Australian Nurses in World War One, Arthur Butler

Medical and nursing sisters of 3rd Australian General Hospital (3AGH) in the tent lines with patients, 1915. Source: www.awm.gov.au/collection/J01438/

When the call first went out in 1914 for nurses to help the Australian war effort their sphere of operation was confined to serving in General Hospitals at the base of operations. As a result nurses did not get to work on the wounded until the first bandaging and treatments had already been performed near the front lines.

By the end of the war this had changed drastically and female nurses were regarded an essential element in the whole process of evacuation of wounded from the war front. By then they provided major therapeutic intervention in the field, at casualty clearing stations, then throughout the course of treatment until the soldier’s discharge, and finally once they had returned home in convalescent hospitals.

Technically however these nurses were civilians, “attached” to the Army for special duties, and not soldiers, like the members of the Army Medical Services. This strange division of duties was a legacy from the earlier years when the nursing of the sick in peace and to some extent the wounded in war, remained a religious or semi-religious calling for women working in institutions like those founded in the 1600s by St. Vincent de Paul.

The modern system of nurses evolved in the Crimean War in 1854, when Florence Nightingale combined the existing religious devotion and discipline with scientific analysis and hygiene standards.[1] From the close of the Crimean War the history of sick nursing is one of education of every part of the community to new ideas as to the status and capacity of woman as trained nurses. In 1860 the Florence Nightingale Memorial Training School was established at St. Thomas’s Hospital, in London. The civil nursing profession and military nursing service grew side by side, and it is from them that the Australian nursing system, civil and military, derived.

The first nursing sisters to arrive in Australia were French members of a religious order.[2] After working for a time in Parramatta they established themselves In Sydney in 1857 where they founded the Free Hospital of the Sisters of Charity which evolved into St. Vincent’s Hospital.[3]  In the 1860s the improvement of the nursing staff was taken up by Sir Henry Parkes who wrote to Florence Nightingale to enlist her sympathy, and help establish a training school. On 4 October 1866, she approved the scheme, and in March 1868 a Lady Superintendent and five sisters arrived in Sydney. Miss Lucy Osburn was the Lady Superintendent; she was addressed as ‘Mam’ by the nurses, and to others was known as ‘The Lady’.

The development of the profession was then taken up by the Australasian Trained Nurses’ Association which originated in New South Wales and the Royal Victorian Trained Nurses’ Association in Victoria[4]. By 1914 the training of nurses was exactly organised and the standard rigidly controlled. By any comparison its scientific and practical standard was as high as any in the world.

When the First World War broke out notices were sent to all efficient and reserve Sisters asking them whether in the event of the Nursing Service being required they were prepared for (a) Home Service (b) Overseas Service. By the, second week in September arrangements were almost complete and in addition to the Efficient Sisters and Reserve Efficient Sisters, more than a hundred fully qualified members of the Australasian Trained Nurses’ Association were eagerly awaiting enrollment.

The occasion did not at the time arise for the general employment of the reserve as such. But with very few exceptions the members of the reserve at once volunteered for service abroad in the A.I.F., as large numbers of the general nursing profession. For a time preference for positions in the A.I.F. was given to members of the reserve and from it were selected the principal matrons, matrons, and most of the sisters that left Australia early in the war. The resolution that trained female nurses should accompany the A.I.F. was determined directly by the request of the British

The 1 and 2 Australian general Hospitals left after the first convoy of soldiers from Albany although an advance contingent of nurses on board to carry out duties on the troop transports. When the first General Hospitals left Australia in December, 1914, 100 nurses were sent in excess of establishment. With the great expansion of Australian Hospitals and other Medical Units in Egypt to cope with the invaliding from Gallipoli further large numbers of Nurses were sent overseas.

In the Gallipoli Campaign the sufferings of the wounded from the landing in the “black ships” on the voyage to Alexandria deeply impressed itself on the Australian public mind and led to the establishment of a quota of trained female nurses who became responsible for the ordering and oversight of all arrangements for the care of the wounded, and for the nursing and “dressing” of serious cases.

The following nurses were attached for duty on the H.S. Guildford Castle on July 5th, 1915: V. Woinarski, M. Brown, A. King, E. Vierk, C. Sorensen; Lyons B. Loughrey. Sister E. R. Collins comments show her appreciation of their work … Their devotion to duty was most marked, they are splendid medical and surgical nurses, and proved loyal and willing workers. Their discipline was good-they never once questioned an order given-and they are able to rise to emergencies and proved adaptable under varied conditions.

