind, releasing cylinders of chlorine gas during the Battle of Loos the following summer, and  Germany upped the horror in July, 1917, delivering artillery shells filled with dichlor-ethyl-sulphide or “mustard gas” just prior to the Third Battle of Ypres.

Chlorine gas attacked the airways.  Severe respiratory swelling and inflammation killed many instantly and the rest struggled to nearby casualty clearing stations with acute congestion of the lungs, pneumonia, and blindness.  Soldiers who had inhaled the most gas arrived  with heavy discharge of a frothy yellow fluid from their noses and mouths as they drowned in their own secretions.  For the rest, partial suffocation persisted for days, and long-term survivors had permanent lung damage, chronic bronchitis, and occasionally heart failure.  Mustard gas burned the skin and respiratory tract, stripping the mucous membrane off the bronchial tubes and causing violent inflammation of the eyes.  Victims were left in excruciating pain and utterly helpless.[1]

Nurses, no less than physicians, were initially confused about the nature of the gas and the severity of its effects.[2]  But they quickly came up to speed and realized that soldiers suffering from poison gas posed a nursing challenge no less formidable than those dying from gangrenous wounds.  Nurses were accustomed to losing patients, but not to being powerless to provide comfort care, to  ease  patients’ agony during their final days.  How to nurse on when nursing was unavailing, when the burns were so terrible that “nothing seems to give relief”?[3]

WWI nurses in gas masks treat soldiers after a gas attack

Of course, nurses did what little they could.  Inflamed eyes were repeatedly irrigated with alkaline solution.  Respirators soaked in hyposulphate could be provided to patients able to use them.  At American Base Hospital 32, soldiers who had breathed in mustard gas were given a mixture of guiacol, camphor, menthol, oil of thyme, and eucalyptus that caused them to expectorate inflammatory material.   According to Maude Essig, an American Red Cross Nurse who worked at the hospital, the nurses helped devise it.[4]

According to Essig, the mixture provided some temporary relief to soldiers with burning throats and mouths.  But nurses otherwise echoed a shared sense of impotence when it came to making gassed patients comfortable.  During the Second Battle of Ypres, when chlorine gas was first used by the Germans, Canadian nurse Agnes Warner recalled the initial wave of gassed troops:  “There they lay, fully sensible, choking, suffocating, dying in horrible agonies.  We did what we could, but the best treatment for such cases had yet to be discovered, and we felt almost powerless.”[5]   Shirley Millard was graphic in describing the severe burn patients who rendered nursing futile.  “Gas cases are terrible,” she wrote at war’s end in November, 1918.

They cannot breathe lying down or sitting up.  They just struggle for breath, but nothing can be done . . . their lungs are gone . . . literally burnt out.  Some with their eyes and faces entirely eaten away by the gas, and bodies covered with first degree burns.  We try to relieve them by pouring oil on them.  They cannot be bandaged or even touched.[6]

Whereas soldiers with even the worst of battlefield wounds usually did not complain,  the gas cases “invariably are beyond endurance and they cannot help crying out.” Millard’s judgment was affirmed by many others.  Maude Essig wrote of a “star patient,” one Leo Moquinn, who “was terribly burned with mustard gas while carrying a pal of his three-quarters of a mile to safety after the gas attack.  Except for his back, she added, his “entire body is one third-degree burn.  He cannot see and has  developed pneumonia and he is delirious.”[7]  Such were the burn patients.

Essig’s reference to pneumonia alludes to the multitude of infectious diseases that accompanied battlefield wounds and complicated (or prevented) recovery. Pneumonia could be rampant during winter months; gangrene and tetanus were prevalent year round.  Typhoid was partially  controlled by the antityphoid serum injections troops received, usually prior to disembarkation but otherwise in the reception huts of clearing stations and field hospitals. But bronchitis, trench fever, diphtheria, cholera, dysentery, meningitis, measles, mumps, erysipelas,[8] and, finally, influenza, were not.  Nurses recorded deaths resulting from various combinations of the foregoing, such as Edith Appleton’s “poor little boy, Kerr,” who died of gas, pneumonia, and bronchitis.[9]

Infected shrapnel and gunshot wounds could be irrigated or bathed continuously in antiseptics, first developed in the 1870s and packed in sterile dressings available in sealed paper packages since 1893.[10]  But in the preantibiotic era, nursing care of systemic infections was limited to the same palliatives we employ today:  rest, warmth, hydration, nutrition, aspirin (and, back then, quinine), all amplified by the nurse’s caring, maternal presence.

