Women medics and the First World War.

Women medics and the first world war

By 1914, the long fight by women to gain entry to medical education had largely been won. However Oxbridge and the London teaching hospitals, including St George’s, still held out and refused to admit women for training. In 1915, in response to wartime staff shortages St George’s relented and admitted it’s first four female medical students. It was the first London teaching hospital to do so. The St Georges Hospital Gazette reported that:

‘Among the many sorrowful effects which the War has had upon us it is pleasant to record one joyful result which we would never have attained without a war. Variety and charm has been added to the Medical School and its works by the admission of ladies as students’ (St George’s Hospital Gazette, April, 1915).

Despite this initial enthusiasm, fears of controversy led to these places being rescinded.  The  female students were impelled to write and plead their cases. In 1916 the medical school acquiesced and allowed them to continue their studies. This indicates that medical training for women remained a contentious issue. By 1917 however, St George’s was prepared to even employ women, albeit temporarily, as house officers.

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Two of St George’s first female medical students (St George’s archive).

Irregardless of the medical school women graduated from, they were still confronted by a scarcity of available positions. Most found themselves limited to work in women’s hospitals, moving to obscure geographical locations or adopting specialities that did not generally appeal to men.  When the First World War broke out there was no official interest in involving qualified female doctors in the war effort. When Dr Elsie Inglis attempted to volunteer, the infamous War Office response was ‘My good lady, go home and sit still’. This was unlikely to ever happen; Dr Inglis like others had been involved in the suffrage movement. Women doctors simply approached their campaign to help the war effort in the same way they had fought for voting rights. They mobilised support, formed voluntary groups and raised money. In effect they simply circumvented  officialdom and offered their services elsewhere, even to foreign governments.

In 1914 the Women’s Hospital Corps was formed by Dr Louisa Garrett Anderson and Dr Flora Murray. The French government, unlike their British counterparts, promptly accepted their offer of help. Under the aegis of the French Red Cross the Women’s Medical Corp successfully ran military hospitals in Paris and Boulogne. In Paris they occupied the newly built Claridge’s Hotel on the Champs Elysee. The organisational skills required to raise funds, recruit staff, design uniforms and equip and manage the hospital were considerable. But both women were experienced doctors and had been active suffragettes, Dr Garrett Anderson herself had even been imprisoned in Holloway. They must have been formidable; the concierge told Dr Garratt Anderson that ‘he would have had an easier time fighting the Germans than facing so many active English Ladies!’ (Papers of Louisa Garrett Anderson,1914).

floramurrayFlora Murray supervising an operation at the Paris Red Cross Women’s Hospital (image courtesy of the Imperial War Museum).

In 1915, ostensibly to free men for service, the Corps was given control of the Endell Street Hospital in London which treated over 25,000 patients during the duration of the war (Murray, 1920). The Scottish Women’s Hospital, which had been formed by Dr Elsie Inglis after her War Office rebuff, distinguished itself in Serbia and France in 1916. In Serbia, the all female staff of the hospital found themselves in the midst of the conflict treating serious injuries in extremely difficult conditions. Moreover they had to fight major epidemics of disease and deal with a starving civilian population. The Hospital’s volunteers were forced to join the retreat during which thousands died. Some chose to take the even more risky option of  staying behind with patients who could not be moved.  Dr Inglis herself was taken prisoner of war.

In that same year, in the light of escalating need, the War Office reconsidered their positions and grudgingly allowed female doctors and surgeons to join the services. Despite the efficiency of the Women’s Medical Corps and the sheer toughness of the Scottish Women’s Hospitals the authorities continued to refuse to countenance the idea of women near the battlefield. Instead volunteer medics were sent  to locations like Malta. This was located far from the fighting and  most of the patients there were being treated for malaria and other infectious diseases.

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The Newnham and Girton units of the Scottish Women’s Hospitals about to leave for Serbia in 1915 (image courtesy of the Royal College of Physicians and Surgeons of Glasgow).

