Sunday 11 November 2018

Nurses - the forgotten heroes of the First World War

[The text below is taken from my book, Nurses of Australia:the Illustrated Story: NLA publishing, 2018), which is now in all good bookshops.]

     Over the course of the First World War, more than 2,286 members of the Australian Army Nursing Service (which included nurses, masseuses, some ward assistants and one bacteriologist) served overseas on active service. (It was a huge number given that in 1914 there were only 4,200 trained general nurses registered with Australian nursing associations.)
     Only fully trained nurses were eligible to enlist in the AANS. They had to furnish references recommending them for military service, pass a medical examination and submit to the same military regulations as the average military officer.
     Hundreds more Australian nurses who wished to serve but had not been accepted into the AANS joined the British nursing services, either the Queen Alexandra’s Imperial Military Nursing Service Reserve (QAIMNSR) or the Territorial Force Nursing Service. Other Australian nurses volunteered to serve with organisations such as the Red Cross, French Flag Nursing Corps, the Australian Voluntary Hospital, Colonial Nursing Service, or St John Ambulance.
     The AANS nurses cared for Australian and allied servicemen in almost every theatre of war during the long four years of war. They also served in hospital ships off the coast of Turkey and in field and general hospitals and Casualty Clearing Stations in countries as diverse as Egypt, Palestine, Greece, India, France, Belgium, and Germany. Australian nurses staffed British and French hospitals and assisted the British, French, Canadian, Indian and South African medical services. 
     During the War, 388 Australian nursing sisters were decorated, with 42 wining military nursing’s greatest honour, the Royal Red Cross. Eight were awarded the Military Medal, and 23 received decorations from the Governments of allied countries.
     The First World War took place prior to antibiotics. Surgery was often performed in the difficult and septic conditions of a Casualty Clearing Hospital and doctors left post-operative treatment almost entirely to nurses. 
     A patient’s recovery, although due in part to a patient’s own powers of resistance and recuperation, was often attributable to the nursing care he received. Careful nursing prevented the onset of secondary pneumonia or further infection which could be fatal, and constant observation allowed the nurse to act quickly to prevent dehydration and excessive blood loss.
     British nurses may have regarded their colonial colleagues with some disdain, refusing to work with them unless ‘fully qualified’, but Australian trained nurses knew they had much to offer. The willingness of Australian nurses to take on whatever type of nursing work presented itself made them highly prized in Casualty Clearing Stations on the front line, and for theatre work. Australian nurses were particularly proud of their ability to act independently when required, unlike the British nurses who were used to a more rigid nursing hierarchy. And the Australian nurses soon needed to use all their ingenuity and pluck.
     Twenty-four AANS sisters embarked on active service overseas with the first big convoy of 44 troop ships on 20 October, 1914. They arrived in Egypt in December 1914 and set up two general hospitals.
     No. 1 Australian General Hospital (AGH), under Matron Bell, (left) was established at the Heliopolis Palace Hotel, a magnificent building, luxuriously furnished, but wholly unsuitable for a hospital. 
     No. 2 AGH, under Matron Gould, took over Mena House (right), also a former luxurious hotel but smaller than the Heliopolis Palace. It may have had a spectacular view of the Pyramids, but it was just as unsuitable for a hospital. 
     The nurses’ home in Cairo was in a former Egyptian harem, ‘a queer, funny old home . . . with barred windows, and inside a huge stone wall twenty feet high.’ (Anne Donnell, Letters of an Army Sister, p.80) Inside the walls was a garden with a pool where the ladies of the harem used to wash their feet. 
     In their early days in Egypt, before the Gallipoli campaign, the Australian nurses made time to enjoy themselves, despite the heat. A nurse who had seen active service in Egypt later recalled that she and her colleagues ‘used to go for donkey rides in the evening and wore divided skirts something like our uniforms. My donkey was called Whisky Straight.’ (Sun, Monday 25 April 1938, p. 9) 
     The Australian nursing sisters visited friends, shopped and took trips to the Pyramids and the Sphinx. A perennial problem, however, was shortage of money, as the Army was notoriously lax about paying its staff. 
     Everything changed after April 1915, when the wounded began pouring in from Gallipoli. In May, No.2 AGH took over another Cairo hotel, the Ghezireh Palace and No.1 AGH had expanded to 3,500 beds. The El Hayat hotel at Helouan, twelve miles from Cairo, became a Convalescent Camp with 1,000 beds. But the casualties kept coming.
