CHAPTER II
AMERICAN NURSES WITH THE BRITISH EXPEDITIONARY FORCE, FRANCE
PLAN FOR SUPPLYING PERSONNEL
In April, 1917, after the arrival of the British mission in Washington, the needs of the British Army, in so far as medical assistance was concerned, were made known to us.1 For service with the British Expeditionary Force in France the British mission asked the United States for medical personnel, including doctors, nurses, and enlisted men, together with the equipment and supplies for a certain number of hospitals.' Accordingly, the War Department called upon the American Red Cross to mobilize six base hospitals for immediate shipment to France to serve with the British Expeditionary Force there.2 These constituted the first organized forces of the United States to be sent to France, and they sailed between May 8 and 24, 1917.3
In accordance with the plan of the British mission, 200 medical officers and 200 nurses were to be dispatched, in addition to the six base hospitals, for service with the British Army during each of the months of June, July, and August, 1917.1 It was stipulated in the plan referred to that at least half of this personnel should be regarded as lent to the British Army only until the arrival in Europe of combat troops from the United States, at which time the American Army should be assured of the services of a minimum of 300 of our medical officers and 300 nurses who, meanwhile, had become familiarized with the local conditions in the war area.1
THE FIRST SIX UNITS
Within six months after the United States had entered the war, approximately 1,100 nurses had sailed overseas, about half of whom were stationed in six British general hospitals.4 The first base hospital units to sail took over British general hospitals as follows, shortly after their arrival in France:3 Base Hospital No. 4 (Lakeside Hospital Unit, Cleveland, Ohio) sailed May 7, 1917, reported for duty May 25, 1917, and took over No. 9 British General Hospital, Rouen; Base Hospital No. 5 (Harvard University unit, Boston, Mass.), sailed May 11, 1917, reported for duty May 30, 1917, and took over No. 11 British General Hospital and later No. 13 British General Hospital, Bologne; Base Hospital No. 2 (Presbyterian Hospital unit, New York, N. Y.), sailed May 12, 1917, reported for duty June 2, 1917, and took over No. 1 British General Hospital, Etretat; Base Hospital No. 21 (Washington University Medical School unit, St. Louis, Mo.), sailed May 19, 1917, reported for duty June 10, 1917, and took over No. 12 British General Hospital, Rouen; Base Hospital No. 10 (Pennsylvania Hospital unit, Philadelphia, Pa.), sailed May 19, 1917, reported for duty June 12, 1917, and took over No. 16 British General Hospital, Le Treport; Base Hospital No. 12 (Northwestern University Medical School unit, Chicago, Ill.), sailed May 24, 1917, reported for duty June 11, 1917, and took over No. 18 British General Hospital, Dannes-Cammiers.
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NURSING CONDITIONS IN FRANCE, WITH THE BRITISH EXPEDITIONARY FORCES
The hospitals taken over by the American units had been functioning actively for three years, and from the beginning of that period had seldom less than 900 or 1,000 patients, and very frequently more than that number in each.The British authorities made arrangements for each of the units to be met and conducted to the hospital which it was to take over. The British matron and a few of the nursing staff (assistant matron, home sister, night sister, etc.) remained for a certain length of time to assist the American staff in becoming acquainted with the ways of British hospitals. The British nursing staffs, members of Queen Alexandra's Imperial Military Nursing Service, were withdrawn from the hospitals almost as soon as the American nurses arrived, and as the American units contained considerably fewer nurses than had the British staffs it became necessary for them to secure additional nurses from some source until more could arrive from the United States. A statement of the nursing requirements of each unit was submitted, and as a result their numbers were supplemented by members of the voluntary aid detachment, which was made up of British volunteer aides-young women, many of whom had had considerable experience in one or more phases of nursing activity. In a number of cases members of the voluntary aid detachment were allowed to remain to serve with the American nurses, because without them there would have been inadequate staffs for the hospitals, but upon the arrival of supplementary units of American nurses six months later, these "V. A. D.'s," as they were called, were withdrawn and distributed by the matron in chief to other British units which were manned exclusively by British personnel.5
MATRON IN CHIEF AND PRINCIPAL MATRONS
