iillHIiiltilltiliillillltllllilllllllilllilllilllltllillilillliilllir^ it riitnili'llllillllliiillMliiiiilliillllllilllllllllllilDltliillii ;i liUtaiiltiii'iiiiiiitiitiiiniiiilHiilliittliliilHiiiiiiitllliiiiiHtMiiiiiiitiiiii liiiiiii ^^"'A L. ...^ , ^GUNTY MEDICAL LIBRARY LOANED BY 0)10 5" HISTORY OF AMERICAN RED CROSS NURSING f^)^ THE MACMILLAN COMPANY NEW YORK BOSTON CHICAGO DALLAS ATLANTA SAN FRANCISCO MACMILLAN & CO., Limited LONDON BOMBAY CALCUTTA MELBOURNE THE MACMILLAN CO. OF CANADA, Ltd. TORONTO I'liotn. hy Harris and I'.uing Jane A. Delano HISTORY OF AMERICAN RED CROSS NURSING BY LAVINIA L. DOCK, R.N. Former Secretary, International Council of Nurses SARAH ELIZABETH PICKETT, B.A. Former Assistant to the Director, American Red Cross Nursing Service CLARA D. NOYES, R.N. Former General Superintendent of Training Scliools, Bellevue and Allied Hospitals, New York City; Former I'rcsident, National League of Nursing Education; Former President, American Nurses' Association; Director, American Red Cross Nursing Service FANNIE F. CLEMENT, B.A., R.N. Former Superintendent, American Red Cross Town and Country Nursing Service ELIZABETH G. FOX, B.A., R.N. President, National Organization for Public Iloaltli Nursing; Director, American Red Cross Public Health Nursing Service ANNA R. VAN METER, B.A., M.S. Former Professor of Home Economics, Ohio State I'niversity; Former Assistant Director, American Red Cross Nutrition Service ILLUSTRATED il5eto gotft THE MACMILLAN COMPANY 1922 All riphts reserved PBINTED IN THE UNITED STATES OF AMESICA m Copyright, 1922, By the MACMILLAN COMPANY. Set up and electrotyped. Published December, 1922. ^=Ff=?P Press of J. J. Little k Ivps Company New York, U. S. A. To AMERICAN RED CROSS NURSES CONTENTS CHAPTER I. Early Growth 1 Origin of the Eod Cross Idea Florence Xiglitingale Nursing in the Civil War Clara Barton. Lavixia L. Dock CHAPTER II. The Episode of the Spanisji-Amehican War .... 25 Organization of the Red Cross in 1898 The Red Cross Sisters Xnrsing under the Government Red Cross Auxiliary No. 3. Lavinia L. Dock CHAPTER III. Affiliation of the American Red Cross with the Nurses' Association G7 The Army Nurse Corps Reorganization of the Red Cross in 1905 The American Federation of Associated Alumnae Accepts Affiliation with the American Red Cross Development of the Nursing Service Partici- pation in Disaster Relief. Lavinia L. Dock CHAPTER IV. The Mercy Ship 139 The S.S. Bed Cross Sails Paignton. England Pau, France Kief, Russia Gleiwitz, Germany Kosel, Ger- many Vienna. Austria Budapest, Hungary Belgrade, Serbia Gevgeli, Serbia Yvetot. France La Panne, Belgium American National Red Cross Headquarters Close of the Early Foreign Relief Program. Sarah Elizabeth Pickett V i viii CONTENTS CHAPTER V. Mobilization 229 National Headquarters Reorganizes The National Com- mittee on Red Cross Nursing Service The Committee on Nursing of the Council of National Defense Special Courses Special Groups The Army School of Nursing The Nurses' Drives Surgical Dressings The Nurs- ing Surveys. Lavinia L. Dock and Sarah Elizabeth Pickett CHAPTER VI. The Relation of the Nursing Service to the Army . . 310 Organization of Units Base Hospitals Hospital Units Emergency Detachments Training School Units Special Units Cantonment Zone Service Mexican Bor- der Service Equipment and Insignia. Sarah Eliz^vbeth Pickett CHAPTER VII. The European War 387 Cantonments of the New Armies Embarkation With the American Expeditionary Forces in Great Britain With the British Expeditionary Forces in France The Zone of the Base, A.E.F. in France Tlie American Red Cross Commission for France Nurses' Equipment Shop, Paris With the French Service de Sante Emergency Hospitalization, A.E.F. in France The Zone of the Advance, A.E.F. in France With the American Expeditionary Forces in Italy With the American Expeditionary Forces in North Russia. SAiLiii Eliz^ujeth Pickett CHAPTER VIII. Service with the Navy 685 Organization of Units T'ni forms and Insignia Navy Nursing Service in the United States Navy Nursing Service at Foreign Stations Detached Service of Navy Nurses. Sarah Elizabeth Pickett CONTENTS ix CHAPTER IX. Nursing Service to the Civilian Population of the Allies 75G The Children's Bureau in France The Refugee Bureau in France The Tuberculosis Bureau in France The Commission for Italy The First Commission for Rou- mania The Commission for Palestine The Commission for Siberia. Saiuii Elizabeth Pickett CHAPTER X. At National Headquarters 953 Auxiliary Nursing Service The Summer Months of 1918 The Influenza Epidemic The Armistice is Signed. Sailvii Elizabeth Pickett CHAPTER XI. Demobilization 983 ^Miss Delano's Death The Close of the Military Pro- gram Overseas Bureau of Information for Nurses Nursing Service, U. S. Public Health Service Casual- ties among Nurses ^lemorials to Nurses Red Cross Aides Educational Projects Military Rank for Army Nurses. Sarah Elizabeth Pickett CHAPTER XII. The Close of the Foreign Emergexcy'Relief Program . 1077 The Commission for Europe The Commission for Po- land The Commission for the Balkan States The Con- traction of the War Organization. Sarah Elizabeth Pickett CHAPTER XIIl. PxfvTICIPATION IX IXTKIiXATIOXAL NlRSIXG EdUCATIOX . 1133 League of Red Cross Societies Schools of Nursing ]\Iiss Noyes' Trip Overseas Child Health Centers Xursiug Activities in Insular and Foreign Possessions of the I'nited States. Clara D. Noyks X CONTENTS CHAPTER XIV. From Eural Nursing to the Public Health Service .1211 Outline of Early Growth Kequirements for Applicants Affiliation Principles Adopted Growth of Central and Branch Units Early Affiliations The Interruption of War Scholarships, Lavinia L. Dock and Fanxie F. Clement CHAPTER XV. Eed Cross Public Health Nursing after the War . . 1293 Elizabeth G. Fox CHAPTER XVI. Class Instruction for Women 1352 Lavinia L. Dock CHAPTER XVII. The Dietitian Service 1375 Class Instruction in Home Dietetics Red Cross Dieti- tians' Service in the European War The Nutrition Service. Anna R. Van Meter Appendix 1443 ILLUSTRATIONS Jane A. Delano Frontispiece PACING PAOE A Group of American Red Cross Sisters who Served at Siboney during the Spanish-American War .... 28 Indoor Uniform, Gray Dress, Apron, Brassard and Cap, of an American Ked Cross Xurse 104 Insignia 116 Clara Dutton iSToyes 232 Outdoor Uniform of an American Eed Cross Nurse . . . 358 American Red Cross Xurses Washing Their Clothing in an Improvised Laundry Set up at American Red Cross Evacuation Hospital Xo. 110, Coincy, France . . . 366 (Above) A Recreation House Built by the American Red Cross for the Xursing Staff of the U. S. Army Base Hospital at Fort ^IcHenry, ^laryland. (Below) Xurses' Mess, Camp Devens, Massachusetts 398 A Xurses' Parade Held in Chicago in 1918 to Stimulate Enrollment for ^Military Duty 420 (Above) Xurses on the Balcony of the American Red Cross Xurses' Club, London, Overlooking the Gardens of Buck- ingham Palace. (Below) Colebrook Lodge, a Conva- lescent Home for American Army, Xavy and Red Cross Xurses Established at Putney, near London, by the American Red Cross 438 Xurses of a U. S. Army Base Hospital Marching off the Docks at Brest, France 486 An Airplane View of Savonay Hospital Center, ^ledical Corps. A.E.F. in France 512 A Corner of a Surgical Ward of American Red Cross Mili- tary Hospital Xo. 1 at Xeuilly. France 536 (Above) American Red Cross ^lilitary Hospital Xo. 5 at Auteuil, near Paris. (Below) The Interior of a Tent Ward at Auteuil 602 xii ILLUSTRATIONS FACING PAGE A Poster by Robert Reid, Planned by the American Red Cross to Stimulate the Enrollment of Nurses for Military Service but Withheld from Distribution at the Request of the W^ar Department 622 A U. S. Army Hospital Train 636 U. S. Army Evacuation Hospital Xo. 6, at Souilly, France 64:() The 112th Field Hospital, A.E.F., Cohan, France, August 12, 1918 656 (Above) Stretcher-Bearers Bringing in a Wounded Soldier to a First Aid Station. (Below) First Aid Station, 168th Reg. Infantry, A.E.F 6G4: (Above) Looking Across the Frozen Dvina River to the American Red Cross Hospital at Archangel, Russia. (Below) Two Types of Ambulance Used by the American Expeditionary Forces in North Russia 682 The U. S. S. Relief 702 An American Red Cross Child Welfare Nurse with Her Charges in the Grounds of the Orphanage and Conva- lescent Hospital, Chateau des Ilalles, near Lyons, France 780 (Above) A Group of Patients at an American Red Cross Children's Dispensary in Paris. (Below) An American Red Cross Children's Dispensary in a Small Town in France 80-1: (Above) A Tuberculous Refugee Child Who Died in an American Red Cross Children's Hospital in France. (Below) A Child Who Lived 852 (Above) Ozjnzio Marino, an American Red Cross Hospital for Children Suffering from Bone Tuberculosis, at Val- doltra, near Trieste, Italy. (Below) A Patient of the Ozpizio Marino 866 Refugees Waiting at the Doors of a Relief Station in Jerusalem 896 (Above) American Rod Cross Nurses and Surgeons En Route to Vladivostok. Siberia. A'isit the lyeysaii Temple, Nikko, Japan. (Below) Nurses of the Siberian Commission Go Shopping at a Market of Manchuria Station . . . 930 Sick Nurses" Quarters, U. S. Navy Base Hospital No. 1, Brest, France 1031 ILLUSTRATIONS xlii TXCISQ PAOE (Above) A Ward of the Vilna Military Surgical Hospital, Vilna, Poland. (Below) The American Red Cross Or- phanage at Liskow, Poland 1092 (Above) An American Red Cross Nurse, Jeannie Frasier, Instructing Two Pupils of a Little Mothers' Class in Elementary Nursing Procedure, Podgoritza, Monte- negro. (Below) An American Red Cross Nurse and Her Interpreter Giving a Lesson in Home Hygiene and Care of the Sick to a Group of Refugees in Tirana, Albania 1106 (Above) The Open Sewers of Tirana, Albania. (Center) An American Red Cross Dispensary in Albania. (Below) A Mosque of Tirana 1110 Three Types of Ambulance in the Balkans 1122 (Above) Roumanian Refugees Living in Mud Dug-Outs in the Devastated War Zones. (Below) An American Red Cross Nurse Serving Soup to Roumanian Refugees . . 1126 (Above) First Class of the School of Nursing, Warsaw, Po- land, Established by the American Red Cross. (Below) Exterior of the School of Nursing, Warsaw, Poland . 1162 Gray Dress, Cape and Straw Hat Worn by American Red Cross Nurses 1212 An American Red Cross Public Health Nurse on Her Rounds 1340 A Rural Red Cross Class in Home Hygiene and Care of the Sick Gathers at a Cross-Roads Meetiner-Place . . . 1372 FOREWORD Perhaps of no other figure in American tradition have there been more stories written, pictures painted, songs sung than of the American Red Cross Nurse. She has personified courage, sympathy and gentle strength in contrast with the brutality of war. Yet of her actual character and work little is generally known. Here is her own story. The experiences of many thousands of nurses, selected from personal letters, reports and official correspondence and recorded in this history, make it both a source book of vital professional significance and a profoundly human document. For the first time there is properly char- acterized and described the magnificent contribution of Amer- ican nurses in aid of human suffering, not only on the battlefield but in all the heretofore hidden places where human- ity was miserable because of war. President, American National Red Cross. The White House, Washington, Nov. 1, 1022. INTRODUCTION Since its establishment in 1909, the American Red Cross Nursing Service lias been the grateful recipient of consider- able interest from the nursing profession and from the laity, ^lany requests have come to National Headquarters for data regarding its origin, its purposes, its organization and accom- plishment. To the answering of these requests, Miss Delano and her assistants gave especial care, feeling that the Nursing Service could repay this interest only by courteous and intelli- gent acquiescence. Nevertheless, the gathering together of such data involved the frequent repetition of painstaking research and correspondence. During and after the European War, such requests were greatly multiplied. Nurses and laywomen in increasing num- bers wrote to Headquarters to ask for information needed for preparing papers for club meetings, speeches or personal nar- ratives. Organizations compiling war records asked for his- tories of Red Cross nursing accomplishment ; chroniclers of the War Department called upon the Red Cross for extensive chap- ters to inchule in the Government's records. Then, too, the national officers of the Red Cross shared with the Nursing Service the opinion that a comprehensive history of Red Cross nursing service, of which no adequate account had hitlierto l)(>en written, should be compiled for the use of individuals and Cha])tcrs. Thus the undertaking which now reaches fruition in the publication of this book, was launched in 1919. The outstanding editorial policy in shaping tliis compilation was the desire to have an authentic history which would recount the metliods of work as well as the w'ork itself. I^y far the greatest amount of material previous to tlie European War lay in Red Cross archives, in tlie Library of Congress and in tliat of the Medical Department of the Army, and the first step taken was to engage an expert in research, to assenil)le, analyze and classify the voluminous records. R)eatrice C()])l(\v fiiow ^frs. Ralph Cha}>man), M.A., of the ITuiversity of Tlliiiois. came from Chicago to perform this service and our especial xvii xviii INTRODUCTION thanks and recognition are due to her for the admirable way in which she carried on her task. It was felt that the nurses who had made history in the field should be the ones best fitted to edit this book which records the work done. Early in 1919 an editorial committee whose membership was largely that of the National Committee on Ked Cross Nursing Service was invited to read and criticize the material. No one refused to share the responsibility. The members of the committee are: Mabel T. Boardman, Anna C. Maxwell, M. Adelaide Nutting. Annie W. Goodrich, Dora E. Thompson, Julia C. Stimson, Lenah S. Higbee, Lucy Minni- gerode, Martha M. Russell, Carrie M. Hall and George B. Chadwick. As the writers to whom the different chapters were entrusted completed their pages, each section was submitted to those of the Editorial Committee who had been most closely related to the work under discussion. While they in no way directed the treatment of material, they gave it most carefr.l critical read- ings and their suggestions were helpful in the extreme. Their corrections and revisions were for the most part scrupulously incorporated in the text and thus the American Red Cross is able to guarantee the fidelity of this text to the truth in so far as it is humanly possible to interpret it. The efforts of the authors have been met by an intelligent and enthusiastic spirit of helpfulness from nurses and lay- women alike. To Miss Boardman, who as secretary of the society was designated by the Central Committee to read and judge the manuscript in its entirety, we are deeply and sin- cerely grateful for much patience, encouragement and aid. Erom Dr. Anita Newcomb jMcGee we have received especial assistance in the matter of verification of official footnotes and of details toucliiug u])on her relation to the War Department in the Spanish-American AVar. To ]\Iarv S. Fergiisson, a member of the National Headquarters editorial staff" and a woman of searching intelligence and keen powers of criticism, whose work on tliis history was interrupted early in 1922 by deatli, we acknowledge our affectionate and heartfelt gratitude. To ]\Ir. Chadwick, whose editorial aid followed the history through its many pages, through complexities of securing a publisher and through much official '^red-tape," we express our many tlianks. ]\Iany others have given us editorial assistance, conspicuous INTRODUCTION xix among whom are Dr. Anna Hamilton of France, Mrs. Richard Aldrich, Miss Laura Drake Gill, General Merritte W. Ireland, Dr. Taliaferro Clark and Dr. Albert Ross Hill. In giving ns data from correspondence and from their wealth of personal recollection and memories, we acknowledge onr indebtedness to ^Irs. Whitelaw Reid, whose secretary, Mr. Irving Rlake, by her direction opened to ns her war nursing records, to Dr. Monae Lesser, Mr. Allen Wardwell, Jr., and many nurses. We also owe recognition for valuable assistance in supplying records to the Librarian of the Library of Con- gress and to the Army Medical Library. In gathering our illustrations we were helped by the Signal Corps, U. S. A., the Air Service, U. S. A., and the Information Section, Naval Intelligence, Navy Department. To the hundreds of nurses who have answered our requests for information and material and to those whose written ex- periences constitute the original sources of this history, we offer this volume as our best endeavor to thank them adequately for their services in this as in all enterprises of the Nursing Service. National Headquarters, Washington, November 11, 1922. r Chairman, Editorial Committee. HISTORY OF AMERICAN RED CROSS NURSING CHAPTER I EARLY GEOWTII Origin of the Red Cross Idea Florence Nightingale Nursing in the Civil War Clara Barton THE Red Cross spirit, the motive prompting the work of the International Red Cross, is simply the instinct of compassion and mercy in a pure form. Such a spirit might be traced down from the beginning of history if a genealogical Red Cross tree were desired. In every age illuminating instances of direct or collateral relationship could be found. It is possible, however, to wander too far atield in a search of this kind and a slight sketch will suffice to introduce the history of the American Red Cross Xursing Service. We need not go farther back than to the Good Samaritan, who typified all the classic characteristics of the Red Cross, the spontaneous, voluntary helpfulness of the private citizen ; com- passion and aid extended freely on the sole ground of common humanity; practical skill and intelligence in binding up the wounds of the thieves' victim ; efficient relief work in leaving the wounded man to be nursed at the inn and in paying for him there. Though Red Cross nursing was first developed in connection with war, not all war nursing in history can be looked upon as rudimentary Red Cross service. It has often been solely for the furtherance of military projects. The presence of the impersonal spirit of pity for and the desire to relieve alike both friend and foe is the essential characteristic of the T?cd Cross idea, as it is also the true ideal in nursing. Hiere Ia no assur- ance that the heroic women of the Gaelic and I'eu tonic tribes, 1 2 HISTORY OF AMERICAN RED CROSS NURSING skilled as they were in medical and surgical nursing, who always followed their men in war to bind their wounds, would rescue as readily a stricken enemy, though it may be that it was so. Haldora, the Dane, in the year 1000 A.D. stands forth as a true forerunner of Florence Nightingale and Henri Dunant, for she assembled the women of her household after a fierce battle and said to them, ''Let us go forth and dress the wounds of the warriors, he they friend or foe." ^ She herself, it is recorded, found the enemy chieftain desperately wounded and tended him long and skillfully until he was healed. In the medieval orders of the Knights Hospitallers with their women's branches, are to be found the first organizations on a grand scale for nursing and relief work of the Red Cross type and it is quite possible that their practice and principles may have become familiar to Isabella of Spain, who was the first on record among queens to take an intelligent interest in the sanitary and hygienic care of her nation's soldiers. Those knightly orders, too, imprinted their influence on the German women, who in the War of Freedom (1813) formed the first modern women's societies for organized war-relief work by volunteers. The armies of Napoleon, on their side, had the nursing service of the Sisters of Charity of St, Vincent de Paul the first trained and discipliMcd nurses of the later medieval period to be officially assigned to the care of sick and wounded men in war. All the heritage of the past and the promise of the future met in Florence Nightingale, whose career was opened to her by the Crimean War. Not only did she there give a complete pattern of the many branches of service later developed under the Red Cross, but also by what she did she inspired Henri Dunant, the founder of the International Red Cross Committee, to his far-reaching achievement. Then by her later efforts slie created the modern army of skilled, secular, professional women from whose ranks the Red Cross Nursing Service is now drawn. It will be essential, therefore, to preface this record of American Red Cross nursing by recalling in some detail the demonstra- tion given by ^liss Nightingale in the Crimea. Her first efforts were of course for the organization of an emergency nursing service. For this she had a mixed com- pany at first of forty women, some of whom were Sisters of Religious Nursing Orders and others hospital-taught women of 'Mrs. Xorrie in "A History of Xiirsing," Vol. II, p. 313. EARLY GROWTH 3 the old school, not trained in the modem way, but experienced. In all, about two hundred nurses belonged to Miss Nightingale's staff, a small group compared with the thousands of n\irses mobilized during the recent World War, but a group historically potent and unique. The nursing service having been appointed in its place and assisted by orderlies and convalescent patients. Miss Xightin- gale next organized a laundry service by renting outside build- ings and employing soldiers' wives for the laundry work. Diet kitchens arose under her hand from which, for the first time, the wounded men were served with nourishing food, and through her efforts the entire kitchen department of the army hospitals was systematically remodeled by the famous 8oyer. The dis- organization and inetiicient management had been such that to Miss Nightingale fell the task of purveying much of the daily supplies and clothing of the patients under her care. In a letter to Mr. Herbert, she wrote (Jan. 4, 1855) : "I am a kind of general dealer in socks, shirts, knives and forks, wooden spoons, tin baths, tables and forms, cabbage and carrots, operat- ing tables, towels, soap, fine tooth combs, precipitate for de- stroying lice, scissors, bedpans and stump pillows." ^ Presently, because kits had been thrown away during a march, she re- clothed a large part of the English army. To provide for an expected intlux of wounded at Scutari, she undertook on her own authority to remodel some abandoned wards, engaged two hundred workingmen, paid them out of her private resources, outfitted the wards and had eight hundred additional beds ready when the need came. To have done this through military channels, at that time, and under the system then in vogue, would have taken months. Miss Nightingale's biographer tells us that this particular feat, more than any other one thing that she did, electrified the "red-tape men" and spread a sensational legend of the ''Nightingale Power." She was both fiercely criticized and greatly praised for this daring piece of initiative, but Parliament later refunded the money it had cost, thus, in effect, endorsing her action. Miss Nightingale urged and planned in minute detail the sanitary engineering works later carried out in the hospitals of Scutari. She herself considered this her best piece of work, for hospitals which had formerly been deathtraps, were thereby put on a level with the best, in ventilation, drainage and cleanliness. These sanitary reforms, "Life of Florence Nightingale," by Sir Edward T. Cook, Vol. I, p. 200. 4 HISTORY OF AMERICAN RED CROSS NURSING in conjunction with her other improvements in nursing and in the hospital dietary, reduced the army death rate from 42 per cent to 22 per thousand of cases treated. Though Miss Nightingale dared greatly on her own initiative when life and death were in question, yet her habitual order of discipline was strict in the extreme and she was punctilious, as a rule, in allowing her private stores to be used solely on the requisition of the medical officers. Her funds for supplies came from her own income, from other private sources and from the Royal Bounty. The needs of the allied armies were not over- looked by her. She sent wines and other supplies to the French Sisters of Charity. When the Italian Sisters suffered a loss of their stores through fire. Miss Nightingale dispatched a consignment of supplies to them. These were friends. Did Miss Nightingale also help the foe ? The rules of war often set a limit to the merciful impulse, but we may surmise what her spirit was from the story told of the Russian boy prisoner who was under her care and who, when asked where he would go after death, replied confidently, "I shall go to Miss Night- ingale." In social service. Miss Nightingale opened new paths, hitherto as wholly untrodden in the army as had been those of her hos- pital reform. Her nurses' families at home were systematically visited and helped by her friends at her request. She brought about reforms in the pay of invalided soldiers, and kept in her bedroom much of the officers' money, because if they offended the purveyor or the commissary, they were likely not to get it. She established reading rooms for the convalescent patients ; opened a post office and encouraged the men to send their money home. She combated drunkenness, to the great derision of the military chiefs. To counteract it she opened a coffee house for the men and set on foot reading and class-rooms for them. She had school-masters sent out from England to teach and lecture, and provided maps, books, papers and games. It was said of her that she was the first person who ever taught officials to treat the soldiers as Christian men. Nor did she forget the soldiers' wives, many of whom had followed the army. She organized a lying-in hospital and secured work for them, choosing friendly visitors to go among them and help them as needed. The war over. Miss Nightingale, as all the world knows, with the gift in money made to her by the grateful British public. EARLY GROWTH 5 founded the Nightingale Training School for Nurses at St. Thomas' Hospital which was the parent of the modern system of nursing. From her, therefore, we may well date the story of the nursing service of the American Red Cross. After the World War a woman of national prominence who had worked through the Civil War was asked to point out the greatest difference between the two wars in the methods of participation by the civilian population ; her answer was : "In the nursing." This was Louisa Lee Schuyler, whose part in the organization of the School of Nursing at Bellevue Hospital in 1873 lends a special interest to the following extract from a letter written by her to Miss Clara D. Noyes on the eve of the entrance of the United States into the World War : In these days, at the age of seventy-nine, when I can not do very active work, my thoughts go back to the early days of the Civil War and of what we are trying to do and did do then on a very small scale compared with today. We wanted nurses for our wounded and sick and there were none to be had. There were no trained nurses in those days, as you know. In our Xew York Brancli of the L'nited States Sanitary Commission it was as easy to get supplies as it is with the I?ed Cross today. They poured in from all over the country. Our receiving and shipping business was enormous. Many a time did our loaded wagons take the boxes on short notice on Sunday down Broadway to a steamer starting for a southern port. We were notified by the Sanitary Com- mission of battles to come that hospitals and hospital supplies might 1)6 ready. Alas ! no trained nurses to be had. Our doctors, Elizabeth and Emily Blackwell, provided one month's hospital training for 100 selected women who vol- unteered to go as nurses. It was most elementary, but it Avas better than nothing and many of them turned out finely and did magnificent work later on, and now the Red Cross ! So much to be thankful for if war must come.^ Not only had the United States no trained nurses during the (Mvil War, but even the International Committee of the Red Cross did not yet exist. It was in IS*).'} that Henri Dunant laid his proposals for a relief society before the Society of Public Utility of Geneva and in ISGI that the Articles of 'Annual Report of Tlic National League of Nursing Kdueation. 1917, pp. 227 22S. 6 HISTORY OF AMERICAN RED CROSS NURSING Convention touching the treatment of the wounded in war were signed at Geneva. To this convention, known as the Inter- national Red Cross Treaty, the United States Government gave its accession in 1882. In the meantime, however, the name Red Cross alone was lacking during the Civil War, for in the work of relief carried on by the United States Sanitary Com- mission a demonstration of efficiency in civilian aid in war- time was given, which was nothing less than extraordinary for a young nation waging its first war on a grand scale. Stille in his ''History of the Sanitary Commission" gives the credit for originating Civil War relief work to women. "It is hardly necessary to say," he writes, "that the earliest move- ment that was made for any relief was begun by the women of the country." The United States Sanitary Commission grew out of a mass meeting held in Cooper Union, Xew York City, on the 26tli of April, 1861, which had been called by the Ladies' Relief Com- mittee. This committee was the work of Dr. Elizabeth Black- well, who had held an informal meeting of women and men at the New York Infirmary for Women and Children. The local New York group took the name "Women's Central Association of Relief" and was, in effect, during the whole war the most powerful and important branch of the Sanitary Commission. Its leading executive officer was Louisa Lee Schuyler. One of the purposes of the association was "to open a bureau for the examination and registration of nurses." Dr. Blackwell was personally intimate with Miss Nightingale and through her friendship she had a clearer idea, perhaps, of what a nurse might be than others had at that time. She labored devotedly in selecting and sending numbers of volunteer nurses to Bellcvuc Hospital for a month of such training as they could get there. As the training school for nurses was not yet founded, that experience could have had but slight value, yet about one hundred of those hastily trained women entered the army hospitals and gave useful aid, many of them continuing in the service throughout the war. Miss Nightingale was in close correspoudoncc with Dr. Blackwell and others on the Sanitary Commission and gave them bountifully of her counsel and advice. She, indeed, in private letters expressed a desire to come personally and help them; but this her fragile health prevented. A letter written to the Secretary of War (^lay 18, 1861) bv the "Women's CVnitral Association of Relief for the EARLY GROWTH 7 Sick and Wounded of the Army, acting in conjunction with the Advisory Committee of the Boards of Physicians and Surgeons of the Hospitals of New York and the New York Medical Association for Furnishing Hospital Supplies in aid of the Army" speaks of nursing as follows : The committee represent that the Women's Central As- sociation of Kelief have selected and are selecting out of several hundred candidates one hundred women, suited in all respects to become nurses in the general hospitals of the Army. These women the distinguished physicians and sur- geons of the various liospitals in New York have undertaken to educate and drill in- a most tkorougli and laborious manner and the committee ask that the War Department consent to receive, on wages, these nurses, in such numbers as the exigencies of the campaign may require. It is not proposed that the nurses should advance to the seat of war until directly called for by the Medical Bureau here, nor that the government should be at any expense until they are actually in service. In this letter it was stated that the Commission for whose recognition the combined associations were pleading, would, among other things, ''incpiire into the organization of military hospitals, general and regimental, and the precise regulations and routine through which the services of the patriotic women of the country may be made available as nurses." As a result of this correspondence and of the efforts of a delegation sent to Washing-ton to represent the associations, official mistrust of civilian volunteer aid, which at first had been obstinate, was allayed : the Surgeon General's attitude of opposition was altered to one of reluctant cooperation and the formal organi- zation of the Sanitary Commission proceeded. For nursing, the services of religious Sisterhoods, which were promptly volunteered, were the first to be accepted. There were nu- merous convents of Sisters of Charity, Sisters of Mercy, Sisters of St. Vincent and others where emergency hospitals were opened, and from whose staffs Sisters and ]\rother Superiors were supplied. Throughout the war a great deal of hospital service was borne by Catholic Sisters, among wliom, as espe- cially distinguished, were ]\rotlier Anthony O'Connell of Cin- cinnati, ^fother Francis of Cliicago, ]\rother Angela of .Mound City and Mother Gonzaga of Philadelphia. Tlic Holy Cross 8 HISTORY OF AMERICAN RED CROSS NURSING Sisters, an Anglican order, conducted important hospital work at Annapolis and Chester and Sister Adeline Taylor had a war nnrsing record of great variety. Much light is thrown on the condition of hospital nursing during the war by the following intelligent commentary taken from Katherine P. Wormeley's small book on the "Sanitary Commission." As one who served with the Commission throughout, Miss Wormley has written : And here a few words may be said on the work that might, we dare to say should belong to women in general hos- pitals. If women comprehended their true work and had the patience to show that they do comprehend it, the deep preju- dice against them, in the minds of the Army surgeons, would be removed. Indeed it has been removed in many instances. But women have not as a general thing, seen their place or their duty. It is hard, perhaps, to do so. It is hard to realize that even benevolence must be obedient. And it is for this reason that Sisters of Mercy, so far, have been pre- ferred as nurses by the surgeons of the Army. It could, however, be shown that the work of women belonging in the world would be more useful than even the work of the Sisters if such women could learn their true place. And if they learned it and kept to it, the result would be that in the end they would have all the power of benevolence that even they would ask. For here it may be said, in deep conviction of its truth, that the surgeons of the Army of all grades are, as a rule, desirous of doing well by those under their charge . . . they are conscientious and faithful men. It is believed and is perhaps capable of proof that if a lady (by which is meant a gentlewoman holding a certain social position) and one fitted for the work could be placed in charge of what may be called the women's department in a hospital . . . namely, the nursing of the very sick men, the special diet and the linen department, with a body of nurses under her charge, a benefit to the hospital would follow, and the surgeons, far from complaining of it would in the end welcome it with sincerity. As to the quality of women's work as a whole, Dr. Bellows, president of the Sanitary Commission wrote : The distinctive features of women's work in this war were magnitude, system, thorough cooperativeness with the other sex, distinctness of purpose, business-like thoroughness EARLY GROWTH 9 in details, sturdy persistency to the close. . . . Everywhere started up women acquainted with the order of public busi- ness: able to call and preside over public meetings of their own SOX ; act as secretaries and committees, draft constitu- tions and bylaws; open books and keep accounts with ade- quate precision , . . enter into extensive correspondence, cooperate in the largest, most rational plans. . , . During the progress of the Civil War nursing assumed two general types : one, a fairly systematic routine under govern- ment direction ; the other, an original spontaneity of action which took its own course and obtained, usually, first the acqui- escence and finally the help of the Government. Of the former type Dorothea L. Dix was the official head, having been ap- pointed as Superintendent of Female Nurses by Secretary Cameron in June, 18G1. Of the latter type was Clara Harlowe Barton, the founder in after years of the American Red Cross. It is said that Miss Dix was one of the first to do actual war nursing, as she took care of some of the soldiers who had been wounded in the Baltimore riots. Her long and remarkable career as a reformer of prisons, almshouses and insane asylums (as they were then called) throughout the entire country and her lofty character, made her seem, probably, as precisely the one woman to direct the war nursing, as Miss Nightingale had so seemed in England. Miss Dix, however, was not a nurse, nor had she had experience in nursing administration and her work in this episode of her life was not on a par with her earlier dis- tinguished labors. As her character and personality have been described, she seems to have been in many ways like Miss Nightingale. She was slight, delicate looking, graceful, had been in her youth beautiful and had a soft musical voice, with winning manners. It was said that her gentle and persuasive tones had a remarkably controlling influence over the fiercest maniacs. She was exceedingly quiet and retiring in her deport- ment and her success with legislatures was due to gentleness and mildness covering an unyielding persistence. She cared nothing for praise or fame. She preferred not to be talked about. She had private means, which she lavished on her work, and her labors for the Government were throughout unpaid. Her standards were exceedingly rigid and her individualism was intense, alienating many of those with whom she had to work in a field where almost everything depended upon suasion. For 10 HISTORY OF AMERICAN RED CROSS NURSING our Government gave Miss Dix, at first, duties but insufficient authority and when later her authority was extended, no penalty was attached for disobedience. Many of the surgeons resented her position. They called her arbitrary, opinionated, severe and capricious. Without a doubt she was somewhat severe. She mistrusted the young and it was said that a woman must be "mature in years, plain almost to homeliness in dress and by no means liberally endowed with personal attractions, if she hoped to meet the approval of Miss Dix." The second type of Army nurse has been thus described by Dr. Bellows: Of the labors of women in the hospital and in the field . . . this sort of service cannot be recorded in the histories of or- ganized work. For, far the largest part of this work was done by persons of exceptional energy and some fine natural aptitude for the service, which was independent of organiza- tions, and hardly submitted itself to any rule except the impulse of devoted love for the work . . , supplying tact, patience, and resources. The women who did hospital service continually or kept themselves near the base of armies in the field, or who moved among the camps, and travelled with the corps, were an exceptional class ... as rare as heroines always are, a class representing no social grade, but coming from all . . . but in all cases women with a mighty love and earnestness in their hearts ... a love and pity and ability to show it forth and to labor in behalf of it, equal to that which in other departments of life distinguishes poets, philoso- phers, sages and saints, from ordinary men.'* It would be a congenial task, if it were possible, to summon before our readers the army of Civil War nurses. There were in all about two thousand, of whom only a few have been re- corded with names and histories. One of the most appealing was Helen Louise Gilson, of Boston, who was so young, girlish and lovely that Miss Dix refused to accept her, but who, nevertheless, through family in- fluence, followed the Army of the Potomac through all of its battles save the first and who displayed abilities that remind one, often, of tlie young Florence Nightingale. The most nearly approaching in her training to the Red Cross nurse of today was Emily E. Parsons, of Cambridge. At * "Women's Work in tlic Civil War," p. 60, Introduction. EARLY GROWTH 11 the outset of the war Miss Parsons entered the Massachusetts General Hospital for experience and remained in it for a year and a half. There was as yet no school for nurses there, but through her social connections she was able to receive spe- cial and careful instruction from the medical men and surgeons. The story of Maria M. C. Hall, of Washington, and her sister, is peculiarly illustrative of the volunteer character of much (yivil War nursing. Like Miss Gilson, Maria Hall was rejected by Miss Dix as being too young. She then went to Mrs. Fales, who had gained an independent position in Wash- ington hospitals. Her importunity finally won Mrs. Fales to throw open the door of a ward, saying as she did so : "Well, girls, here they are, with everything to be done for them. You will find work enough." The "girls" stuck to their job, with no countenance from the surgeons. When a general order was sent out for the removal of volunteers from the wards, Maria enrolled as a "nurse" and drew Army pay, which slie gave to the men. She kept on in this way for a year "with no recogni- tion from any official source" ! As a contrast to this breezy volunteer there was Sarah Edson of New York, who strenuously attempted to found a home and training school where nurses might be prepared for the field. She labored untiringly for this purpose, brought it before the Sanitary Commission, went to the Surgeon General and even had a bill embodying her plan brought to a Senate committee. She may rightly be considered as the first to conceive the idea of an Army School for Nurses. That she was unable to bring her plan to fruition in the intense atmosphere of war does not diminish her distinction. The Sanitary Commission regarded a training school as unnecessary, thinking that the hospital experience itself was the best training and that the urgent needs of the moment did not admit of delay sufficient to pre- pare the amateur nurses who were so imperatively called for. The Surgeon General seemed at first favorably impressed with JMrs. Edson's idea, but finally discouraged it and signified his disa])proval to the Senate committee who had her bill in charge. Every section of the country had its famous nurse. The Confederacy acclaimed Ella K. Xewsom as "Dixie's Elorence Nightingale." She was a wealthy and beautiful widow when the war broke out, and spent her fortune in hospital and relief work and nursing. Perhaps of all the nurses of whom records are left, the most 12 HISTORY OF AMERICAN RED CROSS NURSING picturesque figure and the most widely known is "Mother" Bickerdyke. Truly amazing stories are told of her endurance, her remarkable nursing and purveying abilities, her bold denunciation of rich "slackers" who withheld their money from war work, and her high hand with officials whose standards were less disinterested than her own. Finally, none was more closely linked with the present time than Amelia Barlow, whose work inspired Captain James Scrymser to take the initial steps that brought about the build- ing of the beautiful Xational Red Cross Headquarters at Washington, The hospitals of the Civil War were sometimes temporary adaptations of buildings at hand, sometimes structures hastily erected for the purpose, sometimes public buildings taken over for the occasion. The Capitol at Washington was once so used and hundreds of wounded were distributed in the Senate, House and Rotunda, Hospital ships originated in the Civil War. Coast and river steamers were used. Many such vessels plied on the Ohio and Mississippi rivers with their freight of wounded men. In spite of the utmost endeavors of the women volunteer nurses, Civil War hospital standards were far below those that would be accepted today. The wards were overcrowded, primi- tive in equipment and meager in provisions for operating and for dressing cases. It has been estimated that during those four years approximately six and one-half million men were admitted to hospitals and of them more than 6,000,000 were medical cases, no doubt largely preventable, had preven- tion then been understood. Only 425,270 cases were surgical. After the war the Army nurses formed an association which had its headquarters at Gettysburg. They were wont to meet at the reunions of the Grand Army of the Republic and some of tlieir number survived the war of 1914. A roster of the names of the members hangs in the present Red Cross National Headquarters building at Washington. Their war work ended, the women of the Sanitary Commis- sion went their various ways home and, inspired and strength- ened by their experience, many of them threw themselves with energy into the work of reformation in civil hospitals and other institutions. What they had seen liad made plain to tliem the need of instructed, disciplined nurses and again with the help and eonnsel of .Miss Xiiilitiniiale, women and men \n Xew York EARLY GROWTH 13 City, Boston and New Haven simultaneously established (1873) schools for training nurses in three large hospitals: Bellevue, the Massachusetts General and the New Haven. Smaller pioneer schools already existing in this country and Canada wore streng-thened by this movement and hospitals generally followed the example set them. Whilst the new profession of nursing was thus taking form, one of the volunteer workers of whom Dr. Bellows had written the characterization quoted on a previous page went abroad for travel and there acquainted herself with the work and organization of the Rod Cross. This was ^liss Clara Barton, a woman of New England family, whose fixed purpose it then became to bring about the adherence of the United States to the Geneva Convention. Upon her return to her own country she was instrumental in forming a Red Cross organization which was incorporated in the District of Columbia, under the name of "The American Association of the Red Cross" and of which she became the first president. As this country had but a small army and was considered to be on the whole a peaceful nation, it was anticipated that the chief activity of a National Red Cross would be on lines of relief and succor in times of disaster or natural calamity. Two such calamities, the yellow fever epidemic in Florida (1888) and the Johns- town flood (1880) brought American nurses for the first time into contact with the Red Cross and one of these nurses was the woman who was destined to become, in later years, the head of the Red Cross Nursing Service. It is hardly possible today, for nurses who only know of yellow fever as a preventable and almost extinct disease, to realize its appaJling character before the research and self- sacrifice of scientific men had discovered its mode of trans- mission. A suspicion of the mosquito had, indeed, been put forth as early as 1848, by Dr. Josiah Nott of Mobile, Alabama, but no experimental work had followed his suggestions.^'' The writ- ings of Dr. Charles Finlay, of Havana, Cuba (1881 and 18SG), advanced afresh the clinical evidence against the mos(iuit() and with so much original force that a Yellow Fever Commission was appointed, which brought its investigation to a climax at the time of the Spanish-AmiM-ican War. ]\lajor Walter Reed was its head. Under his direction, at an experimental station '"See Popular S'cicnce Monthlii, Vol. 23, No. 8, p. i'AC). article by King. 14 HISTORY OF AMERICAN RED CROSS NURSING in Cuba, the tests of 1900 were carried out by Dr. Jesse W. Lazear, Dr. James Carroll and Dr. Aristide Agramonti, which proved the role in yellow fever of a special variety of mosquito, the Stegomyia fasciata. In those tests Dr. Lazear sacrificed his life, but as a consequence of that work, Havana, other parts of Cuba, and, later, the Canal Zone were freed from yellow fever and it was shown that, with proper sanitation, the tropics could be made safe for white men. But these truths were still unknown when Miss Barton's aidea went to the help of the fever-stricken South in 1888. In every epidemic of yellow fever, scenes were enacted in Southern cities like those of plague times in medieval Europe. The only hope of safety of medical men and attendants lay, it was believed, in the immunity of acclimated persons, or of those who had survived an attack. It was also believed that negroes were especially immune. It seemed therefore at that time wise and reasonable that, w^hen the Red Cross Society of iSTew Orleans was formed (1883), it should have been ruled that no un- acclimated persons, nor any non-immunes, should be used as assistants by the Red Cross. Miss Barton's writings refer to the well known "Old Howard Association" of New Orleans that carried on heroic service in epidemics in earlier days under Colonel F. R. Southmayd and that had united with the National Red Cross Committee. When the call came from Jacksonville for help. Miss Barton expected to supply it. She wrote : It was arranged that the Southern states, through this society [the New Orleans Eed Cross] should provide all Eed Cross nurses for yellow fever, and that the northern part of the country should raise the money to paj^ and provision them, "We felt this to be a security, and an immediate pro- vision which the country had never before known. Fearing that this might not^ at its inception, be fully understood, I called at once on Dr. Hamilton, then in charge of the ]\rarine Hospital, explaining it to him, and offering all the nurses that could be required, even to hundreds, all experienced and organized for immediate action. Perhaps it was not strange that a provision so new and so unknown in the sad history of plagues and epidemics should have seemed utopian, and as such have been brushed aside as not only useless, but self- seeking and obstructive. Like the entire organization of which it was a part, it has to wait and win its way against custom or even prejudice. . . . Not realizing the opposition EARLY GROWTH 15 there might be to our nurses, we called upon their old-time leader. Colonel Southmayd, to enlist a body of nurses and take them at once to the fever district. He enlisted thirty, both men and women, white and colored, and took a part with him, the rest following next day. Friction developed between the corps of volunteer nurses raised bj Colonel Southmayd and taken to Jacksonville and a little place called MacClenny, and the local boards of health with which the ]\Iarine Hospital Service was cooperating. The clash between the older system of dealing with epidemics and the newer, more scientific methods of the Federal and muni- cipal health officers was inevitable and Colonel Southmayd was withdrawn. These untrained volunteers, of whom there were about thirty, some of whom were of the Negro race, were the first Red Cross nurses in the United States. It would go far beyond our limits to tell the story of the Jacksonville epidemic. In the daily^ press of that time the general picture of distress, terror and death w^as outlined. Through the scene moved many figures brought there by the great need, many of them ministering in faithful unselfishness according to their knowledge, others preying upon a stricken conmmnity. The personal recollection of a worker in that emergency is that a strangely debased type of adventurer came to Jacksonville, immoral, abandoned women and unprin- cipled men. Many such persons were on the lists as nurses and there were Xorthern volunteers among them. The Red Cross idea had been seized by the popular mind and the glamour of the brassard made itself felt. Many actors in those scenes made and wore on their arms or shoulders the emblem to which they had no right whatever. It would, therefore, be unfair to judge the status of Rod Cross nursing even in that formless period, by the individuals who claimed to be Red Cross workers. The local health board very properly deported objectionable characters to a detention and quarantine camp (Camp Perry) in charge of Dr. Guiteras, the yellow fever specialist, and items of this kind occasionally ai)peared in the Xew York papers:" For very good reasons another nurse will be forwarded to Camp Perry tomorrow, ... the action of the Board of "The Rod Cross." ])y Clam Barton, p. 147-148. 'New York Tribune, September 22, 1SS8. 16 HISTORY OF AMERICAN RED CROSS NURSING Health in regard to incompetent and immoral nurses. . . . Two other nurses [their names were printed] are at Camp Perry, sadder if not wiser women. Dr. J. Y. Porter, who was in charge of the Government relief measures, also had charge of Government nurses. Few of these were trained as we count training today, but the "Bureau of Nurses and Medical Attention" answered, in all, over seven hundred calls for help. Many of the aides thus sup- plied were men who had served in various capacities in hos- pitals and were not unfamiliar with scenes of disease and death. The theory of immunity seems then to have been waived and this was especially so at a temporary hospital on the pavilion plan which was erected for the epidemic emergency on the sand dunes outside of Jacksonville. It was called the Sand- hills Hospital and as early as the 20th of August was in charge of Dr. Sollice Mitchell, brother of Neal Mitchell, then presi- dent of the Jacksonville Board of Health. It is at this time that Jane A. Delano, who later takes so im- portant a part in this history, first enters its pages, though not through Red Cross channels. Dr. Sollice Mitchell had been a Bellevue interne. He had had his surgical service in the ward where Miss Delano had been head nurse and through his knowledge of her abilities she was asked to come as superin- tendent of the Sandhills Hospital, a position which she filled with distinction during her two months' stay. Two of her classmates followed her there as volunteers, Wilhelmina Weir, a Canadian, and Lavinia L. Dock, a Pennsylvanian, each of whom had charge of a ward in the hospital. Miss Delano's later distinguished service in the Red Cross gives a special interest to this, her first public seiwice after her training. She had been one of the youngest of her class (188G) and had gone through the hospital so unobtrusively and with so unaffected a quiet and reserve that few of her classmates dreamed of the unusual abilities she later displayed, although all her hospital work had been well and easily done. One of the young internes of that day, who rose to the position of Surgeon General of the United States Navy (Rear Admiral W. C. Braisted) recalled "a singularly clear keen intelligence, an abiding sense of duty and an innate resoluteness of charac- ter" as among her characteristics. Miss Delano was born in Watkins, New York, in 1862. EARLY GROWTH 17 Her family was a substantial one of o^ew England stock. Her father had died in the Civil War and though she was too young to remember him personally, his memory remained with her and animated the intense interest that she felt, later, in the soldiers and nurses of another war. In appearance Miss Delano, at Jacksonville, was pleasing without being beautiful. She was tall and of a very calm, self-contained bearing, blue- eyed and brown-haired, with good teeth and a soft fine com- plexion. She was quiet and serious in manner and spoke but little. She wore the Bellevue uniform of blue and white seer- sucker with the cap, which increased her youthful look and, by contrast, made her poise and quietude seem the more impressive. She was a disciplinarian, and fearless. The hospital on the Sandhills was not long needed. After a couple of months the epidemic abated and the Northern nurses and physicians were quarantined and returned to their homes. A legend has arisen that Miss Delano, in advance of medical knowledge, insisted on the use of mosquito screens in the hos- pital. It was, indeed, thoroughly screened, and this may have been her doing. It has been pointed out, however, that Dr. Finlay's writings two years before had sounded a warning which doubtless made medical men also suspicious of the mosquito. After this emergency Miss Delano had twenty years of varied experience before she came under the Red Cross flag. She spent some time in a mining camp in Arizona, persuaded to go there by Dr. Darlington, later Health Commissioner of Xew York City, who was an old family friend. For five years she was superintendent of nurses in the University of Pennsyl- vania Hospital with Miss M. E. P. Davis as head of the hos- pital. She was one of the first among nurses to take the Special Course in Philanthropy founded by the Charity Organization Society of Xew York City, and she followed this by two years' work as head of the Girls Department in the House of Ivefuge on liandalls Island. In 1902 she was called to be the head of the training school in Bellevue, her ahna mater, and held that position for four years. Then for several years hov time was broken by the ill health and death of her widowed mother. Absorbed in these cares ]\liss Delano was, from l!)()r to 1008, se(iuestered from active nursing associa- tions. Her fi'iends in the later Red (^ross work, however, know that in the Jacksonville expericMice she had reacluHl a clear 18 HISTORY OF AMERICAN RED CROSS NURSING conviction of what a nursing reserve under the Red Cross might mean and of the great usefulness it might have, and they be- lieve that her special feeling for the Red Cross dated from that time. At Johnstown much of the relief and all the nursing work was carried on under the Red Cross. Philadelphia had a Red Cross Society affiliated with the National Association and this group sent a staif of medical men and nurses to work in the tent hospitals which were used for ill and injured persons. The nurses in this corps were rather of the "Staff Nurse, Old Style" than of the ultra modern school. They were, however, well disciplined and accustomed to working under the direction of the physicians who had selected them. Before they arrived Bellevue Hospital had again sent a volunteer nurse, Lavinia L. Dock, who remained until the others came. Miss Barton took a part in the work of relief, leaving the hospital manage- ment to the physicians in charge. After this episode a number of years elapsed without any special awakening of nurses to Red Cross aims. On the eve of the war with Spain, which prepared the way for the present Red Cross Nursing Service, it may be well to give our readers an impression of the advance of nursing after 1873 and of the main lines upon which it had progressed, with some touches of the personality and characteristics of nursing leaders. The women who had entered the pioneer field of regenerating hospitals and opening schools of instruction for pupil nurses were women of strong fiber and intense practical idealism. They entered a special world, the old-time hospital world, where internal conditions of dirt, disorder, immorality among attendants and among patients, bad nursing, coarseness and vulgarity were often hidden behind imposing structures and fine outward appearances. Even among those of the best class, where respectable attendants and a good tone were found, re- forms were difficult enough because of the grotesquely long hours, from twelve to eiglitcen ; the strange survival of sys- tems of duty handed down from the ]\Iid(lie Ages, whore nursing attendants rotated from the wards to the washtubs ; the total absence of teaching and training, and the generally widespread state of satisfaction of medical men and hospital directors with their domains; with the resulting resistance, often intense and obstinate, to innovations, even though brought in the name of EARLY GROWTH 19 Florence Xi<2;litingale, It has been said of these pioneers and their adventures in reform: "The women who plunged into this puhlic housecleaning were so absorbed in it that to them, for a time, the outer world ceased to exist. It was quite as adventurous, quite as exciting, as war nursing. Nurses from different parts of the country met as veterans meet no other introduction necessary than their identity of experience. When order had been restored and time came for constructive work, they, with one accord the country over, took up the problem of giving their pupils ampler teaching and a more careful preparation than they themselves had had. It may be con- fidently asserted that never in a modern country has a more disinterested and useful civic service been performed by women than this regeneration of hospitals by women's boards and nurses during the last three decades of the Xineteenth Century. In all estinuites of the value of skilled nursing by women of education only half the subject is considered if the innnense moral uplift that they have given to institutions be forgotten or ignored.** A number of the early nursing superintendents had been teachers, for instance, Mary Snively, Louise Darchc, Irene Sutliifc, Isabel Hampton and Lucy Drown. Others were representative Southern women with a capacity for driving work before them, such as Ljstra Gretter and Miss Caroline Hampton, Wade Hampton's niece. By far the most were women who had never before undertaken careers outside of the family life in which they had been schooled by circum- stances. Every^ section of the country was represented among the elders in nursing and numy of the strongest figures came from (\inada, of substantial English stock, indomitable, progressive and serving well the country in which they found opportunity to develop their talents. The methods and system of training and instruction in their hands had been steadily rising since 187o. From the course of two years' hospital work, with in- struction limited to the first year, modeled upon Miss Xight- ingale's pattern in St. Thomas' Hospital, American superin- tendents gradually extcMuhxl classes and lectures throughout the course, provided post-graduate work in special hospitals, * "A History of Nursing'." Vol. III. p. 117. 20 HISTORY OF AMERICAN RED CROSS NURSING arranged for affiliation between two or more institutions in order to insure well-rounded experience, lengthened the two years' course to three, shortened hours as compared with the system of 1860, fixed more exacting entrance requirements and made every effort to raise the ethical and professional plane. Organization on a wide scale began in 1893 with the forma- tion of the Society of Superintendents of Training Schools for Nurses, The superintendents at once began forming grad- uate nurses into alumnse societies (only two such societies had been organized prior to 1893) and these in turn were brought together under the name "The Nurses' Associated Alumnse of the United States and Canada." Their first regular convention was held in Baltimore, February, 1897. There were then two hundred and twenty-one^ training schools in the United States and Canada that were regarded by nursing leaders as being already good schools giving a general training, or as building steadily toward that end. They were sending out, yearly, several thousand trained and taught women. The Associated Alumna? had at first been formed in a con- servative way by the graduates of twenty of the foremost schools, but it rapidly became inclusive of all on a broad gen- eral level. The main subject of those early conferences was the protection and maintenance of good standards. For progress was by no means uniform and continuous. Even worse than the direct conflict with the old system, was a swift commercial exploitation of the new one. Opposition had sometimes given place to an imitation skillfully clothed in the appearance of reality. The attractive unifomi, the plausible showing of a well-graded course of instruction in print, and the "diploma" were sometimes cleverly used to disguise purely money-making institutions, or those of one specialty only, lacking in equipment and teaching. The methods of the correspondence school, well enough adapted perhaps to some lines of educational preparation for self-support, were beginning to reach into the nursing field and thus thirty years and less after the opening of the large training schools, there were already almost as many different measurements by which to test the "trained nurse" as there were classes of institutions. Problems of this kind brought nurses to consider two principles as basic; first, that ' Jane Ilodson's book "How to Hcconie a Trained Nurse," listed 299 (1897), not including foreign or post-graduate scliools. EARLY GROWTH 21 the minimum training must be general (i. e., including medical, surgical, gynecological and obstetrical experience) ; next, that nursing education and administration must be directed by nurses. These principles have controlled the nursing profession in all its subsequent history. Absorbed then in educational and disciplinary problems and in the extension of their related branches, the nurses of the country had not yet been called upon as an organized body for any public service, nor had they met any national emergency up to the time of the war with Spain. In her stay abroad after the Civil War, Miss Barton had absorbed the European system of Red Cross nursing and war relief work and had accompanied the German ambulances dur- ing the war of 1870. So deeply impressed was she that on her return to her own country, she hoped and planned to establish that system here. It emphasized the volunteer aid, as shown in these Articles : lY. In time of peace the committees and sections shall train and instruct volunteer nurses. Y. In the event of war, they shall organize and place volunteer nurses on an active footing. YI. The committees shall send volunteer nurses to the field of battle. In 1893 a branch of the American ^National Red Cross was organized in Xew York City and through its efforts a small hospital was opened which. Miss Barton hoped, would be the first of many similar institutions and would prepare Red Cross Sisters on the European model, for service under the Red Cross flag. This little foundation, at first located in a small rented house, was formally opened in 1893 in ]\Iiss Barton's presence and under her direct auspices. To carry on the hospital work and the teaching. Miss Barton had the aid of Dr. A. ^lonae Lesser and his wife, who shared her enthusiasm for the Red Cross nursing of Germany. Dr. Lesser was a skillful surgeon ; his wife, Bettina Hofker Lesser, who was familiar with foreign nursing systems, was also an American trained imrse, having graduated from ]\It. Sinai Hospital School for Nurses, Xew York City, in 1893. The circular showing the organization plan of the Red Cross Hospital is a real treasure from the historical viewpoint. 22 HISTORY OF AMERICAN RED CROSS NURSING Red Cross Hospital & Training Under the direct School for Sisters, New York, auspices of 233 West 100th Street The American National Red Cross, William T. Wardwell, President, Rt. Hon. Clara Barton, A. Monae Lesser, M, D., President, Executive Surgeon. Washington, D. C. In order to become a Sister of the Red Cross the applicant must be of unquestionable character and qualifications. Fur- ther, she must 1, Take the regular two years and three months' course of training at the Red Cross Hospital; or 2. Present certificates from some reputable training school for nurses, and take six months' post graduate in methods specially applicable to war or other national calamity. At the expiration of the course, upon giving satisfactory evidence of requisite fitness, the candidate is graduated as a Red Cross Sister and can thereafter act as such either at home or abroad. In cases of emergency nurses may be enlisted for the spe- cial need upon presentation of their certificates and without taking the six months' course mentioned in 2 ; but it should be understood that at the close of the service in question their relation with the Eed Cross ceases, until they can be gradu- ated in tlie regular way. In this connection, however, credit will be given for character of work done during the enlist- ment-. The certificates above mentioned are : a. A certificate of health and character. b. Certificate (or a true copy thereof) of graduation from training school. c. The enclosed blank properly filled out. Candidates must have no idea that there is any romantic or sentimental attractiveness in the stern demands of war, pestilence or famine. The emergencies of the service are often trying, sometimes involving privation and danger, and only those ready for such work can be of real use. The Sisters are required to be within call at all times, ready to respond to any order authorized by the President of the American National Ped Cross. The institution is absolutely neutral and non-sectarian, not in the sense of ignoring, but of respecting every nationality and all religions. The Red Cross is a volunteer institutioji, guided by and EARLY GROWTH 23 practising regiilar military tactics. The Sisters are required to devote their entire attention during the period of their service to the work to which they are assigned, and must cheerfully obey the instructions of their directors. No salary is paid, but during actual service the best avail- able provision is made for the support and requirements of the Sisters. Information when and where examinations for ranks may be made will be sent upon receipt of signed application. Should at any time one be found unfit for certain service in the field changes will be made as found proper. These regulations are made for the purpose of rendering best aid to the sufferer, best assistance to the physicians and surgeons and to those who devote themselves to attend the sick and wounded. By order of the Eight Hon. Clara Barton, President American Xational Red Cross. Bettina a. IIofkek -Lesser, Sister-in-Chief, lied Cross Hospital. (For male applicants, read Male Attendant instead of Sister) In 1870, when Miss Barton saw German nursing, it was by no means model. The deaconesses were then the best trained and Eed Cross nursing in warjtime was largely in the hands of titled amateurs. Twenty years later, when the New York Red Cross Hospital was opened, a number of excellent training schools for nurses had indeed been developed in German Red Cross hospitals, but the whole system on which their nurses were maintained and controlled was foreign to American ideas. The founders of the Bellevue school had affirmed the principle of economic and professional independence for nurses after completing their hospital course and this was tenaciously held to by the young profession. ]\Iiss Barton and the Lessors did not perceive how much at variance were their nursing ideas with those which had been firmly established around them. Their hospital organization was destined to fail, not because it was of small beginnings, but because what they were hoping to do had already been done in a different and more enduring way. In 189.'3 when the Red Cross hospital in 100th Street was opened, there were all around it in the large training schools of the city, the very women who later took important parts in 24 HISTORY OF AMERICAN RED CROSS NURSING the Spanish-American War work and still later helped to perfect the present Red Cross Nursing Service. But Miss Barton was apparently oblivious of the army of nurses ready trained and eager to serve. Older women, whose memory reached some years back, recalled the fact that even before war was thought of, but as some incident or published word brought the Red Cross to the front, nurses had often applied individually to know how they could "join the Red Cross" and were invariably disappointed at finding no response. Yet with the oncoming of the Spanish-American War, the New York Red Cross Hospital with pathetic inadequacy stood forth to meet the emergency. We do not know how many Sis- ters it had trained, nor how much it was prepared to do in fitting civilian nurses for war work, but it is clear that its resources must have been but slight, for in a later report Dr. Lesser wrote: During the last four years, from the time Sister-in-Chief Bettina had introduced the idea of training Red Cross nurses in this country, we had labored with the desire of having an adequate number of trained Eed Cross Sisters, well known to us and upon whose efforts and capabilities we might rely; unfortunately we met with but indifferent success, there being no thought of war to stimulate the undertaking.^" As the prospect of war nursing came nearer and nurses offered their services in various directions, some to the War Department and others to the Red Cross, the Red Cross Hos- pital enrolled all those of attested character who applied to it, listing some as fully trained, some as partly trained, and others as untrained but capable and intelligent volunteers, and the earliest contingents sent out from it represented all of these groups. A great advance over the chaotic conditions that had prevailed in the yellow fever epidemic was even then obvious. It has been said that there was "only one adventuress" in the first large nursing expedition of the Spanish-American War that was recruited almost entirely by the Red Cross Hospital, and on the other hand that group included a number of pro- fessional and volunteer women whose effective services in action soon became well and widely known. " "Conduct of the War with Spain," Vol. V, p. 2384. CHAPTEE II THE EPISODE OF THE SPANISH-AMEEICAN WAR Organization of the Bed Cross in 1898 The Red Cross Sisters Nursing under the Government Red Cross Auxiliary No. 3 WHEjST the year 1898 opened, the officers of the Ameri- can National Eed Cross were: Clara Barton, presi- dent ; George Kennan, vice president ; Stephen E. Barton, Executive Committee member; David L. Cobb, coun- sel; l)r. A. ^lonae Lesser and his wife Bettina, who were, respectively, executive surgeon and chief of hospital work. Before the United States declared war on Spain, Miss Barton had gone to Cuba with relief for the reconcentrados. With her was a staff of workers, among them being four Sisters from the lied Cross Hospital. In ^[arch, the Cuban Belief Com- mittee chartered the steamship State of Texas and loaded her with food, clothing, medicines and hospital supplies for the Cubans. She was a true Bed Cross Belief Ship, sent under the Bed Cross flag and in conformity with the articles of the Geneva Convention, to be turned over to the American Xational Bed Cross. Miss Barton went to a Florida port to meet the ship and go with it to Cuba, but her plans were frustrated by the declaration of war (April 25, 1898) and the State of Texas did not reach Cuba until she went with the transports convey- ing the United States Army, and entered the harbor of San- tiago. Instead of aiding reconcentrados ]\lis3 Bart(ui had to meet the desperate emergency of aiding ill and wounded Ameri- can soldiers. So far only as the nursing story goes, her efforts will be r(>corded here, but in any estimate of the character and extent of the nursing work it must be remembered that this task was a very ditferent one from that which !Miss Barton had been authoriz(>d to undertake, and that much of the criticism put forth at that tim(> arose from an imperfect understanding of this fact. 25 26 HISTORY OF AMERICAN RED CROSS NURSING At first the Red Cross Hospital functioned as its directors had hoped and meant it should do. At a meeting of the Board of Trustees on April 23, 1898, a committee was appointed to be responsible for a supply of nurses for the war. Sister-in-Chief Bettina (Mrs. Lesser) had a seat on this committee, which began at once to plan for calls for nurses. We may fairly say, therefore, that the Red Cross Nursing Service was historically anticipated at that meeting, by that committee. Soon after- wards its services were formally placed at the disposal of the Government by Dr. Lesser. At the same time a wide reorganization and enlargement of Red Cross circles was under way in New York City. This was initiated by Mr. William Wardwell, president of the Red Cross Hospital and director of the New York Red Cross Society, who, foreseeing the progress of events, brought about the formation of a larger committee called the "American National Red Cross Relief Committee." This new commit- tee was entrusted by Miss Barton with the task of inviting and promoting the cooperation of similar committees throughout the country. Mr. William Wardwell was one of the vice chairmen of the enlarged body and Bishop Potter was its chairman. The Secretary of State (Wm. R. Day) then made it known that the American National Red Cross would be recognized as "the proper and sole representative in the United States of the International Committee," ^ thus fixing the offi- cial status of the Red Cross. Secretary Day also stated that Congressional action would protect the insignia of the Red Cross from use by any unauthorized person. This protection had not previously been accorded by the L^nited States Govern- ment. - The early reports of the Relief Committee gave on the title page the names of Miss Barton and other national officers, fol- lowed by those of the new group in New York City. The American National Red Cross Relief Committee as its first step had appointed a "Women's Committee on Auxiliaries" charged with the duty of organizing similar auxiliary commit- * Letter from the Secretary of State to the War Department, quoted in "The Red Cross in Peace and War." p. 377. ' Confrress did not take the action promised hy ^fr. Day until 1900. See Congressional Discussions and Actions upon Various Measures of tlie Incorporation of the I'ed Cross and the I'rotection of its Insignia, 1S94 to 1910. compiled by Ceii. Ceorge W. Davis with liis Notes on same. Red Cross T>ihrary, National Headquarters, Washington, D. C. EPISODE OF THE SPANISH-AMERICAN WAR 27 tees of women throughout the United States. Almost one hun- dred such auxiliaries were formed, each one taking up some one special responsibility. They were designated by numbers. The Xew York group was known as Auxiliary Xo. 3, but also took the name *'Ked Cross Society for Maintenance of Trained Nurses." Besides organizing the others it became the central agency of relief and also through a committee on nursing, it took over and finally controlled the whole Red Cross nursing service in New York and influenced materially the general service during the war. Reference will be made again to the new auxiliary's activi- ties after following the Red Cross nurses in Cuba and tracing the early steps in nursing which w^ere taken by the Govern- ment. Dr. Lessor's official report, written after the events, says of the first steps taken: Immediately after the declaration of war with Spain, I received the order from the president of the American Xa- tional Red Cross to the effect, "that the Eed Cross Hospital Department shall be ready for service in the war." By the direction of the president (^liss Barton) all applications for enlistment and communications relating to this service were sent to the Xew York Red Cross Hospital. A certain standard of experience and character was established as neces- sary for enlistment on our staff. A number of applications from physicians, nurses and other assistants were received . . . and those whose qualifications and recommendations seemed satisfactory were chosen and placed upon a list for further investigation and final selection. From the large number of names of trained and other nurses the Sister-in- Chief and I had selected men who we believed would l)e physically able to carry wounded soldiers, also trained nurses and gentlewomen who seemed least susceptible to disease, . . .^ When ]\[iss Barton reached the Cuban shore she took her ship to Siboney, where there was need of supplies and aid, and her representatives made their way to the Army hospital. Thev were not inuiiediately acce])t(Ml for service tlierc. so carried their offers to the Cuban hospital, where they \vcri> gratefullv ^ "rondiu't of tlie War witli Sj)aiii." Surpcon ricnci-al's Keport. Vol. V. p. 2:iS4. Sec also "Reports of the Auioricaii Red Cross Relief Cqia- mittees." p. 174., 28 HISTORY OF AMERICAN RED CROSS NURSING accepted. Presently their assistance was asked for by Major La Garde of the American forces, in a hospital designated by him, and was given. The Red Cross Sisters, foreign fashion, were called by their first names. Mrs. Lesser, who was Sister-in-Chief, was Sister Bettina. She and Sister Minnie were in charge of the tents ; Sister Annie with a volunteer assistant, Mrs. White, was in the Red Cross Hospital; Sister Isabelle and Sister Blanche helped with operttions. The need of nurses was already acutely felt. Dr. Lesser said at this point in his narrative: News of another battle was expected. Finally it was agreed to request more Eed_ Cross aid by telegraph. A call for one hundred Sisters was suggested and Mrs. Lesser was consulted in the matter. We had fifty trained nurses and assistants on our lists, also women to act as matrons to distribute nourish- ment, etc., whom we hoped we could rely upon. We promised to send for that number immediately, as we had sent for twenty-five already.* The call for the twenty-five nurses here mentioned is of inter- est, as it gave their names and was signed by Miss Barton. It was sent to Stephen Barton and transmitted by him to the Auxiliary Xo. 3, or to the Red Cross Hospital. As it arrived in Xew York it was written out as here shown: Playadeleste, July 2, 1898. Barton, Xew York, William Street. Siboney Send nurses nuttell coffin shaw sisters lavinia eva gard 5 gardner rutty bouligney Anna nuessing medora alien strom fleigge hilda olsen edith abrams margaret mcguir doctors nuns gill vogel two hundred fifty equipped bed linen towels clothes. _. Bartox.-* Before completing the story of the adventures of the little group of Sisters thus caught accidentally, as it were, in the war current, it is necessary to return to the larger events in * "Conduct of tlie War with Spain." Surgeon Gcnoral's Report, Vol. V. p. 37. = Files of tlie l\e(l Cros.s Society for the Maintenance of Trained Nurses, Mav to July, 18!)8. Cop!