CHAPTER IV
The Army Nurse Corps1
Before World War II, training programs for Army nurses were few andwere designed only to prepare nurses for clinical or functional assignmentsand not to provide military training. Indeed, between 1920, when they weregranted relative rank as officers, and July 1944, when they received fullcommissions, nurses enjoyed only quasi-military status.2 Evenmembership in the Army's Reserve components, authorized for all other MedicalDepartment corps, was denied them.3 Reasons offered for thispeculiar arrangement in 1935 help to explain not only the absence of aReserve corps for nurses, but also the quasi-military status of nursesand their lack of military training:
The creation of a formalNurse Reserve Corps analogous to the Officers Reserve Corps would be difficultto defend * * *. The duties of a nurse in a militaryhospital do not differ in any important particular from the duties * * * in civil hospitals. Preliminary military training is notessential therefore and active duty training periods * * *, similar to those held for reserve officers, are not required.Marriage would terminate eligibility in too many instances and inject analmost prohibitive obstacle to the maintenance of such a corps. The WarDepartment in lieu of a Nurse Reserve Corps relies almost entirely uponthe American National Red Cross Nursing Service for the supply of qualifiednurses during an emergency. This is eminently proper as the Red Cross recognizesthis responsibility as one of its charter obligations and has the nationalset-up for such a mission.4
Even more to the point was a remark made by The Surgeon General, Maj.Gen. James C. Magee, to members of the National Medical Association inMarch 1941, in attempting to quiet their fears that military recruitingwould strip the Nation of public health nurses: "After all there are500,000 nurses in America and we are only asking for 1 to 1 1/2 percent."Before the war, planners considered nurses so plentiful that military requirementscould be met without special programs or incentives.
PREWAR PROGRAMS
As a result of these attitudes, there were few opportunities for eitherbasic or advanced training during the interwar years. Peacetime appointmentsto the Army Nurse Corps were made a few at a time, and nurses receivedonly an informal orientation to the Army at their first station. A fewArmy hospitals provided lim-
1Unless otherwise indicated, this chapter isbased on a study entitled "History of the Army Nurse Corps,"by Lt. Col. Hortense E. McKay, USA (Ret.). [Official record.]
2(1) 41 Stat. 767. (2) 58 Stat. 324.
3Medical Department, United States Army. Personnel in WorldWar II. Washington: U.S. Government Printing Office, 1963.
4Rogers, J. A.: Reserve Nurses. Army M. Bull. No. 32, July 1935.
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ited programs in anesthesia and other clinical skills. Most of thistraining was tutorial, on-the-job training comparable to that providedfor enlisted specialists, and designed to meet the requirements of a specifichospital. Early in 1933, The Surgeon General required six general hospitalsto conduct a course in "Medical Department Administration" fornurses with less than 3 years' service, and by the end of June, 236, abouta third of the corps, had completed the program of 18 lectures.5This appears to have been a "one-time-only" program for thereis no evidence that the series was ever repeated. Finally, funds availableunder the 2-percent clause of the National Defense Act, as amended in 1920,were used to train Army nurses at civilian institutions. Until 1933, thesefunds were used primarily to train instructors for the Army School of Nursing.After the school was suspended, the funds were used to train nurse-anesthetists.6
Interwar programs left the Medical Department with fewer training precedentsthan it had for enlisted men, or even MAC (Medical Administrative Corps)officers. As the Army Nurse Corps grew from 672 on 30 June 1939 to 55,590at the end of August 1945, the need for training became increasingly obvious,and wartime training methods evolved gradually through trial and error.7
BASIC MILITARY TRAINING
Traditional Orientation
In contrast to the 9 months of postgraduate training provided for MedicalCorps officers before the war, Army nurses received little training toprepare them for wartime nursing. The peacetime orientation of an Armynurse began with assignment to a station in the continental United States"to afford her an opportunity to become acquainted with military customs."Much of this initial orientation was spent in personal processing: obtaininguniforms, initiating records, and becoming acquainted with the militarypost, Army hospitals, and nurses' quarters. Instructing new nurses in regulationsgoverning the Army Nurse Corps in "duties peculiar to Army work"was the responsibility of the chief nurse.8
Before World War II, the traditional techniques of orientation werereasonably effective. Their most serious defect was the complete absenceof training for operation under field and combat conditions. Under thestress of expansion between 1939 and 1941, with newly recruited nursesarriving at stations almost daily, informal and tutorial methods becameincreasingly unsatisfactory. Chief nurses were heavily taxed by the responsibilityfor supervising nurses in varying stages of orientation. Individual nursescould not be assured of balanced and progressive basic training to preparethem for unit training.
5(1) Annual Report of The Surgeon General,U.S. Army. Washington: U.S. Government Printing Office, 1933. (2) AdultEducation in the Army Nurse Corps. Am. J. Nursing 34: 725, July 1934.
6(1) Annual Report of The Surgeon General, U.S. Army. Washington:U.S. Government Printing Office, 1940. (2) Annual Report of The SurgeonGeneral, U.S. Army, Washington: U.S. Government Printing Office, 1939.(3) Annual Report of The Surgeon General, U.S. Army. Washington: U.S. GovernmentPrinting Office, 1937. (4) Annual Report of The Surgeon General, U.S. Army.Washington: U.S. Government Printing Office, 1936.
7See footnote 3, p. 127.
8Army Regulations No. 40-20, 31 Dec. 1934.
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After entry of the United States into the war, the system suffered acomplete breakdown. The Medical Department had planned to use affiliatedunits to support combat units. After Pearl Harbor, the Medical Departmentfound itself unable to mobilize and equip them in time to accompany combatforces being shipped overseas. The problem was further complicated by theneed of task forces for station hospitals, an organization which had nocounterpart among affiliated units. As a result, established hospital trainingunits had to be shipped to the theater, and with them, many of the Army'smost experienced nurses.
During 1942, numbered hospitals were usually activated at military postswhere there was a large station hospital or general hospital at which theunit's officers and men could engage in parallel training. Under this system,members of the unit participated in a mixture of formal training and job-understudydesigned to prepare them for their positions when the unit went into operation.9If present during this phase, the unit's nurses were usually assigned toserve in the post hospital, and they received military training only atthe hospital commander's discretion.
As an increasing number of nurses entered the Army, there was even lessopportunity to fit them into an organization. Hospitals were too pressedto provide leisurely orientations, and many experienced nurses were beingpromoted and transferred. Many chief nurses had been recruited only recentlyfrom comparable civilian positions and had little more experience in militaryprocedures than did their trainees. In short, the prewar pattern of on-the-jobtraining proved as unwieldy for mobilizing the Army Nurse Corps as it hadfor other components of the Medical Department.
Program Guides
Despite these problems, a formal guide for training Army nurses wasnot issued by the Office of The Surgeon General until late 1942. Numberedhospitals training in the United States had guidelines for officers andenlisted men but none for nurses. In September 1942, the Training and NursingDivisions of the Office of The Surgeon General recognized that hospitalsdestined for theater assignment required guidance in training nurses. Aprogram was published in October that provided 4 weeks of instruction,including 16 hours of duty assignment in a 44-hour week for nurses in theater-of-operationsunits. Required instruction included military courtesy and customs; uniformregulations; dismounted drill; physical training defense against chemical,mechanized, and air attacks; Army and Medical Department organization;military administration; first aid, field sanitation, and communicabledisease control; ward management; and routine hospital procedures.10
The limitations of this program soon became apparent. Nurses were frequentlyon duty in active hospitals while the rest of their unit was in training,unable to join them in time to participate in unit training, or to be trainedaccording to the
9Smith, Clarence McKittrick: The Medical Department:Hospitalization and Evacuation, Zone of Interior. United States Army inWorld War II. The Technical Services. Washington: U.S. Government PrintingOffice, 1956.