     Auxiliary hospitals were established in Cairo and Heliopolis in whatever large buildings were available. Luna Park in Cairo became an Auxiliary Hospital. It had fifteen nurses, and by 16 May it held 1,620 patients, 700 of whom were accommodated on the skating rink (as in the photo to the left ). The Atelier Auxiliary Hospital was a former furniture factory that had been fitted out to take 500 beds.
     And still the Gallipoli wounded poured in. Tent hospitals were opened in tennis courts and sporting grounds. Hotels, the Aerodrome, the Casino, the Cairo Sporting Club, and Prince Ibrahim Khalim’s Palace all became Australian hospitals. By 10 June 1915, almost 8,000 patients had been treated.
     Tent hospitals were especially troublesome. In a tent, ‘nursing the room’ – making sure that the patients’ environment was safe, well ventilated and free from dust and infection control was in place – was impossible, as is clear from the photo right.
Australian nurses often found Army regulations hard to stomach, especially those relating to uniforms.
     The heat in Egypt was almost intolerable (in a letter of 19 June 1915, Olive Haynes (below) mentioned that it was 122 degrees Fahrenheit in the shade (50 degrees Celsius)), and yet the nurses were expected to wear their long and heavy grey serge frocks with the thick red woollen cape over their shoulders. Haynes complained in a letter to her mother: 
‘Matron has a fit when she sees us without our capes. Everything military is quite mad and unreasonable; they can’t see a foot ahead of their noses for red tape.’ In the same letter Haynes took comfort in the news that the nurses were getting ‘new thin red capes – muslin collars and short sleeves with turn-back cuffs – will be much cooler.’ (Letter Olive Haynes to her mother, 28 May 1915)
     Everyone in the Egyptian hospitals, whether nurses, doctors or wounded soldiers, suffered cruelly from the heat. Haynes wrote that the best part of being on night duty was being able to take her cape off, roll up her sleeves and turn her collar in. She was defiant: ‘I don’t mind if 40 Drs. or officers come along.’ (Letter Olive Haynes to ‘Mim’ 19 June 1915)
     This Australian tendency to independence became a necessity, as the nurses were pitched headlong into situations that no amount of training could have prepared them for. Work on casualty ships, in particular, required a great deal of competence, ingenuity and independent thinking. The photo right shows wounded men from Gallipoli arriving at a hospital ship. 
     From April 1915 these vessels would collect the wounded from Gallipoli and transport them to hospitals on nearby islands. Conditions on the overcrowded ships were horrific. Patients who could not be fitted below decks were treated on the open rolling deck, lying side-by-side on stretchers. On the Gascon, Hilda Samsing wrote of performing her duties as ‘stray bullets pattered on board like rain drops after a shower’, and she graphically described her experiences:
The noise from the shore was most appalling. The incessant booming of the guns with the crackle of machine guns and rifles playing their accompaniment, made us wonder if the Anzac Hill was on a sound foundation. As for the poor old ship, it shook nearly all the paint off her sides, and she has worn a battered look ever since! At 7 a.m. our work began in earnest, and what a day it was! Men who could walk or hobble came up the gangway, and the derrick swung the cradle, with stretcher cases, without stopping, till at 4 p.m. every cot was full, and not a yard of deck space was left to place another man on. And such wounds, and such tired hungry men. We took 700 on board, and when you think they all had to be fed, the 400 cot cases washed, and all those dressings done, fractures set, serious cases operated on, and every man’s name and regimental details entered up in the 24 hours, you will realize a little what our work was like. (Letter Samsing to Watson, undated, reprinted in The Register, 24 November, 1915 p.9)
     In July 1915, Matron Grace Wilson and a contingent of 96 nurses were sent from Australia to Lemnos, a Greek island about 40 miles from the Dardanelles that had become an important army base. It was from Lemnos’ vast, ship-filled harbour at Mudros that troops and supplies were sent across to the Gallipoli beaches.
     Wilson and her nurses were instructed to set up No.3 AGH on the island’s stony, dusty hillside, but they were deposited on Lemnos before their hospital equipment. The photo left shows them arriving on the bare hillside.
     The August offensive on Gallipoli was in full swing and only one or two tents had been hoisted before the first load of two hundred wounded from Gallipoli arrived. 
     The injured men were laid on the ground and the tents that were to serve as wards were pulled up around them as the nurses attended to their wounds. The nurses simply had to make the best of things. When they ran out of bandages, they tore up their petticoats and anything else that they could find to serve the purpose. And, as is clear from the photo right, they had to sleep rough until the tents and equipment arrived.