Nonetheless the war gave female medics, especially at the voluntary women’s hospitals, the chance to treat a wider range of cases. Like their male counterparts they dealt with gruesome wounds, amputations and fierce infections in great numbers. Dr Garrett Anderson described her routine in Paris:

‘I am in the theatre from 2 – 9 or 10 at night and eight or more [operations] The cases come to us very septic and the wounds are terrible. Today we are having an amput’ of thigh, two head cases perhaps trephine and five smaller ones’ (Papers of Louisa Garrett Anderson, 1914) .

Despite their efforts, women serving  their country were, unlike their male compatriots denied official military commission. In addition they were paid less, had one year contracts, were given no uniform and did not necessarily  receive any ration or billeting allowance. Furthermore they would not receive any pension if they were injured (Leneman, p.1593). Dr Jane Walker wrote to the Times in 1918 complaining that:

‘Although many of the medical women in the army not only have a high professional standing in civil practice, but now have a large experience in military hospitals, they rank below the latest joined R.A.M.C. subaltern, and are obliged to take their orders from him. When they travel, they travel not as officers but as soldiers wives’ (Times, 1918).

Whilst women’s’ suffrage had been put on hold for the duration of the war the Medical Women’s Federation decided to challenge this inequality robustly. A number of reasons for treating women in an inferior manner were put forward. Some feared it would be the thin edge of the wedge and that women serving elsewhere in the forces might also want commissions. The military were by nature conservative and some in it’s ranks had no sympathy for claims of sexual equality.

LouisaDr Louisa Garratt Anderson photographed in 1918 (image: Open I)

Perhaps the oddest objection was that the ordinary soldier would not bear examination by female medics or tolerate treatment of venereal disease. This, despite the fact that female nurses dealt with cases of venereal disease and had continual intimate contact with patients.  A doctor was traditionally a masculine authoritarian role and it was felt men might resent being told what to do by a woman. A famous Punch cartoon of 1915 shows a stern looking female doctor recognising a patient. The patient cheerfully points out that as a police constable before the war he had once arrested her in her guise as suffragette. There appear however to have been few examples of any complaints from patients at being treated by a female surgeon or medic. The women run hospitals were, in fact, considered to be far more pleasant places to be than many official alternatives.

endell wardWard round at Endell Street hospital (image courtesy of bbc. co).

Women doctors had some support, from both the British Medical Association and more enlightened officials within the War Office. The then Secretary of State for War Winston Churchill ultimately refused to allow women to hold commissioned rank commensurate to their skills and responsibilities. He concurred with the official line that a commissioned officer had to be able to undertake all kinds of military duties, including where necessary, fighting. The Medical Women’s Federation retort to this was that:

‘Commissions have been given to numbers of medical men who by reason of physical disability or age were not fit for service’ (Contemporary Medical Archives Centre).

The War Office however maintained that a man unfit for full service was still more able to serve than an able bodied woman. In 1919 the Medical Women’s Federation declared that in future it would advise it’s members never to volunteer for any emergency, unless they were treated in the same way as the men.

Despite finally being granted limited suffrage in 1918, many female army medics found themselves  rapidly demoted back the backwoods of hospital medicine, but not all. Some helped found famous hospitals and others became leading figures in their fields. Notably however, few were allowed to continue to practice as surgeons, where their greatest expertise and experience lay.

In the case of St George’s Blomfield wrote of its women students:

… they proved an enthusiastic and efficient body. Most of them became house officers in their turn. Some occupied the higher posts of assistant curator and pathologist with such signal success that their services were retained long after the war had ceased. No more women students were admitted, however, as soon as it became plain that we were getting enough men to fill all the necessary posts in due course. The school is not big enough to harbour women as long as it continues its present prosperity with men’ (Blomfield, p. 92).