10 Mobilization Training Program No. 8-10, 29 July 1942.
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program. The number of those who actually received military trainingbefore their unit was shipped to the theater was further reduced when nursesassigned to a unit were withdrawn because of physical disqualificationfor overseas service or other reasons.
To reduce these problems, the Nursing Division recommended in January1943 that Army nurses under 50 years of age be trained while assigned toZone of Interior hospitals.11 This recommendation was approvedby ASF (Army Service Forces) on 30 May 1943, and commanding officers ofall hospitals of 250-bed or greater capacity in the Zone of Interior weredirected to provide training under MTP (Mobilization Training Program)No. 8-10 to all members of the Army Nurse Corps under 50 years of age.12The guide published for this program late in June reduced the age for suchtraining to 45 and prescribed a list of topics that were nearly identicalto those required under the earlier program.13 Two months later,this ASF directive was superseded by a War Department directive which extendedthe program to all hospitals, regardless of capacity, and added the "basic"to the title.14
Even with these changes, the program proved inadequate. Despite determinedefforts, patient care continued to take precedence over training. Nursesreported to hospitals almost daily, making it difficult to fit them intothe program. Training at hospitals with a capacity of less than 250 bedswas still permissive, difficult to administer, and frequently intermittent.Finally, it became obvious that a new approach to basic training was requiredif nurses were to function effectively within the Medical Department. Inthe last half of 1943, the Training Division, Office of The Surgeon General,recognized the advantages of providing basic training for Army nurses beforethey were assigned to units with a responsibility for patient care. Aftera proposal submitted to Army Service Forces in August for the establishmentof a single basic training center for nurses was disapproved, the MedicalDepartment tried another tack that ultimately proved fruitful.15
Basic Training Centers
Following the rejection of its request to establish a centralized basictraining center, the Office of The Surgeon General countered with a proposalto establish centers within the service commands under a standardized programof instruction. In late July, Maj. Gen. Brehon B. Somervell, CommandingGeneral, Army Service Forces, authorized the establishment of a basic trainingcenter in each service command, and on 16 October, a formal syllabus waspublished. The earlier, local train-
11Memorandum, Col. Florence A. Blanchfield,ANC, for Col. F. B. Wakeman, MC, Chief of Training Division, Surgeon General'sOffice, 14 Jan. 1943, subject: Army Nurse Corps.
12Memorandum, Col. R. T. Beurket, GSC, Executive Officer, TrainingDivision, Army Service Forces, for The Surgeon General, 30 May 1943, subject:Basic Military Training for Army Nurse Corps.
13Army Service Forces Memorandum No. S350-32-43, 23 June 1943,subject: Training of Army Nurses.
14War Department Memorandum No. W350-233-43, 23 Aug. 1943, subject:Basic Training of Army Nurses.
15(1) Memorandum, Col. R. W. Bliss, MC, Chief, Operations Service,Office of The Surgeon General, for Commanding General, Army Service Forces,2 Aug. 1943, subject: Course of Basic Military Training for Nurses. (2)Memorandum, Col. R. T. Beurket, GSC, Executive Officer, Military TrainingDivision, Army Service Forces, for The Surgeon General, 8 Oct. 1943, subject:Course of Basic Military Training for Nurses.
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TABLE 9.-Basic trainingcenters for Army nurses
Service command | Installation and location | First class enrolled | Last class completed | Total graduates |
First | Fort Devens, Mass | 19 July 1943 | 22 Sept. 1945 | 3,663 |
Second | Halloran General Hospital, N.Y. | 19 July 1943 | 15 Jan. 1944 | 545 |
England General Hospital, N.J. | 5 Dec. 1943 | 30 Jan. 1945 | 1,440 | |
Tilton General Hospital, N.J. | 1 Feb. 1945 | 11 Aug. 1945 | 2,011 | |
Third | Fort George G. Meade, Md | 6 Sept. 1943 | 14 Apr. 1945 | 2,317 |
Camp Lee, Va | 1 Mar. 1945 | 4 Sept. 1945 | 1,252 | |
Fourth | Camp Rucker, Ala | 10 Oct. 1943 | 13 Aug. 1945 | 2,080 |
Fifth | Billings General Hospital, Ind | 1 Sept. 1943 | 1 July 1945 | 1,494 |
Fort Knox, Ky | 8 Feb. 1945 | 28 Aug. 1945 | 829 | |
Sixth | Camp McCoy, Wis | 19 July 1943 | 25 Aug. 1945 | 4,120 |
Seventh | Camp Carson, Colo | 22 Nov. 1943 | 25 Aug. 1945 | 2,538 |
Eighth | Brook General Hospital, Fort Sam Houston, Tex. | 19 July 1943 | 23 May 1945 | 1,391 |
Camp Swift, Tex | 15 Mar. 1945 | 4 Aug. 1945 | 861 | |
Ninth | Madigan General Hospital, Fort Lewis, Wash. | 29 Nov. 1943 | 31 Aug. 1945 | 2,739 |
Fort Huachuca, Ariz. (Negro personnel). | 10 July 1944 | 23 Sept. 1944 | 50 | |
Total | 27,330 |
Source: Completed AG ASF Forms R-5218, dated 8 Nov. 1945. In Report-Flow of Trainees Thru Nurses Basic Training Centers.
ing program was retained for nurses with more than 60 days' servicewho had not completed training under previous programs, but all newly inductednurses were required to participate in basic training.16
Most service commands responded enthusiastically to the establishmentof basic training centers for Army nurses. Indeed, several service commandshad already taken the initiative in establishing such centers as shownin table 9. Early basic training centers were established at hospitals,where the chief nurse had a dual assignment as school commandant and hospitalchief nurse. They had the advantage of a close working relationship withthe hospital but the disadvantage of placing dual, and sometimes conflicting,responsibilities on those charged with the program. Conditions at thesepioneer centers were far from ideal. Later centers were established asseparate organizations to increase the efficiency of the program in processing,outfitting, and training newly recruited nurses.
Army nurses assigned to small AAF (Army Air Forces) hospitals directlyfrom civilian life were provided training when 11 AAF nurse training detachmentswere organized in November 1943. This type of training continued until1944 when nurses
16(1) Memorandum, Lt. Col. Florence A, Blanchfield,Acting Superintendent, Army Nurse Corps, for Col. Francis C. Tyng, MC,Chief, Finance and Supply Division, Office of The Surgeon General, 26 May1943, subject: Army Nurse Corps. (2) Letter, Maj. Gen. Norman T. Kirk,The Surgeon General, to Commanding General, Each Service Command, 30 July1943, subject: Training Centers, Army Nurse Corps. (3) See footnote 15(1), p. 130. (4) Letter, The Adjutant General to Commanding Generals, Firstto Ninth Service Commands, 16 Oct. 1943, subject: Course of Basic MilitaryTraining for Nurses.
