‘A very valuable fusion of classes’: British professional and volunteer nurses of the First World War

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‘A very valuable fusion of classes’: British professional and volunteer nurses of the First World War Christine E. Hallett Professor of Nursing History, The University of Manchester, UK

Public perceptions of the work of nurses and VADvolunteers in the First World War have been heavily influenced by a small number of VAD-writings. The work of trained, professional nurses in supporting and supervised the work of VADs has been largely overlooked. This paper examines several of the writings of both volunteers and professionals, and emphasises the overlooked supervisory, managerial and clinical work of trained nurses. In this centenary year of the First World War’s opening months, the paper also explores the ways in which the British mass-media - notably the BBC - have chosen to cling to a romantic image of the untrained nurse, whilst at the same time acknowledging the significance of trained, professional nursing. Introduction For more than four years, from August 1914 until the spring of 1919, teams of British nurses cared for millions of wounded and sick soldiers in military hospitals on every war front. Those who nursed the casualties of the First World War were a combination of trained, professional nurses, volunteers known as ‘VADs’ and military orderlies. The role of the trained professionals was to design plans of care and treatment and systems for delivering them to almost overwhelming numbers of casualties; to implement complex nursing care; and to supervise VADs and orderlies in performing many apparently more mundane tasks. In actual fact, though, what appeared to be mundane – the washing, toileting and feeding of often-helpless patients – was highly skilled work, requiring careful training and close supervision, as well as an educated understanding of human nature. The care and treatment required by soldiers many of whose wounds were extensive and traumatic was far from straightforward, and the work of nurses was a complex combination of fundamental nursing care and highly technical treatments underpinned by scientific reasoning.1 Much of this work was invisible. It took place behind screens in hospital wards, and professional nurses rarely Corresponding author: Hallett, C.E. ([email protected]). On the work of nurses during the First World War, see: Christine E. Hallett, Containing Trauma: Nursing Work in the First World War (Manchester, Manchester University Press): passim. Available online 12 June 2014 1

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wrote about it. Hence, much of what is known has been taken from the memoirs of VADS. Some, such as Vera Brittain’s Testament of Youth gained a large readership because of the significance of their contribution to our understanding of the war and its impact.2 Yet they have also had a distorting influence on our perceptions of nursing, because they are written from the perspective of the untrained volunteer with neither authority nor responsibility in the military hospital ward. This paper exposes some of the distortions which have resulted from this somewhat skewed perspective, and explores the realities of the working relationships between nurses and VADs. Arrogant aristocrats and diffident ladies British cultural perceptions of nursing during the First World War are replete with contradictions. One of the most powerful of these is reflected in widely differing accounts of volunteer-nurses’ behaviour. If volunteers can be categorised as ‘types’ (which, in itself, is highly dubious, given that their individualism was reported to be one of their most prominent features) then the two who stand out most clearly are the wealthy and powerful hospital director and the diffident, ladylike and apparently powerless young VAD. The classic archetype of the first category is Millicent, Duchess of Sutherland (Figure 1), known in her own time as ‘meddlesome Millie’,3 whilst the latter is usually represented in the popular consciousness by author, Vera Brittain (Figure 2).4 Yet a closer examination of the lives and work of both women reveals that the Duchess of Sutherland was neither so authoritarian, nor Vera Brittain so oppressed, as has been assumed.

2 Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900– 1925 (Virago Press, London, 2004 [1933]). See also: Irene, Rathbone, We That Were Young. A Novel (New York, The Feminist Press, 1989 [1932]); Bagnold, Enid, A Diary Without Dates, (London, Virago, 1978 [1918]). 3 Millicent’s memoir of her work in Belgium was published in 1914 as: Millicent, Duchess of Sutherland, Six Weeks at the War (London, The Times, 1914). See also Denis Stuart’s biography: Denis Stuart, Dear Duchess: Millicent Duchess of Sutherland (1867–1955) (Newton Abbot, David and Charles, 1982). 4 Vera Brittain’s memoir was published in 1933; her original diary, from which the memoir was compiled, was first published in 1981: Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900–1925 (Virago Press, London, 2004 [1933]); Vera Brittain, Chronicle of Youth: Great War Diary Edited by Alan Bishop (London, Phoenix Press, 2002 [1981]).

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Figure 2. Portrait photograph of Vera Brittain.

Figure 1. Portrait of Millicent, Duchess of Sutherland, by John Singer Sargent.

The impression that wealthy women with very little training were among the first ‘nurses’ to find their way to the ‘front lines’ of the First World War has been created largely by the exploits of units such as the Millicent Sutherland Ambulance, whose adventures in Namur during the earliest months of the war were recorded by Millicent herself in her brief memoir, Six Weeks at the War, a book which is part propaganda, part ‘girls-own-adventure’ story and part document of the unit’s work.5 The exploits of amateur units such as this one aroused much opprobrium in the nursing press of the time,6 but the idea that Millicent had, in fact, simply ‘swanned’ across the English Channel to the continent to lead a British unit as part of the allied war effort was somewhat misleading. Her earliest, albeit brief, nursing efforts had taken place in a French military 5 Millicent, Duchess of Sutherland, Six Weeks at the War (London, The Times, 1914). 6 See, for example: Anonymous, ‘Is it Just?’ British Journal of Nursing, 53, (4 July 1914): 22; Anonymous, ‘Letters to the Editor, British Journal of Nursing, 53 (19 December, 1914): 497. These and other letters of complaint to the nursing press are cited in: Hallett, Christine E., ‘‘Emotional Nursing’’: Involvement, Engagement, and Detachment in the Writings of First World War Nurses and VADs’, in Fell, A.S. and Hallett, C.E. (eds.), First World War Nursing: New Perspectives (New York, Routledge, 2013): 87–102.

