Monday, May 23, 2022

The nurses – Part 1

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Warwick O’Neill, Military Historian

In 1854, British forces were involved in the Crimean War against Russia. In general it was a poorly run affair, with the highlight of incompetence being the Charge of the Light Brigade, a military disaster that resulted from petty jealousy and clueless command. One result of this poor management, was the shocking treatment of the sick and wounded at the hospital at Scutari. Many soldiers died simply through lack of proper hygiene and care.

In England a young lady by the name of Florence Nightingale read of the conditions and wanted to do something about it. As a high-bred lady of Victorian England, society’s expectations of her was to marry well, breed well, and produce many little upper-class mud-magnets for her husband. Fortunately for the world at large she said, in what I assume was a well-educated and well-enunciated voice “Bugger that. You can shove your Victorian standards up your Kyber. I’m off to the Crimea.” Or words to that effect.

In doing so, she laid the foundations for what would become the expected standard for military nursing through the remainder of the 19th century and throughout the 20th century.

Sixty-one years after she lobbed in the Crimea, women from the newly created nation of Australia would honour Miss Nightingale’s example and follow their countrymen into the most destructive conflict the world had seen, and would continue to do so in every conflict since, ultimately becoming the Royal Australian Army Nursing Corps.

The Royal Australian Army Nursing Corps, not to be confused with the Royal Australian Medical Corps, has been following Australian soldiers, sailors and airmen around the world for over 100 years. You can be forgiven for thinking that the Nursing Corps began with the 1st AIF in World War 1 and it’s perfectly ok to think that….. because that’s exactly what I thought. But like many of us I forgot about that little war which occurred about 15 years before. You know, that South African one, the Boer War? I wrote a book set during that war and even I forgot about it when I first began research for this episode. But anyway, onwards.

The genesis of what would become the Nursing Corp was in 1898 when a small Army Nursing Service was formed in Sydney on 13th August. It consisted of one Lady Superintendent and 24 nurses and were something of a reserve ‘just in case’ kind of set up. The ‘just in case’ became ‘just as well’ a year later when the Second South African War, more commonly known as the Boer War kicked off.

Australia was still a collection of British colonies at the outbreak of the war, so rather than heading over as a combined Australian force, each colony sent its own contingents. The NSW and Victorian mobs decided to send detachments of nursing sisters to accompany the troops. And just to show how generous the authorities were at the time, many of the nurses had the privilege of covering their own expenses – ie they had to get themselves there. Nice huh? But keep in mind this was not yet 50 years since Young Flo lobbed in the Crimea and the military Old Boys Club were still trying to wrap their heads around the concept of women serving in military roles.

The initial detachment of nurses totalled 14, but over the following three years, nurses from the other colonies joined their sisters and a total of 60 would eventually serve in South Africa. Upon arrival they were scattered throughout the country to serve in various British Military hospitals, tending a few wounded troops, but mostly taking care of sick and diseased men. It appeared that not much had been learned from the Crimean experience and many of the hospitals were an unhygienic mess. Many patients suffered from typhoid, contracted through contaminated water, just as they had at Scutari.

In general the nurses were aged between 25 and 40 and all were unmarried. Like their brothers in uniform, they shared a sense of loyalty to the Empire and just like their brothers they suffered the same prejudices from the British military establishment. All of them were viewed as mere colonials, although their skills were often rated highly. Three nurses, Matron Martha Bidmead, and Sisters Elizabeth Nixon and Marianne Rawson, would be awarded the Royal Red Cross for their service.

Sister Fanny Hines of Victoria has the dubious honour of being the first Australian nurse to die during overseas service. Her friend, Sister Anderson, wrote “she died of an attack of pneumonia contracted in devotion to duty. She was quite alone, with as many as twenty six patients at one time, no possibility of assistance, or relief and without sufficient nourishment.”

Paints a pretty grim picture of the conditions the nurses faced. Unfortunately Sister Hines would not be the last to lose her life. Over the following century others would die of disease, some from wounds of their own and some through atrocities committed by enemy troops.

At the end of the war the Federal Government gave consideration to the implementation of a Nursing Reserve, consisting of trained nurses who were qualified and willing to serve in Field Hospitals and Base Hospitals when required. The reserve became reality on 1st July 1903.

At the outbreak of war in August 1914, waves of volunteers came forward to serve in the Australian Imperial Force (AIF) and it wasn’t only the blokes rushing forward. Those ladies who satisfied the criteria also came forward with just as much enthusiasm. Those in the reserve were called up and any others who were suitably qualified, and single, were accepted. Yes, they had to be single. I mean obviously keeping the family house clean was of more vital importance than helping to treat sick and wounded soldiers. Fun times.

Anyway.

All around the country training grounds sprung up to accommodate the eager volunteers flocking to the colours. As you’d expect, whenever a bunch of blokes congregates together in great excitement like this, occasionally their exuberance will lead to injury. The ladies of the Nursing Service would get good practice in dealing with the young men they would be responsible for patching up on foreign fields. A strong bond would develop between the soldiers and the nurses, with many nurses identifying with a specific battalion.