With the reduction of A.A.M.C. Medical Units in Egypt, there were many Nurses in excess of the establishments. Instead of returning those who were not wanted to Australia, they were placed at the disposal of the Imperial Authorities where they worked in many Imperial Hospitals in Egypt and elsewhere.

In May 1915 No. 3 and in August 1916 No. 14 Australian General Hospitals each of 1,040 beds were sent overseas. Each was organised and staffed for a normal reception of patients almost twice-and in expansion three or four times as great as that of most large public hospitals. On 3 October 1915 there had reached England No. 10 General Hospital which was to have been completed in England but was broken up there. It brought 58 nurses who went to Epsom, Wandsworth, and other British hospitals.

In April, 1916, Nos. I and 2 General Hospitals and Nos. I and 2 Casualty Clearing Stations went with the infantry to France. During the process of settling in, the nursing staffs were distributed among various British hospitals. Australian medical affairs in Egypt were for a time administered by Major D. S. Mackenzie, from General Howse’s staff. In August 1916, on the initiative of the War Office, 50 of the surplus nurses in Egypt were sent to Bombay. Another 100 were sent from Australia to meet the needs of the sick and wounded from the operations in Mesopotamia.

In the Gallipoli Campaign the sufferings of the wounded from the Landing in the “black ships” on the voyage to Alexandria so deeply impressed the public mind that In the hospital ships and hospital carriers were sub- Gallipoli c,paien stituted for “black” transports. Each hospital ship had its quota of trained female nurses, and to these, under the medical officers, was passed responsibility for the ordering and oversight of all arrangements for the care of the wounded, and for the nursing and “dressing” of serious cases.

Since May 1915 the centre of activity for Australian nurses in England was at No. I Auxiliary Hospital at Harefield and with the arrival of the Australians on the Western Front the Nursing Service in England gradually increased. No. 2 Auxiliary at Southall to receive 500 patients and its nursing staff soon grew to 40 nurses. No. I at Harefield had accommodation for 900 and a nursing staff of 50 nurses, while No. 3 Auxiliary, which was opened at Dartford, soon extended to take 1,200 and employed 63 nurses. Smaller hospitals were also opened for officers and nurses.

The flow of casualties after the Pozieres operations was so great that many partially fit had to be accommodated in the Command Depots. No. 2 Command Depot at Weymouth grew to accommodate 8,000 patients and its nursing staff included 11 A.A.N.S. nurses. The most important nursing work was carried out in the General Hospitals at the Expeditionary bases where work embraced every variety of surgical and medical nursing.

The change in the military status of the Casualty Clearing Station from a clearing house to the forward centre for scientific treatment was another significant change in the way nurses worked. Initially these clearing stations did not employ nurses but soon their expertise was recognised as being invaluable and work was intimately bound up with the surgical team. The sort of work that the sisters were called upon to do varied very greatly.

The following account is from the diary of Sister Belstead …. the Matron took me to some huge marquees and said she wanted all the patients dressed before 10 a.m. “Can you get them done Sister,” she asked. I looked at the stretchers-in long rows everywhere, “I’ll try” I murmured. But in spite of trying I was not able to do it and another sister came along to help me. . . . 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. One realised this was war indeed. 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.

At the battle of Bullecourt the No.3 Casualty Clearing Station had 17 nurses and by the Third Ypres battle this increased to 34, including 12 team sisters. Six surgical tables were kept constantly going and the hospital included English, Canadian, American and Australian teams.[5] The following statement by Sister B. Belstead probably puts the general point of view of the nursing service … I am strongly of the impression, from my own experience, that sisters are required at Casualty Clearing Station. The cases will not get the treatment they really require from orderlies, who have not the training required. The cases would bleed, for example, and not be looked after really well. The boys when on their own, or the majority of them, are helpless for really bad cases, which would often get into a serious condition without this being noticed. It is not men’s work unless specially trained; and they feel it so. Of course we could not have done without orderlies … I was at “Nine Elms” (No. 3 A.C.C.S.) first, till we left in a hurry when the place was badly shelled. We had a very comfortable time at the C.CS. I found things much more comfortable at C.C.S. than at No. 3 A.G.H., Abbeville. We had plenty of coal, etc. You could get things so much easier; get anything you wanted; the nearer the front the easier to get things. Work was very heavy in patches, worse than in a General Hospital but at times almost empty. I was in the theatre a good lot of the time, and at busy times we had a day and part of the night without stopping.