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hospital. No British military medical unit had admitted ‘amateur nurses’ to travel overseas in the early months of the war. It was only after she had recognised the need for more trained nurses to care for French and Belgian wounded that Millicent assembled her unit, and it was not until October 1915 that her hospital was brought under the auspices of the British Red Cross and began to care for British and Dominion soldiers (Figure 3).7 There was something very troubling for professional nurses about wealthy volunteers, who established their own field hospitals and wrote of their nursing experiences. Such volunteers were often from aristocratic backgrounds, and had been imbued with the confidence that a ‘ladylike’ upbringing brought with it. Not only were they accustomed to giving orders to a wide-ranging staff. They also believed that their high status conferred on them a nurturing capability: they believed they were ‘natural nurses’.8 When Millicent established her first field hospital at Namur in the autumn of 1914, she took it for granted that she would work alongside her eight fully-trained Guy’s Hospital nurses. When the first wounded arrived, she was, initially 7 Millicent, Duchess of Sutherland, Six Weeks at the War (London, The Times, 1914): 1–7. 8 On female volunteer nurses of high social status, see: Summers, Anne, Angels and Citizens: British Women as Military Nurses, 1854–1914 (London, Routledge and Kegan Paul, 1988): 237–70; Ouditt, Sharon, Fighting Forces, Writing Women. Identity and Ideology in the First World War (London, Routledge, 1994): 7–46; Vining, Margaret and Hacker, Barton, ‘From Camp Follower to Lady in Uniform: Women, Social Class and Military Institutions before 1920’, Contemporary European History, 10, 3 (2001): 353–73; Watson, Janet S. K., ‘Wars in the Wards: The Social Construction of Medical Work in First World War Britain’, Journal of British Studies, 41 (2002): 484–510.

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Figure 3. Millicent, Duchess of Sutherland receiving a visit from King George V and Queen Mary at her hospital near Calais.

taken-aback by the horrific nature of their wounds and diffident about her ability to engage with their pain and trauma, but later wrote in her memoir of how: What I thought would be for me an impossible task became absolutely natural: to wash wounds, to drag off rags and clothing soaked in blood, to hold basins equally full of blood, to soothe a soldier’s groans, to raise a wounded man while he was receiving extreme unction, hemmed in by nuns and a priest, so near he seemed to death; these actions seemed suddenly to become an insistent duty, perfectly easy to carry out.9 The idea that she found it so easy to slip into an effective nurturing role was difficult for the professional nurses of her time, because it belied the supervision she was undoubtedly receiving from the trained nurses in her unit, whose years of experience enabled them to steer her into the channels of safe practice with which they themselves were familiar, while at the same time permitting her to believe she was ‘in charge’. The skills practised by the deferential classes went well beyond those that were obvious, and nurses did far more than simply offer direct care and treatment to their patients. Managing one’s volunteers became an art in itself. Indeed, the management of untrained or semi-trained assistants of all kinds was an important skill for the military nurse, who was often obliged to depend upon ‘orderlies’ to carry out many of the essential tasks that took place within the hospital environment.10 Another equally wealthy, if less socially elevated hospital ‘directrice’, Mary Borden, was a Chicagoan, married to a British missionary and living in London at the outbreak of war. In the autumn of 1914, she left her three young daughters and, like Millicent, offered her services to the 9 Millicent, Duchess of Sutherland, Six Weeks at the War (London, The Times, 1914): 27. 10 Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014): Introduction.

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French Red Cross. After several months working under appalling conditions in a typhoid hospital in Northern France, Borden, too, decided to put her wealth to good use, establishing a field hospital at Rousbrugge near the Ypres Salient.11 Borden, like Millicent, was astute enough to hire some of the most highly qualified and experienced nurses of her day. Among her staff at L’Hoˆpital Mobile Chirurgical No. 1 were Agnes Warner, a Canadian nurse who had trained at the New York Presbyterian Hospital, and Ellen La Motte, a fully-trained nurse from the prestigious John’s Hopkins Training School for Nurses in Baltimore.12 Powerful women such as Millicent, Duchess of Sutherland and Mary Borden, along with others such as Mabel St. Clair Stobart, whose work in Serbia was recorded in a vivid and forthright memoir,13 have, rightly, received significant attention from women’s historians eager for evidence that early-twentieth-century women were throwing-off the shackles of nineteenth-century patriarchy and demonstrating their ability to make a meaningful contribution to their country’s war-effort.14 But the attention that was paid in the national press of their day to their apparently effortless governance of entire units of trained nurses meant that professional nurses saw them as usurping the authority of fully-trained and highly-experienced hospital matrons, and arrogantly assuming that their wealthy upbringing and genteel ‘breeding’ could replace three years’ hard training and 11 Mary Borden wrote two very different accounts of her work during the First World War: Borden, Mary The Forbidden Zone (London, William Heinemann Ltd., 1929); Borden, Mary, Journey Down a Blind Alley (London, Hutchinson and Co., 1947 [1946]): 5–13. See also Hazel Hutchison’s Introduction to: Borden, Mary, The Forbidden Zone, Edited by Hazel Hutchison (London, Hesperus Press, 2008 [1929]); Conway, Jane, Mary Borden: A Woman of Two Wars (Chippenham, Munday Books, 2010). 12 Agnes Warner and Ellen La Motte both wrote memoirs relating their work at L’Hopital Chirurgical Mobile No. 1: Anonymous, My Beloved Poilus (St. John, NB, Barnes and Co. Ltd., 1917); La Motte, Ellen N., The Backwash of War: The Human Wreckage of the Battlefield as Witnessed By an American Hospital Nurse (New York, G.P. Putnam’s Sons, The Knickerbocker Press, 1916). On the work of Borden and La Motte, see: Higonnet, Margaret, Nurses at the Front: Writing the Wounds of the Great War (Boston MA: Northeastern University Press, 2001). 13 Stobart, Mabel St Clair, The Flaming Sword in Serbia and Elsewhere (London, Hodder and Stoughton, 1916). See also: Smith, Angela, ‘The Woman Who Dared: Major Mabel St. Clair Stobart’, in Fell, A.S. and Sharp, I. (eds.) The Women’s Movement in Wartime: International Perspectives 1914–1918 (Basingstoke, Palgrave, 2007). For another classic example of a nurse-writer who created her own volunteerunit, this time an aid post close to the Belgian lines, see: Baroness de T’Serclaes, Flanders and Other Fields (London, George G. Harrap and Co. Ltd., 1964). Elsie Knocker, later Baroness de T’Serclaes, was a fully-trained nurse, but she did not choose to work with the official military nursing services. 14 Braybon, Gail, Women Workers in the First World War: The British Experience (London, Croom Helm, 1981); Higonnet, Margaret Randolph; Jenson, Jane; Michel, Sonya; Weitz, Margaret Collins (eds) Behind the Lines: Gender and the Two World Wars (New Haven, Yale University Press, 1987); Higonnet, Margaret and Higonnet, Patrice, ‘The Double Helix’, In Higonnet, Margaret Randolph; Jenson, Jane; Michel, Sonya; Weitz, Margaret Collins (eds) Behind the Lines: Gender and the Two World Wars (New Haven, Yale University Press, 1987): 31–47; Tylee, Claire, The Great War and Women’s Consciousness: Images of Militarism and Womanhood in Women’s Writings, 1914–64 (Houndmills and London, Macmillan Press, 1990); Cooke, Miriam and Woollacott, Angela (eds), Gendering War Talk (Princeton NJ, Princeton University Press, 1993); Higonnet, Margaret, Lines of Fire. Women Writers of World War I (Harmondsworth: Penguin, 1999); Cardinal, Agnes; Goldman, Dorothy; Hattaway, Judith, Women’s Writing on the First World War (Oxford, Oxford University Press, 1999); Smith, Angela, The Second Battlefield: Women, modernism and the First World War (Manchester, Manchester University Press, 2000); Smith, Angela, Women’s Writings of the First World War: An Anthology (Manchester, Manchester University Press, 2000); Higonnet, Margaret, Nurses at the Front: Writing the Wounds of the Great War (Boston MA: Northeastern University Press, 2001); Atkinson, Diane, Elsie and Mairi Go To War: Two Extraordinary Women on the Western Front (London, Preface Publishing, 2009).