Trench foot, a combination of fungal infection, frostbite, and poor circulation, was endemic during the winter months, when soldiers lived in trenches flooded with icy water, often waist-high, for days on end.  They struggled into clearing stations with feet that were “hideously swollen and purple,” feet “that were “raw with broken blisters and were wrapped in muddy, dripping bandages.”[11] But trench feet, however disabling, at least  permitted more active measures.   In addition to giving morphine, there was a treatment protocol to follow, such as this one at a British Military Hospital in the winter of 1917:

We had to rub their feet every morning and every evening with warm olive oil for about a quarter of an hour or so, massage it well in and wrap their feet in cotton wool and oiled silk – all sorts of  things just to keep them warm – and then we put big fisherman’s socks on them.  Their feet were absolutely white, swollen up and dead.  Some of their toes dropped off with it, and their feet looked dreadful.  We would say, ‘I’ll stick a pin in you.  Can you feel it?”  Whenever they did feel the pin-prick we knew that life was coming back, and then we’d see a little bit of pink come up and everybody in the ward would cheer.”[12]

It is the dizzying  confluence of multiple battlefield injuries, many gangrenous, with the effects of poison gas and intercurrent infectious diseases that threatened to, and occasionally did,  overwhelm the WWI nurses.  Reading their diaries and memoirs, one sees time and again how the nurses’ calling, amplified by the camaraderie of other nurses, surgeons, and orderlies who felt similarly called, overpowered resignation and despair.  In a diary entry of September 14, 1916,  Kate Luard referred to the “very special nursing” required by soldiers with multiple severe injuries.  She had in mind

The man with two broken arms has also a wound in the knee – joint in a splint – and has had his left eye removed today.  He is nearly crazy.  Another man has compound fractures of both legs, one arm, and head, and is quite sensible.  Another has both legs amputated, and a compound fracture of [the] arm.  These people – as you may imagine – need very special nursing.[13]

If one adds to such clusters the serious general infections that often accompanied battlefield injuries, one has some sense of what nurses were up against, and just how special their nursing had to be.   When influenza, the deadly Spanish flu, began to swamp clearing stations and hospitals in the spring of 1918, nurses simply added it to the list of challenges to be met with the resources at hand. And they did so in the knowledge that as many as half of the infected would die.[14]  Beatrice Hopkinson, a British auxiliary nurse, recorded the new protocol developed at her General Hospital in St. Omer to meet the rush of influenza patients:

During those early days of the flu the treatment was to strip the patients in one tent, their clothing going immediately to the fumigator.  Then, the patient was bathed in disinfectant and taken to the different wards.  Some of the patients were very ill and died with pneumonia after a few days.[15]

The early days of the pandemic gave way to the later days, and after the Armistice was signed on November 11, 1918, nurses occasionally felt boredom, even mild malaise, when the demands of “special nursing” relented and they increasingly found themselves nursing “mostly mild influenza cases.”[16]

I admire the nurses of WWI because they did what was required of them absent any preexisting sense of what they could be required to do, absent, that is,  anything approaching a  “job description.” Without medical residents, internists, and infectious disease specialists to fall back on, they collapsed specialism into global care-giving identities.  This meant they managed multiple war wounds and  intercurrent infections, prioritizing among them and continuously adjusting treatment goals in the manner of highly skilled primary care physicians.  By the same token, they realized the importance of compassion in the face of ameliorative impotence.  Somehow they found  time to be present, to slip into a ward with a soldier dying of gas gangrene every few minutes “to do something perfectly useless that might perhaps give a ray of comfort.”[17]

Ironically, given the environment in which they labored and their “patient population” of soldiers in extremis, the nurses embodied the values of primary care medicine, since they took upon themselves the role of primary caregivers obligated to stay with their patients through thick and thin, to summon senior colleagues and surgeons as needed, and to ease life transitions, whether to recovery,  convalescence, lifelong disability, or death.[18]   And they did so whatever the weight of multiple assaults on their own bodily and mental integrity.

