Nursing before the War.
Until the 19th century nurses had been regarded as low level domestic servants with very basic skills. In 1865 the Medical Superintendent of Glasgow Municipal Hospital, Dr J. B. Russell, described the profession thus:
‘at present nursing is the last resource of female adversity. Slatternly widows, runaway wives, servants out of place, women bankrupt of fame or fortune from whatever cause, fall back on hospital nursing‘ (Gaffney, 1982, p.140).
In 1867 Florence Nightingale dismissed her predecessors as: ‘those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else‘ (Gaffney, 1982, p. 194).
Barnard, F. (1874) Mrs. Gamp, on the Art of Nursing. This image depicts Dickens’ dissolute, drunken and slovenly stereotype of the early Victorian nurse.
Nursing often involved close physical contact with strangers. This, combined with the cleaning and feeding elements of the role, led to it being regarded as somewhat degrading and thus unsuitable for respectable women. Furthermore, a social stigma attached itself to any woman required to work for a living rather than being supported by her husband or family. As the 19th century advanced however, the social class of hospital patients had begun to diversify. Advances in surgery and care at hospitals resulted in the presence of patients who had previously been tended to at home under the management of personal physicians. This, along with developments in medical science and technology, fuelled the demand for skilled presentable nurses.
Professional nurses at George’s circa 1900 (St George’s archive).
By 1914 there were an estimated 12,000 nursing personnel with some kind of recognised training in Britain (Dingwall, Rafferty and Webster, 1988, p. 47). Such training might have included lectures in pharmaceuticals, hygiene, anatomy and nutrition. There was also plenty of work available as hospitals expanded and new ones opened but there remained no recognised formal skill base. Old prejudices towards the profession lingered and very few middle class women were recruited (Maggs, 1983, p. 47). Nurses, who were largely drawn from respectable working class backgrounds, regarded themselves as educated and genteel. Nursing itself however, remained a new and vulnerable profession.
Advertisement for St George’s Hospital Institute for trained nurses (St George’s Hospital Gazette, May 1914).
Nurses operated within a regimented, hierarchical system with their status demarcated by their uniform and experience. They were expected to be obedient and calm under pressure. Most would have had experience of treating wounds and infections. To modern eyes it seems surprising therefore that they were not immediately acknowledged as an indispensable resource in fighting the war. However 1914 Britain remained a patriarchal culture and there was a resistance to placing women anywhere near the fighting. Nurses were therefore initially regarded as being most useful where they could free able-bodied men for service. Nevertheless due to the sheer numbers of wounded being evacuated from the front, it rapidly became clear that professional nurses were urgently required as close to the battlefields as possible.
Photograph of St George’s nurses taken close to 1914 (St George’s archive).
Professionals and Volunteers.
As the casualties mounted it also became apparent that the number of nurses deployed was, in fact, grossly insufficient. Voluntary Aid Detachment Workers (VADs) were recruited to carry out the auxiliary, unskilled parts of the job such as laundering, cleaning and applying basic dressings. It was dirty, challenging work yet paradoxically recruits were usually drafted from the middle and upper classes. This was partially because the other opportunities to aid the war effort such as work in munitions factories were considered socially unacceptable. There was also a perception that these young women were, due to their class and temperament, ‘natural’ nurses. Providing light care to the poor and elderly had long been considered appropriate pastimes for wealthy young women, as long as they did so out of charity rather than the need to earn a wage. VADs received a salary but were expected to pay for their uniforms and basic training themselves.
Dennys, J. (1915) VAD Recruitment poster (image courtesy of the Imperial War Museum).
As a consequence professional nurses found themselves cast in the role of manager and educator of VADs alongside their nursing duties. Moreover they had to supervise women from higher echelons of society than themselves and may have felt threatened by this influx of unskilled labour. This caused some friction. The professional nurses were occasionally irritated by the sense of entitlement of young, untrained women whom after the war would naturally occupy higher social positions than them. The volunteers in turn, unused to the discipline of the nursing system sometimes found their supervisors harsh and disciplinarian (Hallett, 2014). The VADs however, generally admired the professionalism and skills of their seniors and more often than not the challenges of dealing with the dying and wounded brought them together. The VADs’ contribution was essential and many finished the war as highly capable nurses (Hallett, 2014).
French and British soldiers and German prisoners having their wounds dressed by nurses at a clearing station in 1918. (image courtesy of the Imperial War Museum)
Nursing at the Front.
Life for nurses near the front was difficult. Trained to preserve cleanliness and hygiene they had to struggle to even keep themselves clean and louse-free. Casualties would arrive caked in mud and dirt (Lomas, 2014, p.20) and conditions at both clearing stations and hospitals could be rudimentary. E.M. McCarthy the Matron-Chief of British Troops wrote of the clearing stations near the Western Front in 1915:
‘In the wards there were rows of stretchers with brown blankets only and on bare floors…There were no trolleys or dressing tables, an empty petrol can served for the soiled dressings and a clean piece of paper as a tray for the soiled dressings, and the floor or next stretcher for a table. The cases, acute and light, were all mixed in the same ward.’ (McCarthy, 1919).