     There were no streams or springs on Lemnos. The Greek villages that were located in the valleys had wells, but these could not be used for fear of typhoid. This meant that for the first few weeks the nurses were allocated only one small bottle of water a day to serve for drinking and washing purposes. Eventually some of the officers managed to fit up a water distiller. Although there was now enough water to drink, they never had enough for a luxury such as a bath. Nor was there was any electricity in the camp. They used hurricane lamps or candles in their tents, or they sat in the dark.
     Provisions were short and often the nurses went hungry. They subsisted for the most part of bully beef, rice and onions and army biscuits, although sometimes the nurses bought olives and dried fruit and coarse brown bread from the Greek villages. The photo left is of the tent hospital on Lemnos.
     In the blazing summer heat the nurses could not cool off with a swim in the harbour, for fear of contracting dysentery. When winter brought bitter frosts Matron Wilson had to insist that the Army issue them with warm tunics, trousers and boots. Eventually they discarded formal uniforms to wear men’s woollen socks, gum boots and sheep skin coats.
     Matron Wilson referred to some of the problems faced by her Lemnos nurses in a newspaper article in 1931:
In the summer months it was terrifically hot, and the sun beat pitilessly down on our tents, but by December it was bitterly cold, and what had been only dust and stones before became a veritable sea of mud. We always had to go about our work in heavy gum boots. Night after night, when we were safely tucked in bed, our tents would be torn down by the wind and blown half way across the island. And always, in the whole six months we were there, there was such shortage of oil for our lamps and lanterns that as soon as the nurses had done their work in the wards they had to turn out the lights and sit in darkness. (Inverell Times, Friday 15 May 1931, page 6)
     The nurses kept up a brave front for the wounded men, but privately they sometimes despaired, as Anne Donnell described in one of her letters home:
November 10th.
Today in the lines I passed a dear little dog, stopped played with him, then it suddenly dawned on me what a changed life we are living, and growing accustomed to. No little children to love, no trees, no flowers, no pets, no shops, nothing dainty or nice, practically no fruit or vegetables, butter and eggs once in a month, twice at most. Please don’t infer from this that I am complaining, far from it, and we have much to be thankful for, but how we wish that we could give our serious cases the very best of food and delicacies. Of course it’s only natural that we would wish, for our health’s sake, to have some nourishing food. I do have them too in my dreams at night, when I visit the most beautiful fruit gardens and pick the sweetest flowers while little children play around; don’t smile, for it’s quite true. (Anne Donnell, Letters of an Army Sister, pp.63-4)
     And yet, when Anne Donnell left Lemnos in January 1916 she wrote that she would miss ‘the unconventional freedom and the unique experiences we had there.’ (Anne Donnell, Letters of an Army Sister, p.76.)
     In his official history of the Australian Army Medical Service, Butler said of the Lemnos nurses:
It is clear, however, that the training in the nursing profession, severe beyond most in its standard of toil, self-discipline and resource in compelling order out of chaos, enabled these trained women to adapt themselves to circumstances, bend to clearly recognised ends such means as could be found, and in a short time obtain a comparative mastery of the situation. (Butler, Official History of the Australian Army Medical Services in the War of 1914-1918, Vol.1, p.338)
     In April 1916 No.1 and No.2 AGHs were transferred from Egypt to France (to Rouen in Normandy and Wimmereux in Boulogne in respectively). After the evacuation of the Gallipoli Peninsula No.3 AGH was transferred first to Cairo then to England and later to Abbeville in France. It was at No.3 AGH that a team including Sister F.E. Williams (a bacteriologist) continued valuable research they had commenced on Lemnos looking into the aetiology of dysentery.
     After the heat of the Egyptian desert the nurses thoroughly appreciated the beautiful French spring. But the rain was soon a curse in the tent hospitals. The flapping and leaky tent sides meant that their patients were drenched; often beds were so wet the nurses refused to put men into them. Sometimes there was no flooring under the tents, not even a groundsheet, and the nurses walked through mud to see to patients as beds sank into the ground.