For example Sister Alice Kitchen, the nurse who Patsy Adam Smith follows in her book Anzacs, strongly identified with the 8th Battalion from Victoria. The early days of her diary, on the transport ships and while training in Egypt, are full of accounts of pleasant evenings spent with the officers of the 8th, her interactions with the young men and the excitement of what they were all undertaking.

All too soon the tone of her entries will change entirely.

An early 1900s map of Istanbul and Gallipoli.

By mid-April it was obvious that there were doin’s a transpirin’ as troops were being moved on from the training camp.  Now, one of the many books about Gallipoli that I have at home contains a very compelling insight into what it was like for nurses on the hospital ship, the Gascon on that first day. But of course now that I want to quote from it, I can’t find it. So I’m going to have to paraphrase.

In describing the chaotic conditions on board, the Sister tells how she had been sent to a section of the ship by one of the surgeons. On the way she comes across a young soldier, on his own, looking for someone to help him. She says “a young man, little more than a boy, stood in front of me holding his eye in his hand. The eye was still attached and the poor man was hoping for some kind of assistance. In the bustle of activity I couldn’t think of anything else to do, so I took my scissors, cut the eye loose and directed him to find an orderly to bandage him up.  I left him standing there, holding his eye, as I continued on the other end of the ship.” The Sister in question was in her early 20’s, on a ship on the other side of the world, surrounded by seriously wounded men. It was a far cry from nursing in a clean, calm hospital back in Australia.

The hospital ships hung around off the Coast until their replacements arrived and then headed off to the hospital at Alexandria. Here other nurses, including Sister Alice Kitchin took over their care. The reality of war quickly sunk in and gone were the light-hearted diary entries. Now her records contained comments such as “It is all too dreadful and every day we hear of someone we knew being killed or wounded.” Or “Another poor abdominal died tonight, had no operation. If they are operated on they die and they mostly die if nothing is done.” Before long, Sister Kitchen was taking her turn on the ships.

Due to the distance from Gallipoli to Alexandria, about 1000 kms, field hospitals were set up on the nearby islands of Imbros and Lemnos. The conditions for the 3rd Australian General Hospital on Lemnos were very inadequate for the first couple of months. The few available tents were given over to the wounded, meaning many of the nurses slept outdoors. As tents started to arrive, conditions improved a little, but there were always constant shortages of just about everything. One theme runs through most of the diary entries from the nurses on Lemnos – the lack of water.

Lemnos Island, Greece.

On 9th August as the wounded from the August Offensive from places like Lone Pine and The Nek began to arrive, Matron Wilson noted – “150 patients lying on the ground, no equipment whatever. Had no water to drink or wash.”

The 3rd AGH was set up on a barren, exposed patch of ground and as summer turned to Autumn conditions got even worse. Nurse Louise Young described what it was like as the Autumn storms blew in. “Hardly a night or day did not pass that a tent did not collapse altogether. I don’t think I shall ever get over my dread of wind again, night after night, every bit of canvas creaking, shaking, straining and your mind always wondering which would collapse next.” Hardly a ringing endorsement.

Despite it all, these amazing women continued to provide the best possible care to the wounded soldiers. Without doubt many would have died without the dedicated attention delivered by exhausted, hungry, thirsty and sometimes grieving women. In many cases the nurses had brothers, cousins and friends in the firing line just a few miles away, any one of which could be on the next stretcher bought on board the ship or through the tent flap at the hospital.

But just as it was for the soldiers, Gallipoli was just the entree for the nurses. France awaited most of them, while others followed the Lighthorse to Palestine where their stories continued.

Australian nurses moved first into hospitals in England at Harefield and Southall, and then to field hospitals in France. They were mostly accommodated in Nissen Huts, prefabricated corrugated iron accommodation. Think of an old water tank laid on its side and cut in half. Not exactly the Ritz.

During the Australian attack at Pozieres, wounded men would receive initial treatment at the casualty clearing station by medical corps men before being moved back to the hospitals. There was usually a significant timeframe between CCS and the hospital and during that time the blood and mud dried out and the bandages were almost literally glued to the wounds. It was up to the nurses to remove these bandages and bits of uniform before the doctors could do their work.

Sister Belstead described the work.

The next few days was a continuous stream of wounded each one seemingly as bad as could be. Eight theatre teams working day and night yet it seemed impossible to cope with things; and the men were such bricks, lying on their stretchers waiting for their turn on the operating table.

If one had time to think we would have just been weeping hysterical women but we’d only time to do. It was only afterwards that one thought and realised how as a matter of necessity we had done little or nothing for those who had died.

In the early stages, nurses went no further forward than the field hospitals, but as techniques improved with the treatment of wounded troops at the CCS, it became clear that the expertise of the nurses was invaluable and some were soon sent forward to assist surgical teams. For the first time, nurses were close enough to the front line to be at direct risk of injury themselves.