The matron in chief of the British Expeditionary Force in France kept herself in close telephonic communication with all the British hospitals and the headquarters of the different armies there.6 In each active area was a principal matron who represented the matron in chief in handling all nursing affairs in that area. Frequently these principal matrons served in the capacity of matron or chief nurse of a hospital as well as a principal matron of the area. Chief nurses of the American Army served as matrons of their respective hospitals when the British nurses were withdrawn. Questions of leave, transfer, sickness or discipline were referred by the matron to the principal matron, and she either took action or, when necessary, passed the questions on to the matron in chief.6
INSPECTION TRIPS, BRITISH MATRON IN CHIEF
Very often the matron in chief made unexpected inspections, at which times the matrons and commanding officers were interviewed, both separately and together. By detailed questions concerning all phases of the nursing situation, the matron in chief kept herself informed of the actual conditions and also kept the nurses assured of the interest of British headquarters in their welfare.6 While making inspections, she made especial effort to talk with every nurse she met, and thereby to discern the attitude of individual members of the staffs.6 On almost all of her visits she was accompanied by a secretary, who took notes of every conversation.
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DISTRIBUTION AND DUTIES OF AMERICAN NURSES
Supplementary to the nurses on duty with the six base hospitals, in February, 1918, a group of 99 nurses, designated Casual Group A, arrived in France, and they were distributed among British general hospitals in the Rouen area. 5 A second group, Casual Group B, composed of 87 nurses, reported in France in July, 1918, and these nurses were distributed in different areas, according to the requirements.5 Shortly afterwards mobile units of 20 nurses each were organized from several of the original base hospital groups, and it became necessary to replace the personnel withdrawn from the base hospitals with members of the casual groups which were then serving in British hospitals.
Operating teams were sent to casualty clearing stations near the front lines, and each team was composed of two medical officers, a nurse, two orderlies, and an officers' batman.7 Only the most competent and dependable nurses were detailed to duty with teams, or with the mobile units which served in the forward areas at British casualty clearing stations.6 From time to time selected groups of nurses were drilled in the wearing and use of gas masks, and when an order was received for nurses to go on a surgical team, nurses with such experience were chosen. Sometimes they would remain away on a surgical team only a few days, and sometimes several weeks. Duty at casualty clearing stations was performed in the midst of air raids for many hours at a time, but despite the danger connected with such service, only three members of the Army Nurse Corps were wounded by enemy action.6
The American nurses who served in casualty clearing stations on surgical teams had most worth while and interesting experiences. In no case did any of them endure such hardships as were undergone by English sisters, many of whom served for months at the front, frequently under fire, and often retreating or advancing, as the German lines pushed forward or withdrew. There were, however, a few American nurses who experienced the condition of real warfare for short periods; a few were with casualty clearing hospitals which were obliged to retreat.
BRITISH ORGANIZATION AND METHODS
?PAPER WORK"
The American nurses adapted themselves very quickly to the British methods, although at first there was inevitable confusion in regard to certain details, most of which, after a short time, became adjusted and facilitated by patience and courtesy on both the British and American sides.6 Chief nurses who served with the British Expeditionary Force in France found it necessary to accustom themselves to British "paper work," which was strange to them, and they had also the question of foreign currency to deal with. The salaries of the American nurses were paid by the American Army and could easily be figured in dollars and cents. The agreement with the British Army, however, was that the nurses' maintenance allowance should be paid by British.5 The mess allowance for each nurse was 25 shillings a month, the laundry allowance 6 shillings a week, and the field allowance still another amount; and since it was necessary to prepare the pay roll each month for all of these sums for 100 women, with proper deductions for days in sick sisters' hostels or hospitals,
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or on leave, it can readily be seen that these chief nurses were obliged to become very proficient in English currency. Since these nurses were in France, their pay checks were made out in francs, which did not add to the simplicity of the accounting system.