/r!;;ht, 1S9S. hy Clara Barton. A ((roup of American Red Cross Sistors wlio served at Siboney during the Spanish- American ^^'ar. EPISODE OF THE SPANISH-AMERICAN WAR 29 Red Cross activity which affected the Red Cross Hospital serv- ice, and to trace the steps which had been taken by Miss Barton's officers in preparation for war nursing. In Jnne, 1808, the Departments accepted the offer of services made by the Red Cross. Dr. Lesser wrote : After the Department of War had approved and accepted the services of the Red Cross to supplement tlie work of the Army ^ledical Department in case of need, I called, in the capacity of Surgeon-in-Chief of the American National Red Cross, upon Sur<^eon General Sternburg of the United States Army. I was accompanied by the Sister-in-Chief. We asked the Surgeon Ceneral for information in regard to field service in his opinion a hospital ship would be the best service that we might render. He, however, referred us to Colonel Green- leaf, who, he said, would have charge of the field. After a short interview^ the Colonel said that he felt there would be a land service and that it would be wise for us to be pre- pared." The story now returns to the place where the Red Cross Sisters were left at work with Dr. La Garde. The need of nurses had grown steadily more urgent and finally, as already recorded, a number w-ere cabled for. Dr. Lesser wrote : That morning Miss Barton, with George Kennan and several of her staff, had gone to the front and before leaving Miss Barton instructed her secretary, 1\>\t. C. H. H. Cottrell, in the presence of ]\Irs. Lesser and myself^ that at our request he should cable in her name for such persons and material as should be needed in the hospital department. Since it was the wish of the surgeon of the camp, we cabled first by name and then by special list for fifty nurses, ten assistants, a number of immune jihysicians and complete hospital equip- ment to make at least live hundred patients comfortable. The wounded continued to arrive for four days. Surgeon ^hijor La Garde did me the honor of consulting me in regard to the nursing and I suggested that some of the Sisters leave the oi)eratiiig tables and take charge of the ]iatients in the tents. The rows of tents were then placed in her (Mrs. Lessor's) charg(> and slio jiortioiuMJ tbe work of caring for them among the Sisters assistetl by lios})ital corpsmen.' " l\(>l)(irts. American Xaiional Rod Cross Relief Committees, p. 177. 'C'oiHiuct of tlu' ^^'ar witli Spain," Surtrcon Generars Report, ^'ol. V, pp. 2;{88-238!-2;5ni. 30 HISTORY OF AMERICAN RED CROSS NURSING In the midst of this arduous work, July 15, Dr. Lesser and all his nurses were stricken down by yellow fever. It was sup- posed that their little Red Cross hospital, which had been con- structed in a Cuban dwelling, was infected. At the time much controversy went on as to who was blamable, but since the mode of transmission of yellow fever was then still undemonstrated, the criticism and hard feeling engendered by those disputes were futile. Meantime Dr. La Garde waited impatiently, in great need, for the expected reenforcement of nurses. Still they did not come. They had, however, been dispatched from New York by the Auxiliary No. 3. Dr. Lesser's story tells us : In the meantime word from Assistant Surgeon General Greenleaf was received at Siboney, stating that forty-five Red Cross Sisters, surgeons and other assistants had arrived at Guantanamo, waiting to come to us, and as we returned the same day from the fever camp. Surgeon Major La Garde telegraphed and telephoned repeatedly for them to come, but he received no reply. Feeling that under existing circum- stances, and exhausted from work and illness, we could not continue to work without more assistance, I applied for our return.^ Dr. Lesser and the Sisters went north on the steamship Concho from Siboney to New York (about August 24), but no record of the Sisters' subsequent activities have been found. Concealed at first by the absence of surnames, it is quite possible that they returned into war work under their ordinary titles. The Red Cross hospital had already begun losing its preced- ence because of the larger organization growing up around it. xit the time of Miss Barton's entrance into Cuba, Dr. Lesser had urged that twelve Red Cross Sisters and several others selected by Sister Bettina should be sent on the State of Texas to join the four who were awaiting them in the South, but for some (undoubtedly valid) reason they were not sent, to his great chagrin. At this point the opening first appears of that transition process in the nursing system of the Red Cross which led from the little group of volunteer Sisters to the highly modernized Nursing Service of 1017,'^ and such periods are " '"Conduct of the War with Spain," Surgeon General's Report, Vol. V, p. 2303. * For fuller details see: Reports of the American Red Cross Relief Committees, p. 178. and "Conduct of the War with Spain." Sur^^eon General's Report, WA. \, p. "io'St. EPISODE OF THE SPANISH-AMERICAN WAR 31 painful to those who find themselves displaced. One cannot but feel that the Lessers did not have a "good chance" and that Sister Bettina might have administered easily the larger staff of nurses that she vainly tried to secure. To return to Dr. La Garde ; the failure of the nurses so eagerly awaited and so much needed, to reach him, had its explanation in the unwillingness of the Surgeon General's office to send nurses into Cuba who were not known to be im- mune to yellow fever, for Dr. Sternberg was very careful on this point. Other reports of those strenuous days confirm Dr. Lesser's story and among several references to the nursing situa- tion of that time that are to be found in the report of Dr. Charles 11. Greenlcaf, Chief Army Surgeon in the Field, one explains why Dr. La Garde did not receive his reenforcement of nurses : On the 18th of July we proceeded to Guantanamo Bay, the rendezvous for the Porto Rican expedition. At this place we found a detachment of doctors and female nurses on board the steamship Lampasas that had been sent to work with the Ked Cross Association. As they could not go into Cuba or land from their own ship, I determined to use them in the Porto Pican expedition, and subsequent events demon- strated the wisdom of this action, since the increase of typhoid fever cases on board the steamship Yale was very large, re- quiring the transfer of some eighty odd to the ship on which these nurses were quartered, which I converted into a quasi- hospital ship, notifying the medical officers in charge of the various transports to send their sick to it, and with them descriptive lists, complete transfer lists, and sufficient quanti- ties of medical supplies and rations to last during the return voyage to the States/" Later in the summer a report on this expedition was spnt to the American Ixed Cross by one of the party, Miss Rutty, who had been placed in direct charge of the trained nurses. She was not a nurse, but had been efficient and practical and showed gifts of management. Her report is included at this point, because it is a connecting link between the Ked Cross Hospital war work and that of the Auxiliary Xo. 3, Addressed to Sister Bettina, as still holding the position of Sister-in-Chief, the re- ports of the Auxiliary to be given later show that the Lampasas '""Conduct of tlie \\'ar witii Spain," Report of tlie Surgoon General, Vol. I, pp. G3t)-638. 32 HISTORY OF AMERICAN RED CROSS NURSING party, though made up chiefly at the hospital, was merged in the general department of administration of the auxiliary. Eeport of the Eed Cross Expedition Aboard THE S. S. Lampasas To Bettina Hofker Lesser, Sister-in-Chief, American National Red Cross Left New York July 4 in charge of nine nurses, one surgeon and two assistant surgeons, under orders to conduct party to Cuba. Miss Anna Boligny according to orders joined us at Washington. At the Port of Tampa we joined Miss Gill and her party, and under instruction from Mr. Stephen Barton put up at Tampa Bay Hotel, and waited for transportation. The conduct of the nurses while at Tampa was especially commended ])y the officers of the Army and Navy with whom they came in contact. On the night of July 7, Major Carter of the Divisional Hospital^ General Snyder's Camp, Picnic Island, asked for nurses for typhoid nursing. For this service two night nurses and two day nurses were detailed for duty during our stay in Tampa. July 8 we boarded the S. S. Lampams, and on July 12 sailed from the Port of Tampa, Miss Gill having given into my hands all matters pertaining to the finances of the combined parties. Arrived at Key West evening of July 1-1. At Mr. Cobb's request I went ashore to cable to Xew York for funds. Ship sailed before answer came. We were instructed to re- main on board the JMmpasas at Santiago until Red Cross orders came. Sailed into harbor of Santiago morning of July 19. Colonel Black having gone ashore for orders, re- ported that notbing could be learned of the Red Cross authorities; that on account of the presence of yellow fever, anchor would be weighed at once, and all communication would be cut off. As we were under orders not to leave the ship until so instructed, we sailed to Guantanamo. On the morning of the 'ZOih gave orders that the Red Cross party was to l;e ready to leave the ship at noon. Orders from General Miles that we go on board the Oregon and return to Santiago. An interview being had with (Jeneral ^liles, he autborized us to remain on board while awaiting orders, and such orders failing us said he would gladly utilize us at the front. An additional order came from General ^liles that all inmiune nurses sliould be detailed for work at Santiago. Mrs. P)ull. tbe only immune in our number, was transferred to tlie (Jrr//on in company willi Miss Wbeeler wlio had s})ecial EPISODE OF THE SPANISH-AMERICAN WAR 33 permission to join her father. Colonel Black kindly put me ashore, where 1 cahled to Mr. Stephen Barton explanations, and asking for funds and supplies. Colonel Greenleaf had stated that the sup])lies at hand were only adequate for the needs of their own surgeons. Kumor reached us at this time that Dr. aiid Mrs. Lesser were very ill with yellow fever, and Miss Barton liaving failed to respond to a message sent hy Mrs. Xutall in cliarge of the party on the Nueces and no word reaching us from Dr. Barton, we sailed for Porto Rico. Hav- ing learned that it was absolutely necessary for our future usefulness that an organization be formed, the nurses and doctors held a mass meeting on July 22 and elected me direc- tor and Sister-in-Cliarge. Sailed into Guanica July 25 and on same afternoon received sixteen patients from Comanche. Following morning fifty-seven came from Yale. Anchored off Ponce, evening of 28. Quarantined by Dr. D. R. Burns on account of three cases of measles and pemphigus. Re- moval of quarantine on 31st. On July 31 we were asked to proceed north with our patients. Colonel Greenleaf did all in his power to assist us and requested me to proceed to Washington to report to Surgeon General Sternberg at the earliest possible op])ortunity. Sailed August 1st leaving Miss Chanler and ^liss Boligny at Ponce at their special request, and with General Miles' sanction. According to instructions we landed our one hundred and two patients at the general hospital. Fortress ^Monroe, August 7. From Fortress Monroe I proceeded to Washington and delivered Colonel Greenleaf's letter to Surgeon General Sternberg, going thence to Xew York and reporting to Red Cross authorities on August 9. We now await further orders. Special mention should be made of Mary F. Gladwin, whose management of the diet kitchen merits the greatest credit and appreciation on the part of those who worked with her and also of the Xational Red Cross. Beatrice Aon Ilomrigh was most efficient in systematizing the nursing on a plan which has been placed 0^^ ^'^^- Respectfully submitted, IsABELLE F. Rutty, Sister-in-("harge. !Miss Shaw, a young Bollovue trained nurse who had applied at the Jvod Cross Hospital, was included in this group and her recollections are lively enough to deserve more space than we can give them. She said of the stay in Tampa : Typhoid fever was raging there and the nurses wished to care for the sick men, but there was great difficulty in getting 34. HISTORY OF AMERICAN RED CROSS NURSING permission to do this, as there seemed to be no organization. One never knew what would become of one next. All one's service seemed haphazard. Miss Shaw told how the nurses were repeatedly transferred from one location to another, '"always obeying the last order, no matter how conflicting with the preceding one." Her recollection was that an engineering corps was about to leave for Cuba on the Lampasas and that the nurses, on their own motion, persuaded the captain to take them also. To gain his consent they had to agree to relinquish temporarily the protection of the Red Cross and accept all the hazards of war on a war ship sailing under military orders in hostile waters. When they arrived in Santiago Harbor, the sailors on the ships in the harbor turned spy-glasses on them and shouted "Skirts !" This picturesque but somewhat adventurous expedition of the Lampasas in the early, chaotic period of the first war con- ducted by this country since 18G4, though much criticized at the time, cut a path for later Red Cross nursing service and won many friends for nurses. Dr. Charles R. Greenleaf, Chief Surgeon in the Field, wrote : The service rendered by the members of this detachment of Eed Cross people has been invaluable, and they are entitled to great credit for their devotion to dut}', their zeal and their unremitting care of the sick under circumstances that were peculiarly trying. I shall be glad indeed to welcome them, should they return, and I can always find suitable work for them in the base field hospitals. ^^ Later in the summer Dr. Greenleaf wrote to Dr. Sternberg: Porto Eieo, August 28th. Cabled you to-day for Miss Rutty and thirty nurses. I know her to bo a good administrator and valuable woman and if she can bring with her the nurses who were on the Iximpasas I shall be mucli pleased and you will be sure of good service.' - With this episode the immediate connection of Miss Barton's staff with war nursing ends and no further records arc available of the intrepid little group of Sisters and Sister-in-Chief Bettina. A nursing report written by the latter and covering " 'Conduct of War witli Spain," Vol. I, p. 576. ^Ihid., Vol. I, p. G03. EPISODE OF THE SPANISH-AMERICAN WAR 35 the whole period ot' their serviec is alhided to in several docu- ments, hut cannot he found. It must he conchided that it was not preserved, an oversight that, from the historical standpoint, must he deeply regretted. For some little time Dr. Lesser con- tinued to enroll nurses at the Red Cross Hospital, until the complete organization of Auxiliary No. 3 centered all Red Cross nursing activities in its committee. A few lines are needed for the final history of the Red Cross Hospital. As the war went on, its staif was depleted and its regular work interfered with, but it kept on in the face of difficulties and a certain number of applicants passed through it, some of whom made their way directly into the army service, while others were listed by the Auxiliary No. 3. After the war was over the original New York Red Cross Society en- deavored to carry on the hospital according to its first plans. In 1903 a special corporation was formed to manage it and in 1907 the building at 99th Street and Central Park West was erected and continued for several years as the New York Red Cross Hospital. Agreements with the National Red Cross at Washington were made (1903) by which the New York Society was to have two members on the hospital board and the hospital was to be regarded as an affiliated body under the general jurisdiction of the National Red Cross. It was still hoped, in some quarters, that the National Red Cross might extend the work of developing its own hospitals for the train- ing of Red Cross nurses, but with the gradual abandonment of this idea, as the greater possibilities were perceived of building up a nursing service by the help of the professional forces already existing, the relationship of the Red Cross Hospital to the National Committee ceased to have any vital significance, and in 1914 this relation was finally severed by mutual consent. The hospital changed its name and became the Park Hospital. At the same time that the Red Cross was organizing for aid, the United States (lovcrnment was preparing an official nursing staff in the event of war and because of the close relationship of the Army Nursing Service to the Red Cross, in this as in every c(Mintry, it is important for us to follow here its main lines. 1'lie scope of this work does not permit a detailed pre- sentation of the Army Nurse Corps and its activities at that time, but compels us to pass over much of interest and value that belongs properly to a history of a general, rather than of a specialized kind. 36 HISTORY OF AMERICAN RED CROSS NURSING As early as February, 1898, officers of the Government be- gan to receive applications from women who wished to serve as nurses during the approaching war and all those letters and papers found their way to the files of the Surgeon Generals of the Army and Navy. So wrote the medical woman who became the official head of the trained nurses employed by the government in Army nursing during the war with Spain, and whose imrsing staff developed into the Army Nurse Corps. Anita Newcomb McGee, M. D., was the daughter of the distinguished astronomer, Simon Newcomb, and inherited in- tellectual powers. Her medical studies were taken in the Columbian (now George Washington) and Johns Hopkins Universities. She was a woman of strong personality, attractive in appear- ance, small, with dark hair and dark blue-gTay eyes, of very quick movements and keen, rapid mental processes. Her social and scientific position naturally brought her into close acquaint- ance with Washington's notables and before war was declared she had conversed with the Surgeon General of the Army, General George M. Sternberg, upon the use of trained women in Army work. It was his purpose if war came, to employ women as nurses, but it was Dr. McGee who dwelt upon the importance of having them professionally well trained and who succeeded in carrying this principle into the service. She was a Vice President General of the Daughters of the American Revolution and this society at her suggestion formed a ''Hos- pital Corps Committee" of which she was the chairman, wnth Mrs. Amos G. Draper and ]\[iss Mary Desha as her chief as- sistants. Dr. McGee offered the Government (April 27) the services of this committee and the offer was accepted. In July at the request of the Surgeon General Congress had authorized the employment of contract nurses "regardless of sex." Dr. Sternberg's official reports and papers give the following account of the creation of the Army Nurse Corps and a picture of the deficiencies existing in the pre-war Army nursing system : The original purpose of the ]\Iedieal Department Avas to have all the nursing and other work of tlie hosj)itals, includ- ing the clerical and dispensary work, done by trained mem- bers of the Hospital ('or])s; but the Act approved April 22, 1898, providing for temporarily increasing the Military EPISODE OF THE SPANISH-AMERICAN WAR 37 Establishment, failed to include Hospital Corps privates for the volunteer regiments. The great majority of the Hospital Corps men secured by enlistment and transfer had little or no proper training as nurses and as a consequence were largely inefficient. At the outbreak of the war nursing in the Army was done entirely by the men of the Hospital Corps; but the employment of contract nurses, regardless of sex, was authorized by Congress in March, 1898.^^ Before the 30th of A])ril almost a thousand applications had been received from women who wished to serve as nurses but no examination of these ap])licants had been possible. On April 28 the National Society of the Uaugliters of the American Eevolution offered its services to tlie Surgeon General of the Army in the capacity of an examining board for female nurses and this offer having been accepted, the following day all applications from women were referred to it for examina- tion. The status of this organization rendered it peculiarly suitable to undertake this work. It has headquarters in Washington City and twenty-five thousand members living in every state and territory of the Union and as it had no affiliations with any hospital or body of nurses it is entirely unprejudiced in its judgment. Mrs. Anita Xewcomb McGee, M. D., a physician in good and regular standing and Vice President General, National Society of the Daughters of the American devolution, was designated as director of the "Daughters of the American Kevolution Hospital Corps"' and placed in charge of this work. Her statement regarding the method of selection is as follows: "In accordance with direc- tions from the Surgeon General^ only graduate trained nurses "The Congressional authorization above mentioned was asked for in April, and obtained in July. Special authority for the employment of women nurses in the Army appears in Sections 1238, 12.'5!), 1277, and 1279, Revised Statutes of tlie United States, providing eomi)ensation at forty cents a day and one ration. These date from the time of the Civil War and are the outgrowtli of that war. Xo women nurses were emph)\ed in tlie Army from the time of the Civil War until the Spanish American War. Under date of April 28, 1898, tlie Surgeon (ieneral. by letter to tlie Secretary of War, recpiested authority to em])loy by contract as many nurses, male oi" female, as might be recjuired during tlu> war with Spain at the rate of lliirty dollars a month with a ratioti. The Secretary granted the authority asked for imder date of April ."50, 189S. No legislation in the premises was. how- ever, enacted until tli(> Deficiency P>ill of July 7, LS9S. which autliorized the employment of three Inuulrcd civilian niirs(>s at tliirty dollars a month I'M) Stats. 703). Items for the jiay of civilian nurses without any limitations of luimber or rates of jiay ap|)ear in the Deficiency Ajipropria- tions f(ir the Medical and Hospital Department in the Deiiciency Acts approved January '>, and March 3, 1S99 (30 Stats. 778 and 122.3).' 38 HISTORY OF AMERICAN RED CROSS NURSING were accepted by the Daughters of the American Eevolution as eligible and they were required to fill out blanks like the one appended hereto. In judging a nurse, three points were considered : First, professional ability : as evidence of which endorsements from physicians were usually submitted. In all cases the superintendent of the training school from which the nurse graduated was asked for endorsement, and when this was refused, the nurse was not accepted. A few women physicians in good standing were also accepted as nurses. Second, character: to establish which the endorsement of a Daughter of the American Eevolution was requested (though never exacted). In lieu of this, the signature of any lady of known standing was accepted. Committees of 'Daughters' were formed in all large cities and in many small ones and rendered admirable service in securing suitable applicants. Third, health : as evidence of which a physician's certificate was required. In certain cases, however, Avhere the need for the nurse was too urgent to admit of delay and where there was no reason to doubt her health, this certificate was not filed. Originally the nurses were required to be between thirty and fifty years of age, but the large number of desirable trained nurses who were under thirty caused that limit to be disregarded. The evident necessity for and importance of the limitation of appointments to trained nurses, was neglected only in the sending of nurses to Santiago. As it was essen- tial that they should be immune, it was impossible in all cases to require graduation. The assistance of all organiza- tions that desired to recommend nurses was gladly welcomed and applicants who conformed to the standard were accepted without regard to creed. x\lmost five thousand applications were examined by my associates and myself and about one- fifth of that number were accepted as eligible for appoint- ment." This arrangement with the Daughters of the Ameri- can Eevolution continued until September 7, since which time Dr. McGee, having been appointed acting assistant sur- geon. United States Army, has been on duty in the AVar Department, in charge, under my immediate direction, of matters pertaining to female nurses. In addition to the contract nurses, selected as above stated, Mrs. Xamah Curtis was, on July 13, sent by direction of the Surgeon General, to New Orleans and other cities to secure the service of colored immune women as nurses at Santiago, and thirty-two were selected by her. At the camps at Mon- tauk and Jacksonville the chief surgeons were authorized to contract with nurses who might apply to them, and at each place a small number were enrolled in this way. Tlic nursing EPISODE OF THE SPANISH-AMERICAN WAR 39 at a few of the Army hospitals has been done by volunteers, with whom no contracts were made.^* Though in the quotation above, "directions" are attributed to the Surgeon General, it was really Dr. McGee who defined the standards and aimed at maintaining them, for she was deeply interested in the success of women nurses in the army. Being a woman, she was solicitous for the prestige of women undertaking a new responsibility and as a professional woman herself, she was eager to uphold the professional worth and dignity of the army nurses. The directions actually given by General Sternberg were, that nurses should be chosen from all parts of the United States, if practicable, and that "political pull" should be entirely ignored. In view of the novelty then of trained women nurses in Army service it is interesting to know how Dr. McGee arrived at her decisions in selecting her nurse corps. Although the first printed regulations did not qualify the words "a training school for nurses," yet in fact the best known institutions were always first applied to. In listing them, Dr. ]\IcGee consulted Jane Hodson's book "How to Become a Trained iSTurse," and advised with Georgia M. Xevins (then head of the Garfield Hospital, Washing-ton), Isabel McTsaac, superintendent of the largest training school in the West, the Illinois Training School for Nurses, Chicago, Sophia F. Palmer, then chairman of the Daughters of the American Revolution committee in Roclies- " "Conduct of the War with Spain." Koply of tlio Siirpcon Conoral to the Coinniitteo. Tlie Selection of Female Nurses. Vol. T, pp. 725-72G. The question blank sent to nurses was as follows: Xanie in full. Address and nearest telegraph station. Do you desire appointment in Army or Navy? How soon after receiving an appointment can you leave home? Have you had yellow fever? Are you a graduate of a training school for nurses? If so, wluit scliool and wliat year? W'liat other hospital experience have you had? Have you nursed contiiiuously since graduation? ]f not, what has been your occu])ation? \Miat experience have you had in invalid cookery? What is vour age? Date and place of birth? Color? ' Height? Weight? Are you single, married or widowed? Are you strong and iiealthy and have you always been so? Have you a tendency to any disease? Have you been succt'ssfuUy vaccinated and when? What is vour lei'al residence? 40 HISTORY OF AMERICAN RED CROSS NURSING ter, New York, and other superintending nurses of note. As the war went on, periods of great emergency arose, when women possessing every qualification were not available in sufficient numbers and at those times, the less well-equipped graduate nurses had to be called upon. The first volunteer offers made to the Government had come from individual women. On the declaration of war these were followed by groups, or organized bodies, of which there were in all, as Dr. McGee has recorded, no less than eighteen. Among the earliest were the National Emergency Association of Women Physicians, Surgeons and Nurses, of Chicago, whose president was Gertrude G. Wellington; the Graduate Nurses' Protective Association of New York State through Miss Enright ; an association of the Connecticut Training School through Mrs. John Kerrigan ; the Metropolitan Nurses' Club through Mrs. Mary Hatch Willard ; St. Barnabas Guild Club of Nurses, and many Catholic orders. The Associated Alumnee (whose formation has been de- scribed) requires special mention, for this body subsequently became affiliated with the lied Cross and later broadened into the American Nurses' Association. In April, 1898, it was in session in New York City for its first regular convention after organization had been effected and it there offered its services to the Surgeon General. The president was Isabel Hampton (Mrs. Hunter) Robb, whose contributions to nursing education and to organization are so important and so closely interwoven with our history that we must pause here to bring her before our readers. Isabel Hampton was a Canadian of English parentage, of a fair and stately type of beauty. Her presence was both imposing and winning, for a special graciousness and ardor shone in her blue eyes and gave her sweet English voice a vibrating, electric quality. ]\[iss Hampton had graduated from Bellcvue when still below the usual age of admission. She had held two important hospital positions, first as head of the Illinois Training School, then of the Johns Hopkins School for Nurses, which she organized and directed until her marriage. She liad been foremost in advancing nursing education and in promoting nursing organization. Marriage did not lessen her devotion to her profession and she was, until her death, its chief spokesman in its various causes and undertakings. Her co-officers in the organization at the time of the war were Helena Barnard (Johns Hopkins), ]\Irs. Hawley (Miss Horner from EPISODE OF THE SPANISH-AMERICAN WAR 41 the Nightingale School in England), Tamar Healy (Brooklyn City Hospital) and Jean A. Hopkins (Bellevne). ^Irs. Robb brought the war situation liefore the convention and the following telegram was sent to Surgeon General Stern- berg: The Associated Ahimn.T of Trained Nurses of the United States and Canada, inchtding two thousand graduates of twenty-four training schools, offer their services for any work which the ^ledical Department of the Army may demand of them in connection witli the war with Spain. By direction of the delegates now in session in New York City, (signed) Isabel Hamptox Eobb^ President. By an error in transmission the word "nurses" was written "music" and Mrs. Eobb's name was misspelled. The reply received was the usual courteous form of declining with thanks. As a result of this misunderstanding the convention took no further action, for the time of its adjournment had come, and thereafter its members entered the war service as individuals, many through the War Department, and others through the Bed Cross Auxiliary No. 8. ]Mrs. Bobb, however, went to Washing-ton and saw Dr. Sternberg and Dr. McGco. They warmly welcomed the offer of cociporation, but a definite mutual agreement was not finally arrived at, because of different points of view as to methods. ^Irs. Bobb, with her intimate knowl- edge of training schools and nurses, would have urged a some- what exclusive standard of requirements, which Dr. ]\[cGee, from her more extensive acquaintance with the War Depart- ment's probable needs and what it would do officially, could not promise. The Government's plans were already formulated and well under way. On jMay 10, 1,S!>S, contracts were signed with the first group of six Army nurses. Fi-om this date, then, one; may informally reckon the beginning of the present Army Nurse (^orps, while its purely official date will l)e met with a little later. Two of the six were immunes, chosen by tlu^ Surgeon (ieneral. and witli whom Dr. ^IcGee had nothing to do. The other four were: Jolnu^tta 1>. Sanger and ^I. Agnes Lease, both of the Johns Hopkins; Alice 1*. Lyon of the Hn^oklyn Homeopathic; and :\rargaret E. Scliaifer of the Philadelphia Hospital.^'^ ''" Army Nurse Corps Index, Sur^^con General's oll'u-e, A. X. C. ]Mv. 42 HISTORY OF AMERICAN RED CROSS NURSING They were selected by Dr. McGee for Key West but were not sent there immediately. The relation of the nurses to the Government and Dr. Mc- Gee, during the time of her work as Director of the D. A. R. Hospital Corps, is indicated below. The excerpt given also shows how the formal appointment of Dr. McGee to an army position on August 28, 1898, was made. This began the official existence of the Army N^urse Corps : During the summer all applications from women, whether addressed to the President, the Secretaries of War and iSI^avy, or the respective Surgeon Generals, were sent to us for examination and reply. We were, therefore, more closely associated with the Government than any other volunteer organization; but, on the other hand, the limits of our re- sponsibility had always been sharply defined by the Surgeon General of the Army. We had no official relations or com- munications with the surgeons, and our official connection with a nurse ceused absolutely when she, having been accepted, signed the army contract. But when a large body of nurses had entered the service many questions arose, necessitating official action in the Surgeon General's office, such as the receipt of reports from surgeons and ordering of transfers between hospitals. As I was the person having the greatest knowledge of this work, and as it was impossible for a volunteer to conduct it, the Surgeon General appointed me as acting assistant surgeon. He then believed that the contracting with fresh nurses was about at an end, and there- fore, on September 7 the Daughters of the American Revolu- tion were relieved, with thanks, from further duty in con- nection witli this office. Since that time I have been on duty in the War Department, my orders immediately on ap- pointment having been to Xew York and Montauk.^*^ The nurses who signed contracts with the Government were classed as the ''Xurse Corps (female)," with Acting Assistant Surgeon Anita Xewcomb McGee as their superintendent. These titles were used officially by Dr. Sternberg in his reports of that time to the W^ar Department, but in signing papers Dr. McGee wrote herself '"In charge. Army Xurse Corps." The Corps was classified as consisting of chief nurses, nurses and reserve nurses. After they entered the Army the title " Dr. McGee's testimony, "Conduct of War with Spain/' Vol. VII, p. 3173. EPISODE OF THE SPANISH-AMERICAN WAR 43 "Nurse," formerly applied to the enlisted men on ward duty, was restricted to the women. The regulations governing their appointment and defining their duties, pay and privileges, were issued from the Surgeon General's office. After June 20, 1808, the printed regulations specified "two years residence in hospital training school" for applicants to the Army Nurse Corps, thus defining what had been the actual practice. In the late summer, with the calls for the typhoid camps, the rules had to be sometimes relaxed and nurses were then accepted from small or special hospitals. There were also four large camps where, during the heaviest emergency, the chief surgeons had been authorized to secure women nurses without regard to training. This method did not commend itself as one to be approved. In round numbers the nurses in service were listed as fol- lows : September, 1898 1,200 December 30, 1898 686 July 1, 1899 202 Total serving to July 1, 1899 1,563 Number of applicants 6,000 Fatalities : Trained nurses 5 Catholic Sisters (out of 250) 5 Untrained (immune) nurses 3 (out of 100) All deaths but two were from typhoid. After the war was over Dr. McGee gave interesting testi- mony before the Congressional Committee, from which a brief section is taken: Q. How many of those nurses proved to be thoroughly well-trained nurses? A. We accepted only graduates of training seliools wlio were endorsed by the suj)erintendent of their schools. There- fore less than a dozen that we sent were afterwards found to he undesirable. Q. Did they })rove to Ijc etlicient in the various liospitals? A. A'ery. \\'e have received very satisfactory reports from all hospitals. Q. So far as you know, has the experience in this war shown that female nurses may be properly employed in mili- tary hos})itals? 44 HISTORY OF AMERICAN RED CROSS NURSING A. Yes, sir, decidedly so. Q. How near to the front have female nurses been sent; in other words, how near to the moving column have there been female nurses in military hospitals? A. Female nurses went to Santiago in the middle of July. Q. As a result of the experience in the months just past, do you tliink it advisable that female nurses should be em- ployed in military hospitals? A. Yes, sir, decidedly. Q. Has such opinion been expressed to you by the authori- ties in the Medical Department? A. It has been expressed to me by a large number of surgeons who have been in Washington. Q. The nurses, then, numbering about one thousand, their actions being satisfactory to the medical authorities of the hospital and satisfactory to the organization that selected them, is there any reason, think you, for hesitating to employ female nurses in any military hospital other than that in the immediate vicinity of the firing line, where I suppose no female nurse can go? A. 1 should judge their presence was extremely desirable, as they had a better training than the vast majority of the men available for the Hospital Corps. This is the chief reason. They were employed in foreign armies and are a permanent part of the British army, where their services have been very satisfactory. You spoke in a recent question of one thousand nurses. In giving this number I was speaking only of those accepted by the Daughters of the American Eevolution. Q. To what extent have the religious orders been called upon? A. To the full extent of their offer. Q. Will you tell us what that extent was? A. The Sisters of Charity furnished a few over two hundred of their Sisters; the Sisters of Mercy of Baltimore, thirteen; the Sisters of tlie Holy Cross, eleven; the Sisters of St. Joseph, eleven ; the Congregated American Sisters, which consists of Indian women from South Dakota, five; the Sisters of St. ^largaret. which is a Protestant sisterhood, two; the St. Barnalms Cuild, which is also an Episcopal organization, quite a inimber. We accepted the nurses re- gardless of tlicir religious belief if they filed their ap})lica- tions in the usual way, aiul all those Sisters filled out the application blanks furnished l)y the Daughters, and c(>rtified their qualifications individually and all were vmder contract and received pay exactly as the other nurses. EPISODE OF THE SPANISH-AMERICAN WAR 45 Q. As to those less than three hundred furnished by the various orders, have the reports of them been satisfactory to you? A. Some of the surgeons prefer them to the other nurses and some prefer the others. Q. To what extent have female nurses been employed in diet kitchens in the various hospitals, either as superin- tendents or occupied in the work of the diet kitchen ? A. They have been employed in a considerable number of hospitals in charge of diet work. I have had several calls lately for women to supervise that work. Q. Have the reports that you have received from the diet nurses of those occupied in the care of the diet kitchens been satisfactory to you? A. Yes.^^ About the routine of assigning nurses Dr. McGee said : The original procedure was, when the Surgeon General received requests from surgeons for nurses, he sent over to me representing the Daughters of the American Revolution, with my associates, for a certain number of nurses to go to a certain place. 1 and my associates selected the humber and sent the names and addresses to him. His clerks then made out the contracts and mailed them to each nurse with a transportation order. She then went to the hospital to which she was ordered.^* Dr. McGee's testimony also makes clear in an interesting way the record of the nurses and throws light on complaints that were numerous at that time, of undesirable and unsuitable women who entered in irregular ways through individual heads of camps; but it is needless to enter into these mimitia?. Surgeon General Sternberg should be more than a name to nurses and our readers may be referred to his biography for the details of his life.'" His recognition of women in their professional capacity was very striking indeed, in comparison with the general military reluctance of that time to admit women into war nursing, and the more so, as his own long Army training had made him conservative and averse to innovation. He had little knowledge of what women could do and at iirst ""Conduct of Iho War with Spain." Vol. 7, pp. 316S-3180. "Ibid., pp. .U7;!-:^174. "A Hiojrrapliy of (k'orjrc Miller Sternberg," by Martlia L. Sternberg. 46 HISTORY OF AMERICAN RED CROSS NURSING anticipated placing them only in base hospitals. He appeared an anstere man, not easily approached nor readily persuaded. He was entirely free from political opportunism. "Pull" -was odious to him and this was of the greatest importance to the nursing service. After the war, Dr. McGee said of him : The Surgeon General had of his own initiative and without suggestion from anyone asked from Congress and received an appropriation for the payment of contract nurses, either male or female. Had he not done this, the Xurse Corps could have had no existence, and so it should never be for- gotten that however mucli the Surgeon General may have been assisted by others, the first and fundamental action to- wards the recognition of women nurses in the army was taken by Surgeon General Sternberg. The work that Dr. McGee herself did was pioneer effort of an original and difficult kind and in its execution she commands the appreciation and recognition of the nursing body for break- ing the ice of military routine and opposition to women nurses in the Army and for the care and regard she had for good pro- fessional standards. She bore the brunt of heavy initial respon- sibilities and difficulties, with the usual criticism that pioneers meet, and so made it easier for those who followed her. Many nurses of the finest quality first entered the war nursing through her office, women who became distingnished and who still hold important places in the Army, Xavy and Ilcd Cross services. She was staunch and loyal to them, fair, kind and helpful in her personal relations with them and had their strong regard."*^ One who knew her said of her : Her friends were devoted to her; those who were hostile were equally strong in their feelings. Her ability as an organizer was considerable; her ability to carry her point was remarkable; she kept in touch with her chief nurses, writing often to them. She had great influence with prominent **In the winter of 1808-00, Dr. Mcdee and the menibors of the Army Xurse Corps founded tlie Society of Spanisli-Anierican War Nurses, and Dr. McGee was for six years its president and hiter its honorary president for life. The otlier officers in its first years were: vice presidents. Dr. Laura A. Hughes, Mary J. McCloud, Isabel Jean Walton, Dr. Isabel Elliot Cowman, Annie A. Robl)ins. Rose Meiselbacli. Mary E. Dreyer, Anna Elizabeth McEvoy, Ysabella B. Waters and Elizabeth Porteous; recording secretary, Leia Wilson; treasurer and corresponding secretary, Harriet Camp Lounsbury. EPISODE OF THE SPANISH-AMERICAN WAR 47 politicians and all the nurses believed that she had done much to help pass the Army and Xavy bills after the war. In the autumn of 1900, when the Army reorganization bill, to be referred to later with more detail, was in preparation, iJr. McGee at the request of the War Department wrote the section which made the Xurse Corps, as it had been organized, a pernument part of the Army. This marked the end of the pioneer work and brought a climax of success, long hoped for, to the first chapter of the story of the Army Nurse Corps. Dr. IVIcGee then tendered her resignation, which took effect De- cember 31, 1900, and selected Dita H. Kinney, one of her chief nurses, as her successor. If, as has been said, the present Red Cross Nursing Service was foreshadowed by^ the Red Cross Hospital Committee on which Sister Bcttina sat, it is even more certain that it had an advance demonstration of a prophetic character in the nursing work of Auxiliary No. '5, known also as the Red Cross Society for the Maintenance of Trained Nurses. On the auxiliary were women who had always been familiar with the hospital and nursing conditions of New York City, such as Mrs. James Speyer, president of tlie auxiliary and of the Red Cross Hos- pital, Mrs. Bayard Cutting, Mrs. George H. Shrady, Mrs. William Sheffield Cowles (Theodore Roosevelt's sister) and Mrs. Lanman Bull. Two women of exceptional character bore the direct responsibility of the Committee on Nursing. One of them, ]\lrs. Whitelaw Reid, by her charitable interests was already closely identified with the hospital and nursing worlds ; the other, ^Mrs. Winthrop Cowdin, had not been in contact with nursing matters up to that time. i\lrs. Reid, who was also the auxiliary's secretary, was the first chairman of the Committee on Nursing. An old friend ~^ who worked intimately^ with her through those days has since written of her: Elizabeth ^lills Keid is an exceptional woman, a possessor of large woaltli and of long years of social and diplomatic experience, osj)ecially during the time when lier husband, Mr. Whitelaw I'cid. was American Minister to France and Ambassador to l-'nirland. Slie is a woman gifted with the virtues of sim])]i(ity. of sym])athy and of loyalty to her ideals and her frieiKls. 'I'o any ohjcct which connnands her interest, she has brought })ractical business ability and understanding ="Miss MalH'l Hoaidnian. 48 HISTORY OF AMERICAN RED CROSS NURSING combined with clear vision and whole-hearted devotion. She has given not only of her wealth but of herself to the great causes for which she lal)ored, prominent among which have been the American Eed Cross, the hospitals she has built and aided and the public health nursing service she has done so much to support. Another of the Spanish- American war workers ^^ of the Red Cross wrote of Mrs. Cowdin: Lena Potter Cowdin, in succeeding to the chairmanship of the Nursing Committee, brought to it excellent administra- tive ability and some executive experience in Civil Service Reform Avork. She had had neither previous special interest nor experience in nursing matters. She had, though, the broad human sympathy of her father, the Rt. Rev. Henry Codman Potter, and very unusual qualities of mind and spirit. Her good method, superb grasp of problems and power to inspire loyalty and enthusiasm in her staff made her a rare executive. Personally spirituelle and eager, she re- sembled, to her friends' eyes, a "flying Victory." These women naturally came at once into close touch with the leading superintendents of i^ew York City. Foremost among the latter was Anna C. Maxwell, at the Presbyterian Hospital, eminent by reason of her great gifts and abilities, her compelling personality, stately presence and uncompromis- ing ideals of nursing. Anna Caroline Maxwell was by birth a New York State woman, whose Scotch clergyman father endowed her with the strong qualities so notably blended, in her character, with a great charity of judgment. She became interested in nursing and with a ''love of difficult tasks'' took the course of training in the early days of the Boston City Hospital School. Following this she was for a time Matron in the Xew England Hospital for Women and Children ; and later was called to the position of superintendent of nurses of the training school, Montreal General Hospital, an ex- ceedingly difficult task at which she did not remain long. Later she was superintendent of nurses in the Massachusetts General Hospital for seven years. She was called from there to St. Luke's Hospital, New York City, where she reorganized the school of nursing and where she remained for three years. Then she was invited in 1891 to establish the School of Nursing of the ==Miss Laura D. Gill. EPISODE OF THE SPANISH-AMERICAN WAR 49 Presbyterian Hospital, also of New York, where she spent thirty years, an inmsnal record in this country, and where she built up a school of fine traditions, of international fame, distinguished for the high character of its training and ideals. She was always deeply interested in the Red Cross and from the first an untiring worker in its activities. It may be truly said of ^liss ^Maxwell, that no appeal for help that it was possibly in her power to give, was ever made to her in vain. Another of the New York nursing leaders who took an im- portant part in the war nursing under Red Cross auspices was Mrs. Lucy W. Quintard, at that time head of the school of St. Luke's Hospital. .Mrs. Quintard had graduated from the Connecticut training school in X-ew Haven in 1890, with spe- cial honors (the "Red Seal" indicative of an excellent record). Immediately afterwards she was appointed superintendent of nurses there and remained at the head of her alma mater until November, 1805, when she was called to New York. Mrs. Quintard had, during the war, one of the most difficult posts, that at Camp Wikofi", Long Island, and fulfilled its duties with great tact and ability. After the war she was called to assist in the reorganization of the civil hospitals in Cuba. Later she devoted herself to the Visiting Nursing Association in Philadelphia, where she died. Mrs. Quintard was exceedingly earnest, gentle, but firm in discipline and deeply religious. To her, the war work was a cross. At the New York Hospital was Irene H. Sutliffe, whose whole professional life was identified with its history. She was trained there, was made Directress of Nurses and only left it for the short period of war nursing, until the time came when she finally retired from active service. During her many years of authority there and afterwards, when she went into residence at the New York Nurses' Club, she had a special hold on the affections of her pupils. Of unassuming manner, great kindness and sympathetic insight, her professional career was peculiarly one of personal influence. Other New York superintendents, all women of ability and character and who shared in the responsibilities of that time, though less directly drawn into the war work than the three especially mentioned, were Agnes Lrennan, at Px'llevue ; ]Marv Samuel, at lt(tos(>velt ; ^liss Ivvkert, at tlu^ Post-Graduate ; Katheriiu^ Sanborn, at St. Vincent's; Mrs, Dean, at Mt. Sinai, and Mary S. Gilmour, at 50 HISTORY OF AMERICAN RED CROSS NURSING the "New York City school. With these nursing leaders the women of Auxiliary ISTo. 3 formed a strong alliance. In the early part of the auxiliary's activities Dr. McGee went to I^ew York to talk over with its members the Govern- ment's plans, and was later elected an officer of the auxiliary. The auxiliary agreed to use the application form of the Daugh- ters of the American Revolution (afterwards the Government's) and to adopt the Army requirement of training, while Dr. Mc- Gee promised to give official appointments to all the nurses recommended by the auxiliary. It was then arranged that all the ^ew York superintendents might direct nurses to enter through the auxiliary for war work and thereafter the Wash- ington office made no further investigation of the qualifications of nurses thus supplied. The work of recruiting nurses for Auxiliary ]^o. 3 was organized by Miss Maxwell. An informal committee composed of the jSTew York superintendents established correspondence with training school heads of prominence elsewhere asking them to choose nurses who should hold themselves in readiness for service. Of women thus carefully selected, one hundred and fifty at a time were brought to ]^ew York and suitably housed, there to be in instant readiness if calls came. So un- certain and so imperative were these calls that the reserve nurses were, practically, almost prisoners in their rooms, for little more than an hour could be allowed between summons and departure. Kathcrine ]^. Pierce, head of the Samaritan Hospital in Troy, Iscw York, gave her vacation to start this recruiting work and after that it was entrusted to Mary E. Wadley, a Bellevue nurse. ]\liss Wadlcy was a New England woman of great energy and resourcefulness. Fair and sunny- faced, she was attractive and most capable. She was already successfully conducting a large registry for imrses at 6 East 42nd Street and the war nursing service was brought in to her headquarters. The system was quickly reduced to a smoothly running routine. Telegrams from Washing*ton would call for so many nurses to go at once to . While Laura D. Gill, the auxiliary aide, flew to the station to buy tickets and make reservations, ]\liss Wadlcy summoned by telephone the wait- ing reserves. Immediately when they were off, calls went to the hospital superintendents on her list to fill up the numbers that had been sent out. This method worked exceedingly well. It was expensive to maintain the waiting nurses in New York, EPISODE OF THE SPANISH-AMERICAN WAR 51 but this was a part of the work of the auxiliary, whose re- sources were unstinted. For speed the auxiliary bought all railroad tickets and these funds were reimbursed by the govern- ment. The Woman's Auxiliary No. 3 had a visiting agent of special ability and tact in Maud Cromelien, a nurse from the Massa- chusetts General Hospital. In the late summer when typhoid fever became epidemic in the camps, reports made by Miss Cromelien, who had been sent to the camps to offer the services of the Eed Cross, and the powerful influences brought to bear, as a result of these reports, by Mrs. Cowdin and Mrs. lleid on public officials, finally won out over the Army conviction that women should only serve in base hospitals, and Auxiliary Xo. 3 had the immense satisfaction of supplying trained nurses from its staff" for the first time on an organized system to field hospi- tals, ^liss Cromelien considered that this marked an epoch in the history of nursing, as indeed it did. When this important work was undertaken a number of New York superintendents went themselves to the camps at the head of nursing staffs. Miss Maxwell, who had written many personal appeals to the Sur- geon General to allow nurses to enter the camps, was sent to the Sternberg Hospital at Camp Thomas, Chickamauga Park. !Miss Sntliffe went to Camp Black and ^frs. Quintard to Camp Wikoff at Montauk Point. Their reports are full of interest but can be only briefly quoted. Miss ]\laxwell's report, sent in to her Board of Hospital Managers, follows in part: Sternberg U. S. Hospital, October 31, 1898. To the Board of ^lanagcrs of The Presljvtcrian Hospital, Xew York City. Gentlemen : On August 1, ^Mrs. Whitolaw Eeid and Mrs. Winthrop Cowdiii. mi'iiibers of the American National Red Cross, Auxiliary No. 3 for tlie ^laintenanee of Trained Xurses, asked if tlie Connuittee of our Training School would grant me a leave of absence to go to Chickamauga Park to establish the work of nursing in a Field Hospital at Camp Thomas. ^ ^ ^ ^ I at once telegraphed to all the leading training schools of the country for irraduatcs an in charge of ]\fiss Lida G. Starr, but later others followed and at one time tlie number maintained there by the Society was as large as forty-five. Miss Starr re- mained at Fortress Monroe until late in January, when she was recalled to Xew ^'ork to take charge of one of the parties of nurses sent to ^lanila. 60 HISTORY OF AMERICAN RED CROSS NURSING In August when the Government bought the Missouri for a hospital ship, trained male nurses were offered to Major Arthur, the officer-in-charge. These men were chiefly selected from the Mills Training School and a few with the assistance of Dr. Fisher, of the Presbyterian Hospital. They fully de- served Major Arthur's commendation and on the second and third trips their number was increased to fifteen. Much good was also done by our representative at Fort Hamilton. There the work was in charge of Miss M. E. Wood. Soon after the first party of nurses had been sent to Fortress Monroe and Leiter Hospital, Dr. Anita Newcomb McGee, director of the 1). A. K. Hospital Corps, visited New York to consult with the Committee on Nurses as to the best means of cooperating with the Government in regard to the distinction between Government nurses and nurses sent out by the Society for the Maintenance of Trained Nurses. It was agreed that the Society would cooperate with the Government in every way and to make everything absolutely clear, Mrs. Cowdin, for the Committee on Nurses, visited Washington. After her consultation with the members of the Hospital Corps, a fund of $500 was placed in the hands of Mrs. Amos G. Draper, the treasurer, to pay for immediate transportation expenses for nurses, as Congress had not appropriated any sum for this purpose. In all $5,425.80 were so disbursed by the Society, until the Government as- sumed all further transportation charges on September 6. It was also agreed that the Society would allow the nurses to sign Government contracts when so required, the Society to pay their maintenance and transportation in some cases, in others only transportation. A field nearer home was opened at Montauk. By the courtesy of the ^Managers of St. Luke's Hospital, Mrs. Quin- tard, their superintendent, was given leave of absence, so that she was able to take charge of this department. . . . Miss Young represented the Society at the Detention Hos- pital at Camp Wikoff, with fifty women under her. . . . In all, Mrs. Quintard and Miss Young had ten thousand patients under their care. The following is a summary of the nurses^ partly or wholly maintained by the Society : Fort Wadsworth : Forty-one nurses were maintained and paid by the Society. Charleston: Twenty nurses. Leiter Hospital : Ten nurses. EPISODE OF THE SPANISH-AMERICAN WAR 61 Governor's Island : Six nurses. Tampa : Five nurses. The Convalescent Home for Nurses, Rowayton, Connecti- cut : One nurse. Atlantic Highlands: Five nurses and one surgeon. On hospital cars : Four nurses. Camp Black : Salaries and laundry bills of forty-two nurses were paid by the Society; the Government provided army tents and rations. Fort Ilaniilton : Salaries and laundry bills of twenty-three nurses were paid by the Society; the Government pro- vided army tents and rations. Fortress ]\Ionroe : Salaries of forty-three nurses were paid by the Government; the Society provided maintenance for these, and salaries and maintenance for two lied Cross nurses. Hospital ship Missouri: Salaries of fifteen men nurses were partially paid by the Society; these nurses were main- tained by the Government. Bedloe's Island: One nurse was paid by the Society and re- ceived army rations : There was also one vounteer lied Cross nurse who received army rations. Portsmouth: Six men nurses were paid by the Society. They received army rations, but their transportation was assumed by the Society. General Hospital, Montauk Point: Almost all of the one hundred and fifty nurses under ]\lrs. Quintard's superin- tendence signed the Government contract. Mrs. Quin- tard's salary continued to be paid by the Society, and large supplies of all kinds for the nurses were selected by Auxiliary No. 3 and their expenses to Montauk paid. Sternberg Hospital, Chickamauga : Sixty-four nurses sent by the Society received (Jovernment pay and rations. Additional nuiintenance and supplies for these and for ninety-six other nurses ordered there by tlie Government, were furnished by the Society. Long Island City belief Station: Twcnty-niiio nurses and two surgeons were paid by the Society and maintained by the Kelief Station. In the tents, ^lontauk Station: Owe iiurse was ])aid by the Society and one volunteer nurse was maintained by the Relief Committee. One nurse was sui)porte(l in Miss Clianler's hospital. Nassau Hosjiital and Annex, Hcnijistead: Twenty nurses were paid by the Society and maintained by the Hospital. 62 HISTORY OF AMERICAN RED CROSS NURSING Home for Convalescent Soldiers, Sag Harbor: Six nurses were paid by the Society and maintained by the citizens of Sag Harbor. Convalescent Home for the 8th Regiment at Hunter's Island: Two nurses were paid by the Society and main- tained by funds raised by Miss Chauncey. U. S. Transport Lampasas: of the twenty-nine nurses on this transport, many were volunteers, and the salaries of some and maintenance of all were borne by the Society. Nurses were also supplied on emergency calls to the Eighth and Ninth Regiment armories. . . . With the necessity of reinforcing our troops in the Philip- pines came a new opportunity which the Society was glad to grasp. Knowing that General Otis had asked for nurses for Manila and hearing that they were greatly needed there, the Executive Committee decided to apply the funds remaining in the treasury for this purpose and after a consultation be- tween Mrs. Eeid and Secretary Alger, the suggestion of send- ing nurses to the Pliilippines was favorably received by the Government. While awaiting the official orders from Wash- ington, a Committee on Nurses was appointed by the Presi- dent, consisting of Mrs. Whitelaw Keid, chairman; Mrs. William S. Cowles, Mrs. Charles B. Alexander, Mrs. Edmund L. Baylies and Mrs. James Speyer, ex-officio. A formal offer was made by the Society to send nurses to the Philippines, and on January 8 the following letter from Adjutant General Corbin was received by the chairman : . . . "We have determinned to take three transports from here to Manila, about eighteen hundred men on each. The Secre- tary of War approves your sending four nurses on each. The first ship will leave the loth, the other tw-o before Feb- ruary 1." . . . No time was lost in completing arrangements which had already been carefully planned, so that though for the first party the notice was short, it was possible to send the nurses properly equipped and provided for. The latter were most carefully selected, many of them having already done valualjle work for the Society during the past summer. They were personally instructed in every case by members of the committee, as to their duties. Tlie transport was ins])ected by the chairman and her committee, letters of introduction from promiiK'iit men were secured for the nurses and every- thing possible was done for their comfort and success on the expedition. All signed contracts with the Society for six EPISODE OF THE SPANISH-AMERICAN WAR 63 montlis' duty in Manila and on the transports to take care of tlie sick in the hospital. Miss Ilenshall sailed on the Grant January 19, with Miss Dowliiig, ^liss Tov ne and Miss Ridley. Miss Henshall was not only in charge of this division but was the superintendent of the entire party of twelve nurses. Miss Starr sailed on tlie Sherman, February 2, in charge of the second detachment, taking with her Miss Betts, Miss Sara Shaw and Miss Agnes Shaw. The last transport, the Sheridan, left February 19 with Miss Gladwin in charge of the party of nurses, who were Miss Stirk, Miss Mount and Miss Holmes.^" The report of the committee, with the financial statement for which ^Irs. Speyer justly deserved especial credit, was cordially commended by President McKinley in letters to Mrs. Speyer in April, 1899. Among the names mentioned in the Report are those of several volunteer aides of special ability and usefulness, and two, whose work began with the Lampasas expedition, not only accomplished excellent things in the general field of auxiliary service but commanded the special regard of nurses for the strong influence they lent in support of the professional nursing staff. One of the first women to register at the Red Cross Hospital ** American National Red Cross Relief Committee Reports, pp. 41-59. The contract signed bv nurses in tlie Philippines ran as follows: THIS CONTRACT, entered into this day of 1899, at New York City, in the State of New York, between the Red Cross Society for Maintenance of Trained Nurses Auxiliary No. 3, and Miss of in the State of witnesseth : That for the consideration hereinafter mentioned, the said Miss promises and agrees to perform the duties of Nurse on United States Transports, or in the Philippines. The minimum term of service shall be six months in the Philippines in addition to the time of transportation, unless otherwise determined by the Military Commander, or by the Red Cross Society for Maintenance of Trained Nurses Auxiliary No. 3, as represented by the Superintendent of Nurses. The said Red Cross Society for Maintenance of Trained Nurses Auxiliary No. 3 promises and agrees to pay, or cause to be paid to tlie said ]Miss the sum of $tK) per month, and to furnish Maintenance, Laundry. Medical Attendance during her term of service, and the assurance of means for a suitable return home. AND IT IS FURTHERMORE AGREED that tlie said Miss shall receive transportation while on duty, and on departure from and return to her place of legal residence, from the Government. She shall agree to recognize the authority of the Superintendent of Nurses appointed bv the Auxiliarv. Miss Signed, sealed aTid dclivei'cd in the jiresence of 64 HISTORY OF AMERICAN RED CROSS NURSING for executive service was Laura Drake Gill, a daughter of the New England Pilgrims and Puritans. She was a college woman of broad training and was placed in general charge of the Lampasas party by Mr. Wardwell. Later, she was sent to Chickamauga to place the nurses in the Leiter Hospital and at all other times, had charge of all the transportation of nurses to and from New York, meeting and dispatching them by day or night. Another prominent aide was Margaret Livingston Chanler, of Knickerbocker circles, who after the war, married Rich- ard Aldrich. Both of these aides gave strong support to the post-war campaign of placing nurses permanently in army hos- pitals. Our space allows no full detail of the many nurses who de- serve mention for their part in the Spanish- American War epi- sode, but a few names must be taken from the Army Nurse Corps Index. Some of these became distinguished in other ways later on. Not a few reappeared in subsequent Army and Navy nursing and Red Cross organization. Two members of the Lampasas party, Beatrice Von Homrigh and Mary E. Glad- win, will be met more than once in later pages. Esther V. Hasson, who served in 1898 on the Relief, became Superintendent of the Navy Nurse Corps (1908) and Dita Kinney, as already told, of the Army Nurse Corps. There were women of eminent distinction in training school work then and later, among them Nancy Cadmus, whose administrative career in hospitals was unbroken for years, except for the war service ; Frances A. Stone, associated with Miss Maxwell at the Presbyterian Hospital and Mrs. Louns- bery, with others already mentioned. Especially distinctive was the work of the group of women who, after the war, carried out the organization of modern training schools in the civil hospitals of Cuba and Porto Rico, Lucy Quintard, Sarah S. Henry, M. Eugenie Hibbard, ^lary A. O'Donnell, Amy E. Pope and others.^''' Mary J. McCloud organized a school in the military hospital at ]\rexico City. Elizabeth Stack taught the hospital corps men nursing and die- tetics at Angel Island. On the Army Nurse Corps Index, too, one finds Yssabella G. Waters, whose later compilation of public health nursing agencies in the L^nited States, kept yearly up to date, has become a classic of its kind; Lydia Ilolman, one of ""History of Nursing," Vol. IIT, Cliap. VI. EPISODE OF THE SPANISH-AMERICAN WAR 65 the earliest pioneers in rural nursing; Jane Hodson, author of the well-known book previously mentioned ; Isabel Jean Walton, a New York Hospital nurse since then identified with St. John's Floating Hospital and other public health nursing work. Some of those no longer living must be named. Clara L. Maas was a young Army nurse who during the investigation of yellow fever transmission in 1900-1901, in Cuba, insisted on being allowed to volunteer for the experimental service. She was accordingly bitten by an infected mosquito and died as a result of the too-perfect demonstration. She was buried with military honors and is mentioned with respect in several official records. Louisa Parsons, English born, and a Spanish-Ameri- can war nurse, died in the British Army service in 1915. Emma Duensing, German born, died in the same year in the service of Germany. Kose Kaplan, who had become head of a hospital in Jerusalem, died while caring for refugees in 1917. A little group of Spanish-American war nurses lived to serve throughout the World War. They were : Samantha C. Plum- mer, Edith Rutley, Helen M. Pickel, M. Estelle Hine and Carrie L. Howard. After the w-ar there were many testimonials to the usefulness of the Army nurse. It may suffice to repeat here the conclusion reached by the Congressional committee appointed to inquire into the conduct of the war. In its report, among other recom- mendations was this one: "... Needed by the Medical De- partment in the future; a Reserve Corps of selected trained women nurses." ~^ Its estimate of the nurses ran as follows: In the last twenty years the value, the efficiency and the availal)ility of well-trained women nurses lias been demon- strated and it is much to be regretted that this fact was not fully realized by the medical officers of the army Avhen the war conunenced. It is to be remembered, though, that in . military hospitals in the field women liad heen em])loyed as nurses, if ;it all, only to a very limited extent, and there was good reason for questioning whether a field hospital with a moving army was any place for a woman. Our recent ex- perience may justly he held to have shown that female nurses, properly trained and ])roperly selected, can he duly cared for and are of the greatest value. Those who have l)een serving under contract in our military hospitals, and there have been * "Conduct of War with Spain," Vol. I, p. lS!t. 66 HISTORY OF AMERICAN RED CROSS NURSING about fifteen hundred of these, have with scarcely an excep- tion done excellent work and it is to the high credit of the American soldier that not a single complaint has been made by any nurse of personal discourtesy.^** "Conduct of War with Spain," Vol. I, p. 171. CHAPTER III AFFILIATION OF THE AMERICAN KED CROSS WITH THE NUESEs' ASSOCIATION The Army Nurse Corps Reorganizaiion of the Red Cross in 1905 The American Federation of Associated Alumnw Accepts Affiliation ivith the American Red Cross Develop- ment of the Nursing Service Farticipation in Disaster Relief THE war was not yet over when the idea of securing the existence of the Army Nurse Corps by legislation was agitated by various war workers. In December, 1898, Dr. McGee went to New York to suggest to Mrs. Quintard and other nurses with whom she had been in close touch, the wisdom of attempting such legislation. While she, as a subordinate of the War Department, could not initiate it, she would, she promised, do everything in her power to obtain Congressional approval of an act that should not be too great a departure from the methods and ideas of the Army. At almost the same time Mrs. Kobb went to New York to lay a similar proposal before nurses and Auxiliary members, all of whom received the suggestion with enthusiasm. Tn view of the Army Nurse legislation of 1920, a full account of that first campaign would be interesting, but we must limit ourselves to a brief summary of its main features. A committee of women, many of them of national distinction, with prominent nurses, promoted the bill. ]\rrs. Winthrop Cow- din was its first chairman and among those who, in the course of its duration, served on the "Committee to Secure by Act of Congress the Employment of Women Nurses in the Hospital Service of the United States Army," were Louisa Lee Schuy- ler, veteran of the Sanitary (Commission of the Civil War; ]\rrs, William Osborn and ^frs. floseph Hobson, two of the organizers of the Rellevue School for Nurses; ^frs. Amos G. Draper, prominent in the Daughters of the American lievolution ; ]\Irs. 67 68 HISTORY OF AMERICAN RED CROSS NURSING Wliitelaw Reid, unfailingly helpful in nursing matters and lavish of her influence and means ; Margaret Livingston Chanler and Laura Drake Gill, who had been two of the most hardwork- ing of the volunteer aides ; Mrs. W. N, Armstrong, of Hampton, Virginia ; Mrs. Bayard Cutting ; Mrs. C K. Meredith, Mrs. Harriet Blaine Beale, Mrs. John S. T. Hull, Mrs. Hawley (the English nurse, mentioned earlier as Miss Horner and afterwards married to Senator Hawley of Connecticut), with Anna C Maxwell, Irene H. Sutlift'e, Isabel Hampton Robb, Ellen ]\L Wood, Linda Richards, ]\I. Adelaide Nutting, Mary F. Wadley, Georgia M. I^evins and Lucy W, Quintard. Miss Nutting was the chairman of the committee of nurses and directed the work of informing the rank and file of the points at issue. She was then superintendent and principal of the Johns Hopkins training school where she had entered as one of Miss Hampton's first class and in which she had risen to the position of head of the school on Miss Hampton's marriage. Born in Canada^ Miss Nutting's brilliant mind and untiring energy turned with special attention to educational nursing problems and she will be met in the forefront of such circles of activity, as we go through these pages. Her work at the Johns Hopkins was so original and effective that she was called thence to direct the Department of Nursing and Health at Teachers College, where she surrounded herself with ardent young enthu- siasts and made an international reputation for her department. In the work for the Army Nurse Bill her executive ability was for the first time shown outside of the hospital, for there was then no nursing journal, no close network of central and local associations to facilitate communication. She said, later: One of the things that makes that correspondence stand out in my memory is the fact tliat for the first time in train- ing school work I had some help from a stenographer. The New Y(jrk women insisted upon my using such assistance, which I rather timorously did to a small degree. This was the first time nurses had approached Congress, Miss Nutting wrote : One incident wliich stands out rather clearly was a hearing by the Military Committee of the House or Senate, I forget which, where I had to summon ])y telegram Mrs. Isabel Robb, Miss Mclsaac, Miss Maxwell and various others, including, I REORGANIZATION AND AFFILIATION 69 think, Dr. Billings, who gave us constant help and advice. At the beginning of the hearing in Washington, in walked Mrs. Joseph Hobson, who had heard of it and wanted to give her point of view on the importance of good nursing. 1 remem- ber what an ordeal it was, because as chairman 1 had to intro- duce each member and explain who he or she was and why his views and opinions would bo entitled to respect and when it came to Dr. Welch, who was there and spoke splen- didly for us, I felt paralyzed. Powerful yet intangible opposition to the bill was met with. It seemed to be especially directed against the professional requirements asked for and the stipulation that the head of the Army Nurse Corps should be a nurse. The committee and the entire nursing profession back of them regarded these require- ments and the claim for a nurse superintendent as fundamental. In the process of overcoming the opposition, Margaret Chanler volunteered no less a service than to make a trip to the Philip- pines, to investigate persistent unfriendly rumors that appar- ently came from Luzon and were brought to members of Con- gress in depreciation of the morale of women nurses in the Army. There had indeed been some unfortunate selections made in the early part of Philippine war nursing, when western Red Cross societies had unwittingly recommended several women of unsuitable type, who had been sent home in disgrace. But when Miss Chanler visited Manila (summer of 1899) there was only the carefully chosen staff of seventy-five nurses sent out by the Auxiliary No. 3, working under Colonel Grecnleaf, who was their staunch friend. It was clear that the hostility of the opposition did not then emanate from JNfanila, and myster- iously enough, with Miss Chanlcr's visit it was effectually silenced. The bill sponsored by the committee was brought up in Congress on January 24, 1899, but failed to pass. Kesolute in their determination, the committee continued their work through 1900. They had at first asked for a "Nursing Service Commission" and educational recpiirements alike for the entire staff, i.e., "General hospital training of not less than two years." Three years' training was then established in certain large schools and was being rapidly extended. !Many nurses, too, were taking postgraduate courses. The contest ended in a reasonably satisfactory compromise. 70 HISTORY OF AMERICAN RED CROSS NURSING for the committee finally agreed to accept a section in the Army Reorganization Bill of 1900-1901. This was the section pre- viously referred to, drafted by Dr. McGee, at the request of the Surgeon General, on what seemed to the War Depart- ment acceptable lines. The committee obtained the insertion of an amendment to it specifying in part, for the superintend- ent, the educational qualifications they had wished to secure throughout the staff. Thus amended. Section 19, as it was numbered, read (omitting unessential details) : That the Nurse Corps (female) shall consist of one super- intendent, who shall be a graduate of a hospital training school having a course of instruction of not less than two years, and of as many chief nurses, nurses and reserve nurses as may be needed, provided that tliey shall be grad- uates of hospital training schools and sliall have passed a satisfactory professional;, moral, mental and physical examina- tion.^ The bill was signed by the President on February 2, 1901, and the nurse selected by Dr. McGee to be her successor was duly appointed. Mrs. Dita H. Kinney, the new head of the Army N^urse Corps, had had active service during the war, chiefly in the West and Southwest. She was a New York State woman, trained at the Massachusetts General Hospital (class of 1892.) Her experience before the war had been varied and responsible and she had carried on some pioneer work in teaching the elements of nursing to mothers of families on social settlement lines. Mrs. Kinney had earlier shown her courage by making the first attack in print on bogiis schools for nurses. ^Armv Reorganization Act of 1901 February 2, 1901, Sec. 19, Vol. 31, U. R. Statutes at Larj^e. p. 748. Tiie "Special Coniniitlee in Charpe of the Bill" during the 5C)th Congress were: Miss ^largaret T.ivingston Clianler, Mrs. Harriet Blaine Beale, INlrs. Joseph Hobson, Mrs. ^^'illiam Sheffield Cowles. Mrs. Joseph R. Hawley, Mrs. Amos G. Draper, I\Irs. Jolin S. T. Hull, ]\Iiss Georgia Xevins. The Navv Nurse Coijjs soon followed. It was orgaTiized definitely in 1901; the ^irst effort to pass a bill in Congress was made in 190.3: final passage of the Bill came in 1908. Navv Appropriation Act of May 13, 1008, Vol. 35, U. S. Statutes at Large, j). 129. Dr. McGee helped in framing the Navy Nurse Corjis Bill also and tlrougli her efforts various appro])iiat ion items bent'dtiiig bofh services were secured. In view f)f the later bestowal of "Hank" mi Army nurses, it is inleresting to know that Dr. ]\lcGce opened tlie snliject of rank with the Surgeon General at the time of drafting "Section 19." J^ut tlie Army attitude then was immovably ojijiosed to any such innovation. REORGANIZATION AND AFFILIATION 71 The first few years after the war were full of reorganization plans, both in the American lied Cross and in nursing societies. The lessons of the war were not forgotten and women in New York and elsewhere, who had been at the head of relief and nursing work, held to the Red Cross, hoping to continue the efficient system they had done so much to develop. In that period also, the two nursing societies, the Superintendents' Society and the Associated Alumnae, had joined in a free affiliation for international purposes, under the name The American Federation of Nurses, each one retaining its corpor- ate identity. At a meeting of the Superintendents' Society (October, 1903), a resolution had been adopted giving its councillors power to act for the society in any public question that might arise during the year. This action had been specifically taken with a view to future union with the Red Cross, for which they cherished a desire. The Associated Alumnte were equally alive to this possibility, one of the great questions of that day, and a concerted effort to open np a way of affiliation with the Red Cross was made in the winter of 190-i by executive officers of the two societies. The American Journal of Nursing said in April, 1904: On February 23, a number of well-known women in the nursing profession came together in New York and quite informally a group of New York women met with them in the e\ening to discussion questions of importance to nurses. The out-of-town members present were ^lary M. Riddle, president of the Associated Alumna\; M. Adelaide Nutting, president of the American Federation of Nurses; Isa- bel ^Iclsaac, president of the American Journal of Nurs- ing Company; Sophia F. Palmer, editor of the American Journal of NuKsin>g. and tlie five Chicago members of the class in Ilosjiital Economics at Feachers College. Of tlie well-know]! New York women there were present ]\riss :\raxwell, :\riss Delano, :\riss Wibon of St. Lidiitral Kxiriitivt> C'oiiiinittoc, Vol. 1, i). 102. 