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were no longer recruited directly by the Army Air Forces.17A basic training program for Negro nurses was established at Fort Huachuca,Ariz., but was in operation less than 3 months. After training for womenat Fort Huachuca was suspended, most Negro nurses were sent to Camp McCoy,Wis., for training.18
Program of Instruction
The initial program of instruction prescribed for Army nurses encompasseda period of 144 training hours, including basic military training, administration,organization, military sanitation, and ward and clinic nursing. The largestsingle block of hours was devoted to such basic military subjects as militarycourtesy, care of clothing and equipment, dismounted drill, and physicaltraining (fig. 12). A week was allowed for processing incoming students.With the passage of time, course content was adjusted to provide nurseswith a broader and more balanced program. Hours devoted to Army and MedicalDepartment organization and to the duties of the Army nurse were expanded.In response to reports from the field, increased emphasis was placed onfield training, map reading, tent pitching, efficiency reports, and obstacleand infiltration courses (fig. 13). In April 1945, instruction in malariacontrol and tropical diseases was added to prepare nurses for duty in thePacific theater. Hours devoted to hospital ward duty were gradually decreasedto provide for the inclusion of these subjects. Other changes in the conductof training included an increase in the time devoted to outdoor trainingfrom 19 percent to approximately 35 percent by June 1944 and an increaseduse of "applicatory" training and training aids to provide morerealism.19 Training aids were usually locally fabricated andassembled, and their quantity, quality, and use by instructors improvedas time passed.
Facilities and Techniques
After October 1943, when training centers were established on an Armywidebasis, the basic training program for nurses was better organized. Overheadpersonnel were authorized for administration and instruction, and tablesof allowances were established for supplies and equipment. At first, classroomsat some centers consisted of converted hospital wards with space for 15to 35 trainees. The program grew to larger proportions late in 1944, whenas many as 750 trainees were present at one time, and plans were in processto train as many as 2,000 each month at
17(1) Annual Report of Personnel Division,Air Surgeon's Office, fiscal year 1944. (2) Medical History of Second AirForce, 1944. [Official record. U.S. Air Force, Research Studies Institute,Maxwell Air Force Base, Ala.] (3) Link, Mae Mills, and Coleman, HubertA.: Medical Support of the Army Air Forces in World War II. Washington:U.S. Government Printing Office, 1955.
18(1) Telegram, Lt. Gen. Brehon B. Somervell to Commanding Generals,First to Ninth Service Commands and Military District of Washington, 6Sept. 1944. (2) Memorandum, Lt. Col. Charles H. Moseley, MC, Deputy Director,Training Division, Office of The Surgeon General, for Maj. Edna B. Groppe,ANC, 25 Sept. 1944.
19(1) Letter, The Adjutant General to Commanding Generals, Firstto Ninth Service Commands, 16 Oct. 1943, subject: Course of Basic MilitaryTraining for Nurses. (2) Annual Report of Medical Department Activities,Headquarters, First Service Command, 1945. (3) Diary, Brig. Gen. FloydL. Wergeland, 20 Sept, 1944 to 31 Dec. 1945, entry for 15 May 1945.
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FIGURE 12.-Army nursesin training, Camp Mccoy, Wis. (Top) Army nurses engage in calisthenics.(Bottom) Army nurses crawl through an obstruction on the obstacle course.
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FIGURE 13.-Army nursesin training, Camp McCoy, Wis. (Top) Army nurses negotiate a rope ladderduring basic training. (Bottom) Army nurse negotiates the simulated jungleriver crossing.
some centers. To cope with the increased training load, methods usedin Army Service Forces schools were adopted. Weekly schedules of instructionwere published, lesson plans prepared, and instructor guidance programsinstituted. Unfortunately, instructor guidance programs did not alwaysinclude hospital ward nurses responsible for ward teaching, most of whomwere more concerned with nursing service than with training. Inspectionswere instituted to point out strengths and weaknesses in instructionalmethods and to allow comparison of training between centers.
The facilities provided at basic training centers in 1943 proved inadequatefor the training requirements of later years. Not only did the number ofnurses in basic training grow, but also in 1944, the training load wasfurther increased by the assignment of dietitians and physical therapiststo centers originally intended for nurses. In all, 27,330 nurses receivedbasic training between July 1943 and Sep tember 1945. To accommodate thesetrainees, some commands moved training centers within or between installationsor provided an additional center during periods of heavy enrollment. Whenthe number to be trained by one command exceeded its capacity, nurses weresent to other commands. The number of nurses recruited and assigned totraining centers varied so much from month to month that a high degreeof flexibility was necessary. Only four nurse training centers did nothave to be relocated at some time during the war. Relocation was most oftennecessary because early centers, established at general hospitals, didnot have the capacity to adjust to the 1945 training load. Plans were madein June 1945 to decrease the number of training centers, and by September,all centers were closed.20
From time to time, other problems plagued the program. One was the degreeof realism and "ruggedness" to be injected into training. Fora time, trainees were sent through infiltration courses, but this was laterdiscontinued in the belief that general physical conditioning was morevaluable.21 Other problems that were eventually solved includedan initial shortage of qualified instructors, shortages of clothing, andinadequate training aids. At training centers, these problems were morereadily identified and resolved than they could have been at scatteredhospitals.
The Contribution of Basic Training
Directives and letters issued early in the war, outlining basic trainingplans for Army nurses, failed to realize their objectives. Initial directivesrequired nurses assigned to field medical units to possess a satisfactoryknowledge of basic military subjects broader than that required for dutyin fixed hospitals. Because of inadequate prewar programs, instructorswere rarely available. Directives permitting local program modifications,such as allowing nurses to spend half their basic training time in hospitalwards, frequently weakened the program. This happened most often when nurseswere assigned to fixed hospitals, which did not require a knowl-
20(1) Army Service Forces Circular No. 300,7 Aug. 1945. (2) Army Service Forces Circular No. 323, 25 Aug. 1945.
21(1) Army Service Forces Circular No. 90, 27 Sept. 1943. (2)Office Memorandum, Lt. David M. Campbell, MAC, Training Division, Officeof The Surgeon General, 2 Nov. 1943.
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edge of field techniques to function effectively, and which frequentlyhad patient loads requiring 24-hour nursing service 7 days a week. Establishmentof basic training centers with fixed programs guaranteed uniform and continuoustraining.
Perhaps the most obvious advantage was the high morale developed duringbasic training. Nurses graduating from such programs could be sure thatthey had learned their duties and responsibilities as officers, that theirpersonnel records and immunizations were complete, and that they were correctlyoutfitted. Army nurses were all volunteers, trained in their technicalspecialties. Yet, it was possible to gain the maximum benefit from theseskills only after nurses had become familiar with the Army and the MedicalDepartment and could be confident that they had been trained to come togrips with the special problems of Army nursing.
CHIEF NURSES
Prewar Training
In the interim between World Wars I and II, vacancies and promotionsto chief nurse were rare. Examinations were required for promotion to chiefnurse, and beginning in 1935, a few chief nurses were assigned for a shortperiod to the Nursing Division, Office of The Surgeon General, to supplementknowledge gained in preparing for the examination with experience. Subjectsincluded hospital administration, records administration, efficiency reports,personnel assignment, disciplinary action, nurses' rights and privileges,management of overseas nurse rosters, and the function of The Surgeon General,The Adjutant General, and the Inspector General. Such training was slowand limited to chief nurses who were changing stations. As the Army NurseCorps expanded during 1940 and 1941, the authorization for chief nursesincreased from 72 to 494. During 1941, 180 candidates selected for leadershipand executive ability passed the qualifying examination.22
Informal, on-the-job techniques satisfied the requirements of the MedicalDepartment until 1942, when the mobilization of theater units thinned theranks of experienced nurses at fixed hospitals. At this point, the systembroke down because too many candidates were studying under inexperiencedchief nurses. But until late in 1942, on-the-job training remained theonly technique available.