Nurses also had to cope with brutal injuries and aggressive infections. Their work included carefully removing shrapnel, irrigating wounds and cutting away infected tissue; activities that more closely resembled surgery than nursing care. Due to the heavily manured soil in Belgium and France many soldiers succumbed to tetanus and gangrene, the only practical treatment for which was often amputation. Anaesthetics and pain medication could be scarce; nurses would work on wounds as orderlies forcibly held patients down. The term ‘triage’ was popularised during the First World War. Nurses found themselves making decisions that would have dramatic and lasting effects upon their patients’ lives.
Despite the damp, unsanitary conditions of the trenches this was the first modern war during which more combatants died from their injuries rather than infectious disease (Hallett,2014). In 1915 Nurse Clare Gass described the arrival of casualties:
‘… some terrible cases, oh so much better dead (one young lad with eyes and nose all gone- one blur of mangled flesh –and body whole and sound), heads shattered to pieces or limbs hanging by a thread of tendons. Oh why must such things be?’ (Lomas, 2014, p.21)
These wounds were the consequence of advances in conventional weaponry. The use of chemical warfare such as chlorine, phosgene and mustard gasses however, took combatants and medical staff by surprise. It was particularly hard to treat. One nurse described the effects of mustard gas:
‘Poor things burnt and blistered all over with great mustard-coloured blisters, with blind eyes… all sticky and stuck together, always fighting for breath, with voices a mere whisper, saying that their throats are closing and they know they will choke’ (Blodgett, 2009).
After the War.
British nurses watching a German patient being handed over in 1919 (image courtesy of the Imperial War Museum).
Hospitals such as St George’s continued to deal with the effects of the war long after the armistice in November 1918. Amputees and those poisoned by gas or suffering from disfiguring injuries required continuing care. Nonetheless, demobilisation and the closure of military hospitals naturally led to a dramatic reduction in the need for nurses, leading to a sudden loss of employment and income for many. This particularly affected married women who could no longer serve after the war (Dean, 2012).
Many nurses returned to their pre-war lives but the war had provided not only horrors but opportunities. Some had travelled to places they had never imagined visiting and experienced freedoms and responsibilities they would never have been granted before 1914. It had a lasting effect on many. Agatha Christie, for example, served as a VAD and was able to qualify as a pharmaceutical dispenser after the war. Many of her novels would subsequently feature death by poisoning. Her most famous detective, Hercule Poirot, was a Belgian refugee from the war.
Medicine itself remained a male dominated field but it had become difficult to refute the value of a qualified, skilled nurse in the light of the resilience, stoicism and determination they had demonstrated during the war. Nurses’ fears that the large numbers of volunteers taking on nursing roles during the war would ‘dilute’ their claim to professional status proved unfounded and in 1919 official registration for trained nurses was introduced. In 1933 Blomfield described the post-war body of nurses at St George’s:
‘There is little in common between the kindly, but poorly instructed female of a hundred years ago, and the healthy, young, cultured and highly skilled woman who is the finished hospital nurse of today (Blomfield, 1933, p. 102).’
He goes on to describe the training and rigorous application procedure at the hospital concluding that:
‘The high standard demanded at St. George’s has given her nurses a reputation second to none’ (Blomfield, 1933, p.103).
Barnard, F. (1879) Mrs. Gamp, on the Art of Nursing [Pen and Ink]. Available at: http://commons.wikimedia.org/wiki/File:Fred_Barnard00.jpg (Accessed: 4 November 2014).
Blodgett, B. (2009) ‘Germany’s use of chemical warfare in World War I’, First world war.com, Available at: http://www.firstworldwar.com/features/chemical_warfare.htm (Accessed: 4 November 2014).
Blomfield, J. (1933) St George’s 1733 – 1933. London: The Medici Society.
Dingwall, Robert, Anne Marie Rafferty, Charles Webster, eds. (1988) An Introduction to the Social History of Nursing. London: Routledge.
Gaffney, R. (1982) ‘ Women as Doctors and Nurses’, in Checkland, O. and Lamb, M. (eds.) Health Care as Social History. Aberdeen: Aberdeen University Press pp. 134–148.
Hallett, C. (2014) ‘A very valuable fusion of classes’: British professional and volunteer nurses of the First World War.’ Endeavour, 38 (2), pp: 101 – 109.
Hallett, C. (2014) ‘Stoicism and care in the face of carnage’ Nursing Standard, 28(48).
Imperial War Museum. Collections and Research. http://www.iwm.org.uk/collections-research .
Lomas, C. (2014) ‘In the thick of it’, Nursing Standard, 28 (24) pp: 20-22.
Maggs, C.J (1983) The Origins of General Nursing. London: Croom Helm.
Mc Carthy, E. M. Report 31.7.1919. The National Archives WQ222/2134. Available at: http://www.nationalarchives.gov.uk/ (Accessed: 4 November 2014).
St George’s Hospital Gazette, July 2014.