86 HISTORY OF AMERICAN RED CROSS NURSING established a Red Cross Nursing Department, for the purpose of spreading knowledge more widely among nurses and stimu- lating their interest by giving reports from all sections of the country. It was at first edited by Miss DeWitt, editorial assistant in the Journal office. With this department a system- atic and complete history of Red Cross nursing growth and activity appeared regularly month by month. In that year also, the International Red Cross had resolved to take a part in the crusade against tuberculosis and it was realized that this would need the services of many more nurses. But with all these efforts, it became clear that nurses were not closely enough approached and that they were hanging back. Between the Red Cross Central Committee at Washington, the State so- cieties with the nursing committees and the individual nurse, there was too lengthy a line of communication. Perhaps lead- ing nurses felt this even more definitely than did the Central Committee of the Red Cross. They were aware that the nurs- ing service was too loosely knit together to hold well in a dire emergency. They then made the suggestion that instead of State nursing committees within Red Cross State societies, the State Associations of Nurses, by that time strongly devel- oped throughout the country, should themselves be the bodies responsible for enrollment and should cooperate in this work wdth State Red Cross societies. Several states had actually brought such an arrangement into being. !Miss Damcr, presi- dent of the Associated Alumnre, pointed this out in her address at the Tenth Annual Convention in 1907. She said: Another matter in which we have made the discovery of the need of eooporation is the Eed Cross work. . . . The Red Cross calls upon us nurses in its work in many ways. . . . It has been suggested tliat we ask the state (nursing) associa- tions to cooperate in this matter, to form auxiliary societies among their members or have committees appointed who will enroll nurses for the Eed Cross work. Ohio is very well organized in that respect, and California has recently started an auxiliary. In 1008 came the first severe test of the efficiency of the Red Cross Nursing Reserve, ^vith the calls for help from inun- dated sections of Mississippi, following the tornado and floods that occurred in April of that year. By dint of great effort, the need was met, but the machinery creaked, as explained with candor by the American JuiirnaJ of Xiu\^in(j (June, U08). REORGANIZATION AND AFFILIATION Si After reciting the incidents of mustering the required nurs- ing reserves, it said editorially: Judging from these facts, one receives the impression of prompt and efficient service, but knowing the inner side of the story, the nursing profession is given some cause for serious reflection. . . . The question before us is how to bring all of our forces so into cooperation with the Red Cross that prompt and efficient service may always be at the command of that society with- out unnecessary delays. All other considerations in connection with the Red Cross are secondary to this one of efficient enrollment. Jt should be taken up by every local organization and carried into our state and national conventions until the problem has been satisfactorily threshed out. Otherwise the Red Cross will be forced to train its own workers. So far all the steps taken toward providing a Red Cross Nursing Reserve had proved to be but tentative and oppor- tunistic and did not satisfy the nurses themselves. The genuine affiliation of organized nursing bodies with the Red Cross which finally took shape, began with the work of Isabel Hampton Robb in 1908-1909, though her plan did not then carry in its original form. The story is fully told in Mrs. Robb's words at the second convention of the Federation of Nurses. This body, it is to be remembered, was composed of the two societies, the Superintendents and the Associated Alumna} in joint meetings. At the Superintendent's Convention in April, 1908, Miss Nutting, its president, had asked ]\[rs. Robb to serve as chair- man of a Red Cross Committee and to enable such a committee to confer with the Central Committee of the Red Cross for the purpose of finding out whether any arrangements could be made whereby a settled Red Cross Nursing Service might be established. The following women were selected to serve with Mrs. Robb: Miss Damer (representing the Alumnte), ^liss Nutting (the Federation), ]\Iiss Nevins (the Superintendents' Society) and Miss Maxwell, who had had great experience in the Red Cross work of the Spanish-American War, as member at large. On June 13, 1908, ^Mrs. Robb wrote to Miss Boardman tell- ing her of the nurs(>s' wishes and of tlic existence of the com- mittee. Miss Eoardman replied on July 20, 1908, saying: 88 HISTORY OF AMERICAN RED CROSS NURSING I was very glad to receive your letter and am delighted. . . . This spring there were created three Red Cross Departments on, first, War; second, Emergency, and third, International Relief. A Board is at the head of each Department. General O'Reilly, Surgeon General of the Army and a member of our Central Committee, is the chairman of the first Board and I am chairman of the second. At the time of our annual meeting in December, the 8th and 9th, there will be meetings of these two Boards and there will also be a meeting of the Emergency Board in Washington the first part of October and probably also a meeting of the War Board about the same time. If you are near Washington at that time and could meet these Boards it would be very useful as they are the Boards which will have active charge of those relief measures in which we would probably need the nurses' assistance. Mrs. Robb and Miss Maxwell v(7ent to Washington in October and had an informal conference with Miss Boardman and Mr. Bicknell. They returned to New York and met the other com- mittee members, no definite conclusion being arrived at. Mrs. Robb next summed up the substance of their conference with the Red Cross officials in the following letter to Miss Board- man: Cleveland, October 15, 1908. My dear Miss Boardman : I beg to submit to you in writing the substance of the conversation Miss ]\Iaxwell and myself had with you on October 4, to the effect that the Federation of Xurses, which . . . numbers about 15,000 members, appointed a special committee to confer with the Central Committee of the Red Cross to find out if it might l)e possible to make suital)lc arrangements whereby all nursing and allied work required by the Red Cross Society might be done through the Federa- tion of Nurses under proper organization. Unless some such organization is effected the majority of nurses feel that the most efficient nursing work cannot be attained, nor the proper selection of nurses made, and that in consequence all mem- bers of the profession are subject to unnecessary adverse criticism. The nurses also feel that suitable recognition should be accorded them as a body of professional women and the integrity of their work should be maintained. To those of us wlio have given the matter careful thought, it would seem tliat a satisfactory agreement to both the Red Cross and the Federation of Nurses miirht be reached through REORGANIZATION AND AFFILIATION 89 affiliation, whereby a nursing department carefully planned in every detail miglit be organized that would cover all branches of Red Cross nursing, including that of the Army and Xavy. This would not necessarily mean that women for appointment to any branch of the Hed Cross nursing work must be a member of some nursing organization, but that she should have the qualifications now considered essential for a nurse in good and regular standing. If the Central Com- mittee of the Ked Cross is willing to consider this affiliation proposition, then it will be necessary to hold a conference to decide upon what grounds such an affiliation can be best worked out. Very truly yours, (signed) Isabel Hampton Eobb. To this Miss Boardman replied : My dear Mrs. Robb : Your letter of the loth has been forwarded. ... I feel confident that a plan satisfactory to all can be worked out. I shall be at my otlice in Washington on Thursday and then will go into the matter at length. I want you on the War Relief Board and as a meeting of the Board will be held soon after my return to Washington, your appointment will then be arranged for. The Red Cross president, Mr. Taft, makes this appointment. Yours sincerely, (signed) ^Iabel T. Boardman. A week later Miss Boardman wrote again to Mrs. Robb: There has not yet been a meeting of the War Relief Board, but I think one will be held next week at whicli time your letter will be ])resented to tlie Board and at the same time your ai)poiiitment as a member of that Board to represent the Trained Nurse part of the Red Cross and as a represen- tative of the Federation of Nurses, will be made. I feel sure that this pro])osed affiliation with the Federation of Nurses can be brought about in a way satisfactory to all. Please let mo know when you ex])ect to 1) east so that a meeting of this Board can be held during that time. A meeting of this I^oard will also be held about the time of the regular annual Red Cross meeting, December 8. At the meeting next week or thereabouts, 1 will read your letter to me of Oetol)er 15. Tn order that ^Mrs. Rohb might obtain a seat on the War Relief Board, ]\riss Boardman generously resigiu'd her own, 90 HISTORY OF AMERICAN RED CROSS NURSING thus creating a vacancy which Mrs. Robb was appointed to fill, January, 1909. Having conferred with her committee, Mrs. Robb attended the War Relief Board meeting in Washington (March 25) and there submitted the plan of affiliation as agreed on by her com mittee. The plan was, with but a few modifications, the same as one drawn up by Mrs. Robb herself, earlier in the winter, which had been informally discussed at Red Cross Headquarters and which is now in the Red Cross archives. This historical detail explains dual allusions in Red Cross official material to ''Mrs. Robb's Plan" and ''Mrs. Robb's Committee's Plan." Both were essentially the fruit of Mrs. Robb's ideas. The plan presented follows : To the Eed Cross Board of Control of War Relief: The committee appointed by the Federation of Xurses to devise a plan whereby the Red Cross might enter into affilia- tion with the Federation of Xurses for nursing purposes, begs to suggest the following plan for your consideration. Whereas it has been proven that volunteer service by the individual nurse is not a success owing to the fact that it is impossible to count upon her services in emergency : It would seem advisable to form a regular nursing depart- ment of the Eed Cross. That a permanent Chief Xurse hav- ing the requisite training, experience and organization ability be appointed to the head of this department. That the de- partment be subdivided into four large sections, that of the Xorth, South, East and West, and that a permanent Head Nurse be placed over each of these. That the Federation of Nurses be asked to affiliate with the Red Cross for the pur- pose of supplying the main nursing force. This force to be composed of its members specially selected, and in considera- tion of this, the Federation would request the following privileges : That its nursing force be drawn upon first for active service; that this nursing force have the privilege of wear- ing the Red Cross brassard on nursing service of any kind ; that an executive committee from among its members shall be appointed by the Federation Council to act with the War Relief Board of Control : that the Federation be represented at the Red Cross annual meeting by one or more delegates selected from the Federation. The source of siip])ly shall be drawn from the ranks of the Federation, from other qualified nurses not members of the P^deration, from Si.-terhoods and from so-called "experi- REORGANIZATION AND AFFILIATION 91 enced nurses." It is further suggested that in order to insure a ready supply of nurses the Federation of Nurses be asked to form a central directory in all the large cities of the Union and the head nurse in charge of these directories be put on the permanent staff of the Red Cross Xursing Depart- ment subject in emergencies to orders from the national head nurse. Duties of the Chief Nurse: To organize the nursing force in detail in cooperation with the Executive Committee and Board of Control and the sec- tional head nurses. To keep corrected lists of all nurses on the sectional registers. To visit and inspect the various sections from time to time. To arrange for special courses in emergency training throughout the country. To arrange for Home Nursing courses in the various sections. To talk upon Red Cross nursing matters -wherever and whenever desirable. To study Red Cross nursing organizations of other countries with a view of improving that in America. The Xursing l)e})artment of the Bulletin to be edited by her. Duties of the Sectional Head Nurse: To make lists with records of all trained nurses in their sections : 1. Number of Federated Nurses. 2. Number of Graduated Nurses not in the Federation. 3. Number of Sisterhoods available. 4. Number of experienced nurses available. 5. Lists of nurses on directories. 6. Lists of all available nurses. 7. Represent Red Cross work by at least one lecture be- fore students in training schools. To arrange for and over- see courses on emergency and first aid nursing. Also to give courses on homo nursing. To cooperate with other Red Cross work where possible. (signed) Isabel IIamptox Robb, Chairman. Annie 1)a:\ier, M. Adel-vide Nutting, Georgia Nevins, Anna Maxwell. Thoro woro present besides ^Uss Boardman, Surgeon General Tonicy, Dr. Wise of the Navy, and ^lajor Davis. Exception was taken (quite properly) to the point concerning the use of the brassard (a matter wliich could have been easily arranged) and to the expense the schenu^ would entail. The nKMubers present seemed, reasonably enough in so c^arly a stage of the organization, unready to accept so considerable a plan, as tliero 92 HISTORY OF AMERICAN RED CROSS NURSING would not always be a need for a great many nurses. Mrs. Robb suggested, in answer to this, that they might be used in nursing people of moderate means, but that, it was thought, was outside the Red Cross province. The meeting then adjourned. The plan was talked over further by the Red Cross officers, who thought it elaborate and complicated, and a little later they sent the following statement in regard to it : At a meeting of the War Belief Board held March 25 at the National Headquarters in the War Department the sug- gested outline of plan for the affiliation of the Federation of Nurses with the Eed Cross, prepared by Mrs. Bobb at the request of the Board and after consultation with the Federa- tion of Nurses' committee on Eed Cross nursing, of which Mrs. Eobb is chairman, was presented by Mrs. Eobb and informally discussed. , The Board considered the plan care- fully studied out and containing valuable suggestions, but that as the carrying out of such a plan would involve a large expenditure of money from the Administration Fund of the Society, the Board felt that it would be impossible under present conditions for it to undertake any such elaborate plans. Mrs. Eobb thought that it would involve an annual expenditure of from nine to ten thousand dollars to carry out the proposed plan. As experience has shown that for both war and emergency relief, the services of a nimiber of nurses have very seldom been required for strictly Eed Cross work, the Board ques- tioned as to whether at any time it would be justified in such a large annual expenditure for the proposed plan unless some continuous beneficial use within the Eed Cross sphere of work could be made of this affiliation. The Board hoped that for the present a plan for some limited affiliation may be brought about that will involve little or no expense to the Eed Cross. It is desirous of ob- taining the interest, su})]H)rt and assistance of the Federation of Nurses in Eed Cross work so that the trained nurses of our country may l)e able to take their part in the patriotic and humane service of the Society in time of war or disaster. The Board desired to e.\i)ress its thanks to 3Irs. Eobb and the other members of \ho Federation of Nurses' cominittee on Eed Cross nursintr for the care aiid thought given the proposed plan and regret that the financial question makes its adoption under existing circumstances impossible. Chairman, lied Cross \\'ar Eelief Board. ^ "Minutes, Meeting War Relief Board. Marcli 25, 1909. REORGANIZATION AND AFFILIATION 93 Thus the first negotiations failed, but, in the light of later history, it is interesting to pause a moment and consider how the Red Cross Nursing Service has actually developed, along the lines of the plan presented by Mrs. Robb. The Department of ]^ursing was evolved for war purposes almost exactly as she recommended and gave striking testimony to Mrs. Robb's vision and foresight. The decentralization of the service, as suggested by her under four sections, was rapidly effected after the declaration of war (1017) but instead of four it was necessary to create fourteen divisions, in each of which a full time, paid nursing director with a staff has been required. -^^ The Executive Committee of her plan exists as the present National Committee on Red Cross Nursing Service. The provision to include Sisterhoods was carefully con- sidered (1914) and found of much practical value. For ex- ample, the nursing personnel of Base Hospital No. 102, from Xcw Orleans, was directed by Sister Chrysostom Moynahan and included ten other Sisters. Practical nurses were utilized, especially during the influenza epidemic in 1919-1920, when many hundreds of women were needed. The suggested directories as centers for enrollment were not utilized to any extent but, instead, local committees of nurses attached to state associations were organized and they collected credentials, passed upon the professional qualifications of appli- cants and finally forwarded all papers to National Headquarters where they were filed. The duties of the chief nurse as indi- cated by jMrs. Robb are almost identical with those of the Director of the Department of Nursing. Time has shown that her general plan, while a little startling when first submitted to tli(^ War Relief Board, and pro])ably as a b(>ginning too (elabo- rate, was gradually accepted and that a still furtlua* elaboration, on an even more generous basis, soon became necessary. It was fortunate that this was so, for upon the declaration of war in April, 1917, tlu^re were 7000 nurses enrolled under the Red Cross and so well organized were its state and local connnitte(>s that this enrollment was easily increased with arcat rapidity. Airs. Rohl) (lid not embody in her j)lan lun* conviction that the IumI Cross nurs(es slionld form the Army reserve but her mind was cle;\r on this jioint. Finally her ho})e of se(Mng Home Xursiiig classes developed on a national scale has been fullillcd, ^" This number (inder peace cnnditions was reduced to tMglit. 94 HISTORY OF AMERICAN RED CROSS NURSING beyond, perhaps, even what she foresaw as possible, as we shall learn in another chapter. The Central Committee of the Red Cross, disappointed in their first attempt, took counsel among themselves and planned another way of solving the nursing question. In May, 1909, the War Relief Board proposed placing the Red Cross Nursing Department under a special subcommittee and sent to Mrs. Robb the following resolution passed by them on May 7 to that effect : Resolved, That the subcommittee on .Eed Gross Nursing Service sliall consist of a chairman and fourteen other mem- bers, five to constitute a quorum. The chairman and five members to be members of the War Belief Board, to be ap- pointed by the chairman of the Board ; six members to be appointed by the chairman of the Board from a list of trained nurses submitted by the Nurses' Federation, and three persons to be appointed by the chairman on recommendation of the Board. The chairman and two other members of the committee to be selected from trained nurses, members of the "War Eelief Board. Of the three other members one should be a surgeon of the Army, one a surgeon of the Navy, and the third some other member of the War Relief Board. This will give a membership of nine trained nurses on a committee of fifteen.^^ The resolution was read by Mrs. Robb as a part of her report at the annual convention in Minneapolis (1909) and discussed. Mrs. Robb was keenly disappointed in that the work and thought she and her committee had put upon their plan seemed to have been lost, and she feared that the hope of satisfactory affiliation had faded. But her intense idealism and love of perfection perhaps led her to forget how new and un- tried, as yet, was the American Red Cross organization. It is easy to see, now, how formidable and binding tlie plan must have seemed to the Red Cross executives. Other nurses realized this at the time and believed that it would be better to begin in a smaller way and to build up little by little. The suggested committee of fifteen seemed to them a sensible compromise and ^liss Palmer arose as the spokesman of this group. She spoke of being an officer in the Rochester branch, reviewed the general conditions of Red Cross state work and offered thia motion : "^linutcs, War Relief Board, May 7, 1900.. REORGANIZATION AND AFFILIATION 95 Resolved, That the American Federation of Nurses afiiliate in a body with the National Ked Cross Society and that nurses be nominated by this association to serve with the National Red Cross Committee as outlined by the National War Eelief Board. Miss Delano had gone to the Minneapolis meeting with a hope of securing the assent of the Federation to the proposal made by the Red Cross. Miss Palmer wrote later: I know from my close association with Miss Delano in those early days . . . that she had very definite plans for the development of the service. . . . Although I submitted the resolution for affiliation it was really Miss Delano's resolu- tion, as she had it written out in ink before the meeting and, sitting next to nie, asked me to present it.^- Tliere was an animated discussion and the resolution was adopted, but with an amendment to make the Associated Alumna) the affiliating body, as all the superintendents belonged individ- ually to it. After the annual meeting of the Red Cross in December, 1909, the War Relief Board named the following National Committee on Red Cross Nursing Service, and Miss Delano was made chairman :^^ From War Relief Board Mrs. Whitelaw Reid, Now York City; ^Irs. Isabel Hamp- ton Robb, Cleveland, Ohio; ]\Iiss Jane A. Delano, Office of the Surgeon General, War Department, Washington, D, C; IMiss Georgia Nevins, Washington, D. C. ; Major Charles Lynch, T". S. Army, Washington, D. C; Surgeon W. L. Bell, U. S. Navy, Washington, D. C. From Emergency Relief Board ^riss ^ra])el T. Boardinan, War Department, Washington, D. C; Mrs. William K. Draper, New York City. Nurses' Associated Alumx.e ^liss Sopliia F. Palmer. Rochester, New York ; ^liss Emma ]\r. Xicliols, l-)Ost()n City Hospital, Boston. ^Tass. ; ^liss Linna G. Iiicliardson. Portland, Oregon; Miss Anna C. Maxwell. Presbyterian Hospital, New York City: Mrs. F. Tic-e. Chi- cago, ill.; Miss ^iargaret A. Pepoon. San Diego, California: ^Irs. Harriet Camp Lounsbury, Charleston. West Virginia. "Letter in Red Cross tiles. "-Minutes, War Relief Board. December 20. 1900. 96 HISTORY OF AMERICAN RED CROSS NURSING The American Journal of Nursing said editorially: By the appointment of this committee, with the majority of its members nurses, the responsibility of the nursing de- partment of the American National Eed Cross is placed upon the shoulders of the members of the Associated Alumnae. . . . So far, the nurses of the country have not responded to the call for enrollment in the Eed Cross as they should, the reason frequently given being that such a department under the direction of laymen could not be conducted on a practical working basis. This excuse can no longer be advanced, the work of organizing a Eed Cross nursing service is now in the hands of nurses. With the concentrated strength of all our national and local nursing societies it can be made a practical working force. . . . The action of the Associated Alumnae brings the nurses of this country into distinct relationship with the War Eelief Board and gives to them a very influential place in the ad- ministration of the strictly nursing side of the work of the National Eed Cross. It is an opportunity which has never been ours and one which must receive the most intelligent cooperation from all the affiliated societies in order to prove our worthiness of the confidence which has been shown us. After the meeting at ^Minneapolis, Miss Delano had gone abroad for a short trip but was suddenly recalled by receiving the appointment to the post of Superintendent of the Army Nurse Corps, as indicated in the list given above. Her selec- tion for this responsible work had been made on Miss Board- man's recommendation. The Surgeon General had gone through Colonel Lynch to Miss Boardman for advice and she knowing that ]\[iss Delano was then free (her mother having some time before passed away) and feeling confident of her ability, had counseled them to secure her if possible. Miss Boardman believed this appointment would unify the Red Cross and the Army Xursing work and ]\Iiss Delano shared this feeling, for she once said to Miss Boardman, "one of my reasons for taking this (the Army Nurse Corps) is my interest in Red Cross nursing and I believe the Army Nurse Corps and the Red Cross Nursing Service should work in harmony." The Red (.'ross Bulletin of October, 1919, said of Miss De- lano's appointment: By this arrangement the wliole system of the Ecgular Army Nursing Corps and the Eed Cross Nursing Corps will be placed under one head, so that in case of war the plans REORGANIZATION AND AFFILIATION 97 for Red Cross nursing assistance will fall into complete ac- cord with the demands of the Army Medical Service. Miss Delano will, therefore, be not only fully advised as to the regular nursing strength of the Army Corps, but will know exactly the status of the volunteer aid of the lied Cross Nursing Corps. On a later occasion, when narrating the steps by which Miss Delano went on to her long volunteer service in the Red Cross, Miss Boardman recalled the incidents of that time. She wrote : ... At the time of Miss Delano's appointment to the Army Nurse Corps she was asked by the Eed Cross to accept the chairmanship of its nursing committee. In consenting to do so Miss Delano said that one of the motives which in- fluenced her in taking the Army position was the opportunity it would give to bring about a close relationship between the Army Nurse Corps and the Red Cross Nursing Service. . . . At that time there were not more than twenty nurses report- ing regularly as members of the Army Nursing Reserve and Miss Delano concluded that the best way to secure an ade- quate number of reserve nurses was to do away with this branch of the Army Nurse Corps and to have the Red Cross authorized to ])rovide this service. The Surgeon General agreed to her suggestion. . . . Devoting herself to the serious duty of reorganizing and improving the Army Nurse Corps Miss Delano quietly and carefully studied it. . . . The pay of the Army nurse was so low that it was impossible to obtain graduates of the best training schools and to correct this Miss Delano urged the increase of the pay in an Army appropria- tion bill. The Surgeon General's ofHce approved her sugges- tion and included in it an increase in the pay of tlie superin- tendent of tile Army Nurse Corps, which was also inadequate. \\']ien tin's amendment was submitted to ]\Tiss Delano she promptly struck it out so that she should be untrammeled by any apparent self-interest in her efforts for the benefit of the nurses. After two years as sup(>rintcndont of the Army Nurse Cor])s Miss Delano came to me one day and said: "1 believe now tlu> time has come when 1 can give up my position in the Surgeon (icnerars otlice. A very ca])able nurse. Miss jMcIsaac, will be appointed to succeed me. T have a little means of my own and I would rather live on a crust and serve the Red Cross than do anything else in the world. I will gladly give my services to the IJed Cross if it d\-;ires them, to organize and develop its Nursing Department.'"' 98 HISTORY OF AMERICAN RED CROSS NURSING It was a very wonderful gift . . . there never was a gift given in a nobler spirit. . . .^* The official correspondence touching Miss Delano's resigna- tion as head of the Army i^urse Corps follows : War Department Office of the Surgeon General Washington March 11, 1912. To the Surgeon General, United States Army, Sir: In accepting the position of superintendent of the Army Nurse Corps I did so in the hope of developing in connection with the American Eed Cross an adequate nursing personnel which would in the event of war be available as a reserve for the Army Nurse Corps. The organization of this nursing service is progressing most satisfactorily, but in addition to my duties as super- intendent of the Army Nurse Corps the work has grown be- yond my capacity. Believing that the maintenance of this Eed Cross reserve is as necessary to the Army as the Nurse Corps and that Eed Cross work should be as far as possible volunteer service, I have the honor to submit my resignation as superintendent of the Army Nurse Corps, to take effect April 1, 1912. My only object in resigning is that I may have the time to devote to the development and maintenance of an efficient reserve of Eed Cross nurses for the service of the Army. Very respectfully, (signed) Jaxe A. Delano, Superintendent, Army Nurse Corps. 1st Indorsement, War Department, Office of the Surgeon General, ]\rarch 11, 1912. Eespectfully forwarded to the Adjutant General of the Army, recommending that Miss Delano's resignation ])o ac- cepted to take effect April 1. I view with great regret Miss Delano's separation from the Medical Department of the Army. She aecepted the position of superintendent of the Nurse Corps in August, 1909, with the understanding tbat she wouhl remain in office for only sufficient length of time to put the Xurse Corps on a thoroughly satisfactory basis. This she has done in an admirable manner. ^* Red Cross BuUetin, May 12, 1919. REORGANIZATION AND AFFILIATION 99 When she came to this office there were only 80 nurses on duty in the Army Xurse Corps and there was no eligihle list from whicli appointments could be made. In addition to this admirable work Miss Delano has had charge of the enrollment of l^ed Cross nurses and has now on her list nearly ;5,000 well selected nurses that will be available for service in the oMedical Department in case of emergency. In view of the success which has attended ]\Iiss Delano's work as superintendent of the Army Xurse Corps in j)re- paring that organization to meet fully its obligations in the event of war, it is recommended tliat the Secretary of War in accepting her resignation place on record his appreciation of her services. (signed) Geo. H. Tokxey, Surgeon General, U. S, Army Approved : By order of the Secretary of War, (signed) Leonaud Wood, Major General Chief of Staff. Affiliation was now firmly rooted, but before following it further a brief final glance should be taken at the evolution of the Army Nurse Corps as part of Miss Delano's work. Mrs. Kinney had effected improvements in the Army Nurse Corps, thougli in her time the War Department had cut down very materially on all expenses. She had gained saloon mess for the nurses at sea and helped greatly in improving from the profes- sional and social standpoint the position they had. She did, probably, as much as anyone could have done in those early months, but there was still progress to be made when ^liss Delano took charge. The Surgeon General had planned a Nurse Tveserve which he call(>d the "Eligible Volunteer Corps," ^^ but in this he had not been successful. Early in 1!)04, the Surgeon General had issued the following regulations, which the Journal of Nursing published. EEKiiiiLE List of Volfxteek Xukses The Surgeon General has deemed it advisable to open in his otlice wliat shall be known as the Eligible List of Volun- teer Nurses. The names of acceptal)le graduate nurses who are willing to serve in time of war or luitional emergency will constitute this list and the requirements for enrolhneiit shall be as follows: Applicants must have graduated from a training-school for nurses which gives a thorough professional ^'' A))ivriva)i Joiunial of 'Sursing, Marcli, 1904. 100 HISTORY OF AMERICAN RED CROSS NURSING education, both practical and theoretical, and which requires at least a two-years' residence in an acceptable general hos- pital of not less than fifty beds. Graduates from special hos- pitals and from insane asylums and private sanatoria will not be considered unless their training has been supplemented by not less than six months in a large general hospital. Application for enrollment must be made to the Surgeon General and before being accepted the applicant must submit to the following: (1) A statement of her physical condition filled out in her own handwriting and sworn to by a notary public. (2) A certificate of her health from at least one reputable physician personally acquainted with the applicant. (3) The name of her school and date of her graduation. (4) A certificate concerning the moral, physical and pro- fessional qualifications of the applicant as shown by the records of the hospital must be furnished by the superintendent of the training school from which the applicant graduated. If she was trained under a former superintendent of nurses, her endorsement is also desirable. Blanks for these pur- poses will be furnished by the Surgeon General. Approved candidates will be placed on the eligible list for appointment in event of war or national calamity. Each nurse must agree to enter active service as she may be needed in time of war or national calamity. On the first of January and the first of July of every year she shall report to the Surgeon General, giving her address and enclosing a certificate from some reputable physician showing the con- dition of her health at that time. When called into active service these nurses will be sub- ject to all established rules and regulations and will re- ceive the pay and allowances of nurses of tlie Army Xurse Corps as set forth in General Orders Xo. 54, War Depart- ment, November IG, 1903. !Nnrses did not enroll, however, in large numbers in the Volunteer Corps. In the September, 1905, issue of the Joimuil, Miss Palmer, the editor, wrote: Another year is drawing to a close and at the beginning of August tlie "Eligible List of Volunteer Xurses" stands, since the first appeal in March. li)()4: number of applicants for blanks. 174. Of these there have been returned 42 : not recom- mended by her superintendent, 1 ; total number on the list, 41. Of these the number who liave been or who are at present in the Army are lss" at the Walter Reed Hospital, Washing- ton, D. C, on September 21, lUlt. A general r(M)rgani/ation plan was now issued from Wa?h- inaton as outlined in the followinu' sunnnarv. It Joc^s not seem 102 HISTORY OF AMERICAN RED CROSS NURSING to have applied directly to nursing enrollment, but instituted the ^'Chapter" which from now on becomes a familiar word. The Central Committee at Washington has found it neces- sary to make certain changes in the form of the state branches and in a letter to these branches, under date of Xovember 1, 1909, the reasons are clearly set forth. Briefly stated, these are distances which prevent representation from all parts of a state, with a tendency to concentrate officers and members at some central point, absence of state officers, jealousies, . . . conditions detrimental to the best interests of the lied Cross. Moreover, experience has taught that in case of disaster within the state the governor is the one who makes the appeal for assistance to the rest of the state, or to the President of the United States if national help is needed. Therefore, that the national headquarters with its active working force may be in immediate and close touch with all its branches when relief is needed, new regulations have been adopted by which local branches, hereafter to be called "Chapters," will be in direct communication with headquarters at Washington, retaining fifty cents on the an- nual dues, instead of twenty-five, for local use, and each Chapter may have tlie privilege of sending one delegate to the annual meeting at Washington. The state boards will as- semble only in case of war or serious disasters. The charter, by-laws and regulations for state boards and Chapters have been issued under date of January 1. 1910, copies of which may be obtained from Major General George W. Davis, chairman Central Committee, American National Eed Cross, Washington, D. C.^*' At the first meeting of the Xational Committee on Red Cross Xursing Service, held on January 20, 1910, at the home of Mrs. AV. K. Draper, Xew York, ]\liss Delano's appointment was ratified and slie was asked to take the chair. Miss Georgia Xcvins, head of the Garfield Hospital, was appointed secretary but as she was not present ]\Irs. Draper was asked to act as secretary ])ro torn. ^liss Delano tlien submitted the list of suggestions drawn up by her committee and herself: Outline of Plan for the Enrollment of Xurses Adopted by the Xational Coniniittoe on Ped Cross Xursing Service. Duties of Xational Connuittee: To or,L!'an-ize tlie iiui'.-ing service of the Pcd Cross. '"Chartei-. By-Laws, juul Itc^nilat inns for State Boards and Chapters, American iied Cross. Januarv 1. 1!)10. REORGANIZATION AND AFFILIATION 103 To make uniform rules for the enrollment of nurses throughout the country. To arrange for the estahlishment of state and local com- mittees on lied Cross Nursing Service, and to specify the duties of all such committees. To appoint annually state committees on Red Cross Nurs- ing Service of not less than five or more than ten nurses who are members of organizations affiliated with the Nurses' Associated Alumna3 of the United States, but where a state nurses' association exists which is affiliated with the Nurses' Associated Alumna', appointments must be made from names submitted by the executive committee of such nurses' associa- tions. To issue to local committees on Eed Cross Nursing Service the necessary blank forms for application of nurses for en- rolhnent. To receive and file in the central office of the Red Cross in Washington the application blanks and required credentials of all nurses who have been accepted by local committees for enrollment as Red Cross nurses, and to issue cards of ap- pointment and Red Cross badges to all such accepted appli- cants. To appoint, as headquarters, registries for nurses or other offices recommended by local committees as suitable places for filing lists of enrolled nurses. To keep in the National office of the Red Cross in Wash- ington card catalogues of all state and local committees and of all lieadquarters for enrolled nurses with the approximate number of nurses available at each. To ascertain and keep on file the various sources of volun- teer service available, including Sisterhoods and members of other orders. To arrange for courses in home nursing, hygiene, and first aid under the direction of the Red Cross, utilizing as far as possible for this instruction enrolled Red Cross nurses. To arrange for lectures on the relation of nurses to the Red Cross, and to encourage the presentation of the subject to graduating chisses of nurses throughout the country. To study tlie nursing service of tlie Red Cross in other countries, with the object of improving that in America. In cooperation with the medical departments of the army and navy, to provide instruction for enrolled nurses in the special duties which would be required of them in time of war. All matters relating to tlie services of nurses under tlie Re(l Cross will be referred to the cliairnian or secretarv of 104 HISTORY OF AMERICAN RED CROSS NURSING the National Committee of Nursing Service, and in coopera- tion with such other members of the committee as may be necessary they will be responsible for all assignments of nurses to duty, and when two or more nurses are sent out to- gether one shall be placed in charge or authorized to act as head nurse. The National Committee on Eed Cross Nursing Service shall hold regular semi-annual meetings, one in Washing- ton at the time of the annual meeting of the Red Cross, and the second at the time and place of the annual meeting of the Nurses' Associated Alumnae. Special meetings may be held at any time at the call of the chairman. Full reports shall be presented at the semi-annual meet- ings." Jane A. Delano. The form of application, as prepared by Miss Delano's com- mittee was submitted and with one or two slight changes was approved, as follows : 1. Name of applicant 2. Address 3. Date of birth Place of birth 4. Are you married, single or a widow? 5. Are you a citizen of the United States ? 6. Have you any physical defects? 7. Education and occupation before entering training school 8. From what training school did you graduate? 9. Is it connected with a general, special or private hospital ? 10. How many beds in hospital at time of graduation? 11. Date of graduation Length of course 12. Name and address of superintendent under wliom you were trained 13. Of what nursing organization are you a member? 14. Give name and address of secretary 15. Are you a registered nurse? In what State? Date of registration IG. How have you been employed since graduation? Give information for each year 17. Give name and permanent address of nearest relative. . . . Signature Date "American Journal of Nursing, February, 1910, p. 303. Indoor unifnnn, fr^-ay dress, hrassard and cap. of an American Wetl Cross Nurse. The dress luiitdrni of the Nursing Service consists of a wliite dress of this tyjie. while slices and stockings, the lirassard. tiie cap and tlie cape, hut no apron. REORGANIZATION AND AFFILIATION 105 The chairman then presented suggestions to be filed as ref- erence for the applicants this blank to be entitled "Creden- tials from Training Schools." After a short discussion of the above title, and one or two slight changes in the text, the blank was accepted as follows: 1. Name of applicant 2. Name of training school Address 3. Date of graduation 4. Length of course 5. Number of beds in hospital during applicant's train- ing : 6. Character of hospital : General Special Private 7. Are pupils sent out for private duty ? 8. What, if any, position of responsibility did applicant hold during her training 9. Was her record satisfactory in regard to the following: Work ? Health? Conduct ? 10. Was she employed in your hospital after graduation ? 11. What has been her standing as a nurse and woman since graduation ? 12. Arc you willing to recommend her for Ked Cross Service? Superintendent of Training School Hospital Graduate of Name and address of superintendent under whom the appli- cant was trained : Remarks Date It was moved by Miss Palmer and seconded by Mrs. Robb that the form of application and credentials from training schools bo adopted. These were as nearly uniform as possibh' with tliose used by the (Government, so that in time of war they can be made immediately useful in the Surgeon (leneral's otlice. The rules governinc; the enrollment of nurses for service under the American Ived Cross were adopted, as follows: 1. All nurses enrolled for service under the American National I\ed Cross must have graduated from a school for nurses which gives a thoi'ough professional edutation, both 106 HISTORY OF AMERICAN RED CROSS NURSING theoretical and practical, and which requires a residence of at least two years in an acceptable hospital. In states and territories where registration of nurses is required by law, graduates of schools not acceptable to Boards of Registration will not be considered eligible for enrollment as Red Cross nurses. 2. All applicants for enrollment must be endorsed either by superintendents by whom they were trained, or by a nurs- ing organization which is a member of, or affiliated with, the Nurses Associated Alumna of the United States; or must submit such other evidence of moral, professional and mental qualifications as may be required. 3. All enrolled nurses shall receive a physical examina- tion before being assigned to service, if required, such ex- amination to be made at most convenient point by a physician authorized by the Ked Cross. 4. Xo nurse under twenty-five years of age shall be en- rolled for active service. 5. All nurses called on for service in time of war will be required to take the oath of allegiance. Mrs. Robb moved that this committee recommend that the Red Cross Nursing Corps enroll for paid service. This motion was seconded by Miss Nichols, and after a short discussion was carried. The plan for carrying on the work of enrollment was then discussed by the committee and the following motion made by Miss Cooke and seconded by Miss Palmer was unanimously adopted : That the Central Committee on Eed Cross Nursing Service should ask each State Xurses' Association to instruct their executive committee to appoint a Eed Cross committee, of not less than five members, to organize local committees throughout the State for the purpose of enrolling nurses. The local committees to be seven in number five nurses and two lay members, representing the local Eed Cross ; these committees to have charge of enrollment. The application blanks and credentials of the nurses, as accepted by this com- mittee, to be sent to Washington for filing; and a card cata- logue, giving the name, address, telephone number, school of graduation and date of graduation to be kept by the local committee for reference the local committee also having the responsibility with the approval of the State Nurses Eed Cross Committee, for arranging with some registry, training school or office to take charge of these cards, and be respon- REORGANIZATION AND AFFILIATION 107 sible for the immediate notification of these nurses in case of an emergency call. AMERICAN NATIONAL RED CROSS Branch^^ 19 On recommendation of the Committee on Nurses of the Branch of the American National Red Cross your offer of service is hereby accepted for assignment to duty when and where your services may be required. When assigned to duty your compensation will be at the rate of forty dollars per month when on duty in the United States and fifty dollars per month when without the limits of the LTnited States, in addition to transportation and sub- sistence. This acceptance to hold until your services are no longer required, or until your resignation is accepted. Very respectfully, President Branch/^ American National Rod Cross. To The correspondence between !Miss Delano and her co-workers at that time teems with suggestions and counter-suggestions. The letters are full of interest and many tempt one to in- clude them, but their length precludes all but brief illustrative examples. Mrs. Helen F. Draper to ]\Iiss Delano : I agree with you that as a general thing it is wiser to limit the number of persons to serve on a committee. In this particular instance, however, where we are not starting out on a new basis, but reorganizing a former plan. I think that local conditions have to lie taken into consideration. It would seem to me wiser, as in Brooklyn and New York, to continue the former committees as far as ])ossil)le. 1 tlierefore think that your suggestion in regard to State Committoes is good "Tt shall be the duty of the National Committee to a]iiioint State Connnittees of at least five nurses who are members of organizations affiliated witli tlie Nurses' Associated Aluinna\ but where a State Xursos' Association exists tliese a]ipoint- " Minutes, Xat. Com. on Red Cross Xursing Service. .Taniuuv ill. ]'M0. 108 HISTORY OF AMERICAN RED CROSS NURSING ments must be made from names submitted by the executive committee of such State Nurses' Association.'* I, also, agree to the suggestion in regard to the appointment of local Bed Cross committee by the State Committee on Nursing Service. In regard to the annual appointment of committees, I think if this is done, it should be done only with the idea that two members only should come up each year. I would per- sonally prefer a permanent but if the majority of the Cen- tral Committee on Ked Cross Nursing Service feel that a varying committee is wiser, I would be willing to vote for one where two members were changed each year. The manifold details of bringing affiliation plans into shape and of uniting on some definite lines of activity for peace times are suggested in the following letter from Miss Delano which touches on all the problems then pressing for solution. Of these one of the most significant was that already mentioned as having arisen in 1908, of carrying instruction into the homes of the people. March 15, 1910. My dear ^Mrs. Draper : At last we have the first installment of the Red Cross matter ready, and it seems to me that it would be possible to begin on the formation of the State Committees while we are at work on the other data. In the meantime the State Com- mittees can be plaiming out their work and locating the branches. After talking the matter over a number of times we decided that it would be better to publish all the data in a little book about tlie size of the Constitution of the Red Cross so that every one interested will know all of the steps from the duties of the National Committee down to the actual enrollment of nurses. Miss Boardman thought that it would be well to have a little outline of the Red Cross at the be- ginning and the circumstances leading up to the affiliation of the Nurses' Associated Alumna", which accounts for the little "foreword" 1 am sending you. Some changes may be necessary in the "duties of the National Committee," and we hope you will criti(iz(; and suggest any changes you think necessary. After nnuh discussion and many letters it seemed wise to leave the size of tlie State Committee with the various States. Do you approve of the paragraphs relating to "sources of volunteer service," "the courses in home nursing," "hygiene," "first-aid" (tliese were among Mrs. Rol)b's sug- gestions) and provision for lectures on Red Cross subjects? ]\Iiss Boardman wisbed to leave the matter of assignment of REORGANIZATION AND AFFILIATION 109 nurses to active duty to the National Committee, and the paragraph referring to this was added at her request. . . . In talking with Miss Boardman and Miss Nevins in regard to the appointment of the committees it was suggested that it would be almost impossible to keep track of the members going out at varying periods where there are so many com- mittees to consider. The idea of the annual appointment was that, as a matter of course, all members of the Committee should be reapi)ointed, unless for some reason it seemed best to make a change. If we make any provision for reappoint- ment with so many permanent committees all over the coun- try, there seems more or less danger of having a certain number of inactive people on the committees with difficulty in regard to placing them. This would make it possible to reappoint all of tlie committee, if desirable, or to make changes without hurting anyone's feelings. To the reference in this letter to the home nursing plan Mrs. Draper replied with suspended judgment, as she thought it was too soon to branch out in new directions. What the subsequent developments of this department were will be dealt with in a special section. In April, 1910, Isabel Hampton Robb was suddenly removed by death from the manifold activities in which she took so eager, intense and inspiring a part. In the Amencan Journal of Nursing of May, we read : The shock of her death is so great that it seems impossible yet to collect one's thought sufficiently to look back over her long service to the nursing profession she was still in close touch with all its activities. One cannot tliink of a move- ment of importance of which she was not one of the moving spirits, organizer, supporter; the Superintendent's Society, of which she was president only last year ; the Associated Alumna\ of which she was president for the first five years and at whose meetings she was almost always present; the Journul the course at Teachers College, of which she was one of tht' lecturers: the International Association to which she was a delegate last summer ; the Ked Cross, of whose Central Connnittee she was a member. All of these will miss her sadly. The ^finutos of the C\Mitral Comniittoe said of her: We record with much sorrow the tragic death of ^Irs. Tsat)el Hampton I'oljb, a most valuable member of the War IJelief Koarci and of the sub-committee on l\eil Cross Xursing 110 HISTORY OF AMERICAN RED CROSS NURSING Service, a woman of large insight, warm sympathies and broad experience, to whom we are indebted more than to any other person for the development and perfection of nursing organizations which has made the work of this committee possible. By early summer Miss Delano presented the following en- couraging report on affiliation and enrollment : American Eed Cross Xotes The Xational Committee on Eed Cross Xursing Service announces with pleasure the completion of the plan for the enrollment of Ked Cross nurses. The first step necessary is the formation of State Committees on Eed Cross Xursing Service in accordance with the following provisions. "The Xational Committee shall appoint State Committees on Eed Cross Xursing Service of not less than five nor more than ten nurses who are members of organizations affiliated with the Xurses' Associated Alumnae of the United States, but where a state nurses' association exists which is affiliated with the Xurses' Associated Alumnae appointments must be made from names submitted by the executive committees of such state nurses' associations. Unless changes in personnel become necessary, it is desirable that a majority of the mem- bers of State Committees be reappointed annually." The following State Committees on Eed Cross nursing service have already been appointed. West Virginia: ]Mrs. H. C. Lounsbury, Charleston; Mrs. Mary G. Carpenter, Wheeling; Miss Vernon, Fairmont; M. Virginia McCune, Martinsburg; Mrs. M. Lingenfelter, Hinton. Illinois: Adda Eldredge, chairman, Chicago: Mary C. Wheeler, Quincy; Adelaide ]\I. Walsh, Chicago; Ellen Par- sons, Chicago ; Mrs. Tice, Chicago ; Helena M. McMillan, Chicago; Benna M. Henderson, Chicago. Xew York: Elizabeth Dewey, chairman, Brooklyn; Beatrice V. Stevenson, Brooklyn; ^Mrs. C. V. Twiss, Xew York City; Elsie Patterson, Xew York City; Anna Charlton, Xew York City; Mrs. Ernest G. H. Schenck, Xew York City; ^Irs. Harvey D. Burrill, Syracuse; Sophia F. Palmer, Eochester ; ^larie T. Plielan, Eochester; Eye Morley, Buffalo. To facilitate the formation of these committees the follow- ing states have been assigned to members of the Xational Committee and state secretaries are earnestly urged to com- municate with their organizing member of the Xational Com- mittee for information and advice. REORGANIZATION AND AFFILIATION 111 Emma M. Nichols, Boston, Mass., Maine, New Hampshire, Vermont, Massachusetts, lihode Island, Connecticut. Anna C. Maxwell, New York City, New York and New Jersey. Georgia l\r. Nevins, Washington, D. C, District of Colum- bia and Maryland. Mrs. H. C. Lounsbury, Charleston, W. Virginia, West Vir- ginia, North Carolina, South Carolina, Georgia, Kentucky and Tennessee. Mrs. Frederick Tice, Chicago, Illinois, Michigan, Iowa, Minnesota, jMissouri, Arkansas, Louisiana. Linna G. Eichardson, Portland, Oregon, Washington, Ore- gon, Idaho, Montana, Wyoming. IVfargaret A. Pepoon, San Diego, Calif., California, Nevada, Utah, Arizona. States unassigned will communicate directly with the Chairman of the National Committee on Nursing Service, State, War and Navy Building, Washington, D. C. (signed) Jaxe A. Delano, Chairman National Committee on Nursing Service.^" States which were not yet organized were summed up thus by Miss Delano : To myself, as chairman of the Committee, came the mother's share, all those states which did not seem to fit in any locality, many of them without state organizations. I am sorry that I am not able to show a better report of my own work. Pennsylvania has begun its organization. Delaware has not been communicated with. Mrs, Lounsbury is going to consult with Mrginia to bring about an organization, while the delegates are here. Florida has no state organization. Texas is at work and I hope will very soon be organized. North Dakota and South Dakota have no state organizations. Nebraska has, and has a delegation here, and we hope to have something done before it goes back. Kansas has no state organization. Colorado has. New ]\rexico has none. Alabama has none. Mississippi has none. Ohio is organized with ^Fiss Johnson, who is in charge of the district nurses in Cleveland, as chairman. Indiana is or- ganized with ]\riss Elizal)eth Johnson of Indianajiolis, chair- man. Wisconsin, one of the two states admitted this session, is organized. With true western spirit they had their coni- *" Afncricnn JournnJ of Xiirsiti'j, May. IHIO, p. .399. 112 HISTORY OF AMERICAN RED CROSS NURSING mittee all appointed in case they were accepted, so there was very little trouble, and Miss Matthews is chairman. I think you will agree with me that this is a good showing for a very few weeks' service. Within a couple of months the results of the labors of the National Committee members to whom had been entrusted the sections of the country above named, were recorded in Miss Delano's notes, together with an outline of her own coast-to- coast tour of speech-making before audiences of nurses. She wrote : The response from various sections of the country has been most gratifying and already the following State Com- mittees have been appointed and are at work organizing Local Committees : Massachusetts, chairman, Mary M. Eiddle ; Xew York, chairman, Elizabeth Dewey: District of Columbia, chairman, Anna J. Greenlees; Maryland, chairman, Mary C. Parkard; West Virginia, chairman, Mrs. H. Camp Louns- bury; Georgia, chairman, Mrs. A. C. Hartridge; Tennessee, chairman, Lena A. Warner; Illinois, chairman, Adda Eld- redge; Michigan, chairman, Mrs. L. E. Gretter; Iowa, chair- man, Helen Balcom; Louisiana, chairman, Emma L. Wall; California, chairman, Moselle Eichie ; Oregon, chairman, Jennie V. Doyle; Oliio, chairman, Matilda L. Johnson; In- diana, chairman, Elizabeth Johnson; Wisconsin, chairman, Stella S. Mathews. . . . The following letters show how the work of tying up State societies of nurses with the Ked Cross was completed : December 2, 1910. General George IT. Torney, Chairman, of the War Eelief Board of the American Eed Cross. Sir : In accordance with the provision of the By-Laws of the American Kcd Cross, Article 15, paragraph f, page 21, which reads as follows: "Societies of Nurses. The Central Commit- tee sliall have authority to establish a class of membership into which may be invited permanent State or Territorial so- cieties of nurses. When accepted into membership by the Central Committee any such society shall be entitled to dele- gate representation in the annual meeting of the American Ked Cross under terms and regulation prescribed by the Central Connnittcc/' I would request, as cliairman of the Connnittee on Eed Cross Nursing Service, that membership REORGANIZATION AND AFFILIATION 113 be allowed all State Nurses' Associations organized for the enrollment of Red Cross nurses. If this suggestion meets with the approval of the Central Committee of the American Eed Cross, the following State Nurses' Associations would be eligible for membership : California; District of Columbia; Georgia; Illinois; Indiana; Iowa; Louisiana; Maryland; Massachusetts; ]\[ichigan; Ne- braska; New Jersey; New York; North Carolina; Ohio; Oregon; Pennsylvania; Tennessee; West Virginia; and Wis- consin. Very respectfully, (Jane A. Delano) Chairman, National Committee on lied Cross Nursing Service. December 5, 1910. To Miss Delano: . . . Tliat the plan in general, as outlined in report sub- mitted by tbe Chairman of the Subcommittee on lied Cross Nursing Service, is apj)roved and the Chairman is requested to transmit the same to the Central Committee for its con- sideration and action. (signed) TORNEY. An example of the letters sent throughout the country is this one of Mrs. Louusbury. TiiK American National Ekd Cross Washington, D. C. National Headquarters, lioom 311, State, War aiid Navy Building Miss I'resident State Nurses Association. Dear M Tbe National Eed Cross Nursing Service has l)een tlior- ougbly reorganized, and is now ready to receive the names of nurses wlio wisli to be enrolled for service. The plan of tbe National C^onimittee is to enlist the active sympathy and cooperation of the jiresidents of the State Nurses' Associa- tions and tlirough tiiem to reach tbe individual nurses. You are conlially invited to assist in this great work, and to act as the distributing center for . 1 enclose a booklet containing tbe rules and regulations for tbe Ameri- can lied Cross Nursing Service, and sample copies of tbe application for enrollment, tbe card for tiling in Washington 114 HISTORY OF AMERICAN RED CROSS NURSING and the card for the endorsement of applicants by State or Alumnae Society. Will you kindly let me know if you will assist us in this great work, which seeks to place in the hands of the Red Cross in Washington the names and addresses of graduate registered nurses, who can be called upon in time of war or national calamity. Will you send me the names of four responsible nurses of who will assist you, acting as a State Committee? An early reply will be much appreciated. Sincerely yours, (signed) Harriet Camp Lounsbury, E. N. Mrs. George Lounsbury. We must pass over ]\riss Delano's trips to the West in the sum- mer of 1910, primarily to inspect the Army J^urse Corps. It is more relevant to give, here, some glimpse of how the Red Cross enrollment went on, as recorded by Mary A. Clarke in her personal recollections of Miss Delano : On her return to Washington about December 1, 1910, she asked me to come to assist her in the work of enrollment. . . . Miss Delano was just getting settled in a cozy home. . . . She was essentially domestic in her tastes. . . . The Ameri- can Eed Cross offices were then in the State, War and Navy Building, but ]\Iiss Delano, expecting to do her Eed Cross work before and after her day at the War Department, made her office in her home. Her largest room was fitted up for Eed Cross work. . . . Applications and letters were gone over daily. A vast num- ber of typewritten letters of instructions and large packets of circulars were sent east and west, north and south. . . . Every application was carefully gone over, first by me and then by Miss Delano. . . . When the nursing service was reorganized it was found that about 950 nurses liad l)ecn enrolled under the old dispensa- tion. Through tlie Journal ]\Iiss Delano sought to locate them all, list names and addresses, number of their badges, date of enrollment and ascertain how many were still available for service. . . , Steadily as time went on, qualifications for enrollment be- come more stringent. Training schools everywliere were anxious to come up to the requirements, some insisting upon more extensive preliminary education on the part of their applicants, others lengthening tbeir course of instruction, and some superintendents adding beds to the liospital's former cai)a(ity in order to meet the fifty-bed requirement. . . . REORGANIZATION AND AFFILIATION 115 It was soon evident that the more the enrollment of nurses was restricted the more eager nurses were to join. By July, 1911, applications were coming in at the rate of 200 a month. . . . Miss Delano was single minded in her determination to en- roll only those women who, in addition to professional effi- ciency were well recommended personally both by the hospital superintendent and the president of the alumnae associa- tion. , . . She was tenacious of her point as to the personality of the nurse because she felt that the women chosen for Eed Cross nursing must be of such uprightness of character, purity of life and good judgment, that they could be relied on to do the discreet and right thing wherever placed. ^^ The home-loving phases of Miss Delano's many-sided per- sonality, to which ]\Iiss Clarke made reference, were further described by a close friend who later made her home with Miss Delano : I grew to love her dearly, not only for her goodness to me but because of her personal charm, her interest in all that per- tains to home life, her love of animals and flowers, her almost child-like enjoyment of the simplest pleasures. A strong sense of humor carried her through many trying situations and she loved both to hear and to tell a good story. She was rarely idle, rest to her meaning only change of occupation. She worked deftly and swiftly, making every moment count, and she played, when not overburdened as in the last year, with the same thoroughness. An excellent housekeeper in methods familiar to Xew England, she was interested in the smallest details of lior household. . . . Tt was a pleasure to watch the motion of her hands, they were so capable and eflicient. She was very orderly as to her belongings, but at the same time deliglitfully inconsistent, for she would allow her pet dog to take liberties which to most people would liave been annoying. lie adored her and from the moment her car turned into our street he was at the door with a rapturous greeting. She ])rofessed to have forgotten how to nurse, yet I shall never forget an illness when sbe carried nie l)odily to her home, put me to ])ed and cared for me licrself with wonderful tenderiiess, skill and resourcefulness. . . .-- In January 1011 ]\Iiss Delano l)(\uan writing the Rod Cross DepartnuMit of the A})icriani Journal of Xursi)};/, a rcspoiisi- " ^^pTll()^all(luIn in Kcd Cros^ Archives. " (,}. M. Ncvins, Am( riaui Journal of Sursing, \'ol. 19. p. (iUn. 116 HISTORY OF AMERICAN RED CROSS NURSING bility which she carried until her death. In her first notes she wrote : At a meeting of the Central Committee of the American Red Cross held on jMonday, December 5, 1910, the following resolution was adopted: That each State or Territorial nurses' association organized for the enrollment of Red Cross nurses be admitted to mem- bership in the American Red Cross with the right to send a delegate to the annual meeting. . . . [The names of the states admitted to membership followed; they have already been given.] We will confine this report more especially to the activities of the Committee on Red Cross Nursing Service. The im- portance with which this work is considered is shown by the official report of Surgeon General George H. Torney, chair- man of the War Relief Board, Avhich was read at the annual meeting and from which we quote the following: "Probal)ly the most important accomplishment of the War Relief Board during the year has been the organization of two departments, the First Aid Department and tlie Nursing Department. It was realized that the importance of these two classes of work had become so great and demanded such close supervision that it was essential that two departments be created. The wisdom of this decision has been proved by the outcome. The work of the First Aid Department and of the Nursing Department will be described by their re- spective chairmen. I feel, however, that I can allude to the importance of the work of these departments with more grace than can these chairmen." . . . Since some of our nurses can be relied upon only for or- ganization work, and realizing the importance of this, either in time of peace or in tlie event of war, it was resolved "that all nurses, members of Red Cross Committees, be asked to enroll even though unable to respond to a call for active service. The first suggestion of Knral Xursing was made in 1010 at the annual meeting: A letter from ^liss Wald to ]\Tr. Schiff was then read by the chairman. ^liss Wald set forth the needs of the rural communities for nursing and wished to know if the Red Cross might not consider taking up such a work. While the fact was recognized by the (V)mmittee that effort should be made to keep uj) the interest of enrolled nurses, it was thought that preparation for war, and emergency work in the form f/^'^^l Tn>i_aiiia (actual ^izc) ]. I'ailiri" ^^()^ll li\' an Ainciicaii lied ('r(i>s iiiii'so. 2. PjadiiO W(ini liy an Aiiu'iicau Itt'd ('r(i~s llimi.' Drifust' iiui-sc. :!. I'didanl ( imw (ili-iolcti' ) ti'i-iiicil y worn li\ an Ahu'i-icaii KimI ('r(i>s 'I'dwii and ('oiiniry iinr-t-, 4. liaduf worn li\ an AimTicaii IN-d (i-o-s dietitian. "). ln~i,L:nia ndlar df\ ice I wniii duriiiL' the l-".iir()|i('an War liy incndiiTs nl' tlic l'. S. Aimy Nnrsc ('(ir]i>. (i. I'ii'~imi1 insiunia (ctillai device i worn liy nienilur- nt ilie r S. Arni\ Xiir-e (dip- 7. In-iiinia icidlar dc\'ice i wnrn hy incndiers; lit the r. S. \av\ \iir-e Cui-ii-. S. (dii)-. de\ ice of tlie ('. S. I'liidic !lc;ilth Sei\ ice. worn liy niemliei's of tlie Xui'sinu Sei'\dce, V. S. Tublic Health Scr\ iiH>. REORGANIZATION AND AFFILIATION 117 of le( ures from army officers, if possible, and later perhaps, the formation of home nursing classes, were preferable to any o.her nursing work by the Ked Cross at present. Mrs. Draper strongly urged that the Ked Cross direct its attention for some time to come to the subject of thorough organization. Mrs. Tice moved that a committee including Mrs. Draper, Mv. and ^Irs. Glenn, and ^liss Alaxwell be ap- pointed to confer with Miss Wald. This was carried. Mrs. Draper then brought up the question of assistance to the chairman of the Ked Cross Nursing Service. The small office of the superintendent of the Army Kurse Corps was wholly inadequate and she was no longer able to do the con- stantly increasing work of this committee unaided. Major Lynch moved that the Red Cross be asked to appropriate a sum not exceeding $1200 annually for salary of a clerk and room rent. It was carried. A paper was read at the same meeting on the "Coordination of Social Agencies," by Annie Laws, secretary of the Cincin- nati Chapter. IMiss Laws, as Miss Wald had done, brought larger social problems forward. She said among other sug- gestive things: The question has arisen in the minds of many as to whether the great American Ked Cross, pledged to help humanity in so many directions, might not extend its fostering care, through the visiting Red Cross nurses, to others needing help quite as badly as tuberculosis patients, in some cases more. Also, whetlicr the fact that the Red Cross with its insignia being so al)solutely identified at Cliristmas-time with a more limited organization, and yet !)eing ])rought so prominently forward, does not tend to confuse the minds of many ])eo])le and obscure the larger significance of the Red Cross, and make it apjH'ar as an adjunct rather than as the great inter- national and national emblem. . . .-'^ This paper and ]\Iiss Wald's letter contain tlie initial sugges- ti(uis of important sul)se(pu'nt work of tho lied (^ross for public health which will form the subject of later cluipters. The year 1!>11 saw the first movement of the I'nited States troops since the lied Cross Nursing Service had conu' into existence and ]Miss Delano said in her Journal notes: All Red Cross nurses will be interested in tlu^ mobiliza- tion of 20. 0(10 I'nited States troops on tlie Mexiean frontier, " TIcpnrt ef tlic Annual ^fect inir <>f tlie Ked Cress Xursini.'- Service C'oni- niittee. Deccniher 7. I'.UO. 118 HISTORY OF AMERICAN RED CROSS NURSING and over 2000 marines in the Gulf of Mexico, for never before in the history of the country has such a large body of soldiers been brought together in time of peace. . . . Should a sud- den need for nurses arise, there stand ready to cooperate with the National Committee on Eed Cross Nursing Service, 141 nurses on 2-1 State Red Cross committees, and 233 more on local committees. These committees, with nearly 1300 en- rolled nurses, are a guarantee to the nation that neither the stress of calamity nor the turmoil of war will ever again find us wholly imprepared. The National Committee on Red Cross Nursing Service has in contemplation a plan for providing instructive lec- tures to be given by medical officers of the army to assemblages -of nurses in different parts of the country. Two of these have already been given by Colonel L. M. Maus, Chief Surgeon ,of the Department of the Lakes ; one in Illinois, the other in Wisconsin, at the meeting of their respective State associa- tions.^* A letter to Mrs. Reid from Miss Delano at this time gives a pejSQjtall .touch to the activities of each : Hay I thank you for your most generous contributions toward the work of the National Committee on Red Cross Nursing Service and tell you something of what has been ac- complished during the past year : , . . We have a special Red Cross Department in the Journal of Nursing, and the interest shown by nurses all over the country is most gratifying. We send to each nurse enrolled the usual badge and an appointment card like the enclosed, which is really a card of identification in case the badge is lost. I am sending by separate mail copies of our various blanks, which may be of some interest. I have been hoping all winter that we could arrange for a reception for enrolled Red Cross nurses in Boston at the time of the meetings of the Associated Alumnje in June, and Just when I was wondering how it could be managed your contribution came through ]\lrs. Draper. Nothing, I am sure, would more stimulate interest in our Red Cross work than bringing the enrolled nurses together. I have talked this over with ^Irs. Draper and ^Miss Boardman and they both feel sure tliat you would approve of our using a por- tion of this last contril)ution for the expenses incurred in giving this reception. We will send an invitation to each en- rolled Red Cross nurse in tlie Ignited States (we have now ^ AmrricfDi Journal of \ursing, Ay.vU. 1011, p. ."iHT. REORGANIZATION AND AFFILIATION 119 nearly IfiOO), and hope that many of the Alumnae Associa- tions may send them as delegates to the Boston meetings. Mrs. Draper, ^liss Boardman, Major Lynch of the Army and Dr. Elliott of the Navy have all promised to assist in re- ceiving, and !Major Lynch has suggested that we invite all the physicians in Boston who are on the Army Medical Ee- serve list. It was, suggested at the meeting of the Associated Alumnae last year that it would be a great advantage to have a well- known nurse attend the various meetings of State Societies, Alumnae Associations, etc., and speak to the nurses in regard to the purposes of our larger organization, the educational value of the Journal of Nursing, and the responsibility of individual nurses toward tlie Red Cross. We selected Miss Isabel Mclsaac, for many years superintendent of the Illinois Training School for Nurses, for this work. She was em- ployed for six months, receiving $100.00 a month, and made a complete tour of the various states. All of her traveling expenses Avere met by the nurses themselves, leaving only her salary of $(500 to be shared by the American Journal of Nurs- ing, the Red Cross and the Associated Alumnae. Your con- tribution of last year made it possible for the Red Cross to do its part, and I feel sure that we have been more than repaid by the interest aroused in all sections of the country. This is a hopelessly long letter, but I am sure you will for- give me, for I feel that I must tell you again how thankful we are for your interest and help. To have your name on the Committees means much, and I really want you to know just what progress we are making. Believe me, Yours sincerely, (signed) Jaxe A. Delano. Tho June !Nrocting of the Associated Alumnae in Boston, 1911, was made a special Ked Cross nursing event. A Red Cross reception was hold at the Hotel Brunswick, and letters of greeting and congratulation were read. Dr. Torncv wrote : War Department, Office of tho Surireon General. Washington, D. C.'. May 25, 1911. Dear ^liss Delano : It is witli great gratifieaticHi that I learn that nearly 2000 nurses liave enrolled in the Hed Cross Nursing Service. The !^^e(li(al l)(>])artTueiit always looks upon these nurses as its reserve in tiini^ of war. and tliis large enrollment is the most eneoura2fin graduat(>s of training schools c<)nnected with general hospitals of at least lifty beds, unless the appli- cant has had subsequent hosj)ital experience or ])ost-grailuate "War Department. Ceiicral Orders No. 170. Dctcmlicr -27. lull. 122 HISTORY OF AMERICAN RED CROSS NURSING work. Graduates of training schools connected with hospitals for the insane must have had at least six months training in a general hospital. ... A special committee was provided for, to outline a course of lectures for enrolled Eed Cross Xurses. Mary E. Gladwin, superintendent of the City Hospital, Cleveland, Ohio, was made chairman of this committee, with the privilege of selecting her associates. . . . Lectures for Eed Cross Xurses Object of Lectures 1. To keep alive the interest which already exists, and to bring to the attention of the young graduate the desirability and importance of being identified with the Eed Cross Nurs- ing Service. 2. To be a means of education and preparation for future work, either in time of peace or war, 3. To give enrolled nurses more knowledge of the history, aims and achievements of the Eed Cross, a better under- standing of relief problems in general, and of the modern humanitarian movements which so closely concern nurses. 4. To furnish a pleasant and useful pretext for bringing enrolled nurses together in localities where it is seldom pos- sible to provide military or Eed Cross speakers. To give to nurses in such places a community of interests which shall make them more valuable to the Eed Cross. 5. To have these papers printed, but not published until after they have been well distributed and used. To furnish them to Local and St-ate committees, part of whose duties it shall be to see that they are regularly and properly used. Suggested Outline I. History of Eelief and the Eed Cross. (a) Before the Crimea. (b) Florence Xightingalc. (c) Solferino and Henri Dunant. (d) ]\lodern Eed Cross. II. San P>anciseo Disaster. (a) The Disaster. (b) Immediate Eelief. (() Eeliabilitation and Eeconstruetion. III. The Italian l-]art]iquake. (a) The Disaster. (b) Eelief Work Eoad flaking, Shoemaking, etc. REORGANIZATION AND AFFILIATION 123 IV. Chinese Famine. (a) Description of Country and Cause of Famine. (b) Famine Camps Material Used for Food. (c) Newspaper Criticism, i.e., Futility of Fre- quent Kelief Unless Steps Are Taken To- wards Prevention. V. Spanish- American War. VI. :Military Hospitals. VJI. The l?ed Cross in Other Countries. VIII. Notable Medical Achievements of U. S. A. IX. Forest Fires, ^line Disasters. X. Eelief Work for Celebrations and Parades.^" The full committee on the lecture course were : ]\Iary E. Gladwin, ^Nfabel T. Boardman, Major Lynch, Ernest P. Bick- ncll and ^liss Delano, ex-othcio. Important details of perfected organization were referred to by Miss Delano in her report of 1912 : At the last meeting of the National Committee, held in Washington, December 4, 1911, it was decided that every nurse enrolled for service under the Red Cross must be a menil)er of an organization affiliated with the American Nurses' Association. Believing tliat in order to do effective work, there must be coordination of the various Ked Cross activities, it was sug- gested by the National Committee that there should be ap- pointed on the Red Cross relief committee of each institutional nieml)er an enrolled Ped Cross nurse to represent the nursing service. In the notes of April, 1912, there comes the anticipation of the beautiful building in which the Eed Cross is now housed: ^Mention was made in the November Journal of the proposal to erect in the city of Washington a national monument to tlic memory of tlie brave women of the Civil War. At tliat time no suggestions had l)een offered as to the form which this memorial should take, but it seemed a gracious tribute to the work of women many of wliom liad served as nurses during tbe four years of war. It is now proposed that the monument to be erected shall take the form of a buibling to be given as lieadquarters to the American Ped Cross in perpetuity, it s(>'nis most appropriate that the humanitarian work of til? American Ped Cross in all the years to come '"Journal Department, Octoher, IHll. 124 HISTORY OF AMERICAN RED CROSS NURSING should be carried on in a building commemorating the zeal and devotion of the patriotic women who inaugurated the Sanitary Commission, raising millions for relief work and who braved the dangers and discomforts of fever stricken camp or crowded ward to lessen the suffering of the sick and wounded. Can we wonder that a memorial to them has appealed to the public conscience and finds favor with all who shared in the sorrow and anxiety of those years? In the summer of 1912 the Ninth International Red Cross conference was. held in Washington, the first outside of Europe. The sessions were held in the Pan-American Build- ing. The Secretary of State selected foiir nurses as official delegates. These were : Misses Maxwell, ISTevins, Mclsaac and Delano. The Red Cross Nursing Service committees were also represented, for there were present Mrs. Gretter of Michigan; ]\Iiss Giberson of Pennsylvania; Mrs. Tupman of Georgia; ]\riss Robinson of Illinois; ]\liss Stuff of Nebraska; Miss Rom- mell of Minnesota; Misses Black and Fletcher of Virginia; ]\risses Gladwin and Echols of Ohio ; Miss Wilkinson of Con- necticut and Miss Perry of North Carolina. At that meeting the m(>morial to Miss Nightingale was agreed upon of which Miss Delano wrote in her August notes: The Eed Cross societies of the world agreed to raise a fund to be known as the Florence Nightingale Foundation. A spe- cial committee was appointed to make recommendations con- cerning tliis fund with Sir John Furley ol the St John's Ambulance Association as chairman. Miss Boardman and Miss Delano were asked to serve on this committee. It was agreed tliat a medal, accompanied by a certificate on vellum, to be called the Florence Nightingale Medal, sliould be in- stituted and that six such medals, to be increased to the number of twelve in the event of a great war, should be avail- able annually; that they should be granted only to trained nurses who may liave especially distinguished themselves by great ajid exceptional devotion to the sick and wounded in peace or war. Xo country may ])r()pose more than one can- didate for this medal annually. Tlie final award is made by the International IJed Cross Committee at (Jeneva. The awarding of tliese medals to nurses will be akin to the be- stowal of the X'ictoria (*ross to British soldiers for "bravery in action'' aiu] will he the highest honor which can be paid to any nurse. A most fitting memorial to one "who rescued REORGANIZATION AND AFFILIATION 125 from obscurity and sliaino a noble profession," may this Night- ingale Medal prove ever an incentive to higher and higher standards of duty among us. At that time Miss Delano did not enlarge upon the discussion held over the Florence Nightingale Medal, but later (1918) she told something of her part in it, and as it illustrates very interestingly her tact in meeting the foreign viewpoint in nurs- ing, we include here her subsequent narrative of the difficulty of limiting a Nightingale ]\Iedal to a nurse trained on the Nightingale system : I was placed on a committee to decide as to the awarding of the Nightingale medal for service in time of war; and I assure you it was no easy task for me to convince the other members of the connnittee (I believe I was the only member representing this country, but at any rate I was the only one that spoke for nurses alone) first that it should be given only for the actual care of the sick aiid wounded ; and second, that it should only be awarde War Ivclicf Board since the oi-ganizatiiui of the nursing service, was ;i|)})()inted also a member of the National Ivelief Doai'd. The tii'st intimation of an aj)proaching war threat is given in the cdnnnittce reports of that meeting. Miss Delano's notes contain the following suggestive paragraph: "Proceeding's National League for Nursing Kchieation, 1018, page 161. 