The A.I.F. nurses attached to the British served chiefly (in order of numbers) in India, Salonica, and France. The first batch of nurses who reached India from Egypt in July 1916 they were distributed to the various garrison hospitals. By the end of October 1916 some 148 A.A.N.S. nurses were serving in the various hospitals in India. On 6th October 1917 the War Office cabled to the Defence Department for trained nurses for the expansion of units in India. The Minister for Defence approved and by December 1917 five large war hospitals were staffed entirely by Australian nurses.

Compiled from Arthur Butler, Official History of the Australian Army Medical Services, 1914–1918, Volume 3, Special Problems and Services, 1st edition, 1943

References
[1] Butler, Arthur Graham , Official History of the Australian Army Medical Services, 1914–1918, Volume 3, Special Problems and Services, 1st edition, 1943, 524
[2] Sisters of the Good Samaritan, Catholic Freeman’s Journal. 25 April, 1935, http://trove.nla.gov.au/ndp/del/article/146398356?searchTerm=sisters%20parramatta%201857&searchLimits=l-category=Article
[3] Saint Vincent’s Hospital, Not withstanding the many demands made on the benevolence of the public during the last year, it is gratifying to notice that the subscriptions towards the founding of the Hospital under the care of the Sisters of Charity continue in an encouraging condition. We perceive from the Treasurer’s account, published in our last issue, that the sum of £1291 7s was received during the year, leaving a balance of £439 9  on hand after paying several items of expenditure and a portion of the purchase money of the retired and salubrious house and grounds of Tarmons. We have no doubt but the remainder of the purchase money, £4000, will be paid off within a few years under the untiring exertions of Mr. and Mrs. Plunkett, and of the other benevolent and zealous ladies and gentlemen who have entered heart and soul into the noble work of founding a Free Hospital for the sick poor. We feel great pleasure in copying from our contemporary the Empire, the following very correct and creditable notice of this Institution: — Free Hospital of the Sisters of Charity. It is difficult, amid the bustle of political and economical warfare, to obtain attention to plans and institutions that have for their object no worldly triumph, no progress in material civilization, but only the unobtrusive task of relief to suffering humanity — a task which is brilliant only in the eyes, and dear only to the heart, of Christian faith and love. And yet hospitals come very near to the interests of very many. Especially in a country like this, there must be numbers to whom the thought that there is at hand, should they be overwhelmed by sudden violence, or sickness, an asylum in which their couch of insensibility, or pain and weary helplessness, will be tended by those who have higher motives than money, however honestly earned, and spirits tempered to that union of- delicacy and patient strength which Christian self-sacrifice alone can give: there must be many here to whom this thought will give especial satisfaction, and these will be glad to hear that the Hospital of the Sisters of Charity has already made fair progress in its beneficent work. Fifty patients attend the house for medical advice and relief; and the sick ward, though not at present large nor full, has its grateful occupants ; and from all quarters we hear of the kindness and assiduity with which Dr. Robertson, the excellent medical officer of the house, employs his skill for the relief of the sick. The sisters have in him a most zealous minister and emulator of their charity. He is an admirable specimen of a noble and benevolent profession, and no doubt finds that the religious atmosphere in which his patients live gives a twofold medicinal energy to those external means and appliances, in the diligent use of which Al mighty God has generally bound up his blessings of bodily relief and health. We venture to predict a rapid increase of calls upon the resources of this house, and trust that the public will see how well and effectively their charity is there dispensed. Everything is in its favour — a most salubrious and peaceful situation, talented medical advisers, and nurses who nurse for the love of God. Freeman’s Journal, 29 November 1857, http://trove.nla.gov.au/ndp/del/article/115562466?searchTerm=st%20vincent&searchLimits=l-decade=185
[4] They amalgamated into one body in 1933
[5] Butler, Arthur Graham , Official History of the Australian Army Medical Services, 1914–1918, Volume 3, Special Problems and Services, 1st edition, 1943, 5258