On the night of 22 July 1917, Clare Deacon was serving with the 2nd Australian Casualty Clearing Station at Trois Arbres near Armentieres when an air raid warning was sounded. Rather than taking shelter in the bunkers, Clare, who was off duty at the time, and two other nurses ran into the hospital to rescue patients. They risked their lives by evacuating them from the burning building while the station was being bombed.

Later in England, Clare was awarded the Military Medal which was personally pinned on by King George V.

In July 1917, Sister Rachael Pratt was on duty at a casualty clearing station in Bailleul, when a German bomb exploded near her tent. She was hit in the back and shoulders by flying shrapnel which punctured her lung. Despite being seriously wounded herself, she continued to care for her patients, making sure their wounds were treated……right up until she collapsed. She was awarded the Military Medal for her “bravery under fire”. Following surgery in Britain, Pratt was posted to various Australian auxiliary hospitals there before returning to Australia at the end of the war. As a result of her war service, she suffered from chronic bronchitis for the rest of her life.

These are just a couple of examples of the bravery of these nurses. But of course these were only the exciting adrenaline pumping examples. Day in, day out in both the CCS and field hospitals these women faced the hardships and horrors of seeing broken, bloodied and dying men. The long hours, poor diet and primitive living conditions pushed the nurses to their physical and mental limits. But they still forged on, a different but just as impressive kind of courage.

The other main area in which Australian nurses served was the North Africa Campaign, following the ANZAC Mounted Corp through Sinai and Palestine. Unfortunately records relating to these nurses and the conditions they faced are as rare as rocking horse sh…manure.

Like their counterparts on the Western Front, they were still dealing with wounds from bullets and bombs. There was less mud, but the desert bought its own unique challenges. Small cuts often festered into desert sores and although not debilitating in the main, proper treatment was required in order to keep men fit for fighting.

The desert war was more mobile than the Western Front. As the fighting moved on, the wounded had further to go to reach the hospitals, being bounced around in ambulance carts over rough tracks. As you could imagine, that kind of movement wouldn’t do much for broken bones or recently stitched up wounds. Again it was the nurses who treated these men when they finally arrived and had to deal not only with the result of the fighting but also the results of the rough journey.

One lady who does have at least some mention in the records is Matron Rose Creal of 14th Australian General Hospital. The letters and postcards of nurses who served under her at 14 AGH describe a matron who was kind, firm and just. One new recruit to the 14 AGH wrote to her mother: ‘Matron is so good to our girls tho’ we won’t admit it to anyone.’ Once acute casualties were appropriately managed, Creal allowed her nurses to care for their sick or wounded brothers, friends or loved ones. She attempted to give her nurses additional leave when they had friends or brothers in town on military leave.

At an administrative level Creal had the double task of keeping the two Australian matrons-in-chief (Miss Tracey Richardson, Melbourne, and the matron-in-chief in England, Miss Evelyn Conyers, Horseferry Rd, London) fully informed. She was also responsible for chaperoning white, Christian women in a religiously diverse country as they cared for thousands of men. She was a disciplinarian but staunchly defended any accusation of misconduct laid against her nurses with vigour. 

For her services in Egypt Matron Creal was awarded the Royal Red Cross (1st Class)

Creal’s 14th AGH had an average of 30 nurses at any given time. In November 1916 they were responsible for about 570 patients. Following heavy fighting at Magdhaba and Rafa that number rose to over 900 and by May 1917, after the battle of Gaza, to 1140. Compare that to the modern nurse to patient ration of around 1 nurse to every 4 patients and you get an idea of the workload.

During the First World War Australian nurses served in 192 locations in Egypt, Lemnos, England, France, Belgium, Germany, Italy, Greece, Turkey, Salonika, Palestine, Mesopotamia and India, as well as on 39 ships.

There is no complete official nominal roll of nurses for World War One so it is difficult to determine the exact number of Australian nurses who served. According to the Australian War Memorial 2,139 nurses served with the Australian Army Nursing Service, and 130 with the Queen Alexandra Imperial Military Nursing Service.

Of those nurses who served overseas for whom there are detailed statistics, seven were under 21 (despite the official minimum age being 25), 1,184 were aged 21–30, 947 were aged 31–40, and 91 were 41 or older.

25 nurses died from injuries or from disease whilst on active service, and 388 were decorated for “bravery in the face of danger.”

Initially I thought I’d be able to cover the entirety of Australia’s military nursing involvement in just this one article. How wrong I was dear reader. But if nothing else I am flexible, so I’ll be breaking it up into two articles. We will pick up the story line of the amazing women, later to be joined by amazing men, who have made up the Australian Army Nursing Corps next time.

Related story: The nurses – Part 2

Other military items by the author, Warwick O’Neill, can be found at: https://www.australianmilitaryhistorypodcast.com/
You can read more about the author, Warwick O’Neill, here.

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