The War Office in fact continued its stance until the Second World War became imminent when again a generation of female doctors and surgeons would be called upon. That generation however were even less inclined to tolerate the inequalities their predecessors had been but even then they were only granted ‘relative’ rank and often denied commissions.

Bibliography.

Blomfield, J. (1933) St George’s: 1733-1933. London: The Medici Society.

SA/MWF/C.163. Contemporary Medical Archives Centre, Wellcome Trust.

Leneman, L. (1933) ‘ Medical Women in the first world war-ranking nowhere’, British Medical Journal, 307 (December) pp.1592 – 1594.
Murray, F. (1920) Women as army surgeons. London: Hodder and Stoughton.
Papers of Louisa Garrett Anderson, The Women’s Library, London.

St George’s Hospital Gazette, 1915.
The Times Letters page, The Times, 4 July.

Patients and the First World War

Patients and the first world war

One of the primary purposes of military medicine during the war was to preserve a precious resource. Patients were ‘repaired’ to be battle ready and a field surgeon or hospital was as much a part of the military complex as a sapper or gun emplacement. Patients were assessed for fitness to fight at every point during their care, with all but the most severely wounded in a loop that inexorably led back to the battlefront. Those undergoing treatment were aware of the situation they were in, one convalescing soldier described every patient such as himself in terms of being a:

‘…wheel in a complicated machine [and] all must work together otherwise disorder and chaos would inevitably result’ (Recollections of the Hospital Keighley and its Auxillaries, 1919, pp: 32–33).

If this seems harsh it should be remembered that the concept of an ordinary soldier as a valuable asset was a major driver in providing care. Just a century before, an injured combatant could expect little more than a place on a floor, minimal attention and most likely a painful death from disease or infection. Paradoxically, during the first world war, whilst injuries were inflicted on a hitherto unseen scale, medical services actually managed to deliver a higher chance of survival than ever before.

arraWounded waiting to be evacuated after the Battle of Arras in 1917 (image courtesy of the Imperial War Museum).

Patients during the First World War were treated differently according to rank and local conditions but there were established processes that most would have experienced in some form. The first was evacuation and ‘triage’, a term popularised during this period. Only the very seriously ill would get a ‘Blighty Ticket’ sending them back to hospitals like St George’s for care and convalescence.

blighty caseA postcard showing a wounded soldier being evacuated to ‘Blighty’ (image courtesy of WW1 postcards.com)

Established hospitals such as St George’s put beds aside for injured servicemen from the very outset of the war (St George’s Hospital Gazette, October 1914). Whilst wards followed the conventional layout of beds and treatment stations the buildings they were set up in varied widely. There were large ‘hut’ hospitals constructed especially to deal with the influx of wounded but a diverse range of buildings were also commandeered for use as ad hoc hospitals. However the treatment for all injured soldiers followed the medical mores of the time; bed rest, a ‘soft diet’, fresh air, and activities to promote good morale were all prioritised.

craigleath hospitalPatients at Craigleath hospital (image courtesy of WW1 postcards.com).

It might have been expected, even if some surroundings were basic, that everyone would be happy to be away from the battlefield but responses to the care offered were mixed. Many were relieved to have a bed and a bit of peace. However for others the confinement to a bed itself was sometimes resented. As one author noted in a hospital magazine:

‘The clothes [being] tucked in to such an extent that it is well-nigh impossible for [the patient] to move . The bed is no longer a bed, it is a nightmare’ (Ammonite, 1917, pp: 286–287).

Others were not happy with the general conditions they encountered. In 1917 one soldier, admitted for injuries caused by gas, described the Royal Naval Hospital as:

‘the closest combination of prison and workhouse I know’ [with] ‘infamous rules galore, scanty ill-cooked grub and general treatment rotten’ (Liddle Collection, 1917).