Our hospital consists of tents. My ward is a big tent with about a hundred beds, all surgical cases, and it is hard going every minute one is on duty. The weather has been dreadful. We have had the second Deluge, I think. Anyhow, the whole place is a quagmire, and we have to slosh through mud and water. My ‘uniform’ consists of a very abbreviated skirt, rubber boots tied round at the knees, a sou’-wester jacket and hat. In this rig the boys call me the ‘Little Skipper.’ Other times I’m ‘Little Ausie!’ We have to be ready to go out in the pouring rain, while the mud is awful. I sleep in a tent which leaks badly, so I have to put an oilskin right over my stretcher and put the clothes I want to keep dry when I go on duty under the same oilskin. There is an anti-aircraft gun stationed about 50 yards from my sleeping tent, and I had just dropped off for a few hours' sleep the other day when it started. By the time I got out the enemy plane, was almost overhead. Mr first thought was for my helpless patients in the ward close by, but the bombs fortunately dropped clear. This was my third-air raid, and I must confess I’m not fond of them. (Letter from unidentified Australian nurse, reprinted in the Mail, 20 October 1917, p.6)
     Then came winter. Housed in tents or lightly built huts, the nurses suffered terribly in one of the coldest winters on record in France. Bed sheets froze if a hot water bottle burst. The nurses took their boots into bed with them so that they would be wearable in the morning. Ink and medicine froze and they even had to melt the ice in basins to wash patients.
   The general hospitals were set up just in time to receive Australian casualties from the major battles of the Western Front: Fromelles, Somme, Ypres, Amiens, Poperinghe. The hospitals were within hearing, and often range, of the shells. Between April and December 1916 the three Australian general hospitals alone had eighty-seven thousand casualties. Their patients came directly from the Casualty Clearing Stations near the front line. Nursing staff who had thought (correctly) that Gallipoli was a nightmare came to realise that at least it was short. Then, after three and a half hellish years nursing on the Western Front, just as the fighting slackened closer to the Armistice in November 1918, they faced another, deadly enemy. The influenza epidemic had begun.
Nurses who worked in the Casualty Clearing Stations such as that in the photo left were closest to the front line, and conditions were difficult and dangerous. During often nightly bombing raids, the nurses would sit in the dark fields with their tin hats and gas masks on as bombs fell nearby and anti-aircraft shells whistled over their heads. Then they returned to the tents that served as their bedrooms to find that their clothes had been shredded by shrapnel. 
     And always, there were wounded soldiers to be treated. Sometimes, in one room of a Casualty Clearing Station as many as ten operations would be going on while another fifty men lay waiting at the door for their turn. Members of the surgical teams, including the nurses, might operate for 24 hours straight, stopping only for food. 
     In a letter of 1 May 1918, written after she had been invalided out with nervous fatigue, Anne Donnell described the work of No.48 British CCS in France, near Amiens.
You will all know that the C.C.S. Hospitals are the nearest to the front lines. The wounded first pass through the field dressing stations and then usually come by ambulance to the C.C.S, and then close to the C.C.S is a rail head, from which the hospital trains take the patients down to the various bases. It is usual for two C.C.S.’s to be close together and work in conjunction with the other. Our next door neighbour was 21 C.C.S., and we received the patients alternately, perhaps every two hours, or four, or twelve, just according to how fast we were admitting or how many. . . . One thing, I was free to use my own discretion in giving morphia or stimulants, and you may be sure I was ever ready with either, when I thought it the least bit necessary. (Anne Donnell, Letters of an Army Sister, pp.212, 214.)
     Anne Donnell was the only Australian nurse at No.48 British CCS and missed her compatriots. Sometimes, just chatting to a fellow countryman was enough to lift the spirits:
I think it was the 2nd December when in the morning the night sister greeted me with, ‘Sister, I’ve got an Australian here for you.’ . . . He suffered very much pain and shock and I kept him all day, and made myself snatch a minute now and then for a little chat. He seemed pleased to have met an Australian Sister and vice versa. I was delighted and proud of my Australian. (Anne Donnell, Letters of an Army Sister, pp.218-9)
     Most AANS nurses worked in one of the big general hospitals or auxiliary hospitals. General hospitals were the largest medical units, and they were much larger than the Australian general hospitals that the nurses were used to. Although the authorised bed limit for the general military hospital was 520 beds, very soon most had doubled this, or more. 
     Every type of surgical and nursing work took place in these large and crowded hospitals, and the Australian nurses needed to take on increased responsibilities. In wartime conditions nurses also had to master the use of equipment that had formerly been used only by doctors. Often they did so with no formal training, such as this Red Cross nurse in the photo left who administers anaesthetic, which would never have occurred when she was a nurse in Australia.      