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technical instruction in a fully-equipped hospital.15 And the focus on them in their own time drew society’s attention not only away from the professional nurses who were making their efforts possible but also from the tens of thousands of volunteer-nurses working as part of the Voluntary Aid Detachments, who were helping to establish auxiliary hospitals at home in Britain under the auspices and control of the Red Cross and the Order of St. John of Jerusalem (St. John’s Ambulance Brigade).16 In the spring of 1915, such VAD-nurses, as they came to be known, were admitted to military hospitals, which meant that many found their way to general hospitals in British military bases in Northern France. Three such volunteers – Vera Brittain, Irene Rathbone and Enid Bagnold – wrote particularly vivid memoirs of their time in military hospitals.17 Brittain’s Testament of Youth became so influential that it had a transformative impact on the British collective memory of the First World War, fixing the young, beautiful and vulnerable VAD in a nation’s cultural consciousness as a central figure in the history of the First World War. In March, 1915, Brittain had commented in her diary that she would like to try the ‘stern work’ of nursing, adding ‘surely the soul grows thereby’. At the Royal Devonshire Hospital, she found the military nurses ‘quite young and very kind’18, but at her first military posting, the First London General Hospital at Camberwell, she found herself almost as severely tested by the hospital’s military regime as by the heaviness of the work. She found many of the trained, professional nurses strict and overbearing. Her memoir demonstrates a high level of self-awareness, as, from the vantage-point of the early 1930s, she recognises her youthful desire to attain a heroic identity through the challenges presented by ‘dirty’ and potentially demoralising work. It also traces the despair she experienced when the disillusionment occasioned by the pettiness of military bureaucracy coincided with the grief of profound loss, after her fiance´e, Roland Leighton was killed on the Western Front. The traumas of the VAD The memoirs of VADs have proved powerful because of their vivid and moving references to the horrific suffering of wounded men during the war. They stand as important witness-testimonies: direct channels through which a sense of the real trauma of the First World War can be captured. Bases such as Boulogne and Etaples were like ‘cities of hospitals’ containing units of all kinds – from huge general military hospitals to smaller establishments run 15 Hallett, Christine E., ‘‘Emotional Nursing’’: Involvement, Engagement, and Detachment in the Writings of First World War Nurses and VADs’, in Fell, A.S. and Hallett, C.E. (eds.), First World War Nursing: New Perspectives (New York, Routledge, 2013): 87–102. 16 On the work of VADs, see: Thelka Bowser, The Story of VAD Work in the Great War (London, Imperial War Museum, 2003 [1917]); Sharon Ouditt, Fighting Forces, Writing Women. Identity and Ideology in the First World War (London, Routledge, 1994): 7–46; Lyn MacDonald, The Roses of No Man’s Land (Harmondsworth, Penguin, 1993 [1980]). 17 Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900– 1925 (Virago Press, London, 2004); Irene, Rathbone, We That Were Young. A Novel (New York, The Feminist Press, 1989 [1932]); Bagnold, Enid, A Diary Without Dates, (London, Virago, 1978 [1918]). 18 Vera Brittain, Chronicle of Youth: Great War Diary Edited by Alan Bishop (London, Phoenix Press, 2002 [1981]): 171, 229.