COURSE IN ANESTHESIA
A number of American nurses stationed with the British Expeditionary Force were given the opportunity to take a special course in anesthesia. At Rouen, where the Cleveland (Ohio) unit (Base Hospital No. 4) was stationed, there were especially good facilities for giving such a course.5
LIVING CONDITIONS
QUARTERS
The quarters occupied by the nurses with the British Expeditionary Force in France were long, single-storied huts, divided by partitions into small compartments or cubicles, each of which had an electric light.6 Heat was furnished by oil or coal stoves. The British Army provided its own nurses with camp kits, each of which contained a portable camp bedstead with bag, a pillow, a water-proof sheet, a tripod washstand with canvas basin, bath, and bag, a folding chair, a waterproof bucket, and a kit bag to hold all of these articles.6 With such equipment a British nurse was able to occupy otherwise unfurnished quarters and be reasonably comfortable. The first American nurses to arrive in France with the United States Arny had no such equipment, and when the British nurses were withdrawn from the hospitals the American nurses faced quarters which had no furniture.6 The London chapter of the American Red Cross immediately came to the rescue and furnished the necessary articles until the United States Army took steps to remedy the condition.6 For a time camp kits were supplied, but in June, 1918, the question again arose when the director of the Red Cross bureau of nursing in Paris wrote to the director of the department of nursing, American Red Cross, in Washington, stating that many of the nurses who had been sent over had been given this equipment, but that the order authorizing such action had been countermanded. 8 Upon inquiry, the superintendent of the Army Nurse Corps learned that the Medical Department of the Army was prepared to furnish the articles included in the "camp kits," and she accordingly made request on July 22, 1918, that 100 sets of the desired articles be sent to the medical supply depot in England for issue to American nurses who were detailed for duty with the British forces, and that when such supply was exhausted a further supply be obtained. 9
FOOD
The food was sufficient, though it seemed odd to breakfast on tea, bread, and cold ham; but gradually the chief nurses learned how to adjust the menus and, by collecting from each nurse a little extra money (in francs) for the mess fund, to provide the articles to which the nurses had been accustomed.10 The American nurses failed to appreciate the recurrence of custard and canned fruit for dessert, and the presence of the volunteer aid detachments, who were satisfied with the British food, did not make the problem of food any easier. It should be added that there was never any lack of jam or preserves, and that on the whole the food was palatable and nourishing.
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LAUNDRY
Laundry presented the greatest problem. With most of the hospitals under tents, it was impossible to keep white uniforms in wearable condition.6 Laundries adjacent to the hospitals sometimes attended to the hospital laundry, but personal laundry and nurses' uniforms were not often so included. French peasants in the vicinity could be employed to wash, but their work was not entirely satisfactory; in some cases the laundry was done in convents.6 No starch was available; and, as winter advanced, the water supply, already scarce, became scarcer. Partial solutions to the problem of the uniform were found in the authorization of the gray indoor uniform and the so-called "butcher's apron." 6
FIG. 5.-"Butcher's apron" to protect the uniform
RECREATION
Forms of recreation were few. The habit of making tea a regular function was in many ways desirable. It furnished opportunities for a few minutes' rest and relaxation which undoubtedly added greatly to the powers of endurance of the nurses during the long periods of very hard work. Concert parties were one source of interest and amusement, and in a very short time the Americans developed baseball teams and improvised tennis courts; but long walks and picnics were the usual form of recreation. The question of dances was a very serious one with the units attached to the British hospitals, because British sisters a were not allowed to have them.6 The Americans, however, found that
a The British nurses are all called “sisters." Sisters are in charge of wards; nurses are less experienced.