     And it was not just nursing care that they provided. Nurses were expected always to be cheerful and feminine and to give comfort to the wounded. They regularly took on the task of writing home to soldiers’ families to inform them of their patients’ progress. Or they would write to let a loved one know as gently as possible the circumstances of a soldier’s death. 
     Sometimes, however, maintaining a cheerful face was difficult:
I only know that I am not a mere nurse, but represent to them for the time being their dearest ones, and many a time I find myself going to the marquee flap to hide the tears that will gather, and ask for strength to control a distorted face and go back. (Anne Donnell, Letters of an Army Sister, p.216.) 
     Lonely patients were often singled out for extra care. In June 1917, Anne Donnell was transferred to the British Hospital at Le Tréport, which was dealing with the masses of wounded from Bullecourt and Vimy Ridge. It was so close to England that the families of many seriously wounded patients were able to come over to visit them or take them home. Anne pitied a young man whose family had not yet arrived. 
There was no time to special, one just did what one could for each, and then it was, I thought, a case of the survival of the fittest. . . . But this laddie in the corner, I thought, shall have some special care, and Matron brought him some lovely oranges that he fancied, so I quietly sat down and fed him and told him he would be mine until his mother came. He gave me the loveliest smile as he replied, ‘and I’ll make you my special,’ but quickly added, ‘You must forgive me, Sister, I wouldn’t have said that under ordinary circumstances.’ Next morning when I came on duty, his bed was empty. . . . His parents arrived – too late to see him, but I was so thankful to be able to give them his last message of love. (Anne Donnell, Letters of an Army Sister, p.170) 
     To give some hint of how difficult it was to ‘special’ one young soldier at that time, Donnell reported that in ten weeks over 12,000 patients went through that hospital.
     The Australian nurses found that the Armistice of November 1918 brought mixed feelings. As Anne Donnell wrote:
There is a certain amount of quiet excitement with most of us. Some are overjoyed and I wish I could feel as they do, but I am terribly depressed. … I think of the gladness, then follows the sadness, and in the gladness I am saddest because I think of those who have lost, the mothers at home whose sunny boys are not going back to make them glad. (Anne Donnell, Letters of an Army Sister, pp.272-3) 
     No AANS nurses lost their lives due to enemy action in the First World War, but 21 died due to illness and disease: three in Egypt, four in India, two in France, three in England, one in Salonika, eight in Australia. Four Australian nurses who enlisted in the QAIMS also died on service. But many nurses never really recovered from the strain of those years and from what they had seen and experienced. 
     The status of nurses within the general Australian population – already high before the war – increased as soldiers returned full of praise for the nurses who had treated them or their mates. On Anzac day, nurses were allowed the privilege of marching beside the soldiers.
     And yet, the role played by Australian nurses in the war soon faded from memory. Nurses were little mentioned in the official war histories and in peacetime many nurses were reluctant to bring attention to themselves and what they had achieved, preferring to stand in the shadow of the Anzacs.
     Or perhaps they did not want to remember what horrors they had seen and experienced in those four years. As one newspaper article from 1931 put it:
The epic story of the part that the army nurses played in the Great War can never be told in full — her own reticence is in itself an effective barrier — and it is a story that has been largely overshadowed by exploits more spectacular. (Inverell Times, Friday 15 May 1931, page 6)
     The exploits of the Australian Diggers at Gallipoli, Fromelles, Ypres, Passchendaele, Mons, Poizieres and the other famous battles may well have been more spectacular than those of the ‘girls in grey’, but they were certainly no more heroic.


Mary Hoffman said...

What a brilliant post for today, Deborah! Thank you.

Kirsty Harris said...

It was just like reading from my book More than Bombs and Bandages

abigail brieson said...

"Or perhaps they did not want to remember what horrors they had seen and experienced in those four years."
The past four years were too difficult to remember and impossible to forget. Between 1914 and 1919 the world had changed yet those fighting and serving in the War held onto memories of the world they had left - only to return home to find that world no longer existed; or the loss of friends and companions and men they never even knew the names of; personal horrors; had left men and women empty. All each cared for had been lost forever. Some sought to understand in their own ways; to distance; to reconnect; some never could and with one final action, a last bullet, went to 'join their mates'.
Thank you for the post. Too little is known or recognized of Women's service.