The military hospital was as full of distinctions, rules and constraints as any army base. Whilst patients were spared the shells and gas at the front, treatment itself could be painful and recovery was far from guaranteed. However those hospitalised had the shared experience of fighting at the front and an ‘esprit de corps’ did exist amongst patients. Much like the ‘Wipers Times’ (which was produced in Ypres by soldiers to entertain each other) hospital patients produced newspapers with a content that often satirised hospital life (Reznick, 2004).

The ordinary soldier was inclined to view his time in hospital with a grim, chippy, resignation and the therapies to encourage morale and recovery were often pilloried. One was the insistence on playing music, many soldiers enjoyed singing but sometimes the endless use of a gramophone grated. Another irritation was the attention of well-meaning upper class women making ignorant comments. When she was a volunteer nurse, the writer Enid Bagnold wrote exasperatedly of ‘the lady who comes in to tea and wants to be introduced to everyone as though it was a school treat’ (Bagnold, 1918, p.15).

cartoonwellcome“What will you do when leave hospital, my poor fellow?”

“Oh! I’ve got a splendid job in a brewery making ‘ops, and my friend here he’s going in for short’ and !”

Cartoon satirising well to do hospital visitors (image courtesy of Wellcome Images).

Soldiers recovering in Britain were required to wear a loose blue uniform, known as the ‘convalescent blues’. The reasons for this were partially practical. Uniforms from the front were worn, tatty, full of lice and had to be disinfected or replaced. A hospital uniform was the cheap utilitarian answer. However it also had a psychological role, that of reinforcing a sense of institutionalisation and discipline. Moreover there was also an undeniable propaganda purpose in forcing convalescents to wear the ‘blues’. It marked them out as heroic ‘Tommies’ whilst highlighting that they were being cared for by the government; reassuring for those whose family members remained at the front.

conbluesPainting of convalescent soldiers in their blue uniforms by Robinson (1920), (image courtesy of Wellcome Images).

The patients themselves had mixed feelings about them. To start with officers were exempted; they received an armband and an allowance to help them buy new clothes. Everyone else had to wear the outfit at all times and some found it undignified whilst others felt that it took away their individuality. Produced in one size only, they were often ill-fitting and some complained that the uniforms resembled pyjamas. There were advantages to wearing the uniform however, the attention could be positive and there was no risk of being presented with the dreaded white feather for cowardice. The injured soldier also gave the public at home the opportunity to be charitable and help the war effort. They would often be be given free entrance to theatres or gifts by grateful citizens.

A popular gift for someone wearing the convalescent blues was tobacco. It sometimes appeared that the army at the front ran on nicotine. Some frowned on this but the general consensus was that any small comfort was to be encouraged. In fact there were official charity drives to provide ‘Smokes for Soldiers’ and ‘Fag Day’ was the flag day for collecting funds in order to do so. Tobacco obtained with the fund could was also distributed to wounded and convalescing soldiers and sailors.

fagday

Poster promoting ‘Fag Day’  (image courtesy of the Imperial War Museum).

It might have been expected that the stress on cleanliness and hygiene would preclude smoking on wards and whilst there were sometimes limitations this does not appear to have been generally the case. Gifts of cigarettes and tobacco were regularly presented to the men at many London hospitals.

Alcohol was more problematic. At the front, despite some opposition, soldiers received a rum ration. The known tendency for it to dull reactions was considered to be outweighed by its ability to lift morale and comfort the troops. In clearing stations it was sometimes used as a disinfectant and pain suppressant. Those on leave in France and Belgium could also buy wine and spirits from the local population.

drinking postcardCartoon ridiculing the drinking prohibitions introduced during the war (image courtesy of WW1 postcards.com).

The situation on the Home Front was different. In fact it was women who caused the greatest consternation as they were drinking more than men. This was particularly worrying in the case of munitionettes and drivers but the government was also concerned about productivity and morality in more general terms. The result was that one of the most unusual laws in British history was passed in some areas in 1916. The so called ‘Treating laws’ forbid anyone to buy a drink for someone else, even a family member or spouse.