126 HISTORY OF AMERICAN RED CROSS NURSING At its annual meeting in 1912 the American Medical Association authorized the appointment of a committee whose duty it should be to confer with the American Eed Cross with a view to establishing a comprehensive system of cooperation between the Eed Cross and the physicians of the United States. This cooperation is expected to be effective in providing prompt and adequate medical and surgical attendance on the occurrence of great disasters and also to afford a reserve upon which the Red Cross may draw for a medical personnel in the event of war. It is probable that a system of enrollment will be adopted which will eventually build up a large force of Red Cross physicians representing every section of the country. The committee representing the American Medical Association in this matter consists of Dr. George M. Kober, Washington, D. C, chairman ; Colonel F. A. Winter, of the Army Medical Corps, and Surgeon E. M. Blackwell of the Navy. The American Journal of Nursing in February, 1912, made this commentary on the situation indicated in the sentences just quoted : Xo department made a better showing of work done during the year than that of nursing service as presented by Miss Delano. The medical department of the Red Cross is much less well organized, although the American Medical Associa- ton has now taken the matter in hand and working through a committee will enroll a corps of physicians for Red Cross service and to act as an army reserve in time of war. In April, 1913, there recurs in Miss Delano's notes the in- timation of impending war. She wrote: A special committee has recently been appointed [of which Miss Delano was a member] to formulate plans for the or- ganization of a Red Cross personnel to be called upon for service, either in time of disaster or with the military forcas in the event of war. . . . It is proposed as an experiment to organize at various selected points hospital columns made up of the following: One director, three assistant directors, who shall be physicians, six chief nurses and forty-five nurses. It is intended that these physicians and nurses shall be brought together for special instruction in the duties which would be required of them when called upon for service under the Red Cross. It has been estimated thai in the event of war with a first x^lass power nearly half a mUIion volunteer troops would he REORGANIZATION AND AFFILIATION 127 needed at once and four thousand nurses for the Army alone, with an additional thousand nurses for the Navy, It is impossible to estimate the future demands but with our ex- perienced committees of nurses and the ever increasing en- rollment we feel sure there would be no failure on the part of the Nursing Service of the Ked Cross. From this time on there were changes preparatory to war service. The NTational Committee on Nursing Service had some of these changes. !Miss Delano's notes say: Owing to his transfer to the Philippines, IMajor Charles Lynch, Medical Corps, U. S. A., has resigned from this com- mittee and in his place Major R. U. Patterson, Medical Corps, U. S. A., has been appointed. ]\Iiss Georgia Nevins, who had served on the committee since its creation has also resigned and ]\Irs. Lena S. Higbee, superintendent of the Navy Nurse Corps, has been appointed by the War Relief Board as her successor. !Miss Julia C. Stimson and Miss Mary E. Gladwin have also been appointed to fill vacancies on the committee. The full committee is as follows : Miss Jane A. Delano, Miss Emma ^I. Nichols, Chairman. Miss Alma E. Wrigley, ^liss ^label T. Boardman, Mrs. Whitelaw Reid, Mrs. William K. Draper, Miss Anna Maxwell, Maj. R. U. Patterson, ]\Iiss Isabel McTsaac, Dr. T. W. Richards, Mrs, Lenah Higbee, Dr. Wm. H. Welch, i\Iiss !Mary E. Gladwin, Mrs. Frederick Tice, Miss Julia S. Stimson. As the enrolled Red Cross nurses form the reserve of the Army,-'" the Surgeon General of the Army has detailed a member of the Army Nurse Corps, Miss Anna Reeves, to assist in the record work of the Red Cross oflice. This will add to the efliciency of the service and give the chairman more time for constructive work. There has been a satisfactory increase in the number of enrollments, and even more discrimination and careful selec- tion of nurses on the part of the T^ocal Committees. '\\'e now have over 4,*^00 enrolled Red Cross nurses, and have Local ^^ Thoujr'i in praotiro this hiul bcH'n accepted for a lonted in IflKi and reads: riie enrolled nurses of tlie American Red Cross Xursinj: Service will const ilute the Reserve of the Army Nurse Corps, and in time of war or other emerjrency may, willi their own consent, he assiirned to active duty in tiie military estahlishment." Maiuial for Mediial Department, l". S. Army. 1!)1G. 128 HISTORY OF AMERICAN RED CROSS NURSING Committees in practically all of the large nursing centers in the United States. The committees appointed primarily for the enrollment of nurses have responded with enthusiasm to all demands made upon them. In organizing our rural nursing service, we have sought their advice and assistance. In the development of our classes of instruction for women we shall rely upon them to suggest instructors and examiners from among the Red Cross nurses.^ Early in 1914 Miss Delano reported: Late in April the National Committee on Red Cross Nurs- ing Service was instructed by the War Belief Board to com- municate with all Local Committees asking for a list of nurses available should it be necessary to call on our Red Cross personnel for service in Mexico. The response was so prompt and enthusiastic that we felt secure in urging all nurses not to begin preparations for service or give up their present positions unless definite instructions were received. It seemed wise, however, to have a small group of Red Cross nurses ready, and a few Local Committees in nearby cities were asked to prepare eligible lists. These nurses were then requested to present themselves for physical examination, anti- typhoid treatment and vaccination for smallpox. On ]\Iay 9, a call came from the Surgeon General of the LTnited States Army for three Red Cross nurses to go to Vera Cruz, and the following Washington nurses wore selected from among those on the available list: Kathrine Donnelly, Lulu T. Floyd, Nannie B. Hardy and Alice B. Harvey. These nurses reported at once to Red Cross Headquarters, and in a few hours all necessary preparations for their departure had been made._ They left Washington on Sunday afternoon, May 10, in charge of ]\Iiss Elizabeth Reed, a member of the Army Nurse Corps, who has been assigned as cliief nurse for Vera Cruz. A circular of information giving definite instructions con- cerning uniforms and equipment has been prepared in the hope that our nurses may avoid the common mistake of carry- ing useless luggage and leaving at home the things most needed. A special field uniform of blue-gray had been adopted, of such material and style as to launder easily and pack in small space, the cap, collar and apron of which can be laundered without starch ; while most suitable for service in a warm country tlie uniform is still neat and attractive. ^*^ "Reports, National Committee on Nursing Service, December, 1913. ^American Red Cross Magiizine, July, 1914. REORGANIZATION AND AFFILIATION 129 This note of July, 1914, recapitulated what seemed later to have been a game of child's play, faintly foreshadowing the terror about to descend on the world. In this section of this history no attempt will be made to do more than compile in very brief form the share of the Nursing Service in those instances where nursing was required to supple- ment the general work of relief. The San Francisco fire, following the earthquake, brought out nurses as volunteers. Affiliation had not taken place, but there was a local Red Cross society, with a committee on nurses. The chairman of that committee, Mrs. L. L. Dunbar, wrote: There was no further need of the Eed Cross Society in San Francisco until 1906. In 1905 when Congress made the society national, an organization was effected in San Fran- cisco with Judge Morrow as president. There seemed no hurry and Judge Morrow was a busy man and no committees were appointed until April 17, 1906, when a meeting was called, and Judge Morrow appointed the committees on nurses and physicians. Then the very next day came the earthquake and fire. I had been appointed chairman of the committee on nurses, but I w^as out of the city at the time and could not get back into it for a week. Meanwhile our nurses had responded to the need, and though without or- ganization had done much. As soon as I was able to get back to the city and some organization could be effected, conditions greatly improved. ^^ The call to send nurses to the scenes of the Mississippi floods (April 1908) has been mentioned as the first such demand that was made on the Washington Headquarters after the interest of nurses in the Red Cross had led them to join local and state Red Cross societies in fairly large nundxTs. Eighteen nurses were sent from New York, Pennsylvania, and District of Columbia Branches of the Red Cross, and emergency hospitals were established. The work centered in Hattiesburg, ]\Iissis- sippi. Half an hour after the wire came to Philadelphia, ask- ing for nurses, the nurses wore on their way. The character of the service rench^rcd is shown in tlic report of the New York Branch, from which the following brief portion of the narrative as told by the nurse in charge is taken: ^ Red Cross Magazine, January, 1908. 130 HISTORY OF AMERICAN RED CROSS NURSING We arrived in Hattiesburg, May 17. Previous to the coming of the Red Cross nurses the local relief committees had sent to New Orleans for six Charity Hospital graduates and were paying them at the rate of $25 per week for relief work in the two hospitals. Three of these nurses were discharged soon aftpr the arrival of the first detachment of Eed Cross nurses, and the remaining three after our arrival. Three of our nurses were assigned to night duty, two to day duty, and I was to act with Major Simpson and Captain Ashford in coordinating the food, medical sup- plies and repairs, also clothes, equipment and the names of discharged patients who were entitled to transportation, etc. . . . My duty was to go each morning to the hospitals, army tents and Eed Cross relief stations; and collect and inspect all requisitions, when needful make suggestions and eliminate all requisitions not provided in the list of medical and com- missary supplies provided by the Relief Expedition. These requisitions were then taken by me to the official offices to be approved and signed, then to the storehouse to be filled and delivered. All complaints from either superintendents, patients or head nurses regarding supplies, etc., were furnished me in written signed complaints, to be adjusted by the offi- cials in whose department they were. As the buildings were from one-quarter to one-half mile apart and as I went mostly on foot, my first week was a pretty busy one, until I had learned to systematize my work. May 29, 1908. (signed) Gexoveva Pettit.^^ The Dallas floods occurring in the summer of 1908 created conditions that called for nurses. The service was supplied entirely by the Texas Red Cross State Nursing Committee. Its president, Mary Sherman Allen, wrote of the experience that she and her staff had there : As many people in the larger camps were sick, from ex- posure and the terrible experience they had passed through, some being days in tree-tops before rescued, it was thought advisable to establish eniergeney hospitals in Camp Hay and Camp Ferris. We, therefore, issued a call for nurses and nearly all of our enrolled nurses responded to the call, and "The American National Red Cross Society, at its meetin;,' licld last November, decorated Kli/,aV)ctli M. Hewitt and J. Beatrice Howman. both of the Nurse Corps. United States Navy, with a service bar for volunteer work done under the Red Cross at Hattiesburpr, Miss., after the cyclone of last spring. Tlie bar is f)f bronze and on its face are the words, Hattiesburg, 1908." Amcn'ra?! Journal of yursing, September, 1908. REORGANIZATION AND AFFILIATION 131 immediately we established a large field emergency hospital, fully equipped with drugs, sanitary dressings, cots for the sick and all appliances to care for those that needed the at- tention of the lied C'ross. Doctors Stoval, Furgeson, Black and Davis had charge of the medical department ; Miss Mary Ennisson, charge of the hospital work, and the Misses Annie Swinsky and Adrian Palm, trained lied Cross nurses, charge of nurses' department. Our Emergency Hospital stood at the head of a broad avenue of tents. The camp presented a beauti- ful picture and the United States flags and lied Cross flags floating above our hospital tents could be seen for miles around. Sanitary conditions and perfect order were main- tained during the entire time. Our doctors and nurses were kept busy caring for cases of fever and other diseases caused by exposure. Our doctors and nurses cared for many cases of destitution and sickness in ])oth camps, as well as in all parts of the city where needed, and it has been the universal expression that the prompt, ellicient and systematized work of the Eed Cross did much in preventing an epidemic of fever.'" 'No nurses were sent from America by our Red Cross at the time of the earthquake in Sicily (1908), but three or four American nurses wore in Italy at that time and volunteered their services. It is interesting to know that one of these was Alice Fitzgerald, a .lohus Hopkins inirse, whose later important position as chief nurse of the conmiission to France and still later as director of the nursing Service of the League of Red Cross Societies, will he fully told in another chapter. When a building collapsed in Philadelphia, -luly, 1009, a single Red Cross nurse, ^largaret B. Simon, was the heroine of this accident, and for her work she was commended by personal letters from the ^^fayor of Philadelphia, and from the (then) President Taft. At the time of the dierrv ^line disaster, nurses, though ready, were not sent by the Washington office, as the Visiting Xurses' Association of Chicago had enough of its staff to till the required ser\'ic('. During the Mexican border disturbance's in PHI. the Cen- tral Office of th(> Xursing Service at Washington responded promptly, twice, to calls for nursing aid, once for Douglas, Ari/oiui, and next from l'"l Paso, l\>xas. In the former case the exi)ected necessity did not aris(\ and in the latter, two Ameri- '''^'' A )i)rri('tni loitrmil (if XiirsiiKj. Oclolicr, lOOS. 132 HISTORY OF AMERICAN RED CROSS NURSING can Red Cross nurses began to organize work, which was then taken over by the Mexican Red Cross. When the Austin Dam broke in 1911, the Red Cross Service stood ready to provide nurses, but they were not needed, as the State of Pennsylvania provided physicians and nurses. In the floods of early summer, 1912, Mississippi and Louis- iana being the chief sufferers, the Red Cross Nursing Service organized relief for the sickness which resulted from the floods and the hot weather. A staff of nurses was mustered by the Kansas City Local Committee on Red Cross Nursing Service at the request of the Washington ofiice, to be sent to Mississippi, leaving New Orleans nurses to supply Louisiana. Camps were formed for the refugees and the nurses were stationed in these. Thirteen nurses were assigned to duty. Miss Delano wrote :^* In each case the response to our call was prompt. Too much cannot be said in praise of the splendid spirit shown by the nurses. The Omaha cyclone occurred in March, 1913. In the American Bed Cross Magazine for July, 1913, Miss Delano wrote : Soon after the April number of the Bed Cross Magazine went into print we were called upon to face a series of dis- asters such as this country had never before experienced. The efficiency and preparedness of tbe Nursing Service of the Eed Cross were well tested and the nurses were foimd ready to meet all the demands made upon them. As soon as the news of the Omaha disaster was received in Washington communication was established, through the courtesy of the Tnited Press, with Aliss Lillian B. Stuff, Act- ing Chairman of the Xehraska Committee on Red Cross Xursing Service, and authority was given her to call out Red Cross nurses and to organize sucli relief as lay in her power. An emergency hos])ital of one hundred and fifty beds was established in a local gN'umasium where they cared for the injured and homeless. ^liss St\iff, in her re])ort, says. "We did not wait for calls to come to us, but made a house to house canvass as many were huddled together among neighbors without proper cloth- ing in which to n])pear to ask for aid. Xor did we confine our efforts entirely to nursing, but gave whatever lielp was needed." ^ AmrrircDi Journal of Xursiur;, Scptenilier, 1912. REORGANIZATION AND AFFILIATION 133 A hospital of one hundred fifty beds was established and eight Red Cross nurses were continued in service there for some weeks after the disaster. Two days after the Omaha cyclone, vague rumors came to us over press wires of the Dayton horror. Telegram after telegram was sent to our Local Committees on Nursing Service and on March 2(5 a message came through from Cin- cinnati concerning the assignment of their own nurses to duty and asking that one hundred additional nurses be sent to them at once from adjoining cities. The chairman of tlie National Committee on Red Cross Nursing Service and ten Red Cross nurses left Washington with Miss Boardman on Friday, March 28, at midnight on a special relief train sent out by the Washington Post. This train reached Cincinnati Sunday morning and found the most perfect cooperation between the Local Chapter, nursing committees and various relief agencies. ^^ In her Annual Report, ]\liss Delano said : During the first forty-eight hours following the Ohio flood, which occurred ^larch 25, seventy-seven nurses were assigned to duty by the Cincinnati Local Connnittee, and in response to telegrams sent from Washington one hundred and thirty-six nurses from other cities reached the flooded area during the next forty-eight hours. These nurses were sent from Chicago, St. Louis, Detroit, Ann Arbor, Cleveland, and Akron, wliile ten went from Washington and Baltimore on the "Post Special" with the cbairinau of the National Committee. Red Cross nurses were assigned to tlie following cities in the flooded area : Columbus, Dayton, Hamilton, ]\liddlcton. West Carrolton, Portsmouth, ]\Iiamisburg, Glendale, Peru, Shawneetown, Catlet^burg, ^Maysville, Point Pleasant. The number of nurses assigned to dutv at any one place and the length of service depended upon local conditions. We Avere fortunate in having an active I\e<] Cross Chapter in Cincinnati coojierating with the T^ocal Coimnittee on Nursing Service, and through the proin])t action of Miss Annie Laws, secretary of the Chapter, Miss (ireenwood. cliairnian of the nursing coinniittee, and Miss l\eineckt\ l\e(| Ci'oss nurse in charge of headquarters, nurses \ver(> sent to the stricken com- munities before organi/.e(l relief could be undertaken. De- tailed reports of the work done by our nurses under the supervision of Miss Mary \\. (Jladwin, chairman of the Ohio "/i-nr/ Crnss Ma(jn::inr, July, 1013. 134 HISTORY OF AMERICAN RED CROSS NURSING State Committee, and in charge of the nursing relief in Dayton ; Miss Ella Phillips Crandall, of Teachers College, New York, responsible for about fifty nurses doing sanitary inspection work under the direction of Major T. L. Ehoads, Medical Corps, United States Army; Miss Mary C. Wheeler, superintendent of Illinois Training School for Nurses, Chi- cago; Miss Emily McLaughlin, superintendent. Harper Hos- pital, Detroit; Miss Julia C. Stimson, in charge of social service work in St. Louis, Mo., Miss Jennie L. Tuttle, superin- tendent. Visiting Xurse Association, Columbus; Miss Mary B. Wilson, and Miss Abbie Eoberts, of Cincinnati, have already appeared in the Red Cross Magazine. These nurses and many others were relieved from responsible positions, and in some instances substitutes were employed in order that they might meet their obligations as enrolled Eed Cross nurses. In describing the work of the Red Cross nurses in Dayton, Miss Glad%vin wrote : They may be found serenely picking their way around wrecked furniture, sodden mattresses, ruins of porches and sheds; wearing rubber boots, with skirts kilted high, wet nearly to the waist; sending sick people to the hospitals, in- specting plumbing, back yards and cellars ; superintending all sorts of work from feeding the baby to the digging of trenches. Through all parts of the flooded city nurses go on similar errands, inspecting nearly nine thousand homes and reporting conditions found. Through the activity of Mrs. H. C. Loun^bury, chairman of the West Virginia State Committee on Eed Cross Xursing Service, most efficient relief was rendered at Point Pleasant, West Virginia. Mrs. Lounsbury and two other Eed Cross nurses "went down the river on a boat loaded with supplies furnished by the citizens of Charleston and the neighboring towns." They found little sickness at Point Pleasant, and devoted their efforts chiefly to the distribution of clothing and supplies and the establishing and maintaining of sanitary conditions. '*''' The nurses were on duty for four weeks, and it is recorded that in Dayton alone they cared for over two thousand cases of illness or accident. This was the severest test yet given to the Ked Cross Xursing Service, and the way in which it was met "' Pv('I)ort of tlio Xatinna] ('niumitto' on Red Cross Xursing Sorvice, 1913. REORGANIZATION AND AFFILIATION 135 was justifiably regarded as a triumphant proof that organiza- tion was now in perfect running order.^''' When a terribly destructive fire in Salem made thousands of people homeless the Boston Local Committee on Ked Cross Nursing Service took charge of nursing relief. Stations were appointed and Red Cross nurses assigned to each. A Mater- nity Hospital with a Milk and Baby Hygiene Station was organized and a Contagious Hospital established. The work of the inirses was largely preventive and was well and thor- oughly done. The Eastland disaster which occurred in 1915, was reported as follows: On July 24 one of the large excursion steamers, which had been chartered by the employees of the Western Electric Com- pany, overturned just before the boat was ready to leave the dock. There were about twenty-five hundred people on board and of this number over nine hundred lost their lives. The accident occurred about seven o'clock in the morning. The chairman of the Local Committee on Red Cross Nursing Service, Miss Minnie Ahrens, heard of the catastrophe on the way to her odice and started at once with another nurse for the scene of disaster. She telephoned immediately for additional nurses, not only to headquarters of the enrolled Eed Cross nurses, but to the registrar of the Central Di- rectory and all Public Health Xursing organizations. Nurses responded quickly and reported on arrival to the chairman of the Committee for instructions. By one o'clock at least one hundred nurses were on duty. They worked in the pour- ing rain wherever the rescued were carried, and many taken from the water before nine o'clock were resuscitated. About noon shelter was provided in the Beed Murdock Wholesale Grocery Building, and artificial respiration, hot applications and other emergency treatments were continued as long as there was the slightest hope. When nothing more could be done for the injured, a morgue was eistablished at the Second Kegiment Armory where relatives could identify their dead. Five Ked Cross nurses were assigned to duty in an emergency liospital at the morgue to give such care and comfort as might be possil)le to tliose who were bereaved. This emergency hos- pital was continued with relays of Red Cross nurses until "See also articles on the Dayton Disaster in the Amrricnn .Joitmal of Xurfiing. li)l.'?. The Red Cross in Dayton, by Mary K. (Jladwiii. Tlie Work of the Cincinnati Local Red Cross Xnrsinjif Service Coininittec, by Mary H. Greenwood. Report sent to Miss Delano hy Ella Phillips Cran- dall,' etc. 186 HISTORY OF AMERICAN RED CROSS NURSING Wednesday^ July 28, all serving gratuitously. In closing her report Miss Ahrens, who had charge of the work and who rendered most efficient service, said : "It is at such a time that we realize and appreciate the value of our Eed Cross Nursing Service. Without organization it would have been impossible to have had such cooperation.^ The year 1917 had a number of calls for nurses in times of disaster ; six were called to ISTew Castle in Indiana ; nineteen to New Albany, Indiana ; four to Chester, Pennsylvania ; eight to Atlanta, Georgia ; thirty-four to two Illinois towns ; five to Hickman, Kentucky ; three to a Missouri town ; one to Spring- port, Michigan; five to East St. Louis; one to Clay, Kentucky. The crowning disaster of 1917 was the explosion at Halifax, Nova Scotia. The terrible calamity resulting from the explosion of war munitions in the harbor of Halifax, on the 6th of December, 1917, will long be remembered. Amidst the many forms oi relief and succor called for by the unparalleled destructiveness of the disaster, nursing aid was needed. From this country a number of nurses were recruited in desperate haste by Red Cress committees and hospital authorities of the New England states, as being the nearest to the scene. The Providence Local Committee on Red Cross Nursing Service sent fifty nurses in charge of Grace L. Mclntyre, Chief Nurse ; various hospitals sent physicians and nurses ; the Com- mittee of National Defense and the Public Safety Committee formed units of physicians who chose their own nurses, and thus the New England Division Headquarters of the Red Cross was not called upon to supply nurses. Miss Delano was kept informed of the movements of nurses and on December 17 wrote to Elizabeth F. Sherman, of Provi- dence, who had been prominent in collecting Miss Mclntyre's staff: December 17, 1917. May I thank you for your very satisfactory report of the Halifax activities. It is our desire that Bed Cross Com- mittees shall cooperate in every way possible in relief work of this kind without waiting for orders from Headquarters, as the important thing in disaster relief is to meet the need "Annual Report of tlie Comniittoc on Red Cross Nursing Service, 1915. See also tlie Red Cross, by Minnie Alirens, Ameruxi7i Journal of \ursing, October. 191"). REORGANIZATION AND AFFILIATION 137 as quickly as possible. I am more than glad that you were able to secure the nurses, and appreciate greatly your untiring efforts in the matter. In this brief summary of special emergency nursing episodes there has been no attempt made to cover purely local, isolated instances where Red Cross nurses have come forward. Nor can the numerous list be included of such preparations for nursing care as were made, for instance, at the time of the Veterans' Reunion at Gettysburg, and similar reunions ; still less the long list of such occasions as might be covered by the term ''Dress Parade." For events of this kind the report of a typical year will give sufficient idea, as follows: Annual Report, 1917. Relief Actwities. The following relief activities have been conducted during the past year by our Local Committees: Date Town or City Occasion of Service Red Cross Nurses on Duty January 1 Pasadena, Calif. Tournament of Roses 2 ;March 4 \A'ashington, D. C. Inauguration 19 March 5-10 Cleveland, Ohio Central Armory Celebration 10 " 12 New Castle, Ind. Cyclone Disaster 10 from Indiana " 23 New Albany Tornado Disaster 5 " 4 Cincinnati " Kentucky April 10 Chester, Penna. Kddystone Disaster 4 " 16 to Washington, D. C. Encampment, Navy May 26 League May 21 Atlanta, Ga. Fire Disaster S 8 " Ploomington, HI. " 25 Charleston, 111. Cyclone Disaster 4 " Jacksonville Mattoon, 111. Cyclone Disaster () " 15 ' 1 ' Peoria, 111. Chicago, 111. Ft. Wayne, Ind. " 20 Hickman. Kentucky Cyclotic Disaster ;") " 10 Brooklyn, N. Y. I'livciling Lafayette Statue by General JofTre 4 138 HISTORY OF AMERICAN RED CROSS NURSING Date Town or City Occasion of Service Red Cross Nurses on Duty May 30 Bridgeport, Conn. Memorial Day Exer- cises 8 " 31 to Mineral Point, Mo. Tornado Disaster 3 June 30 June 2-9 Washington, D. C. Confederate Reunion 20 " 9 Springport, Mich. Tornado Disaster 1 " 17-22 Atlanta, Ga. Rotary Convention 4 " 3-6 East St. Louis, 111. Race Riots 5 July 4 Phelps, N. Y. Military Maneuvers 3 " 4 Newport, R. I. Parade 1 " 28 to Bridgeport, Conn. "Lordship Park" 1 Sept. 3 August 4 Clay, Kentucky Mine Disaster 1 Albany, N. Y. State Federation of Women's Clubs 9 Septem- Grand Rapids, Mich. Union Depot for 2 ber 10 troops passing through CHAPTER IV THE MERCY SHIP The S. S. "Red Cross" Satis Paignton, England Pau, France Kief, Russia Gleiwitz, Germany Kosel, Ger- many Vienjia, Austria Budapest, Hungary Belgrade, Serbia Gevgeli, Serbia Yvetot, France La Panne, Bel- gium American National Red Cross Headquarters Close of the Early Foreign Relief Program. A WHITE ship banded with scarlet, with a Red Cross flaming on her funnels, weighed anchor in the sunlit waters of the Hudson River and with the bells and whistles of ferries and tug-boats, the salute of liners and the throaty roar of men-o'-war to voice the God-speed of a nation, steamed out to the gray Atlantic, bound on a rare mission to warring Europe. The day was September 12, 1914. Against the lower rail of this good ship, the Red Cross, was banked a line of women, who watched Manhattan fade away and knew not what horror of war might be theirs before they saw that broken sky-line again. The white caps, the gray uni- forms, the line of scarlet as the fresh sea wind blew back the active service capes, proclaimed their identity. The Red Cross Xursing Service, conceived in the suffering of the Civil and Spanish-American wars, brought into being by the affiliation of the American Nurses' Association and the American Red Cross, nurtured and developed through five years of intensive organi- zation by Miss Delano and the Xational Committee, faced the most formidable test of its hitherto dormant powers. With its present resources untried, its potential strength unguessed, it was shouldering its first burden of neutral humanitarian ser- vice to the Allied and Central Powers. At a joint meeting of the International and War 7-felief Boards held on August 5, 1014, the Am(>rican Red Cross voted to charter a ship to carry trained jxu'sonn(4 and hospital 139 140 HISTORY OF AMERICAN RED CROSS NURSING supplies to the countries involved in the European War. The story of the immediate consequences of this action was told by Miss Boardman in the Red Cross Magazine of October, 1914: A committee consis|;ing of Mr. Bernard N. Baker, of Baltimore; Surgeon General William C. Gorgas, U. S. A.; Surgeon General William C. Braisted, U. S. N. ; and Chief Constructor Richard ]\I. Watt, U. S. N., was appointed to secure a suitable ship. No American vessel was available, but two ships were most generously offered free of charge by the Hamburg-American Line and by the Austro-American Line. The committee inspected both ships and finally selected the Hamburg, of the former company, as best suited to the purpose. By special Act of Congress [then in session], the ship flies the American and Red Cross flags, has a temporary American registry and has changed her name to that of the Red Cross, sailing from Xew York. According to the colors designated for such a ship by the treaty of The Hague, she was painted white with a broad red band. Major Kobert U. Patterson, Medical Corps, U. S. A., Chief of the Red Cross i\Iedical Bureau, soon secured his corps of surgeons. Miss Delano, chairman of the National Committee on Red Cross Nursing Service, through the cooperation of her Local Committees, selected from among volunteers from our five thousand Red Cross trained nurses, those best fitted for this special service. [Miss Helen Scott Hay was general superintendent of nurses of the Red Cross Ship.] Admiral Aaron Ward, U. S. N., retired, who was in Europe, accepted by cable the request that he take charge of the expedition, joining the ship in England. Admiral Blue, of the Navy, lent his aid to secure the rest of the officers. Cap- tain x\rmistead Rust took command of the ship and with him are associated other retired officers. Commander E. H. De- lany, U. S. N., as chief engineer; Commander J. S. Dodd- ridge, U. S. X., and Lieutenant Gilford Darst, U. S. N. ; Mr. Richard D. L. ^lolnm is the paymaster. Captain Jarka, superintendent of this line, gave invaluable service in the coaling and provisioning of the ship. The painters hung along lier sides and busily plied their brushes the moment the coaling was over. The S. S. Red Cross Avas loaded from warehouses in Brook- lyn, the use of which were donated by Mr. Irving Bush. Colo- n(!l S. L. 1). SlfX'um, U. S. A., r(;tired, was in command of the loading of liospital and other supplies. Four hundred thou- THE MERCY SHIP 141 sand pounds of cotton, two hundred and fifty thousand meters of gauze, fifteen thousand pounds of bandages, thirty gallons of iodine, two thousand cans of ether, rubber gloves, vaseline, cocoa, tobacco and other comforts and necessities for the care of the sick, filled the hold of the liner. Because of this cargo and because of her passengers, the Red Cross received the name of the "Mercy Ship" from the friendly press. The professional personnel of this relief expedition was made up of ten units, each composed of twelve nurses and three surgeons. Units A and li were assigiied to Pan, France ; 1) and F to Paignton, England ; C and II to Kief, Pussia ; G and I to Germany; K to Austria and E to Budapest, Hungary. A Serbian imit, of which Dr. Edward W. Ryan was director and ^lary E. Gladwin, chief nurse, had proceeded five days before the sailing of the ]\Iercy Ship on the merchant liner loannina bound for the Mediterranean and Nish. The superintendent of nurses of the S. S. Red Cross was Helen Scott Hay. The assignment to the Mercy Ship which brings her for the first time into this history was in keeping with her subsequently romantic and brilliant career in Ked Cross service. She was graduated from Northwestern Academy in 1889 and received her B.L. degTce from Northwestern University four years later. Further theoretical phases of her broad education were completed in 1900 at the University of Chicago. She had entered the Illinois Training School for Nurses in 1893 and following her graduation became associated in executive capacities of varying types with the Southwestern Iowa Hospital for the Insane at Clarinda, Iowa, and w^ith private sanatoria in Los Angeles, California. She was super- intendent of nurses at the County Institute for the Insane and Indigent at Chicago and later superintendent of the hospital and training school of the Pasadena Hospital, Pasadena, Cali- fornia. Private duty nursing claimed her attention at inter- mittent periods. An interesting break in her professional career is marked by a year as principal of the Savannah High School, her native village iu Illinois. She became superintendent of nurses of her alma mater, the Illinois Training School, in I'.KXl and remained tlu^re until 1912. After eighteen months spent in travel, she undertook the organization of the W(^st Suburban Hospital and School for Nurses at Oak I*ark, Illinois, and re- mained there six months, resigning to accept her first lied Cross servi('(\ 142 HISTORY OF AMERICAN RED CROSS NURSING Miss Hay's early war service was closely interwoven with a project of nursing education which first linked the American Red Cross with the development of foreign nursing. Before the declaration of war, Queen Eleanora of Bulgaria had ap- pealed to National Headquarters for advice and assistance in establishing a training school for nurses in Sofia in accordance with American standards. In the Red Cross Annual Report for 1914, Miss Delano stated this prospective plan of the keen-visioned Queen: She wished to secure an American superintendent to or- ganize a training school and to send to America four Bul- garian young women of education and promise who could fulfill the requirements for admission to one of our best schools for nurses. These pupils were to enter the Presby- terian Hospital School for Nurses in New York City. Miss Helen Scott Hay was selected by the Red Cross to establish the school in Bulgaria. The Bed Cross assumed the re- sponsibility for her salary for three years and she was to have sailed for Bulgaria [August 4, 1914]. The declaration of Avar made it necessary to abandon our plans temporarily, ren- dering it possible, however, for us to assign Miss Hay to duty on the Bed Cross Ship. In organizing the nursing stafi's of the ten units. Miss Delano and Miss Hay were guided in their assignments by the princi- ple that graduates from the same school and section of the country would work advantageously together. An earnest spirit characterized these surgeons and nurses bound on their cru- sader's mission during that memorable September of 1914. In a leading editorial the Ainerican Journal of Nursing voiced the sentiment of the Red Cross : ''Our nurses have been sent not to lead others or to show how Red Cross work should be done, but to supplement the existing relief work, to piece in where there is no one else to serve." Individualism also gave way before the Red Cross ideal of neutrality. Although all the nurses were native-lx^rn citizens of the United States, many of their names were distinctly con- tinental. After a first moment of astonishment, they agreed to follow the European custom and to be known only as "Sister Donna" or ''Sister Charlotte," titles appropriate indeed when it is remembered that the old Sanskrit word for "sister" meant "comforter." The one hundred and twenty-six nurses sailing on the Mercy THE MERCY SHIP 143 Ship had boen assembled through the Local Committees of Manhattan, Boston, Brooklyn, Philadelphia, Baltimore, New Hampshire, New Jersey, Rochester, Biitfalo, Detroit, Albany, Chicago, Kansas City, Cincinnati, Akron, Cleveland, Colum- bus, Connecticut and Washington, 1). C. A diary written dur- ing the quiet days at sea, presented a vivid picture of this swift mobilization: On board the S. S. Red Cross, September 22, 1914. Almost a month has passed since a telegram came from ]\Iiss Delano saying, "Report Wednesday in New York for Red Cross service in Europe." As I read over that telegram, a queer feeling come into my throat. Then with pencil and pad I was soon busy making out lists of necessary articles. Ilurried shopping followed in the morning. Constant tele- phone calls from friends brought varied questions: "Why are you going?" "It won't be any fun !" "How I envy you the opportiinity !"' "Please send me postcards every week, won't you?" "1 have a cousin in Germany give her my love." "We have just finished a bushel basket of bandages for the Allies we want you to take over." To have only forty-eight hours in which to adjust your affairs and to get your mind into a realization that all things of your former life are to cease and an entirely new and very real existence is to begin is no easy task. I can still hear my mother's "Yes, you should go," though the look in her eyes belied her words. ]\[y brother's "Be a good soldier, sis!" is all mixed up with "duffel bags" and "war zones" and the prescribed number of flannel night-gowns to be taken. On Wednesday evening, September 2, nurses began to arrive in Xew York from all parts of the country. In view of the fact that many nurses were on their vacations, their mobiliza- tion within two days after their "travel orders" were received, was remarkably swift. They were entertained at the Central Chil) for Xurses, 54 East 34th Street. This was conveniently near the Xew York County Chapter, where they were equipped with the regulation uniform upon their arrival. Gray uni- forms, white aprons, caps with a small Bed Cross in front, soft colhirs, a navy blue cape lined with scarlet and with the Bed Cross on the left side, a dark blue felt hat, a water-proof duffel bag of brown canvas closed with a bar and lock and conspicu- ously marked with a Bed Cross encircled by the words, "Ani(>ri- can Bed Cross," were given each nurse. The duffel bags, con- lU HISTORY OF AMERICAN RED CROSS NURSING taiiiing three additional bags, one for shoes, one for laundry and one containing scissors, needles, cotton, buttons and a piece of the uniform material, were the only luggage allowed, except a suit case or hand bag. Gray sweaters were also furnished. Warm storm coats were later added to this equipment. An ^live green blanket, with a Red Cross woven in the center was presented to each member of the expedition, to be used as a steamer robe or extra bed covering in the hard and unusual places of war where they soon might find themselves. The pleasant hours on board the Mercy Ship was busily taken up with classes. The daily routine resembled more closely that of a training school than an ocean voyage. The nurses breakfasted at eight o'clock and spent the morning at lectures given by the surgeons on such subjects as First Aid, languages, contagious and infectious diseases, anatomy, anaesthetics, ban- daging, the metric system, field surgery and allied subjects. At eleven-thirty, they exercised in the gymnasium. After luncheon they practised nursing technique for an hour and a half. At four o'clock, they attended classes in French and German. They dined at seven. Prayers w^ere conducted by Sister Helen Scott Hay at eight-thirty and the nurses retired at ten o'clock. The grim realities of war hovered near the staunch S. S. Red Cross as she plowed her w^ay through the heavy seas. Letters and diaries of the nurses recounted the eventful days in the war zone : Monday, September 14. About 3 A. M. the searchlights of the British cruiser, Essex, found us. After our flags were nui up and our illuminated Red Cross had flashed back our identity, we were allowed to proceed. As this is my first ocean trip, my ha})piiiess will not be complete until there are "shots across the bow" and I see a whale. They found three stowaways, two of the old crew; sighted four ships, ordinary trading vessels. Tuesday, September 15. Another lesson on bandaging at 9 :30. Passed south of the banks of Newfoundland at noon. The sea is still rough, the sun warm, a strong wind blowing. Huge waves come breaking over the decks. We are taking the eastern course direct. Wednesday, September 16. A beautiful, warm, bright morning. They found two more stowaways who looked as if they had been making their home in the coal boxes. Had a very interesting talk on solutions, preparations for aspirat- ing, venous section and lumbar puncture. It is dark and THE MERCY SHIP 145 cloudy and looks very much like rain. The Lusitania sent a wireless at 8 P. M. saying we were coming to a storm. Everything is being tied fest and tacked down. Friday, September 18. Such wonderful weather and the sick chirping up. Our class this morning was on the care of the wounded in the field. Then in the afternoon we were shown the engine room. I thought my time had surely come; we went down, down, down. It was the cleanest but also the oiliest place that I had ever seen. There is one fact which penetrated my brain and remained there : the stokers are not the miserably unhappy mortals one is likely to imagine. The one J saw was blissfully smoking a pipe and singing. Then after I had smiled sweetly (and no doubt patronizingly), great was his Joy when 1 put my hand on a rod covered with tar. He laughed outright and so did I. Monday, September 21. IMajor Patterson received a wire- less this morning from Dr. I?yan of the Serbian unit, stating they have had bad storms for five days. I really think we are all feeling the de})ression of this awful fog. It is just the feeling that one would have after being put in a cold pack and then forgotten by the nurse. Tuesday, September 22. Another heart-to-heart talk with our superintendent has brought home to us that neither the best bandage nor the deft handling of a wound will win for us a place among those we hope to assist; the keen and ready sympathy that w^e show them will make or mar our mission. Wednesday, September 23. Bishops Headlight has just blinked a welcome. Land, at last! One war vessel at anchor in the harbor sent the following message by wireless: "God bless you and good night." With her flags unfurled to the brilliant glare of searchlights from land and from battle craft in the harbor, the S. 8. lied Cross lowered anchor on the evening of September 23 in the Bay of Falmouth, England. Surgeons and nurses of four units were to leave her at this port, D and F^ to report to the American Ambassador in London for assigiiment to service with the British ; C and H to proceed north by way of Scotland and Sweden for Petrograd, Kussia. The remaining six units des- tined for service in France, Gernumy and Austria were to remain aboard for debarkation at other ports. Among the low hills of southeast England lay Paignton. Here on October 1, 11!14, Unit F reported for duty at "Oldway House," then a war hospital for Tommy Atkins. 146 HISTORY OF AMERICAN RED CROSS NURSING "Oldway House" was formerly the country estate of Paris Singer, of ^ew York, and had been loaned by him for hospital purposes to the Committee of the American Women's War lie- lief Fund. This group of American women, then resident in England, included among others, Lady Arthur Paget, Lady Henry, the Duchess of Marlborough, Lady Randolph Church- ill, Mrs. Whitelaw Reid, Mrs. John Astor and Viscountess Harcourt. Sir William Osier, Baronet, served as consulting physician and Lieutenant Colonel R. C. Gunning, Royal Army Medical Corps, as military commandant. To this beautiful place with its spacious parks facing the Channel, its broad terraces and columned fagades, its marble stairways and tapes- tried walls, came Unit F with Sister Mabelle S. Welsh, a former superintendent of nurses at Peter Bent Brigham Hos- pital, Boston, as supervisor and Dr. Howard W. Beal of Worcester, Mass., as director. In the meantime. Unit D with Dr. Robert W. Hinds, of Buffalo, New York, as director and Sister J. Beatrice Bow- man, of the Navy Nurse Corps, as supervising nurse, had been sent to the Haslar Royal Naval Hospital, near Portsmouth. This unit remained at Haslar for six weeks before it was called to Paignton to supplement the staff at ''Oldway House." A brief description of the Haslar hospital is therefore given before the work at Paignton of Unit F and the combined work of Units F and D is detailed. Sister Beatrice of Unit D wrote: From owr hotel windows overlooking Falmouth Harbor, we saw tlie Channel and the Bed Cross as she steamed out, and tlie S. S. Tennessee as she swung into her place. At ten o'clock on the morning of October 3, we started for Gosport. Even tlie roads and foliage seemed old-Avorld and quaint. Lady Hotham says that Americans are not con- sidered foreigners here and indeed they do not treat ns so. One would think we were some near relative turning up after years of separation. This is the largest hospital, naval or military, in England, with a capacity of two thousand and six hundred l)eds, and a possible emergency one of seven thousand. Each of the ninety-nine wards has twenty-eight to thirty patients. Picturesquely sea-going was the language at Haslar. The floor was "tlie deck," upstairs "top-side," and downstairs "be- THE MERCY SHIP 147 low." The nurses' office was the ''Sister's cabin," the operatiiifr room '"the theater," the Hospital Corps "the siek berth staff. ' Small wonder that the American mirses gasped to hear the British Navy Sisters refer solemnly to a critically ill patient as "that jolly sick man just gone below !" But it was necessary to supplement the staff at "Oldway House," Thus after six weeks of absorbingly interesting work at the Naval Hospital, the order came for Unit D to proceed to Paignton. The Matron of "Oldway House," Gertrude Fletcher, was an Australian woman whose long experience during the Boer War had helped prepare her for the delicate task of directing the work of the English and American nurses. When Unit D arrived on November 12, they found that Unit F had previously been given the care of a ward of sixty-seven beds, one-third of the entire house. This responsibility was continued, but shifted so that Sister jMabelle Welsh of Unit F became Matron's first assistant on day duty and Sister Beatrice Bowman of Unit 1) was appan wounds, the first we have had ; one has eight bullet wounds in one leg, another through the shoulder, and a sabre cut on the arm, the only case of this type in the hospital." At the close of their six months' service, four of the Ameri- can nurses, iucliuling Sister Mal)elle Welsh, asked to l)e rc- lieved from duty on account of the lightness of the work. In a letter addressed February 23 to ^liss Delauo, ^Tatron Gertrude Fletcher gave a penetrating glimpse of the two stages which cverv nurse in active, service soon \nidcrirocs: 148 HISTORY OF AMERICAN RED CROSS NURSING War nursing as a whole is a demoralizing experience. As long as the work is heavy, all is well, but when long periods of waiting arrive, even the most level-headed of women are apt to become lacking in judgment to a degree that astounds one. The work begins with such stirred up emotions and enthusiasms, and one can never quite tell where that will lead. This is why I regard the second stage of war nursing as the test. I have gone through it all before, so it becomes like nursing a familiar disease. At Miss Fletcher's request, National Headquarters appointed Sister Louise Bennett and Sister Elizabeth Weber as super- visors of their respective units. With fifteen English sisters, seventeen probationers and twenty-six American graduate nurses, the nursing staff at "Oldway House" had been experi- encing difficulties of seniority and Miss Fletcher felt that better discipline could be secured by having the remaining Americans work under their own leaders rather than under British nurses. During the spring, the work grew heavy. Three additional nurses and two doctors from the United States arrived April 5, 1915. Miss Fletcher expressed her relief in the following letter : The whole of England seems to be preparing for heavy times ahead, and nurses apparently are going to be difficult to get. Soldiers and everybody else can see no other possi- bility than that we must have an immense amount of sickness when the summer sets in. The men say that even already while the weather is so cold, the odor from the dead horses alone is dreadful, and whenever they start to dig a fresh trench they come upon the dead. Therefore, it can be nothing short of a miracle that will prevent a summer of sickness and dis- ease. However keen may have been the disappointment of the American nurses that they w-ere not always busy to the utmost capacity of their streuiith, or however delicate the relations be- tween probationer, Sister, supervisor, Matron and director, the work with Tommy Atkins '"imself" was intensely satisfying. Sister Beatrice wrote : Our patients had great fun at our expense on Washington's Birthday. One of our probationers, a girl from Virginia. sent to London for some artifi<-ial (iherries which she passed among all of us Americans and which we wore, greatly to the enjoyment of our thirty-two convalescents. When I came THE MERCY SHIP 149 on duty the next morning, I found every man Jack of them had tied about his neck on a string an apple, or an orange, or a banana. When I asked what the decorations meant, I was greeted witli this answer: "Well^ yesterday being George Washington's birthday, we thought we'd celebrate Adam's and Eve's today !" To the white beds filling the reception halls and guest rooms of that stately palace-hospital came soldiers from the Seven Seas. Princess Pat's troopca* lay beside "those black Gurkhas, a fine lot of men they be." Blackwatch and Patriot sunned themselves on the terraces, or limped through the gardens. The patients delighted to write poems which they presented to the nurses. Among the popular subjects was "Frozen Peet" : Tingle, tingle, little toes. Them wot's 'ad 'em only knows Nothin's pleasant, nothin's sweet, 'Bout a pair of frozen feet ! Standin' in trenches wet an' cold Is wot's caused 'em, so I'm told. They throb all night, and burn all day, But are cured by friends from U. S. A. They work all day and watch all night, To do their bit to get chaps right. A Corporal of the King's Own Eegiment. Spring came over the Devonshire hills, bringing splendid Canadian troops to Paignton, some of them blinded, others choking with poison gas, and the horror and weariness of war grew harder to bear. "We don't say much about it," wrote Sis- ter Louise, "but we are all heartily sick of tliis endless cruelty and wickedness." The monotony of ten months' continuous duty was broken by vacations and short trips alx)ut England. The American Ambassadors in the various belligerent coun- tries received word August 1 that the American Red (Voss was withdrawing its foreign units on October 1, owing to lack of funds. With a record of 1905 admissions during the period the Anu-rican Wonu'u's War Hospital was operatc^d by Ameri- can lied Cross, Enits E and 1) withdrew September -'50, 1!)15. Early in the spring of 11*15. the American Red Cross had assigned two units to the Belgian (iovernment to assist in the care of their wounded at La Pann(\ Belgium. 1'he personnel of the S. S. licd Cross were recalled after a year's foreign ser- vice, but these later units were retained in Belgium until the 150 HISTORY OF AMERICAN RED CROSS NURSING completion of their entire twelve months' duty. Several nurses of the Units D and F were accordingly transferred by Miss Delano to La Panne. Five other nurses remained at the invita- tion of the British War Office at Paignton. Other members of the units returned eventually to the United States. In a sunny valley below the Pyrenees lay the city of Pau, France. The French units A and B of the Mercy Ship Expedi- tion were detailed for duty at this famous winter resort. Dr. Reynold M. Kirby-Smith, of Sewanee, Tennessee, and Margaret Lehmann, of Philadelphia, were in charge of Unit A; Dr. Roades Fayerweather, of Baltimore, Maryland, and Alice Henderson, of Baltimore, were in charge of Unit B. On their arrival, October 3, 1914, at Pau, the American surgeons and nurses were greeted by the mayor and residents of the town and by many Americans then living there. "Pau is a prosperous little city," wrote Sister Alice Henderson, "every one seems quite well-off and prices on food and clothing have advanced little, if at all. Were it not for the soldiers on the streets, one would never know that a war is raging." Since the hotels were all liable to be requisitioned for the soldiers, the Palais d'lliver, a pleasure-designed casino, was secured and equipped as a hospital. The Winter Palace had formerly been the center of the great gayety of Pau and its rooms and corridors were large enough to accommodate 1G6 patients. In the center of the palace was a palmarium; the Americans put long tables down the middle of the room between the palms and blossoming vines and the convalescents had their meals there in the warm sun- shine. Every window of the Winter Palace commanded a view of the white Pyrenees which loomed above Pau. Although the nurses were all American-born, some of them had names of Teutonic origin and tlie French felt and even expressed some doubt as to their sympathies. This was one of the reasons why the units were assigned to southern France, instead of to Paris, where professional nurses were greatly needed. Paris was the headquarters for the Government and the Army. During the first weeks of their stay at Pau, the Americans received few patients. However, they soon earned the confidence of the local authorities. "We are not only wanted," wrote Sister Emma, "but we are needed. I do not think that we will be moved nearer the front," she added, "it is easv to understand now wliv we were sent to Pau. As individ- THE MERCY SHIP 151 uals on our own resources, it might have been possible for us to work at the front but as an organization representing a neutral government, this appears to be quite out of the question." Finally in the last days of November, many wounded were sent to the Palais d'Hiver. Arabs, Belgians, Moroccans, Alge- rians and French were unloaded from the hospital trains. "One has little idea of what this war really is," wrote Sister Alice, after a convoy of 110 wounded had arrived, ''until you see a train of wounded come from the front, the men so dirty, so ragged, so tired, so sick, yet not one of them ready to admit that he is either hungry or exhausted or that his wound is more than a scratch !" Christmas in France during this first year of the war was a time of anxiety and suffering. The drive on Amiens was in progress ; every province was sending its men to the defense of la douce terre de France. As Pau was a recruiting center for the surrounding country, the streets swarmed with soldiers of every class and type. From her busy operating-room, Sister Emogene E. Miles wrote on December 20 : This past week has been sad. Our ears are filled with the sound of drums, of bugles, of marching men. They are mobilizing all the available recruits for the January drive, calling boys eighteen years old, though volunteers of sixteen are accepted. i)r. Kirby-Smith was absent one day last week and he tells us that at every station on his way home were mothers bringing their sons to the train. After it had pulled out, many of those poor youngsters would weep, their heads bent, yet unashamed. Pau has tremendous barracks, now filled with men and boys getting into uniforms, drilling and being sent off to the Army at once. They are in sore need of more men. When the soldiers go to the train, their friends meet at the barracks and thrust a bouquet into each gun. A train loaded with wounded came to Pau on December 21, direct from Amiens. Before the arrival of these grands blesses, a notice had been posted from the chief medical officer in the Depart me nt-Basscs-Pyre nee s, stating that in future consign- ments all seriously wounded men were to be sent to the Ameri- can Hospital. These patients had truly undergone the rigors of trench warfare. One man's mud-saturated clothes bore out his statenu'nt that he had been standing in water-filled trenches for tlircH' weeks. ]\lany of the patients coming from crowded hospi- 152 HISTORY OF AMERICAN RED CROSS NURSING tals further up the line, had sloughing bedsores. A desperate case of tetanus, which reqiured special nursing day and night for several weeks, recovered, to the vast surprise of the French. Although the First Aid dressings were uniformly excellent, the majority of the wounds were badly infected. This infection was caused by mud-soaked uniforms full of bits of straw touch- ing the wounds before the dressings could be applied. The hospital at Pau occupied a geographical position w^hich increased the professional difficulties of the American units. Although they were near enough to the front to receive patients forty-eight hours after injury, often with only First Aid dress- ings on their wounds, they were also far enough back in the zone of the base to be the cynosure of many tourists' eyes. Sister Alice wrote: We must always be on dress parade. The scores of Eng- lish, French and American visitors who come to visit us each week make it necessary that we keep the hospital ready for inspection at 'any moment. At the present time, I am satisfied that we are doing all that we could handle efficiently. Were we in some isolated place, or at the line, we could easily take care of many more patients. As it is, however, we seem to have made a lasting impression on the French in demon- strating the value of trained nursing as opposed to volunteer effort. The American units found their French patients courteous, appreciative and simple, with the naivete of children of the soil. Robert Ilerrick, then American Ambassador to France, wrote that ''the popular nickname of jjoilu, the unshaved, has an inti- mate significance. The littlc! French soldiers are not parade soldiers, but common, plain men, careless of appearance." ^ Barbusse described in Le Feu the characteristics which so en- deared their patients to the American nurses: They are not soldiers, they are men. They are not ad- venturers, warriors for massacre, butchers or driven cattle; they are pbjughinen and laborers, easily recognized as such under tlieir uniforms. They are up-rooted civilians. In tbeir silence, iii their immobility, in the masks of superhuman calm on their faces, reflection and fear and longing are visible. They are not the sort of heroes they are jiopularly supposed to be. l)ut their sacrifice is nohh'r than tliose who have not seen them will ever he able to divine, '"/'orwrs (Irs I'rnlus," W. A. BiitUrficld, ]5oston, Mass., p. 3, THE MERCY SHIP 163 Sister Emma wrote on December 31 that a man in her ward, the father of four babies, had received not one word from his wife since the war began. Another young- man, she wrote, seemed dazed after his thirty-two days in the trenches, where he had slept only in snatches, always drinking black coffee to keep awake. "He returns very soon. It is dreadful to hear him say with a shrug of the shoulders: 'Eli hien, 1 shall soon be dead, I go for France.' We see only mourning on the streets. The women do all the work, driving oxen and mules, plodding through nnid and rain drawing loads of produce to the city, delivering bundles of wood and sweeping the streets. Every day more men go to the front." Always grateful, always re- spectful, always appreciative of the slightest attention, never forgetting their merci heaucuup, never failing in their sympathy for their fellow wounded, the French soldiers were the wonder and inspiration of all comers. Sister Margaret wrote: "It was always a beautiful as well as a most touching sight to watch the convalescents welcome the new blesses. They hail them hilariously, telling them of the good care they are to receive, assisting us in making our French understood and helping generally in making the newcomers feel comfortable and at home." When a soldier died at Pau, it was the custom for one surgeon and two nurses to attend his funeral. First marched the veterans of the little city, old men scarred in former wars for France, then the slow chanting priests, then the military escort. As very few poilus could be attended to their last sleep by mem- bers of their immediate family, the American doctor and the two nurses walked slowly before the flag-draped casket. Sister Vashti Bartlett wrote : "All along the way, the black dressed women and children stood at attention. Even small boys of five and six would drop their playthings and remove their caps. As we walked slowly down the road to the burial ground, I thought of the thousands of dead on the battle fields, denied even this last poor homage." It was a sad day both for patients and nurses when a soldier was dismissed from the American Hospital. Every one soon knew every one else in this small family of theirs. In a letter to Miss Delano, Sister Vashti enumerated her patients: No. I having been a waiter in London, spoke luiglish; No. II, Leclierec. always ready tu help, eonies t'roiu northern France, now under (ierman oceiijnition. When he was told 154 HISTORY OF AMERICAN RED CROSS NURSING that he must leave Pan, he had no place to spend his precious eight days' leave before returning to the front. As French soldiers receive only one cent a day, when one's family could not send one money, c'est dommage, n'est-ce pas? Xo. Ill, Chuzel, the baby of Salle D, holds the record for having killed sixteen Germans. Xo. V, a twenty-one year old sergeant, is a veteran in hos- pital experience. "You know, Sister," he said solemnly, "to be wounded twice means to be wounded thrice, and then one is killed and goes who knows where?" As the busy winter months slipped by in the daily routine of hospital life, little if any word from the other Red Cross units scattered over Europe came to the American Hospital at Pau. A cablegram from Major Patterson, at Xational Headquarters, brought in the latter part of February, 1915, how-ever, serious news of Serbian Units 2 and 3. A severe epidemic of typhus was sweeping Serbia, Every member of the commission at Gevgeli save five had been infected. Until additional assistance could arriye from the United States, would not one surgeon and three nurses from Pau report immediately at Xish ^ Every one of the American family volunteered. Dr. Kirby- Smith, the senior director. Sister ^largaret Lehmann and Annzi V. Lofving, of Philadelphia, and Sister Rebecca Watson, of Baltimore, were chosen and left Pau in ]\Iarch to sail on the CaUdomen from ^Marseilles for their destination in Serbia. After their departure, Dr. Roades Faycrweather took charge of the Pahis d'lliver as senior director, with Sister Alice Henderson as supervising nurse. As other yacancies occurred, surgeons and nurses were assigned to till them from Washington or were transferred from Paignton. With a record of having treated 598 patients to a conclusion, the Palais d'lliver was closed on September 16, 1915. During their twelve months of duty at the Palais d'lliver more than 225 major, as well as innumerable minor operations, were per- formed. Throughout their stay at Pau, the American surgeons and nurses were gi'catly assisted by the untiring courtesy and ((xiperation of ^layor Alfred dc Lassence and his daughter, ^Ime. de Cabrole. ^Irs. Henry Hutton, lime, de Arizcun and .Margar(>t Porter, American women living in France, had charge of the sewing room of the hospital and did sph^ndid work. ]\lrs. Leonard ]]rown. ^Irs. Wadsworth Rogers, Presi- dent of the Comiic dvs Danivs, Mrs. John Cushinu- and Mr. THE MERCY SHIP 155 George A. Bucklin, Jr., the American consul at Bordeaux, greatly furthered the work of the American units through their personal service and interest. Kief, which was a clearing-house for thousands of Russia's wounded, is situated on the Dnieper Kiver, with the Black Sea to the southward and the (^arpathian mountains to the west. This Russian city was the destination of Units C and H of the Red Cross Mercv Ship Relief Expedition. Units C and 11 left the S. S. Red Cross at Falmouth Harbor for London on Wednesday, September 80, 1914, and started the next day on their long journey for Petrograd via Scotland and the North and Baltic Seas. When the crowded little steamship Balder docked at Gotten- burg, Sweden, the Americans were met with the cordial welcome which was to characterize their reception all along the way to Kief. A brief stay at Raumo, Finland, was made pleasant by the cordial hospitality of the population. This Finnish village, then used as a port of landing :^or refugees, boasted no hotel. The women prepared food, however, for the passengers of any ship which came to their wharves, and on many days fed more refugees than the town had inhabitants. The American sur- geons and nurses breakfasted in small groups at dilierent houses. A representative of the Russian Red Cross escorted the units from Raumo to Petrograd. At the capital city of Russia, the Honorable George T. ^larye and his wife and Mr. Winship of the American Embassy, acted as hosts. Her ^lajesty, the Dowager Empress ]\Iarie Feodorovna, who was the head of the Russian Red C^ross, received the Americans at the Illagen Pal- ace. Lest the field uniforms of the American Red Cross, not then as familiar as they grew to be in later years of the war, should fail to be recognized and the work of the units accord- ingly hindered, the American surgeons were given high rank as medical officers in the Russian Army and the nurses were pre- sented certificates as Russian Red Cross Sisters. At last on October '1^, Units C and H set out for their final destination. Kief, a five days' trip of nine hundred miles. The special troop train on which X\\v\ traveled drew freight cars containing furnitur(\ linen, kitchen and laundry supplies for a -iOO-lxnl hospital and four car loads of American Red Cross medical supplies from the United States. Dr. William S. Magill was scMiior (lir(>ctor of the Russian units and Sister Helen Scott Hay was senior su[)ervisor. Dr. 156 HISTORY OF AMERICAN RED CROSS NURSING Phillip Newton, of Washington, D. C, was director of Unit H and Sister Lucy Minnigerode, one time superintendent of the City General Hospital, Savannah, Georgia, and later of Columbia Hospital for Women and Children, Washington, D. C, was supervising nurse. Dr. Edward Egbert, of Wash- ington, D. C, was director of Unit C and Sister Charlotte Burgess was supervising nurse. During November, the units set up an American Red Cross hospital in a wing of the Polytechnic Institute, which crowmed the crest of a hill just outside the city of Kief. On the first floor, they established administrative offices, pharmacy and living quarters. The second and third stories were utilized as operating and dressing rooms and as wards. In the basement, large rooms were given over to the reception of patients ; and an efficient system of baths, which awakened the interest of many other hospitals in Kief, was set into operation. All incoming patients received a bath, a haircut and a shave from the sanitars before they were, admitted to the wards upstairs. Seriously wounded and helpless cases were sponged off by the nurses in rooms adjoining the main baths. To transform this school into a hospital required not only equipment but genuine hard work. The rooms where the wards were established were large, with high ceilings and many win- dows ; the amount of scrubbing necessary was consequently great. On one occasion the Red Cross officer who purchased supplies for Kief, sighed when he saw Sister Helen Scott Hay's shopping list. "Holy fathers I"' he ejaculated, "I think that Sister Helen actually eats scrub brushes ! I've bought about all there are in Kief now !" In one of her letters to ]\Iiss Delano, Sister Helen told to what use these articles had been put: 'T wish you might have seen your Amerikaii Spii Cestriiza scrub ! Some say we have lost face thereby ; but w^iat our twenty-four nurses did to those dirt-littered wards is a poem in itself and a subject riaht worthy for epic or knighthood I" After a month spent in preparation, the hospital was formally opened in l)e('eml)er, l!i]4. The majority were sent up from the Austrian Front, tlie (^irpatlis, as they called it; Siberians, Great and Little Russians, Polos, Tartars, Eessarabians, Gruz- ins and Cossacks from the Don and from the Caucasus lay in the white cots and thanked the American Sisters for their ser- vices with simple, courteous, heartfelt expressions of gratitude. Sister Lucv ^Minnic^erode wrote: THE MERCY SHIP 157 They tell us stories of the war, hut never speak of their experiences as a hardsliip. One man described having been wounded at a place tiie soldiers call "the mountain of death." He lay among the bodies of his company on the field for five days, giving himself First Aid, before the firing lifted enough for anyone to bring him in. Another owed his life to a peasant woman, to whose shell-rifled hut he had crawled. A third was buried in a trench for dead, but managed in three days to dig himself out.^ The American Christmas, with its carols and tree, and thir- teen days later the Russian holiday, celebrated by a second tree and a vaudeville show for the patients, came and went in the busy routine of hospital life. The big Polytechnical Institute Hospital was operated under a nursing schedule of nine hours' day duty and ten hours' night duty, of two weeks duration for the American nurses, and ten days duration for the Russian Sisters. The coming of many visitors to the American Red Cross Hospital at Kief made necessary the same "dress parade nurs- ing" as at the Palais d'Hiver in Pau. A large medical school nearby sent its students in groups of twenty and thirty to see the work of the American surgeons and nurses. Visiting Army officers of high rank came to inspect the institution. One asked if the Sisters were good to their patients. A soldier replied : "i^ot good, double good !" A ranking general inquired how soldiers managed with nurses who could not speak their lan- guage. A big Cossack answered him : "What need to speak. Excellency ? They do everything for us without asking !" Sister Lucy wrote of the confidence with which the Russians regarded the Americans : The patients themselves were quick to realize the difference in the nursing service given them in tlie American and in the Russian hospitals. Xeitlier ])atient, sanitar nor Russian sis- ter would have been willing to return to the way of caring for the wounded to which they had been accustomed. Letters from ex-patients testify to their appreciation; to their willing- ness to hel]) as far as they were able; to tlieir patience under terrible sutTeriiig and after months of extreme liardship; to their unselfishness witli each other and tlieir gratitude for anv service rendered. ' "Kxppricnccs of Unit C at Kiet. Russia," Lucy Minniperode; Red Cross Dcpartnu'iit. American .Journal of Xursing. December, 101.5, Vol. XVI, p. 223. 158 HISTORY OF AMERICAN RED CROSS NURSING Of course^ many individual cases of special interest de- veloped. The top sergeant who had part of his jaw and all of his tongue shot away and who lingered between life and death for many weeks, finally recovered and remained in the hospital to teach others, wounded in like manner, how to feed themselves and to keep the mouth properly cleansed. The first blind soldier, who with the aid of his comrades' direc- tion learned his way about the hospital, taught others, blinded like himself, how to keep themselves and find their way about without assistance. Courage, endurance and a blind deter- mination to get well were potent aids toward recovery. The organization and personnel of the units underw^ent im- portant changes following the termination of the first six months of service. Dr. Magill had been relieved from duty, November 7, 1914, and the units had been without the guidance of a general medical director. A more satisfactory unity of command was secured upon the arrival in April, 1915, of Dr, H. H. Snively, of Columbus, Ohio, as senior director. Six of the original nursing staff had left Kief in March, 1915, to return to the United States and eleven relief nurses arrived with Dr. Snively. Further vital changes occurred in June. Sister Helen Scott Hay left J^iei on June 2 to investigate the school of nursing project in Bulgaria. Sister j\linnigerode with two other members of Unit C returned to the United States in June by way of the Pacific ; mines in the IsTorth Sea and sub- marine warfare endangered the shorter route. Sisters Char- lotte Burgess, Alma Foerster, Rachel Torrance and Alice Gil- bourne were transferred from Kief to the Serbian units. The remaining surgeons and nurses settled down to a summer of strenuous activity. Sister Mabel Rich became supervisor of Unit C, Sister Sophia Kiel, supervisor of Unit H. The hospi- tal was increased on the first of July from 400 to 500 beds. Tlie anticipated activities on tlie Polish Front did not take place, however, and the ominous lull gave opportunity for tlie tired surgeons and nurses in Kief to take welcome vacations. Of the accomplishment of the units at Kief, statistics show that the mortality rate of the American Bed Cross Hospital was three and seven tenths (3.7) per cent.^ During the nine months in which this hospital was maintained under American manage- ment, 4050 cases were admitted, 97f) major and 53,233 muior operations and dressings were performed. ' Ntjicricaii Red Cross Annual Report. 1015. p. 18.. THE MERCY SHIP 159 When the American Kcd Cross recalled its foreign units in October, 1915, the American family at Kief separated into small groups, each going its own way. Several of the surgeons and inirses returned to the United States. Dr. Phillip Newton took charge of a flying field hospital in the Ilussian Army. Dr. Snively, with Dr. Brown ]\[cClintic, Dr. T. Lyle Hazlett, Sophia Kiel, II. Lee Cromwell, Florence Farmer, Edwina Klee, Mary Hill, Aurel Baker, Margaret Pepper, Clara Bamdollar and Eleanor Soukup undertook service with the Russian Ked Cross. They were sent in Xovember, 1915, to establish a 200- bed hospital for Eussian soldiers at Khoi, Persia. In this an- cient city seventy-five miles from a railroad, with its narrow arched streets and its curious bazars where merchants, with long beards dyed red, squatted on rich carpets and cried their wares, the Americans set up a Red Cross hospital. Tiie build- ing they used was a low adobe structure in which camel drivers had housed their caravans. On February 12, 1916, the Ameri- cans left Khoi for Kasbin, Persia, where both a military and a Bed Cross hospital had been established. While here, Sister Eleanor had a rare opportunity to learn something of Persian customs : The Persian house was a mass of mud walls with a flat roof, built aroinid a (oni])ound aiul surrounded by a ten foot mud wall which excludes all view of the yard or harem. l]ntrance was through a strong wooden gate in the wall, always attended by a keeper. The patient was placed upon two narrow tables in a damp, cold room, and a Ca'sarean section performed in the midst of her entire family and a molla who prayed all the time. As tables, chairs aiul beds are not found in Persian homes, when the o])eration was over, the patient was put into a bed consisting of a narrow mattress laid upon the floor. Every family, whetlier rich or poor, possesses many exquisite rugs. Presuming that all water was brought from the well, I hadn't given this much thought, but one day when going to the house, 1 noticed at the small stream running through the middle of tlie street (scarcely wide enough for a team of horses), a woman wasliing clothes by beating them with a club ; further down a mother was bathing her child and yet further on a young girl cleaning the head of a sheep for some future meal. When I arrived at my destination, the servant was di])ping uji in an earthen urn water for cooking and drinking. Tliis shows how rapidly epidemics may spread, as we saw later when cliolera broke out. 160 HISTORY OF AMERICAN RED CROSS NURSING We had another patient, a Persian woman recently mar- ried, who had made an attempt at suicide by taking large doses of opium and strychnine. After several days she re- covered enough to tell us that her husband whipped her. She resented it very much. He, however, was present and said he beat his wives once a month whether they needed it or not just to show them their place. He divorced her the next day by commanding her to go away with her dowry.* Again on March 24, the Americans moved, this time to a hos- pital established in a carpet factory in Hamadan. A special detachment, consisting of Dr. McClintic, Eleanor Soukup and a Russian Sister, started in April to Kermanshah for surgical work at the front, but the advance of the fierce Kurds in June drove them back, after many adventures, to Kasbin. The fur- ther record of the work of these Amerikanskii Cestritza in the Persian desert, colorful, vivid, full of the swift dangers and sufferings of guerrilla warfare, became no longer that of an American Red Cross unit, but was merged into the record of splendid achievement of the many men and women who carried on individually their service for the wounded in the European War. The smoky city of Gleiwitz, situated in the wealthy province of Silesia, that thick finger of Prussia which extends southward between Austria and Russia, was the destination of Unit I. Unit G, the second of the two detachments assigned to Germany, was destined for nearby Kosel. The Red Cross Relief Expedition of 1914, it will be remem- bered, was comprised of ten units, two of which had been assigned to each of the five belligerent nations. The detach- ments destined for England and Russia had left the Mercy Ship at Falmouth. Erom the decks of the S. S. Bed Cross as she lay in the yellow waters of the Gironde River, France, the units destined for Germany and Austria watched the surgeons and nurses disembark for Pau, Franco. So, with four remain- ing units, the Bed Cross weighed anchor October 4 for Rotter- dam, her final port of entry. At last the Mercy Ship steamed up the ^laas River, through level Holland fields. The Ameri- can nurses as they leaned along the rail, exclaimed with pleasure at the pictures(]_ue scene, the windmills and the children who clattered along the banks in their wooden shoes pointing with delight to the great Red (h-oss on the ship's white sides. * "Witli llic Uussiatis ill Persia," Mlcaiuir Soukup MfCIiutic, American J(/Hrn unit. 162 HISTORY OF AMERICAN RED CROSS NURSING Unit I went on duty October 18. Dr. Charles H. Sanders, of Calvert, Texas, was director and Sister Anna L. Reutinger, formerly Directress of Nurses, Lying-in Hospital, New York City, was supervisor. Sister Donna Bnrgar described her im- pressions of that first morning in the wards : The theater was a living picture of the tragedy of war. The stage, the boxes and the galleries were there just as you would see them in any theater at any time, but there were no chairs nor seats for patrons. In their places stood low slatted iron beds covered with straw ticks, a single straw pillow and a bhie checked bed cover. Nearby stood plain pine tables, one for every two beds, in which the last bare necessities of main- taining life of man were kept; the dark bread, the daily al- lowance of butter, the knife, fork, spoon, tobacco, soap, pocket- comb and an occasional toothbrush and always a much worn picture of the wife, the children or sweetheart. . . . If we did not see orchestra chairs, neither did we see the ordinary theater-goers, dressed comfortably and well, intent on pleasure, with laughter in their faces and joy in their voices. In their place we saw many weary soldiers in worn, mud- stained, torn uniforms, with dark dried blood stains telling the tale of wounds of hours and days before.