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Keeping the troops alive in war-time :
A nursing and surgical perspective

Joint Meeting of the History of Science, Ideas and Technology, and the SA Medical Heritage Society

9 May 2009

SPEAKERS : Caroline Adams, Dr Joan Durdin, Dr Donald Beard

Pursuing the theme of ‘Keeping the Troops Alive in Wartime’, I propose first to provide a comment on the education which prepared nurses for their role with the military service at the Boer War and also in the armed services during the Great War of 1914-1918. Then I will look at other factors which influenced nurses’ preparation for ‘nursing the troops’. Thirdly I will share some observations of their role as perceived by nurses themselves in combat situations – as found in letters and diaries and in the course of oral history interviews.

The South Australian nurses who, in 1900, rose to the challenge to care for the Australian troops in South Africa were in several important ways better equipped for their role than their predecessors in the Crimea had been, fifty years earlier. In the first instance the hospitals in Adelaide in which they had received their nursing experience were all established since the Nightingale era and incorporated some of the features recommended by Nightingale for institutional nursing – space, light and ventilation and some provision for dealing with infectious cases. An early record of nursing at the Children’s Hospital refers to the use of Lister’s carbolic spray for disinfection in operating theatres. When a nurse went off duty having cared for an infectious case, she was required to sit ‘for a few minutes’ in a chair under which a tray of sulphur was burnt! .

The first hospital to institute nursing training was the Children’s Hospital in North Adelaide, three years after its opening in 1876. In 1887 Martha Bidmead, the leader of the group of six SA nurses at the Boer War, took the one-year course of training and was the 25th Children’s Hospital nurse to complete the course. From what can be learnt about the training program there was an intention to provide both a theoretical and a practical foundation for nursing, with one lecture a week, and quarterly examinations for the five or six trainees. Early records indicate that the authorities found difficulty in allocating time for lectures.

At the Adelaide Hospital a program for nursing education began in 1890. Under the leadership of a newly appointed Lady Superintendent of Nurses from the London Hospital (which was already an established training school for nurses), first-year nurses received twelve lectures. A nurse’s lecture notebook from the year 1894, now in the RAH Archives, reveals that the course comprised 12 sessions. Reading the carefully written notes, one could believe that the course was especially designed for nurses who might find themselves in a wartime situation. For example, the first 2 lectures were on haemorrhage, and included structure of blood vessels, method of locating the pulse and noting its rate and nature, the types of haemorrhage and manner of dealing with each. Next were two comprehensive lectures on wounds, in similar detail, bristling with technical terms. Lectures continued on the topics of inflammation and its treatment, antiseptics, fractures, burns and shock. Then followed lectures on specific diseases, with emphasis on enteric fever and other infectious diseases. Boer War nurses Amelia Stephenson and Agnes Cocks trained at the Adelaide Hospital in the decade prior to the outbreak of the Boer War.

Two of the South Australian Boer War nurses, Agnes Glenie and M. O’Shanahan, trained at the North Adelaide Hospital, later Calvary Hospital, whose first matron, Miss Edith Noble, had experience in the Nightingale system of nursing in Britain. One may assume that she laid down a formal pattern of education for nurses who came to this private hospital in North Adelaide. O’Shanahan is described as having had experience as a charge nurse there. The skills of Nurse Glenie, who was at the North Adelaide Hospital at a time before the issue of nursing certificates, was nevertheless highly regarded. She was one of two nurses awarded the Distinguished Service Medal on her return from the war in 1902 and in 1905 was one of the first nurses to be admitted to the register of the Australasian Trained Nurses Association, not barred from membership by the lack of a formal qualification.

The sixth of the Boer War nurses, Miss A Watts completed training at the Private Hospital, Wakefield Street under the supervision of Alice Tibbitts, who had been the first nurse to complete training at the Children’s Hospital. From the slender evidence of each hospital’s training program, it would appear that the nurses were well equipped, for that period.

I will not elaborate on the training program for nurses who served in the Great War and the Second World War, except to note that a modest program of formal education, to underpin practical nursing, had been laid down by the Australasian Trained Nurses Association in 1905. All training schools followed this syllabus until 1920. After that date the training schools were required to follow the syllabus adopted by the newly established Nurses Board of South Australia. The hours of instruction showed little increase on that of the 1890s – a total of 39 lectures were prescribed to be given over the three-year training period - and all formal instruction was taken in the nurses’ off duty hours. Trainee nurses were primarily engaged to provide direct nursing care. This they did, in 10-hour nursing days, six days each week for three years.

From reports of the nurses’ performance in the armed services, and from their own observations as illustrated in their correspondence, their basic education served the Boer War nurses well. Lady Frances Brown, widow of a military surgeon, had played an active role in equipping the nurses for their overseas service. She arranged for the publication of many of their letters in the Adelaide newspaper Observer. Through their letters we learn of their self-confidence, their appreciation of professional etiquette, their respect for their patients and for the orderlies who assisted in nursing care, their tenderness towards the very young, and the dying patients. The nurses were themselves disciplined, and they appreciated discipline in others. An example is Martha Bidmead’s comment on the exemplary behaviour of the British soldiers whose bedside lockers were ‘a model of neatness and order’, something that did not bother the happy-go-lucky Australian soldiers. Bidmead’s sense of humour helped her to cope with unexpected difficulties such as maintaining her dignity when crawling through narrow tent doorways in the company of a medical officer, each trying to give way to the other. She saw it as something of a ‘set to partners’ affair.