As a result there were no mass public drives to provide soldiers with gin or brandy or to encourage them to drink. However it was common for pub landlords to give drinks to serving and recuperating soldiers. Gifts of alcohol to convalescents in hospitals were not unusual. In the case of officers alcohol was freely available, a Canadian officer being treated at King Edward VII’s Hospital for Officers recalled that:

‘The butler used to come round the wards before meals and take one’s order for dinner. Liquor was available in any form by request’ (Reznick, 2004, p.64).

At the beginning of the war recruiting officers had been dismayed by the health of many volunteers, the results of poverty and poor nutrition amongst the general population. This, combined with the privations in the trenches might have been expected to ensure that food, at least, would be gratefully received. However patients complained about both the ingredients and the portion size of their meals. As one soldier drily observed in 1917:

‘Unless you are on a starvation diet, your food, consisting mainly of fish, soup and eggs, is fit for the gods – the gods being ethereal creatures and not standing much in the need of solid sustenance’ (In hospital,1917, p.80).

The First World War hospital was not simply about care and recovery.  A military hospital, in which an injured soldier could spend months recuperating, was often also a community. It emphasised the soldier’s continuing role in the war, his job was to recover and this was part of his service. The use of uniforms and team activities was designed to ensure the recovering serviceman remained institutionalised. Towards the end of the war, when Russia had undergone a revolution and soldiers were increasingly mutinous the British government was particularly worried about morale. Hospitals, with their concerts, music and cheery patriotism were part of the effort to prevent rebellion and foster comradery amongst an increasingly brutalised and weary fighting force.

amputeeAmputee being treated at Queen Mary’s Hospital, Roehampton (image courtesy of Imperial War Museum).

Nonetheless, the wounded, especially those from poor backgrounds received free treatment they would have been unused to prior to the conflict.  After the war many continued to benefit from medical care provided by charities and hospitals such as St George’s.

Bibliography.

Ammonite, ‘Beds and bed making’, (1917) Southern Cross: Magazine of the First Southern General Hospital, pp.286-287.
Bagnold, E. (1918) A Diary without Dates. London: William Heinemann.

Cayley Robinson, F. (1920) Acts of Mercy: The Doctor [paint on panel]. Available at: http://blog.wellcomelibrary.org/label/frederick-cayley-robinson/ (Accessed: 4 November 2014).

Imperial War Museum Collection. Available at: http://www.iwm.org.uk/collections-research (Accessed: 4 November 2014.
‘In hospital’ the magazine of the Fourth Northern General Hospital (1917).
Wallis, S. J.(1917) Letter from S.J Wallis to his brother George Wallis, 3 and 6 November. Leeds University Library, Liddle Collection.
Recollections of the Hospital Keighley and its Auxillaries. (1917) London: Wadsworth and Co.
Reznick, J. S. (2004) Healing the Nation. Manchester: Manchester University Press.

Wallis, S. J.(1917) Letter from S.J Wallis to his brother George Wallis, 3 and 6 November. Leeds University Library, Liddle Collection.

Wellcome Images. (2014) Available at: http://wellcomeimages.org/ (Accessed 11th November 2014).

WW1 Picture Postcards. (2014) Available at: http://www.worldwar1postcards.com/ (Accessed 11th November 2014)

Nursing and the First World War.

 

Nurses and the first world war

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).

gamp

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.

archive3

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.

nurseschool

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.

archive1

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.

nursing vad poster

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).

muddy field nurse

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.

handling prisoner of war over

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.

nurse picnicNurses having a picnic in Egypt (image courtesy of the Imperial War Museum).

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).

Bibliography.
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.

St George’s and the outbreak of the First World War.

This year marks the centenary of the outbreak of the First World War. The Library will be publishing four blog posts reflecting on the experiences of medical staff and patients during the conflict, not only at St George’s but within the wider medical community. The posts will be published at the beginning of each week during November starting from today. We hope you will find them interesting.