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by the Red Cross and Order of St. John of Jerusalem. At quiet times, patients would arrive at the base having already been washed and fed at casualty clearing stations and on hospital trains, but during ‘rushes’, many cases arrived still covered in the mud of the trenches and having received only emergency treatment.19 The experiences of nurses at such times could be quite harrowing. Volunteernurse Lesley Smith wrote of the physical, psychological and emotional pressures that base hospital staff could find themselves under during busy periods: [In one bed was a man with a face wound]. One eye had been enucleated and there was a leering cavity where the eye should have been. I had to pull rolls and rolls of filthy gauze out of that socket and then pack rolls of clean gauze, soaked in eusol, though the small hole. Just as I had finished, Sister called me to help her and I went to hold an amputation where there was a large pocket of pus above the wound that had to be cleaned. The man could no longer stand an anaesthetic every day, nor had any stamina left to bear the pain. Tears and sweat poured down his face before we began, and he whimpered helplessly as I lifted the stump. It was a horrible dressing. . . The men who were going to die usually came to us so ill that they only lasted for a day or two, but in those desperate weeks we had one case after another who might have recovered, whose lives we fought for, and who died in spite of us after days of agony.20 She describes a particularly poignant case – a patient she refers to as ‘Railton’ who dies on a day when her ward is particularly busy, making it difficult for her to give him the comfort he needs: ‘Sorry to keep you, Nurse – I won’t be long now – Am going fast, ain’t I?’ I choked and fumbled stupidly for a word, and finally managed to tell him to hold on, there might be a change at any moment. He just brushed that aside and still holding me with his eyes said: ‘I’m frightened, Sister. Is it all true what they say in church?’ His voice had dropped to an agonised whisper and I had to bend down to catch what he said. ‘Will I be forgiven?’ I tried to say what he wanted to hear and he slowly lifted his hand off mine and said ‘Thank you’. I fled down the ward to roll over the amputation’s head and prevent him choking himself.21 The tendency to dwell on the horror of confrontation with war was a feature of female volunteers’ writings and was not confined to those who nursed. Helen Zenna Smith’s somewhat dramatised account of the experiences of 19 Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014): Chapters One and Two. 20 Lesley Smith, Four Years Out of Life (London, Philip Allan, 1931): 122. 21 Lesley Smith, Four Years Out of Life (London, Philip Allan, 1931): 126.

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volunteer ambulance drivers dwells in detail on the gruesome sights and sounds to which many young women were exposed. In one episode, Smith, speaking in the voice of her diarist, exposes the true horror of war-injury: See the stretcher-bearers lifting the trays [sic] out one by one, slotting them deftly into my ambulance . . . a man is spewing blood, the moving has upset him, finished him. . . He will die on the way to hospital if he doesn’t die before the ambulance is loaded. . . It isn’t pretty to see a hero spewing up his life’s blood in public, is it? That man strapped down? That raving blaspheming creature screaming filthy words. Oh merely gone mad. . . See the man they are fitting into the bottom slot. He is coughing badly. No, not pneumonia. Not tuberculosis. Nothing so picturesque. Gently, gently, stretcher-bearers. . . he is about done. He is coughing up clots of pinky-green filth. Only his lungs. . . He is coughing well tonight. That is gas. You’ve heard of gas, haven’t you? It burns and shrivels the lungs to. . . to the mess you see on the ambulance floor there.22 Trauma can be clearly traced through the writings of British volunteer-nurses’ memoirs. It is also found in the writings of American and Canadian volunteers working for the French and Belgian military medical services. Such writings often have a sentimental tone.23 One woman who served with the French Service de Sante´, and was said to have obtained a full Red Cross ‘war-training’, wrote of the poignancy of the deaths she witnessed: In these days I have lost four, two peritonitis, one hemorrhage, one tetanus; and several others are in a desperate condition. I have never left my ward except for six hours’ sleep each night, and one hour yesterday when I walked behind the bier in the nurse’s post of honor. . . I haven’t the time nor the heart to tell you the tale of my days, but I tell you this, that I shall never get hardened to the last agonies and heartbroken families. And when my little No. 23 flung out his arms last night to say, ‘Goodbye’ (he knew he was going) ‘O, my sister, my sister! Kiss me!’ I tell you it took control to finish giving the last of my 34 antitetanus injections a few minutes later.24 This author appears to have written with two goals in mind: to bring home to her audience the suffering and bravery of her patients, and to make people aware of the nature of nursing – in particular, its extraordinary combination of compassionate personal engagement and technical expertise. Grace under pressure: British professional nurses’ narratives of stoicism Where the writings of volunteer-nurses often adopt a sentimental tone, those of trained professionals have an 22 Helen Zenna Smith was the pen name of Evadne Price: Helen Zenna Smith, Not So Quiet. . . Stepdaughters of War (New York, The Feminist Press, 1930): 91–93. 23 See, for example: Millard, Shirley, I Saw Them Die. Diary and Recollections of Shirley Millard ed. Adele Comandini (London, George, G. Harrap and Co, 1936); Mortimer, Maud, A Green Tent in Flanders (New York, Doubleday, Page and Company, 1918). 24 Anonymous, Mademoiselle Miss: Letters from the Front (Liskeard, Cornwall, Diggory Press, 2006 [1916]): 23–25.

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air of restraint. The professional women who nursed the wounded of the First World War valued the ability to endure pressure and strain without ‘cracking’. A series of narratives, written by professional army nurses at the end of the war reveal the significance they placed on qualities such as fortitude and stoicism. The originals survive in the Army Medical Services Museum in Aldershot, UK, and a selection of these was brought together after the war into a volume with the rather functional title: Reminiscent Sketches, 1914–1919.25 The provenance of the articles is uncertain, but it seems likely that individuals were deliberately selected and invited to write of their experiences with the purpose of recognising and promoting the QAIMNS and its Reserve; the original narratives are stored, mostly anonymously, although some have surnames attached.26 Two of the accounts related in Reminiscent Sketches recall the experiences of nurses on hospital trains. One deals with the difficulties encountered in the earliest months of the war, before there were sufficient numbers of purpose-built, fully-equipped hospital trains: ‘Only those who have experienced it know what it means to undress a heavy man, badly wounded and lying on the narrow seat of a railway carriage. . . On many an occasion it seemed a task worthy of Hercules’.27 Another writer recalled that the ambulance train she worked on in the early months of the war was ‘made up of ordinary French rolling stock’ in which the ‘lying’ patients were placed in ordinary couchettes. She recorded the adventure of moving from carriage to carriage. If the train ‘got up speed very suddenly, one would find oneself flying through the air, hanging on to the rail of the coach. In our early days this used to create great excitement in the stations, and the people would rush out to see us, but later I think they got fairly used to seeing us performing these acrobatic feats.28 Later, when based in a casualty clearing station (CCS), this same nurse recounted her feelings about her work: When I went up to his side, he looked up at me and said ‘Sister, am I going to die?’. Even though so many were dying and had died during those terrible days when the fighting was so heavy at Hill 60, I think this case affected me more than all the others. He had been my patient during several days, and in spite of his terrible suffering there had never been one word of complaint, or of pity for himself all through.29

