CHAPTER VII
THE NURSING SECTION; RECONSTRUCTION AIDES
THE ARMY NURSE CORPS
The few hundred nurses who formed a part of the six base hospital unitsassigned to service with the British Expeditionary Forces, and the othernurses who arrived in France during the early period of the American ExpeditionaryForces, were for five months under the general jurisdiction of the officeof the chief surgeon, A. E. F., after that office was established in June,1917,1 and of its personnel division after that division wascreated in July.2 On October 2, 1917, General Pershing cabledto the War Department a request that a competent member of the Army NurseCorps be sent to Paris to serve as superintendent of nurses of the AmericanExpeditionary Forces.3
The chief nurse of Walter Reed Hospital was selected for this assignmentand, with an assistant, reported for duty on November 14, 1917, at headquarters,line of communications (then in Paris), and on the day following was assignedas chief nurse, line of communications.1 At the time in question,most of the nurses of the American Expeditionary Forces were on duty atbase hospitals in France, and these (other than the six above mentioned)were under the administrative control of the chief surgeon, line of communications.4Whenheadquarters, line of communications, moved to Tours in January, 1918,the office of the chief nurse accompanied it as a part of the personneldivision, office of the chief surgeon, line of communications.4No member of the Army Nurse Corps served in the office of the chief surgeon,A. E. F., until that office moved to Tours and there absorbed the officeof the chief surgeon, line of communications, in March, 1918.4The office of the chief nurse then became a section of the personnel division,chief surgeon's office.4
On October 8, 1918, the Surgeon General notified the chief surgeon thatauthority had been received from the Secretary of War for the appointmentof a director and two assistant directors of the nursing service in France,and for a director and two assistants for our nursing service in base sectionNo. 3 (England).1 No such appointments were made in base sectionNo. 3, however, for the chief surgeon of that section decided that so manyadministrators for the nursing service there were unnecessary and, therefore,continued in that section the office of chief nurse which had been establishedthere June 17, 1918.1 The chief nurse of the American Red Crossin France, who formerly had been chief nurse of Base Hospital No. 21, wasappointed director of the nursing service, A. E. F., and on November 15,1918, reported to the chief surgeon, A. E. F., at Tours,1 thusreplacing the chief nurse, A. E. F., who left, on December 2, to becomeassistant to the superintendent of the Army Nurse Corps in the SurgeonGeneral's office.1 The chief nurse of base section No. 3 anda nurse who had been assistant to the chief nurse were appointed assistantdirectors of the nursing service, A. E. F., November 18 and December 14,
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respectively.1 The staff of the director of the nursing service,was further augmented by assigning to it, on January 13, 1919, a nursefrom Base Hospital No. 7, who formerly had been matron of General HospitalNo. 22, British Expeditionary Forces, and, on February 3, 1919, the chiefnurse of Base Hospital No. 27, the duties of the last-mentioned memberof this staff including both service at the central office and inspectionof the nursing service in hospitals.1
Most of the nurses who served in the American Expeditionary Forces arrivedas members of base hospital units, but others came in replacement units,and were not attached to any hospital until assigned in France.1 Otherssailed as casuals (one group of these, which arrived in the summer of 1918,including 500 nurses) and a few as members of small organizations suchas mobile operating units, psychiatric units, etc.; one group consistedof anesthetists.1
On August 11, 1917, the chief surgeon, when submitting to the chiefof staff, A. E. F., an estimate of the medical personnel that would benecessary for an army of 1,000,000 men, calculated that the number of nursesrequired for such a force would be 22,430; however, at no time did thequota of nurses approximate this estimate.4
In the first six months after the United States entered the war a fewmore than 1,100 nurses arrived, of whom about half served in the six basehospitals assigned to the British.1 From November, 1917, untilMarch 31, 1918, less than 900 others arrived, and there was a consequentshortage on that date of 400, even under the reduced priority scheduleprescribed by the general staff, A. E. F.1 At this time therewere only 2,088 nurses in France, of whom approximately 700 were underBritish control.1