Wartime Training
Under pressure, stopgap methods were used to accelerate the trainingof chief nurses. Early in 1942, the Superintendent of Nurses, Col. JuliaO. Flikke, ANC, revised instructions for training chief nurses to incorporateessential information on personnel procedures and administration. Trainingprocedures were relaxed in April, when written examinations for promotionto chief nurse were abandoned. Commanders empowered to promote officerswere authorized to promote nurses to
22 (1) See footnote 6 (4), p, 127. (2) AnnualReport of The Surgeon General, U.S. Army. Washington: U.S. Government PrintingOffice, 1941.
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the position of chief nurse to fill vacancies in units under their commandand were required only to report the promotion to The Surgeon General.After a few months, even the requirement for a report was suspended.23Late in 1942, an effort was made to give chief nurses short courses atfour general hospitals, but because of patient loads, only one programwas successful.24
Aside from this course, and one developed late in the war by the ArmyAir Forces, a formal training program for chief nurses did not evolve duringWorld War II. Throughout the war, nurses at service command headquartersprovided informal guidance through letters and visits, and some devisedmore detailed training. At the hospital level, chief nurses attempted toprovide on-the-job training for potential candidates, but the mountingpressure of patient loads limited training to Army procedures at the expenseof administrative principles and theory. Such training was ostensibly forduty in the theaters, but the duties of chief nurses in Zone of Interiorhospitals were also emphasized. Nurses were selected on the basis of civilianadministrative experience and physical ability to serve overseas. Thosewho had already been in the theaters and were qualified to return werealso selected. Army Air Forces established a 4-week training course atBowman Field, Ky., in the autumn of 1944, and later transferred it to theSchool of Aviation Medicine, Randolph Field, Tex.25
NURSE ANESTHETISTS
In contrast with basic military training, which could not be conductedefficiently in hospitals, the training of nurse anesthetists could be carriedout only in a hospital with an active surgical load. The on-the-job trainingprogram for nurse anesthetists that evolved during World War II demonstratedthat prewar techniques could be adapted to wartime training conditionsin technical fields requiring a high degree of supervised practice.
The Prewar Program
The Army began training and utilizing nurses as anesthetists duringWorld War I. Satisfied with the results, the Medical Department continuedto use nurses in this capacity throughout the interwar years. No quotaswere set, and peacetime training was limited to providing replacements,but in response to "occasion and necessity," a few Army nurseswere sent to civilian hospitals or the Army Medical Center, Washington,D.C.26
23(1) War Department Circular No. 118, 23 Apr.1942. (2) War Department Circular No. 202, 23 June 1942. (3) Army RegulationsNo. 40-20, 15 Aug. 1942.
24Blanchfield, Florence A., and Standlee, Mary W.: OrganizedNursing and the Army in Three Wars, vol. 1, p. 362. [Official record.]
25(1) Memorandum, Nursing Division, Office of The Surgeon General,for Col. Arden Freer, MC, Chief, Professional Administrative Service, Officeof The Surgeon General, 15 Jan. 1945.(2) The Army Nurse 1:10, October 1944.
26(1) Huntington, P. W .: Medical Department Professional ServiceSchools, Army Medical Center, Washington, D.C. School Year 1934-35. ArmyM. Bull. No. 33, October 1935. (2) Stimson, Julia C.: The Army Nurse Corps.In The Medical Department of the United States Army in the WorldWar. Washington: U.S. Government Printing Office, 1927, vol. XIII, pt.2. (3) See footnotes 6 (1), (2), (3), p. 128.
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Between 1939 and 1941, Army expansion increased requirements for trainedanesthetists. During this period, 15 nurses were sent to civilian hospitals,and 16 others were trained at general hospitals and the station hospitalat Fort Sam Houston, Tex.27 Despite these efforts, trainingfailed to keep pace with expansion.
Wartime Programs
The outbreak of war increased and sustained the demand for anesthetists.The first response of the Medical Department was to issue program guidesthat did little more than continue local programs on an expanded scale.Courses were authorized at Walter Reed General Hospital, Washington, D.C.;Army and Navy General Hospital, Hot Springs, Ark.; Fitzsimons General Hospital,Denver, Colo.; and Lawson General Hospital, Atlanta, Ga.; and at severalstation hospitals.28 More courses were added as new hospitalsopened. In the absence of a standardized program, significant variationsin course length and content developed.
The first clear outline of the duties and training of nurse anesthetistswas provided by The Surgeon General in a directive issued to the servicecommands on 11 November 1943. Under this directive, course length was standardizedat 6 months, and Zone of Interior training was limited to general hospitals.Administrators were required to submit the names of students to The SurgeonGeneral when they entered training.29 Later, this stipulationwas changed to require the names of nurses completing the course, accompaniedby a statement of proficiency and the supervision they would require intheir duties. The names of students failing the course and the reasonsfor their failure were also required.30 Nurses were to be trainedto administer inhaled anesthetics and to care for patients under all othertypes. They were not expected to give intraspinal, intravenous, local,or endotracheal anesthetics, but were expected to be able to care for theinstruments with which they were administered. By mid-1944, about 100 nurseshad completed the program.31
Until July 1944, nurse anesthetists were not listed in hospital tablesof organization, and the Medical Department could make only rough estimatesof its requirements. Their incorporation into tables of organization clarifiedrequirements, which in turn pointed out the need for a formal program ofinstruction. Such a program was prepared by the Training Division, Officeof The Surgeon General, and approved by Army Service Forces on 17 August1944 as "a general guide for the balanced training of members of theArmy Nurse Corps in general anesthesia."32 Included inthe subjects required were the principles of anesthesia, pharmacology inrelation to anesthesia, the signs and stages of general anesthesia, andthe effect of anesthesia on the body. Both pre- and post-operative patientcare was covered
27See footnotes 6 (1), p, 128; and 22 (2),p. 136.
28Letter, Col. Julia O. Flikke, ANC, Assistant Superintendent,to the Surgeon, Headquarters, Sixth Corps Area, 23 Mar. 1942, subject:Army Nurse Corps.
29Letter, Maj. Gen. Norman T. Kirk, The Surgeon General, U.S.Army, to Commanding General, Each Service Command, 11 Nov. 1943, subject:Course in Anesthesia.
30Army Service Forces Circular No, 140, 13 May 1944.
31(1) Annual Report of the Surgeon General of the Army, forthe Commanding General, Army Service Forces, fiscal year 1944. (2) Memorandum,Maj. Gen. Norman T. Kirk, The Surgeon General, U.S. Army, to CommandingGeneral, Each Service Command, 15 Aug. 1944, subject: Nurse Anesthetists.(3) See footnote 29.
32Army Service Forces Program of Instruction for ApplicatoryTraining of Nurse Anesthetists, 17 Aug. 1944.
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in detail, as well as procedures in anesthetic emergencies and oxygentherapy. Instruction was also required in methods of obtaining medicalsupplies. The scope of instruction, methods of presentation, and detailsof subject and sequence were prescribed, and only minor modifications couldbe made without the approval of The Surgeon General. The staff and itsmethods were subject to inspection by Medical Department consultants insurgery and anesthesiology. Reports of course capacity, numbers enrolled,and course completion were closely supervised, and the practice of holdingstudents for service after they had completed their training was prohibited.By these techniques, the Medical Department was able to standardize andcontrol on-the-job training at a large number of widely scattered hospitals.