Nurses, technically noncombatants, suffered alongside the troops.  During rushes, their clearing stations, hospitals, and living quarters were under land and air assault and occasionally took direct hits.  They contracted infectious diseases, especially flu,[19] during which they usually carried on with the aid of simple analgesics until they felt better or worse.  When Helen Boylston became feverish in November, 1918, a symptom she attributed to diphtheria, she braced herself for a long-awaited evening dance with “quantities of quinine and finally a stiff dose of whiskey, and I felt ready for anything.” But not ready enough, it turned out.  She collapsed at the dance with a bad chill and had to be carried to her bed.  When she went on duty the following day, she became delirious in the ward and was lugged off by an orderly and subsequently seen by a doctor. “So here I am,” she wrote in her diary.  “I’ve developed a heart and a liver, and am as yellow as a cow-lily.  I have to lie flat on my back and be fed.  For three days I lay motionless all day long, not caring to move or to speak, I was so tired.”  Boylston was soon joined by a second nurse with diphtheria, placing the camp “in a panic,” with every staff member now given daily throat cultures.[20]

Despite training in the use of gas masks in the event of direct shelling, mask-less nurses suffered the effects of poison gas from daily proximity to patients on whom the shells had landed.  Their own vulnerability to gas attack and attenuated exposure to the poison lent special intensity to their care of burn victims.  They understood, with Maude Essig, that mustard gas burns indeed meant “terrific suffering.”[21]  Whether infected or poisoned, they usually labored on until they collapsed or were so near collapse that medical colleagues ordered them out of the wards, whether to bed, to a general hospital for treatment, or to a nearby convalescent homes for recuperation and a desperately needed “time out.”[22]

Civil War nurses too eased transitions to death, but their nursing goal during a soldier’s final days was to reconfigure mortal battlefield injury into the promise of a beneficent afterlife.   So they stayed with the dying, soliciting final confessions of sinful living, allowing soldiers to reminisce and reflect, and soliciting (and writing down) words of comfort  to sustain family members in believing that their soldier had died a “good death.”[23]  World War II, on the other hand, witnessed the development of new vaccines, a national blood bank program, the widespread availability of sulfa drugs in 1941 and penicillin in 1944, major advances in the control of shock and bleeding and in battlefield surgery, and much greater speed of evacuation of the seriously wounded to European and stateside base hospitals.  Taken together these advances created a buffer between nurses and the prolonged witnessing  of soldiers dying in unrelievable pain.

It was the nurses of WWI who took it on the chin.  They could not sustain themselves and their patients with the naturalistic view of the afterlife popular during the Civil War.[24]  Nor did they have the benefit of more “modern” technology and organization to shield them, if only somewhat, from the experiential onslaught of  dying soldiers.   It was not death per se but the agony of dying – from infected battle wounds and/or systemic infections,  gas gangrene, chlorine and mustard gas,  rushed amputations followed by reinfection and blood loss –  that took them to their own existential no-man’s-land, the kind we encounter in the writings of Mary Borden and Ellen LaMotte.

In the summer of 1917, the nurses at No. 12 General Hospital on the outskirts of Rouen struggled with a gas victim whose paroxysms of coughing came every minute and a half “by the clock,” and who had not slept in four days.  To quiet him, they rigged up a croup tent under which they took turns holding a small stove that heated a croup kettle from which the soldier could breathe the steam.  When sleep finally came, they were “ready to get down on their knees in gratitude, his anguish had been so terrible to watch.”  To their head nurse, Julia Stimson, they remarked that “they could not wish the Germans any greater unhappiness than to have them have to witness the sufferings of a man like that and know that they had been the cause of it.”[25]

It was bearing witness to unrelievable suffering that was the worst assault borne by the nurses.  “It is dreadful to be impotent, to stand by grievously stricken men it is impossible to help, to see the death-sweat gathering on young faces, to have no means of easing their last moments.  This is the nearest to Hell I have yet been.”  This is the voice of an anonymous British Red Cross nurse, unsettled by the dying Belgium soldiers she encountered on ambulance runs in the fields of West Flanders in the winter of 1915.  The American nurses at No. 12 General Hospital brushed up against this same hell, and they could think of no greater punishment for enemy combatants than to witness what they witnessed, often for weeks on end.  And yet the nurses of WWI were not stymied by seeming impotence in the face of pain.  They labored on to the breaking point in the service of soldiers who, all too often, were already broken.  This makes them warriors of care and, in a devotion to patients that was literally and not metaphorically self-less, heroes of the first rank.