The consequent shortage of nurses in the American Expeditionary Forceswas due primarily to the great need for combatants and to lack of transportfacilities.4 At times there were as many as 1,400 nurses inthe mobilization station in New York, awaiting transportation, severalgroups being thus detained as long as three months.5 By themiddle of April, when the shortage of Medical Department personnel hadbecome so acute that a breakdown in its service was threatened, the shortageof nurses was estimated at 1,121.1 On May 3 a cable was sentasking that 555 be sent immediately.1
On June 30, 1918, nurses serving in Europe, or designated for foreignservice, were distributed as follows:5 British forces, 755;French forces, 14; American forces, 3,323; awaiting transportation or enroute to mobilization station, 1,258; total, 5,350. This number includednurses sent to the American Red Cross Military Hospitals Nos. 1, 2, and3.5
Because of the increase of our combat activities in the ensuing weeks,Medical Department personnel was engaged to such an extent that on July27, 1918, the chief surgeon reported that the resources of the MedicalDepartment were practically exhausted in so far as personnel was concerned,and on August 10 a cable was sent from general headquarters, requestingabsolute priority for medical organizations, including 2,312 nurses.1During that month, 1,000 nurses arrived in France.1
Under date of September 21, the personnel division reported that theshortage of nurses continued to be acute; all hospital units were shortof nurses and demands were being made by camp hospitals for large numbersof them
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because of the epidemic of influenza.6 It was impossible,of course, to furnish all the nurses requisitioned by various organizations.6
When the armistice was signed there was a total of 8,587 nurses on dutyoverseas, the number short of actual needs being approximately 6,925;7the number of patients in hospital under treatment on November 12 totaled193,026, distributed in 153 base hospitals, 66 camp hospitals, and 12 convalescentcamps.8 The number of nurses on duty in the hospital centers,where the largest number of patients were grouped at this time, was asfollows:1 At Mesves hospital center where patients in 10 basehospitals and in the convalescent camp numbered 20,186 on November 16,the center's peak day, there were 394 nurses.1 At Mars hospitalcenter, on November 16, in six hospitals and in the convalescent camps,14,302 patients were cared for by 493 nurses.1 At Allerey, onthe 17th, in 6 hospitals and in the convalescent camp, there were 17,140patients, cared for by 360 nurses, and at Toul on the 28th of November,in 7 hospitals there were 10,963 patients, cared for by 320 nurses.1The maximum number of nurses at certain centers at one time was: Mesves,650 on January 4, 1919; Mars, 642 on December 4, 1918; Toul, 438 on February1, 1919.1
Between November 11, 1918, and January 25, 1919, when the greatest numberof nurses was on duty in the American Expeditionary Forces, nearly 1,500nurses arrived-more than the total number received in 1917.4The greatest number of nurses reached in the American Expeditionary Forceswas recorded in the week ending January 11, 1919, when their number totaled10,081, including approximately 700 on duty with the British.4This total should show as of the first week in December, for there wereno arrivals subsequent to that date.7 At this time the strengthof the American Expeditionary Forces was approximately 1,750,000 men.9With the exception of casual nurses who were separated for various reasons,the first group which left France was that with Base Hospital No. 2, whichsailed early in January, 1919.1 From that time the return ofnurses was gradual, averaging from January through April, 1919, about 200nurses a week.1 During the last week of April over 800 nursessailed.1 No chief nurse was appointed for any of the sectionsof the Services of Supply except base section No. 3.4
One of the important developments of the nursing service in France wasthe appointment of a chief nurse at some of the hospital centers.1This plan, which was not prescribed in orders from higher authority, developedat the several centers independently, in an informal manner in November,1918, and was a natural result of the grouping at each center of severalhospitals under a general command.1 It developed to differentdegrees in the several centers and was apparently of value in every placewhere it was tried, except that in one or two instances the center chiefnurse was unable to secure cooperation.1 The plan was adoptedat the following centers:1 Allerey, Bazoilles, Beau Desert,Mars, Mesves, Nantes, Savenay, Toul, Vichy.