In the military hospitals the nurses each had charge of 6 tents, each accommodating 6 patients but there were times when the number of tents increased to 15. The nurses appreciated the orderlies but saw them as having very hard lives. Rather than report them for occasional unsatisfactory behaviour, they were known to give them ‘a severe talking to’ instead. Nursing of typhoid patients held no fears for the nurses. Glenie and O’Shanahan were commended for volunteering to travel to Pretoria to nurse in an outbreak of this disease, which had claimed doctors and nurses among its victims. One can appreciate Martha Bidmead’s comments, after accepting a posting to lighter duties following a period of illness. She wrote of her delight with the rest and quietness, after ten months of constant rush, and the turmoil of a military hospital, with its reliefs of orderlies, parades, and bugle calls.

Soon after the nurses’ return to Australia the establishment of the Army Nursing Reserve made provision for some degree of preparation of nurses in the armed services. It was an outcome of reorganisation of the military forces after Federation. The Commonwealth Gazette of May 1904 reported the appointment of Matron Margaret Graham, of the Adelaide Hospital, as the first Superintendent of the Army Nursing Reserve in South Australia. In the following years many nurses became ‘reservists’ and attended lectures on the organisation military hospitals, hygiene, and military surgery for which proficiency certificates were awarded.. Soon after the outbreak of war in 1914 Miss Graham and two other members of the Reserve, Nurses Davidson and Crosby-White, were the first to be called up and they left for overseas in October of that year.

Over the next 4½years more than 300 South Australian nurses served in military hospitals in Britain, France, Egypt and Greece. From letters and diaries, and half a dozen oral history records of South Australian nurses who served in World War One, we learn something of the qualities that the nurses brought to their task, of the situations they faced, of their attitudes to danger and to unfamiliar situations, their confidence in their own capacity to adapt to meet the demands of each situation, their humanity as they cared for and comforted young soldiers who they probably related to as to their brothers.

These factors are all illustrated in oral history transcripts. Sister Kathleen Conway began training at the Adelaide hospital in 1911, at the age of 20, and on completion of the 3-year course applied immediately for military nursing service. After several months of waiting, she and five frustrated young nursing colleagues determined to make their own way to Britain, to join the British Army nursing service. They embarked on a civilian vessel, but, approaching Port Said soon after 25 April 1915, were required by Australian authorities to disembark and join other Australian nurses already in Egypt. They were appointed for duty on hospital ships bound for the Dardanelles to evacuate the wounded during the early stages of the Gallipoli campaign. Here are Kathleen’s words:

We were anchored about a mile offshore. The soldiers who were sick or wounded were being brought to the ship in barges. We had to stay until another hospital ship came, but something went wrong and no other ship came for a long time. The barges kept coming, and men were dying and being buried at sea, and more came. We didn’t rest for 52 hours – neither did the doctors. They were operating day and night. We nurses had a pocket full of morphia (tablets) and a pocket full of aspirin. We gave them as we saw fit. And we had to note what was given, so that we didn’t give another dose too soon. We just went where we could, stepping over the poor fellows lying all over the decks.

Irene Bonnin’s diary reveals how different her army nursing experience was from that of nursing at Calvary Hospital. On 22 July 1916 she found time to make a diary entry, after a frantic week at the Casualty Clearing Station near Rouen, France:

July 2 was a most terrible night. July 1 was the big offensive and all day Sunday patients were pouring in. New tents were opened. When we went on night duty two of us worked together, with one orderly. We had ten tents, with 15 beds in each, and an emergency tent with some kind of tarpaulin stuff on the floor, and mattresses. We admitted 110 during the night. We were somewhat in a whirl.
One might describe the last remark as a masterpiece of understatement, but whirl or not, they got on with the job, working until they could be relieved, and thankful for any rest.

An experience which Dora Birks remembered clearly in years later was at a hospital in Boulogne, not long after the Armistice. Some of the most seriously wounded soldiers were not fit for evacuation to hospitals in Britain, and Dora, with an orderly to help her, was on night duty for a month in a ward with 40 patients. When the patients had settled she moved frequently among them Many were restless, and were thankful for a nurse who would sit with them for a few minutes. She recalled :

As the orderly and I sat in the silence, waiting for anyone who needed us, we heard drip-drip-drip. It was blood from the leg of a badly wounded man!. The orderly rushed for help, and two men came with a stretcher and carried him to the theatre. In the early hours of the morning he came back - without his leg.