^ Within a few days Unit I had an opportunity to witness the remarkably swift and thorough '^turn-over" of patients which characterized the entire German sanitary service. Sister Anna Reutinger described it: A few days after our arrival an order came at 8 A. M, to prepare sixty-five patients for discharge in two hours. Within an hour after their departure, we admitted sixty-eight new stretcher cases. The arrival of a transport of seriously wounded is an indescribable scene. Their bloodless and haggard faces reflected the agony they were suffering. Woujuled five days previously in a battle many miles from the railroad, their first conveyances Avere springless farm wagons and crude home-made carts. In these they traveled twenty- four hours, without food or drink and were then packed in freigln cars with little straw to lie upon, getting no sleep and a limited amount of food. Their dressings, not changed during four days, were stiff and foul. One of our patients had Ijcen lifted from the l)attlefield, placed with three others in a wagon, jolted ovit rougli roads all night long. He dis- '^"Tn f;iei\\itz.'' Donna G. liurgar, A?ncrican Journal of yursinr], Vol. XV, p. I0!)4. THE MERCY SHIP 1G3 covcrefl at dawn tliat his comrade liad pas,scd away in the darkness, probably rroni hemorrhages and exhaustion. They hiy on tiie hard floor of the foyer, since they could not l)e taken into the wards until the vermin-covered uni- forms and boots were removed those sad-looking uniforms, a few days before so spotless and clean, now mud-caked, bullet- pierced and blood-stained, with here and there an arm or leg missing. On arrival they received a cup of hot coffee and a sandwich. The uniforms were put into bags and sent to the garrison hospital for fumigation. The boots, helmets, belts and knapsacks were kept in separate bags. Often the sol- diers' feet were so swollen it was necessary to cut the boots to remove them. Baths were given in bed since we were han- dicapped by having no bath tub or available place to install one. Fortunately whenever largo transports arrived, the neighbors brought in buckets of hot water and in such cir- cumstances they were of great value. The first consignment of men had worn their uniforms eight weeks without once removing them. At the end of their second week in Gleiwitz in addition to their duties at the Vikloria Theater^ Unit I was phiced in charge of two private Kliniken. These annexes each accommo- dated twenty-five officer patients and were luxuriously equipped and furnished. The twelve American nurses were distributed so that one day and one night nurse w^as always on duty in each KJiiiik. They were assisted by young German women of good family, II el fv rumen, who also acted as interpreters. The system of volunteers worked well in Germany ; because of the strict military discipline, an order given in a military estab- lishment was obeyed in every detail. Under an American graduate nurse's constant supervision, the wounded received excellent care in the face of many emergencies. "Always hem- orrhages!'' wrote Sister Anna. Gleiwitz was an important military center. Sister Anna told of the shifting movements of the Kussian and German armies : At one time tlio "Russians were supposed to be within thirty miles of (ilciwitz. Their guns were heard all night. ^leu and boys from fourteen to twenty-one were ordered to the interior. Accompanied })y sorrowing mothers they marched to the station, each allowed to carry nothing but a small pack- age. The atmosphere was tense with anxiety and ai)prehension marked c\ery feature, \either letter, teh^gram. t<'lc})lu)ne nor 164 HISTORY OF AMERICAN RED CROSS NURSING person was permitted to leave the city for seven days. We were notified to be prepared to depart within an hour's warn- ing. Gloom and fear had seized the people. The troop trains were now moving at fifteen minute intervals. They con- tinued to pass for five days and nights, two million men, with big and small guns, horses, supplies and all that go to make up an army transferred from West to East. At this time Austrian-Hungarian soldiers appeared before homes at mid- niglit, begging for lodging. Twelve applied at a private clinic that had been turned over to us and the poor fellows, fagged and footsore, dropped on the cellar floor, the only vacant spot, and were sound asleep before we could bring them straw to lie upon. The Germans were again driving the Russians back; and again the freshly wounded were poured into the city. Gleiwitz being a garrison town our attention was frequently directed to squadrons of Uhlans leaving for the front, in full war equipment with splendid mounts and uniforms, their banners unfurled and decorated with roses, the mounted bands on dappled greys. They were magnificient bodies of men, full of buoyancy^ patriotism and eagerness for the fray. What a contrast to the unfortunates who returned to us wounded, vermin-covered, helpless, crippled and maimed for life, with faces paled and pinched from loss of blood and with hands and feet frozen, arms and legs missing, eyes shot out, bones crushed, muscles, tendons and nerves torn, all heaping pain and agony upon the sufferer ! Sister Anna made brief comment upon the mental attitude in which the patients arrived : Their lingering death and bodily injuries can be moderated to some extent, but what about scars of a soul seared or brutal- ized by this awful lust of blood I I cite one of many similar histories of a young university student, twenty-two years of age. 1 discovered him sitting alone and apart on several oc- casions in an apparently melancholy mood. He told me finally tliat he had bayoneted a Kussian in a charge attack: "It was either he or I and I regret exceedingly that he did not get me. 1 still feel my bayonet going through him. I will never knowingly kill again." The American nurses described their wounded as strong, clean, healthy men, patient, courageous, frugal and childishly appreciative. Four nurses sailed in February, 1915, from Xcw York to relieve members of Unit I, who wished to return to the United THE MERCY SHIP 165 States at the end of their six months' service. The war zone was then full of danger; one of the relief nurses, Edith Wood, described her passage in the following letter to Miss Delano: The accident to the S. S. Touridne furnished us with ex- citement for two (lays. Of the fourteen vessels receiving her S. 0. S. we were tlie first to reach her, turning l)ack in a dense fog eighty miles from our course. Our captain liad to reduce speed one-half to allow Jai Tonraine in her crippled condi- tion, to crawl slowly behind us. Sunday afternoon, two French cruisers, called by wireless, came up, swung about and one before and after, escorted our charge away toward Le Havre. We congratulated ourselves that we were not on a burning shij> carrying 400,000 rounds of cartridges and in momentary danger from German torpedo boats ! All night long we have lain at anchor in Dover. Torpedo boats and destroyers patrol up and down near us, and gray- hulled battleships slip in and out through the fog. Our life boats have been swung clear on the davits, from the time of our entrance in Channel waters. The Rotiercknn has her name in three great rows one below the other on each side, in large letters about four feet square, composed of electric lights. As we moved out toward the North iSea this morning, the wreck of a liner drifted past us. Upon their arrival at Gleiwitz in March, the four new nurses found that Unit I was in sore need of reenforcements. From tlie Viktoria Theater, the American Ked Cross Flospital had been moved to a concert house nearby, which accommodated 140 beds, an increase of sixty beds over the capacity of the theater-hospital. Unit I retained, moreover, the two Kliniken. Sister Anna was extremely loath, in view of the pressure of work, to allow two of the four new nurses to go on to Kosel, but they were needed equally and had to go there. Although Sister Anna's letters to Miss Delano were persist- ently cheerful, the Gleiwitz L'nit was not without its difficulties. One hundred and seventy-three beds, always full, taxed the strength of eleven nurses. The ten hours' duty and the lack of a common languagx^ and of recreational facilities made the ser- vice more severe. The presence of the llelferinnen in the wards further complicated nuitters. Sister Anna wrote : The first duty of our (Jerman If cifprinnen is to write anon of the entire military hospital. Dr. II. H. Xewnum, of Knoxville, Tennessee, was made general operator. Within a few weeks of their ar- rival, a station of jifty beds was ojiened in a public school near- THE MERCY SHIP 167 by and assigned to 13r. John Lancer, of New York, thereby making a total of 1.'30 bods to be cared for by Unit G. Sister Frances H. ^leyer, of the New York City Hospital, was super- visor of Unit G. A German Ked Cross sister was assigned to the American Ked Cross Lazaret to interpret for the surgeons and to record histories. The even tenor of their days at Kosel was interrupted on January 7, 1915, when Dr. Bradbury was called home by the critical illness of his wife. Four nurses returned to the United States at the termination of their six months' duty, March 3. As the Garrison Lazaret was transformed in ^larch into a central operating station for Kosel and as all major cases remained five or six days under the care of the Americans be- fore they were returned to their own wards, the work was heavy for the nine remaining nurses. Dr. Gilbert A. Bailey, of Chi- cago, appointed to succeed Dr. Bradbury, arrived in Kosel March 12 with one relief nurse, Sister Caroline Bauer. Dr. Xewman succeeded Dr. Bailey as director on April 22. Two relief nurses destined for Kosel sailed in July on the S. S. Noordan. With them was the first Harvard Unit of inO surgeons and nurses, which has been assigned independently of th? American Bed Cross for service under the British Expeditionary Forces. To these two nurses, after days of danger in the war zone, the Noordam with her life-boats swung out above huge electric letters which proclaimed her neutrality to German submarines, the quaint town of Kosel, set among fields of waving grain, seemed peaceful indeed. When the Garrison Laznnd, was closed on September 15, 1015, 750 cases had been treated to a conclusion and 275 major operations p(>rformed. Only a few of the surgeons and nurses returned to the Uuited States. Drs. Xewman and Lien with Sister Frances and seven of her unit joined Dr. Snoddy's group in Berlin for duty among German prisoners in Moscow and Siberia. Unit K of the S. S. lied Cross arrived on October 14, 1014, in Vienna, Austria, tli(> gayest capital city of Europe, to estab- lish Beservc Hospital Xo. S for Austria's wounded and were assigned to a brick and stucco school building in the Johann- Hoifmann Platz. Here they set up a military hospital of 400 beds, splendidly eciuipped through the generosity of the Aus- trian Bed (^ross. Dr. Gary A. Snoddy, of Knoxville, Tennessee, was director. Three American surgeons, Dr. Fred G. IJenton, 168 HISTORY OF AMERICAN RED CROSS NURSING of Owego, ^ew York, Dr. Walcott Denison, of St. Louis, and Dr. P. A. Smithe, of Enid, Oklahoma, composed his staff. Sister Lyda W. Anderson, of the Illinois Training School of I^ursing, Chicago, was supervisor of nurses. Wounded soldiers coming by train from the front were received in the school gymnasium, which had been equipped with beds, benches, bathtubs, showers, diet kitchen, dressing room and steam sterilizer. Dr. Snoddy described to Major Patterson the arrival of a transport: Ambulances drive to the door of the receiving department, which is capable of handling thirty bed and seventy sitting patients at one time. Here hot nourishment, stimulants and medical attendance are given immediately. The spectacle is one of suffering, exhaustion, discouragement and filth. Xext to the physiciaii and dietitian in the receiving line is the barber, and then the chemist comes with his lice-killing applications. The bath stewards are ready with tubs for the sitting patients and tables for the prone cases. The record writer is busy. Surgeons and nurses stand by in three operat- ing rooms, one for aseptic cases and two for septic. The ward nurses are at their posts with beds prepared. Patients are handled at the average rate of twelve per hour. The American Red Cross hospital needed efficient organiza- tion and high professional skill as its work was subject to con- stant comparison with the best organized clinics of Europe, such as that of Eiselberg in Vienna and DoUinger in Budapest. Sister Lyda's report of November 24 to Miss Delano bore testimony to the ease with which the Americans cared for the wounded : This afternoon we are enjoying a little lull after a heavy night and morning's work. We received a message yesterday noon that a transport would arrive at nine P. M. today. They did not come until midnight, but we had them bathed and their wounds dressed by three o'clock this morning. This is our third transport, about ninety wounded in all. They ba\e not Ijeen severe cases, but all filthy with dirt and vermin. Many have not had their clothes off for weeks, nor have they even had their faces washed. It is the greatest gratification to see them in their com- fortable br'(]s I Though scrubbing from thirty to sixty men makes us feel we liave really done something, the work so far has not been so strenuous but that we have been able to do it thoroughly. Good and generous equipment makes the work THE MERCY SHIP 169 convenient and comfortable. We no doubt have harder days in store for us. Our f^reatest difficulty lies in compromising on methods and in adjusting ourselves to military regulations. Home-sickness was a potent foe with which all the nnits had to combat. "Like cool water to the thirsty, is the sound of his mother tongue to a man in a far country." Few of the nurses spoke German, however, and Sister Lyda urged the members of her unit to meet with tact and diplomacy situations that con- stantly arose because of the lack of a common language. Al- though they were not in sympathy with the extremely practical and systematic habits of the American graduate nurse as op- posed to the more sentimental point of view which Europeans entertained toward the care of their wounded soldiers, two Viennese volunteers of high social standing gave much time and energy towards making the Americans comfortable. They succeeded well. "Our meals are late and long but very good indeed," wrote Sister Lyda to Miss Delano, ''Personally I like the life here in Europe, though to be sure it is abnormal now. Wien is not the happy city I visited several years ago. It is in sack-cloth and ashes. They are beginning to resume their gayety to a small degree. The Royal Opera and the con- cert halls are open again." Sister Lyda's description of the bread lines alone, served as an index to conditions: The husbandry of foodstuffs was more carefully considered as time went on. Bread was issued at bakeries, restaurants and hotels only upon presentation of bread tickets. These cards allowed one a week's supply. Flour was obtained in the same way. This law was rigidly enforced. On Tuesdays and Fridays jio meat could be purchased. Cream could not be taken from the milk. Peasants harl)oriiig their crop of meal were all required to give it in to the general su])ply for com- mon distribution. Bread lines formed, extending the whole length of the block, forenoons and afternoons, at the several hundred stations in the city, people waiting hours for their allotment of bread. This was a heavy, black bread made from potato flour princii)ally, and could be prepared so as to i)e quite ])alatable. l)ut when made very cheaply, was heavy, black and soggy. Foodstuffs had more than trebled in price during our year in Vienna. Sup])lies of all kimls, so much wanted last winter, will 1)e much more needed this winter. Some months back they issued a call ill Vienna for all the old linen to be used, when fraved into ravelings, as a substitute for absorbent cotton. House- 170 HISTORY OF AMERICAN RED CROSS NURSING wives were required to give up all copper and brass utensils to be melted and sent to ammunition factories. Some splendid heirlooms, beautiful Russian samovars and oriental urns were sacrificed. An especially designed iron finger ring worn by anyone signified that this person had thrown a jewel into the coffer and accepted this war decoration instead." One year later, horse-flesh was selling in Vienna at fifty-six cents a pound ! Dr. Snoddy gave Major Patterson an interesting analysis of the effectiveness of projectiles as shown by the first thousand cases which came to Reserve-Spital No. 8. He judged that the high velocity rifie bullet was the most destructive from hand weapons. Distinguishing features of the German, Austrian and Serbian bullets were lead cores, ogival heads and flat tra- jectories which deformed easily. The Russian bullet, conical- pointed and of smaller calibre, was generally less harmful. The French bullet, large in size, of solid brass with high penetrating power, did not easily deform. Shrapnel shells were by far the most effective of projectiles from artillery. The octagonal iron balls used in French shrapnel were more destruc- tive than the lead or alloy balls of the other nations. German bombs fired at short range from mortar guns threw many frag- ments of shell when exploding and literally swept the enemy down.'^ The American nurses found the German-speaking Austrian soldier particularly appreciative, quiet and obedient. Sister Lyda wTote : The Austrian soldier accepts the war submissively, as the inevitable, lu^ver questioning for what he is fighting, or whether the sacrifice of his precious life is adding to the glory of bis country or is fulfilling anything of value to the world. Seeing troop after troop of the best men of the coun- try, as fine as tlie world has to offer, talented men often of great minds, inarching out daily, few to return and these few maimed and useless citizens, one wonders that it did not stir anarchistic feelings. '^ " "Kxpcricufcs nf I'liit K at Vienna. Austria," a paper read by Lyda W. Anderson at the I'^leventli Annual Meeting of tlie American Red Cross, ]:)cceinl)er 8. im.'). ' "N1, fourtecui (lays after the arrival of the unit, " Piipcr read hy Lyda Anderson before tlie American lied Cross Annual Meetiii.Lj, I'.ll"). THE MERCY SHIP 173 Dr. Charles MacDonald, of Salem, New Jersey, director, and Sister Alice Beatle, of Cleveland, Ohio, supervisor, opened the doors of the American Red Cross Hospital. The iirst assifrn- ment of patients was made up of soldiers desperately wounded during the Austrian drive on Belgrade. It is significant of the neutrality of the lied C^ross that its units should bind up the wounds of both Hungary and Serbia in the capitals of these countries that were fighting each other. Within ten days. Unit K had received K^f) stretcher cases. Sister Katrina Hertzer described the condition in which the patients arrived : Serbs, All)anians, Hungarians, Croatians, Austrians, Monte- negrins and Russians began tlieir long journey from the front on stretchers, ox-carts and hay wagons to the nearest rail- road, where hospital trains brought them filthy, hungry, ex- hausted to us. Many of them had their faces blown away ; pus flowed down their chests and on tiie beautiful new Ked Cross blankets. As they arrived with their first dressings still on their wounds after fifteen days' travel, it was ahuost impossible to protect the beds. We dressed many cases three and four times a day. Hideous mutilation was the rule, not the exception. It was a frightful thing to take off foul dressings and see below the shattered, yellow flesh, the labored inspiration and ex- piration of the exposed lung. The thought of what pain these men were suffering used to sicken me. Baron Armin Popper, General Staff, was military com- mander of the Hcd Cross Hospital at Budapest. ]\Iany former American citizens residing in the city opened their houses to the members of Unit E. Countess Sigray, the daughter of Marcus Daly, of X(>w York, and Countess Zichy, formerly Miss Mabel Wright of Boston, took a keen interest in their com- patriots' work. (V)untess Szechenyi, nee Cxladys Vandcu'bilt, presented Unit E with a beautifully complete X-ray apparatus. Dr. Ilertzog, military conmiander of the Buda])est hospitals, often made rounds with his staff at No. 4. Professor -lulius Dollinger invited the surgeons and Sister Alice to attend his famous clinics. Between the lines of Sister Alice's small leather diary ap- peared a brief story of tlu^ first month's work: O(tol)or .'')(). 1!11 I Supplies arriving all day were li>te(l and put in ])lace. ^lany gifts from peasants n'ccived. 174 HISTORY OF AMERICAN RED CROSS NURSING October 31 Hospital turned over to American Red Cross by II err Ober.stubsarzt Hertzog; forty-two wounded soldiers arrived. November 4 Nurses dressed cases until 2 A. M.; two leg amputations. Archduchess called again. November 10 Twelve patients from Galicia, badly frozen; heavy work. November 11 Nurses had cholera vaccine. November 13 Twenty-two wounded from Serbian Border 141 patients in all. November 24 Professors from University visited us. Novemljer 25 Fortress Przemyzl in Poland has fallen ! November 28 Twelve patients admitted; 172 in hospital. November 2ii Mrs. Gerard from Berlin visited us. December 1 Eighteen Budapest hospitals quarantined be- cause of typhus. The work proved absorbingly interesting. Sister Alice wrote of the different nationalities which sifted through the American Hospital : ^loravians, Slovaks, Dalmatians, Magyars, Germans, Euth- enians, Poles, Poumanians, Italians, Croatians, Helvetians, Turks, Serbs and Pussians come to us, and somehow we man- age to find out their wants and make them comfortable; Quite frequently we find a man who speaks English. A few days ago I said to a new arrival: "And so you speak English, do you?" "Well, jus' toPable, Miss." The Huiigarians take excellent care of all wounded they receive and are very clever at improvising hospitals in school- houses, theaters, the Stock Exchange, art galleries, ware- houses, private homes, clubs and sub-stations of banks. The women do a tremendous amount of work here, of a type never essayed before. The wives and children of soldiers must be cared for; places must be provided for the blind and crippled whose asylums are now being used for hospitals, and em[)l()ynient must be found for thousands. This requires genuine organizing ability. The longer \ stay here tlie more deeply am I impressed with the fact that the women who undertake foreign service for the American Pe(| Crcjss must be fine women before they are good nurses. Their work does not count for nearly as much as does their g(,'neral bearing and conduct, both in and out of the liospital. Although th(; lueuibers of the Budapest Unit were far re- moved from National Jleadcpiai'ters they were in an excellent THE MERCY SHIP 175 position to receive wisps of information regarding the other American Red Cross personnel. Sister Lyda from nearby Wien wrote of the interesting work accomplished at Gleiwitz and Kosel. Sister Helen Scott Hay, writing from Kief, as- sured Sister Alice that the Russian soldiers were quite the nicest patients she had ever seen. A New York newspaper woman brought tragic word of Serbia. Political jealousy, intrigue and cunning ran high in the Hungarian capital. ^'Small won- der," wrote Sister Alice, "that they term Budapest the whirl- pool of modern Europe." During the early spring of 1915, the city became a maelstrom through which gray hordes streamed down to the Carpathian and Italian frontiers. Sister Alice wrote on March 11 to Miss Delano: You have read in the papers about the movement of Ger- man troops to Galicia, Serbia and Transylvania? Those mil- lions of men keep marching past our hospital, week in and week out. Troop trains constantly go by night and day, loaded with soldiers and ammunition. Army wagons, am- bulances, artillery, automobiles, ox-carts and aeroplanes form a never-ending procession. All types of vehicles from an imperial coupe to a Fifth Avenue motor bus are used. The German soldiers are always singing. At almost any hour of the night when one awakens, we can hear "Die Wacht am Ehein" or "]\[orgenroth." As they swing past our hos- pital in the daytime the infantry smartly salute the Stars and Stripes above their heads. Hot summer months brought no cessation of work to Unit E. Sister Alice's letters referred repeatedly to the unselfish help- fulness of the wounded. When it became evident that he could not recover, a critically ill soldier was removed in July to a hospital nearer his home. His comrade in the next bed, who had helped care for him constantly, came to Sister Alice the next day and asked if his cot might not be placed by the side of some other very sick patient. "Die Schwestcrn have taught me how to be gentle," he said, "and I would help." When the American flag and the Red Cross banner were lowered for the last time, September 20, 1915, the Red Cross hospital closed its doors with a record of 1543 cases and 813 major operations. The death rate was less than one and one- half per cent of the total admissions. Dr. Crookston, Dr. Met- calf and Dr. IMiller, with eleven nurses, joined Dr. Snoddy's unit for service among (i(M'man prisoners. 176 HISTORY OF AMERICAN RED CROSS NURSING When the American Red Cross had offered its ten relief units in August, 1914, to the belligerents of the European War, the detachment of twelve nurses and three surgeons destined for duty in Serbia, had not been sent upon the S. S. Red Cross, because of the expense that would have attached to an extended trip of the vessel down through the Mediterranean for just these fifteen. Thus a dingy merchant vessel instead of the white Mercy Ship brought Unit ]^o. 1 to Saloniki for its destination further north, at the time the first overwhelming tide of- suffer- ing and disease incident to the Serbs' gallant part in the war rushed across the sunny agricultural lands of the little Balkan principality. The Serbian people had always been a nation of farmer- soldiers. Pride in ownership of field and cattle-herd had bred a fierce national love of independence. Manual toil, shared alike by rich and poor, had developed a fine, upstanding democ- racy. The people had clung desperately through years of in- ternal and external warfare to the hope of a great Jugo-Slavic kingdom. Since the dawn of European history, the Balkan peninsula had constituted the natural trade-gates to the East and its control had been the goal of ambitious world-powers since the days of Alexander the Great. Exhausted by two previous wars, Serbia chose to submit to the terms of Austria's ultimatum of July 23, 1914, rather than to endure her power- ful neighbor's "punitive expedition." But in spite of Serbia's humble agreement to eight of the ten Austrian demands, Aus- tria declared war July 28 on the seemingly defenseless little kingdom to the south. History records the resultant action of Russia, Germany, France, Great Britain, Italy and the United States. Serbia swiftly mobilized her five million population. An heroic band of !)00 medical men marched away with the new Army. Serbia had only one doctor for every 5500 of her sturdy peasant-soldiers. The government immediately accepted the offers of sanitary assistance which were extended her by the Red Cross societies of several then neutral nations. Among these contingents of surgeons and nurses was the American Red Cross Serbian Unit Xo. 1, of which Dr. Edward W. Ryan, of Scranton, Pennsylvania, was director and ^lary E. Gladwin was supervising nurse. Miss Gladwin's share ill Red Cross nursing in the Spanish- American War has already been mentioned. She was graduated from the Boston City THE MERCY SHIP 111 Hospital, was in turn superintendent of nurses of the Woman's Hospital, New York City ; of the City Hospital, Cleveland, Ohio; and of the Akron (Ohio) Visiting Nurses' Association. At a Japanese base hospital during the Russo-Japanese War, she had received experience in the lonely, monotonous, ex- hausting school of war nursing. As chief nurse, she had di- rected the relief work of many American Red Cross nurses during the Dayton flood. Upon the arrival of Unit No. 1 at Nish, Crown Prince Alex- ander asked the Americans if they were willing to report to the Military Hospital at Belgrade. The Austrians were at that time bombarding the city. Unit No. 1 accepted the chal- lenge with alacrity and on October 15, 1914, took over this excellently equipped institution, then filled with wounded Serbs. The Military Hospital at Belgrade consisted of nine modern stone pavilions, erected in 11)07 by the military authorities. The main building had two wings in which were two large operating-rooms, a laboratory, a main office and four wards of fifty beds each constructed according to modem standards with white-tiled floors and ample windows. Adjacent to the main building were medical and surgical pavilions of one hundred beds each. Nearby were the administration building, the kitchen, laundry, chapel and morgue. A magazine and trenches plainly visible from the windows of one pavilion brought home to the Americans their closeness to war. Grave difficulties confronted this unit of three American surgeons and twelve nurses. During the first seventeen days of heroic house cleaning, they cared for approximately one thousand lightly wounded Serbs. Dr. Ryan's responsibilities were greatly increased by his appointment on November 25 to the general directorship of the military and civil hospitals in the entire city. His and Miss Gladwin's professional and ad- ministrative duties were further complicated by the fact that they could connnunicate with National Headquarters, Wash- ington, D. C, only through the already overtaxed cables of the State Department. ]\redical supplies could not be obtained in Belgrade. Food for the patients was unsuitable and inade- quate. Overhead sliri(>ked the Austrian shells. ]\Iiss Gladwin described the bombardment of th(^ city: There was no time during the first six months that some of the guns were not lired. My room was a little white-washed 178 HISTORY OF AMERICAN RED CROSS NURSING one. Every time one of the big French guns would fire, for example, it would show the flash on my wall. It would illuminate the wall and then, in a second or two, I would hear the boom of the guns. That kept up night after night.^^ At two o'clock on the morning of November 30, the Serbian authorities notified Dr. Ryan that they were evacuating Bel- grade because their supply of ammunition was almost exhausted. They left one hundred of their seriously wounded in his care. Of the taking of the city, Dr. Ryan wrote Major Patterson: Xo authorities were left. As there were many robbers about, stores were looted. . . . Many people were being held up in broad daylight and it was necessary to do something for the poor who had no food. As we had not enough for the patients at the liospitals, I sent men into the country to bring in all the food they could lay their hands upon. But before their return the Austrians arrived and forty-eight hours after the first troops, their wounded. We worked day and night until w^e could no longer con- tinue. We had wounded men everywhere. Starting at six o'clock in the morning we would dress wounds all day. About nine o'clock at night we would start to operate and work until five or six in the morning. Many nights we got no sleep and never more than three hours. Halls, floors of wards and every place a man could fit in, we had filled. We had in this hospital for several days three thousand wounded and one day we had nine thousand in the grounds. I was then force;! to beg the Austrian officials to send some of them to the hospitals in Hungary. During the Austrian occupation, the American Red Cross furnished food, coal and wood to all the hospitals in Belgrade and supplied six thousand loaves of bread daily for the poor. Soup, a little meat, a few beans, and an allowance of two hundred and fifty grams of bread, comprised the rations for patients and staff of the ^Military Hospital. An insupportable burden of work confronted the nurses. The Austrians brought hundreds of cases of frozen hands and feet, dysentery, recurr(>nt fever, typhus and typhoid to the American Red Cross Hospital. Other patients suffered from every type of rifle, shrapnel, grenade and bomb wound. Ox-carts and hay '"Paper read by ^liss Glarlwin before the Nineteenth Annual Convention of the American Nurses' Association held at New Orleans. La.. 101(5; later published in the American Journal of Nursing, June, 1916, Vol. XVI, page Of)."). THE MERCY SHIP 179 wagons had transported some of the patients, often without even First Aid dressings on their wounds, from remote moun- tain towns. Gangrene set in and the exhausted nurses, on their slow rounds to minister to those who possessed at least a fighting chance for life, had to pass by the doomed men. Miss Gladwin wrote of the pitiful cries of the dying : There was a Avard next to mine, with a door leading directly into it. I could hear every sound in it and I used to tumble into bed at two or three o'clock in the morning and hear those men in the ward. They begged and prayed in all languages for help. They swore, they tore their bandages and the nights when I got up (it took all my strength of mind to stay in bed), I knew exactly what I would find when I went in, the men in their agony tearing off the dressings, the dark streams of blood on the floor. ^^ In the meantime the Serbs had received a fresh supply of ammunition from the French. They rallied and advanced on the too-confident Austrians with a fury which drove them com- pletely out of Serbia. The order to evacuate Belgrade came as quickly to the Austrians as to the Serbs. Cannon began to thunder afar during the early dawn of December 13. At 'eleven o'clock, Serbian and French heavy artillery had found the range and were pounding the slopes of the city. Dr. Ryan wrote : By one o'clock, the battle was raging on the outskirts. At dark, shells were bursting everywhere. The streets were jammed with cannon, soldiers, supply wagons and horses going toward the bridges that would take them across the Danube and Save rivers to safety. Tliey continued the retreat until the next morning, when the Serbians destroyed the bridges, leaving those who had not gotten across, as pris- oners on this side. About five hundred Austrian wounded were left in our care. The following days brought lighter work to the big military hospital. The care of the Serbian wounded was not so heavy. ''The work has been indescribably hard," wrote Miss Gladwin to ]\liss Delano, "but it has grown nuich lighter during the last two weeks, "^riie nurs(>s are becoming a little rested, in readi- ness for the ]S'(\xt Thing, whatever that may be." The Xext Thing was typhus. Hordes of refugees pouring " Paper reiXfl 1)v Miss (Jladwin l)oforc the Xinctpoiith Annual Convention of tlip AnuTioan Nurses' Association lield at New Orleans. La., initi; later published in the Amrricnn Journnl of Xursincf. June. 1916, Vol. XVI, page 90."). 180 HISTORY OF AMERICAN RED CROSS NURSING down from the frontiers, a shortage of adequate food and the total dearth of Serbian doctors and nurses favored the con- tagion until it swept the little principality, A graduate of Roosevelt Hospital, then in Nish, wired l^ational Headquar- ters: "Tvphus raging throughout country. Mortality high. Cholera feared later. Help urgently needed, especially doctors, nurses with hospital isolation equipment, disinfectors for typhus clothing." ]\lr. Bicknell, National Director of the American Red Cross, then in Europe with the Rockefeller Com- mission, cabled : "Typhus overshadows everything else." Dr. Ryan's report for February gave fuller details : During the month we added to our number about 800 patients, totaling 1850 in all. Typhus has overrun Serbia. In Nish alone there are one hundred deaths a day and I believe at least fifty a day here, though Belgrade is better off from a sanitary standpoint, than any city in Serbia. Typhoid claims its share. Many die also from relapsing fever. There are always shells passing over us, as the Aus- triaus retaliate on Belgrade the French fire on the City of Semlin across the river, now exceedingly high. This pre- cludes the possibility of military action for some time to come. Fortunately it will give us a chance to try to get rid of the typhus upon us. Until April, 1915, at the height of the typhus epidemic, Unit 1 had worked entirely alone as the only group of American surgeons and nurses in northern Serbia, but circumstances out- lined below then drew to them members of two other American Red Cross units which had previously been assigTied to duty on the southern frontier at Gevgeli. During the autumn of 1914, following the success of Unit Xo. 1, the Serbian Government had requested Xational Red Cross Headquarters to send addi- tional surgeons and nurses to assist them in caring for their sick and wounded. In response, two units had been sent to Serbia in Decomber, 1914, and had been assigned to a large military hospital and prison camp at Gevgeli, fifty miles inland from the Greek border. Dr. Ethan Flagg Butler, of Washing- ton, I). C, was director of Serbian Unit No. 2; Dr. Ernest Pendleton Alagrnder, of the same city, was director of Serbian Unit No. 3; ]\lathil(le Krueger, of Detroit. Michigan, was super- visor of the twelve nurses who comprised the nursing staff of the two units. A detailed account of their struggles at Gevgeli will follow. THE MERCY SHIP 181 While Dr. Ryan and liis associates were endeavoring to check the spread of the; typhus epidemic in Belgrade, word came dnring the last davo of February, 1915, to the American consul at Nish that tlu? majority of the members of Units A'o. 2 and 3 had been infected with typhus at Gevgeli. He im- mediately communicated with Dr. Kyan and with National Red Cross Headipiarters. JMajor Patterson cabled Dr. Kirby- Smith at Pan to send one surgeon and three nurses of t-he French units to the aid of the stricken Americans, and in- structed Dr. Ryan to investigate immediately the situation at Gevgeli, Upon his arrival there, Dr. Ryan found that only four nurses of the staff of twelve and two doctors of the original number of six had escaped infection. These six Americans still on duty were, however, taking good care of their own sick. Dr. Ryan suggested that Units 2 and 3 withdraw from Gevgeli to Saloniki as soon as the health of the patients permitted. He then on March 3 returned to l>elgrade and resumed his efforts to combat the typhus which was becoming epidemic in Belgrade. For the next three weeks. Dr. Ryan was the only American surgeon in the big Military Hospital. His two assistants had returned to the United States, March 3, in company w'ith three nurses of Unit i^o. 1 whose strength had not been equal to the strain of the Austrian occupation. The depleted unit tried gal- lantly to meet its responsibilities. ''Life is rather monotonous," Miss Gladwin wrote Miss Delano, "we go nowhere and sec few people, but we get along surprisingly well. I am as usual well," she continued, ''a little thin perhaps and acquiring gray hairs steadily, but happy and content to be in Serbia and glad to have escaped the fuss, feathers and festivities which seem to have overtaken some of our units." In the m(>antini('. Dr. Kirbv-Sniith and the nurses from Pan had arrived at Saloniki and there luul found several convales- cent members of Serbian Units No. 2 and 3. Leaving the nurses there, he had then gone on to Gevgeli and found that the patients were })rogi-essing well there and that the remaining members of Units No. 2 and 3 wonld be able within a few days to withdraw entirely from that ill-fated Serbian hospital camp. He and Dr. Butler then ])roeeeded to In-lgrade to consult Dr. Ryan regarding the next move. Lliev arrived at the Military Hospital on the 'very day that Dr. Ryan himself came down with typhus. !Miss Gladwin wrote of her emotions when she first saw them : 182 HISTORY OF AMERICAN RED CROSS NURSING I went back to the sterilizing-room and as I entered I looked up. There in the doorway stood two men in the uni- forms of American Ked Cross surgeons. I rubbed my eyes, because I thought that my wish for help was making me see visions, but I went forward and found Dr. Kirby-Smith and Dr. Butler. It seemed the merest accident which had brought them there, but 1 shall always believe it was in answer to prayer. The contagion swiftly overtook other members of the unit at Belgrade. On March 28, ^liss Gladwin wrote Miss Delano that Ida Lusk, a Bellevue nurse, was desperately sick with typhus. Dr. Kyan had developed pneumonia. "It is pitiful," ]\liss Gladwin added, ''to hear him in his delirium going over and over again the details of the work." Immediately upon his arrival, Dr. Kirby-Smith wired to Dr. ]\ragruder at Saloniki for which reenforcements from Units 2 and 3 as might safely be spared. Then with Dr. Butler, he set to work. In that over-crowded hospital shelled by enemy fire, with an exhausted nursing staff and a stricken director. Miss Gladwin and the remaining seven nurses faced the rounds of duty with cheerfulness and equanimity. Fear held their hearts in a grip of iron, but the discipline of their profession steadied them and sent them about their duties, which was soon to in- clude the care of other desperately ill nurses and the burial of one of their best-loved surgeons. With the calmness of the experienced sanitarian, Dr. Kirby-Smith reported to his su- perior officer at Xational Headquarters : The typhus situation : At the time of my arrival, the epidemic was at its heiglit, with nine hundred cases under treatment in the ty])]uis pavilions. These buildings were not under our administration. Our own wards were overcrowded, and patients liad iioccssarily Ijeen admitted i]i such large num- bers that tliere was no chance to give them careful examina- tion. The result was that typhus l)ecame epidemic in our pavilions. Iivaii ])robab]y contracted the disease by working in tlie wards. This may also be said of Miss Lusk, although she had sj)ecialed several (-ases. Dr. ^lagruder arrived in Ikdgrado ^larch .31. He liad fever of 104 degrees within a few hours, in fact he had not been well for several (];\\< ]rior to leaving Ckngeli, l)ut notwith- standing this, he continued liis work of arranging transpor- tation for his party and supplies, working hard at a time THE MERCY SHIP 183 when he should have been in bed. During the first days of his illness, his condition did not give us undue alarm, but thirty-six hours before his death, he was suddenly over- whelmed by poisons of the disease. He died April 8 and will be buried here in the Civil Cemetery. Miss Helen Kerrigan, of Brooklyn, Xew York, was taken suddenly ill April 13. Typhus was positively diagnosed a few days later. She evidently contracted the disease from work in the wards. Miss Helen Smith became ill April 18. She had specialed Miss Lusk and had not been on duty in the wards for a month. j\Iiss Eebecca Watson (from Pan) developed severe typhus May 5. The nurses have been moved to a part of the hospital espe- cially cleaned and disinfected for their occupancy. Only occasional cases now develop in our wards, and it is believed that we will soon have the disease entirely stamped out of our pavilions. Of course, there remains the chance that our personnel may be bitten by an infected louse, conditions being such tiuit we have not entire control over every one with whom we come in contact. Tiie routine of the hospital now runs smoothly. Dr. l^utler with Dr. Downer as his assistant is in charge of the surgical pavilions, and the enclosed list of operations gives an idea of the work being accomplished [averaging five daily J. Drs. Kirkpatrick and Hagler each have a largo pavilion. ^ly duties are largely administrative, but 1 have given my per- sonal attention to the members of our party stricken with typhus. Dr. Pyan is making a good convalescence, and I hope soon to turn over to him the management of his hos- pital. 1 will at oiu'c start for home, with Miss Lehmanu and Miss Lofving [.May 9, 1915J. While the routine work of saving life and warding off death to the last moment of resistance, went on as usual within the American Hospital, spring came to ]^elgrade with soft winds and vivid sunsets. Clear balmy days brought out the con- valescents in wheel-chairs to watch the French aviators circling the city on their way to and from scouting expeditions across the Danube and the Save. Though the enemv made ready to renew his assault, all S(>rl)ia drew a vast sigh of relief and faced the sunnner with hope. Typlius was gone, thanks largely to that band of forty-seven sanitarians under Dr. Ivichard P. StrouiT, which the Hockefeller Foundation and the American 184 HISTORY OF AMERICAN RED CROSS NURSING Red Cross had sent during the dark days of early spring,^^ And no longer did the menace of cholera fill man, woman and child with paralyzing fear. Upon the arrival, April 13, of six relief nurses and two surgeons, better days came quickly. Following their convales- cence, Miss Smith and ]\[iss Kerrigan were transferred to an American Red Cross hospital at Yvetot, France. When tired members from all three units were invalided home in June, Miss Delano sent others to fill the gaps. Miss Gladwin's letter of July 7 to Miss Delano differed greatly from those short notes written in previous months: You are cordially invited to a tea at the American Hos- pital at four-thirty o'clock. You will have no difficulty in finding us, as our flag on the clock tower is visible from many parts of the city. The sentry at the gate will let you through the archway. Come along the drive under the tower. As you open the front door leading into the big, cool hall, you will see Old Glory again, colorful and splendid against all our whiteness, giving you a sense of protection and security. Come straight down the corridor to double-doors opened wide in welcome. A great, white-tiled room, with enormous window spaces; a long writing-table covered with green blot- ters ; a newspaper table ; and a tea-table gay with bright chintz, a bunch of blue and white larkspur, another of purple ten- Aveeks stock, red and white geraniums in pots and begonias covered witli coral blossoms, that's our tea-room where you may find on any afternoon a warm welcome and many cups of Sir Thomas Lipton's "best." You will like the Red Cross family. You know all my girls, hut you haven't seen them in their gray gowns as they come from their work in the wards. You will like the way they look, a little tired and worn, perhaps, but contented and happy, wonion who have made a name for good behavior and hard work such as belongs to no other mission in Serbia. You may not know the men so well. Though he may be called away before his second cup is poured, our Director Avill come. The Second-in-Command will drink his tea with great enjoyment. The Professor will bear in his hands a potted geranium wliich he carries from room to room seeking sunny windows. IJumor hath it that he sings a lullaby to it every night ! The riiotographer with his big pipe in the corner of his " For an account of the work of this commission see "tender the Red Cross Flag," Mabel T. Bourdinan, J. J3. Lippincott Company, 1!)15. THE MERCY SHIP 185 mouth and his hands dripping "hypo," will hurry across from the dark room to show you his latest picture of the market- place. Come see our Student, our Atheist, our Democrat and our Boy lor yourself ! Delay in the long-expected advance of the Russians and Serbs upon Budapest lightened nuiterially the work at the American Hospital during the summer, but tried the nerves of officers and privates alike. During the hot sunmier months, the immaculate hospital on the hill maintained an average of six hundred patients. Quiet days brought the Americans welcome opportunity to become bet- ter acquainted with their simple-hearted, generous, appreciative soldier charges. One sister wrote of her orderly : The linen closet on my floor was not clean enough to suit me. After I had spent an entire afternoon on it, one of the "bolachi" (as they call the men who helj) us), came into the ward cla])ping his hands and beckoning me to follow. I did so, thinking that he had seen the linen closet and approved. When we both got to the door, he clapped his hands even more delightedly and motioned me to open it. To my astonishment out flew two white pigeons. He had arranged a cozy nest for them among my immaculate sheets ! At intervals he would come and get me to go with him to see his pets fly out and light on his head. When they were banished, he seemed al- most heart-broken. Every time an Austrian bullet is removed from a Serbian's wound all the patients get around his bed and sing the Serbian national anthem. 1 had a boy of seventeen who had had a bullet removed from his foot. On his return from the operating-room he was still half under the ana'sthetic and 1 left him for a few minutes to get a hypodermic. I returiied to find him sitting up in bed, completely surrounded by other patients, all whooping lustily ! The second Austrian oflFensive, long expected by the French and Serbian armies, was launched against lielgrade in Septem- ber, IDIT). The Anu-rican Red Cross Hospital quickly fllled with wounded. Although the American I^'d Cross formally re- called th(ur foreign units on October 1, IDIT), the Serbian ^linister of War, in the nanu' of their King, begged the Ameri- cans to renuiin, assuring them that the Serbian Crovernment would gladly defray expenses. Ijulgaria was on the vergt* of 186 HISTORY OF AMERICAN RED CROSS NURSING a declaration of war. One hnndred and twenty thousand Ger- man troops were massed across the River Save. Dr. Downer described how the Anstrians captured the city : From our vantage point we could witness every move in the desperate undertaking. The broad river lay beneath us and to the right rose the Kalenegdan, the old Belgrade fortress, with its white tower and its white walls, dating from the days when the Turks were masters of the city. Just across the river the combined Austro-Hungariaii and German heavy artillery were hurling their great projectiles, searching for the Allies' artillery positions. Allied artillery were dropping shell in Semlin, trying vainly to reach the guns that were slowly battering down their own defenses. The Austrians' thirty-point-five mortars were throwing entire houses into the air, leaving great craters fifteen feet deep and thirty feet in circumference. Added to this, the city caught fire and at night was a most wonderful sight. In this wild scene we could see thin battalions of Hun- garians, lying with their feet still in the river on the Bel- grade side of the stream, held in check by a murderous rifle and machine gun fire from the old walls of the Kalenegdan and the trenches along the Danube; the damaged pontoons full of dead men floating down stream with the swift cur- rent; the Germans making their bloody struggle to cross over the Gypsie Island and finally the combined Austro-German rush from the river to the trenches and the fearful hand-to- hand fighting with bayonets, knives and club-guns. After that came the street fighting, the rally of the Serbs from Porlock Heiglits back into Belgrade, in which heavy infantry and artillery fighting raged around the gates of our hospital all night, until finally in the morning the Serbs retreated for good. And then we heard the distant booming of the cannon at Avile, showing that the Serbs were resisting to the last the terrible onrush of the Austro-German forces. ^^ Under that symbol of mercy which they had worn so well, Serbian Units 1, 2, and 8 could not at this hour desert the crowded hospital. They remained at their posts of duty when the dusty, gray hordes again swarmed the streets and they kept the doors of the Alilitary Hospital open alike to Austrian, Ihilgarian and Serbian wounded. After six weeks of stress, they turned over the management of the hospital to the Aus- ""Tlio 'I'liriop-Capturfil Capital," Dr. Earl B. Downer, Americati lied fyijss M(t(iazinr, ID] (I, N'ol. XI, j). 7S. THE MERCY SHIP 187 trian military authorities and entrained November 28, 1915, for Vienna. From Vienna, in groups of three and four, the surgeons and nurses went their several ways homeward to merited rest. On the single railroad which in 1914 cut directly north and south across Serbia, lay the isolated depot of Gevgeli. In this dreary town near the Greek frontier, American Ked Cross Units No. 2 and 3 established and attempted to maintain a military hospital under conditions which made their brief stay a disastrous vet heroic incident of American Red Cross service during the first year of the European War. J3uring the last weeks of December, 1914, American Red Cross Units No. 2 and 3 arrived in Saloniki and were assigned by the Serbian Government to the ]\rilitarv Base Hospital and Prison Camp which had been opened in Gevgeli to supplement the already overcrowded hospitals scattered throughout the central part of the small principality. Dr. P^than Flagg Butler, of Washington, D. C, was director of Unit No. 2; Dr. Ernest Pendleton ^lagruder of the same city, was in charge of Unit No. 3; ^lathild Krueger, of Detroit, Michigan, was supervisor of the twelve nurses. So highly developed were the medical departments of the armies of the Allied and Central Powers at the outbreak of hostilities, that sanitary conditions existing in the Balkans seemed at first unb(>lievable to the pioneer surgeons and nurses who went there in 1914. Native standards of living, primitive to a degree astounding to Americans, were lowered by the lack of food and other supplies of every description, by the short- age of lab(^r and J)v the absence of a native medical and nursing personnel. Emily Louise Simmonds, a graduate of the Roosevelt School of Nursing, New Vork C^ity, who undertook service under the Serbian Red Cross, wrote of her impressions of three military hosj^itals in Serbia during the winter of 1914: Cevgeli is the first Serl)ian town across the Tirook frontier; it really represents a station dejiot and a cigarette factory of fdiir stories, surrounded hv a connnunitv of squalid little huts. At KraguycNats [ nortliern Serbia). I went for a walk one afternoon wlicn I saw a dressing-room orderly emptying waste cans, filled with the pus dressings, in a ditch ojiposite the main building. He answered my question by stating in a 188 HISTORY OF AMERICAN RED CROSS NURSING surprised voice that they luul never hurned them and it seemed unnecessary to start now. Of 2500 Austrian prisoners at Uskub, 1000 are dead, 200 are on their feet and the rest are down with wounds and typhus. Here their liospitals are in long, low-roofed barns with two-foot windows on one side only. Beds are often pushed together so that three men lie on two cots, with 200 in each barn, dying at the rate of forty a day. One of their buildings was on a steep hill and the orderly used to empty the dressing-cans over the wall where they would l)low about in all directions. The Turks (Uskub was Turkish two years ago) used to pick these over, taking the cleanest ones to line their wadded waistcoats. I don't want to be disgusting, but I do want to make you appreciate that this may be the beginning of an epidemic and is an instance of what is happening all over the country. If any help is cominjr it must come at once and must be of drastic measure. The American Red Cross Units l^os. 2 and 3 were placed in charge of an improvised hospital located in the cigarette factory described by Miss Simmonds. It was without heat, water, or drainage and it sheltered under its leaking roof 1200 surgical patients. Two days after the arrival of the units, 560 addi- tional wounded raised the quota to well over lYOO sick and dying men. Hospital equipment consisted of straw mattresses laid on the tobacco-littered Hoor. Every drop of water had to be brought from a distance. All waste and excreta were carried to a cesspool several hundred rods from the building. The bas(>ment was filled with an accunnilation of soiled clothes and linen over which thousands of body lice crawled. When Saints' Days did not forbid, three Turkish women came to wash a fe\v sheets and pajamas in small crib-shaped tubs similar to American chopping-bowls. Gevgeli was a snuill community. Serbian oiRcers occupied the few wretched lodging-houses. Quarters in private houses could not be secured. Tlie nurses bad to be assigned to a native hotel in rooms approximately twelv(> feet S(iuare, without light or heat, three women to a room. The beds consisted of straw mattresses mounted ou wooden frames. One small tin basin and a water jug were the only toil(>t accommodations furnished the twelve* nurses, 'j'lic do<-tors were (juartercnl nearby at the cholera barracks. Their meals, cooked in the general hospital kitchen and served in the staff dining room, were adequate, THE MERCY SHIP 189 except perhaps tlic traditional Serbian breakfast which con- sisted of tea with lemon and toasted black bread. Miss Krueger stated the spirit in which the American units started to work: In this unsanitary location, the bnildinf^ crowded to its doors, with vermin and filth on every hand and no prospects of obtaining vitally needed equipment for promoting better sanitary conditions, we went to work, not optimistic nor sanguine of results, but with a determination to do our best. . . . A staff of two liundred nurses would have been inadequate. For four days we spent our entire time getting all seriously wounded into one ward, averaging four hundred dressings a day. Badly infected wounds were the rule, not the exception. Many had not been dressed since temporary First Aid on tiie field ten days to two weeks previous. Every day we realized more and more how pitifully inadequate was our force. Con- ditions grew more disheartening with each week.^* The tobacco factory was so dirty that the American surgeons did not dare attempt there the heavy surgical work impera- tive for the recovery of the patients. Dr. Butler accordingly secured, January 1, 1915, a large tobacco shed for use as a temporary surgical hospital. At the cost of much time and discouragement, the Serbian Government finally furnished a small amount of equipment, including windows, a most import- ant item. On the day of the first operation, January i;>, the American flag was bravely hoisted over this warehouse. A sifting process of seeking out operative cases in the tobacco factory and of scrubbing, sluiving and clothing them before transportation to the warehouse for operation, soon filled the so-called "American Hospital" to over-capacity. Miss Krueger continued : Most tragic of all was the meager and unsuitable food supply. Two meals a day consisting of vegetable soup and coarse brown bread was the allowance for all patients. They were fed on this diet and then treated for dysentery, typhoid and other intestinal diseases with a wisdom equal to that of the sage who dipped up water in a sieve. Possibly some notes " Papor prp])aro(l liy Miss Knicfj^cr for the convention of tlio American Nurses' Association, \'.U~k al San Francisco, Calif.: later publislied in the .\7nerivan Journal of \ursing, Vol. XV, p. 1014-1015. 190 HISTORY OF AMERICAN RED CROSS NURSING taken from my diary give a better picture of things as they were: January 7 All the wards of the tobacco factory very cold; patients suffering; food very scarce; impossible to get milk or eggs. No clean clothes for the patients or beds, no laundry done for four days, being holiday week. Nurses all have bad colds and begin to show strain of work, which is fatiguing, depressing and disheartening. I insist on their having one afternoon and half Sunday to get out in the air and sunshine. January 20 New cases of typhus, pneumonia and smallpox developing daily. Four hundred cases of recurrent fever, many of them among Austrian prisoners who have been our only helpers. Sanitary conditions indescribable. January 28 Medical wards almost hopeless, so many desper- ately sick patients, very little food and no orderlies to help with the work. One of lOur doctors arid two Ameri- can nurses off duty with temperatures 103 degrees ; prob- ably typhus.^^ The fight at Gevgeli had begun against overwhelming odds. On their arriv^al Units Nos. 2 and 3 had found the sick and wounded in so pitiful a condition that common humanity had prompted the Americans to assume charge immediately, with- out taking the time necessary to render their own living con- ditions at least reasonably safe. Massed against them were lack of equipment and supplies, overwork, a strange language and that potent ally of typhus, the body louse. The members of Units Nos. 2 and 3 went down one by one before the fever. Dr. Lane was unable to report for duty January 28 ; Clara Tulloss, January 29 ; Clara Slusher, Janu- ary 30 ; and Dr. King, February 7. Anna Lockerby wrote Miss Delano : On ^londay, February 8. ^liss Krueger did not feel well, but was on duty all day until four o'clock. Two hours later her temperature was 102 degrees. Wednesday, there was no doubt that she had pneumonia. Wilhelmina Weyhing did not feel well yesterday. February 12 ; today she had a temperature of 104 degrees; typhus, of course. We are very much crippled in our work. Dr. Butler says we must come first. Our dressings arc holding out. What we need most is niilk. cocoa, rice, eggs and any kind of other "Paper proparrd l)y Miss Knioppr for the convention of the American Nurses' Assnciation. 191."). at San Francisco. Calif.: later piiblislied in tlie Amrriran Journal of Xursivij. Vol. X\', p. 1015-1016, THE MERCY SHIP 191 food. All diet we give our patients is cabbage soup. Sir Thomas Lipton and his nurses stopped to see us on their way to Xish and left us siicli food as he couhl spare from his ship. Dr. Butler has worked hard to get a place at last where we can have our cook and buy our own rations. Teresa Curley was the next member of the units to become infected. On February 18, Dr. James F. Donnelly, of New York City, came down with it; the following day, Maude Ellis; the following day, ^lary Siehrs ; on February 21, Mary D. Cox. The next day ^liss Krueger developed typhus fol- lowing pneumonia. Of the original eighteen comprising the units, four nurses and two doctors remained on duty. Miss Lockerby wrote ^liss Delano: In two rooms we liave three nurses each and across the hall, two others, all typluis, some cases three weeks old and one eleven days, blisses Fry, Tetrault and I care for them; Miss Canfield is nursing Drs. King and Lane during the day. Drs. !Magrudcr and Butler have done everything in their* power to help. When the crises came, they wanted to stay up all night so we four could sleep. There have been so many things besides the sick nurses. I was the second person in Dr. Donnelly's room and helped the doctors. Xone of the nurses know of his death yet. That was a very hard day. Something has come up concerning Dr. which required a firm stand from the director. The nurses were quite excited at first. I said they must obey or go home and they rememl)ercd what you had said in Xew York to Miss Krueger. 1 felt sure that in her illness you would want me to make the same stand. Dr. has left the unit. February was a dark time for all Serbia. "We have ourselves lost one hundred and five doctors," cabled the Serbian Ked Cross to American Xational lied Cross lleadcpuirters. Four of the British lied Cross Unit died at Uskub. Two surgeons and three nurses of the Russian Red Cross succundx'd at Xish. So tragic were the losses in the Dutch and Gr(H'k contingents that these units were withdrawn from the country.'*' Sir Thonuis Lipton, win) had lu'onght over the l>ritish lied Cross units on his yacht Er'nij saiil in cable dispatches: "One can *".l)rri(n Red Cross Mdynzinr. Vol. X. p. ISO. 192 HISTORY OF AMERICAN RED CROSS NURSING scarcely imagine the terrible ravages of tjphiis, far worse than typhoid and even the Black Plague." Only with difficulty was Serbia able to bury her dead. Drastic measures were imperative. When Dr. Ryan came down from Belgrade, a consultation was held between the American surgeons and two doctors of the Serbian Red Cross and it was decided to withdraw Units Nos. 2 and 3 from Gevgeli to Saloniki, Greece, as rapidly as the condition of the sick would permit, for recuperation and reorganization. Dr. Kirby-Smith, with three nurses from the French units, were on their way to Saloniki from Pau. He and his party, in- cluding Dr. George W. JMellon, of Beaver, Pennsylvania, who volunteered his services when he heard on shipboard of the desperate need, reached Saloniki on March 18 and found Dr. Butler and several convalescent members of Units Nos. 2 and 3 in a third-class hotel, the only one in the Greek seaport which would receive the infected Americans. Leaving the three nurses there, Dr. Kirby-Smith went with Dr. Butler to Gevgeli where Dr. MagTuder was taking care of the remaining members of the two units. Miss Lockerby's report of March 19, to Miss Delano told of conditions at Gevgeli: I am so happy I am almost afraid to write. All of our sick were able to sit at table for dinner. I could hardly keep the tears back, I felt sure this day would never come. Seven of our convalescents are in Saloniki. Dr. Xirby-Smith came down today leaving his three nurses with them there. Now the days grow warmer and the quaint native women come out in tlieir bright dresses to gossip as they stand knit- ting by tlie roadside, clicking their tongues as fast as their needles. . . . Tills week we were able to do a little hospital work. I gave chloroform for twenty-one operations. Sometimes this meant that I didn't get to ]\liss Krueger, whom I am caring for, until five o'clock. She is very anxious for us to get back on duty. Major Patterson cabled Dr. Kirby-Smith to consolidate the units, as the health of the individual members permitted, at Belgrade. Gradually strength returned to the eight convales- cent nurses and to Dr. King and Dr. Lane at Saloniki, enabling them to return early in A])ril to the United States. On March 25, Dr. Kirby-Smith and Dr. Butler had gone THE MERCY SHIP 193 to Belgrade to interview Dr. Ryan about bringing the unin- fected nurses and doctors to Belgrade. After wiring Dr. Ma- gruder to bring up what reenforcements he could spare, they remained at the Military Hospital to take care of Serbian Unit No. 1. Dr. !^IagTuder with the three "surviving" nurses reported at Belgrade, !March 81. "At last our wishes have come true and what is left of Units Nos. 2 and 8 are here !" wrote Miss Lockerby. Their joy was short-lived. On April 18, she wrote again : "All our time since January has been a strain, but it seemed almost more than we could endure to have to bury Dr. INIagruder. You will never know how much he helped us," she continued, "he was sick before we left Gevgeli, but he wouldn't give up, nor at Saloniki. He died after five days' illness here and was buried in the Civil Cemetery." Here ends the separate history of Serbian Units Nos. 2 and 3. Subsequently they shared the experiences of the Americans at the Military Hospital in Belgrade. Just as the subsequent history of the three Serbian units merged into one, so has the record of individual experiences, massed together in the archives at Xational Headquarters, been merged into an awesome whole. The terse cable messages, the short letters written in fear and exhaustion which recount the fortunes of the gallant units at Gevgeli and Belgrade, picture war surgery and war nursing with terrible reality. Filth, monotony, hunger, peril, agony, dishonor and despair were there ; so also were courage and faithfulness unto death. Let the fact that human strength faltered once or twice show the intense strain of th()s(> days! For one man w'ho left his post of duty at an hour of need, there were eight surgeons for whom pestilence licld no terror. For one nurse demoralized by utter exhaustion, there wei'e twenty-two others brave and strong and sane under the lingering shadows of death, Florence Nightin- gale's experience's at nearby Scutari were not more difficult than tliose of these Red Cross luirses. In far (jlevgeli, a white stone cross marks the ivy-covered grave of an American surgeon. Dr. James F. Donnelly. In an ancient burial-ground in Belgrade, where black marble shafts point skyward among dark cedars, another Red Cnv-^s physician, l)r. Frnest P. ]\Iagru(lc>r, rested (juietly until cessation of hos- tilities permitted the return of his body to his native soil. During th(> happy days before the war, young Dr. ^Fagruder had i:'(>ne to Scotland to ascertain whether he was a descendeut 194. HISTORY OF AMERICAN RED CROSS NURSING of the famous MacGregor Clan. There he had met and mat- ried the daughter of Lord MacGregor of Edenchip, Valquhider. A letter written by his widow from her father's home during the first days of her loss bears testimony to the spirit of sacri- fice with which the Red Cross moves forward : Realizing as I do how immense are the claims on the funds of the American Red Cross, I have already written Miss Boardman to acknowledge my appreciation of the action of your committee in making an allowance to me and my little son. I hope it will enable me to keep my small boy with me. It is my great consolation to know that my husband laid down his life in the service of others. I feel I should like to express to you the admiration, the deep admiration, I have as a Britisher for the noble spirit that actuates the American Red Cross. In these days when all Europe is in anxiety and mourning and when a dreadful spirit of hate has raised its head above our boasted civilization, one sees in the selfless devotion of Americans, in no way ])ound to share our suffering, a ray of real comfort and hope and a glory far greater than any won upon the battlefield. Here ends the experiences of the units which had sailed upon the Mercy Ship for service in European theaters of war. Three other units were assigned, however, by National Head- quarters during the winter of 1914-1915 ; one of them went to Yvetot, France, and the other two to La Panne, Belgium. A brief account of their experiences belongs in this chapter which summarizes the service of the American Red Cross to the Central and Allied Powers before the entrance of the United States into the World War. The first year of the war had been marked by the estab- lishment of many hospitals under organizations of varying types and aims. Throughout the first six months, wounded had come back from the ]\Iarne and from Ypres in increasing hordes. The existing capacities of the sanitary services of the Allied Powers had been greatly overtaxed by the influx of patients, and their development retarded by shortage of supplies, personnel and transportation facilities. By serving on committees in- terested in the establislinient of auxiliary hospitals and con- valescent homes and by contributing lavishly to the support of such institutions, men and women in every station of life, lx)th in England and in the United States, seized avidly the oppor- THE MERCY SHIP 195 tunity for dissipating thoir own emotional tension and for genuinely aiding the wounded soldier. At Yvetot, France, on the Kiver Seine, within easy reach of Kouen, one of the principal military bases, the French Gov- ernment placed at the disposal of the Committee of VHopital de V Alliance Fondation Atujlaise et Americaine a large mon- astic school for boys, J eft vacant eight years before by the separation of Church and State, this structure to house a mili- tary hospital for the care of British, French and Belgian soldiers. The hospital was supported by volunteer contribu- tions from industrial workers in Great Britain and America. The aim of the committee, whose chairman was Dr. F. S. Pearson, Bishopsgate, E. C, was to afford other industrial groups, particularly those engaged in the manufacture of gov- ernment supplies and munitions of war, an opportunity to give "their bit'' for something tangible. Backed by the influential London committee and by many Americans of wealth, the hospital was in a splendid position to secure equipment and personnel. It was later ranked second to the American Am- bulance at Paris, conceded to be an ideal institution of its type. Dr. Ralph Fitch, a Bostonian, was director of the Alliance Hospital. He had practiced his profession in Rochester, i!^ew York, and was an orthopedic surgeon of brilliant powers. Be- fore sailing for France in December, 1914, where both he and his wife gave prodigally of their wealth and services, Dr. Fitch had requested nursing assistance of the American Red Cross, should the need be great enough to justify the expenditure. After his report of conditions existing at Rouen, France, Xa- tional Head(piart('rs contirnicd his appointment as a Red Cross surgeon, in order that Red Cross nurses might be assigned to the Alliance Hospital, and dispatched on the Rochamheau Feb- ruary 2;5, 1015, a unit of nine nurses, with Mary M. Fletcher, of Charlottesville, Virginia, as supervisor. Upon their arrival at Yvetot, ^larch 2, 1915, the American nurses found a well-equipped institution with chapel, admin- istration building, bacteriological laboratories and six large wards of fifty beds each. A separate wing of the building containing one hundred and eighty beds, which was operated by the French Kcd Cross, brought the total capacity of the liospital to five hundred. A convalescent home accommodat- ing between thirty and forty patients was maintained at nearby \'euilU'-les-lu)Ses. 196 HISTORY OF AMERICAN RED CROSS NURSING Alliance Hospital was governed by a Board of Administra- tion consisting of the chief medical officer, Dr. Dudley D'Avergne Wright, of London; Dr. R. R. Fitch, Captain T. J. C. Warren, of New Zealand, and Mr. George S. Taylor as business manager. Two English surgeons and two students or ''dressers" completed the medical staif. Sixteen English Sisters including Matron Adelaide A. Wood and ten proba- tions, with the ten Americans, composed the nursing staif. Eighteen infermiers, French soldiers unfit for duty at the front, served their military term there under a French Ad- jutant. To supplement these orderlies, six young English and American men acted as stretcher bearers and ambulance drivers and did general repair work. To volunteers from Great Britain and the United States was delegated much of the routine hospital detail such as the care of the laundry, the kitchen, linen rooms and the vestiaire. Baron Rothschild's chef was major domo in the kitchens. During the first weeks, the nurses at the Alliance Hospital experienced the same inactivity which taxed the cheerfulness of the American units at Paignton and Pan, but as the winter of 1915 dragged on, the Americans gradually won the con- fidence of the English and French authorities, so that the care of large numbers of patients was entrusted to them. Two of the American nurses were placed in charge of one of the wards. A third was appointed night superintendent, acting in Matron's place when she was absent in England for several weeks. "We have tried very hard indeed," wrote ]\Iiss Fletcher, "to remem- ber not to spill our efficiency over onto the aprons of the Eng- lish sisters and probationers." The work at the Alliance Hospital was almost entirely sur- gical. Many bone eases required plating, and all wounds had to be drained freely. After a winter in the trenches, with nerves pounded thread-bare by shelling and "wind" shortened by continual cigarette smoking, the soldiers were in poor condi- tion for long general antesthesia. Hence the eases di'agged out while the surgeons waited for wounds to heal before at- tempting second and third operations. Mary K. Nelson, in charge of Dr. Fitch's operating-room, described the patients arriving from Ypr(\s as wretchedly wounded, their mud-soaked uniforms a torturing, exhaustive! burden. The American nurs(!S found a certain deep satisfaction in caring for cases which they received from hospitals further THE MERCY SHIP 197 up the line. In writing to the Princeton Chapter, which paid the salaries of several of the Pau and Yvetot nnrses, Miss Fletcher said: To get cases whicli have been unavoidably neglectcfl in an overcrowded hospital for from two days to two months, may seem uninteresting and perliaps not (jiiite fair from a })ro- fessional point of view, it does, however, present a wonder- fully humanitarian opportunity to give them scientific surgical care. Since it is not our country which is at war, we cannot all expect to be at the front. The English Tonnnies are marching througli under my window, with an unending procession of lorries, transports and yellow-brown ambulances, on their way to Amiens and Nismes. About every ten days splendid young, fresli men go through on machine guns from Havre straight for the front. They are usually about forty at a time and arc called the Sundry Brigade. They are all sure of death. When they stay over night at Yvetot, the hospital has an impromptu concert. Any one whom the others think can sing even a bit is sent up to perform. You always feel that these boys who can cheerfully undertake to entertain this company must have nerve enough to do anything. They are always given coffee and cakes aiul are so appreciative and cheerful it makes jour heart ache. You know almost all of them will go down. One of our patients, a man of thirty, has lost both arms. Yesterday his wife, who had not seen him for months, came into the ward. His face was heart-I)reaking to look at. He tried so hard to keep the tears back, but they would come and she had to wipe them away. August, 1015, brought many changes to the Alliance Hos- pital. Of the ten nurses, one felt it necessary to return to the United States. Later ^liss Fletcher turned over her su- pervisory duties to INIiss Nelson. ''Remembering what you said about the on(> thing yon would insist on, 'no foolishness','' wrote ^liss Fh^cluM- to .Miss De- lano, "it is pretty hard for a supervising nurse to have to con- fess she is engaged." "Sever your c(Uinection with your unit at once," answ(u-(^d IVliss Delano; "under pres(Mit conditions, tliere is no room in the Red (^ross for s(>rvice and romance at tlu^ sam(> time." Accompanying this official message, however, wiuit a personal 198 HISTORY OF AMERICAN RED CROSS NURSING letter: ''I am delighted to hear of your engagement, my dear," wrote ]\liss Delano, *'and hope most sincerely that he is worthy of you and will make you happy." To fill the two vacancies caused by Miss Fletcher's resigna- tion and the return of the other nurse to America, Sisters Smith and Kerrigan were transferred to Yvetot from Belgrade after their recovery from typhus. The greatest change came, however, on August 15, 1915, when the French Government requested Dr. Fitch and the American nurses to take charge of ^lilitary Hospital Xo. 48 bis, at St. Valery-en-Caux, a little iSTorman hshing town on the Channel, between Dieppe and Le Havre. The nurses at once fell to work house-cleaning their new hospital. Streimous days and nights followed. Only two of the nurses were independent of their salaries ; eight of them, however, decided to remain on at St. Valery-en-Caux without remuneration after the Eed Cross had recalled its foreign units on October 1. Miss Delano cabled that the nurses might retain their Red Cross equipment. Miss Xelson acknowledged this gift and in the same letter described how heavy their work had become : With onr constant influx of seriously wounded men directly from the front, it was almost impossible for us here in this little village on the coast to obtain uniforms and aprons immediately. Over at home such a supply is a simple matter, but here it is very different. You will appreciate that our entire thought, time and energy has been given to the work itself, to the care of the wounded and the management of the hospital. It is iu)\v long past midnight and common sense reminds me that at least six hours of sleep are necessary. We all seem to have grown accustomed very easily to longer hours of duty. At last we have the work welioped to find! During the antunni, l!)