Instructional Methods
Before the standardization of programs, courses prepared locally exhibitedmarked differences in content and the time allotted to supervised practice.The course developed by The Surgeon General in 1944 was intended primarilyto develop competence in the administration of inhaled anesthetics. Ninetypercent of the course consisted of supervised practice. Students receivedhighly individualized instruction, usually in formal conferences, and observedinstructors administering anesthetics. Later, the student was allowed topractice partial, and then complete application. Students were requiredto administer a minimum of 100 anesthetics under supervision before completingthe course, and some Army hospitals required a minimum of 300 practicecases. Despite the urgent need for trained nurse anesthetists, the availabilityof patients suitable for student practice limited course enrollments tobetween two and six students.
Another factor limiting the number of students was the practice of retainingqualified anesthetists in student status to provide service at the hospital.After this practice came to the attention of The Surgeon General, it wasdiscouraged by allowing inspecting officers discovering cases of excessiveretention to recommend the transfer of one of the offending hospital'sexperienced anesthetists. When students were unable to gain enough clinicalexperience at a hospital, The Surgeon General was notified.
After January 1944, when the course was confined to general hospitals,an MC officer was designated course director and was assisted by selectednurse anesthetists. The selection of instructional personnel was closelysupervised by the Surgeon General's Office, and practicing anesthetistswere encouraged to become course directors.
Nurse anesthetists were also trained in theaters of operation, but programsoutside the Zone of Interior failed to achieve the standardization of thosein the continental United States. Nurses in the Mediterranean theater,for example, were trained on a continuing basis at four general hospitals.The program theoretically required 3 months in residence, but in practicevaried from 1 to 3 months, depending on the time a nurse could be sparedfrom a unit.33
33Medical Department, United States Army. Surgeryin World War II. Volume II. General Surgery. Washington: U.S. GovernmentPrinting Office, 1955.
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Selection of Students
Before World War II, the Superintendent of the Army Nurse Corps selectedstudent anesthetists from nurses who demonstrated aptitude and interest.After the establishment of the Army Service Forces, responsibility forselection rested largely on hospital commanders. Inequalities of supplyand demand were resolved by liaison at service command level. Selectionprocedures became more formal in August 1944, when courses were standardized.Students were required to be volunteers from the Army Nurse Corps who hadcompleted the basic training course. Consultants to service command surgeonswere encouraged to expand their activities to include selection. Consultantswere encouraged also to check on the progress of students they selectedso as to overcome the conflict of interest created by assigning studentsto facilities that were responsible also for patient care.34
Strength and Utilization
Early in World War II, hospitals were not required to report nurseswith specialized training, and the training of nurse anesthetists was wellunderway before training requirements could be estimated. To determinethe number of nurse anesthetists actually serving in the Army, two surveyswere conducted by The Surgeon General in April 1943. The first requestedservice commands to list the hospitals doing major surgical work and thenames of anesthetists at each station with their grade and an evaluationof their work.35 As the need for anesthetists became increasinglyacute, a second survey was made by personal letters requesting the namesof nurses who had completed the anesthetists course and a statement oftheir proficiency. In September 1943, the Medical Department estimatedthat 2,495 nurse anesthetists would be needed for numbered units and Zoneof Interior installations. With only 273 reported on duty, 2,222 wouldhave to be recruited or trained.36
Recruiting experience revealed that 3.7 percent of the nurses enteringthe Army had postgraduate courses in the combined areas of neuropsychiatry,operating room procedures, and anesthesia, but there was no report of thenumber who were qualified anesthetists. The Medical Department hoped totrain 260 annually and to recruit the remainder by assuring them of properassignments on entry into the Army. This goal was not even approached in1944. Prospects were brighter in 1945 because of the pace set during thefirst 6 months. It was estimated that 2,000 qualified nurse anesthetistswere in the Army in July 1945. Approximately 220 completed training inZone of Interior hospitals between December 1941 and December 1945.37
34Letter, Brig. Gen. Fred W. Rankin, ChiefConsultant in Surgery, Office of The Surgeon General, to Lt. Col. BradleyL. Coley, MC, Headquarters, Eighth Service Command, 24 July 1944.
35Letter, Maj. Gen. James C. Magee, The Surgeon General, U.S,Army, to the Commanding General, Each Service Command, 27 Apr. 1943,subject: Assignment of Anesthetists.
36Memorandum, Lt. Col. Sanford V. Larkey, MC, Chief, SchoolBranch, Training Division, for the Director of Training, Surgeon General'sOffice, 23 Sept. 1943, subject: Training of Nurse Anesthetists.
37Completed AG ASF Forms R-5218, dated 8 Nov. 1945. InReport-Flow of Trainees thru Nurses Basic Training Centers.
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As a result of the decentralization of training, withdrawals from thecourse can only be estimated. For the short period in which records areavailable, the number was not excessive. In common with other programs,they rose sharply after the surrender of Japan, even though courses werenot suspended. Hospitals were notified in September 1945 that courses insession would be completed but that future courses would be canceled, andnurses were allowed to withdraw from the course to separate from the service.38
NEUROPSYCHIATRIC NURSING39
Before World War II, there was little need for trained psychiatric nursesin the Army. Psychiatric cases were kept in Army hospitals only until arrangementswere made for them to be sent to either St. Elizabeths Hospital, Washington,D.C., or other institutions providing long term custodial care and treatment.At the outbreak of the war, there were no special training programs forArmy nurses in neuropsychiatry and no plans for developing such programs.During the war, courses were established at various Army hospitals, butthe development of a full-blown program was frustrated by the War Department'srefusal to authorize an Armywide school. The problem persisted despiteefforts by both the Nursing Division and the Neuropsychiatry ConsultantsDivision to convince other divisions of the Surgeon General's Office andthe War Department that a formal program was essential. In common withmost developments in psychiatry during World War II, each step forwardwas a limited victory for those attempting to educate higher authorities.
In the wake of the passage of the Selective Service Act, new hospitalswere built. Typical hospitals had closed neuropsychiatric wards designedto give maximum security. The nurses' office was separated from the patientarea by a locked iron grillwork, and patients were housed in wards behindthis partition. Space and facilities for anything other than custodialcare were severely limited. Attempts were made to screen incoming nursesfor previous experience, but many chief nurses questioned the need fornurses to care for patients who were neither physically ill nor confinedto a bed. The nurse, nominally assigned to psychiatric wards, often spentmuch of her time in surgical wards or performing administrative tasks.Little time was spent in locked-ward sections. This lack of recognitionof the role of psychiatric nursing resulted in patients being under thecare of nurses with a variety of backgrounds; some nurses qualified neitherby training, experience, nor desire for their duties. Others, with desirablebackgrounds, were malassigned.
Attempts to Establish Formal Courses
During the first year of the war, the Medical Department attempted tosatisfy its requirements by drawing on nurses who had received psychiatrictraining at
38Memorandum, Col. Florence A. Blanchfield,Superintendent, Army Nurse Corps, to Col. Floyd L. Wergeland, MC , Director,Training Division, Office of The Surgeon General, 10 Sept. 1945.
39Unless otherwise indicated, this section is based on: MedicalDepartment, United States Army. Neuropsychiatry in World War II. VolumeI. Zone of Interior. Washington: U.S. Government Printing Office, 1966.