St Georges and the outbreak of war

The outbreak of war in August 1914 was accompanied by a swell of patriotism in Britain and many appeared to accept the morale boosting suggestion that the War would not only be easily won, but that it would also be ‘over by Christmas’. Although confidence in the British Empire ran high, others were less sanguine and their outlook was epitomised by Viscount Grey’s famous comment of that same month:

‘The lamps are going out all over Europe, and we shall not see them lit again in our life-time’ (Spender, 1925, pp. 14-15).

At St George’s Hospital and Medical School however, both administration and staff appeared to share the  enthusiasm of the nation for war. A writer in the St George’s Hospital Gazette described the:

‘patriotism of the younger and (many of the older men)’. He continued to note that within a few days of the declaration of war ‘practically the entire resident and non-resident staff volunteered their services to the Admiralty or War Office ‘(St George’s Hospital Gazette, Oct 1914, p. 99).

The dark side of this burgeoning patriotism also revealed itself. Forty nurses were reported to have attempted to have a housekeeper with a German name removed from her position; she only survived by revealing she had changed her nationality (Bloomfield, 1933, p. 92).

gazz

Title plate from The St George’s Hospital Gazette, October 1914.

The first effect of the war upon St George’s was the loss of medical personnel to the Territorial regiments or the Royal Naval reserve. They were soon joined by professional nursing staff; in October 2014 alone twenty two joined the British Red Cross Society (St Georges Hospital Gazette, Oct 1914, p. 106). At the same time there was naturally no respite in the workload of a busy London hospital. Visiting staff and Registrars stepped in to take resident posts, retired employees returned to work and despite placing a hundred beds at the disposal of the War Office, the hospital coped. This was partially ascribed to:

‘… Certain rearrangements evolved in the depths of the brain of the Superintendent, who , fortunately, is an ex-Wrangler…’ (St Georges Hospital Gazette, Oct 1914, p. 100).

The first major engagement, The Battle of Mons, took place in August 1914 and St George’s staff who had volunteered saw service soon after signing up. A St George’s medic wrote of treating casualties who had arrived after a lengthy train journey at an unnamed military hospital in France:

‘Of the wounds I need not say much, except that taken on the whole they were more severe than one sees in England’ he continued ‘The more severe injuries however, especially those caused by shrapnel were generally very foul, with a certain amount of gangrene and cellulitis’ (St George’s Hospital Gazette, Oct 1914, pp. 97 – 98).

British_wounded_Bernafay_Wood_19_July_1916

Walking wounded 1916 (photograph courtesy of the Imperial War Museum).

Most of the younger doctors who volunteered from St George’s and elsewhere had no experience of military medicine. Some of the senior medical staff however had held military rank and worked in theatres of war, particularly during the Boer War. A letter published by the Lancet in September 1915 reflected this:

I have looked up my old notebooks relating to my experiences of the Boer war and Zululand rebellion of 1906 in the hope that [they] may be of use to others who have not had the advantage of previously treated cases of rifle wounds’ ( The Lancet, 1914, pp. 642–44).

In hindsight this might seem naïve, but during the early stages of the conflict few comprehended that advances in medical science such as blood transfusions would be matched by advances in weaponry. Medical establishments had historically evolved from military and religious organisations. This was reflected by the hierarchical disciplined systems adopted by institutions such as St George’s. The organisation of nursing on the wards had developed from Florence Nightingale’s theories, which were themselves condensed from her experiences in the Scutari Military Hospital during the Crimean War (Nightingale, 1859). In that, and subsequent conflicts, the majority of deaths were caused by infection and disease rather than injury, so the importance of medical care in contributing to military success was understood. Moreover advances in medicine including an awareness of sepsis and disinfection had improved recovery rates from injury. The late Victorian and Edwardian eras had also witnessed a growth in interest in public health including sanitation, infection control and hygiene. Therefore it is not surprising that there was initially a degree of confidence in modern medicine’s ability to deal with the war wounded.

hospital in cambridge

Interior of a military hospital ward in Cambridge (photograph courtesy of the Imperial War Museum).