!."), ]\Iiss Xelson built up a strong nursing stalF at St. Valery-en-Caux. To supplement the eight from Yvetot, she secured three ''casual" American ntirses, two Lnglisli s sicrs and iiiiic partiallv-trained women. The capacity of rifo/>lln] A ii.rilitiri' Xo. 4:5 was then raise(l from sixty-five to ono Inindi'cd and sixty-one beds. Besides directing the nursing stall'. Miss Xclson had charge of the operating-room. The surgical department had been greatly strengthened by the THE MERCY SHIP 199 acquisition of a portable X-ray plant, with an electric genera- tor, from the French Service de Sante. With the increased nursing strength and witli this excellent equipment, Dr. Fitch's hospital received a monthly average of one hundred and fifty patients. In a letter written October 26, to Miss Delano, Miss Nelson told of the pressure under which they worked : I scrubbed up shortly after three P. ^l. and had my gloves off only about half an hour for a bite of dinner in tiie steriliz- ing-room about eight that evening. It was four-thirty the next morning before we finished, only to begin again that after- noon. As ever so many of our grands blesses are bad joint wounds, the work in the wards does not lighten. The nurses have borne up remarkal)ly well under the strain. Dr. Fitcii is very considerate. He planned no operations to- day and placed his big ear at our disposal. The four night nurses went driving this morning and six others will get the air the rest of this afternoon. Until wo have more nurses, it seems unwise to take more patients or to open our convalescent hospital of thirty beds at Veuille-les-Koses. We need it though, for it is hard to start these boys away to other hospitals for their convalescence just when they begin to pull up. Such wounds as I have never seen before and 1 thought I'd seen horrible ones, shattered hips, knees and shoulders all calling for expert nursing care. "Whenever there came a lull in military operations Vllopital Auxiliare No. 4-'5 /;/,s' drew patients from the surrounding country, or nursed the saddened Belgian refugee children in nearby orpiuinag;es. Three of the American nurses returned to the States during the spring but Miss Xelson, Helen Kerri- gan, Josephine Clay, Helen Spaulding and Marion M. Rice remained. Here, during the summer of 101 (>, ended the letters and records which tell of the events of the Yvetot Unit. The little hospital at St. Valery-(Mi-('aux continued to render yeoman service during t\w cnu-ial winter of l'.)l*)-l!)17. Xearby Amiens was the IIead(]uarters of the l>ritish Expeditionary Forces. The enemy was nuissing his streng-th against Verdun, while the Allies hung breathless on the outcome of that savag(> as- sault. Pounded by ev(U'v type of artillery fire, shattered by shrapiu'l, mowed by machine guns, poison-gas and Fhinmien- u-erfer, France during these months was lKlding the heights 200 HISTORY OF AMERICAN RED CROSS NURSING of Verdun at a total cost of 550,000 casualties among her picked soldiery, some of whom lay unburied among the craters on the shell-plowed slopes, while others came straggling back through casualty clearing stations to the French and Allied bases. How gallant a part the American staff of VHopital Auxiliare No. 43 bis played in later Red Cross endeavor will be found in a subsequent chapter. When the American Red Cross had first offered its medical and nursing units to Europe following the declaration of war, Belgium had asked only for supplies. The Belgian Red Cross mobilized with Albert's Army, but no sanitary organization could cope with the wounded which flooded back to the coast towns of the Channel and the j^orth 8ea. By February, 1915, Albert with his forty thousand Belgians held a strip of land forty miles long and ten miles wide from the Yser to Holland. Directly in the path of the Taubes, at La Panne, Belgium, the Belgian Red Cross was reorganized and from this uncon- quered territory on February 21, came their appeal to the American Red Cross: We need about twenty or thirty nurses, four or five sur- geons, one thousand beds complete with sheets, covers and rubber sheeting, tents for housing one thousand beds; tents for personnel and large quantities of surgical dressings, tetanus sermn. (signed) DePage. Antoine DePage, a surgeon of Brussels, and Lieutenant- General ]\Ielis, Inspector General of the Health Service of the Belgian Army, headed a committee appointed by King Albert to organize Belgian Red Cross field hospitals. While Dr. DePage was building the pavilions of VHopital de VOcean on the sand-hills four miles above Xieuport, Madame ^Marie De- Page, his wife, made a flying tour of the principal cities of the United States to raise funds to support this medical city of twelve hundred beds. In response to her solicitation, the American Red Cross pledged itself to support two units, of three surgeons and twelve Red Cross nurses each, at La Panne, as it had done in 1!)14 for England, France, Russia, Germany, Austria and Serbia. Xational Headquarters also donated two complete field hospitals and $20,000 for their maintenance. On April 17, lOlT), I5(']gian Fnits Xos. 1 and 2 sailed on the S. S. >7. Lovis for LivciqxK)]. Dr. Albert R. Goodman had THE MERCY SHIP 201 been appointed senior director of the two vinits, but was obliged in London to return to the United States and Dr. Robert Hinds, of Buifalo, succeeded him there. Dorothy M. Ferree, of the Henry Street Settlement, New York City, and of Phipps Institute, Philadelphia, was general supervisor of the twenty- four nurses. Under the shadows of war, the Belgian units were delayed three weeks in London. Already VUdpilal de I' Ocean was being shelled and it was deemed unsafe to send additional personnel there. Dr. DePage came over to England in May to consult with the director of the Belgian units and to welcome his wife on her expected return from the United States with drafts for $100,000 which she had raised for Belgium's soldiers. Her eagerness to reach La Panne had made her disregard Germany's warning to the passengers scheduled to sail on the Lusitania on her last fatal trip. The giant liner was sunk and the body of Marie DePage was recovered and was brought in to her husband on the docks. Payment of the lost drafts was cancelled and the fruits of her labors were later sent over by a more fortunate courier, but the American nurses in London were not soon to forget that earnest, intelligent, eager little woman who had waved good-by to them in New York with her smiling farewell : "I am here so that you can be there." Dr. DePage brought his wife's body to La Panne on May 20. The Belgian Units Nos. 1 and 2 had left London the day before for the beach-hospital. From Dieppe to Nieuport- les-Bains, they found themselves veritably in the war zone. At Forges-les-Eaux, where they spent a night at a hospital which sheltered three hundred wounded, they found hotels, busses and trains operated entirely by women and convalescent soldiers. Calais was in total darkness. A Frenchman guided them with a small pocket flashlight to motors which carried them to a school-house; there they spent the night on iron hospital cots which now filled every available building. ^liss Ferree described the fifty-mile ride in ambulances to La Panne, May 19 : The roads are well guarded evcrywhore; thirteen sentries stopped us to see our passports. At noon we drove straight througli the ruins of Dunkirk. La Panne has one long street into wliicli run several smaller ones. The houses appear to have been set down care- 202 HISTORY OF AMERICAN RED CROSS NURSING lessly in the ?and. The beach and sea are beautiful, but all else is desolate among the ruins of shelled villas. The streets swarm with soldiers in from the trenches. The population seems to have swollen overnight from two thousand to ten thousand. Here too, all lights are put out at night and curtains tightly drawn, Marie DePage was buried among the sun-bleached dunes of the shining beach near V llopiial de I'Ocean. Between double lines of soldiers moved the flower-covered casket, followed by American, British and Ijelgian nurses, Dr, DePage, accom- panied by his two sons, who had come in from the trenches for their mother's funeral, marched with officers, Belgian nobility and foreign medical units to the lonely grave, then returned with resolute countenance to carry on the work for which his wife had given her full, joyous life. The first year of the war did not allow Belgium's citizens the luxury and comfort of prolonged grief, there was too much to be done. As viewed from the sea, J'llopifal de F Ocean rose high above the white sands on the sloping beach. A summer hotel had been converted into the main building. Four large tem- porary pavilions, lightly constructed of wood, with corrugated iron roofs on which huge Ked Crosses had been painted, had been erected around it to form the wards. Surgeons and nurses were quartered in summer villas, taken over by Dr. DePage. ''The hospital is very complete," wrote Dr. Hinds, the director of the two Ked Cross units, to ]\lajor Patterson, ''it has two steam laundries, a bacteriological laboratory, a small steam sterilizer, and an instrument-maker who manufactures from steel strips excellent operating-knives and even nickels them afterwards." A newly-installed bath system of twenty-four tubs bathed Ave hundred soldiers a day who came in relays from the front. One regiment was always ([uartered at Da Panne; after scrubbing up, the men received clean underclothing and their uniforms were de-loused and mended. ]\Iiss Winch, an English nurse of tact and executive ability', was ^latron of the hospital. Her staif consisted of well over one hundred and fifty French, English, Belgian, Canadian, American, Danish and Swiss nurses, speaking many different languages, and trained under different customs. The hours of duty were from s A.M. to S P.^l., with two hours off, be- sides ample tinu^ for meals and four o'clock tea. La Panne lav in the coveted road to Calais which commanded THE MERCY SHIP 203 the control of the Channel beyond. Three lines of defense stretched their barbed wire entanglements and sand bnlwarks between Vllopital dc VOrean and the enemy. No one could wholly nnderstand duriiiii,- the snmmer of lOlf) jnst exactly why the Germans did not blow the hospital-city entirely off the shell-cratered beach. Some said the enemy would not harm Elizabeth of Belgium, whose days were spent among the wounded. It was quite a formal occasion when the Queen of the Bel- gians visited the pavilions. Nurses and all patients whose streng-th permitted, remained standing while Elizabeth dis- tributed chocolate and cigarettes. Dr. DePage carried ''the smokes" and ^liss Ferree the candy. A lady-in-waiting always followed the Queen from ward to ward. Dix, a sparrow which one of the boys had brought from Dixmude, had little under- standing of court etiquette. It perched first on Miss Ferree's stitHy-starchcd Red Cross cap and persisted in remaining there until she shook it off. It flew to Dr. DePage's head, then back to its vantage ground above Miss Ferree's neatly brushed hair, where it sat in digiiity until the general laughter of the ward startled it again and it flew to cling \\\i\\ cold thin claws to Queen Elizabeth's hand. "It is remarkable how happy every one is here," philosophized Miss Ferree in her reports to Miss Delano, ''and how soon one gets over momentary fear." Eleven mirses of Belgian Units Xos. 1 and 2 returned October 1, 1915, to the United States after six months' service at La Panne, and their places were filled by nurses whom ]\Iiss Delano transferred from Paignton, England, and Pan, France. Sister Vashti Bartlett took ]\Iiss Ferree's place as supervisor; Dr. W. T. Fitzsimons, of Kansas City, ^lissouri, succeeded Dr. Hind as senior director of the Belgian units. The Americans from Paignton and Pau found life at La Panne vastly more exciting than that among the Devonshire hills or the sunny vall(\vs of the Pyrenees. A fragment of a German shell tore up the bath-room floor of the Albert and Elizabeth pavilion. Another killed nine and injured forty civilians in the street outside. Off-shore the British fleet lay thundering a tremendous response to the long-range German guns. Half with })leasure and half with dread, the nurses watched the great whitc^ geysers flung up by enemy shells, sus- pended for a nionuMit like phantom sails drifting on the blue level of the water. At niuht tlicv lav awake and listen(Hl to the 204 HISTORY OF AMERICAN RED CROSS NURSING "coo-ey" of big Berthas singing through the air over their heads. Their own window^ were zealously curtained and only a dim candle flickered in the long, silent wards. The night- nurses often paused to watch like summer sheet-lightning, the flashes from the trenches a few miles away. The glow of an occasional star-shell often silhouetted a belated fisherman com- ing home across the lonely, glistening beach. Throughout the winter of 1915-1916, Taubes and Zeppelins released their bombs on La Panne as they returned from raids on the Channel ports. Sunday seemed a popular day for bombing because sunshine brought out the crowds on the beaches. The American nurses were not soon to forget the horror that one or two well-placed bombs made. The anti-air craft guns were as noisy as the Taubes, but doctors and nurses no longer left their busy wards to see how many victims the bombing par- ties caused. Fortunately the weather often kept the air craft behind the German lines. The clinging white fog of the Flan- ders coast chilled the nurses' heatless rooms. The cold rains and harsh winds sweeping down from the ]SJ^orth Sea sent them shivering about the loosely-constructed pavilions. Lydia Shrope could not throw off a lingering cough. When Dr. Fitzsimons told her that she had developed tuberculosis, she returned with Grace Bentlcy to the United States in February, 1916, bitterly disappointed in having to leave the Belgian service. After a gallant struggle at a private sanatorium and later at Fort Bayard, Xew ^Mexico, where the Bed Cross had sent her, she died at Fort Bayard, July 14, 1918. L'II6}/ital de I'Orean received only Belgian soldiers and the work was largely surgical. Sister Emogene Miles, who had been in charge of the operating-room at Pan, found the service at La Panne exactly as difficult, as splendidly worth- while as she had anticipated that war nursing near the front would l>e. Sixteen beds in a surgical ward which received only serious operative cases were assigned to her. An English girl acted as her aide. Three Belgian doctors were in charge of the ward. ''Lliey surely work hard to save these exhausted men," concluded Sister Kniogene, "tlie work is sad and many die. I never before gave so many hypodermics as I do here." Gas gangrene with its fetid, sweetish odor, was omnipresent. During the early Flanders spring, iSTational Headquarters recalled Jielgian Units Xos. 1 and 2, after they had completed a year's service at La Panne. This period of time was equal THE MERCY SHIP 206 in duration to that which the units of the Mercy Ship had spent in service to the other belligerents. The nurses of the Belgian units left La Panne in May, 1910. Some joined the American Ambulance at Paris; others did further war nursing in Eng- land; but the majority returned to the United States, where ominous clouds were gathering. On the Western Front, France, Belgium and England faced the "blood bath of the Sommc." Between August, 1914, and May, 1916, Miss Delano alone held in her powerful hands the strands of policy and admin- istration which extended like light steel wires from Washing- ton to the fifteen supervising nurses located in England, Russia, Germany, Austria-Hungary, Serbia and Belgium. National Headquarters of the American lied Cross was then located in a three-story red brick house on the corner of Seven- teenth and H Streets. The Nursing Service occupied two me- dium-sized rooms and a hall-way on the second floor. The finances of the Red Cross did not permit spacious offices, nor had the beautiful memorial building, furnished by contribu- tions from the government and from public-spirited citizens, been completed. Miss Delano shared a single, bare, high- ceilinged room with her stenographer and her assistant, Anna Reeves. A rusty leather couch stood against the wall on one side ; her oak desk occupied a corner. At the back of her swivel chair was a commonplace oak bookcase. Directly in front of her desk was a huge, high-backed wicker chair. By reason of the sunlight slanting in from the windows to the left and behind her, ]\Iiss Delano held the advantage sought by many astute executives, of being able to see every change of expression about the eyes and mouths of the nurses. Army officers and volunteers who faced her during the innumerable conferences held in that busy office. ]\Iiss Reeves had been detailed by the Surgeon General of the Army on Xovcniber 17, lOlo, for duty in connection with the selection of nurses for the Red (h'oss Reserve. She was a graduate of the Piiiladeiphia General Hospital and had joined the Army Nurse Corps in 1910. Upon \wr assignuKnit to the Red Cross she assisted ^liss Delano with the enrollment and helped to recruit and to eciuip the nurses for the Mercy Ship, Her desk and the typewriter table stood on the other side of the room, between an open fire-place and the main door. Adjoining Miss Delano's office was the hall in which Marion Oliver, of New York, worked over the nnich-discussed ])roblem 206 HISTORY OF AMERICAN RED CROSS NURSING of the mobilization of laj-women for war service. At ]\Iiss Boardman's request, Miss Oliver had come to National Head- quarters in 1915 to organize groups of nurses' aides similar to the Voluntary Aid Detachments of the British Red Cross. She was appointed a member of the National Committee on Red Cross Nursing Service in December, 1915, and continued a member of Miss Delano's family until the Red Cross decided that the service of nurses' aides, if such became necessary in the event of war, should be directed by a Red Cross nurse. The Red Cross Town and Country Nursing Service occupied the second room ; here Miss Fannie Clement and her assistants held sway until the removal of this section in July, 1916, to the Mills Building. In a small attic room upstairs, the files of the National Committee, then containing the names of six thousand enrolled nurses, were handled by a Washington nurse, Lily Kanely, of the New Haven Hospital Training School, who also assisted Miss Oliver in the details of examinations and certificates of Red Cross instruction in Elementary Hy- giene and Home Care of the Sick. Equal simplicity existed in other departments at National Headquarters. Miss Boardman was the guiding spirit of the organization. ]\Iajor-Gcneral George W. Davis, U. S. A., retired, was chairman of the Central Committee. Mr. Ernest P. Bicknell, formerly of the Chicago Bureau of Charities, was national director; his duties kept him in Europe the greater part of 1914-1915. In a large room on the first floor Major Robert U. Patterson, ]\ledieal Corps, U. S. A., detailed by the Surgeon General of the Army to the Red Cross, was chief of the Bureau of ]\ledical Service. ^^Ir. Charles L. ]\[agee was secretary of the organization and also acted as dis- bursing officer for the treasurer, the Honorable John Skelton Williams. The pay-roll for the entire National Headquarters, including the clerical staff and a single messenger, contained barely fifty names. ^[iss Delano's official family numbered ten members and an efficient yet informal group it w:is. Althougli she was through- out her Red Cross labors a full-time volunteer, Miss Delano appeared every morning at nine o'clock; often her arms were full of flowers and bright leaves for the vases on her desk and bookcase. Her singular graciousness of personality pi^rvaded the dingy rooms and (>voked from her staff" an interc^st in the Nursing Service which prompted them to work cheerfully after THE MERCY SHIP 207 office hours and durinfj; holidays if need existed. "When you'd once really seen her big heart underneath," said one of her assistants, "you never noticed afterwards how impatient she got with you, or how late she asked you to stay." She often brought her "live stock" to the office. On such occasions her secretary took complete charge of her parrot, bequeathed ^liss Delano by her mother. Polly could not be left alone in the apartment on Biltmore Street, when her mistress was on one of those flying trips to New York, nor could Patrick, an Irish terrier, then on an indefinite visit to ]\Iiss Delano, though the property of an intimate friend. Patrick often sat in the wicker chair, watching the Mount Pleasant cars swing up Connecticut Avenue from PI Street, or crawled across the rugless floor to lick the shoe polish from the glistening boots of Army officers who came to interview his hostess. Warmth of personality characterized Miss Delano's attitude toward every one with whom she came in contact. Her letters to her supervising nurses brimmed over with cordiality and a boundless interest in their welfare. At the time the Red Cross Ship sailed, she equipped with her own hands all members of the various units. She made innumerable visits to the offices of foreign consuls and representatives that the nurses' pass- ports might be visecd. She held earnest, protracted confer- ences with her supervisors, warning them with almost prophetic insight of the troublous days ahead of them. A phase of her many-sided personality was shown in a letter (May 4, 1915) from Helen Fidelia Draper, herself a stanch friend of the Nursing Service : I expect it may have seemed almost too much of an effort for you to come to my house last Friday afternoon. I felt this especially when 1 saw you dressed in ''your best party clothes." 1, too, feel repaid each time wc welcome the nurses and send them olT with a hearty Godspeed. For many nurses who sailed in intervals during 1915 as well as for those of the Red Ooss Ship, ^liss Delano's hand- some figure as slio waved good-by from the docks or from the deck of a tug-boat, was often their last definite impression be- fore distance or pcrhajis a mist of tears blurred their vision. That her "lambs" were now far removed from her immediate solicitous care, dismayed J\liss Delano not a whit. She and Miss Reeves and her secretary packed on the leather couch 208 HISTORY OF AMERICAN RED CROSS NURSING in her office the Lig wooden Christmas boxes which she sent to all the foreign units. With her own money and an even greater expenditure of thought, she bought the articles which went to fill them. The contents of one such box are enumerated in her letter to Vashti Bartlett, at La Panne: four dozen cans malted milk ; six dozen cans condensed milk ; four dozen cans cocoa ; four dozen cans coffee ; one thousand beef cubes ; four dozen cakes sweet chocolate ; two dozen cakes toilet soap ; two dozen tubes tooth paste ; two dozen toothbrushes ; one dozen sweaters. Not content with this, she wrote to the families of the nurses then in active service that the Red Cross would gladly send their presents through official channels lest they be lost in the unsettled shipping conditions. Many of the nurses' salaries (sixty dollars a month) were met through the generosity of Chapter and individual members of the American Red Cross. Letters written by Red Cross nurses to these donors formed one of the strong personal bonds by which Miss Delano endeavored to unite ardent supporters at home with Red Cross workers in the field. Two hundred and fifty-five nurses including the one hundred and twenty-nine of the original units and the additional one hundred and twenty-six others who relieved them, were en- gaged in war nursing between August, 1914, and December, 1915. Miss Delano vigorously denied in a letter written April 9, 1915, to the editor of The Survey, the rumors of atrocities current at that time : I am indeed glad to reassure you that so far as we have been able to determine, no l?ed Cross nurses from any coun- try have met with the mutilation spoken of so frequently. Of" the treatment experienced by our own units, there is absohitely no truth in any sueli reports. One of our units was in Belgrade when that city was captured by tlie Austrians; thousands of soldiers poured into the hospital and were cared for in the same wards with the Serbians already there. Tlie city was recaptured again Ijy the Serbian troops, again by the Austrians, and the American Eed Cross remained inviolate. ^[iss Delano felt an intense personal responsibility for the nurses' health. Slie was greatly distressed that their rooms were so often without heat, as a letter of thanks written Janu- ary 26, 1915, to the Graduate Nurses' Association of Charles- THE MERCY SHIP 209 ton, "West Virginia, sliowed. When cables arrived telling of the typhus epidemic at Gevgeli, her anxiety expressed itself in an immediate, wholly characteristic recommendation to Major Patterson : "May I ask," she wrote, "that six dozen nightgowns, two dozen bath towels, four dozen hand towels, four dozen boxes talcum powder, be ordered for the use of the sick nurses in Serbia and delivered as soon as possible to Red Cross Head- quarters, New York, addressed to me, so that I may pack them in a trunk to go over with the next unit of nurses ?" To JVIiss Krueger she wrote: "I am more than grieved to hear of your illness and that of the other nurses at Gevgeli and am so worried for fear you are not able to get any kind of suitable food. Were it not for fear that there would not be enough nurses to take care of those who are ill," she added, "I should not send other nurses into this danger, but with this thought in mind, we shall probably send additional ones by the first steamer. It often seems to me that I must go abroad at once, if 1 did not realize so completely that my place is here at Headquarters." To Miss Gladwin she wrote: I am sending over with the unit sailing March 16, garments for the nurses to wear when caring for vermin-covered pa- tients. We liave evolved these garments with the advice of people who have lived in these countries. While they are not es])eeially beautiful, I do believe they will lessen the danger of infection. The skirt is made like Turkish trousers, has little exten- sions to fit in the top of the shoes, tying tightly around the ankles. The waist has no opening through which vermin could gain access to the body except at the neck and sleeves. These are arranged to tie tightly as you see. Her extreme practicability, which expressed itself by having these garments made for the nurses, provoked considerable laughter at her expense, in which she would have undoubtedly joined more heartily had s\w not been S(i distressed. ''The service at Gevgeli has been a perfect nightmare to me," she wrote to J\Iiss Gladwin on April 17, "and T have been actually afraid to read the cables as they come in. ... I have notified the families of all the sick nurses, as it seems to inc they have a right to know the conditions. I am simply hcart-lu'oken to think that typhus has (extended to your unit at I>elgrade." 210 HISTORY OF AMERICAN RED CROSS NURSING This intense maternal solicitude did not in any respect, how- ever, imply indulgence. Miss Delano was a stern disciplin- arian. To her supervising nurses she wrote : Do you think the foreign authorities are pleased with the service our nurses are giving? The only thing that worries me is the possibility of conditions becoming a little lax if our units are not fully occupied. Will you impress upon the nurses the importance of dignified and professional conduct both on and off duty? Please do not hesitate to write to me quite frequently if you have any worries. Should any unexpected complications arise, cable me. If you think it necessary for the good of the service to relieve any nurses from duty, be assured that I am ready to support any action you may take, even to the extent of sending nurses home. We have many others anxious for European duty, so I do not believe it would be worth while to temporize much should there be any breach of discipline. Three principal defects in the organization of these pioneer Red Cross units were apparent to Xational Headquarters in 1916, a realization of which was to save much confusion and unhappiness when the Red Cross organized a medical and nursing personnel a year later upon the entry of the United States into the war. First, when the Mercy Ship sailed, the authority of the chief nurse and the relation of the medical director to the nursing staff had not been defined. Second, some of the nurses themselves .did not seem to possess imagina- tion enough to perceive that this condition was due to the speed with which the units were dispatched to Europe and therefore called for even greater exercise of their professional ideal of loyalty to their immediate superior than would have been necessary at home. Instead of endeavoring to live up to this ideal, which was one of the foundation stones of nursing ethics, they took advantage of tlu* geographic separation of the super- visor from the Xursing Service at Xational Headquarters and were the means of partially disrupting the discipline and lower- ing the morale of the entire medical and nursing staffs. Third and most confusing, was tlie effort to enforce Army procedure upon groups of people untrained in its complexities and wholly ignorant of its uses, as were the surgeons and nurses of the S. S. Rod CroHH. The first manifestation of an absence of esprit de corps THE MERCY SHIP 211 presented itself in an open disloyalty between several nurses and their supervisors. This was due in part to a lack of sup- port given by the- medical director to the supervisor and in part to the attitude of a few nurses who seemed to regard their foreign assignment as more of a sky-larking expedition than a disci])linod war service. Perhaps Miss Delano and her su- pervisors in their jealousy for the reputation of the American Ked Cross Nursing Service abroad, may have set up more rigid standards than graduate nurses, long since freed from the severe discipline of training school days, would brook. At any rate, individual nurses complained to the medical directors of various units and the directors, some of them young men whose service as internes had been completed only a few years before, undertook to adjust this ticklish problem with the supervisors. But these women had enjoyed many prerogatives and had borne grave responsibilities at home as superintendents of hos- pitals and training schools. They resented the interference of the youthful medical men in disciplinary matters relating purely to the nursing staff and accused the directors of lack of cooperation and the tale-bearing nurses of disloyalty. The directors then reported their views to Major Patterson, while the supervisors laid their cases before Miss Delano. Lively discussions ensued at National Headquarters. To secure effi- cient nursing service, [Miss Delano maintained, as did her supervising nurses, that the same system of discipline prevail- ing in every well organized hospital should exist also in the Red Cross organization, that all matters relating to the discipline of the nursing staff should be handled by the supervising nurse through recommendations to the medical officer of the unit and to the chairman of the National Committee on Red Cross Nursing Service at Washington, D. C. ; and that the director of the unit should support the authority of the supervisor as long as her services were satisfactory. After thorough investi- gation, ]\[ajor Patterson in January, 1915, issued the following letter of instructions to all directors for foreign units : All of your dealings with the nurses should be through the senior supervisor. . . . Your surgeons shoukl l)e in- structed to refer all requests for detail of nurses, orders, complaints, or other matters regarding the nurses to you to be acted on by you at your discretion. When these units were ()ristion are heard." A letter to a nurse, a close friend, who ditfered radically in o])inion from the medical director of her unit, illustrated Aliss Delano's impartiality, a quality which com- manded the respect of all who kn(nv her well : I wish, however, to tell you exactly what I said to ^lajor Patterson, so that you may understand my position. Of course, 1 know (and so do you) that sonnet inies you are a little '"(litru-ult;"" liut 1 realize that in this inciilciit ihciT liad 214 HISTORY OF AMERICAN RED CROSS NURSING been (^reat provocation and I think that you know me well enough to feel sure that I have only the good of the service at heart, even though this meant the sacrifice of my dearest friends. I have said that I would not consent to your re- turn, except on your own request, until the arrival of the new medical director. If, when he has looked all the ground over, he feels that your relief will be a benefit to the service, I shall be willing to accept his recommendation. Had there been time on the part of Jiational Headquarters to establish a definite plan of organization and communica- tion before the units sailed, much discouragement and unhap- piness would have been avoided when the units found them- selves face to face with these difficulties in the far corners of Europe. Miss Delano appreciated keenly her share of this responsibility. In a particularly trying instance, she wrote to one of her supervisors with singular tenderness and sympathy : I do not wish you to feel in any way that your work has been in vain. I am most unreconciled that things have been allowed to drift along to such a futile ending, but if you have had difficulties in , I certainly have not been free from them at this end. Xever for one moment have I faltered in my support of you and your policy, nor have I doubted for one moment that all would" have been well if you had received from the beginning the support due you, not only professionally but personally. Your letter of discouragement makes me feel as if I had failed you. 1 have taken the liberty of reading the paragraph of your letter, in which you ask to be transferred to another country as one of the "rank and file" to ^liss Boardman. It may comfort you a little to know that she regrets as much as 1 do all tlie unpleasant experiences you have met. Two years later, _Mis3 Delano said to Miss Hay, then re- turned from Europe, '"Xo one will ever know the difficulties I had in trying to support you supervising nurses, nor what ^fiss Boardman has done in trying to secure for nurses the proper relationship and authority which she felt was due the Xursing Service in th(> K(h1 Cross organization." Among the mass of corrospondcnce at Xational IIoad(|uarters which contains the history of the ^lercy Ship, there appears only one letter of derogatory criticism of the nurses as a whole. This estimate was aiven bv a British ^Matron and it will be THE MERCY SHIP 215 appreciated that she was prejudiced to some degree by national ditlerences in training, precedent and temperament which placed the American nurses working under her in a strange environ- ment, at grave disadvantage: ''I think few of them have the real nursing instinct or love of humanity about them," the British nurse wrote, ''they are keen on their own comfort. Their theory, I thought, seemed better than ours, but their practice not nearly so finished as that of a good English nurse. Their discipline was nowhere and their independence too awful." ]\Iiss Dehino responded: "1 am always glad to hear both sides of a question and will take up the matter with the super- visors in charge of these units. The service at has also tried the very souls of our nurses." National Headquarters recalled fourteen of the foreign units October 1, 1915. Belgian Units Xos. 1 and 2 remained at La Panne until the completion of a year's service. The Yvetot Unit was no longer under the American Red Cross. In the Annual Report for 1915, JMajor Patterson stated the reasons for recalling the surgeons and nurses of the Mercy Ship: As the war liad been in progress for nearly a year, it was felt that the sanitary service of the various belligerent countries, as far as personnel was concerned, should be well organized and that with few exceptions they were in such a position that further assistance of surgeons and nurses from the American Ked Cross was no longer greatly needed. This was not true, however, regarding supplies, which it was felt would steadily diminish. These would be increasingly diffi- cult to obtain and, therefore, would continue to be needed in varying amounts by all warring countries. The money that otherwise would be required for the pay- ment of salaries, travel and other necessary expenses would be saved and tlie funds thus released would be available to continue tlie ])ur(hase of medical, surgical and other hos- pital supplies for the Ked Cross societies of the belligerents for many months. Although she had expressed a fervent hope that the nurses sli(uild return immediately to the United States, Miss Delano's interest and encouraging letters followed many of them through their further service in Europe. Four nurses remained on official fori'ign duty in Serbia and Bulgaria. ^Imc. Slavko Grouitcli, wife of the rnder-S(M'retarv of Uoreigii Affairs in .S(>rl)ia, had recjuested in duly, 1915, that the American Red 216 HISTORY OF AMERICAN RED CROSS NURSING Cross organize a unit of two doctors and two nurses to estab- lish in Nisli a hospital for infants and young children. Funds raised bv Mme. Grouitch were turned over to the Red Cross to defray expenses. With Dr. Louise Taylor Jones, of Wash- ington, D. C, as director, Dr. Catherine Travis, New Britain, Connecticut, as assistant, ]\Irs. Maud Metcalf, of Bellevue Hospital, and Miss Grace Utley, of Hahnemann Hospital, New York City, as the nursing personnel, the Mabel Grouitch Baby Hospital was opened Augiist 20, 1915, at Nish, Serbia, there to exist for a few brief crowded months. Dr. Jones had started the dispensary under canvas. The main building was opened October 1. Mme. Grouitch de- scribed this tirst Serbian baby hospital : The Serbian Government has given us a really nice build- ing, the former Old Peoples' Home. Over three hundred cases have been treated in the dispensary during these first five weeks. Women walk all night from remote villages to bring their children. It is heart-breaking to see the wretched, absolutely starved little bodies and the fearful cases of hernia due to the poor mother and baby having been uncared for at birth. The white enameled cribs and beds are the delight and wonder of all. The diet kitchen with its stove and special arrangements, was marveled at with almost religious awe bv' the peasant women who heard for the first time of the necessary care in the preparation of their children's food. The store-room was viewed with that respect always given to abundance by very poor people. In September, 1915, after the hospital and clinic were well established, Dr. Jones returned to the United States, leaving Dr. Travis in charge. In addition to being a hospital center boasting eleven mili- tary and civilian institutions, Xish was the seat of the Serbian Government. In nearby Kraguyevatz were located the arsenals. A member of the Grouitch Baby Hospital described the move- ments of the Serbian troops: For ten days the trains bave been constantly transporting soldiers to tbo Bulirarian frontier, train after train, day and nigbt. Miles of men niarcli tbrough Xish. I have waved to tbem from tbe bill wbcre our clinic is sitnatcd and tboy answer with a shout. At five o'clock one morning, in the THE MERCY SHIP 21T pouring rain, a train filled to the guards passed by with soldiers standing in straw on open freight ears, all singing at the top of their lungs: "There is my Serbia; There is my home !" If the wounded are brought back to Nish, our Baby Hos- pital will at once be turned into a military one. I know we shall take care of the grown-ups with as much zeal as we give the babies. Even if we have soldiers in every bed and on straw stacks in the halls, we will keep the clinic going for the mothers. The Austrian-Bulgarian offensive was hurled against Ser- bia early in October, 11)15. The Mabel Grouitch Baby Hos- pital became a field ambulance October 13 and with mem- bers of the sanitary commission hastened to the front. Grace Utley described the flying squadron of mercy: For ten days we were on the firing line, giving First Aid to the wounded on the field. This sometimes meant imme- diate am))utati()n of a limb, operation on the brain, emergency surgery of all kinds. The bravery of tlie men was magnificent; for some, one prayed for swift death. We saw the big guns silence two batteries. The cannonade of the Austrians and Germans was a solemn thing to hear. We evacuated before the on-coming enemy; moving back a station, we set up our tents anew for the wounded, so that our "Front" was a constantly changing one. We now await here in Nish the arrival of the Bulgars, the Turks, the (Germans. Many places around us have fallen; our turn comes soon. The Baby Hospital under the Stars and Stripes and the Red Cross flag goes on until we are called again to the front; or until the floods of wounded turn this into a military hospital; or until the Bulgars shall order us on our walk with tliousands of other refugees to a port where a ship will take us home; or until we shall be taken prisoners of war. Of the lawlessness which broke out in Nish immediately before the Bulgarian occupation, Miss Utley wrote: Tlie storehouses not under American jurisdiction in Xisli were thrown open to the puhlic. The i)lace where automobiles were kept, as well as any other things that could he of use to the enemy, were hurned uj). Casks of wine were broken open and people carried it into tlieir houses in ])itchcrs. ])ails. or anv utensil handv. ^luch of it streanu'd over the mud. 218 HISTORY OP AMERICAN RED CROSS NURSING Even little children were drunk in a short time. Some of the people broke the windows of their own shops and carried away things without discrimination, or simply destroyed them. The powder magazines were blown up at one o'clock in the morning of the fourth of Xovember. Add to the terrific explosions the constant crackling sound of the flames as they licked up the gunpowder; the sight of mighty towers of solid flame here and there and at intervals a fresh explosion ! One can realize fully how it might affect men who were ill and weak and helpless. For a short time we had almost a panic within our compound. Of their sole protection, Maud Metcalf wrote: Upon our return from the front, we were requested to take over a military hospital filled with wounded Serbians. We went out to its crowded wards one wet dreary afternoon and by the next morning all the officials had left, leaving us with 1100 patients. We were not the most cheerful people in the world. To our dismay, moreover, we found that we were left without an American flag. I M'alked three miles to a village to find all the stores closed and their windows tightly boarded up. After a great deal of talk, a shop-keeper pulled down one board and let me in. I bought some red and white sateen and a little square of blue cloth. Back I hurried to the hospital and we pro- ceeded to make a flag, the other members of the unit cutting out stars while I sewed the stripes together. All of us won- dered what our fate would be. I sat up all night to finish it and in the morning wo cut off a limb of a tree for a pole, nailed the flag to it, fastened the pole to a window frame and there it hung through sunshine and storm for five months while we stayed at our post. At half-past ten o'clock on the night of Xovember 7, 1015, the Bulgars and Turks captured Xish and on the next day the Germans came in, 00,0(10 strong. The military hospital, flying the American and lied Cross flags, remained unharmed and the nurses and surgeons eared without discrimination for the wounded of both the Allied and the Central Powers. National Headquart(>rs cabled the recall of the ^[abel Grou- itch IJaby Welfare Unit in X()vend)er, 1015. :\laud 2^Ietcalf reported in December to Helen Scott Hay in Sofia. Grace Utley and the other Amcu'icans returned home during 1016 after many delavs. THE MERCY SHIP 219 During the snmmor of 1015, Helen Scott Hay and Rachel Torranc(^ had undertaken in Sofia, Bulgaria, under gracious (^ueen Eleanora's protection, the organization of the training school first proposed in 1013. Before taking up the details of this project, it is of interest to read Miss Hay's characteriza- tion of its sponsor: What Queen Elizaocth was to Hungary, that was Eleanora to her adopted country, a woman whose constant thought was for the help of her j)eople. But for her wisdom and in- comparable strength and fearlessness, the small though con- vincing demonstration of good nursing methods in hospitals and in home would not have been possible in Bulgaria in 1915 nor j)robably for long years to come. Of the German house of Keuss and brought up near Vienna, her family, father, brothers and sisters, were all iioted for their kindness and gcnerosit}-. Her concern for the sick be- gan when the parisli priest taught her the simple remedies which she applied in care of the sick poor of the neighbor- hood. In the Kusso-Japanose War, she had good opportunity to learn the value of skilled nursing. During the Balkan Wars, she as Queen was head of the Bulgarian Eed Cross and then indeed the lack of good nurses and good nursing schools was impressed upon her. That she at once began to plan how this defect might be remedied is characteristic of her sympatlietic desires for her people and of her indefatigable purpose. . . . In her manner, she was simple and without ostentation and repeatedly surprised even her best friends by her sound wisdom and good sense. There was nothing of the dilettante about her. in questions of curriculum and discipline, she would have been a helpful speaker in any group of nurse in- structors. . . . No detail was too insignificant for her at- tention if it meant someone's happiness or added comfort. A village wedding, an insane soldier, the ambition of an or- phan girl for an education, everything that would help she did at once. Schools for the deaf and dumb, help for the blind, care and cure of the tubercular, a thousand interests big and little were hers and of her strength and her means she gave to the utmost. . . . Two other women instrumental in the organization of the ''Queen's School" were Madame l>aknietietl', Avife of the Bul- garian di])lomat who was latiu- Amhassiidor to the Fnited States. an(i Miss Inez Abbott, directf.ti' <.>f the Girls' Scho(_)l in Samakov. 220 HISTORY OF AMERICAN RED CROSS NURSING Miss Hay wrote of her assignment to Bulgaria and her reception there : To Kief early in 1915 came Mr. Bieknell from Bulgaria, where Queen Eleanora had discussed with him her ardent de- sire to see the School established, even though the times con- tinued unpropitious. As I was then about to return to America, Mr. Bieknell felt that I should go to Sofia and acquaint myself witli conditions there; so early in June, 1915, I went to Sofia with the understanding that my mission was only to inform myself of conditions such as would be helpful should the School project be resumed later. From the moment of my arrival in Sofia, the Queen was most hospitable. . . , During the weeks which followed, I visited the Alexander, Wed Cross and Clementina Hospitals, met numerous men and women favorable and unfavorable to our plan and had many conferences with the Queen. At this time Bulgaria seemed to me to be singularly peaceful com- pared with tbe military Eussia I had just left. True, she was still weary from the Balkan Wars and who could tell what the King, Cabinet or ^Minister might do when faced with the increasingly complicated situation due to the European War? Scarcely had my first week in Bulgaria passed before I found that the Queen was arriving at the same conclusions I held : that the need was beyond question and that the time was as o})portune as it was ever likely to be. "You are here,'' she said, "and \vc should begin at once. There will be big difficulties and much opposition but my shoulders are broad." The plans proposed months before in Washington were that the Alexander (the Government) Hospital of 1000 beds should 1)0 used for the jiractical training and that in turn the Hospital would pro\i(le Inrdvd and lodging for the entire School besides a stipend of 10 levs monthly for each ])upil. The Samaritan Society of Sofia were to provide uniforms and textbooks and to work to secure funds for a permanent nurses' home. But times had changed and interest shifted and the only concession whicli tlie Queen could get for the Schofd after days of weary effort was the nursing care of one pavilion and tliat without return of any sort. A private house in the nei,i:hborho()(| -aas secured for the nurses' home, was fitted and furnislied in exquisite taste under her per- sonal direction and ail expenses with it, with the pupils' gen- erf)us uniform allowance and other items came trom the (Queen's ])rivate purse. THE MERCY SHIP 221 On September 15, the School was opened with Miss Hay as Director and Rachel Torrance as assistant. The pupils num- bered eight; one of them had had full college training; two had had two years in college ; two others were graduates of high schools and the rest had had some years in high school. All were Bulgarian and all but one spoke English. A course of study covering two years and corresponding to the "Standard Curriculum" had been adopted by Miss Hay. Of the fortunes of the School, Miss Hay wrote: On the very fust morning of classes, the Queen brought us the news that Bulgaria was on the eve of mobilization, having thrown in her fortunes with Germany and Austria. We must therefore place our pupils at once, she said, in the Alexander Hospital to assist in caring for the soldiers. I begged for a few weeks, even a few days, for preliminary training and we were able to give almost a month to it. In the excitement of a nation going to war, no wonder we found our pupils un- usually apt ! All day long they made beds and poultices, gave each other baths and simple treatments to the music of a military band or of fife and drum that in the parade ground hard by was continually welcoming troops of war-weary vet- erans and exuberant recruits pouring in from all quarters ol the kingdom. Then fighting began of? to the West and North and we made ready our pavilion at Alexander Hospital. As a good nurses' school, we must stand for the highest standards of cleanliness and order. Scarcely was the last yard of paint scoured white, the last toilet made spotless, the last bed benzined, however, when the German lied Cross with doctors, nurses and vast supplies began arriving in Sofia to take over the direction of all military hospitals in Bulgaria. To Alex- ander Hospital came the chief. Dr. Goldammer, and his as- sistants. With our pupils we were left the nursing care of our pavilion, l^ut not for long were we allowed to enjoy our clean quart(>rs. A nurses' school meant to the (icrinan direction undesirable complications and (most obnoxious I) division of autbority and they would have none of that. So with tbank-yous and good wishes all around, our School was transferred to Foteenoff Hospital nearer the center of the city. FoteenofT Hospital was under the Queen's control and was directed by a sympathetic Bulgarian physician, Dr. Micliael- ovsky. For five months, the "Queen's vSchool" flourished there, 222 HISTORY OF AMERICAN RED CROSS NURSING but early in 191G Dr. ]\Iichaelovsky grew ill and a German physician was put in charge and German Sisters were installed in the operating-room. Miss Hay wrote: These were the days of increasing animosity between Ger- mans and Americans. Moreover, German methods of train- ing are wholly different from ours. And again arose the question of divided authority. Sad it was but unquestionably true that the building up bi a good nurses' school under American methods was not then feasible. The Queen, too, came to the same conclusions, probably on account of the in- creasing opposition of the King and Prime Minister to her giving any longer her favor and protection to Americans. So the transfer of the pupils of our school was made and back they went to the Alexander Hospital. . . . However, the Queen was not the one to relinquish easily a project as dear to her as was the introduction of American nursing methods in her country, so she begged Miss Torrance and me to remain in Bulgaria so that the School might l)e resumed speedily as soon as the war was over. Even if the Germans did not further desire our services, there were many Bulgarians whom she felt we might assist. And was it not to help these that we had come to Bulgaria? Ami so it was decided that we could help most effectually in the care of the refugees. In Phili])opolos, second city of Bulgaria in size, with a normal population of 60,000 there were a large number of refugees, some the remnants of other Balkan Wars, others just arriving from the Greek and Macedonian fronts where fighting had already begun. National Headquarters cabled its approval to the change in assignment and authorized ]\Iiss Hay and ]\Iiss Torrance to spend their small balance of five hundred dollars in general relief work. Miss Hay wrote : The plan was that we should work in cooperation with the American missionaries under the American Board; their long residence made them familiar with local needs. We were attached to a local women's organization, the Samari- tans, which endeavored to find the neediest sick and supplied them with milk and eg,<,^s. The women in tliis grou}) under the aide U'adershi]) of .Airs. Stephen Kaltcheff, stood sponsor for us. two straneech- ing in wliispering tones: "Sister, do you think I shall live tc reach home? 1 want only to live one day at home again in Hungary," and then the skeleton hand and arm would steal from underneath the bed clothes in an attem])t to take m\ hand and kiss it for the solace and commiseration oU'ered The psychopathic cases were usually melancholia or the busy, chattering type, the subject of their mania being invariably the horrors of war. 226 HISTORY OF AMERICAN RED CROSS NURSING Scurvy worked great havoc among the captives. We aided 856 victims of this disease whose teeth had fallen out and who were unable to walk from stiff and swollen joints. In fact, it seemed that every sickness known to civilized man found here a ready prey. A major general suffering from nephritis told me that the lieutenant general to whom he had surrendered Avas a prisoner in his country and on his return to his home he would endeavor to have his captor re- leased and sent back to Russia. "We are two broken men," he said, "with only perhaps a few months more, which should be spent with our families." We can readily comprehend the depths of their despond- ency, returning blind, crippled and ill, many of them to destitute families and many of them to endure in pain and poverty a living, lingering death. We often wondered if our twentieth century civilization was but mockery, or if it had only endowed barbarians with more efficient and ruthless weapons and methods of slaughter. Where, we asked, is the culture, where the loving message of Christianity, where the humanity that can countenance such savage and infamous cruelties? The only answer from this gruesome slaughter- house of hopes and desires was the pathetic prayer of the sufferers for peace. Although by Christmas, 1915, the Red Cross had closed its foreign program, Miss Delano, as chairman of the National Committee on Red Cross Nursing Service, was in an excellent position to gain a bird's-eye view of almost every phase of war nursing. She saw the American Ambulance which had been established in September, 1914, at Neuilly, France, by the American Ambulance Committee of Paris. Here many American Red Cross nurses were stationed with Margaret Dun- lop of the Pennsylvania Hospital, Philadelphia, as chief nurse. She saw the first Harvard Unit serving with the British Ex- peditionary Forces at General Hospital No. 2-3. The McGill University and the Chicago ^Medical units were their close neighbors. From personal letters written by Red Cross nurses scattered with other organizations in all parts of the world, she gathered wdsps of information about the nursing situation. Two members speaking for the American Ambulance might well have voiced the feelings of other nurses serving in the war: We never saw the flashing battle-line, that arch of bright steel that stretches 300 miles l)etween France and Germany, we did not hear the cannon or Ion"- lines of men cheerin"- as iTHE MERCY SHIP 227 they swept into action, or the dying horses scream; we saw none of tlie pageantry of war; but we did get a glimpse be- hind the scenes of its most real, its most lasting part. We saw the long ambulance trains, those "rivers of pain" running back from tbe lines; we saw strong men sobl)ing with agony like children; we saw them crippled, dying; we saw their women struggling alone against anxiety and poverty, pale women with that look in their eyes which comes of sleepless nights and unshed tears; we heard little children crying for the father's love they will never know again. All these things are the necessary routine of war. We have seen and we caji never forget." At the close of this first early chapter of American Krd Cross participation in the European War, ]\riss Dehmo summed up the value of the service which had been rendered by the American Ked Cross nurses : Two hundred and fifty-five nurses have been sent to Europe, When we think of the vast number of sick and wounded, the thirty thousand patients cared for by our units seems piti- fully small. T do believe, however, that we have established in European countries, where modern training schools for nurses have not yet been organized, a definite standard of nursing, which will surely produce results later. Our nurses have had a valuable experience which should be of benefit to our own country. They have learned how to care for large numbers of patients all weary, ill, hungry and cold and to make them comfortable in the shortest pos- sible time without disturbing the routine of the hospital. ITe have learned that women can be mobilized without con- fusion ; that their chances of illness when carefully selected seem to l)e no greater than men's ; that they face danger with equanimity. We have learned also the special type of nurse most desirable for service of this kind. Out of this experience we should bo able to do a splendid piece of constructive work for our own country. We should be able to guarantee a satisfactory nursing personnel not only for national relief in time of calamity, !)ut for etlicient service should our country be confronted with that greatest of all disasters War.^-^ For the American Ived Cross, the first enthusiasm of world sympathy had s})ent itself. But an all-shadowing responsibility ^' .[mcrinni Journal of Xiosinf/. \'()1. X\'. ]). ^iriA. '" Ainciuan Hrd Cross Annual lU'jiort, 11)1."), pp. 44-45. 228 HISTORY OF AMERICAN RED CROSS NURSING loomed ahead. Although popular inclination clamored for peace, men and women at National Headquarters stood looking ahead to a day not far distant, when American men might wait in a welter of sand, mud and flesh as the trenches about them crumbled under enemy fire ; when American boys might lie in casualty-clearing stations under a Mexican sky or in a I'lemish farm-house, tearing at wounds in blessed delirium or biding their turn in stoic consciousness of physical agony. War, dimly visible through diplomatic and economic events of 1915 and 1916, was hurling at the American Red Gross the challenge of its charter obligation : Look to thine own ! CHAPTER V MOBILIZATION National Headquarters Reorganizes The National Com- niittee on Red Cross Nursing Service The Committee on Nursing of the Council of National Defense Special Courses Special Groups The Army School of Nursing The Nurses' Drives Surgical Dressings The Nursing Surveys. The International Conference of Geneva in 1863 recom- mended "that there exist in every country a committee whose mission consists in cooperating in times of war with the hos- pital service of the armies by all means in its power." Suc- ceeding to all the rights and properties of the earlier organiza- tion, the American Red Cross was reincorporated under Gov- ernment supervision by an Act of Congress approved January 5, 1905. In the charter of that date under which it still acts are enumerated four purposes of its creation, three of which deal with relief to the sick and wounded of the Military Estab- lishment, as follows : First. To furnish volunteer aid to the sick and wounded of Armies in time of war, in accordance with the spirit and conditions of the Conference of Geneva of October, 18G3, and also of the treaty of the Red Cross, or the treaty of Geneva, of August 22, 1S()4, to which the Ignited States of Aiuorica gave its adhesion on iMarch 1, 1882. Second. And for said purposes to perform all the duties devolved upon a national society by each nation which has acceded to said treaty. Fourth. To act in matters of voluntary relief and in ac- cord with tlie military and naval authorities as a medium of communication between the ]ie()])le of the T'nited States of America and their .\rmy and Xavy. and to act in such mat- ters between similar national societies of other governments through the ''Coniite International de Secours'' and the Gov- 229 230 HISTORY OF AMERICAN RED CROSS NURSING ernments and the people and the Army and Navy of the United States of America. For two years before the declaration of war, April 6, 1917, the Red Cross underwent a period of tensely active but silent mobilization. The experiences of the foreign units, which had witnessed the initial collapse and subsequent reorganization of the sanitary formations of the belligerents, had made clear to the xVmerican Red Cross that it must be ready to meet its responsibilities should the United States enter the conflict. Even a year earlier, namely in April, 1914, Miss Delano had begun making plans for an enlarged enrollment. At a meeting of the National Committee on Red Cross Nursing Service held April 24, she requested the State Committees to send to her lists of all training schools in the respective states which fully met the Red Cross requirements ; also additional lists of those meeting the requirements only in part. She asked further for lists of nurses who were especially well fitted to serve as (1) superintendents; (2) head nurses; (3) clinic nurses; (4) dietitians. Under a revision of the By-Laws of the American Red Cross adopted by the Central Committee at the annual meeting in December, 1915, the National Committee on Red Cross Nurs- ing Service, which had been a subcommittee of the War Relief Board, was thenceforth to be appointed directly by the Red Cross Central Committee and to work under its direction. In December, 1915, the members of the Central Committee were: William H. Taft, chairman; Gen. Charles Bird; Mabel T. Boardman ; Admiral William C. Braisted ; John W. Davis ; Robert W. DeForcst : Gen. William C. Gorgas ; John Bassett Moore ; Judge W. W. ^hu-row ; Charles D. Norton ; James Tanner ; John Skeltoii Williams. At a meeting of the Central Committee on l)eceml)er 13, 1910, the Surgeon Generals of the Army, Navy and Public Health Service, the presidents of the three national organizations of nurses and a number of other officials designated by title were made ex-officio members of the National Committee on lied Cross Nursing Service. In February, IDIT. the National Committee, on its own recom- mendation to the Central Committee, was increased to forty-six members 1)v the appointment of twenty-three additional repre- sentatives from the three national societies of nurses. The three relief boards, i.e., War, National and Interna- MOBILIZATION 231 tional became advisory boards. All activities were grouped under two main departments: Civilian Kelief and Military Itelief. Ernest P. Bicknell, who had been national director of the organization from his appointment in 1908 became Di- rector General of Civilian Relief and Colonel Jeiferson Ran- dolph Kean of the Medical Corps of the United States Army was made Director General of Military Relief. Col. Kean outlined the scope of the Department of Military Relief in the Red Cross Annual Report of 1916, as follows: It has supervision of all the work of the Chapters relative to the various branches of military relief work, such as Euro- pean war relief, assistance to our own soldiers, instructions in First Aid and Home Care of the Sick, etc. It deals directly and without the intermediation of the Chapters with the military units such as base hospitals, ambulance companies, hospital units, surgical sections, sup- ply depots and naval and emergency detachments of nurses which are organized with the approval of tlie Medical Depart- ments of the Army and Xavy to reinforce these services in case of war. It administers also all agencies of assistance to the sick and wounded soldiers of foreign countries and to prisoners of war. These manifold activities were conducted through three bureaus: ^lajor Robert U. Patterson of the Medical Corps of the United States Army, who had been Director of the Bureau of ]\Iedical Service from its creation in 1914 was continued as Director; Dr. Theodore W. Richards, United States Xavy, was in charge of the Bureau of Supplies ; and from September, 1910, Clara 1), Xoyes was the Director of the Bureau of Nursing Service. Upon the last-named, newly-organized Bu- reau was placed the responsibility for all work in connection with the selection of nurses for enrollment and the organization of units of nurses for service, the assignment of nurses to duty and all details relating to the courses of instruction under th(> Red Cross in Home Hygiene, Home Dietetics, the ])repara- tion of surgical dressings and hospital garments; evcrvtliing, in short, except the public health nursing (then the Town and Country Xursing Service). The rush of work of every kind during 191^ is indicated in the Annual Rep^u-t for that year. It shows that nicnibcr- ship in the Red Cross had risen from i!2,()U0 to some ."UlOjUUU 232 HISTORY OF AMERICAN RED CROSS NURSING odd and even that was only a beginning. The appointment of Miss Noyes as Director of the Bureau of Nursing was of great moment to the Service. To take up this task of infinite detail, untold anxieties and extreme responsibility, she re- signed one of the foremost nursing positions in this country, that of General Superintendent of Training Schools for Nurses, connected with Bellevue and Allied Hospitals, New York City. Clara Dutton Noyes had had long experience in the admin- istrative work of her profession. Born at Port Deposit, Mary- land, she came of Connecticut parentage. Her father had served, as had J\Iiss Delano's, in the Civil War. Miss Noyes was graduated from the Johns Hopkins Training School for Nurses in the class of 1896, where she served for a year after graduation as a head nurse. She was for some years super- intendent of nurses at the Hospital for Women and Children, Boston, and later superintendent of St. Luke's Hospital and School of Nursing, New Bedford, Mass., leaving there in 1910 to accept the general superintendency of Bellevue and Allied Training Schools. Trom 1913 to 1916 she was president of the National League of Nursing Education, and president of the Board of Directors of the American Journal of Nursing from 1911 to 1918. As a result of her broad and many-sided interests she brought to the Red Cross a keen appreciation of nursing problems. Professional claims were never ignored even in the intense absorption of her Red Cross work. She be- came president of the American Nurses' Association in the spring of 1918, serving thus through the trying days of war and demobilization. On April 3, 1916, Miss Delano first approached Miss Noyes, who was at that time also chief nurse of Base Hospital No. 1, Bellevue, the first unit to complete the organization of its nursing personnel. Miss Delano had hurried to New York to confer regarding the Bellevue and Presbyterian units of nurses, then being detailed with their respective base hos- pitals. On her return to Washington, she wrote to Miss Noyes : Ever since I saw you at Miss Maxwell's, I have been won- dering if you really would consider coming to the Eed Cross. There is no (loul)t in my mind that there is wonderful opportunity to develop for this country a service such as we never dreamed of in the hoginning. It is a piece of work which needs constant thought and 1 should he very happy if ^^^^1^ ii^^ P m k f ; j 1 i 1 Jj ^p 1 1: ' .. . _ . i^; - .. ^fy.-i : . 44 Photo, by Harris and Exnng Clara Dutton Xoves. MOBILIZATION 233 by any chance you are willing to consider coming to Wash- ington. The Director General of Military Relief, Col. Jefferson E. Kean, has under his department two bureaus, Medical and Nursing Service. Major Patterson is chief of the Medi- cal Bureau and you would be chief of the Nursing Bureau. I sliould still be chairman of the National Committee on Eed Cross Nursing Service, but this committee would become advisory and could be called upon if needed. For several years Miss Delano had been hoping to free her- self from the confining office life which she had led since 1909. Her resignation from the Army Nurse Corps in 1912 to de- vote her attention undividedly to the Red Cross had been the first step toward this relinquishment of executive detail. Her wish was to establish a capable director of the Xursing Service at National Headquarters and to continue holding her own position as chairman, thus releasing herself from excessive routine. She dreamed, also, of a little home in the country to be prepared for her later years, for she had inherited a love of rural peace and quiet from her New England ancestry. The war pressure now gave impetus to her plan for the office, but banished that for her own future. Miss Noyes, however, was not at first disposed to give up the work at Bellev^ie, with its large branch hospitals at Harlem, Fordham and Gouverneur, and its specialized schools of mid- wifery and of male attendants. On June 1 Miss Delano took up again with Miss Noyes the need existing at National Head- quarters for an able organizer and executive. She wrote : I am still hoping that you will be able to come by the fall and it would be my idea to build up a definite group of nurses who would really be assistants to the "Chief of the Nursing Bureau"' or "Superintendent of Nurses" or whatever the new position may be called. This would relieve the Washington Office of many details and would divide the work so that local interest would be maintained, still leaving the direction and final word at Eed Cross Headquarters. We must have a strong woman in Washington ! There is too much at stake now to take any chances and 1 feel in my very soul that you are the person for the place. ]\Iiss Board- man adds her persuasion to mine. A letter written five days later gives a more vivid picture of the press of work at Head(]uarters, and shows that Miss 234 HISTORY OF AMERICAN RED CROSS NURSING Xoyes was giving grave consideration to Miss Delano's urgent appeals : I am hoping that it may not be necessary for you to come until you can do so with an easy mind concerning Bellevue. It is an awful wrench even at the best to give up such an important work and I am willing to do my share. Things were pretty bad here when the rush first came, for it was diflficult to get extra stenographers, at least good ones. So many of them had gone from the Departments to "the front," in this case over to Fort Meyer. We are getting on better now and tlie feeling that you are available if a great need comes makes it all mncli easier. We can surely wait through July unless new conditions develop in Mexico and if I keep well, perhaps even longer, so that you too may have a vacation. I am so tired I can scarcely write. Was at the office all day yesterday and Sunday as well. Miss Delano outlined the. new work more definitely in a letter written on the seventh : Instructions for enrolled nurses as members of hospital units should be prepared. Outlines are needed for chief nurses who are to undertake the practical instruction of nurses" aides. Some method should be developed for the inspection of classes of instruction to women so that incapable instructors should not be allowed to continue. There will be a new course in Dietetics ready in the fall, which will make supervision more than ever necessary. I believe there is a distinct menace to our nursing standards in the development of this lay personnel unless it is carefully directed and supervised and that at this time no work in the entire country compares with it in far-reaching results or importance. T simply cannot do it alone but will help in every way in my power and as 1 have said before, am perfectly willing as chairman of the Xational Committee to support you to the uttermost in any policy which you may think desirable. ]\riss Xoycs came to \Vashington on June 13 to interview Miss Delano, Miss Iloardnian and General ^Murray, thou act- ing chairman of tlic^ Kxecutive (^)lnmittee, regarding the Ked Cross appointment. On June 24 a short note from ^liss Delano to Miss Xoyes gives a second picture of Xational Headquarters: MOBILIZATION 235 You can imagine how busy v/e are and how interesting it is! We have just opened another ofliee across the street [H and 17th | for vohmteer workers. . . . They are address- ing envelopes and sending out hundreds of form letters. The Chicago Chapter has agreed to employ a nurse and Xew York is also ready. There is a tremendous piece of organization work to be done and your country certainly needs you ! I am trying to be patient, for I am sure you will do what is best, but you cannot know how many times a day I long for your cool judgment and wise counsel. Miss Xoyes accepted the directorship of the Bureau of ISTurs- ing July 24 and came to Washington September 10, 191G, to devote her whole time and all her powers to the Ked Cross. A woman of clear judgment, of excellent organizing ability and jealously ambitious for her chosen profession, she was wholly relied on by jMiss Delano, with whose more intense and dramatic nature the exceeding reserve of Miss Noyes was in striking contrast. Under the cool poise of her outward bearing there was a naivete and warmth of personality, only appreciated by those who knew her well. Like Afiss Delano, she was tall and of commanding presence. Like her, too, her gray hair became snowy white during her Red Cross labors. The nursing staff now mimbered five, not including the Rural Service. Besides Miss Delano, Miss Xoyes, Miss Reeves and Joseplrine Johnson, Katrina Hertzer, a member of the Navy Nurse Corps, who had served with Unit E at Budapest, was detailed on September 20, 1916, by the Bureau of Medi- cine and Surgery of the Department of the Xavy to act as Imison officer between the Navy Nurse Corps and the Red Cross, at that time organizing Navy base hospitals and detach- ments. ]\riss Hertzer was born in Ohio and was a graduate of the Illinois Training School for Nurses. Before her assign- ment by Surgeon General Braisted to the Red Cross, she had been superintendent of nurses of the City and County Hos- pital, St. Paul, Minn., and chief nurse, U. S. Naval Hospital, Chelsea, Mass. On the 25tli of January, 1917, the Red Cross Headquarters organization moved from its old location to the beautiful build- ing on Seventeenth Street facing Potomac Park, which was erected as a memorial to the "Heroic Women of the Civil War" and d(xlicated as the administration h(\id(iuart(U's in pc^rpctuity of the American Red Cross. In common with tlit> other de- 236 HISTORY OF AMERICAN RED CROSS NURSING partments the Nursing Service had completely outgrown its old quarters. Singularly appropriate is this Georgian-Colonial structure of Vermont marble, set opposite the ellipse of the White House, the second in that fine chain of buildings which extends down Seventeenth Street to the Tidal Basin. On its left is the Corcoran Gallery of Art ; on its right, Continental Memorial Hall, belonging to the Daughters of the American Revolution, and just beyond that is the Pan-American Building. Its history goes back to the Civil War, to two of Lincoln's volun- teers of 1861, Francis Barlow and James Scrymser. Sergeant (later General) Barlow was wounded at Antietam and again at Gettysburg. His wife, a member of the Sanitary Commis- sion, went to the battle line to nurse him, there contracted typhus and died, 1864. To her husband, she typified the spirit of women in war time and in 1896, not long before his death. Major General Barlow prophetically said that some day the nation would build a fitting monument to the women of the Civil War. His friend. Captain Scrymser, heard his words and was afterwards one of the guarantors for the amount pledged for the building. The story of how the memorial was assured and built may be read in Miss Boardman's book ''Under the Red Cross Flag." On the first floor to the left of the stairway Miss Delano and Miss Noyes shared two spacious rooms, green-tinted, with books and photographs, soft-toned rugs and dark solid furni- ture, all in marked contrast to the scarred oak desks and worn floors of the H Street ofiices. Miss Delano then matched her one wicker chair by others equally comfortable. She often received contributions from friends who were interested in the Nursing Service and these went into a special fund for equipment, books, or other things connected with the welfare and comfort of Red Cross nurses. The volume of routine work of the Nursing Sendee at this time was outlined by ]\liss Delano in a letter written on August 'M, lOlC), to Miss Boardinan : The only tliinliss. Jr.. and Edward X. TTiirley, w itli William Howard Taft, chair- man, and Eliot Wadswortli, vice chairman of the Central Committee, ex- oilicio. MOBILIZATION 239 take charge of the mobilization of dietitians for the base hos- pitals and to supervise class instruction for women in the Ked Cross course of Home Dietetics. Helen Scott Hay was the next nurse to join that strong group brought by Miss Delano to National Headquarters. She and Kachel Torrance had had an eventful trip home from Bul- garia, following the declaration of war by the United States. The organization of the base hospitals, which called for twenty- five nurses' aides for each one, had given great impetus to the class work in Elementary Hygiene and Home Care of the Sick. Miss ^oycs^ duties in the selection and assignment of nurses were multiplying to dimensions beyond the control of one in- dividual. Miss Hay accordingly came to Washington in July, 1917, as dii'ector of the newly-created Bureau of Instruction. In January, 1918, ^fiss Hay resigned from the Nursing Service to undertake at the request of the Surgeon General some special work for the Army Nurse Corps and Harriette Sheldon Douglas, a graduate of the Boosevelt Hospital, New York City, became director of the Bureau of Instruction. At this time, the scope of this Bureau was broadened to include the assign- ment of nurses' aides to foreign services and the name of the Bureau was enlarged to that of the Bureau of Nurses' Aides and Instruction. With Lliss Douglas there came an interesting link with the Civil War days, for she was the daughter of the late Dr. John Hancock Douglas, attending physician during General Grant's last illness, who was also one of the three associate secretaries and Chief of Inspection of the Sanitary Commission during the Civil War. Though she had not been engaged in active nursing for some years, ^liss Douglas volunteered her services to the Bed Cross in the early winter of 1917. Her appoint- ment to the Bureau of Nurses' Aides and Instruction was a particularly happy one, in that she combined the viewpoint of both the laywoman and the nurse. Slender and spirituelle, a flame of ardor in earnest eyes lit the view !Miss Douglas had so clearly of the human creature in every lonely and neglected pa- tient. As a sister of Bishop Harding of Washington, she was also in a particularly fortunate position to bring to the support of her work the interest and enthusiasm of many Washington women. Lucy ^linnigerode ( Im-IIcvuc ) joined ^liss Noyes' statl' in August, 1917, to take charge of the special units tluni l)(>ing 240 HISTORY OF AMERICAN RED CROSS NURSING organized for the War Department and for Red Cross foreign commissions. She too had sailed on the Mercy Ship, serving in Kief; she too was intensely devoted to Miss Delano. She continued her Red Cross work until December, 1918, when she undertook a supervisory tour of the U. S. Public Health Hospitals, later becoming superintendent of nurses of the U. S. Public Health Service. Absolutely fearless, impulsive and out- spoken, devoted to her friends, resolute toward opponents, in Miss Minnigerode were found many attributes of the typical pioneer. The Town and Country Nursing Service had as its Director Pannie Clement and later Mary S. Gardner and Elizabeth Fox. An account of this Service and its leaders will be given in a subsequent chapter. Other nurses who assisted Miss Delano and Miss Koyes at N^ational Headquarters at various periods during the war were Lyda Anderson, Florence Patterson, Virginia Ward, A. Maury Carter, Adeline H. Rowland (Mrs. Robert Gourlay), Josephine Johnson, Sarah Addison, Barbara Sandmaier, Lulu J. Justis, Charlotte Brewer, Adelaide Tennant, May Claypool, Charlotte Garrison, Elsbeth H. Vaughan and Marie Roder. In that memorable summer of 1917, thousands of letters in- undated National Headquarters. Many were deeply touching in their genuine desire to help ; others were full of war-hysteria ; some were shocking in their unconsciously displayed reversal to the frame of mind of the massed audiences at thrilling mo- ments of the gladiatorial combats of the Coliseum: all effer- vesced with "patriotism." One woman stated as her chief rea- son for volunteering that "her family had always taken an active part in disturbances of the nation." Another wrote : Will you accept my servicos as an unprofessional nurse? 1 am a woman .'35 years okl, have a quiet disposition, a clean character and always keep my nerve under some very tryin<^ circumstances. T work every day on a milk wagon, so you see I am strong and not lazy. A commercial firm wrote : Kindly furnish us with lists of names and addresses of the nurses who are members of your organization. Upon receipt of your reply, we will be pleased to send you a full-sized bottle of our best grade of malted milk for your trouble. MOBILIZATION 241 The flood of letters had, indeed, begun even a year before, and was stemmed very largely at first by the steady work of volun- teers. Of the first staff" of faithful volunteer helpers, Miss De- lano had written : During the summer of 191G, there was such an enormous increase in the correspondence coming to the office of the chairman of t!ie National Conmiittee on Red Cross Nursing Service, that it was found impossible to conduct the work without a great increase in the office force. Believing in the desirability of utilizing volunteer workers for Ked Cross service, we asked for the assistance of various groups of women who had had our course of instruction in Elementary Hygiene and Home Care of tlie Sick ami others interested in Red Cross work. Among the first to volunteer were Miss Joan Ohls and Mrs. Callan O'l^ughlin, who came to us when the pressure of work was greatest, and hel])ed us to conduct a mailing bureau through which thousands of letters and circulars were sent out. Both Miss Ohls and Mrs. O'Laughlin came to the office daily through the greater part of the summer. ^Irs. G. S. Meloy and Mrs. Richard Wetherill, of Lanham, Maryland, came regularly for several months, giving to the Eed Cross an entire day each week. They were of the greatest assistance, as they helped in many details of office work re- quiring a high degree of accuracy. They were assisted from time to time by Mrs. F. N. Wells, Mrs. Edgar Brown, and Miss Cross, also of Lanham, Marylaiul ; the Misses Stewart, of Washington. D. C, and Miss P]ugenie J. Cuthbert, of Chevy Chase, ^Maryland. Mrs. Robert Walcott Weeks devoted practically the entire summer to Ked Cross work in the office of the chairman of the National Committee on Red (^ross Nursing Service, com- ing as regularly as any other member of the office staff, assist- ing in every way j)ossible. The Misses Malum. Haas, Lloyd, Hardy, Harvey and other enrolled Red Cross nurses came frequently as volunteers and ]\Iiss Lucy ^linnigerode devoted her afternoons to Red Cross work, taking as her special task the sending out of api)oint- ment cards and badges to enrolled Red Cross nurses. Volunteer secretari'js (f this calibre were regularly available tlirougli the crisis and numy were called upon. By September, 11)17, more than 5,000,000 p(H)ple had been enrolled as lied Cross members; by December, there were lJw,O00,OOO. Chapters, numbering ."itj^ when war was dt'clared, 242 HISTORY OF AMERICAN RED CROSS NURSING totaled 3,700 one year later, with a quota of 8,000,000 volun- teer workers, a man-woman-and-child power such as no other organization in the world could claim. This brought, however, an incalculable amount of detail to National Headquarters, which would have been entirely ''swamped," had not the War Council created the new organization plan called ''decentraliza- tion, with Division offices." National Headquarters had main- tained a branch office in New York City as early as 1912, the budget appropriations for which were contained in the Minutes of a meeting of the Executive Committee held Decmber 30 of that year. As the need for Red Cross disaster relief in- creased, the following action was taken by the Executive Com- mittee, meeting October 31, 1913 : Mr. Bicknell then presented to the committee a suggested plan for the extension of the administrative efficiency of the Bed Cross in organization and emergency relief. The plan, as outlined, involved the employment of four Division di- rectors or superintendents, to be stationed in each of the following points : San Francisco, Denver, Chicago and New York or Washington. . . . After some discussion by members of the committee, General Torney moved that the tentative plan submitted by ^Ir. Bicknell be authorized. Motion sec- onded by Mr. Tanner and adopted.^ When imperative need for greater administrative machinery arose in 1917, the now "decentralization plan" elaborated this principle through thirteen instead of four districts. It was described by Mr. Davison as follows : The word "decentralization" in this case resolved itself into the partitioning of the United States into thirteen di- visions, ea(;h division a smaller Bed Cross, with all its depart- ments and bureaus under a divisional chief and a force com- plete in every detail with the various lines of endeavor firmly and clearly outlined. Wlien once the foundation was com- plete, the War Council had no more to do with tlie Chapters or any of their activities, save in the way of judging the needs, devising methods and fixing standards. The Chapter's business was regulated in the department to which it belonged by the divisioiuil otlicers. The Division manager was ... to his division what the general manager in Washington was to the entire organization. Washington Headquarters was now free to proceed with the handling of the larger problems ^Minutes of tlic Executive Coinmittec, American Red Cross, page 3G8. MOBILIZATION 243 which were daily growing to greater magnitude and impor- tance.