25 Anonymous (ed) Reminiscent Sketches, 1914–1919 by members of her Majesty Queen Alexandra’s Imperial Military Nursing Service (London, John Bale, Sons and Danielsson, Ltd., 1922). 26 See, for example: Anonymous, ‘The Passage of a Dudshell through the Western Front, Or, Some Experiences of an Army Nurse in the Late War’; Duncan, ‘Work at Casualty Clearing Stations’; D.P. Foster, ‘Life and Work of a Casualty Clearing Station’; Luard, ‘Work at a Casualty Clearing Station’; Army Medical Services Museum, Aldershot, UK. 27 M. Phillips, ‘Life on an Ambulance Train’; in Anonymous (ed) Reminiscent Sketches, 1914–1919 by members of her Majesty Queen Alexandra’s Imperial Military Nursing Service (London, John Bale, Sons and Danielsson, Ltd., 1922): 41–4. See also: Hallett, Containing Trauma: 87–88. 28 Anonymous, ‘The Passage of a Dudshell through the Western Front, Or, Some Experiences of an Army Nurse in the Late War’; Anonymous account, Army Medical Services Museum, Aldershot: 14. 29 Anonymous, ‘The Passage of a Dudshell through the Western Front, Or, Some Experiences of an Army Nurse in the Late War’; Anonymous account, Army Medical Services Museum, Aldershot: 30.

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She is anxious to emphasise ‘the wonderful fortitude and cheerfulness [of the men] through all their suffering’;30 and this tendency to value stoicism and courage in their patients may have made it more likely that nurses would feel that they, too, must display these qualities. Reminiscent Sketches offers valuable insights into work in casualty clearing stations, where only trained professional women were allowed to work. One author, known only as ‘Luard’ describes the rapidly changing nature of the work in a CCS, as staff cope with ‘rushes’ of patients following front line assaults.31 She observes that a sister ‘sent up from the Base at a quiet time would find a peaceful little Hospital carrying on the ordinary ward routine, with daily off-duty time, picnics and sports in Summer or concerts and entertainments in Winter’.32 Soon, however, ‘certain ominous signs would appear’ with the expansion of wards, the introduction of huge volumes of dressings and equipment, the erection of 6 or 8 tables in each operating theatre and the arrival of large numbers of operating teams. Then, ‘in the early hours of the morning would come the great moment, and the roar of the bombardment which had often been going on for days, would burst into the deafening intensity of ‘Zero’.33 Within hours, ‘walking wounded’ and ambulances would begin to arrive at the CCS. These would be triaged – or ‘sorted’ according to the severity of their injuries – into those who could wait, those who must be operated upon immediately, those who must be resuscitated before being operated upon, and those who were ‘moribund’ and could not survive. Three hundred men could arrive at one time, until the CCS was full, at which point a neighbouring CCS would take-over. Typically, two or three CCSs would work together in this way, so that each would have a chance to treat its 300 casualties before the next batch arrived. In the chaos of battle, however, the system often broke down under pressure of numbers, and casualties would ‘pile up in thousands’.34 Another writer commented that ‘life and work of a Casualty Clearing Station takes the Sister out of the ordinary routine of Hospital life in an instant; she is given a charge where the success of the ward must depend upon her own initiative and resource’.35 From the establishment of the trench system on the Western Front in late 1914 to the German breakthrough of March 1918, many CCSs became almost permanent fixtures and, at quiet times, their work routines could resemble those of base hospitals. Foster believed that ‘for the majority there never was a

happier set of whole-hearted strenuous workers’. Nurses were given ‘scope for originality and initiative’ and ‘individualities were called out’.36 Such experiences must have been unusual for professional women accustomed to the rigidity of the early-twentieth-century hospital routine. In the CCSs, according to Foster, ‘normal routine’ was reduced to ‘a background for guidance but could never be adhered to’.37 For some nurses, ‘the sordid side, the endless stream of wounded men, the depressing atmosphere of unsatisfactory news from the line, the mud and cold, the noise of the guns, and the nightly bombing preyed upon their nerves and they were not happy’.38 Foster’s willingness to explore this ‘sordid side’ and to acknowledge the unhappiness of many CCS staff-members is unusual. Most authors simply emphasised the value they placed on being close to the front lines. ‘Duncan’ recounted that she could ‘always remember how gladly I welcomed the orders when in February 1915 I was sent to my first CCS, one which the previous month had been shelled out of Bethune, and had had to move a little distance back’.39 She added: ‘Here, I think, one fully realised for the first time what the fighting really meant, and what our men were passing through and enduring every day in the line’.40 Trained nurses wrote in pragmatic terms about their work. Where a volunteer was likely to offer dramatic emphasis or poignancy, professionals wrote in a more prosaic style, and were unlikely to focus on their own trauma. For this reason, and because they rarely wrote with publication in mind, their writings have received less attention than the deliberately stylised outputs of their professional contemporaries.41

30 Anonymous, ‘The Passage of a Dudshell through the Western Front, Or, Some Experiences of an Army Nurse in the Late War’; Anonymous account, Army Medical Services Museum, Aldershot: 30. 31 Luard; ‘Work at a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. The writer is almost certainly the ‘Katherine Evelyn Luard’ who wrote two memoirs of her First World War work: Anonymous, Diary of a Nursing Sister on the Western Front 1914–1915 (Edinburgh and London, William Blackwood and Sons, 1915); K. E., Unknown Warriors: Extracts from the Letters of K. E. Luard, RRC, Nursing Sister in France (London, Chatto and Windus, 1930). 32 Luard; ‘Work at a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. 33 Luard; ‘Work at a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. 34 Luard; ‘Work at a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. On casualty clearing station work, see: Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014): Chapters Two, Five and Seven. 35 D.P. Foster, ‘Life and work of a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot.