Center chief nurses acted as assistants to the director of nursing service.At Mesves her duties were prescribed as follows:1
1. To assist the commanding officer of the center in suchmatters pertaining to the nurses of the center as he may see fit to assignto her.
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2. To assist in the distribution and readjustment of nurseswithin the center, according to the pressure of work in the various hospitals.
3. To keep informed by frequent visits of the conditionsin the hospitals of the center, as they affect the nursing personnel suchas quarters, the mess, means of recreation, care of sick nurses, etc.
4. To bring to the attention of the director of nursingservice, after consultation with the commanding officer of the center,any matters which seem to need special adjustment.
5. To act as chairman of a committee of chief nurses ofthe center. This committee will make suggestions for regulations governingthe conduct, and social relations of nurses, which shall be, as far aspossible, uniform for the entire center. These suggestions should be presentedto the commanding officers for their approval and indorsement. The objectof this committee will be to promote the welfare of the nurses within thecenter, and to maintain a high standard of service and conduct within theArmy Nurse Corps.
6. To act as hostess of the center. In that capacity shewill meet each new chief nurse arriving at the center and see that thelatter has all information that will assist her in the performance of herduties. She will also, in cooperation with the commanding officers andchief nurses of the center, endeavor to promote a wholesome social lifeamong the nurses.
Similarly, as prescribed by regulations, a chief nurse was designatedfor each hospital where a group of nurses was on duty, whether mobile,evacuation or base, and whether it was part of a center or operating independently.1
Experience showed that the nursing units definitely organized by a headnurse in civil hospitals and colleges, among women who were accustomedto work together were more quickly efficient than were those composed ofcasuals gathered from many sources.1 The latter, with no previousdivision of assignments according to the particular qualifications of eachmember were inevitably handicapped at first by a lack of mutual acquaintanceship.1
RECONSTRUCTION AIDES
The employment of reconstruction aides was an innovation during theWorld War, and it was not until during the armistice that any great useof them was made overseas.
A memorandum published December 31, 1917, by the Surgeon General, coveringthe organization under the division of military orthopedic surgery, andgiving the duties, status, etc., of the "woman's auxiliary medical aides,"was given application in the American Expeditionary Forces. These aideswere engaged in physiotherapy work.10 Their designation waschanged to "reconstruction aides," and some of the provisions for theiremployment were modified by the Surgeon General on January 22, 1918.11
On May 3, 1918, the Surgeon General authorized the chief medical officerof each army or separate auxiliary force12 to appoint head aides,not to exceed two to each hospital, from among the reconstruction aidesserving overseas.
On May 21, 1918, the chief surgeon, A. E. F., initiated a cabled requisitionfor 30 reconstruction aides for service in overseas orthopedic hospitals.13This request received a favorable reply,14 but several monthselapsed before they began to arrive in numbers. This led the senior consultantsto try and secure them through the American Red Cross. On July 13, thedirector of professional services was notified that the senior consultantsof special services should look far enough ahead to prevent the employmentof aides from the Red Cross, thus necessitating that organization cablingto the United States for replacements.15
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Requirements for reconstruction aides who were engaged in occupationaltherapy work, were outlined in a circular published by the Surgeon General,August 8, 1918.16
Early in August a request was cabled that 20 reconstruction aides besent over with each base hospital, half of them to be trained in physiotherapyand half in occupational therapy.17 These aides were to be carriedas civilian employees and not included in the reports and returns of nurses.18Toward the end of that month the senior consultant in orthopedic surgerywas notified that the Surgeon General was organizing reconstruction aidesin groups of 20 members each and that these groups would be sent as fastas possible to the American Expeditionary Forces, as enumerated units,for further reassignment there.19 A reconstruction aide unitarrived at Havre, October 19.20 Certain aides had arrived beforethat date18 but from that time forward their numbers increasedconsiderably. Upon arrival they were assigned to hospitals and hospitalcenters.