^ Miss Delano and Miss Noyes appointed in each Division prominent nurses who handled all nursing details in their im- mediate states. Only vital questions of policy were referred to National Headquarters. This group of ''Division Directors of Nursing/' representing as it did strong women of nn-ognized standing in their districts, comprised the very backbone; of the Nursing Service. Through their hands passed all applications for enrollment received from Local Committees, all manage- ment of class instruction, public health nursing, early surveys and other details. On their shoulders rested the ultinuite re- sponsibility of recruiting the many thousands of nurses requi- sitioned by the Surgeon General. To them came, too, the well- nigh overwhelming demands for nurses for the influenza epi- demic. Miss Delano outlined thus the relation of the nursing repre- sentative to the Division manager and the Bureau of Nursing at National Headquarters : As the success of the Xursing Service and our ability to secure the nurses in the large number likely to be needed during the period of the war depends entirely upon main- taining tlie interest and enthusiasm of the graduate nurses throughout the country, it seems to me of primary importance that the person in charge of the Division Bureau of Nursing Service shouhl be a ]\ed Cross nurse and should be in truth the representative of the Nursing Service. She should be appointed by the chairman of tiie National Committee on l\ed Cross 5s"ursing Service, subject, of course, to the ap- proval of the Division manager. Furthermore, since the direction of all the activities of tlie Bureau of Nursing Service within the jurisdiction of the Division will be in charge of this person, it is liighly important that we secure the services of nurses who. by reason of their education, e\[)crience. professional standing, executive ability and knowledge of conditions in the Division, will be highly qualified to fill tliesc ini[)orauit positions. I believe that this otlice. tbrough the national organizatii)n of nurses, is best prepai'cd to secure tlie (lualified ])ersonnel. All professional ))bases of the work of the Division Director of the Xui'siiig Service should be subject to the direction ""Tlie Aiiicricaii Itcd Cross in tlie (Jrcat \\"iir," pages Ui-17. Tlic Mac'inillaii Coinjiaiiy. liU!). 244 HISTORY OF AMERICAN RED CROSS NURSING of the Bureau of Nursing Service at National Headquarters, for only in this way will it be possible to maintain the neces- sary standards and uniform policies of the Eed Cross Nursing Service. It will be necessary for the Division Director of the Nursing Service, in administering her Bureau, either personally or through her functional assistants, depending upon the extent of the activities in her Division, to : (1) Supervise Chapter work as related to nursing activities and advise Chapters on matters of policy and practice pertain- ing to nursing service as prescribed by National Headquar- ters. (2) Supervise instruction of persoimel within her Division and cooperate with Chapters and committees on Red Cross Nursing Service on matters relating to enrollment of in- structors. (3) Supervise the organization and administration of Chapter instruction in Elementary Hygiene and Home Care of the Sick and in Home Dietetics. (4) Advise and cooperate with Chapters on matters relat- ing to class equipment. (5) Study and advise on methods of promoting enroll- ment in classes. (6) Cooperate with Local and State Committees on Nurs- ing Service in promoting enrollment of Red Cross nurses. (7) Summarize periodic reports relating to activities un- der the Nursing Service as received from Chapters and compile Division reports of these activities for the Division manager to transmit to National Headquarters. ( 8 ) Perform such other duties as may be designated by the Bureau of Nursing Service at National Headquarters. In the December, 1917, issue of the Journal, Miss Delano reported the appointment in October of these Division represen- tatives. Elizabeth Ross, a graduate of the Newton Hospital, and a public health nurse of high standing, served in the New England Division, which included Maine, New Hampshire, Vermont, Massachusetts and Ehode Island. Miss Ross had organized the Xursing Center of the Woman's Municipal League of Boston and had also acted as supervisor of the Nor- wood Civic Association. Carolyn C. Van Blarcom (Johns Hopkins) resigned as secre- tary of the Illinois Society for the Prevention of Blindness to represent the Nursing Service in the Atlantic Division, which included New York, Connecticut and New Jersey (except MOBILIZATION 245 Camden). Of Dutch descent, she was possessed of keen organiz- ing ability and of brilliant processes of thought and expression. At varying periods of her uscl'ul career, she was assistant super- intendent of nurses at her alma mater, then superintendent of nurses, St. Luke's Hospital, St. Louis, superintendent of the New Bedford Tuberculosis Sanatorium and secretary of the National Committee for the Prevention of Blindness. Upon her arrival in June, 1U17, at Atlantic Division Headquarters, New York City, she immediately set up the organization of a nurses' equipment division for the base hospitals then embark- ing for France and to her acumen was largely due the establish- ment of the efficient system which characterized this important detail of mobilization for foreigTi service. Another conspicu- ous piece of her work was the recruiting of hundreds of Red Cross and Army nurses then in New York who marched in the historic first Red (^ross parade of the autunui of 1!)17. During the later part of that year. Miss Van Blarcom under- took a speaking tour of the United States to interest nurses in enrolling for war service, after which ill health necessitated her resignation from Red Cross service. Florence Merriam Johnson followed Miss Van Blarcom in January, 1918, as director of nursing of the Atlantic Division. A graduate of Smith College and of the New York Hospital, she had been connected with the Cornell University ]\Iedical Dispensary, New York ; had done social service work for the New York Association for the Improvement of the Condition of the Poor; and for the Harlem Hospital. She later became a member of the faculty of the Department of Nursing and Health, Teachers College, Columbia L^niversity, Her remark- able service in facilitating the embarkation and debarkation of nurses in foreign service brought her the Florence Nightin- gale Medal of the International Red Cross. A woman of poise, intelligence and great charm, she combined sympathetic warmth of personality with firm executive ability to such an extent as to make her one of the most capable and well-loved nurses of the "younger generation" which the war brought forward. The Pennsylvania Division, which included the Jveystoue State, Delaware, and Camden, New ficrsey, was represented by Susan Francis (Reading Hospital, Pennsylvania). She was long associated with state organization work and with early Red Cross Nursing Service projects. Miss Francis had been 246 HISTORY OF AMERICAN RED CROSS NURSING superinteudent of nurses of hospitals in the City of Washing- ton, in New Orleans, and in Philadelphia. Georgia Marquis Nevins came to the Potomac Divison (Dis- trict of Columbia, Maryland, Virginia and West Virginia) af- ter twenty-three years of service as the head of Garfield Memo- rial Hospital, Washington. Her name has appeared more than once since an early point in our text, in connection with profes- sional progress and growth. She was one of the first class graduated under Miss Hampton at the Johns Hopkins. An ardent sponsor of the Army Nurse Corps and also of the bill for registration of nurses in the District of Columbia, she was at one time president of the National League for Nursing Edu- cation, then known as the American Society of Superinten- dents, and for many years was secretary of the American Nurses' Association. Her Red Cross service began in 1909, as secretary of the National Committee on Red Cross Nursing Service. A New England woman, she represented a type of all the sturdy virtues of that section. Jane Van de Vrede (Milwaukee County Hospital, Wauwa- tosa, Wisconsin) was the nursing representative for North and South Carolina, Florida, Georgia and Tennessee. Miss Van de Vrede was for nine years assistant bacteriologist of the Department of Health, Savannah, Georgia. As secretary of the State Board of Examiners of Nurses for Georgia, and as vice chairman of the Savannah Red Cross Chapter, and secre- tary of the Local Committee on Red Cross Nursing Service of that city, she brought to her duties a wide, extremely practical knowledge of southern nursing resources. The Gulf Division, to which L. Agnes Daspit (Touro Infir- mary, New Orleans) was appointed, included Alabama, Mis- sissippi and Louisiana. ]\Iiss Daspit had long been associated with the Red Cross Nursing Service, as chairman of the Loui- siana State and Local Committees. She was at one time president of the Louisiana State Nurses' Association and chair- man of the Advisory Board of the State Board of Examiners. The Southwestern Division, covering the immense distance of Texas, ]\Iissouri, Kansas, Arkansas and Oklahoma, was for- tunate in securing so able and tireless an organizer as Lyda W. Anderson, already known to rc^aders of this history as super- visor of Unit K of the jMercy Ship, jMarv ^r. Roberts (Jewish Hospital, Cincinnati) served as nursing representative in the Lake Division, embracing Ohio, MOBILIZATION 247 Indiana and Kentucky. Both as superintendent of nurses in the Savannah Hospital, and assistant superintendent of nurses of the Jewish Hospital in Cincinnati, she had had long experience in administrative work. As a former president of the Ohio State Association of Graduate Nurses and a member of the State Board of Nurse P^xaminers, she too was excellently fitted for the tasks before her, A child welfare nurse of national reputation, Minnie H. Ahrens (Illinois Training School for Nurses; Teachers Col- lege) directed Red Cross activities in Illinois, Wisconsin, Iowa, Nebraska and Michigan, the states comprising the Central Division. Though Miss Ahrens' name had been long asso- ciated with high standards of nursing education, she was per- haps best known as an organizer and the first superintendent of the Infant Welfare Society, of Chicago. The Northern Division, ^linnesota, North and South Da- kota and Montana had as its nursing representative Edith A. Barber. A graduate of the Garfield Park Hospital, Chicago, IVIiss Barber was at one time superintendent of nurses of the Green Gables Sanatorium, Lincoln, Nebraska, and a member of the training school staff of the Li^niversitv of Minnesota. Lettie G. Welch (Illinois Training School) w^as appointed to the Mountain Division including Colorado, Wyoming, New ^^Fexico and Utah. Formerly superintendent of nurses of the City and County Hospital, Denver, she had served for several years on the Colorado State Committee on Red Cross Nursing Service. Lillian L. White (Protestant Episcopal Hospital, Philadel- phia), also long associated with nursing education, gave up her position as assistant superintendent of nurses of the Univer- sity of California, to represent the Red Cross Nursing Service in the Pacific Division, embracing Nevada, Arizona and Cali- fornia. Miss White had at various periods of her career been superintendent of nurses of the Knoxville (Tennessee) Gen- eral Hospital ; of the Merritt Hospital, Oakland, California, and head of the ]3aby Hospital of that city. Including Washington, Idaho, Oregon and Alaska, the NorthwestcM'u Division had as its nursing representative ^May S. Loomi.s (Illinois Training School). She was a surgical inirse of long experience. Chairman of the Washington State conunittee on Red Cross Nursing Service since 1015. she gave up her pf)sition as supervisor of nurses at the City Hospital, 248 HISTORY OF AMERICAN RED CROSS NURSING Seattle, to accept the Red Cross appointment. Miss Loomis was for several years president of the Washington State Nnrses' Association. Following the estahlishment of the Divisions, the Executive Committee voted on December 6, 1917, to create the Depart- ment of Nursing, combining under one executive all phases of the nursing program. ]\Iiss Delano became the director, her vision of a lightened responsibility and a country home relin- quished for the time, and the representatives in the Division offices were given the title of Division Directors of the Depart- ment of i^ursing. This organization was put into effect in the spring of 1918. Miss Noyes, who had been on a speaking tour since December, 1917, returned to ^National Headquarters in February, 1918, and became director of the newly created Bureau of Field Nursing, through which the selection and as- signment of all nurses for war duty, either military or civilian, were carried out. Some of the changes then occurring have al- ready been mentioned. The reorganization of the Town and Country Nursing Service will be spoken of under its own chapter heading. With the National Committee on Red Cross Nursing Ser- vice acting in an advisory capacity, with the strong Head- quarters' organization at Washington and with corresponding Departments in all Divisions, the Red Cross Nursing Service now faced the greatest nursing needs of American and world history. From its inception in the scattered efforts of the Civil and Spanish-American wars, its peace time development from 1909 to 1917, one step toward more complete organization had followed fast on the heels of another, until the creation of the Department of Nursing marked the final perfection of this great "machine," so cffitMcnt and withal so silent and unobtru- sive, that few indeed realize how vital and far-reaching were its workings and how great its results in the alleviation of hu- man suffering. The Niitional C\)mniittee on Tved Cross Nursing Service guided th(> policies of developuKMit of American Red Cross nursing service. The members of the National Committee who served at the outbr(>ak of the war were Jane A. Delano, chairman; William C. Oorgas, Surgeon General of the Army; W. C. Rraisted, Surg(Hui General of the Navy; Rupert Blue, Surgeon General of the Public Health Service; Annie Good- rich, president, American Nurses' Association; S. Lillian Clay- MOBILIZATION 249 ton, president, National League for Nursing Education ; Mary F. Beard, president, National Organization for Public Health Nursing; Colonel Jefferson li. Kean, Director of Military Re- lief, American Red Cross; W. Frank Persons, JJirector of Civilian Relief, American Red Cross; Major C. H. Connor, Director, Bureau of Medical Service, American Red Cross; Dr. T. W. Richards, Director, Bureau of Naval Service, Ameri- can Red C^ross; (ylara 1). Noyes, Director, Bureau of Nursing Service, American Red Cross; Fannie F. Clement, Director, Bureau of Town and Country Nursing Service, American Red Cross; Enmui IL Gunther, chairman, Committee on Dieti- tians; (appointed for three years) IMabel T. Boardman ; Mrs. Wm. K. Draper, New York City; Mrs. Wm. Church Osborne, Ntnv York City ; Anna C. Maxwell, Presbyterian Hospital, New York City; Mary E. Gladwin, Akron, Ohio; ]\Irs. Frederick j\I. Tice, Chicago; Lillian D. Wald, New York City; M. Adelaide Nutting, New York City; Amy Milliard, Bellevue Hospital, New York City; Susan C. Francis, Phila- delphia; Louise M. Powell, New York City; Jane E. Nash, l^altimore ; (appointed for two years) Julia Stimson, St. Louis ; Emma Nichols, Boston City Hospital ; Dora E. Thomp- son, head of Army Nurse Corps; Lenah S. Iligbee, head of Navy Nurse Cor])s; l^]lhi Phillips Crandall, New York City; Georgia ]\L Nevins; Anna L. Reutinger, New York City; Eliz- abeth G. Fox, Visiting Nurses' Association, Washington; Har- riet Leete, Cleveland. Ohio; Anne H. Strong; Sinnnons College, Boston; (a])pointe(l for one year) Alma E. Wrigley. Pasadena, Cal. ; Carrie M. Hall, Peter JJent Brigham Hosi)ital, Boston; Lucia Jac(jnith. Memorial Hospital, Worcester, Mass. ; Anna C. Jannne, State Board of Health, Sacramento, Calif.; Menia S. Tye, Sparks .Meinorial Hospital, Ft. Smith, Ark. ; Ennna L. Wall, ^ew Orleans, La.; Mathild Krueger, JMenomonie, Wis.; Agnes (r. Deans, Detroit, ^lich. ; Eth(>l S. Parsons, Division of Health, San Antonio, Texas; ^fary C. Wheeler, Illinois 'J' rain- ing School, Chicago. Duties of the committee were: 1. To organize and supervise the Xursing Service of the /Vnierican Ii(-<] Cross. It is desirable tbat the delegate selected should be a mem- 252 HISTORY OF AMERICAN RED CROSS NURSING ber of the State or a Local Committee on Eed Cross Nursing Service. Local Committees consist of at least six nurses appointed by State Committees on Red Cross Nursing Service. The duties of Local Committees on Red Cross Kursing Ser- vice were: 23. To make recommendation to the National Committee as to the appointment of headquarters, where a list of enrolled nurses and other personnel of the Nursing Service may be kept on file, siicli headquarters to be preferably registries for nurses or training scliool offices, as it is important that a place should ])e selected where nurses may be secured at all times day and night. 2-i. To issue circulars of information and blank forms for enrollment to applicapts, and to decide whether applicants fulfill the requirements and are desirable. 25. To receive applications for the enrollment of nurses and to secure the required credentials except from nurses interested in the Town and Country Nursing Service, w^hose applications should be forwarded direct to Eed Cross Head- quarters, Washington, D. C, where credentials will be se- cured.* Of the numbers and activity' of the Committees Miss, Delano said, in the Annual Report for the year ending December 31, 1917: In addition to the National Committee, we have forty- eight State Committees and one hundred and two Local Committees on Eed Cross Nursing Service, four State and thirty-four Local Committees having been appointed since January 1, 1917. About one thousand nurses are serving the Eed Cross gratuitously on these committees. After the war she wrote of the work of the State and Local Committees: To the State Committees on Eed Cross Nursing Service, and the Local Committees representing local nursing organi- zations, the Nursing Service of the Eed Cross owes much during the past years. TJie large enrollment of Eed Cross nurses was due in a great part to the activities of these com- mittees. Approximately one thousand graduate nurses are serving gratuitously as members of State and Local Com- *A. R. C. 159, July 12, 1917. MOBILIZATION 253 mittees on Red Cross Xursing Service, and the value of tlieir services cannot be overestimated. Durin*,^ tlie period of the war, these committees held frequent meetings to pass on the application of thousands of nurses and sacrificed their vacations, and often their positions, in order to do this vol- unteer work of the Eed Cross. When the need for nurses for active service hecamc pressing, during the period of the war, the Nursing Service of the Ked Cross appointed on its Local Committees those women especially who were unable to accept active service, but who had given generously of their time and money to carry on this important part of the Ked Cross work. These Local Committees in this way prepared thousands of nurses for active service; advised them in regard to their home conditions and their release from positions ; and it was only through their cooperation and assistance that the work at National Headquarters was made possible. The size of the ISTational Committee on Red Cross Nursing Service and the widely-separated locations of its members made it imperative to have a small but efhcient Executive Committee. Organized July 28, 1917, this was composed of any members then stationed in Washington, with the presidents of the three national societies of nurses. This small committee shared the responsibility of the problems of the Red Cross Nursing Service as they arose day by day. Soon after the appointment of the War Council by Presi- dent Wilson on ^lay 10, 1017, its chairman, ^Ir. Henry P. Davison, arranged special conferences designed to bring the difierent Red (Voss Departments together to consider nursing problems and to make recommendations in regard to the Ser- vice. On this committee there were representatives of the War Council; the R(>d Cross Committee on Co()peration ; the Red Cross JNTedical Advisory Committee; and the National Committee on Red (^ross Nursing Service. Dr. Simon Flexner, Chairman of the Red Cross jMedical Advisory Committ(>e, pre- sided at a meeting of this conference which was held at Head- ([uarters, July 2-'}, 1017. A nundx'r of mendters of tlu> Na- tional Committee on Nursing Service had been invited to attend. Those ])resciit were: (from the R(>d C^'oss National Committee on Nursiug Service) ]\Iiss Delano, chairnnm; Miss Noyes, Director, Bureau of Nursing Service; ]\riss Clement, l)ir(H'tor, Bun^ftu of Town and Country Nursing Service; ]\riss Hay, DircH'tor, Bureau of Histructi(ui for Women: Miss Deans; ^Irs. William K. Drap(>r; ]\liss Nutting; ^liss Good- 254 HISTORY OF AMERICAN RED CROSS NURSING rich; Miss Beard; Miss Clayton; Miss Wald; Miss Hilliard; Miss Thompson; Mrs. Higbee; (from the Red Cross Com- mittee on Cooperation) Jndge Robert S. Lovett; Messrs. A. D. Hodenpvl, George Wharton Pepper, Edward 1). Butler, John F. Moore, and L. K. Frankel; (from the Red Cross Medical Advisory Committee) Doctors Biggs, Chapin, Flexner, Kerr, Rose, Ryan, Rosenau, Smith, Pearce and Richards; (from the War Council) Messrs. Davison and Wads- worth. The entire field of nursing needs and desirable standards of nursing qualifications for Red Cross war enrollment was thor- oughly g-one over. It was agreed that there was no immediate shortage in well-trained nurses and that the Red Cross was adding to its available reserves in every w^ay that foresight could dictate. It was found that the real crisis of the nursing situation lay in the future and that while present needs were being met the war demands would increase rapidly and it w^as of the greatest importance that well educated women should be urged to take the nurse's training. At the end of the con- ference the chairman (Dr. Flexner) was directed to appoint a small conference committee to meet on a later day in that same week and settle finally, if possible, the war nursing policy of the Red Cross in regard to the standards for enroll- ment and to report its conclusions to the War Council. Dr. Flexner appointed Miss Delano, Miss Xutting, ^liss Beard, Dr. William H. Welch, Dr. Herman M. Biggs and Dr. Winford H. Smith. On Friday, July 27, all except Dr. Welch and Dr. Biggs who were unable to be present, met at Red Cross Headquarters. Dr. Flexner took the chair and Dr. R. M. Pearce (of the Medical Advisory Committee) acted as secretary. The con- ference committee examined its nursing problems in a frank and thorough -going way and in due time its report was laid before the War Council and accepted by that body. The ques- tions considered were : 1. Size of liospitals in wliich nurses are trained, i.e., aver- age nunil)er of patients per day. 2. Age limit at tlie time of enrollment. 3. Early graduation of classes iii (a) three year, (b) two year schools. -1. Short trainin purposes of this history, may be thus summarized. The rumors fell under three heads. First, that Red Cross nurses abroad had become victims of forcible outrage by enemy soldiers, or even by Allied officials, and that numbers of them (the numbers, always mentioned, varied from fifty to several hundred) had become pregnant and were being brought home to be cared for in American hospitals. Names of hospitals, especially two well-known ones in New York City, were sometimes specified. Second, that Red Cross nurses, as a result of forcible outrage or personal immorality, or both, had become infected with venereal disease and were quar- antined at a French port, usually named. In this legend also the numbers ran high ; the writer personally heard that nine hundred such victims, all nurses, were behind stockades at a locality in France. Third, that Red Cross nurses had come back to their homes with eyes gouged out, tongues slit, or hands and toes cut off. It soon became clear that these rumors constituted a definite propaganda, arising from an unknown source. This might have had one of two purposes ; one, to add fuel to the flames of hatred against an enemy ; two, to retard the enrollment of nurses in the Red (^ross and thus endeavor to cut off at its source the supply of nurses to serve in military hospitals. The Committee on Nursing S(>rvice concluded that while both purposes w(^re served, the latter was the one directly aimed at and indeed, while (Mirollmeiit was not prevented, its c(nirse was often made infinit(>ly difficult by the popular reaction to the rumors. The Nursing v^ervice, desirous of avoiding pn])licity in the daily press as tending to assist the propagandists, took u]i each report separately as it reached Ilcadipiartin'S. Such word usu- ally came in from some nurse or Red Cross member, indignant, 262 HISTORY OF AMERICAN RED CROSS NURSING shocked and incrednlons, yet having at hand no way of making authoritative denial. They were then given a categorical denial by the Nursing Service and were requested to obtain and for- ward to Headquarters the names of persons from whom the rumor was heard, with dates and names of places involved. Every such clue was painstakingly followed up and invariably ended in nothing. It was, however, learned that the mode of starting the rumors on their way was this : On a railway train of some small rail- road, in a remote or provincial region, a well-appearing woman traveler, getting into conversation with other travelers, would modestly mention 'herself as a Red Cross worker from abroad and would then with deep feeling relate most confidentially the horrid tales, presently alighting at some small town, there to disappear without trace. Or again, travelers in a far distant locality, again on the railway, would be attracted by the sight of two apparent invalids, so heavily bandaged as to be practi- cally invisible and would learn from a kindly woman or man in charge that they were Red Cross nurses whose eyes had been put out, tongiies slit, or hands chopped off. In no instance did any one see beneath the bandages. As these tales were whispered from one to another they sometimes got into local papers and were often given credence by well-meaning but ill-balanced persons. Statements based upon them were occasionally recklessly made at public meet- ings, sometimes even at local Red Cross meetings. An embar- rassing detail in counteracting them was that members of an- other national society of the highest standing more than once disseminated these absurdities, as proving the need of their own ministrations and of the enlargement of their own facilities in the war zones. The rumors were dealt with almost entirely by the Red Cross. In several instances the Department of Justice was called on for assistance. One quite prominent woman physi- cian was called before a federal jury and reprimanded and in another case a man was fined $1000 and costs. Similar rumors M'cre set on foot regarding Canadian nurses and Government circles in Canada luul the same difticulty in denouncing them. The tah>s were usually repeated with no malicious intent and were well known in nursing circles, but there, naturally, were not believed. The following hotter written by ]\liss Delano is a type of the many that she wrote in this connection: MOBILIZATION 263 December 4, 1917. My dear Mr Your letter addressed to has been referred to me for reply. Similar rumors have come to this office from time to time, and I can only assure you as emphatically as possible that there is absolutely no truth in the statement. We have alto- getber about four thousand nurses, about three thousand of these in service in France. They are definitely assifj^ned to base hospital units under military authority, or under the direct supervision of the lied Cross. Of all our nurses in France only two or three have returned, and it would be impossible for any large number to be brought back in the condition mentioned in your letter without the Eed Cross being fully informed of the matter. Would it not be possible to take up quite definitely with T . . . . F . . . . , who has circulated the report, this matter, compelling him to give the source of his information and as a lawyer interested in lied Cross activities take such steps as may be necessary to prevent the repetition of this untruth in your community? I can well understand that you would hesitate to do this without definite information from Head- quarters. I may assure you that there is no foundation for the rumor. A similar rumor is being circulated concerning Canadian nurses and I wrote to the Department of Militia and De- fense, Ottawa, Canada, for a definite statemont, whicli was promptly received, denying absolutely all foundation for the rumors. It seems evident that it is a definite propagaiula which should be met as promptly as possible. We have tried to avoid any newspaper publicity, as it would only spread the rumor. I shall appreciate greatly any further information you may secure, and bopc for your cooperation in branding such rumors as malicious falsehoods. Appreciating greatly your having written to the Wed Cross direct, Believe me. Sincerely yours, (signed) Jaxe A. Delaxo, Chairman Xational Committee on Ked Cross Xursing Service. As the magiiitudc of the war tasks became plain, extensive systems of coordinated ('ft'ort were woven into the social fabric and the energies of nurses, bent to the support of the Ked Cross Xursing Dejiartmcnt, or to associated war-Wdi'king gronjis, gave results that are distinctive in international lied Cross nursing 264 HISTORY OF AMERICAN RED CROSS NURSING history, not only for the bold and original methods adopted, but also for the proof that, even in war emergency, an exten- sive increase in nursing personnel is possible, without seriously lowering the hard-won standards of professional competency. Early in June, 1917, an Emergency Committee on I^ursing was organized by Miss Nutting and Miss Wald in New York City to include a number of prominent nurses, all of whom were members of the Red Cross National Committee and one of whom was Miss Delano, as also several prominent physicians, with Miss Julia Lathrop, Chief of the Federal Children's Bureau. The purposes of the Committee were : "to devise the wisest methods of meeting the present problems connected with the care of the sick and injured in hospitals and homes; the educational problems of nursing; and extraordinary emergen- cies as they may arise." The founders of this Emergency Committee had been fearful that under the great excitement of war, the usual objects of their care might be neglected and they planned to guard those objects; i.e., the daily nursing of the sick in the homes and hospitals and the teaching and preparing of nurses for their fields, while the Eed Cross, officially charged by the govern- ment to be directly responsible for war nursing would naturally be absorbed in that immense obligation. With the formation of the Council of National Defense (composed of the Secre- taries of War, Navy, Interior, Agriculture, Commerce and Labor) an Advisory Commission of seven specialists was nomi- nated and appointed by President Wilson. Dr. Franklin Mar- tin, as one of the seven, organized the General Medical Board and this Board took over tlie Emergency Committee and made it the National Committee on Nursing of the Council of Na- tional Defense with ]\Iiss Nutting as .its chairman, to function under tlie direction of the cliairman of the General Medical Board. Dr. ^lartin himself being chairman of the Committee on ^ledicine and Sanitation of the Board, came into close e(jrrespondence and professional contact with the nurses on all the committees. There was also under the Council of National Defense a subcommittee on Pulilic Health Nursing and a com- mittee on Home Nursing. ]\riss Delano had a place on each and her special part in their conferences was to prevent as far as possible overlapping and duplication of effort, as from her post at Red (h-oss Ileadcpiarters, she had a knowledge of the entire field which none of the others could possess. MOBILIZATION 265 As the national pace speeded up, frictional reduplication of activities was not always preventable and it may be reasonably concluded that the single task of nursing during- the war would have evolved more smoothly and expeditiously had the Xursing Committee of the Council of National Defense organized itself for its special interests under the Red Cross (as a subcommittee of the National Committee) and this the more as they were all Red Cross Nurses and the majority of them members of the National Committee on Red Cross Nursing Service. Miss Nutting's committee, as it was informally called, had from the beginning a special concern for the underlying edu- cational factor in nursing and to its leaders it could not have seemed otherwise than that they were specially responsible for that trust, for clearly the Red Cross alone, as then organized, could not have cultivated the educational field in addition to its vast administrative domain, but its readiness to cooperate and contribute show that the second commJttee would have had equally wide scope had it been a special Red Cross committee. Miss Nutting's committee stood close to the educational world and its activities bore the impress of her original and boldly resourceful mind. Her suggestions and plans gave great im- petus to those intensive yet educationally sound courses opened for nurses in women's colleges, in connection with hospital training, of which Vassar gave the most highly perfected ex- ample, to be presently described and known as the Vassar Plan, Tn the recruiting of pupils for the trainiug schools, in the movement to induce schools for nurses generally as a war duty to admit college women for training on a two-year instead of three-year basis, and in the inception of the Army School ^liss Nutting's committee did original and distinctive work. Of permanent value to nursing literature are th(^ committee's nine pamphlets, most of which were prepared by Isabel Mait- land Stewart, a professor in the Department of Xursing and Health at Teachers College. Their studies of war nursing problems should make them useful to the Red Cross societies and nursing associations of other countries as well as to our own. The committee on Home Nursing, ^liss Wald its chairnian, was closely tied to the Department of Labor and concerned itself primarily with all aspects of industrial nursing, so called, especially in those industries which were engaged in war work, and with strengthening public health nursing in industries and in the homes. 266 HISTORY OF AMERICAN RED CROSS NURSING The purposes of the subcommittee on Public Health Nurs- ing and some parts of its plans are told in the following ex- cerpts : This committee was created by Surgeon General Blue for the purpose of relating the work of the public health nurse to the many problems of hygiene and sanitation brought into prominence by the war. These problems are suggested by the names of the other sub-committees of the Committee on Hygiene and Sanitation, for example, the Committee on Alcoholism, the Committee on Venereal Disease and the Com- mittee on Drug Addiction. The public health nurse must be the instrument which will make preventive medicine effective. It is wise, therefore, to create a body, the function of which shall be to study the changing conditions produced by the war and to be ready to recommend to any given community a plan for establishing a public health nursing agency whenever these changing con- ditions demand it. First : The purpose of the committee is : To collect and edit material relating to the disastrous effects of the last three years of war on the community health of the European nations at war. Second : To procure informa- tion of the present status of community health work in this country and of the extent to Which such work is endangered by a state of war, and, further, to procure information as to the need of the greater extension of it by a state of war. Community health work in areas about the cantonments must be imdertaken by public health nurses. Therefore, the Nursing Bureau of the Red Cross is asking the help of this committee in enrolling all public health nurses for pul)lic health nursing service either here or in Europe, and is further turning to the secretary of this committee to act in an ad- visory capacity for the selection of public health nurses for these areas. ^ This subcommittee gathered important data bearing on pub- lic health activities ; made a special census of public health resources, agencies aiid nurses at home ; assisted the Red Cross in securing nurses for the sanitary zones surrounding canton- ments ; initiated at Teachers College, with the help of Miss Nutting and through scholarships donated bv the Red Cross, the educational preparation for ten nurses neccssarv in the campaign against venereal diseases conducted bv Surgeon Gen- eral Blue ; gave impetus to the long-discussed plan of intro- " Report of Subcommittee on Public Iloaltli Xursing. November, 1917. MOBILIZATION 267 ducinp: preliminary public health instruction into the senior year of training schools for nurses and was especially promi- nent in urging that public health nursing should be accepted as the equivalent of active military duty. ^liss Delano wrote of nursing groups cooperating in mobili- zation : The Red Cross is working in close cooperation with the American Xurses' Association, an affiliated body with whicli it has for many years enjoyed intimate and harmonious rela- tions. Practically all of the enrolled Red Cross nurses are included in tlic membership of this association. Another organization with which the Red Cross is co- operating is tlie Xational Committee on Nursing, recently appointed by the Council of National Defense with M. Ade- laide Xntting as chairman and Ella P. Crandall as secretary. The Red Cross is cooperating with this committee in a movement to enlist young college women in nursing as a patriotic service. As the Red Cross sees it, the l)ig problem is not only providing for the present nursing needs but safe- guarding against the possible needs two, three and five years from now. Therefore, it is urging the young women of America to prepare themselves for the most efficient work as nurses by submitting themselves to the training courses of high class schools of nursing. Several of our leading schools have agreed to admit graduates of approved colleges, who are otherwise acce})table as candidates for nursing, to special courses which will grant them credit for one academic year. The Red Cross will rely upon the thousands of Red Cross Chapters, branches and auxiliaries, the Women's Conuuittee of the Council of Xational Defense, and similar organizations of women to supply lists of volunteer workers when needed. These organizations are already compiling lists of volunteers in the various communities. To give a complete list of all the groups and associations that aided the Red Cross Nursing Service would mean, in effect, listing almost all those engaged in war service, but three names that must be especially mentioned, aside from the na- tional nursing groups, as cooperating agencies entitled to special appr(>ciation were : the American Council of Education ; the Association of (^)llegiate Alumna? ; the United States Food Administration. Of the special courses designed to facilitate mobilization bv shortening the period of hospital training and giving instruc- 268 HISTORY OF AMERICAN RED CROSS NURSING tion under college auspices, that at Vassar was the first and set the most excellent example to others. The generous inten- tion of the college to offer its ample facilities during the sum- mer of 1918, ''as a training school for young women for patri- otic service in whatever lines of work offer the greatest oppor- tunities or present the greatest needs" had been declared by resolution at a meeting of the Provisional Alumnae Council on June 9, 1917. The committee who recommended the nursing course as finally established were : Mrs. John Wood Blodgett, chairman, Frank li. Chambers and Frank L. Babbitt. To this decision Miss Nutting's counsel had largely contributed, and toward the success of the course Mrs. Blodgett's brilliant ser- vices were inestimable. The course offered pupils twelve weeks instruction in anatomy and physiology, bacteriology, chemistry, hygiene and sanitation, elementary materia medica, nutrition and dietetics, the psychology and sociology of nursing, nursing ethics and history, elementary imrsing procedures with models, and spe- cial lectures. This was combined with a disciplinary regime and physical training. It was followed by two years of work in selected schools of nursing connected with hospitals. Those consenting to join in the plan were called Cooperating Schools and Hospitals. The League of l^ursing Education gave three of its members, Isabel ]M. Stewart, A. ^I., professor of Nursing, Teachers College, Columbia University ; Elizabeth Burgess, B. S., State Inspector of Training Schools, New York, Education Depart- ment, and Anne Strong, A. B. (Bryn Mawr), assistant pro- fessor of Public Health Nursing, Simmons College, Boston, as an advisory committee to arrange the curricukmi in coopera- tion with the Vassar faculty members. The expenses were also cooperatively met. The Associated Alumnie of Vassar bore the cost of the publicity and recruiting campaigns; the pupils paid moderate fees and the Red Cross War Council on January 9, 1918, appropriated $75,000 for the general expenses. By the time the Armistice was signed nearly fifty colleges, as reported by ^liss Nutting's committee, had com})leted their plans for opening similar courses to student nurses, if such should have been made necessary by the continuance of the war. Courses in ciglit colleges had been formally approved by the Surgeon General. An encampment for lay women was that of the Women's MOBILIZATION 269 Section of the Navy Loagiio next to be mentioned. Its official leaflet gave the following statement of its plan: The National Service School, Inc., was organized by the Women's Section of the Navy League in 1910, to train American women for the duties which come to them in war times and in other national disasters. The first National Service School was held at Chevy Chase, Maryland, in May, 19 1(). Nearly one thousand students were trained there and the American Ked Cross, the Army, the Navy and tiie Marine Cor])s cooperated in the instruction and running of the school. Thus the instruction and methods used were standard and official and had been worked out by experts. Since May, the following National Service Schools have been held : Sec- ond National Service School, The Presidio, San Francisco, California; Third National Service School, Lake Geneva, Wisconsin ; P'ourth National Service School, Narragansett Pier, Khode Island. There were three courses, any one of which might be selected at the preference of the student. They included First Aid ; making surgical dressings ; signal work ; wigwagging and semaphore; knitting and plain sewing; bicycling; plain teleg- raphy and wireless ; household hygiene and home care of the sick. The question of the instruction of Ked Cross nurses' aides is rooted in the early history of the Nursing Service. After the Red Cross became affiliated with the American Nurses' Association (100!)), there had been no mention until the year 1912 of the volunt(H>r aide so familiar in Europe. Then, fol- lowing the Ninth International Ked Cross Conference in Wash- ington, there was a movement to form Women's Detachments on the European plan. This step was questioned by ]\[iss De- lano, as shown in tlic following letter written by her at that time. (Letter from ^liss Delano to ]\Iiss Boardman, September 27, 1912) : ... T do feel that tlie outline of instruction gives a wrong impression of the object of the course and can only rc]H'at wliat 1 said this afternoon in regard to the possibh^ dangers. This jiaper will reach a great number of ])eople and I con- fess that tlie i)()ssible results worry me. I did not speak tliis morning of tlie effect this new undertaking may liave npon tlie nursing sM'\i(e. but with no ])rovision for eoiiperation. I see ])ossibilit ies of future misunderstandiiiLi's and friction. If 270 .HISTORY OF AMERICAN RED CROSS NURSING we have Red Cross nursing committees located in various cities and towns throughout the country, working as we hope in cooperation with the Red Cross Chapters, the institutional members and the committees appointed by the American Medi- cal Association, would not this detachment of women working apparently independently, be a source of confusion and mis- understanding? How could one be sure that work would not be duplicated with inevitable friction and misunderstand- ing? I know so little of the details of this present organiza- tion that my opinion may be valueless, but I see nothing to indicate cooperation or definite supervision. In organizing the Red Cross enrollment of nurses and in planning for the rural nursing, it has always seemed most important to me to have the advice and support of physicians. In the same way, I can scarcely imagine the organization of courses on home nursing without the cooperation and interest of nurses. We can scarcely compare the conditions in this country with those in France. The training given their nurses is most inadequate. In the written schedule of work I am in doubt whether the term "nurse" refers to graduates or to members of the women's detaclmients. If the latter, I am wondering how it will be possible to teach aseptic surgical technique in the time allowed for First Aid and home nursing. I do not mean to make difficulties. I am sure you will believe this, but think- ing only of the ultimate good, my mind is filled with doubts and misgivings. I have spent three years in building up the Red Cross enrollment, and have always believed that the suc- cess of the Red Cross and its activities depends primarily upon the coordination and the cooperation of all its depart- ments. Miss Delano brought this subject before the American Nurses' Convention in 1912 and on November 14, of that year, the members of the National Committee on Nursing disap- proved the plan of a separate Women's Detachment, but gave unqualified approval to the organization of classes of women for instruction in First Aid, home care of the sick and allied sub- jects designed to aid women in the care of their ow^n families, and pledged the cooperation of nurses for such teaching.*' It was subsequently agreed by the Red Cross that indepen- dent Women's Detachments should not be organized ; that classes for women (except those in First Aid) should be directed by the Nursing Service and that a volunteer service '^American Journal of Xursing, December, 1912. MOBILIZATION 271 of women, if such should ever be required in war, should be under the direction of the Ked Cross Nursing Service. The classes for women in Home Care of the Sick and Home Hygiene, which later developed widely, thus partly arose from the relinquished plan of Women's Detachments. With the threatened warfare of the ^lexican border, 1916, and the estab- lishment of base hospitals there, the National Committee on Red Cross Nursing Service, at a special meeting during the Convention of the American Nurses' Association at New Orleans, 19 IG, had agreed that the nurses' aides, if needed, should be a responsibility of the nursing profession, which they would not evade, provided that their teaching and duties were justly defined in relation to the actual care of the sick. ''Volunteer nurses' aides" were, in fact, called for in 1916 and their status was thus defined by Colonel Jefferson Randolph Kean, Director of Military Relief: Volunteer Nurses' Aides. Provision has been made for the assignment to our base hospital units of a limited number of women who are not nurses by profession. They will serve without pay but may be furnished with transportation, lodg- ing and subsistence, when tbe unit to which they are attached is called into active service. Nurses' aides will be prepared for duty under the supervision of the nursing service of the Eed Cross and will be required to take at least the course of instruction in Elementary Hygiene and Home Care of the Sick and pass a satisfactory examination in the same. It is also desirable tliat they take such other courses of instruction as may be provided by the Ked Cross. The chief nurse of the base hospital \init will be responsible for the selection of all nurses' aides attached to her unit and will, if necessary, arrange for their instruction. .When called into service they will serve under the direction of the chief nurse of the unit.'' To this explanation ]\riss Delano added: Practical experience as nurses or partial training as such cannot be accepted in lieu of our course in Elementary Hygiene and Home Care of the Sick, as one of the chief ad- vantages of this instruction given by a Eed Cross nurse is to enable the Eed Cross by observation to judge of the qualifica- tion of those taking the course and their probable fitness for service. '^liss Delano in Ai)icriclf felt and was difficult to stem. It was finally counteracted by the plan for an Army School of Kursing to he described in another section. After protracted conference witli the Surgeon OeneraFs office during the early summer of 1018, the Red Cross ]^ursing MOBILIZATION 277 Service made an attempt to organize a group of Reconstruction aides, women especially trained to give remedial exercises, either in physio- or occupational therapy, prescribed for the care of patients in hospitals and other sanitary formations of the Army. Lists of nurses expert in this specialized work were first collected by M\ss Noyes. A tentative plan of the Red Cross embraced the training of college women in these branches. Josephine Saunders, of New York, was finally given an appointment in the Surgeon General's office to develoj) these groups entirely within the War Department, but the Red Cross cooperated with the Army in mobilizing them, as is shown in the following description of these aides and their field of work : At a meeting of the War Council held June 27, 1918, the following vote was passed and communicated to Miss Delano : VOTED : That Appropriation ISTo. for the purchase of equipment, including uniforms for the outfitting of nurses be, and it is herewith amended to cover Eeconstruction aides (female) who are being or- dered for service overseas by the Surgeon General's oflieo, with the understanding that the Director of the Department of Nursing shall confer with the Otfice of tlie Surgeon General of the Army as to the necessary uniform and equipment. The War Department wrote to JMiss Noyes : I am enclosing a circular sent to Reconstruction aides re- garding overseas and domestic equipment. Please let me know if this meets with your approval. I am having mimeographed a signed authorization without which no aide should be allowed to purchase equipment at cost from the Hed Cross. (signed) Fuaxk B. Granger. Through the Bureau of Xurses' Equipment in Xew York City, the Red Cj-oss furnislicd complete (Miuipment free of charge to Reconstruction aides assigTied overseas and supplied ward uni- forms at cost to aides employed in Army hospitals in this country. L(>aders and assistants in recreational therapy, a highly expert and specializ(>(l form of aid to invalided so](li(>rs, had taken up the entrance to a iicld in which the R(>d Cross antici- 278 HISTORY OF AMERICAN RED CROSS NURSING pated developing an extensive and useful service. These plans were, however, terminated with the Armistice and subsequent reconstruction of the Army hospitals. On April 23, 1917, the Red Cross Committee on N^ursing Service considered the whole aspect of the public health nursing service in its relation to the war and at subsequent meetings throughout 1917, the exemption of public health nurses from military service always called forth lively discussion. A sub- committee of the National Committee on Red Cross Nursing Service was accordingly appointed, which recommended a plan by which various groups of nurses then performing essential service were placed in a Special Service group. There were already certain groups of nurses who were re- garded by the Red Cross as exempt from active military duty, i.e., those at Red Cross Headquarters and in Division offices; Chapter supervisors ; members of the Rod Cross State and Local committees; members of the Red Cross Town and Country Nursing Service, and those holding important positions in hospitah, training schools and public health organizations. The Special Service group as now defined gave public health nurses, as well as those serving in hospitals, a recognition simi- lar to that accorded the nurses who enrolled for war nursing. Such recognition had been asked for by the subcommittee on Public Health Nursing of the Council of National Defense (Miss Beard's committee), on May 28 when it recommended to the Committee on Hygiene and Sanitation the advisability of seeking to obtain, from the Council of National Defense, a "pronouncement" recognizing public health nursing as a war service. Brief extracts from the correspondence between ]\Iiss Delano and Miss Beard give the clearest statements of this special enroll- ment. Miss Delano wrote, September 12, 1917: In view of the probable demand for pi;blic health nurses for work in the zones surrounding the military cantonments and possibly for public health work in France, the National Committee on Red Cross Nursing Service has provided for a special enrollment of public h(>alth nurses exempting them from other service, as has already been done for tlie nurses enrolling as instructors. It would seem desirable, however, that a communication be sent from tlie subcommittee on Public Tlealtli Nursing or the General Medical Board of the Council of National Defense, MOBILIZATION 279 bringing the importance of this service to the public health organizations' attention, and urging that they release a cer- tain proportion of the nurses upon their staffs for enrollment with tlie Ked Cross for this service. I will in turn communi- cate with our Local Committees authorizing them to enroll nurses for this special service. In response to this letter ^fiss Board sent to the various organizations for public health nursing a questionnaire, and an appeal, in which she said: So pressing is the immediate need for carefully selected nurses for public health duty that the Eed Cross has asked this committee to send out an appeal to public health nurses to enroll in a special class exempted from all other service. This does not mean that a public health nurse may not en- roll for other duty. It will be a high mark of patriotism to serve in our own countr}'. It may even ])ecomc the supreme test of devotion to remain at one's regular post of duty. It is certain that the greatest discrimination must be exercised in the "selective draff in order to avoid disrupting or seriously depleting the home work wliile providing, from the already inadequate ranks of public liealth nursing, our full proportionate quota for war duty wherever needed. This committee urgently requests you to answer the en- closed questionnaire within three days of receipt and begs that your decision l)e made in the light of the nation's two great equal needs, i.e. : first, to guard the health of our sol- diers and sailors and those of our allies; second, to protect our home defenses in the face of new dangers and increased demands. The regulations framed and issued by the Red Cross !N'ursing Service in regard to this special group were these : 1. A nurse shall ])e eligible for enrollment in the Special Service grouji, providing she is an enrolk'd l?ed Cross nurse, eligible for active duty, vet holding a position in which in the opinion of the Ked Cross she is more valuable at present than A. R. C. filo. ScptpinlxT 15. 1017; also Koports of :Mis9 Nutting's committee. The quest iomiaire asked for: 1. Name of orfranization. 2. Names of * staff niemlxrs indispensable loeally. 3. Members wlio could be spared and wlien available. 4. Cbaracter of service rendered by each, fi. Names of members tlien in active duty with the Red Cross. 6. Names of those enrolled. 7. Those who liad applied for enrollment, 8. Those iutendini,' to apply for enrollment. 280 HISTORY OF AMERICAN RED CROSS NURSING in war service. Nurses physically or otherwise disqualified for active war service are not eligible for this enrollment. . . . 4. A committee appointed by the Division Director, Bureau of Nursing Service, shall act upon applications and shall issue a chevron to each nurse whose application has been approved. 5. The names of all nurses in the Special Service group will be forwarded to the American Eed Cross, Department of Nursing, at Washington, in order to prevent the assignment of these nurses to active war service. 6. The Special Service enrollment of a nurse relates to the position she holds at the time the chevron is issued. If a nurse changes her position, the person, organization or in- stitution which employs her shall immediately inform the Bureau of Nursing of the change of status and shall also re- turn the chevron. Nothing shall prevent the filing of another application should the nurse assume a new position in which she may be essential to a community. Before making application for nurses in the Special Service group which entitles them to the chevron, consider- ation should be given to adjustments with the view of con- serving graduate nurses, i.e. : 1. For utilization of student nurses wherever possible for positions as head nurses, social service and visiting nurses. 2. Consideration of other assistants to graduate nurses, such as Home Defense Nurse, and attendants. The Special Service Chevron is to be issued by a com- mittee appointed by the Division director to such enrolled Eed Cross nurses as are fit for active service but are fulfilling important responsibilities in their present positions. After the committee has granted a chevron no call for active military service will be sent a nurse, without consulta- tion with the Board by whom she is employed. By establish- ing this ''Chevron Service" the Eed Cross hopes to give nurses and organizations a freedom to develop the most im- portant teaching in training schools and in ])ublic health centers in order to conserve tbc health of our own country. If a nurse is not physically fit for active service or has personal responsibilities that make it impossible that she should go, she should apply for enrollment in the Home Defense. The form of the letter sent by the Department of J^iirsing to public healtli associations was: In view of the very great demands for nurses for military service and considering the many nurses disqualified for this MOBILIZATION 281 service, the committee respectfully recommend that every institution prepare now to meet the even greater need in the future and wherever possible, a nurse eligible for military service and now exempt from such service be substituted by one who is not qualified for such service. Our nursing re- sources being limited such readjustments will be absolutely necessary. Witli tlie assurances that the Department of Xursing of the American Ked Cross has the interest of your institution at heart, 1 beg to remain, Very truly yours, (signed) Jane A. Det^no, Director, Department of Nursing. The form of the letters sent to nurses entering the special service group was: Upon the recommendation you have been })laced in the Special Service group of tlie American Eed Cross Xursing Service and you are temporarily exempt from active military service. You are hereby privi- leged to wear the enclosed chevron imtil such time as you are released for active service. With good wishes for the success of your present work, I am, Very sincerely yours, (signed) Jane A. Delano, Director, Xursing Service.^'* The form of the letter sent to nurses eligible for a special service chevron was : I note tliat you are holding an important position at present and since it is the wish of the Xursing Service of the Ameri- can Ecd CVoss to disturb as little as possible the work of organizations such as yours, I am writing to learn if it is your wisli to he considered for exemption from active mili- tary service at present ? We wish to associate all our good nurses definitely with the American Ked Cross and are therefore plaeing nurses holding important positions in a S])ecial Service group, issu- ing to them a chevron to wear denoting their exemption frcmi active military s(>rvi(e temporarily, I judge from your a])plication that this is your desire but since we can only consider siu'h requests uiton the recom- mendation of the head of the institution, I will ask you to ^"Special SiTvicf s came forth and, as was often declared bv a Ked Cross lecturer, Dr. Thomas E. Green, helped greatly to save the day. The Army School of Xursing, though not originating with the Ked Cross, was a prominent feature of the mobilization of nurses for war and in its inception and growth was closely woven together with the processes of Ked Cross enrollment and assignment for sen-vice. The constructive idea which gave rise to the Army School was Miss Goodrich's, for she had been delegated by the Surgeon General as chief inspecting nurse, with an assistant, also a nurse, to visit and inspect nursing iix ^,\., K. C. Form 4!t.l. ^Nlarcli, 1018.. 284 HISTORY OF AMERICAN RED CROSS NURSING the cantonments. Their appointment had been made in re- sponse to a recommendation of the Committee on Nursing un- der the Council of National Defense and a similar proposition offered by the Hospital Division of the Medical Department of the Council of National Defense. The report made by Miss Goodrich after the inspection included these words : 'Tt is therefore recommended that an Army school of Nursing be created and that wo be permitted to present a detailed plan relating to the same." The report and its recommendations were considered at a conference of Medical and Army officers and nurses, the latter being ^liss Delano, Miss Thompson, superintendent of the Army Nurse Corps, ]\Iiss Clayton, president of the National League of Nursing Education, Miss Burgess and Miss Good- rich. Miss Goodrich submitted full plans to the Surgeon Gen- eral, March 24, 1918, but for reasons of space only a part of her outline can be here given : A plan whereby through an Army School of Nursing the most complete nursing care may be provided for the sick and wounded soldiers at home and abroad, for the period of the war and for as long thereafter as the Government may de- cree. . . . The plan to provide for an easy, constant and almost un- limited expansion of training fields and consequent increase in student and graduate nurses, in order that the arising demands of the service may be fully met. Through the provision of the student Ixjdy to have in the process of training large groups becoming increasingly compe- tent thereby enabling tlie release of the most experienced nurses for the foreign and other demanding fields without lowering the efficiency of the base hospitals. To raise immediately the standard of the nursing care of the sick in tlie 1)ase hospitals by the provision of an increased nvmiber of persons to render such care. The plan as presented provides that the school, to be known as the Army School of S'ursing shall be located in the office of file Surgeon (iencral. Through this office the enrollment of the students will take place and all matters relating to the general management of the school shall be dealt with. The faculty jiresided over by the dean of the school is to determine all questions relating to the course of instruction; the general administration of the school being entrusted to the dean. It is suggested that an Advisory Council lie a]> poinfed com])ose(l of members of the ]\ledical Department; MOBILIZATION 286 the superintendents of the Army and Navy Nurse Corps; the Director of the Department of Nursing, American Red Cross; tlie presidents of the American Nurses' Association, the National League of Nursing Education and the National Organization for l'ubli(; Health Nursing; tlie dean of the school of nursing and other members of the nursing pro- fession conversant with the problems of nursing education, to make recommendations concerning the appointment of the faculty, the relations between the military and civil hospitals and other matters relating to the general policy of the school. In order that the scliool may come into immediate existence and that as large a group of students as possible may be ob- tained before the heat of the summer, the committee makes the following recommendations: (1) The immediate appoint- ment of a dean or acting dean of the school. {2} Details. (3) That the l\ed Cross Department of Nursing be asked to issue to those who have successfully completed a course in Elementary Hygiene and Home Care of the Sick the applica- tion blanks and announcement in order that should these applicants desire to enter the Army School of Nursing and should they meet the requirements for admission they may be immediately enrolled. (4-5-0. Details). (7) That the dean be authorized to recommend for appointment a director, an assistant director, a full time instructor, and one or more part time instructors in addition to the regular nursing staff of each base hospital selected as a branch of the school of nursing. That the deaii be authorized to confer with the command- ing otlicer and the chiefs of the medical and surgical staffs of such base li()Sj)itals as are selected concerning the ap- pointment of medical lecturers and instructors. . . . The Sccretarv of War approved the plan on ^lay '24:, 1918, and the Surgeon General appointed the advisory committee: War Department Office of the Surgeon General Washington. June 0, 1018. Office Order No. 53. The Advisory Council of the Army School of Nursing is hereby appointed, the members of which shall be as follows: Colonel \V. II. Smith, cliainnan; Colonel C. L. l-\irbush; Ccdonel W. T. Longcope; Miss M. Adelaide Nutting: Miss Lillian D. W'aM ; Miss Anna C. Maxwell; the superintendent 286 HISTORY OF AMERICAN RED CROSS NURSING of the Army Xurse Corps; the superintendent of the Xavy Nurse Corps; the director of the Department of Nursing, American Eed Cross; the president of the American Nurses' Association ; the president of the National League of Nursing Education; the president of the National Organization for Public Health Nursing; the dean of the Army School of Nursing. By direction of the Surgeon General, (signed) C. L. Furbush, Colonel, Medical Corps, N. A. At its second mooting, February, 1919, the advisory council recommended placing the school on a permanent foundation by Act of Congress and submitted this their resolution, together with an outline draft of a suitable act, to the Surgeon General for his approval. ]\Iiss Delano, Miss Goodrich and ]\[iss Thompson were appointed a committee of three to present the plan for the proposed school, but its outline and details as completed followed Miss Goodrich's suggestions. The Army School of Nursing was made a Division in the Surgeon General's office. On May 27, 1918, Miss Goodrich was placed at its head Avith the title of Dean and was directly responsible to the Hospital Division. In a meeting of the Committee on Nursing, Council of Na- tional Defense, September, 1918, it was decided "that a com- mittee be appointed by the chair to develop a program for the participation of the civilian hospitals in the training of pupil nurses or hospital assistants for army service in affiliation with the Army School of Nursing." The members of this committee were : Jane A. Delano, Annie W. Goodrich, Lillian Glavton, Ella P. Crandall, Dr. S. S. Goldwater, Colonel W. H. Smith. The first meeting was held on September 20, 1918, and the minutes for that meeting embody the coordination plans ar- rived at between the Kcd Cross and the school. From them have been taken only those details which illustrate this adjust- ment for smooth working and the avoidance of duplication : ^linutes of the Special Committee Appointed to develop a program for participation in civilian hospitals in tlie training of pupil nurses or hospital assistants for Army Service in affiliation with the Army School of Nursing, Council of National Defense, Washington, D. C, 10:30 A. M. MOBILIZATION 287 September 20, 1918. The chairman stated tlie purpose of the meeting and asked for suggestions from those in attendance. Upon request, !Miss Goodrich, Dean of the Army School of Nursing, pre- sented a suggestive plan of affiliation of civilian schools with the Army School of Nursing. . . . Miss Delano urged the importance of enrolling afliliated students for military duty through the Ked CVoss only and not directly into the Army Nurse Corps in order to secure a permanent registration of future nursing forces; she also urged the enrollment in the Ked Cross of all senior classes pending graduation, subject of course, to the individuals who wish to be enrolled. Miss Delano raised the question of enrolling hospital as- sistants through the Eed Cross. While this matter was gen- erally felt not to be pertinent to the main issue and should therefore be left for consideration with other details of de- velopment, the chairman ruled that in the absence of ob- jections. ]\liss Delano's urgent request for its consideration at this time would be granted. Dr. Goldwater moved as follows: "Resolved that civil hos- pitals which have the necessary facilities be encouraged to arrange for the training and use of hospital assistants accord- ing to the plan and (lualifications of the Army School of Nurs- ing that such hospital assistants should be enrolled through the American Ked Cross with the understanding that they will acce})t service as required either in hospitals in which they are trained, with the American Red Cross, or in the Army Hospitals."' The motion was seconded by Miss Nutting and carried unanimously. ]\riss Delano moved that the students in schools for nurses contemplating atliliating with the Army School of Nursing be given an ()})p()rtunity to enroll as Red Cross Student Nurses, such enrollment to constitute graduate enrollment n])on com])letion of this course, and the recommendation of the dean of the Army hospitals. The motion was seconded by ]\Iiss Nutting and carried. ^liss Nutting made the following motion: "Having lieard from approximately three hundred training schools of the country and a])])r().\imately two hundred having expressed a desire to afhliate with the Army school, this committee ap- proves in general tlie ]ilan of affiliation as ]iresented by ]\Iiss C.oodrich. Dean of tlie Army School of Nursing, with the nnderstanding that it is subject to further modifications as later cxperienc(^ may inake advisable." The motion was seconded bv Miss Clavton and carried. 288 HISTORY OF AMERICAN RED CROSS NURSING To provide for the public health nursing instruction of stu- dents of the Army school at Henry Street Settlement, New York City, the Red Cross through the Xew York County Chap- ter contributed $40,000 for each of the school years of 1919 and 1920. A provision of $0000 was also made by the Ameri- can Red Cross in San Francisco with the University of Cali- fornia for the Army School at Letterman General Hospital. The full details of these gifts are found in the Annual Report of the iVmerican Red Cross for the year ended June 30, 1921. In compliance with a request from the Surgeon General of the U. S. Army, the Executive Committee of the American Eed Cross on January 13, 1921, authorized the chairman to make available for the New York County Chapter funds not to exceed $40,000, or such part thereof as might be necessary to cover assistance through the New York County Chapter to nurses in the Army School of Nursing taking the course in public health nursing at the Henry Street Settlement and Teachers College, New York City. This was in continuation of assistance which had been given through the same channel and under the same conditions during the previous year and was to come, if feasible, from funds which had been set aside by the Xational Organization for financing the work of the New York County Chapter by special arrangements with this Chapter. Up to December, 1920, eighty students had taken the course, and seventy-nine more to June, 1921. Scholarsliips amounting to $()000 for 1919-20 were given to ^lajor Julia C. Stimson, Dean of the Army Nurse Corps to be used for thirty students of the Army School of Nursing at the Letterman General Hospital for incidental expenses in connection with the course in public health nursing at the University of California; $2250 were given in ]\Iarch, 1921, and $2280 in August, 1921, for the same purpose. The Army school had an immediate and pronounced suc- cess. The foremost civilian training schools for inirses affiliated with it and by tlie date of the Armistice, it had 1099 students on duty in twenty-five hospitals, 507 more awaiting assign- ment and a total of 10,089 applications filed. One of the valued pieces of work accomplished by the Red Cross Bureau of Information for Nurses, established during demobilization, was to refer to civilian schools of nursing these 5G7 accepted candidates for the Arniv school. MOBILIZATION 289 Following the plans for tho contiiniance of the Army school,^""* it was luadc a pcniiaiicnt school in July, l.)li>, and Miss (iroodrich thou rcturnod to hor work at Teachors College. She was succooded hy .lulia Catherine Stinison as dean. By the early part of lit 18 the Surgeon General's office had given ont the word that fifty thousand graduate and student nurses must he enrolled and availahle during the period up to January, 11)10. Tho Red Cross Xursing Service had .already taken definite steps toward enrolling a quota of five thousand nurses that had been asked for by the Surgeon General's office; for the period ending June 1, 1918. On March 14 Miss Delano reported these steps as follows: A letter to the superintendents of 2000 or more training schools urging them to increase the supply of nurses for inmiediate service by advancing the date of graduation. A letter to the hoards of registration urging early ex- aminations and as promj)t action upon papers as possible. (The provisional enrollment has been authorized to accept nurses pending the return of the result of their examination.) A special letter to the State iSTurses' Associations explaining the necessity of close cooperation Avith the Divisional di- rectors. A circular letter was also sent to the ten thousand sub- serihers of the Jounidl calling attention to the need of nurses, the War l\isk Insurance and the necessity of registra- tion. A small enrollment leaflet has been sent o\it in the general correspondence of the Divisional directors and also in the correspondence of the Amcricnn Journal of Nurs-ing and to the siil)seril(>rs. A special letter from the director of the Bureau of Fi(^ld Xursiiig was also sent out to the superintendents of 2000 or more trainiuir schools urging them to organize training school units from the senior class and the alumna' associations. Xow in view of the greatly increased re(iuisitions the Red Cross decided to conduct an intensive "drive" for nurses be- tween the dates of Jniie ') and July 17, 11)18. Miss Delano wrote in April in the -Journal: ""Xo act of Coii;i:rcss antliori/.injr tho Army Scliool of Nursiii^r lias Iiceii jiasscd 1(> (late f 1 '.)-2 1 ) . It is contimicd as a group of 'civiliaii pin- ployt'cs of tlic Mcilical I )fjiartiii('iit.' " J. C. Stimson. 290 HISTORY OF AMERICAN RED CROSS NURSING The survey which has recently been made [by nursing so- cieties] indicates that there are not more than 65,000 regis- tered nurses in the United States. If we are to meet the needs of the Army and the Xavy with registered nurses alone, it will be necessary to withdraw not far from fifty per cent of the total number of registered nurses. Even though we include all graduate nurses who are not registered, placing the total at about one hundred thousand, at least thirty-three per cent of the entire number must be secured, if we are to provide nursing care for our Army and Xavy. In view of these figures it seems evident that a special campaign for the enrollment of nurses must be undertaken, not only to bring to the nurses the great need, but to insure the cooperation and assistance of the public and physicians of the country as well. It does not seem fair to place upon the nurses the entire responsibility of a decision. We believe that the community must share with the nurse the responsi- bility for her withdrawal from the community and protect her as far as possible from too great a financial sacrifice. The Red Cross is therefore taking steps toward organizing a definite campaign which we hope to undertake in the early spring. A special committee has been appointed by the chairman of the Xational Committee on Eed Cross Xursing Service, representing the three national organizations of nurses, to aid in preparing the publicity material and in carrying out this special campaign. The representatives of the three or- ganizations are Katharine DeWitt, secretary of the nurses' association and assistant editor of the American Journal of Nursing; S. Lillian Clayton, president of the Xational League for Xursing Education ; and Ella Phillips Crandall, executive secretary of the Xational Organization for Public Health Xursing and of the Committee on Xursing of the Council of Xational Defense.^* The Surgeon General himself wrote an appeal to the Eed Cross in behalf of the drive. He said : May 25, 1918. I am informed that on the third of June it is the intention of the Red Cross to start a Drive for Xurses for the Army. The American Red Cross is a great recruiting agency for Army Xurses and through this agency I wish to ap])eal to the nurses of the country to enroll for service in the Xurse Corps of the Army. "Rod Cross Department; Atncrican Journal of yursing, .April, 1918. MOBILIZATION 291 The need of a great number of nurses is acute, and any assistance the Ked Cross can render the War Department in obtaining for the Army Nurse Corps the number of nurses required will be a service to the country. (signed) William E. Gorgas, Surgeon General, U. S. Army. The machinery used for the drive was very largely the organi- zation of the Red Cross Chapters, which had taken on vast dimensions under the war stimulus. In August, Miss Delano summed up the methods used for, and the results obtained by, the drive: It was decided to call upon the Chapters of the American Eed Cross to cooperate in securing the required number (it may not be generally known to the nurses of our country that the Eed Cross now has a membership of more than 22,000,000 adult members and 9,000,000 junior members, with 3885 Chapters, 14,208 chapter-branches, and auxili- aries) ; in order that the vital need of our country for nursing service might be brought to practically every graduate nurse in the country. It was understood, of course, that the formal applications for enrollment should come in through the usual committees on Red Cross Nursing Service and the Division ofKcers. This was a new departure, and the results have confirmed us in the belief that our nursing service will be greatly strengthened by this close contact with the general member- ship of the American Eed Cross. We have found the Chap- ters throughout the United States most cooperative and anxious to assist, and we feel that the Nursing Service of the Eed Cross will be permanently benefited by the relation- ship which has been established in this way.^^ Results of the ''Xurses' Drive" can best be appreciated bv a brief comparison of enrollments during the fiscal year of 1917- 1918 and the subsequent five months terminating Xovember 1, 1918. No method for determining the exact returns of the drive was attempted, but the unparalleled increase in enroll- ment over previous months was due in large part to this pub- licity campaign and to the unceasing labors of local Chapters and comniittees on Red Cross Nursing Service. During the fiscal year of 1917-1018, 11,213 nurses were enrolled, an average of 817 a month. The impetus of the "Miss Delano in American Journal of Xursing, August, 1',)1S. 292 HISTORY OF AMERICAN RED CROSS NURSING "nurses' drive" was first felt in June, 1918, when enrollment increased from approximately 900 to 1500 nurses. During July 2664 nurses were enrolled and in August 2700, the highest figure reached during the war. For the five months beginning July 1 and ending December 1, 11,118 nurses joined the Red Cross reserve, an average of 2220 nurses a month an in- crease of almost 300 per cent over previous months and a number equal to the entire enrollment in 1917. By the autumn many Division directors reported that they had reached and passed their qiiota, but the cessation of hostili- ties then made it needless to enroll further members. In speak- ing before an audience of nurses a year later, Miss Noyes gave some interesting details of the immense and fatiguing labor involved in the enrollment and the intensive ''drive." Alluding to Miss Delano she said : ^Yorking with her at Xational Headquarters for over two years, it was my privilege to see something of her devotion to the cause which she served. Many times when we reached the end of a weary day's work and the pressure seemed almost more than human power could stand I have heard her say, when asked if she were tired, ''Well. I suppose it is no harder for us to die at our desks than for the boys to die in the trenches." When the Armistice was signed the papers of six hundred nurses were in the War Department ready for assignment and several thousand more had given their date of availability between that time and January 1, 1919. With the addition of those who had entered the Army (3000) and the Navy Nurse Corps (500) direct, the total number of nurses in service at the time the Armistice was signed was, as nearly as it is possible to estimate, about 25,000. The Army had asked for the phenomenal number of 25.000 nurses by January 1, 1919, and 50,000 1)y the first of June, 1919. Great anxiety had been felt on the part of tliose who were working close to the scene, as to the possil)ility of meeting this demand and at tlie same time meeting the civilian needs of our Allies and of our own country. Figures speak for themselves. The response by the nurses to the call of the colors is a conclusive refutation of any criticism that tliey failed to meet their war obligations. It is easy to speak of 20. 