36 D.P. Foster, ‘Life and work of a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. 37 D.P. Foster, ‘Life and work of a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. 38 D.P. Foster, ‘Life and work of a Casualty Clearing Station’; Anonymous account, Army Medical Services Museum, Aldershot. 39 Duncan, ‘Work at Casualty Clearing Stations’, Anonymous account, Army Medical Services Museum, Aldershot. 40 Duncan, ‘Work at Casualty Clearing Stations’, Anonymous account, Army Medical Services Museum, Aldershot. 41 Hallett, Christine E., ‘‘Emotional Nursing’’: Involvement, Engagement, and Detachment in the Writings of First World War Nurses and VADs’, in Fell, A.S. and Hallett, C.E. (eds.), First World War Nursing: New Perspectives (New York, Routledge, 2013): 87–102. 42 Files for Marcella Kearney and Mary Cresswell: War Office, 1903–1926, ‘QAIMNS: Professional qualifications and recommendations for appointment of staff nurses’, WO25/3956, National Archives, Kew, London, UK. See also the citations of these files in: Christine Hallett, Containing Trauma: Nursing Work in the First World War (Manchester, Manchester University Press, 2009): 199.

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The trained nurse: bullying martinet or longsuffering professional? When the Queen Alexandra’s Imperial Military Nursing Service was assessing the suitability of trained, professional nurses for entry into the military nursing service, references from hospital matrons were checked very carefully. The ability to supervise the work of junior staff and untrained assistants – orderlies and VADs – was seen as being of paramount importance. Many individual War Office files on military nurses contain expressions of praise such as, ‘a most excellent nurse capable of managing and supervising’, or ‘[having] judgement and capacity for management and supervision’.42

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There is evidence that British professional nurses and the VADs they supervised – particularly in Britain’s 24 territorial hospitals – experienced a level of tension and mistrust, which sometimes bordered on animosity. Such tensions have received much attention because of their prominence in the writings of the three particularly wellknown and highly articulate VADs mentioned earlier: Vera Brittain, Irene Rathbone and Enid Bagnold.43 But they may not have been as prevalent as these writings suggest. There is little doubt that some of the nurses encountered by these VADs were both poor leaders and shallow thinkers. Brittain writes in her original diary of one such nurse: Sister Borner has a talent for making work. Tonight when I asked if I should take the clean towels round she exclaimed ‘Oh no! no! no! I always take them round myself, otherwise I know there will be a muddle’. So poor Miss Brittain has so far fallen from her pedestal as not to have sufficient brain to give out thirty clean towels and take thirty dirty ones away! Such is the reputation of a VAD. No wonder I want work in which I can exercise a little initiative.44 Other nurse-representations in the corpus of VAD-writings (for example, Sister Ewart in Rathbone’s We That Were Young and several of the unnamed nurses in Bagnold’s Diary Without Dates) indicates that some trained nurses had neither charisma nor imagination.45 Yet other, more hidden, examples reveal the existence of trained nurses who impressed their VAD-assistants with both their intelligence and their leadership skills. One anonymous VAD-diarist wrote of a matron she worked for at a general hospital on Salisbury Plain, who was: ‘human, perceptive, discriminating, the lot’,46 while other VADs wrote of having been treated with great compassion by trained nurses. VAD, Margaret van Straubenzee, who served at Clandon Park Hospital in Surrey, described how, when she contracted influenza, she was carefully nursed back to health in a ward converted out of the matron’s own bedroom.47 One of the main difficulties faced by trained nurses whose profession was only just beginning to carve-out a place for itself was the class-conscious prejudice that infused the society of their time. Professional nurses, who worked to earn their own living, were in an invidious position. Many – if not most – would have viewed them43 Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900– 1925 (Virago Press, London, 2004); Irene, Rathbone, We That Were Young. A Novel (New York, The Feminist Press, 1989 [1932]); Bagnold, Enid, A Diary Without Dates, (London, Virago, 1978 [1918]). On the significance of these three texts, see: Hallett, Christine E., ‘‘Emotional Nursing’’: Involvement, Engagement, and Detachment in the Writings of First World War Nurses and VADs’, in Fell, A.S. and Hallett, C.E. (eds.), First World War Nursing: New Perspectives (New York, Routledge, 2013): 87–102. 44 Vera Brittain, Chronicle of Youth: Great War Diary Edited by Alan Bishop (London, Phoenix Press, 2002 [1981]): 347. 45 Irene, Rathbone, We That Were Young. A Novel (New York, The Feminist Press, 1989 [1932]): 196; 210; Bagnold, Enid, A Diary Without Dates, (London, Virago, 1978 [1918]): 23–24; 29; 67. 46 D. M. Richards, Blues and Reds; Memoir; P328; Imperial War Museum, London, unpaginated. 47 Margaret van Straubenzee, Extract from the memoirs of Margaret E. van Straubenzee, VAD at Clandon Park Hospital, Guildford, Surrey, c. 1916–1919, Red Cross Archives, X/142, LIB88/595, T2 (STR). For further information relating to this incident, see: Christine E. Hallett, Containing Trauma: Nursing Work in the First World War (Manchester, Manchester University Press, 2009): 210.

