Nurses in war
Article Outline
Summary
If it appears that the development of orthopaedic surgery is dominated by men, then it is very clear that the history of orthopaedic nursing is dominated by women.
In the first two articles in this series reference was made to Agnes Hunt the ‘mother’ of orthopaedic nursing. Before embarking on the military background to nursing in general and trauma nursing in particular it would seem pertinent to document Agnes’s history.
Agnes Hunt and the birth of orthopaedic nursing
Agnes Hunt was born in 1867, the sixth of 11 children born to Rowland and Florence Hunt of Boreatton Park, Baschurch in Shropshire. At the age of nine Agnes developed septicaemia, which even today has a risk of mortality. This infection spread to her hip resulting in osteomyelitis, an infective chronic inflammatory condition of the bone. She described this period as her “apprenticeship to crippledom – and also the great education of pain”. Out of her affliction stemmed her determination to help others in pain by becoming a nurse and, in spite of her disability, she qualified in 1891, later also qualifying as a district nurse (Carter, 2000).
In 1900 Agnes’ mother retired to Florence House in the village of Baschurch in Shropshire and opened it as a convalescent home of the Salop infirmary. Two upstairs rooms were furnished as wards and Agnes became the nursing superintendent of the home for crippled children. The most crippled children were housed, eventually, in a shed in the garden; open to one side to allow fresh air and sunshine for those children unable to walk. Fresh air and good food were the basis of treatment and many of the children responded to this treatment – it was most likely that good nutrition and nursing care had the most important role to play in the improvements in the children’s health – the role of fresh air has never really been proven.
Agnes first met the great orthopaedic surgeon, Robert Jones in 1903 when her hip condition deteriorated and she went to see him in Liverpool. Shortly afterwards he visited the Baschurch home and expressed unqualified approval of the treatment provided. In 1904 he became honorary surgeon to the home and shortly afterwards he suggested it would save time if he made a monthly visit to perform operations there. The word hospital was added to the name in 1905. A training school for nurses was started in 1910. Eventually success outgrew the Baschurch site and a former military hospital at Gobowen near Oswestry was commandeered for a new hospital with 320 beds that was opened in February 1921 as the “Shropshire Orthopaedic hospital”.
This was really a beginning for orthopaedic nursing as we know it today. Adams (1997) acknowledges the special contribution Agnes Hunt made to the development of orthopaedic nursing:
“The great pioneer of orthopaedic nursing in Britain was Agnes Hunt. Her early career is reminiscent of Miss Nightingale herself as private wealth, a completely self-assured approach to public authorities and excellent political connections served to ease her path towards her desired goal. It is fascinating to speculate on the different path that the development of orthopaedic nursing might have taken if this nurse-led initiative had continued. … And Miss Hunt had not engaged the services of Robert Jones”.
Nursing in war
Like orthopaedic surgery, war has proved a major catalyst for the development of orthopaedic nursing and contributes significantly to its history. There are at least three very famous nurses who, one could argue, were the forerunners of trauma nursing. War features in many developments in health care and the latter half of the nineteenth and the first half of the twentieth centuries saw a good few.
Florence Nightingale is widely regarded as the grandmother of nursing. Her most famous contribution came during the Crimean War, which became her central focus when reports began to filter back to Britain about the horrific conditions for the wounded. Taylor (2001) identifies how she was working at the Middlesex Hospital, in central London when she volunteered to superintend the nursing of patients suffering from cholera. Troops in the Crimea were also ravished by cholera and a despatch from the newspaper correspondent Howard Russell convinced the Secretary of State at War, Sidney Herbert, that Miss Nightingale’s approach to nursing would be beneficial there. On October 21 1854, she and a staff of 38 women volunteer nurses, trained by Nightingale and including her aunt, Mai Smith, were sent to Turkey, some 545
km across the Black Sea from Balaklava in the Crimea, where the main British camp was based. Nightingale arrived early in November 1854 in Scutari. She and her nurses found wounded soldiers being badly cared for by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients. Most nurses know this story well.
Less well known, although improving, in the history of nursing is Mary Seacole. In 1854 Seacole travelled to England from her home in Jamaica and approached the war office to ask to be sent as an army nurse to the Crimea. Because of her ethnicity she was refused interviews with the war office as well as with Elizabeth Herbert, the wife of the secretary of state for war, who was recruiting nurses. Undaunted, Seacole funded her own trip to the Crimea where she established the British Hotel near Balaclava to provide ‘a mess-table and comfortable quarters for sick and convalescent officers’. On the battlefield she nursed the wounded and was known as ‘Mother Seacole’. After the war she returned to England, destitute and in ill health. The press highlighted her plight and money was raised through a grand military festival held over four nights at the Royal Surrey Gardens. The festival attracted thousands of people and was supported by Lords, military commanders and almost a thousand artistes. She was awarded the Crimean Medal, the French Legion of Honour and a Turkish medal.
In comparison to Florence Nightingale, Seacole did not come from a wealthy middle class background or have any formal training. Not only did she suffer from the restrictions placed on women at the time but she was also hindered in her nursing career by the colour of her skin. Despite these prejudices, she established herself as a pioneer of the nursing profession. While Florence Nightingale, it could be argued, was more of a nurse administrator, Mary Seacole was a true trauma nurse. She died in 1881.