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civilian hospitals before entering the Army.40 When thisproved inadequate, members of the Nursing and Psychiatric Consultants Divisiondirected their efforts toward establishing an Armywide training course.Planning for the course began early in 1943, shortly after the establishmentof the School of Military Neuropsychiatry at Lawson General Hospital, Atlanta,Ga.41 In the summer of 1943, the officer in charge of preparingprogram guides for the course reported: "All plans are made and wehave nurses ready to send, but Army Service Forces had not approved itso we can't go ahead until they do."42 At least part ofthe difficulty in gaining approval for the program arose from the inabilityto justify training on the basis of tables of organization: even a 1,000-bedgeneral hospital for neuropsychiatric patients overseas was authorizedonly one neuropsychiatric nurse, the same strength authorization approvedfor a nonspecialized general hospital.43 For some reason, theTraining Division of the Surgeon General's Office also refused to approvethe program.44
In October 1943, the School of Military Neuropsychiatry was moved toMason General Hospital, Brentwood, N.Y., and plans were again made to conducta post graduate course for nurses. Finally, in February 1944, a 12-weekprogram in neuropsychiatry was established under the authority of the SecondService Command, without Army Service Forces approval as an Armywide school.An overstrength of 10 nurses was authorized for the hospital, and the hospitalcommander was directed to give them "such didactic instruction asmay be feasible with their duty assignment."45
Local Programs
In the absence of an Armywide school, hospitals began to establish localprograms. Early in April 1944, Lt. Col. Ruth I. Taylor, ANC, Headquarters,First Service Command, was informed that a course in neuropsychiatric nursinghad been started at the Station Hospital, Camp Edwards, Boston, Mass. On3 June
40(1) Letter, Maj. Julia O. Flikke, Superintendent,Army Nurse Corps, to Capt. Ida W. Danielson, ANC, Assistant Superintendent,Headquarters, Sixth Corps Area, 28 Nov. 1941. (2) Letter, Capt. Ida W.Danielson, ANC, Assistant Superintendent, to Maj. Julia O. Flikke, Superintendent,Army Nurse Corps, Office of The Surgeon General, 13 Dec. 1941. (3) WarDepartment Circular No. 34, 1 Feb. 1943.
41(1) Memorandum, Col. Florence A. Blanchfield, Superintendent,Army Nurse Corps, to Brig. Gen. Charles C. Hillman, Chief, ProfessionalService, Office of The Surgeon General, 18 Jan. 1944. (2) Annual Report,Mason General Hospital, Long Island, N.Y., 1943.
42Letter, Capt. Kathleen N. Atto, Assistant Superintendent,ANC, to Lt. Col. Pearl C. Fisher, ANC, Headquarters, Sixth Service Command,7 Aug. 1943.
43(1) War Department Table of Organization and Equipment No.8-5508, 26 Oct. 1943. (2) War Department Table of Organization and EquipmentNo. 8-550, 3 July 1944.
44In TM (Technical Manual) 12-406, "Officer Classification,Commissioned and Warrant," 30 Oct. 1943, psychiatric nursing was recognizedas a specialized field of nursing and coded as MOS (Military OccupationalSpecialty) 3437. In describing the requirements for awarding this MOS,TM 12-406 stated that nursing experience in a neuropsychiatric ward wasessential. It strongly recommended postgraduate training in psychiatricnursing but did not make such training mandatory.
45(1) Memorandum, Maj. Gen. Norman T. Kirk, The Surgeon General,U.S. Army, for Commanding Officer, Mason General Hospital, 8 Feb. 1944,subject: Training in Neuropsychiatric Nursing. (2) Memorandum, Maj. Gen.Norman T. Kirk, The Surgeon General, U.S. Army, for Commanding Officer,Mason General Hospital, 13 Jan. 1944, subject: Training in NeuropsychiatricNursing. (3) Transmittal Sheet, Lt. Col. Charles H. Moseley, MC, DeputyDirector, Training Division, Office of The Surgeon General, to Col. FlorenceA. Blanchfield, ANC, Nursing Division, Surgeon General's Office, 8 Feb.1944, subject: Training in Neuropsychiatric Nursing.
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1944, Colonel Taylor informed The Surgeon General that 15 nurses wouldcomplete the first course on 30 June 1944 and that, because of the reducednumber of patients at Camp Edwards, the school would be transferred toCushing General Hospital, Framingham, Mass., on 1 July. Colonel Taylorrecommended that three full-time nursing instructors be assigned to CushingGeneral Hospital and that the school be approved by The Surgeon Generalso that an authorized certificate could be presented upon satisfactorycompletion of the course.
On 16 June 1944, Maj. Gen. Norman T. Kirk concurred with the establishmentof a course in the First Service Command, but added that he did "notdeem it advisable to authorize or approve a neuropsychiatric nursing school."46While The Surgeon General did not object to the issuance of a certificateof completion, he advised that a local certificate be used because the"Certificate of Proficiency, Various Courses, Special Schools, U.S.Army" (MD Form 60e) was not to be used for local courses.
In December 1943, authority was given to provide a 3-month affiliationin neuropsychiatric nursing at Fitzsimons General Hospital, for studentnurses from St. Joseph's Hospital School of Nursing, Denver, Colo. In May1944, Army and cadet nurses were also accepted in the course.47In June, The Surgeon General authorized official recognition for the courseby issuing a certificate to Army Nurse Corps officer graduates.
Because of continued failure to obtain approval for an Armywide postgraduatecourse, commands were encouraged to establish their own schools in thefall of 1944. By the summer of 1945, each service command had establishedat least one course for nurses. A total of 585 nurses and 296 cadet nursescompleted these courses in service command hospitals.48
OPERATING ROOM NURSES
The training of operating room nurses was seldom mentioned in hospitaland service command reports. All nurses received operating room trainingand experience in their basic program, but the number with advanced skillsand experience was below wartime requirements. On-the-job training wasrequired to sharpen unused skills and to develop competence in specializedfields of war surgery.
A formal course in operating room techniques was established at CushingGeneral Hospital in August 1944 to prepare nurses for duty with surgicalteams and for overseas assignment. The course was initially 3 months, andconcentrated on training nurses for general surgery, neurosurgery, andplastic surgery. Included were 75 hours of lectures, demonstrations, films,and discussions. The basic principles of operating room technique werereviewed, and, under careful supervision, nurses
46Letter, Lt. Col. Ruth I. Taylor, ANC, Chief,Nursing Service, Headquarters, First Service Command, to Commanding General,Army Service Forces, 3 June 1944, subject: Report of Neuropsychiatric NursingSchool 3114 SCU, FSC, Camp Edwards, Mass.
47These were senior students from civilian schools of nursingwho elected and were accepted to serve their final 6 months before graduationin Army hospitals. For a discussion of the Cadet Corps Program authorizedby Public Law 74, 78th Congress, see The United States Cadet NurseCorps 1943-48. PHS Publication No. 38. Washington: U.S. Government PrintingOffice, 1950.
48See footnote 39, p. 141.