The supervisor of reconstruction aides was at first located at Savenay21but in January, 1919, joined the chief surgeon's office at Tours.1All occupational therapy aides for overseas service were versed in simplebedside handicrafts.22
The reconstruction aides were under the direct supervision of the director,nursing service, their function being to carry out instructions in therehabilitation of wounded in methods of physical and occupational therapy.aWhen practicable they were quartered at the hospitals and were entitledto rations, to the laundering of uniforms, to transportation; also theywere entitled to $4 per day when traveling. They were authorized to purchaseQuartermaster Department supplies on written approval of the commandingofficer, but were not entitled to heat and light.23 The reconstructionaides had the same pay as nurses, and increase of pay was applied to themas well.24
On December 29, 1918, there were 200 reconstruction aides serving inthe American Expeditionary Forces, distributed among 20 base hospitals.25By March 15, 1919, this number had been reduced to 93, of whom 71 wereengaged in physical therapy and 22 in occupational therapy.26These aides were then attached to 10 hospitals distributed among 6 hospitalcenters.26 On May 1, 1919, there were 109 aides in the Servicesof Supply (55 occupational, 54 physiotherapy) distributed among 14 hospitals.Thirty other reconstruction aides were at that time on duty with the ThirdArmy in Germany.27
On June 18, 1919, the chief surgeon, Third Army, was notified that reconstructionaides were not now considered civilian employees and that they were tobe returned to the United States before June 30.28
aSee Circular No. 56, chief surgeon's office, Nov. 19, 1918, quoted in the appendix.
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PERSONNELa
(July 28, 1917, to July 15, 1919)
ARMY NURSE CORPS
Bessie S. Bell, chief nurse, A. N. C.
Julia C. Stimson, director, nursing service.
Nina E. Shelton, assistant director, nursing service.
Blanche S. Roulon, chief nurse.
Arma E. Coffee, assistant chief nurse.
Marion G. Parsons, nurse.
SUPERVISOR, RECONSTRUCTION AIDES
Marguerite Sanderson
REFERENCES
(1) Report from Julia C. Stimson, Res. A. N. C., directorof nursing service, A. E. F., to the Surgeon General, U. S. A., May 31,1919. Subject: Nursing activities, A. E. F., on the Western Front, fromMay 8, 1917, to May 31, 1919. On file, Historical Division, S. G. O.
(2) Memorandum from the chief surgeon, A. E. F., to thechief of staff, A. E. F., July 28, 1917. Subject: Weekly war diary. Onfile, Historical Division, S. G. O.
(3) Cable No. 197, par. 3, from Gen. John J. Pershing,to The Adjutant General, October 2, 1917.
(4) Report from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. Army, May 1, 1919. Subject: Activities of the chief surgeon'soffice to May 1, 1919. On file, Historical Division, S. G. O.
(5) Annual Report of the Surgeon General, U. S. Army,1918, 429.
(6) Weekly war diary, chief surgeon's office, A. E. F.,September 21, 1918.
(7) Report from the chief surgeon, A. E. F., to the commandinggeneral, A. E. F., April 17, 1919. Subject: The Medical Department, A.E. F., to November 11, 1918. On file, Historical Division, S. G. O.
(8) Final report of Gen. John J. Pershing, September 1,1919, 77.
(9) Report of "Strength of the A. E. F. by monthsas shown by the consolidated returns for the A. E. F.," January 12, 1924.On file, A. G. O., Returns Section, Miscellaneous Division.
(10) "Circular of information concerning the woman's auxiliarymedical aides," the Surgeon General's Office, December 31, 1917. On file,Historical Division, S. G. O.
(11) "Circular of information concerning the employmentof reconstruction aides, Medical Department, U. S. Army," the Surgeon General'sOffice, January 22, 1918. On file, Historical Division, S. G. O.