The period which followed showed the development of military nursing services in many countries. In the UK a Naval Nursing Service was formed in 1884 followed by the formalisation of Army Nursing Services in 1889. Similarly in Canada nurses served with the military during the North-West Rebellion of 1885, although it was not until 1901 during the Boer War that nurses officially became part of the Canadian Army Medical Corps. The Australian Army Nursing Service was formed in 1898 and was also deployed to South Africa during the Boer War being officially recognised as a reserve of the Australian Army Medical Service.
The huge number of casualties in the First World War confirmed the need for trained nurses as part of the military medical organisation. Front-line casualty Clearing Stations could take up to 1,000 patients. Early surgical intervention improved mortality rates but required expert nursing. In New Zealand, a mass call-up of nurses severely disrupted civilian care and, as many of the nurses were senior, also affected nurse training. The individual nurse remembered from this era is recognised for her patriotism more than her nursing skills in spite of saying that she wished to be remembered as a nurse who tried to do her duty.
Edith Cavell was born in Norfolk 1865, trained at the London Hospital and by 1907 was considered a well-qualified nurse. In 1907 she was invited to develop a nurse training school in Belgium and was appointed matron of the Berkendael Institute in Brussels. The status of the school was enhanced by the Queen of Belgium, requesting a nurse from the Institute when she broke her arm and by 1914 the institute had achieved an international reputation and Edith was regularly teaching both doctors and nurses.
When World War I broke out, the hospital was taken over by the Red Cross. Nurse Cavell is alleged to have helped hundreds of soldiers from the allied forces to escape from occupied Belgium to the Netherlands, in violation of military law. In 1915, she was arrested and court-martialled by the Germans for this offence. UK and US diplomats disagreed about whether anything could be done to help her case, with Sir Horace Rowland, from the Foreign Office suggesting “I am afraid that it is likely to go hard with Miss Cavell, I am afraid we are powerless.” The sentiment was echoed by Lord Robert Cecil, who joined the coalition government in 1915 as an under secretary for foreign affairs after working for the Red Cross. “Any representation by us,” he advised, “will do her more harm than good”. She made no defence, being questioned for only five minutes, admitted her actions and was executed by firing squad at 2am on October 12 the day before her fiftieth birthday.
She immediately became a popular martyr, entering British history as a heroine. Edith Cavell’s case became an important article of British propaganda throughout the war and 40,000 new recruits joined the army in the week following her execution. Canada named an impressive mountain and lake in the Jasper National Park, Alberta after her. In the UK today Edith Cavell is not remembered in the same way as Florence Nightingale but these were all pioneering women, what ever history tells us about them.
Ordinary nurses were active in all theatres of war during the First World War and ironically Taylor (2001) describes the arrival of British nurses in Basra in 1916, where the fight currently goes on. A recent article (Philpott, 2007) describes modern military nursing that still has some reliance on the field hospital, but also quickly airlifts military personnel back to the UK for care.
In the UK the Royal Air Force Nursing Services were formed in 1918, whereas New Zealand nurses were and still are seconded to the other forces from the Army Nursing Service. Other surprising anomalies between the services are evident throughout their history. Canadian nurses were given commissioned status from the outset, during the Boer War. By the First World War there was a huge range of nursing services in the UK varying from the trained commissioned officers to the Voluntary Aid Detachments (VAD). New Zealand nurses were given commissioned status in 1942 although Australian nurses remained non-commissioned. Canadian nurses were not allowed to fill posts involving flying duties although they had been given air evacuation training with the American nurses in Kentucky.
No great heroines emerged in the Second World War although nurses were again deployed in all theatres of war. Compulsion was used in Australia and Britain to enhance the distribution of women’s labour, including nursing; voluntary recruitment campaigns were confined to Canada (Strachan, 1997). Remuneration was poor and the development of the military ‘obedience’ philosophy continues to this day. However it could be argued that good nursing care at the many stages of evacuation in hugely varied theatres of war was a major contribution to the 94% survival rate of UK casualties who reached Casualty Clearing Stations (Brayley, 2002).
Conclusion
The individuals described in this article are characters in a fascinating story; giants in the history of orthopaedic and trauma care. It is important to remember that they are not the only players on this stage and many nurses contributed to the improvement of these early services. They do, however, provide a fascinating insight into how leadership, talent and selfless effort have made orthopaedic practice some of what it is today.
References
- . From crippledom to orthopaedic nursing: Pyrford 1908–1945. History of Nursing Journal. 1997;2(4):23–37
- . World War II Allied Nursing Services. Oxford: Osprey Publishing; 2002;
- . The early days of orthopaedic nursing in the UK – Agnes Hunt and Baschurch. Journal of Orthopaedic Nursing. 2000;4:55–58
- . Battlefield nursing. Nursing Standard. 2007;21(32):78–79
- . Employment conditions for nurses in Australia during World War II. In: Rafferty AM, Robinson J, Elkan R editor. Nursing History and the Politics of Welfare. London: Springer; 1997;Chapter 11
- Taylor, E., 2001. Wartime Nurse: 100 Years from the Crimea to Korea, Isis Oxford.
PII: S1361-3111(08)00006-X
doi:10.1016/j.joon.2008.02.005
© 2008 Elsevier Ltd. All rights reserved.