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Figure 4. Nurses and VADs at Mount Stuart Royal Naval Hospital. Reproduced by kind permission The Wellcome Trust.

selves as ‘ladies’, consciously placing themselves in the ranks of British gentility: the middle class. But they were still living in an era when many saw the earning of one’s own keep as an automatic disqualification from such genteel status.48 Sharon Ouditt has argued that, in promoting the idea that middle- and upper-class women were somehow morally superior to those of lower social status, Katharine Furse, Commandant-in-Chief of the Voluntary Aid Detachments advanced ‘a feminism predicated on an individualism that was available only to women of a certain social class’.49 The Britain of the early twentieth century was not an easy place for paid, professional nurses. They were tainted by their incomes. Their salaried status made their position in the middle ranks of society tenuous. But they were living in a changing world, and historians would later argue that it was, in part, the war itself that broke down society’s prejudices towards working women (Figure 4).50 Spirit of cooperation The notion that VADs sometimes experienced a level of hostility from trained nurses that could border on bullying and harassment is based on scant but powerful evidence. Yet, there is also evidence that some nurses and VADs worked well together in a spirit of cooperation.51 Thelka Bowser, a VAD-member who, during a period of convalescence from serious illness in 1917, wrote a brief history of the VAD movement’s wartime activities, argued that in the base hospitals of northern France: 48 Anne Simnett, ‘The Pursuit of Respectability: Women and the Nursing Profession’, in White R. (ed) Political Issues in Nursing: Past, Present and Future, Vol. 2 (Chichester, John Wiley and Sons, 1986); Robert Dingwall, A. M. Rafferty; C. Webster, An Introduction to the Social History of Nursing (London, Routledge, 1988): 69–70. 49 Sharon Ouditt, Fighting Forces, Writing Women: Identity and Ideology in the First World War (London, Routledge, 1994): 4. 50 See, for example, Sheila Rowbotham, Dreamers of a New Day: Women Who Invented the Twentieth Century (London, Verso, 2010). 51 I argue in my book, Veiled Warriors, that nurses and VADs came to appreciate each other over time: Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014): Chapters Six and Seven.

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Katherine Hodges, working under the close supervision of a trained British nurse on the Eastern Front declared her gratitude to the sister who was ‘wonderfully good and patient with my stupidity’,54 whilst Florence Egerton, who had been posted to a Territorial hospital in Leicester, wrote enthusiastic letters home to her mother about how much she was learning from the sister on her ward, who was, in turn praising her work and trying to persuade her to enter nurse-training (Figure 5).55 And there is evidence for the occasional close friendship between nurses and VADs – even in the unlikeliest of sources. Hidden amongst the pages of Vera Brittain’s Testament of Youth is one intriguing example. Brittain gives the pseudonym, ‘Hope Milroy’ to the sister she worked for on the ‘German Ward’ at No. 24 General Hospital in Etaples, and writes of how ‘Milroy’ adopted an air of abrasive eccentricity to induce her staff to work more conscientiously and effectively: Figure 5. Doctor and two nurses treating a wounded soldier with two VADs assisting. Reproduced by kind permission The Wellcome Trust.

The Trained Sisters have learned to appreciate the work of VAD members and freely acknowledge that they could not possibly manage without them; whilst on the part of the members they give respect and willing obedience to the skilled women who have spent years in acquiring their knowledge of nursing. There is wonderfully little friction, considering the enormous numbers of people who have been thrown to work together suddenly under somewhat difficult circumstances. Here again we get a very valuable fusion of classes.52 Bowser was at pains to emphasise how ‘women in the highest ranks of society are content to scrub and clean’ adding that, in her view, such women can be likened to the gentlemen who enlisted in the ranks, and were content to spend their time enduring ‘rough food and hard sleeping places’ with men ‘utterly apart from themselves in taste’.53 But this last phrase, with its emphasis on the middle and upper classes being ‘utterly apart’, carries, for a modern readership alert to early-twentieth-century class consciousness, more than a hint of snobbery. The idea that the gentry were cultured, while the working class fighter was a person who ate ‘rough food’ and slept in ‘hard’ places – suggests that the middle and upper classes viewed their working class compatriots almost as a different species from themselves. It probably took an unusual combination of self-confidence, composure and magnanimity for a professional nurse to withstand the often unconscious air of superiority that was given off by some middle- and upper-class volunteers. But not all VADs were so self-assured, and many of those who doubted their own abilities as nurses came to place a high value on the kind and impartial support they received from their fully-trained nurse-supervisors. 52 Thelka Bowser, The Story of VAD Work in the Great War (London, Imperial War Museum, 2003 [1917]): 75. 53 Thelka Bowser, The Story of VAD Work in the Great War (London, Imperial War Museum, 2003 [1917]): 76.

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The staff of 24 General described her as ‘mental’, not realising that she used her reputation for eccentricity and the uncompromising candour which it was supposed to excuse as a means of demanding more work from her subordinates than other Sisters were able to exact. At first I detested her dark attractiveness and sarcastic, relentless youth, but when I recognised her for what she was – by far the cleverest woman in the hospital, even if potentially the most alarming, and temperamentally as fitful as a weather-cock – we became constant companions off duty.56 ‘Hope Milroy’ was, for Brittain ‘a highbrow in active revolt against highbrows’, whose family (of clerics on one side and actors on the other) annoyed her, and who had entered the nursing profession as an act of rebellion. The most distinct impression we gain of Milroy was of a highly intelligent woman. But Milroy also seems to believe that she must present a tough fac¸ade to the world. Brittain’s skilful prose conveys a sense of someone who feels a compassion she is unwilling to show. In writing of Milroy’s work with her German prisoner-patients she comments that this highly trained nursing sister ‘displayed determination and efficiency but never compassion. . . though she dressed their wounds with gentleness and skill’. One amusing story, captured by Brittain’s terse skilful writing tells of how ‘Milroy’ managed to show both contempt and care for a patient: ‘Nurse!’ she would call to me in her high disdainful voice, pointing to an unfortunate patient whose wound unduly advertised itself. ‘For heaven’s sake get the iodoform powder and scatter it over that filthy Hun!’57 54 Miss K. Hodges, Private Papers; 1974, 92/22/1; Imperial War Museum, London: 83–84; 87. For further detail, see: Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014): Chapter Six. 55 Florence Egerton; Papers; 812/1–11; Red Cross Archives, London, UK. For further detail on Florence Egerton’s wartime work see: Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014): Chapter Six; Conclusion. 56 Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900– 1925 (Virago Press, London, 2004): 342. 57 Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900– 1925 (Virago Press, London, 2004): 342.