As the war continued, the adoption of trench warfare meant the combination of wound and infection would become a major and recurrent challenge. The first shipment of wounded back to St George’s arrived on the King’s and Hope Wards in mid-October 1914. (St George’s Hospital Gazette, Oct 1914, p.100). John Lavery’s painting: The First Wounded, London Hospital, August 1914 although somewhat idealised suggests how the wards at St George’s might have looked. In the painting the wounds are probably not depicted in their full severity but the injuries and conditions prevalent amongst those admitted would have been similar to those treated at St George’s later that year. The most common problem was frostbite which continued to be the case throughout the war (Atenstaadt, 2006). Infections were also rife as was rheumatism, most probably caused by trench fever. Of the trauma cases upper limb injuries were more numerous (Park and Park, 2011). Although hospitals like St George’s were at this point staffed by professional medics and nurses used to treating infection and trauma, the scale and violence of the injuries must have profoundly affected the staff working with the first tranches of war casualties.

(c) Rosenstiel's; Supplied by The Public Catalogue Foundation

John Lavery. The First Wounded, London Hospital, August 14 (courtesy of Dundee Art Gallery).

This seems to have concentrated the minds of some medics, as a less grim consequence of the outbreak of war at St George’s was a rush to marry sweethearts, with the Gazette recording four such marriages (St Georges Hospital Gazette, Oct 1914, p. 108).

The effects of the War and the speed of its escalation in terms of manpower and effort can be detected within issues of the St George’s Hospital Gazette which appeared during its early months. As the war continued the numbers of St George’s staff involved increased and some were taken prisoner, injured, or killed in action. One of the first casualties was Septimus Hibbet, a House Physician at St George’s who was lost with the H.M.S Formidable in January 1915, one of the first battleships to be sunk during the war (St George’s Hospital Gazette, Oct 1914, p.102). In a surreal footnote a survivor of this sinking was reputed to have been resuscitated by a sheepdog called ‘Lassie’ who may have provided the inspiration for the famous Hollywood films (Clarke, 2008).

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HMS Formidable (photograph courtesy of the Imperial War Museum)

BIBLIOGRAPHY

Atenstaadt, R. L. (2006) ‘Trench foot: the medical response in the First World War 1914 – 1918’, Wilderness and Environmental Medicine, 17(4), pp: 282 -289.

Blomfield , J. (1933) St George’s 1733 – 1933. London: The Medici Society.

Clarke, N. (2008) Shipwreck Guide to Dorset and South Devon. Charmouth: Nigel J. Clarke Publications

Ministry of Information First World War. (2014) Ward of the 1st Eastern General Hospital which stands on the grounds of Kings and Clare Cricket Fields, Cambridge. Available at: http://media.iwm.org.uk/iwm/mediaLib//290/media-290607/large.jpg (Accessed: 29 October 2014).

Lavery, J. (1915) The First Wounded, London Hospital, August 1914 [Oil on canvas]. Dundee Art Gallery, Dundee.

Nightingale, F. (1859) Notes on Nursing: What it is and What it is Not. London: Blackie & Son.

Park, M. P. and Park, R. H. R. (2011) ‘Art in wartime: The First Wounded, London Hospital, August 1914’, Medical Humanities, 17(1), pp: 23-26.

Spender, J. A. (1927) Life, Journalism and Politics. London: Cassell and Company Ltd.

(1913-1914) St Georges Hospital Gazette.

(1914-1919) St Georges Hospital Gazette (1914 – 1919), 22.

The Royal Navy 1914 – 1918. HMS Formidable. Available at: http://www.iwm.org.uk/collections/item/object/205319700 (Accessed: 29 October 2014).