(12) Memorandum from the Surgeon General of the Army tothe Supply Division, S. G. O., May 3, 1918. Subject: Approval of letterof appointment for reconstruction aides. On file, Historical Division,S. G. O.
(13) Cable No. 1153-S, subpar. A, from General Pershingto The Adjutant General of the Army, May 21, 1918.
(14) Cable No. 1434-R, par. 4, from The Adjutant Generalof the Army, June 3, 1918, to General Pershing. On file, A. G. O., WorldWar Division, chief surgeon's files, (231.238).
aIn this list have been included the names of those who at one time or another were assigned to the division during the period July 28, 1917, to July 15, 1919.
There are two primary groups-the heads of the division or the section and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
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(15) Third indorsement from the chief surgeon, A. E. F.,to director of professional services, A. E. F., July 13, 1918; on letterfrom the senior consultant, orthopedic surgery, A. E. F., to the chiefsurgeon, A. E. F., July 11, 1918. Subject: Reconstruction aides. On file,A. G. O., World War Division, chief surgeon's files (231.238).
(16) Circular, "Reconstruction aides in occupational therapy,"Office of the Surgeon General, August 8, 1918. On file, Historical Division,S. G. O.
(17) Cable No. 1546-S, par. 9, from General Pershing toThe Adjutant General of the Army, August 2, 1918.
(18) First indorsement from the chief surgeon, A. E. F.,to the commanding officer of Base Hospital No. 9, August 6, 1918; on letterfrom the commanding officer, Base Hospital No. 9, A. E. F., to the chiefsurgeon, A. E. F., August 2, 1918. Subject: Reconstruction aides. On file,A. G. O., World War Division, chief surgeon's files (231.238).
(19) Letter from the chief surgeon, A. E. F., to seniorconsultant in orthopedics, August 28, 1918. Subject: Reconstruction aides.On file, A. G. O., World War Division, chief surgeon's files (231.238).
(20) Telegram from senior consultant in orthopedic surgery,A. E. F., to the chief surgeon, A. E. F., October 15, 1918. On file, A.G. O., World War Division, chief surgeon's files (231.238).
(21) Memorandum from the commanding general, A. E. F.,to the chief surgeon, A. E. F., November 4, 1918. Subject: Contract andoath of office taken by reconstruction aides. On file, A. G. O., WorldWar Division, chief surgeon's files (231.238).
(22) Cable No. 267-R, par. 3, from The Adjutant Generalof the Army, to General Pershing, November 14, 1918. On file, A. G. O.,World War Division, chief surgeon's files (231.238).
(23) Second indorsement, from the chief surgeon's officeto the commanding officer, Base Hospital No. 94, U. S. A. P. O., 713-A,France, January 30, 1919; on letter from the personnel officer, Base HospitalNo. 94, to the chief surgeon, A. E. F., January 30, 1919. Subject: Payof reconstruction aides. On file, A. G. O., World War Division, chief surgeon'sfiles (231.238).
(24) Telegram from the chief surgeon, A. E. F., to thechief surgeon of the advance section, A. E. F., December 21, 1918. On file,A. G. O., World War Division, chief surgeon's files (248).
(25) Report from Marguerite Sanderson, supervisor of reconstructionaides, A. E. F., to the chief surgeon, A. E. F., December 29, 1918. Onfile, Historical Division, S. G. O.
(26) Report from Marguerite Sanderson, supervisor of reconstructionaides, A. E. F., to the chief surgeon, A. E. F., March 15, 1919. On file,Historical Division, S. G. O.
(27) Report from Marguerite Sanderson, supervisor of reconstructionaides, A. E. F., to the chief surgeon, A. E. F., May 1, 1919. On file,Historical Division, S. G. O.
(28) Telegram from the chief surgeon, A. E. F., to thechief surgeon of the Third Army, June 18, 1919. On file, A. G. O., WorldWar Division, chief surgeon's files (230.366).