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Conclusion In the spring of 2014, the BBC presented a television drama series entitled The Crimson Field, which focussed on the extraordinary (fictional) experiences of a group of British nurses and VADs in a general hospital situated close to an unnamed base on the coast of Northern France.58 Much of the drama replicated well-rehearsed cultural tropes of the twentieth century. Reluctant to take a British audience too far outside its cultural ‘comfort zone’ the programmes writers, directors and producers depicted the general hospital as a place where beautiful and youthful VADs struggled with the brutal realities of war under the often-intransigent gazes of their strict and disciplinarian professional supervisors. Yet, the series also contained hints that programme-makers were beginning to embrace a willingness to depart from these entrenched perspectives. Such a shift in the standpoint of one of Britain’s most traditionalist establishments suggests that the later twentieth century must have seen an even greater shift in public consciousness. In The Crimson Field, the hospital’s matron, ‘Grace Carter’, is portrayed by actor, Hermione Norris, as struggling with – rather than relishing – her superior status, and the audience is left in no doubt that her admonishments of her young VAD-charges is fuelled by a genuine concern for the volunteers’ safety, combined with a sense of feeling almost overwhelmed by responsibility. Meanwhile, professional nurse, ‘Joan Livesey’ (played by actor Suranne Jones) respects the VADs on her ward, entrusting them with more responsibility than some of her nurse-colleagues consider to be appropriate. Such small shifts in the portrayal of First World War nursing work perhaps, at least in part, reflect the efforts of scores of women’s historians and critical theorists – writers such as Claire Tylee, Margaret Higonnet and Angela Smith, to offer a more nuanced perspective on women’s wartime nursing contributions.59 Of equal significance are the efforts of historians who have consciously and deliberately focussed on the actions of trained, professional nurses, opening-up new areas of historical knowledge and understanding.60 In the spring of 2014, as I write this paper, the BBC is also filming a new feature-length adaptation of Vera 58 The Crimson Field, Writer: Sarah Phelps; Directors: David Evans; Richard Clark; Thaddeus O’Sullivan. 59 Tylee, Claire, The Great War and Women’s Consciousness: Images of Militarism and Womanhood in Women’s Writings, 1914–1964 (Houndmills and London, Macmillan Press, 1990); Higonnet, Margaret, Lines of Fire. Women Writers of World War I (Harmondsworth: Penguin, 1999); Higonnet, Margaret, Nurses at the Front: Writing the Wounds of the Great War (Boston MA: Northeastern University Press, 2001); Higonnet, Margaret, ‘Authenticity and Art in Trauma Narratives of World War I’, Modernism/modernity, 9, 1 (2002): 91–107; Smith, Angela, The Second Battlefield: Women, modernism and the First World War (Manchester, Manchester University Press, 2000). 60 Harris, Kirsty, More than Bombs and Bandages: Australian Army Nurses at Work in World War I (Newport, NSW, Big Sky Publishing, 2011); Harris, Kirsty, ‘‘All for the Boys’’: The Nurse-Patient Relationship of Australian Army Nurses in the First World War’, in Alison S. Fell and Christine E. Hallett (eds.), First World War Nursing: New Perspectives (New York, Routledge, 2013): 71–86; Rae, Ruth, Veiled Lives. Threading Australian Nursing History into the Fabric of the First World War (Burwood, NSW: College of Nursing, 2009); Keeling, Arlene, ‘‘Alert to the Necessities of the Emergency’’: U.S. Nursing during the 1918 Influenza Pandemic’, Public Health Reports: Special Supplement on Pandemic Influenza, 125, (2010): 105–112; Christine E. Hallett, Containing Trauma: Nursing Work in the First World War (Manchester, Manchester University Press, 2009); Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford, Oxford University Press, 2014).

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Figure 6. Photograph of Kate Evelyn Luard, author of ‘Unknown Warriors’. Reproduced by kind permission, Caroline Stevens.

Brittain’s Testament of Youth. Although little is yet known about where the programme writers and directors will choose to place their emphasis, it has already been reported that one of the main, named characters in the film has the name, ‘Hope’. There is little doubt that the struggles and conflicts endured by VAD, Vera Brittain, will continue to dominate the public’s perception of First World War nursing. This reflects an appropriate cultural response both to the significance of her pacifism and to the quality of her writing. But the VAD is not the only nurseheroine to be valorised by an outpouring of public enthusiasm in this centenary-year of 2014. The memoirs of professional nurses such as Kate Luard and Edith Appleton are also featuring in the lists of major publishers (Figure 6).61 In the last few years, another significant and seismic series of events has disrupted our perception of nursing. The British healthcare system is experiencing a major public scandal, with the revelation in the so-called ‘Francis Report’ of both an excess mortality and an uncaring culture 61 Kate Luard, Unknown Warriors (Stroud, The History Press, in press); Cowen, Ruth (ed.) War Diaries. A Nurse at the Front. The Great War Diaries of Sister Edith Appleton (London, Simon and Schuster, 2012).

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in one British hospital.62 Research had already revealed a statistical significance between patient mortality and the ratio of trained to untrained nursing staff.63 Yet, the unsurprising finding that the more trained nurses an

62 Robert Francis, QC (Chair) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (London, HMSO, 2013). 63 Linda H. Aiken, Sean P. Clarke, Douglas M. Sloane, Julie A. Sochalski, Reinhard Busse, Heather F. Clarke, Phyllis Giovannetti, Jennifer Hunt, Anne Marie Rafferty, and Judith Sharmian, ‘Nurses’ Reports on Hospital Care in Five Countries’, Health Affairs, May/June 2001 20(3):43–53; Royal College of Nursing, UK, Setting Safe Nurse Staffing Levels – An Exploration of the Issues. (London, Royal College of Nursing, 20013); Kutney Lee, A., Sloane, D.M., Aiken, L.H. (2013). Increases in nurses with baccalaureate degrees associated with lower rates of post-surgery mortality. Health Affairs, 32, 579–586.

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institution is willing to employ, the fewer patient-deaths it experiences, have yet to find their way fully into the consciousness of a society that still clings to the idea of the ‘natural born nurse’.