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this was one of the most desirable forms of social affairs for both nurses and officers, and wherever it was possible to hold a dance without offense to the British or the French this proved an excellent diversion.6
CARE OF SICK NURSES
According to British regulations, when a nurse became ill in a British Expeditionary Force hospital she was allowed to remain in quarters no longer than 24 hours.6 At the end of that time, if she had not improved, she was transferred to a sick sisters' hostel or hospital, an institution maintained for the care of sick women in many British Army areas. These hostels had their own staffs of medical men and sisters. Every possible comfort and attention was given the sick, and as they were always situated and beautiful surroundings conditions were most conducive to rest and recovery.6
LEAVES OF ABSENCE
British sisters were granted leaves of absence at regular intervals, and while on leave were permitted to go only to specified places, which were designated as leave areas, where traveling and hotel accommodations for these were arranged for.6 This system differed from the American system, which permitted nurses to go on their leaves almost wherever they chose to go, although many times they were forced to travel without the proper facilities and to run the risk of not being able to secure hotel accommodations.6 The British system had been worked out after many months of experience and seemed to offer a solution to many of the problems incident to the presence of unchaperoned women in areas which were filled with thousands of soldiers and officers convalescent or on leave. Moreover, by having special leave areas it was possible to arrange for special trains for sisters on leave and to secure every comfort for them in especially designated hotels or pensions.6
CASUALTIES
On the night of August 17, 1917, during a German air raid, a member of the Army Nurse Corps attached to Base Hospital No. 2, on duty at Casualty Clearing Station No. 61, was struck by a piece of shrapnel, thus necessitating the removal of one eye.6 A second nurse during the night of September 4, 1917, while serving with Base Hospital No. 5, received a shrapnel wound in the face, but it was so slight that she did not have to be relieved from duty.6 The third nurse, who was attached to Base Hospital No. 10, had been sent with a team to a casualty clearing station, which the Germans bombed. When this occurred,the group retreated to Amiens, near where they had been located, but the raids were in progress here as well. The nurse referred to was wounded in the leg by shrapnel in March, 1918, and did not return to duty until the latter part of July, 1918.6
DEATHS
Up to the time of the signing of the armistice four members of the Army Nurse Corps who were attached to the first six units that proceeded to France died while in the service, in addition to the two members of Base Hospital No.12, who died as the result of an accident on the S. S. Mongolia.6 b
b See Chapter 1, p. 310.
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REFERENCES
(1) Memorandum from T. H. Goodwin, Colonel, Army Medical Service, April 30, 1917. On file, Record Room, S. G. O., 172158 (T. H. Goodwin).
(2) Annual Report of the Surgeon General, United States Army, 1918, 265.
(3) Histories of base hospitals concerned. On file, Historical Division, S. G. O.
(4) History of American Red Cross Nursing. The Macmillan Co., 1922, p. 442.
(5) Report on work in France of the United States Army Nurse Corps. Appendix (i), prepared July 12, 1919, by Dame E. Maud McCarthy, matron in chief, British troops in France and Flanders. On file, Army Nurse Corps Section, Personnel Division, S. G. O.
(6) History of Nursing activities, American Expeditionary Force, on the Western Front during war period May 8, 1917, to May 31, 1919. By Julia C. Stimson, director, nursing service, A. E. F. On file, Army Nurse Corps Section, Personnel Division, S. G. O.
(7) Article "A Trip to the Casualty Clearing Station, March 21-26, 1918." By Saidee N. Hausmann, former reserve nurse, Army Nurse Corps. On file, Army Nurse Corps Section, Personnel Division, S. G. O.
(8) Letter from Jane A. Delano, director, department of nursing, American Red Cross, to Dora E. Thompson, superintendent, Army Nurse Corps, June 26, 1918. On file, Record Room, S. G. O., 426.1 (A. E. F.) (Y).
(9) Second indorsement from Dora E. Thompson to Col. C. R. Darnall, finance and supply division, S. G. O., July 22, 1918. On file, Record Room, S. G. O., 426.1-1 (A. E. F.) (Y).
(10) Julia C. Stimson: Finding Themselves. The Macmillan Co., 1919, p. 57.