During the following weeks Dora took a special interest in this young Canadian soldier whose courage impressed her. He longed for some fresh fruit and, being on night duty, she could go into Boulogne in the daytime, where she bought apples for him. Another of her assignments at this time drew on her skills as a communicator, and on her empathy with both patients and their families. The matron asked her to help deal with an accumulation of letters from parents who were anxious for news of their sons. Dora had to interview the ‘boys’ and write messages for them, to be included with her formal response to the inquiry. Such services must also have been valuable in keeping up the soldiers’ morale. There were also times when it was not a case of ‘keeping the troops alive’, but comforting them as they died. With the outbreak of the influenza epidemic, Dora Birks’ letters had sometimes had to convey news of the death of a soldier whose life had so far been spared, only to succumb to the ravages of the epidemic. She referred to her appreciation of continuing correspondence with mothers to whom she had written.

In 1917, after a lull in the recruitment of nurses for the Army Nursing Service, a sudden demand was created by the fighting in the Balkans. The British army was desperate for nurses, and many South Australians, some straight from their training schools, were despatched with a party of 300 nurses on the Mooltan, bound for Egypt and Greece. Enid Cherry and several friends from the Adelaide Hospital were among them. In Salonika they experienced the conditions of nursing in both the summer hospital (in the hills) and the winter hospital on the muddy plains nearer the coast. How quickly they had to adapt to primitive condition! Provisions for personal hygiene were limited for the nurses in the tent hospital. Enid described melting snow for water in which to wash in the mornings, putting face washers and tooth brushes on the kerosene heater to de-frost, keeping their veils in good condition by ‘pressing’ them against walls or window panes. Enid contended that many of their patients were from Britain, men who had been taken from the gaols to join the fighting forces! She found them to ‘very good patients’.

Kathleen Bryant, who had trained at Broken Hill, also went to Salonika. Her first experience of army nursing was at the 7th AGH at Keswick, but she soon left for Melbourne, with 7 other nurses. A lengthy voyage on SS Runic took them to Durban, their fellow passengers including Australian soldiers returning to the front after sick leave. After a delay of several weeks in Durban (a wonderful holiday) they continued on their way to the Middle East and had their first involvement in the war when, from their ship, they watched as a mine-sweeper which was protecting their convoy met its mark, and blew up. “It was so interesting that we weren’t anxious – it was just a bit of a shock”, she said. At Salonika in the mid-summer of 1918 she was settled at a hospital staffed by British doctors and Australian nurses. She contended that the winter hospital, at a lower altitude, was on a site that had been condemned for mules, and lacked many comforts as a tented hospital. Outside the tents the nurses wore sou’westers and gum boots. Before entering a ward they appreciated the services of ambulant patients who formed up to scrape the mud off their boots. Many of the nurses succumbed to malaria, and others suffered the ravages of dysentery during this period and were invalided home. Kathleen was among the survivors, and recalled the day shortly before 11 November, when it was reported that the war had ended. Everyone received an issue of rum – which, to their disappointment, was not repeated when the authentic announcement was made a few days later. In mid-1919, on returning by ship to Adelaide, all passengers were taken to Torrens Island to be quarantined. Kathleen allowed her colleagues to dose her heavily with aspirin, when an unexpected rise in her temperature was noted on the planned day of release.

Another Kathleen, Kathleen Waterhouse, completed her training at the Children’s Hospital in 1917 and waited for several months for her application for military nursing to be accepted. Her pay-book, issued on arrival at Keswick, proved invaluable in reminding her, at the time of interview, of her subsequent postings and their duration – Bombay, after 3-day train trip across India, where she nursed at Colaba, the garrison hospital for that part of India. Then a transfer to Rawalpindi and later to a convalescent hospital in the foothills of the Himalayas. The nurses who had been the shortest time in the service remained for longer after the end of the war, and it was 28 October 1919 when the last entry was made in Kathleen Waterhouse’s pay book.

A few glimpses army nurses are doubtless typical of many others who made the transition from civilian to military nursing. Nurses made light of the demands on their energy, the restrictions that were imposed by wartime conditions, the dangers to which they were exposed. They accepted a new military discipline, even when its imposition seemed them to be misplaced, and, most importantly, they put their best efforts into meeting the needs of the soldiers who needed their skilled services.

Many of the experiences of these nurses have been replicated among subsequent generations. Forty years before the Boer War Florence Nightingale’s dictums with regard to hygiene led to endeavours to make the hospital environment safer. Practices such as hand-washing, observing cleanliness of equipment and of the person, were established and nurses were to the forefront in embracing and implementing the changes. With each war, innovations have involved nurses in new procedures, handling of new apparatus, adapting to a wider range of observational skills, contributing to the team action demanded both by the discovery and testing of new ways of doing things. Advances in neuro-surgery, orthopaedic surgery and intravenous therapy are just a few that come to mind.

The unique role of the nurse was defined in the 1960s as ‘assisting the individual, sick or well, in the performance of those activities contributing to health, or its recovery, (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge’ . There is no doubt that the nurses who cared for the troops in a succession of wars have effectively fulfilled this role.

Nursing in South Australia, First One Hundred Years, Nurses Centennial Committee, 1939.

Virginia Henderson, Basic Principles of Nursing Care ,International Council of Nurses, 1969.