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became experienced in the administration of blood and plasma and inscrubbing and circulating duties. Training was also received in orthopedic,urological, and vascular surgical procedures.49 The course wasincreased to 4 months in May 1945 to provide instruction in operating roomadministration. Thirty-six nurses completed the course.50
The amount of operating room training conducted on-the-job at Zone ofInterior hospitals and hospitals overseas is unknown. No reporting procedurewas established, and courses were never standardized. Course length variedfrom 75 to 85 hours of classroom work and from 295 to 420 hours of clinicalexperience. In July 1945, the Office of The Surgeon General began preparationof an outline of a 4- to 6-month course in operating room technique thatincluded some 50 hours of classroom instruction. The length of the clinicalphase depended upon the facilities available at the hospital conductingthe course.51 Work on the preparation of the course stoppedat the end of the war.
FEVER THERAPY NURSES
Fever therapy was one of the few specialties in which the Army NurseCorps was able to meet its training. In part, this was due to the prioritygiven this treatment for sulfonamide-resistant gonorrhea early in the war,and in part, because the advent of penicillin reduced the requirement forfever therapy. Until the effectiveness of penicillin in treating gonorrheawas demonstrated in 1943, fever therapy training was an important partof the postgraduate program for nurses.
At the beginning of World War II, there was a wide disparity betweenthe recommendations of experts and the average care given patients withgonorrhea. Beginning in June 1940, cooperative efforts by the SurgeonsGeneral of the Army and the Navy, and the Subcommittee on Venereal Diseases,Division of Medical Sciences, National Research Council, produced a seriesof directives standardizing treatment. Among the developments resultingfrom their efforts was the establishment of fever therapy centers at designatedgeneral hospitals in 1942 and an expansion of the program to other typesof hospitals in 1943.52
The first known training program for nurses followed the establishmentof a Department of Fever Therapy at Walter Reed General Hospital in 1941.Eight nurses were reported trained that year.53 As fever therapycenters were established, nurses either were trained on the job or weresent to other hospitals for an unspecified period for training. After September1942, The Surgeon General took an active part in arranging for the trainingof doctors and nurses in this specialty. When hospitals did not have trainedpersonnel to operate fever therapy cabinets (hyper-
49Poole, R.: Army Courses in Operating RoomTechnic, Am. J. Nursing 45: 270-271, April 1945.
50(1) Annual Report, Cushing General Hospital, Framingham, Mass.,1944. (2) Annual Report, Cushing General Hospital, Framingham, Mass., 1945.
51Memorandum, Col. Florence A. Blanchfield, Superintendent,Army Nurse Corps, for Chief, Training Division, Office of The Surgeon General,17 July 1945, subject: Outline for Course in Operating Room Technic.
52Medical Department, United States Army. Internal Medicinein World War II. Volume II. Infectious Diseases. Washington: U.S. GovernmentPrinting Office, 1963.
53Annual Report, Walter Reed General Hospital, Army MedicalCenter, 1941.
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therms), they were required to submit the names of two nurses selectedfor training to The Surgeon General.54 Once a program of fevertherapy had been established at a hospital, replacements were trained asneeded.
The purpose of fever therapy training was to teach nurses to producean artificial fever by the use of therapy cabinets. Skilled nursing wasrequired during all phases of therapy from preparation, through the inductionof a fever ranging from 106o to 107oF., until post-fever recovery. Nurses had to be trained todetect the signs of irreversible physiological reaction. Treatment timeusually exceeded 8 hours, and one patient was treated daily. Medical officerswere on call for emergencies. No reports were required, and no attemptwas made to keep statistical records.
The absence of a standardized training program produced a wide varietyof courses. Some medical officers held the opinion that a minimum of 3months in a busy clinic was required, while others defended the observationand treatment of a minimum of 25 cases. With special selection and carefulsupervision, course length could be reduced to 1 week. Courses establishedat Army hospitals varied from 1 week to 3 months.
FLIGHT NURSES55
Before World War II, proposals for the training of flight nurses receivedan unsympathetic response from both the Air Corps and the American RedCross. At the beginning of the war, air evacuation was not an acceptedpractice, and it was not until terrain problems in Alaska, Burma, and NewGuinea made it expedient to transport patients by air that attention wasfocused on developing an evacuation system.
On 18 June 1942, the Army Air Forces was assigned responsibility fordeveloping an air evacuation system, and primary planning responsibilitywas delegated to the Air Surgeon. As a result of initial efforts, the 349thAir Evacuation Group, Headquarters and Headquarters Squadron, was activatedon 6 October to control and train flight surgeons, flight nurses, and enlistedpersonnel for air evacuation. The table of organization, issued in November,set up the squadron as a unit composed entirely of medical personnel, havingno planes assigned. The 349th consisted of three squadrons, each with aheadquarters section and four evacuation flights. The headquarters sectionincluded the Commanding Officer, a Chief Nurse, and a MAC officer. Eachflight, headed by a flight surgeon, consisted of six flight nurses andsix medical technicians, one nurse and one technician to a team. On 30November, an urgent appeal was made for graduate nurses with experiencein aviation to volunteer for the Army Nurse Corps and subsequent assignmentto the AAF Evacuation Service. On 18 February 1943, a formal graduationceremony was held for the first 39 nurses to complete 4 weeks of flighttraining.
The original 4-week course consisted of military indoctrination, airevacuation and tactics, survival, physiology, mental hygiene, and loadingprocedures. In
54Circular Letter No. 86, Office of The SurgeonGeneral, U.S. Army, 18 Aug. 1942, subject: Fever Therapy in the Treatmentof Gonorrhea.
55See footnote 17 (3), p. 132.
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February 1943, after the graduation of the first class, the trainingperiod was expanded to 6 weeks, and in November, it was lengthened to 8weeks. The additional time allowed the inclusion of instruction on wardmanagement, operating room technique, sanitation, and patient care, and2 weeks of specialized training at hospitals in Louisville, Ky. The amountof in-flight training depended upon the availability of evacuation planes.
Flight nurse training remained under the control of the 349th Air EvacuationGroup until June 1943, when the AAF School of Air Evacuation was activatedat Bowman Field, Louisville, Ky. At that point, it was placed under theadministrative control of the Commanding General, AAF, and the Air Surgeonwas charged with the responsibility for supervising curriculum and research.In October 1944, the School of Air Evacuation was absorbed into the Schoolof Aviation Medicine, Randolph Field, Tex.
At the time of its transfer to the School of Aviation Medicine, thecourse was extended to 9 weeks and divided into three equal phases. Thefirst two phases consolidated material from the previous curriculum, andthe last 3 weeks were devoted to participating in evacuation under theguidance of an experienced instructor. Course content gradually expandedto include familiarization with the types of airplanes used in evacuation,methods of loading and unloading, and the use of supplies and equipmentprovided for in-flight care. Special instruction in aeromedical physiologyprovided a foundation for further training in the use of oxygen equipmentin high-altitude flights. Because doctors did not usually accompany patientsin flight, nurses were prepared to treat shock, hemorrhage, and other emergencieswithout the assistance of a flight surgeon. Problems in the transportationof neuropsychiatric patients also received consideration. Course lengthdid not change again until 20 August 1945, when each of the phases wasshortened to 2 weeks to increase the number of flight nurses availablefor deployment to the Pacific theater.
Because nurses accepted for flight training were volunteers who metrigid standards, the rate of attrition was remarkably low. Under standardspublished in December 1942, applicants were required to be members of theArmy Nurse Corps, between 21 and 36 years of age, between 105 and 135 poundsin weight, and between 62 and 72 inches in height. Applicants had to certifytheir willingness to participate in regular and frequent flights and toindicate any previous flying experience. Previous supervisors were requiredto certify the applicant's professional qualifications, personality, andjudgment. Later, 6 months of experience in the Army Nurse Corps was alsomade a prerequisite. Between December 1942 and October 1944, 1,079 flightnurses graduated from the School of Air Evacuation at Bowman Field. Anadditional 435 students graduated from the School of Aviation Medicinebetween November 1944 and June 1946. Only 15 students failed to graduate.