_______________________

[1] Christine E. Hallett, Veiled Warriors:  Allied Nurses of the First World War (Oxford: OUP, 2014), 79-80, 203.

[2] E.g., Julia C. Stimson, Finding Themselves: The Letters of an American Army Chief Nurse in a British Hospital in France (NY: Macmillan, 1918), 80; John & Caroline Stevens, eds., Unknown Warriors:  The Letters of Kate Luard, RRC and Bar, Nursing Sister in France 1914-1918 (Stroud: History Press, 2014), loc 1945.

[3] Maude Frances Essig, My Trip with Uncle Sam, 1917-1919:  How We Won World War I, unpublished journal written during the summer, 1919, entry of March 24, 1918.

[4] Agnes Warner, My Beloved Poilus’ (St. John: Barnes, 1917), loc 861.

[5] Warner, My Beloved Poilus’ , loc 814.

[6] Shirley Millard, I Saw Them Die: Diary and Recollections (New Orleans, LA: Quid Pro, 2011), loc 514.

[7] Essig, My Trip with Uncle Sam,  entry of March 24, 1918.

[8] Erysipelas is an acute bacterial infection of the upper dermis, usually of the arms, legs, and/or face, that is accompanied by red swollen rashes.  Without antibiotic treatment, It can spread through the blood stream and cause sepsis.

[9] Edith Appleton, A Nurse at the Front:  The First World War Diaries, ed. R. Cowen (London:  Simon & Schuster UK, 2012), 111.

[10] Rodney D. Sinclair & Terence J. Ryan, “A Great War for Antiseptics,” Australas. J. Dermatol, 34:115-118, 1993.  These nineteenth-century antiseptics included salicylic, thymol, Eucalyptus oil, aluminum acetate, and boric acid.

[11] Helen Dore Boylston, Sister: The War Diary of a Nurse (NY: Ives Washburn, 1927), loc 154.

[12] Kathleen Yarwood (VAD, Dearnley Military Hospital), in Lyn MacDonald, The Roses of No Man’s Land (London: Penguin, 1993 [1980]), 197-198.

[13] Luard, Letters, loc 1245.

[14] Millard, I Saw Them Die, loc 472.

[15] Beatrice Hopkinson, Nursing through Shot & Shell: A Great War Nurse’s Story, ed. Vivien Newman (South Yorkshire: Pen & Sword, 2014), loc 1999.

[16] Hopkinson, Nursing Through Shot & Shell, loc 2609.

[17] [Kate Norman Derr] “Mademoiselle Miss”: Letters from an American Girl Serving with the Rank of Lieutenant in a French Army Hospital at the Front, preface by Richard C. Cabot (Boston:  Butterfield, 1916), 76-77.

[18] For an exposition of these values and how they gained expression in American medicine in the nineteenth and twentieth centuries, extending through “general practice” of the 1950s and ’60s, see Paul E. Stepansky, In the Hands of Doctors:  Touch and Trust in Medical Care (Santa Barbara: Praeger, 2016).

[19] “The flu is back again and everybody has it, including me.  I’ve run a temperature of one hundred and two for three days, can hardly breathe, and have to sleep on four pillows at night.” Boylston, Sister, loc 630.

[20] Boylston, Sister, loc 1350, 1357.

[21] Essig, My Trip with Uncle Sam, entry of March 23, 1918.

[22] E.g., Luard, Letters, loc 1247:  “Sister D, the Mother of all the Abdominals, has her marching orders and goes down to Rouen to a General Hospital tomorrow.  Her loss is irreparable.”  Edith Appleton  recounts taking care of three sick nurses and a sick VAD at one time:  “I have begun to feel like a perpetual night nurse to the sick sisters as I have another one to look after tonight with an abscess in her ear”(A Nurse at the Front, p. 123).  Maude Essig contracted erysipelas in the spring of 1918 and reported feeling “awfully sick” the following fall, when she relied on “quinine and aspirin in large doses” to keep going (My Trip with Uncle Sam, entries of April 9, 1918, April 14, 1918, and October 27, 1918).

[23] Drew Gilpin Faust, This Republic of Suffering:  Death and The American Civil War (New York: Vintage, 2008), chapter 1.

[24] Faust, Republic of Suffering, pp. 178, 187.

[25] Stimson, Finding Themselves, pp. 80-81.

Copyright © 2017 by Paul E. Stepansky.  All rights reserved.  The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

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