THE SENIOR CADET NURSE CORPS
The concept of a Senior Cadet Nurse Corps first emerged during WorldWar I, when the Medical Department planned to train senior students fromcivilian nursing schools to utilize their services and simultaneously preparethem for military
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service after graduation. The end of the war terminated the programbefore it could be put into effect.56 After the Army Schoolof Nursing closed in 1933, the Army had neither the facilities nor thepersonnel to train student nurses. Reestablishment of the school was neverseriously considered during World War II because experienced Army nurseswere reluctant to take on the added burden of training students when ithad been demonstrated that civilian nurses could be utilized after a brieforientation to military life. As a consequence, the Cadet Nurse Corps ofWorld War II was developed primarily to meet the needs of civilian hospitals.As the Corps history states: "Perhaps the strongest case for the CadetNurse Corps was the plea of hospital authorities that nursing care in civilianhospitals was in a desperate state. Since the military forces took onlygraduate nurses, it was not expected that the Cadet Nurse Corps would directlyor immediately aid the Army and Navy, except in the use of advanced students* * * they would help to replace graduatenurses enlisting for military service."57 For its part,the Medical Department hoped that an increased supply of civilian nurseswould aid Army recruiting and that, in any event, senior cadets in Armyhospitals would temporarily ease the shortage of nurses.58
Authority for the formation of the U.S. Cadet Nurse Corps was providedon 15 June 1943 by the Bolton Act which made the U.S. Public Health Serviceresponsible for its administration.59 The purpose of the programwas to allow schools of nursing to expand their primary training capacityby sending senior students to Federal hospitals for their last 6 monthsof training. At the same time, participating schools were required to acceleratetheir programs and provide student nurses with their primary training withina period ranging from 24 to 30 months.
Anticipating the passage of the Bolton Act, the U.S. Public Health Servicecalled representatives of the Federal nursing services together in early1943 to coordinate planning. On 5 April 1943, Lt. (later Lt. Col.) MaryC. Walker, ANC, was assigned by the Surgeon General's Office to organizeand supervise the program in Army hospitals and coordinate plans with otheragencies.60 Broad policies were formulated at a series of conferencesand disseminated through U.S. Public Health Service regulations, guides,and bulletins. The Surgeon General sent the first specific instructionsto Army hospitals in November 1943.61
Under the program worked out through these conferences, schools andState boards retained their traditional prerogatives, while Federal hospitalsrecruited cadets and provided facilities. The U.S. Civil Service Commissionacted as the clearing house for Cadet Nurse Corps applicants. Studentsappointed to the U.S. Cadet Nurse Corps were pledged to remain in essentialmilitary or civilian nursing during the war, although the pledge was notbinding.
56See footnote 26 (2), p. 137.
57See footnote 47, p. 143.
58See footnote 3, p. 127.
5957 Stat. 153.
60Diary, Nursing Division, Office of The Surgeon General, U.S.Army, 1942-45, entry for 5 Apr. 1943,
61Letter, Maj. Gen. George F. Lull, Deputy Surgeon General,U.S. Army, to Commanding Officer, Station Hospital, Camp Edwards, Mass.,19 Nov. 1943, subject: United States Cadet Nurse Corps-Senior Cadet Period,Army Hospital.
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FIGURE 14.-Senior cadetnurses in training. (Top) three senior cadet nurses, right, receive trainingin operating room procedures at the Station Hospital, Camp McCoy, Wis.,Army Nurse Corps officer, left, administers anesthesia. (Bottom) Seniorcadet nurse, center, receives supervised on-the-job training in the dressingroom on a neurosurgical ward at England General Hospital, Atlantic City,N.J., August 1944.
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The Program in Army Hospitals
The program began with a survey to determine the quality and quantityof facilities available to cadets. State boards of nurse examiners thenused these surveys to evaluate the hospital nursing staff, clinical, educational,and recreational facilities, and living conditions. Representatives ofthe State boards also visited Army hospitals on invitation. State boardshad the power to withhold approval until the Army corrected conditionsthat did not meet their standards. Usually, hospitals were cooperative,since it was estimated that each student would provide services equal to80 percent of those expected from a graduate nurse.
The first senior cadets were assigned to Army hospitals on 15 June 1944.By 1 October 1945, the U.S. Civil Service Commission had submitted 9,891applications to The Surgeon General, and 5,688 applicants had been acceptedand assigned to Army hospitals. Of these, 1,674 were still in trainingon 1 October 1945, and all but 61 of the balance had completed the course.62A total of 44 Army hospitals had participated in the program before theMedical Department withdrew in February 1946.63
Techniques of Instruction
The assignment of cadet nurses within a hospital depended upon the needsof the hospital. At first, efforts were made to plan clinical instructionfor individual cadets (fig. 14), but this was discontinued. In the 6-monthcadet period, about 120 hours of instruction were provided, including 2hours of ward teaching each week and a total of 70 hours of Army basictraining. The time spent in basic training was later reduced to 50 hours.Periods of instruction were included in a 48-hour work-week, but physicaltraining was done during off-duty time. Records were sent to the home schoolwhen cadets completed their training, including a summary of the cadet'sinstruction and clinical experience, a record of illnesses, and an efficiencyreport.64
Results of the Program
Despite the quotas established for Army hospitals, the number of cadetsassigned to them varied. Early estimates indicated that 50 percent of thesenior cadet nurses could be trained in Federal hospitals, but in practice,only 15 percent enrolled, and only 6.4 percent of these were assigned tomilitary hospitals. The Army trained 85 percent of those assigned to militaryhospitals, even though it participated for only 20 of the 64 months theprogram was in operation.65
For most purposes, the senior cadet program came too late to be of useduring World War II. Even after the Bolton Act was passed, cadets couldnot be assigned
62See footnote 3, p. 127.
63History of Nursing Branch, Military Personnel Division, Officeof The Surgeon General, 1 June-30 Sept. 1945.
64(1) Army Service Forces Circular No. 168, 3 June 1944. (2)Army Service Forces Circular No. 292, 6 Sept. 1944 (3) Army Service ForcesCircular No. 75, 28 Feb. 1945.
65See footnote 49, p. 144.
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to Federal hospitals until Congress amended the Act to provide a stipend.At the beginning of the program, the Army optimistically agreed to train1,500 senior cadets every 6 months and agreed to limit acceptance to 50percent of each class. Such precautions proved unnecessary because of thestrong influence of nursing schools on their students. Student interestincreased only after the President proposed drafting nurses in January1945.66 Available evidence does not permit measurement of theprogram's impact on civilian nursing, or on recruitment rates. Even thenumber of students graduated is not a measure of impact, because the seniorcadet's promise to remain in nursing throughout the war was not legallybinding.
Direct recruiting was not a primary objective of the program, but theMedical Department did make efforts to interest cadets in Army nursing.Despite efforts to make them "feel a part of it," very few cadetswere ultimately persuaded to remain in the service. There is no recordof the number of cadets who accepted appointment, but only 93 had beencommissioned by 1 January 1945.67
66Congressional Record, vol. 91, pt. 1, p.67. 79th Congress, 1st Session.
67See footnote 3, p. 127.
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