000 nurses, hut impossible for anyone to j)icture the tremendous amount of work in connection with the enrollment and assiuiinient of these to service. The or- MOBILIZATION 293 ganization at Tfed Cross Headquarters had to be developed with the utmost regard for complete cooperation. Ill order to ])re])are a nurse tor duty with the military establishment it was frequently necessary to send many communications both by lett<-!r and telegram back and forth before the nurse became sufliciently stable to refer her papers to the War Department. This was necessary lest some accident occur whereby the transportation which was issued from Washington might go to an address at which tiie nurse could not be found. To prepare a nurse for service directly under the Hod Cross was even more dillicult, as the precautions adopted by the State and War Departments before a passport could be issued were extremely complicated. Investigations through the Military Intelligence Department for loyalty were required for everyone, and it frequently took weeks and even months to secure the passport of a nurse for overseas duty with the civilian population in those countries tliat were turning to the Red Cross for help. I mention thus briefly some of the purely routine procedures tliat held the individ- uals in charge of the various bureaus under the Department of Xursing at their desks from early morning until late at night, holidays and Sundays, from the time diplomatic rela- tions with Germany were broken until several months after the signing of the Armistice.^'' The Student iSTurse Reserve campaign, like that for the creation of the Army School, was stimulated electrically bv the v(>rv high hgur(> issued from the Surgeon (ienerars office early in litis, in estimating the probable need for nurses and assist- ants. A formal statement of the launching of the campaign is found in a letter from Dr. Franklin ^lartin, member of the Advisory Commission, Council of Xational Defense" to ^Ir. Henrv P. Davison. It was dated June 27, 1918, and ended with the words : . . . Immediately following these re})orts. "Miss Patterson, director of the Womairs Connnittce, Council of Xatidiial Defense, iirescntcd an outline of a caiu])aign, as extensive in its scope as that of t\\o Red Cross enrollment of nurses. for recruiting t^.j.ooo students for both military and civilian hospitals, whicli her committee is al)out to launch at the request of the Coniniitte(> on Xursing of the Council. As you know. th(> Surgeon (ieiKTal's otlice, the Ked Cross and the (i(>neral Medical Pxjard are coo|)('rating. "Tlip T\(h] Cross Xuisiiiix Service. Twenty-tifth Aiimuil Report. Na- tional League for Xursiinr Kdiuatinii, lUlU. 294 HISTORY OF AMERICAN RED CROSS NURSING The Red Cross cooperated by circularizing all of its Chapters, bv opening Chapter offices as recruiting centers and by assign- ing Red Cross workers to help carry on the campaign. The publicity material was the work of Miss Nutting's committee and was submitted for approval to the Publicity Department of the American Red Cross. An example of the material follows : The Government is now calling for 25,000 young women to join the United States Student Nurse Reserve and hold themselves in readiness to train for service as nurses. Age: The call is for women between the ages of nineteen and thirty-five. Qualifications : Intelligent, responsible women of good edu- cation and sound health are wanted the pick of the country. A college education is a valuable asset and many hospitals will give credit for it. Credit will also be given for a special scientific equipment or for preliminary training iu nursing, such as that given in special courses now being conducted by various colleges and schools. Enrollment : Women will be given an opportunity to enroll in the United States Student Reserve in any one of three ways : 1. As engaging to hold themselves in readiness until April 1, 1919, to accept assignments to nurses' training schools in civilian hospitals. 2. As desiring to become candidates for the Army Nursing School recently established by authority of the War Depart- ment, with branch schools in selected military hospitals. 3. As engaging to hold themselves in readiness until April 1, 1919, to accept assignments to either a civilian training school or the Army Nursing School. The Student Nurse Reserve campaign was a work of infinite detail and in its course many puzzling and exceedingly com- plicated obstacles of an educational or economic nature were mot with. Its results shed light upon our own professional problems and may even be found helpful in other countries. For this reason some parts of the final report are here given: The entire protrram as outlined was dependent upon keep- ing up a large, steady su])ply of candidates of superior quality for both our civil training schools and the Army sehooj, and it was soon evident that the latter would arouse great interest and attract many do-irahle applicants. . . . . . . There arc many practical difficulties to be overcome. For example many j^-raniniar school graduates are not eligible MOBILIZATION g95 in the state in which they enlisted, and they may be unabld to bear their expenses even to an adjacent state. Thus while vacancies still exist and applicants await a[)pointnient, it is often impossible to accommodate either. The large number of reassignments are due chiefly to three causes, i.e. : (a) Lack of information on the application forms regarding denomina- tional preference, (b) Inability of the candidates to meet the expenses of travel and equipment, (c) Direct recruiting in localities, in many instances, into their own schools in- stead of through this committee. Disappointing delays have arisen, due largely to four causes, i.e.: (a) Incomplete application forms, (b) Incom- plete and often inaccurate information regarding age and educational requirements and the number of students needed, (c) An utter lack of precedent for or experience in such a piece of work, (d) Inadequate staff of workers. However the fact remains that, whereas in June, July and August, many hospital training schools were suffering for lack of students, there are now thirteen states (this number was later increased to seventeen), in which needs of all schools have been met. As the need for large numbers was urgent and immediate, and as fourteen state laws called for only grammar school education, the committee thought it necessary not to exclude such applicants in the first drive. Later two years of high school was made the minimum requirement. By common consent, the thousand and more ineligible candidates were urgete report of canditlates 296 HISTORY OF AMERICAN RED CROSS NURSING recruited and assigned has been prepared by states and by schools and copies sent to each state.^^ The campaign was closed on December 15, 1918. Some 14,000 or more applications were dealt with and of these, 13,800 odd candidates were enrolled for entrance into schools for nurses. Those who met all the requirements numbered 5380 and were assig:ned to the Army school. To the civil schools of nursing 5185 were directed. The others were on a waiting list. Much was learned of the hospitals. In one state alone, for example, twelve hospital training schools were dropped from the ac- credited list, as undesirable for the training of Student Nurse Reserve candidates. The instructions and demonstrations to volunteers for mak- ing surgical dressings for the Army were first given by Red Cross nurses. As the work spread over the country, it was stand- ardized by regulations from the Nursing Service in consulta- tion with Army surgeons. It was estimated that 8,000,000 women working in Red Cross Chapters made 253,000,000 surgical dressings between April 0, 1917, and October 1, 1918, while for twenty months ending February 28, 1919, the number was 306,- 966,759. There were more than 30,000 workrooms, where asep- tic conditions were maintained as in the surgical workrooms of a hospital. In addition to the dressings, many millions of other articles of clothing and hospital equipment were made. When the Mercy Ship sailed at the outbreak of the war, a small group of Washingtonians went immediately to work to prepare surgical dressings for the Red Cross. Admiral M. E. Mason, chairman of the District of Columbia Chapter, ap- pointed a committee composed of Abbie B. and Edith M. Mc- Cammon, Annie Power and Mary Randolph to develop this activity. In a little shop on Eleventh Street, donated through the generosity of Mr. M. A. Leeso, they opened on December 1, 1914, the first official Rod Cross workroom the parent of hundreds of supply depots, later set up in libraries, railroad terminals, department stores, clubs, Sunday School rooms and remote country sclioolhouses. At a meeting of the National Committee on Red Cross Nurs- ing Service, held June 20, 1917, in New York City, Miss Delano described the work of this first committee on surgical dressings : "Report of the Committee on Nursing, General Medical Board, Council of National Defense, April, 191!). MOBILIZATION 297 A circular was issued in 1915 and distributed generally to Red Cross ('hapters. This was used as a hasis of work until the publication early in 1!)1(), of a second panipidct intended for United States War l\elief. At this time, the standard boxes were also adopted and their contents defined. In order to maintain a definite standard for the preparation of these dressings, we realized that a course of instruction must be adopted. A plan was accordingly worked out and appoint- ment cards authorizing their recipient to act as instructors, were issued to those recommended for this work by the com- mittees in charge of our surgical dressing workroom. During the spring of 191(i, classes were organized not only in connection with our Chapters but in cooperation with the Woman's Section of the Navy League. It may be interesting to state the method followed in the adoption of standard dressings. In cooperation with the Supply Department of the Eed Cross, I visited various hospitals in Boston and elsewhere, such as the Boston City Hospital and the Presby- terian and Bellevue Hospitals in Xew York City, and selected samples of their various dressings, operating-room gowns, helmets, etc. We then secured complete sets of dressings from the Army and ?^avy Hospitals, so that we had typical dress- ings from about twelve different hospitals. A conference was then held between surgeons and nurses from the Army and Xavy, Eed Cross personnel and several nurses who had had experience in Europe. The various dressings were examined and those which seemed common to a majority of hospitals were selected. A sample box was pre- pared and submitted to directors of units such as Dr. Crile of the Lakeside Hospital in Cleveland. Slight changes were made on their suggestions, and the so-called Red Cross dress- ings were adopted. In September, lOKi, the responsibility for hospital sup- plies was turned over to ^liss Xoyes. Slie and Dr. Bichards, a representative of the Xavy, revised the supply circular, but no radical changes seemed necessary. Throughout the winter months of lOlG and 1017, the in- terest of women in all parts of the United States in the prepa- ration of surgical dr(>ssing^ developed beyond the capacity of a central office at Xational ircadquartcrs to handle. ]\[iss Noyes had prcpar(>d a special course^ in the making of these dressings and also a second c()nrs(\ after satisfactory comple- tion of which the student was certified as being able to act as an instructor for other classes in the preparation of dressings. 298 HISTORY OF AMERICAN RED CROSS NURSING Hundreds of certificates, one for the general course and a second for the instructor's course, went out under Miss Noves' signa- ture to all sections of the country and became the keystone over which the Red Cross workrooms sprang up in schoolhouses, churches, clubs and industrial centers. Before a woman was certified as an instructor, she was re- quired to submit a sample box of the various types of surgical dressings. No sooner had Miss Noyes examined and cleared her desk of these samples than the Mail Division would send up a hundred more. The top floor of the "]\Iarble Palace" billowed with cotton and gauze. Vashti Bartlett was the first nurse to assist Miss Noyes ; later, volunteer nurses from Wash- ington lightened the burden of the overtaxed director and her assistants. Among these was Mrs. Charles Silliman (Mary V. Lee, Johns Hopkins). After examination, these innumerable white pads and neatly-folded bandages were passed on in clothes-baskets to Mrs. Theodore W. Richards, who sorted out the perfect articles and packed them into complete model boxes to be returned to Chapter workrooms. To zealous women waiting impatiently in Red Cross Chap- ter and Branch headquarters for their certificates, the Nursing Service may have seemed over-exacting in their insistence upon perfect dressings. Sharp adherence to standards resulted, how- ever, in great economy of materials and time. Overworked nurses in evacuation and base hospitals, moreover, could not stop to refold a pad whose ravelled edges might result in discomfort and danger to their patients. Great pressure was being brought to bear at this time upon the Nursing Service to change the types of dressings to suit the preferences of in- dividual surgeons. The aim of National Headquarters had always been to prepare a type of dressing which anyone could use. As this standard had been reached after conference with leading authorities of the Army, the Navy and civilian insti- tutions, Miss Noyes turned a polite but deaf ear to protesting physicians who came to interview her. After the Nursing Service had given over this work to the Women's Bureau, a special committee went to Europe to study the entire question, and the Red Cross models were later changed. On June 23, 1017, Miss Noyes wrote as follows to Col. Kcan: Since Jamiarv 1, the work of the Surgical Dressings and Garments Division of the Bureau of Nursing Service has ex- panded with groat rapidity. Thousands of inquiries are com- MOBILIZATION 299 ing to us from Chapters, branches of Chapters, auxiliaries, groups of workers and individuals who are interested in the preparation of surgical dressings and hospital garments. Every new Chapter and auxiliary at once desires this jiarticu- lar work, Althougli circulars of information and detailed directions are sent concerning the organization of classes and the manufacture of dressings and garments, questions are constantly arising which must be referred to an authoritative head. We have divided the country into eight districts Boston, New York City, Philadelphia, Baltimore, Cleveland, Chicago, Colorado Springs and San Francisco, for distribution of sample boxes of dressings, patterns, emblems and informa- tion. As the pressure upon these Chapters has increased, it has seemed desirable to authorize other distributing ceiiters and the following are preparing to qualify as such Atlanta, New Orleans, St. Louis, ^Minneapolis and Seattle. It would be safe to say that workrooms have not only been established in all of our cities, but towns and country districts have developed in the same direction. The following workrooms stand out conspicuously as models of efficiency: New York City as developed under "Sirs. Belmont Tiffany. Chicago as developed under Mrs. John Glass. Washington, D. C, as developed under Mrs. T. W. Richards. Baltimore as developed under ]\[rs. Thos. S. Cullen. Cleveland as developed under ^frs. E. S. Burke. There are many others equally proficient. The statistics appended show the status of the work at the present time : Since December 15, 19in. No. of completed surgical dressings classes 330 No. of pupils qualified 4799 No. of enrolled Red Cross nurses qualified 15f) No. of lay instructors qualified 3G3 No. of sample boxes sent from this office 4.") I You will note that lo() Red Cross nurses have Ijccmi qualified and enrolled as instructors in this course, but we believe that the instruction and management of workrooms could safely be entrusted to our qualified workers and lay instructors. Red Cross nurses are required for the more important work of caring for sick and wounded soldiers and sailors. To provide administrative channels through which this trans- fer could 1)0 effoctcd, t\w Executive Committoo established duly l\ 1'.>17. uiidiT tlic 1 )(']tartnicnt of Chapters, a bureau 300 HISTORY OF AMERICAN RED CROSS NURSING through which all women's activities for the Red Cross (other than professional nursing) should be recognized and developed. The vice-chairman also appointed a Woman's Advisory Com- mittee, consisting of the following members : Mrs. William K. Draper, chairman ; ^[iss Mary Goodwillie, vice-chairman ; Miss Mabel T. Boardman, ]\rrs. Joseph M. Cudahy, Mrs. Frank V. Hammar, ]\Irs. E. H. Harriman, Mrs. George Wharton Pepper, Mrs. Leonard Wood, Miss Lavinia H. ISTewell, Mrs. William H. Crocker, ^[rs. Preston S. Arkwright, Mrs. August Belmont, Mrs. J. Randolph Coolidge, Jr. To the Woman's Bureau, of which Miss Florence M. Marshall was director, was immediately delegated all work connected with surgical dressings, hospital garments and refugee clothing. In the Red Cross Annual Report for 1917, Miss Delano summarized the benefits derived from this transfer: This reorganization served two purposes; it released a large number of nurses, who have been acting as instructors in surgical dressings and hospital supplies, for other service, and it marshaled the forces, not only of women volunteers, who were fitted to become instructors, but of the great army of volunteer workers throughout the country just when the emergency demanded such a realignment. It left the Xursing Service free to deal with its purely professional duties. During the period in which the United States was at war, several surveys of the nvirsing profession were made in order to obtain a working estimate of the nursing strength of the country. Immediately after the declaration of war by this country, the Xational Committee on Red Cross Xursing Serv- ice, as a first step, carried out a preliminary classification of its own enrolled members under the heads of nursing special- ties. Miss Delano wrote :-^* With tlie declaration of war, there was a decided increase in the aitplif-ation of nurses for enrollment with the Red Cross. Tlip enrollment from January 1 to October 31, 11)17, has been over TOOO, e states wlun-e State nurses' associations did not exist. The census was completed in March, 1918. Early in 1918 Congress inquired into the nursing reserves of the nation: Mr. Trannnoll submitted the following resolution (S. l?os. 185), wliich was read, considered ])y unanimous t'oiisont and agreed to : KESOLVFl): That the Senate Committee on Military AfTairs be, and it is hereby, directed to investigate and re- port to the Senate at the earliest practicable date the avail- " See Report of Coniinittee on Xursiiig (Council of National Defense) July 29, 1<17. 306 HISTORY OF AMERICAN RED CROSS NURSING able number of trained nurses for service with the United States Army; and whether or not this present available number will be adequate for the needs of the Army when increased by the anticipated future increments, taking into consideration the increased demand when the Army shall more largely engage in active conflict; and to investigate and report on the advisability of at once establishing train- ing sources or schools for nurses for future service with the Army Hospitals ; and to investigate and report what, if any, provisions have been made to this end by the War Depart- ment.' As the summer wore on and the Red Cross continued to draw nurses from institutional fields for the Military Establishment, Miss Noyes was confronted by the imminent possibility of breaking down completely the efficiency of the nursing sys- tems in already overcrowded civilian hospitals. General Gorgas in August, 1918, was calling for one thousand nurses a week. The civilian population constituted, however, the second line of defense. Their health might be seriously undermined by this exhaustive drain upon the supply of physicians and nurses. "We have only one graduate nurse left," wrote superintendents of smaller schools of nursing to Miss Koyes, "and if you call her into service, w-e shall be forced to close our doors." Some institutions had already done so. To secure scientifically accurate data by which the Nursing Service might be guided in its withdrawal of nurses from civil establishments, !Miss Delano and ]\Iiss Noyes suggested early in the summer of 1918 to the War Department and to offi- cials at National Headquarters that the Red Cross make a complete survey of the nursing resources of the nation. On August 27, 1918, the Surgeon General wrote to Mr. Davison, chairman of the War Council : Because of the increased military programs it is necessary that there sliould be immediately available definite informa- tion as to tlie number of graduate nurses available for mili- tary service; also supplementary nursing personnel, trained hospital attendants, and all others who are qualiiied to render aid under the direction of graduate nurses in the care of the civilian popnlation. As the Red Cross is the agency for recruiting nurses for the Army Nurse Corps I wish you would take immediate ** Congressional Record, January 10, lOlS, p. OtiT. MOBILIZATION 307 steps to make a natioii-wido survey of the nursing resources in order tliat a sulTicient number of graduate nurses may be withdrawn for military service with the least interference to the possible needs of the civilian population. (signed) William C. Gorgas, Surgeon General, U. S. Army.^^ Immediate steps were taken for complying with Dr, Gorgas' request. The ^linntes of the War Council meetings for the 119th meeting, held September 20, 1918, give a full account of what was done: . . . under date of August 29, 1918 (D. R., p. 14G9), the chairman had replied to the above letter of the Surgeon General of the Army, stating that the Ked Cress deeply appreciated the importance of the work suggested, and that the acting general manager had been instructed to set up special machinery at Headquarters under expert guidance, to manage the survey which will be conducted through Red Cross Chapters. The chairman further stated that a comprehensive plan had now been submitted (I). E., p. 1538) by the assistant general manager for the making of such a survey; that questionnaires had been prepared which would be sent out througli the Chapters, through which very comprehensive information on the nursing resources would be made avail- able; that, under this plan, an executive manager of the nursing survey, ^Ir. Frederick C. ]\Iunroe, had been ap- pointed, and a special organization had been set up at Xa- tional Headquarters, at the Divisional Headquarters, and thence to every Chapter and branch in the country; that the work of canvassing the field to secure facts about every nurse would involve a house to house canvas in many parts of the country, and hence would require large forces of workers; that if all tlie facts that can be useful are to be gathered from this survey, the tabulation work would be very great; that the number of questionnaires that would be sent to Xational Headquarters to be classified and analyzed is estimated roughly at 3(i0.000; tliat tabulation of "'this great number of questionnaires can be done only by mechan- ical means, and that ]ilaiis were now being comi)leted to use the so-called 'Tlollerith System." which would involve ma- chines, punches, special cards, filing cases, and a force of fifty or sixty clerks for al)out two month's. " Documents uf Record, pp. 14GS-G9. 308 HISTORY OF AMERICAN RED CROSS NURSING He further stated that a request for an appropriation of $60,000 had now been received from the director of the Department of Nursing, approved by the assistant general manager, to cover the. cost of making this survey, including the printing and distributing of questionnaires, Headquar- ters' expense for machines, punches, cards, filing cases, and clerical hire, and Division expenses for clerks, traveling and publicity. [The appropriation was granted. ^^] The statistical division was under the direction of Mr. C. S. Qiiinn. In a letter sent to all the Division directors, Miss Delano said in part: The survey is quite apart from the enrollment of Eed Cross nurses and will be conducted more nearly like a census than an enrollment, and for this reason it will be necessary to secure the assistance of people who have had experience in conducting surveys and compiling statistics. Mr. Munroe, of Boston, who is an expert along these lines, has been placed in charge of the work at Red Cross Headquarters. I have already appealed to the State nurses' associations, who made the former survey, urging their cooperation and we are advising with the Committees on Nursing of the Ameri- can Red Cross and the Council of National Defense and the Surgeon General's office. . . . We are anxious to secure definite information concerning all the nursing resources of the community, including not only graduate nurses, registered and unregistered, but pupil nurses, practical nurses, trained attendants, midwives, etc. This places the whole work on a difl'erent basis from any previous survey and will make available the information so greatly needed at this time to meet military necessities and protect the welfare of the communities. Definite plans outlining the work will be issued as soon as possible. The coming of tlie Armistice with its welcome relief from high tension had an inhibiting etfect on the processes of the survey and when, in the spring of 1011) the Bureau of Nurs- ing Survey reported that field activities were drawing to a close, it had received but 57.0% of the expected returns. The questionnaires filled out in sufficiently complete form to be "See Minutes of the llOth Meeting of the War Council, September 26, 1918, pp. 1556-1557. MOBILIZATION 309 utilized showed 155,918 women broadly classed as nurses, and coming under all the various headings indicated in the letter quoted above, from Miss Delano to the Division directors. From the averages it was computed that the whole number of nurses of all grades, in the country, would be about 209,288, but the minute classifications could not be pushed to a con- clusion, nor was the final completion of the survey as a whole possible, after the return of peace. CHAPTER VI EELATIOX OF THE NURSING SERVICE TO THE ARMY Organization of Units Base Hospitals Hospital Units Emergency Detachments Training School Units Special Units Cantonment Zone Service Mexican Border Service Equipment and Insignia. POPULAR opinion has made of the American Red Cross nurse a romantic embodiment of personal beauty, of steadfast courage and sympathy, of womanly sweet- ness and gentle strength. It has, moreover, pictured her at the forefront of war, set high above the ugliness and stench of combat, unperturbed, serene and holy by reason of this beauty of person and character, a shining ideal toward which the dy- ing soldier turned his glazing eyes. Among the eighteen thousand American Red Cross nurses who served with the American Armies during the European War, sentimentalists could have foiind scarcely a single woman who fulfilled in outward appearance at least this radiant con- ception of the angel of the battlefiMds. Instead of the flowing white veil and the immaculate uniform of popular fancy and postered fame, the Red Cross nurse wore the utilitarian cap of the graduate nurse and the practical gray uniform of the field; sometimes she was muffled up in slicker, with storm lx)ots on her feet and sou'wester pulled down over her eyes ; or again she had drawn a sagging, weather-beate^i sweater about her shivering body. Instead of a seraphic-faced girl, she was far more frequently a woman of mature years, long familiar with the seamy side of human relationships, long acquainted with the sadness born of working day and night with the- two supreme realities of human existence. Life and Death. She had little opportunity for gentle speech to the wounded in moments of stress, only time and streniith to utter brief words of instruc- tion to corpsmen and stretcher-bearers who assisted her. Highly- trained instrument in the care of the sick that she herself 310 I RELATION OF NURSING SERVICE TO THE ARMY 311 was, she could manifest no reactions of her own personality or of her own emotions. Though her throat might ache with sym- pathy, her mind must be alert, her eyes must be clear, her hands steady for the performance of her manifold duties. As the personality of the individual woman was lost in the efficiency of the expert nurse, so was the identity of the Ameri- can lied Cross Nursing Service lost in that of the Army Nurse Corps. So close was its relationship, so whole-hearted was its cooperation with the United States War Department that its nurses, during the last months of the duration of hostilities, cheerfully laid aside the Ked Cross, that symbol of humani- tarianism which had led them to pledge loyalty and service to an ideal of patriotic altruism, that they might conform in all particulars to the regulations of the Military Establishment. How the individualistic humanitarian instincts of the relief worker during the Civil and Spanish-American Wars crystal- ized into the Ked Cross ideal, how the affiliation of the Ameri- can nursing profession brought this shadowy vision of the care of the sick and wounded of armies in war from the realm of vague aspiration into that of definite actuality, how this germ- idea developed into the official reserve of the United States Army and Navy Nurse Corps, has already been shown. Into this complex pattern of American war nursing, the lives and accomplishments of many women have been woven. Among the seven who in turn have stood at the head of the Govern- ment's nursing forces, Dorothea Dix, Anita Newcomb Mc- Gee, Dita Kinney, Jane Delano, Isabel McTsaac, Dora E. Thompson, and Julia C. Stimson the World War brought into sharp relief the last two as superintendents of the Army Nurse Corps. By training and temperament, these women were both uniquely fitted for the work each accomplished in the Army Nurse Corps. ^liss Thompson was a veteran member of this organization. After post-graduate work in operating-room methods at her alma mater, the City Hospital, BlackwelFs Is- land, New York City, she did private duty nursing for four years in New York City. She was enrolled as a nurse April 22, 1002, in the then infant Army Nurse Corps and was ap- pointed as a chief nurse in August, 1005. Service followed at Letterman General Hospital, where her work as eliicf nurse during and after the San Francisco eartlnpuike was highly coinnuMided. Lat(>r, she was sent to ^lanila to serve as chief 312 HISTORY OF AMERICAN RED CROSS NURSING nurse of the Division Hospital. In May, 1914, she became a member of the American Red Cross Nursing Service. Dur- ing the same year, she was appointed Superintendent of the Army Nurse Corps, following the death of Miss Mclsaac. In this capacity, she served until December 30, 1919, when she tendered her resignation. She then took extended leave of absence, at the expiration of which she was appointed as- sistant Superintendent of the Army Nurse Corps and at her own request was assigned to duty in the Philippines. Painstakingly faithful to minutiae. Miss Thompson pos- sessed that type of mind often described as the first pre- requisite to genius. Hers was an infinite capacity for detail, which made her invaluable in the performance of her sharply defined duties in the Surgeon General's ofiice. Iron-clad regu- lations handed down by the high ofiicials of the War and State Departments controlled to the last detail the complicated process by which an American Red Cross nurse was assigned to active Army service. Miss Thompson piloted the Army Nurse Corps through these narrow channels with a faithfulness characteristic of the "Army mind." Beneath a certain cold reserve of manner born of her exacting tasks, she possessed gen- tleness and sweet restraint. She was absolutely free from what may be termed the politician's instinct. The meteor-like ascendency of Julia Catherine Stimson of- fered sharp contrast to the unobtrusive rise of her predecessor. In the blinding light of war, her dominant personality stood out in the same bold outlines as did her Amazonian physique. Her regular, boyish features habitually wore a thoughtful ex- pression, which brought to the observer an impression of dig- nity and power. Her well-trained mental processes, clean-cut often to the point of brusque speech, were as direct in their focus as were her keen blue eyes. The daughter of a New York clergyman. Miss Stimson was gTaduated from Vassar College and from the School of Nurs- ing of the New York Hospital, New York City. For three years she was superintendent of nurses at the Harlem Hos- pital. She went to St. Louis in October, 1911, to do social sen^ice work in Wasliina-ton University and in the St. Louis Children's Hospitals, and later became superintendent of nurses of the Washington University Training School for Nurses. She volunteered in 1009 for patriotic service under the Red Cross, when enrollment of nurses was being under- RELATION OF NURSING SERVICE TO THE ARMY 313 taken through Red Cross Chapters. Her first opportunity for active duty under the ]{ed Cross flag came in 1913 during the Ohio flood. When the Red Cross Department of Military Relief author- ized the organization of Base Hospital No. 21, within the Washington University ^ledical School, Julia Stimson was ap- pointed chief nurse. She served with distinction during its subsequent assignment to the British Expeditionary Forces. Her successful work in the Washington University School of Nursing, as well as the fact that she was an alumna of Vassar, caused her name to be brought forward during the spring of 1918 as a natural selection for the head of the preparatory course of the Vassar training school project. The Chief Surgeon, American Expeditionary Forces, however, assigned Miss Stimson in April, 1918, tq the office of the American Red Cross in Paris at the request of the Red Cross commis- sioner to serve as Chief Nurse of the American Red Cross in France. On November 15 of the same year. General Ireland, who throughout his service as Chief Surgeon of the American Forces in France and later as Surgeon General, United States Army, had been a stanch friend of the Red Cross Nursing Service, appointed ]\Iiss Stimson Director of the Nursing Ser- vice of the American Expeditionary Forces. In July, 1919, Miss Stimson returned to the United States to succeed ^liss Goodrich as Dean of the Army School of Nursing. Secre- tary of War Baker appointed her Superintendent of the Army Nurse Corps five months later. The special relationship between the Army Nurse Corps and the American Red Cross Nursing Service was defined in a paragra])h drafted by ^liss Delano when she was su])erint('n(l- ent of the Army Nurse Corps and was printed in the (1910) ^lanual of the .\ledical Department, United States Army. The paragraDh follows: 102. The enrolled nurses of the American National IJed Cross Nursing Service will constitute the reserve of the Army Nurse Corps, and in time of war or other emergency may with tlu'ir own consent be assigned to active duty in the Military Mstatdisluncnt. When the emergency necessitating the cnij)loyment of reserve nurses is iinniin(>nt. th(> Surgeon General will rt-quest the propt'r oflicer of the Red Cross Society to nominate from anu)ng the enrolled nurses (jualilied for the work to he done as many as the Siin:eon (leneral 314 HISTORY OF AMERICAN RED CROSS NURSING may deem necessary to enable him to choose those for as- signment to active duty. (a) When called into active service they will be subject to all the established rules and regulations for the govern- ment of the Xurse Corps, and will receive the pay and allowance of nurses on the regular list. (b) A reserve nurse will not be relieved from active serv- ice except by order of the Surgeon General. Except in case of misconduct she will, if she so desires, be furnished travel orders to her home before the order of relief shall take effect. . . . (c) When a reserve nurse is assigned to active service the Surgeon General will by letter promptly advise the proper officer of the Eed Cross Society to that effect. When she is relieved from active service he will communicate that fact likewise by letter, stating the cause of her relief and whether her services have been satisfactory,^ On December 18, 1916,- Secretary Baker issued Eegiilations Governing the Employment of the American Red Cross in Time of War, which contained the following paragraph: ''10. The Red Cross units organized for service with the Army or for the purpose of training personnel therefor are : 1, am- bulance companies; 2, base hospitals; 3, hospital units; 4, sur- gical sections; 5, emergency nurse detachments; 6, sanitary training detachments ; 7, information service ; 8, refreshment units and detachments ; 9, supply depots : 10, general hospi- tals ; 11, convalescent homes." EiScient and friendly cooperation of the closest type existed during the European War between the Army Xurse Corps and the American Red Cross Xursing Service. By letter, by tele- phone, by special messenger. Miss Thompson and Miss Delano and Miss Xoyes kept in touch with each other. Calls went from the Surgeon General's office, first located in the ^Mills Building and later moved to temporary offices flanking the Botanical Gardens at Eighth and B Streets, to Xational Red ^Manual for the ^Icdical Dcpartmpnt. U. S. A., 1916, p. 47. * These Regulations of December IS, lOlG, were later rephiced by Speeial Refrulations, Xo. CI. War Dei)artnient, October 8, 1917, wliich Regulations '"include and are identical with the Regulations Governing the P^inploy- inent of tlie American Red Cross in Time of War (Uecemlier 18. 1916) and General Orders Xo. 82, War Department, 1917." Special Regulations Xo. 61 formed the oflicial guide-book of tlic American Red Cross during tlie remainder of the participation bv the United States in the European War. RELATION OF NURSING SERVICE TO THE ARMY 315 Cross Headquarters; IMiss Xoyes in turn sped these demands to Division oltices and Local Committees; while the Red Cross publicity organization spread the appeals broadcast over the leng-th and breadth of the land, until on November 11, 1918, the United States Army Nurse Corps totaled the largest body of professional women ever mobilized for patriotic service. Far removed, however, from its final war strength of 21,- 480 members was the Army Nurse Corps on April G, 1917. Only 235 regular and 165 reserve members constituted the Government's nursing forces when the United States declared war. jMilitary science decreed that the sanitary personnel within the armies of civilized countries should constitute ten per cent of the strength of the forces. Secretary Baker confirmed this opinion by his orders of June, 1917. The General Staff, Ameri- can Expeditionary Forces, finally agreed that the total sani- tary personnel, ofiicers, nurses and enlisted men, should be seven and sixty-five hundredths per cent (7.05%). The Chief Surgeon in a letter submitted August 11, 1917, to the Chief of Start" stated that for an army of one million men, 22,430 nurses would be required. He added that ''it is believed that if this calculation is erroneous, the error will be on the side of conservatism." ^ The Army estimated that the ratio of one nurse to every ten hospital beds was a safe one. In a memorandum prepared in February, 1918, by the Surgeon General's office for Secre- tary Baker, the following statement w^as made : The ten-bed-to-one-niirso ratio is admittedly a restricted allowance, offering scant margin of safety to take up a serious epidemic. As shown on the tabular sheet, the present actual ratio in the I'nited States is one nurse to 15.8 beds. To meet an epidemic emergency, additional nurses must be re- quested after the need has appeared, making at least tem- porary inadequacy inevitable.* The assii:nment to active dutv of fiftv base hospitals orcran- ized by the Jied (^ross in 1916 and 1917 for the Army formed the skeleton of the hospitalization of the United States Medi- cal Department in France. When these massive colunnis were ^"History of Xursino: Activities, A.E.F., on tlio \Vo8torn Front during tiiu ^^'ar I'l'iiod," J. ('. Stini-^oii. p. 7. Suri^'coii (Jcncrars otlice. W iisli.. I). C. * See letter written hy Jane A. Dehuio on February 1"), 1018, to General William C. Uori'as; Ked Cross Archives, Wash., D. C, 316 HISTORY OF AMERICAN RED CROSS NURSING ordered overseas during the summer of 1917 and to the can- tonments of the National Army, Surgeon General Gorgas au- thorized the organization of fifty additional ones, beginning with Number Fifty-four. These base hospital units were to be organized on a basis of five hundred beds, with a nursing personnel of sixty-five members. The Surgeon General's office stated that they did not believe that these units would be or- dered into the field, however, until after the original fifty base hospital units which the Red Cross had organized and equipped had been called into active service.^ The first branches of the American Army to see foreign service were six base hospital units which were assigned to duty with the British Expeditionary Forces several weeks after the United States declared war. Upon arrival in France, these units were placed in charge of six British general hos- pitals, of from fifteen hundred to twenty-five hundred bed capacity, which were located in the Rouen and Le Treport areas. The original nursing staff of sixty-five members was found to be inadequate, so the Surgeon General's office called for additional nurses in sufficient numbers to raise the staffs to one hundred nurses each. Nurses from Red Cross hospi- tal units were used for this purpose and "casuals" were also sent over. The organization of all future base hospital units was undertaken on a basis of one hundred nurses rather than sixty-five. On February 21, 1918, Miss Thompson wrote Miss Delano of the first change in method of assignment of reserve nurses to active service from the former system of unit organization. The Surgeon General's office suggested that, in the future, the nurses who were enrolled by the Red Cross should not be assigned to specific base hospital units, as had been done with the first fifty, but that they should be held as a general nursing reserve, to be called upon as available and as needed. "The advantage of this procedure," wrote Colonel Winford Smith, then in charge of the Base Hospital Division of the Surgeon General's office, "would be that it would not be necessary to keep track of specific groups which might have to be with- drawn from sei"\nce at some place to go with the base hos- pital to which they had been assigned, nor would it be neces- sary to hold nurses on the inactive list because of their ^ Soe letter written by Dora E. Thompson to Clara D. Noves, October 8, 1017. RELATION OF NURSING SERVICE TO THE ARMY 317 assignment to base hospitals not yet in service. If the nurses are enroHed in a general reserve, they can be called as needed and assigned where they are needed most." " Under this plan, the Surgeon General's office hoped to develop a reserve supply in the cantonment hospitals, from which nurses would be drawn when a base hospital was to be organized for service in Great Britain or France. The method by which the Surgeon General's office advised the ^N^ursing S(>rvice of the needs of the Army is well illus- trated in two rcHjuests for imrses which were received in the late winter and early spring of 1!)18. On February 28, 1918, Colonel Smith wrote !Miss Delano that the Surgeon General would require approximately five thousand nurses between !March and June, in addition to those already assigned to base hospital units. jMiss Thompson partially echoed this request in a letter written to Miss Noyes on March 4, in which she asked that the Red Cross ''nominate as soon as possible 450 mirses needed for innnodiate assignment, in addition to the one hundred nurses" a month which the Red Cross was mobilizing during January, February and March for immediate assign- ment to the American Expeditionary Forces. During the middle of December, 1917, ]\Iiss Xoyes had ex- perienced difficulty in convincing nurses that the time had arrived for them to relinquish their civilian affiliations and to undertake active military service. The Red Cross enrollment, then of eight thousand nurses pledged to active service upon call, was at this time wholly unclassified. Two methods of utilizing this nursing reserve confronted Miss jSToyes; on the one hand she migh^ weed out from the general files of the Xurs- ing S(>rvice by detailed and tedious correspondence the names of all women who met the citizenship and physical require- ments of the Surgeon General's office and who were, more- over, w'illing to respond to an immediate call ; on the other hand she might present the military nec^l to the nursing pro- fessicm by speaking personally to large groups of nurses in all parts of the country. She finally decided to take a speaking trip during DccfMnbcM-, 1917, and January, 1918, through the principal cities of tlie Unit(Hl States to address mass meetings of nurses. Slie returned to Headquarters during the middle of February, 1918. "Sep IcttiT written ])v Dora E. Thompson to Jane A. Delano, February 21, 1018, 318 HISTORY OF AMERICAN RED CROSS NURSING Hardly had she begun when she found out the reasons why nurses were slow to volunteer for the additional base hospitals and the groups of "casuals" for which the War Department was then pressing the Red Cross. To her appeals for nurses for cantonment hospitals in this country, members of her audiences responded with the statement that three thousand nurses were known to be listed upon the muster-rolls of the fifty base hospitals then awaiting assignment to active duty, and that several hundreds of these very women had been mark- ing time for weeks at the port of embarkation, Ellis Island. Their transportation was delayed on account of orders to hold all non-combatants and to rush the combatants overseas, but this information, of course, was not given out to the public for obvious reasons ; nor was it known in the Surgeon General's office when the nurses would be sent overseas. Notification as to accommodations on the transports was often sent but a few hours before sailing. As long as the services of these women remained unutilized, argued Miss Noyes' listeners, the demands of the cantonments could not be so urgent. Direct foreign assignment, moreover, appeared far more picturesque, more desirable. On the other hand, the Surgeon General's office held to the policy that the nursing staffs of base hospitals should not be scattered among the cantonments at this time, as the sailing of their units was imminent and it was thought that their assigmnent and almost immediate withdrawal would add to the already heavy burden at the camps. Miss Thomp- son and Colonel Smith, naturally, knew that an initial experi- ence in military routine in the cantonment hospitals for nurses as well as for officers and enlisted men would heighten their efficiency, so in order to correct the general misunderstanding that the Red Cross was in no great need for nurses for the Army, the nurses of the various units were finally sent to the cantonments and Army general hospitals throughout the coun- try for duty pending the sailing of their units. Miss Thomp- son wrote Miss Delano on jNlarch 8, 1918: "In order to meet the need for nurses in this country, the entire group of nurses attached to base hospitals not yet ordered out, will be ordered into service upon receipt of their names in this office. It is thought advisable, however, that no more than ten (10) nurses from any one base hospital be ordered to any one cantonment hospital, lest we cripj^le the hospital when the nurses must be withdrawn." RELATION OF NURSING SERVICE TO THE ARMY 319 By the late spring of 1918, the Surgeon General's office had estimated the ininibcr of nurses which the Army would require of the Ked Cross reserve. In a letter written March 8, Colonel Smith stated that "the number of nurses estimated for our re- quirements up to January, 1919, including those now in ser- vice and the 5000 asked for by June 1, is 25,000." Early in the summer of 1918, this number was greatly increased. On July 27, Brigadier General Robert E. Noble advised the Di- rector General of ^lilitary Relief that at least 2500 additional nurses would be needed between that date and September 15. On August 1, 1918, Surgeon General Gorgas issued to the Red Cross his historic appeal : I call upon your organization, as the chief nurse recruit- ing agency of the Army, to employ every possible means to increase the enrollment of nurses for immediate assignment to duty. With the contemplated increase in the Army both at home and overseas, there must be a proportionate increase in the number of nurses in the service. The Army today is grow- ing faster tban the Xurse Corps is increasinj?, and as the Armies overseas enter the front line trenches in jrreater num- bers, the greater will be the need for nurses in the Army Nurse Corps. I, therefore, urge upon the American Eed Cross, through its agencies, to l)ring to the attention of tlie trained nurses of the country, tlie necessity of immediate offer of service, and tlien enrollment in tlie Army Xiirse Corps. I hesitate to deal in concrete numbers, but I desire to emphasize the fact tbat I need today a very material in- crease in the Army Xurse Corps, and desire this increase in the ratio of at least a thousand a week for the next two months. These requests, together with the assistance which the Amer- ican Red Cross was giving the Women's Committee of the Council of National Defense in recruiting student nurses for the Army School of Nursing and for civilian hospital schools,'^ ' Soo letter written July S. IHIS. by the aetinir general nianairer Xatioiial Rod Cross nea(Itter to Cliapters attached to and transmitted by the above letter of the act in'' ":eneral manager. 320 HISTORY OF AMERICAN RED CROSS NURSING brought, by July, 1919, the total needs of the Army to fifty thousand graduate and student nurses. Fifty thousand grad- uate and student nurses ! This was the responsibility which fell to Miss Delano, more than to any other woman. As chair- man of the N^ational Committee, the American Red Cross and the American nursing profession had entrusted to her vision the development of Red Cross nursing service. If now at the supreme moment, this organization which her brain and hand had created and nurtured, failed to meet the obligations which war laid upon it, to her more than to any other woman would belong the overwhelming catastrophe and despair of its failure ; and in crowded wards of base hospitals and evacuation sta- tions, American men would have to endure the agony of modern battle casualties, unalleviated by adequate nursing care. A definite problem of supply and demand confronted the Red Cross. On one side of the equation were the nursing re- sources of the country, distributed in the fields of private duty nursing, in institutional work, in public health nursing and in the advanced classes of schools of nursing. On the other side were the needs of the Military Establishment. The responsi- bility of the Red Cross was to select from these fields nurses sufiicient in number to meet war needs, yet to withdraw them in such a way that the health of the civilian population would not be jeopardized. According to the Regulations Governing the Employment of the American Red Cross in Time of War, which Secretary Baker issued on December 18, 19 IG, the four types of unit through which the Army secured nurses from the Red Cross were base hospitals, hospital units, surgical sections and emer- gency nurse detachments. After steps had been initiated to meet the general demands, groups of nurses expert in the care of special diseases were or- ganized by the Xursing Sem-ice for duty in four special hos- pitals of the ]\ledk'al Corps, the Orthopedic; the Fracture; the Eye, Ear and Throat ; and the Psychiatric Hospitals. Public health nurses also were called for by the U. S. Public Health Service for duty in extra-cantonment zones. Paper charts and pamphlets outlining the requirements, pur- pose and probable future service of each type of unit were sent out to Local Committees on Red Cross jSTursing Service and to civilian hospitals from National Headquarters, and later to the same Local Committees from Division offices. With RELATION OF NURSING SERVICE TO THE ARMY 321 unremitting energy, the field workers set out to fill the units. Individual luirses were approached with the suggestion that they undertake military service in some one of these units. If they met the requirements of the Army, they were enrolled in the Red Cross Nursing Service and their names checked off against given positions in the organization charts of the units. When one of these structures was entirely complete, its muster- in-roll or personnel-list was sent to the War Department. The Surgeon General then orderc^l the nurses into active service; travel orders were issued to each nurse. The procedure by which the majority of nurses serving in the European War were mustered into military duty is well illustrated by the de- tailed steps taken in the case of a member of an emergency detachment. "JMary Brown," a nurse engaged in private duty nursing at Cascade, Iowa, desired military service. She had previously learned that the Red Cross Nursing Service was the reserve of the Army Nurse Corps, so she wrote to the nearest Local Com- mittee on Red Cross Nursing Service. The chairman of this Local Committee opened correspondence with Mary Brown, or in a personal interview, required by the National Commit- tee if possible, gave her the necessary application papers, told her that an emergency detachment was then under process of organization in her locality and advised her to join it. Mary Brown expressed her willingness, filled out her application papers and in due time underwent a complete physical exam- ination and immunization for typhoid and paratyphoid. (This inoculation was later given at cantonment hospitals.) The chairman of the Local Committee in the city near Cascade entered Mary Brown's name on the lists of one of the emer- gency detachments for which the committee was responsible, secured her training school credentials, her certificates of exam- ination and inoculation, her latest address and her date of availability and sent them all to tlu^ director of the Depart- ment of Nursing, (Ventral Division, who passed upon them and forwarded them to National Ileadqiiartc^vs. Miss Noyes then wired ^farv JJrown and in a telegraphed answer received confirmation of tlH> statement in her enrolhnent pajDers that she would ho availal>l(> for assignment on June 5 at Cascade, Iowa, ^liss Noyes then s(>nt this Inst yellow telegi'am, together with the other papers, to ^liss Thompson. The Surgeon Gen- eral's oi'der followed within a few davs: 322 HISTORY OF AMERICAN RED CROSS NURSING Mary Brown, Reserve ISTurse, Army Nurse Corps, now at Cascade, Iowa, will proceed without delay not later than June 6, after having taken the oath of office, to Camp Dodge, Des Moines, Iowa, and will report to the Commanding Officer, United States Army Base Hospital, for assignment to duty. Travel is necessary in the Military Establishment.^ This task of locating and stabilizing nurses which devolved upon Miss Noyes and her associates was fraught with tedious and troublesome detail. In addition to professional creden- tials, immunization and physical examination certifications, it was necessary that the enrollment papers of every nurse show the address at which she might be reached within a certain period of time. To this location, within a prescribed number of days, the Surgeon General sent instructions, as has been shown before, bidding the nurse take oath of office and proceed to her post of duty. If the nurse was not at this given place at the time specified in her papers, the order for her oath of office and her transportation had to be revoked and a corrected one issued. ISTurses often could not understand why travel orders could not be forwarded to another town like personal mail. The War Department, overburdened with clerical de- tail, for its part failed to see in the call for an issuance of new orders anything but carelessness and inefficiency on the part * In addition to the requirements for enrollment in the Red Cross Nursing Service, the Surgeon General set up the following regulations: "Citizens of the United States, native or naturalized, are alike liable to service and no discrimination should be made as far as the manner in which the citizenship was acquired is concerned, if the loyalty and fidelity of the individual is unquestioned. In case of medical imits or individuals intended for service directly with or under tlie forces of our allies, care sliould be taken not to assign to such units or detail for such service persons wlio are naturalized citi- zens of alien enemy origin." Married nurses were not eligible for service with the Army Nurse Corps. The length of service was covered in the following regulation: "Re- serve nurses assigned to active service during war will be expected to serve as long as they may l)e needed. A nurse who desires relief from active service may apply therefor by letter to the Surgeon General, through tlie proper channels, stating her reasons in full. If the reasons are sufficient in the judgment of tlie Surgeon General her request may be granted. Return transportation will not be authorized to nurses who have served less than on'e year, unless the need for their services ceases to exist, or to those who are discharged for misconduct. A nurse who is found to be unsuited for the service physically, professionally or temperamentally, will be furnished transportation to lier home for relief from active service, without regard to length of service." RELATION OF NURSING SERVICE TO THE ARMY 323 of the Ked Cross in giving an inaccurate address in the first pLace. Hence arose the necessity for establishing the rule that a confirmation telegram be received from the nurse before her papers were sent to the War Department. An idea of the correspondence which was carried on between National Head- quarters, Division offices, State and Local Committees and in- dividuals before a nurse could be assigned to active service, may be gained from the following letter written October 12, 1017, by Miss Noyes to all nurses organizing units for the Army: Organizing nurses will please bear in mind the following points to make the Service more efficient: First : Do not report to lied Cross Headquarters a nurse as "ready for duty" before communicating with her in order to determine this fact. Information upon this point two or three weeks old is many times found to be inaccurate. Second : Please determine from each nurse her latest ac- curate address. Third: Communicate with each individual nurse imme- diately before sending her name to this office in order to make definitely certain her date of availability and her accurate address. Fourth : Impress upon the nurse that except in case of grave illness it is impossible to release her from her promise to answer a call wlien once her name has been sent to the War Department. Fifth : When a nurse is reported to the Surgeon General's office as "ready."' assignment to duty, oath of offiice and transportation will be forwarded by that Department. If, by any chance, this is forwarded to an incorrect address, it is not only a very serious inconvenience to the War Depart- ment to revoke tliesc orders, but a reflection on the efficiency of the Ped Cross Xursing Service. Sixth: In all cases when the nurses live in an adjacent town, it is advisable to have them assemble at their own expense at the larger point where the detachment has been organized. In tliis way, tliey can proceed together to their point of destination. If this is not possible, individual trans- })()rtation orders may be issued to each nurse from her own home. E(iuipment occupied the last phase of the manifold duties devolving upon ^liss Xoyes and her associates. After ^Tary I'jrown had served her apprenticeship at Camp l)()di:o, the long- 324 HISTORY OF AMERICAN RED CROSS NURSING coveted orders for foreign assignment were forwarded her through her chief mirse and off she went to Ellis Island with instructions to report as soon as possible to the director of JSTnrsing Service, Atlantic Division, American Red Cross, re- garding equipment. In New York City, the Bureau of Nurses' Equipment supplied uniforms, blankets, sou'westers, boots and other comforts to soften the harsh living conditions of these nurses of the American Expeditionary Forces. The middle span of cantonment service was omitted for the members of the iirst base hospital units. Their orders read for them to proceed direct to the port of embarkation and Europe. As was often the case with the soldiers, many nurses waiting patiently in cantonment wards never received foreign assign- ment. These units through which nurses were mobilized by the American Red Cross were not only complex in detail, but dis- similar in purpose. Consequently, each form of organization would be treated separately. In modern warfare, with its enormous armies in the field, its fleets of capital ships at sea and its instruments highly per- fected in the science of killing, it is imperative that the Army and Navy be supplemented by organized volunteer aid. Sir Frederick Treves summarized this need : In time of peace, no army medical service can be main- tained on a war footing. There is involved at such times an elaborate scheme for expansion in war; but one promi- nent and inevitable feature of that scheme is the enrohment of a vast body of doctors, nurses, orderlies, motor drivers, clerks, cooks, dispensers and the like. In such a work, a civilian society can act with greater ease and promptness than can a huge organization like the AVar Office, and thus it is that in the supply of personnel, the Red Cross societies have undoubtedly rendered sterling service. Tn the Red Cross Annual Report for 1916, ^"^ Colonel Ivean outlined the zones into which the military service for the rescue of the wounded of armies in the field were divided : 'The Medical Record. Vol. 90, page 4GC. "* nie Annual Iicport of tlio Anu'rican National Rod Cross is published yearly in two fornis, tlic first a full report pnblislied by the chairman of the Central Conuiiittee, tlie secfjnd a somewhat ablireviat(>d report published as a Document of Record of the House of Representatives. The quotations and jtage references which are used in this history are taken from the full Annual Report published by the American Red Cross, the so-called "unofhcial report," ratlier tlian the Congressional Document. RELATION OF NURSING SERVICE TO THE ARMY 325 The medical service of the zone of the front is one of first aid, temporary shelter and transportation of tiie wounded to the rear. It is manned by trained sanitary soldiers of the Army and requires for its service nearly the entire per- sonnel of the peace establishment. The Ked Cross units and personnel are not admitted to this zone. The medical service of the second zone, tlie militiiry l)ase, consists of sick transport trains and base hospitals and is largely manned by a personnel from civil life, recruited either by the Red Cross or the Medical Department of the Army. Its base hospitals are the first true hospitals en- countered by the wounded man in his Journey to the rear. Here for the first time he finds a good bed with a mattress, instead of a cot; trained nurses instead of sanitary soldiers; and the highly trained and specialized practitioners from civil life. Here he finds quiet and rest and the conditions suitable for recovery. The third zone, that of the home country, receives the overflow and the convalescents from the base hospitals near the theater of war. In it the civil hospitals of the country are called into use in addition to such general hospitals as the medical department may establish. Its medical staff are, with the exception of a few trained administrative officers, physicians and nurses drawn from civil life. Of this structure, the base hospital is the central span and the most imjiortant contribution which the Ked Cross can make for the safety and comfort of the wounded. It is immediately and urgently needed as soon as war is de- clared, yet because of its numerous personnel and massive and costly equipment, it has never heretofore been provided in time of peace. Yet so large and complex an organization cannot be improvised. Its varied and specialized personnel when brought together, require time and training to fail into orderly adjustment and eillcient operation. A chance aggregation of doctors and nurses can no more claim at first to be an efficient hospital tiian a thousand men collected from the streets can be regarded as an eifective regiment. Like- wise, its elaborate equipment cannot be ])urcha>e(l in a day, or a week, nor yet in a month, especially in time of war. It has already been shown that by Presidential Proclama- tion, dated August 22, 1!)11, and Act of Congress of April 24, 1912, the Ked Cross personnel constituted in time of war a part of the sanitary services of the (JovernuKMit. In con- formity with this edict and these statutes, the War Depart- 326 HISTORY OF AMERICAN RED CROSS NURSING ment, upon the recommondation of George A. Torney, Surgeon General of the United States Army, issued on September 10, 1912, Circular No. 8, which contained the following regula- tions : 2. When the War Department desires the use of the serv- ices of the Ked Cross in time of war, or when war is im- minent, the Secretary of War will commimicate with the president of the society, specifying the character of the serv- ices required, and designating the place or places where the personnel and material will be assembled. 3. When any member of the Ked Cross reports for duty with the land forces of the United States pursuant to a proper call, he will therefore be subject to military laws and regulations as provided in Article Ten of the Interna- tional Red Cross Convention of 1906, and will be provided with the necessary brassard and certificate of identity. 4. Except in cases of great emergency, Eed Cross per- sonnel serving with the land forces will not be assigned to duty at the front, but will be employed in hospitals in the home country, at the base of operations, on hospital ships and along lines of communications of the military forces in the United States. 5. Red Cross organizations will not establish independent hospitals or other institutions, but will assist military sani- tary formations at the places above indicated. 6. Before military patients are assigned thereto, separate establishments maintained by the Red Cross Society will be placed under the immediate direction of a medical officer of the Army. Such officer will be held responsible for the management, discipline and records of the institution; he will regulate admissions and discharges and see that the interests of both the Government and the patients are conserved. 7. Xo columns, sections or individuals of the Red Cross Society will be accepted for service by the War Department unless previously inspected by a medical officer of the Army and found qualified for the service expected of them. 8. Tlie Red Cross Society may be called upon in time of war, or when war is pending, for the following columns of personnel: (1) physicians and surgeons; (2) dentists; (3) pharmacists; (1) nurses; (.")) clerks; (0) cooks; (7) litter bearers, dri\ci-s and oilier transport personnel; (d Cross spent, in round figures, $."),- 000,000 in equipping base hospitals. In addition, Xational Headquarters made a number of appropriations to meet spe- cial needs." ^^ Tlie equipment of each unit required the use "The Purvey, rd)nmry 7, 1917, Vol. 37, p. .'^87. "Annual Report. Anu'ikan Rod Cross, 1917. ]). 22. "'"Tlie Work of the American Red Cross during the War," p. 41. 334 HISTORY OF AMERICAN RED CROSS NURSING of seven freight ears to transport its beds, bedding, ward furni- ture, drugs, dental and surgical instruments, laboratory supplies and equipment, mess gear, sterilizers, ambulances, touring cars, motor trucks, motorcycles, complete X-ray plant, kitchen and disinfectors. The initial supply of surgical dressings and hos- pital garments was at first furnished through committees of Women's Auxiliaries of the parent hospital and the cost amounted to $8000 for each base hospital unit. After ^National Headquarters had built up its surgical dressings department, the Red Cross assumed entire responsibility for these articles. The relation between the local Red Cross Chapter which furnished the funds for equipment and the base hospital unit was, in Colonel Kean's words, ''that of a big sister, close and cordial, but without parental authority." ^^ In view of the great pecuniary assistance which was expected of the Chap- ters, the question of whether they should not have a controlling voice in the selection of officers and in other details of organiza- tion, had naturally arisen, but National Headquarters had not felt it wise to authorize this because the military and profes- sional personnel of the units would naturally demand that direct control be of a military and professional character. A base hospital first included a personnel of 265 souls, with "such subordinate administrative personnel as may be neces- sary" and "such Red Cross volunteers as may be authorized by the Director General of Military Relief, upon the approval of the Secretary of War." ^^ The original number of nurses was placed at fifty, but was later increased to sixty-five and then to one hundred and the rest of the personnel raised propor- tionately. The personnel of a base hospital as originally au- thorized included twenty-throe doctors (later raised to fifty) ; fifty nurses (later raised to one hundred) ; twenty-five nurses' aides (never called out) ; fifteen reserve nurses (later raised to twenty-five) ; and twenty-five reserve nurses' aides (lun'cr called out) ; and other personnel necessary to care for a five- hundred-bed hospital (later raised to one thousand beds). In the Regulations Governing the Employment of the American Red Cross in Time of War, authorization for the nursing staff was contained in paragraph twelve, viz., that "the "See Annual Report, American Red Cross, 1916, p. 41. " Regulations Ooverninj^ the Kmployment of the American Red Cross in Time of War, December IS, 1910. ' RELATION OF NURSING SERVICE TO THE ARMY 335 organization of a base hospital will be . . . fifty nurses, mem- bers of the Ked Cross JS'iirsing Service, one of whom shall be chief nurse and one of whom may be a dietitian. Twenty-five volunteer nurses' aides." To the chief nurse, in consultation with the director of each base hospital was delegated the selection of the nurses, the dietitian and the nurses' aides. All members of the nurs- ing staff thus selected were required to be enrolled in the Red Cross Xursing Service. To save unnecessary correspondence and to hasten appointments, Red Cross application blanks were sent to chief nurses, who secured the training school credentials of each nurse not already enrolled. The blanks were then sent to the Secretary of the Local Committee on Red Cross Xursing Service. The nursing staff consisted of one chief nurse ; one assistant chief nurse ; one night chief nurse ; one charge nurse, operating-room ; five assistant nurses, operating-room; one charge nurse or dietitian; ^'^ one assistant uurse or dietitian ; one charge nurse, linen room ; thirty-eight nurses for medical and surgical wards ; fifteen reserve nurses not on the muster-roll. It was suggested that at least three of the nurses should have had some practical experience in the care of contagious diseases. As muster-rolls of the base hospitals lengthened and as the Chapters purchased and stored the equipment for each unit, the eagerness of laywomen to share in this type of war service grew to such dimensions that the Surgean General and the Red Cross decided to include among the personnel of the base hospitals twenty-five nurses' aides, with a reserve of the same number. This group included for each hospital four diet kitchen aides, four aides to be assigned to the linen room, two aides to the nurses' quarters and fifteen to the wards. Like the nurses, these aid(>s were required to enroll in the Red Cross and to undergo a thorough physical examination. Their in- struction in the care of the sick has already been set forth in a preceding section. Throughout the strained summer of lOlG the organization of base hospitals proc(Hxled. A vivid picture of !Miss Delano remained in the meninrv of one of h(r secretaries at Xational Ilc^adtpiarters. At the close of an oppressively warm Sunday's '' Full iuforination ('(mceruing requirements for service ns Red Crciss (lictiliiuis may l)e found in tlie cliaptcr relating to the Ked Cross Nutri- tion Service. 336 HISTORY OF AMERICAN RED CROSS NURSING work, the chairman of the National Committee was on her knees on the floor sorting out nurses' papers. Her secretary reached over to a file-case and the string of beads which she wore caught on a corner of the drawer, broke and scattered about the floor. With a sigh of relief, Miss Delano said: ''You go on wi^h the papers and I'll gather up the beads. I'm so tired I can't keep my mind on the work." After the personnel of a base hospital unit had been en- rolled, the nurses and enlisted men were required to sign in duplicate the muster-roll of the unit. This early system of re- quiring nurses to aflix their signature to the muster-roll was later discontinued. Since nurses were members of the pro- fessional staff, the Surgeon General decided in 1917 that this troublesome detail might well be eliminated. The American Red Cross entered into a definite contract with every parent institution which had undertaken the or- ganization of a base hospital unit. The following contract illus- trated this relation: The parties in this agreement hereinafter referred to as the EED CROSS and as THE HOSPITAL shall refer to the American Red Cross and to the Lakeside Hospital, Cleveland, Ohio. The Hospital does hereby agree to assemble from its staff graduates, nurses, employes and friends, a trained personnel for a five-hundred bed Army base hospital, and to keep the specified posts of such a personnel filled, in accordance with the specifications as made and from time to time re- vised, by the Surgeon General of the United States Army. It also agrees to keep in the official muster-roll and ready for service, this personnel and at the call of the Red Cross, immediately assemble such persons for transportation under the Government orders. From time to time as vacancies occur, they shall be filled by persons nominated by the Hos- pital Trustees and the Director, and those so nominated shall be ap])ointed to such vacant posts, provided they con- form to the prescribed regulations. At a call from the Red Cross for the services of this unit, the superintendent of the Hospital is hereby authorized and is instructed by the Trustees of the Hospital to release and send, wherever and whenever ordered, the enlisted personnel of this unit, and with the Director, to select substitutes for any who are un- able to go. The employees sent with the Hospital unit shall not re- main on the Hospital pay-roll during absence, but no em- RELATION OF NURSING SERVICE TO THE ARMY 337 ployee of the Hospital shall be dismissed from the Hospital service, or fail in reinst^itement at the close of such service, because of absence on account of the call of the unit to active service. In consideration of the maintenance of the above personnel by the Hospital, the Hod (Jross agrees that the above men- tioned unit shall (constitute a part of its reserve medical organization and be known by the name of the Hospital as well as by its ofllicial number. It is understood tliat after the calling of this unit it will be out of the Ked Cross re- serve organization and controlled entirely by the Govern- ment. It is also understood that, whenever this Hospital Unit is called out by the Ked Cross or Government, that its entire expenses, including transportation from Cleveland, are to be paid either by the Eed Cross or the Government. Eliot Wads worth. Acting Chairman, American .Ked Cross. Samuel Mather, President, Lakeside Hospital. To the Lakeside Unit belongs the honor of being the first base hospital to complete its muster-roll, and also to be mobilized into active service. Colonel Kean in a letter written Dr. Crile on July 31, 1910, gave the Lakeside Unit the designation of Red Cross Base Hospital Xo. 4. lie stated that while Xational Headquarters had originally intended to give numerical desig- nations to base hospital units in the order in which the com- pleted muster-rolls had been received, this plan had not been possible on account of unexpected delays encountered in com- pleting the muster-rolls, especially in the column of male administrative personnel. "The purchase of equipment," con- cluded Colonel Kean, "therefore began before the rolls were completed and it became necessary to give numbers to the base hospitals in order that accounts might be opened with them in this office for the purchased property and in order that the equipment so purchased might be duly marked." On August 1, 1!>1G, Colonel Kean transmitted to the chair- man of the Red Cross Central Committee the completed muster- roll of American Red Cross Base Hospital Xo. -1 (Lakeside) with the recommendation that "this unit be enrolled in the office of the Surgeon General, U. 8. A., under Paragraph IG, Circular l^o. 8, S. G. O. September 10, 1912." On'the same day, ]\rajor General Arthur ^Murray, L^. S. A. Retired, then chairman of the Central Committee, forwarded the muster- 338 HISTORY OF AMERICAN RED CROSS NURSING roll and Colonel Kean's letter to the Adjutant General, for transmittal to General Gorgas. On August 5, the Surgeon General informed the Red Cross that "the receipt of muster-in roll of Base Hospital 'No. 4 (Lakeside) Cleveland, Ohio, Dr. George W. Crile, Director, is acknowledged. The same has been placed upon the records for future reference." Thus in complete readiness for immediate mobilization upon future need, the first one of that subsequently long list of Red Cross base hospitals was entered among the reserve personnel of the United States War Department. A list of these units may be found in the Appendix. In addition to these first fifty base hospital units, the Curs- ing Service supplied twenty nurses to serve on the staff of Base Hospital No. 55 which was organized by Dr. Balch, of Boston, Mass. Jessie Grant was chief nurse of this unit. Two other units, which were designated as Supplementary and as Replacement Hospitals, each had their full complement of one hundred nurses furnished by the Red Cross, but these units acted as a reserve in furnishing nurses for other hospitals and so were not regularly organized as Red Cross base hos- pitals. Another unit, called the British Base Hospital, had its nurses furnished by the American Red Cross with the definite destination of service in England in view. After the completed muster-rolls of several base hospitals had been filed in the War Department and the equipment for each had been stored in warehouses provided by the Govern- ment and the Red Cross, Is^ational Headquarters desired to see how these "canned hospitals" would meet the test of actual mobilization. The Xational Committee on Red Cross Medi- cal Service at a meeting held June 15, 1916, requested the American Red Cross to order out on October 28 one of its base hospital units in Philadelphia. Colonel Kean stated that "the purpose of this mobilization was primarily to demonstrate that the organization existing on paper was a practical and serviceable one ; secondly, to ascertain what difiieulties would stand in the way of such a mobilization; and thirdly, for the instruction in medical preparedness of the great body of sur- geons who would be in Philadelphia at that time, in attendance upon the Clinical Congress of Surgeons and the American College of Surgeons." ^^ Base Hospital Xo. 4 was selected for trial mobilization. On "American Red Cross Annual Report, 191G, p. 30. RELATION OP^ NURSING SERVICE TO THE ARMY 339 the brow of pictiircsquo Belmont Plateau, Fairmont Park, Phil- adelphia, Pa., Base Hospital Xo. 4 mobilized on October 28, 191(j, under eighty-five dun-colored Army tents. Twenty- five nurses, with (irace Allison as chief nurse, reported, but no nurses' aides were present, owing to a decision not to call them out. The camp, covering twelve acres, had been erected by a detachment of the Medical Department sent over from Washington, U. C, under the command of Major Harold W. Jones. Twenty-four hours after the arrival of the nurses, all wards were in readiness for patients. Tents are not the most satisfactory housing equipment for "so large and sedentary an organization as a base hospital." On exhibition at Fairmont Park was a splendid model showing the arrangement and materials of an ideal base hospital, created under the supervision of Dr. George E. Brewer, of ISTew York, and his assistant, Dr. Sidney K. Burnap. Colonel Kean summarized the benefits derived from the trial mobilization of Base Hospital No. 4: The mobilization of this hospital marks an epoch in Red Cross develoi)mcnt as concerns its obligations to assist the medical service of the armed forces in time of war. It is the first practical and concrete demonstration of the ability of the Eed Cross to do this. It takes the scheme of Eed Cross military units as a part of the Medical Service out of the domain of theory into that of accomplished fact. The cost of this mobilization was in all $5035.75. The freight on equipment and incidentals, $355.15, was paid for by the Xew York County Chapter.^" During the fall of 19 IG and throughout the year 1917, Miss Novcs carried practically alone the work of orijanizinir the nursing staffs of the first fifty base hospitals, a task fraught with extensive detail. In the organization and equipment of its base hospitals for the Army, including a total personnel of 4397 nurses, the Red Cross accomplished the greatest single project of medical and nursing preparedness in history. The amount of time required to purchase the ecjuipment of Base Hospitals Xos. 1 and 2 in Xew York in fl)n(' of pence, without any restrictions of funds or military "red tape" amounted to four months. Advocates of preparedness felt that economic conditions existing in a "AiiuTican Rod Cms? Annual Report. 1016, p. 30. 340 HISTORY OF AMERICAN RED CROSS NURSING nation at war would greatly increase the period necessary for these mechanical arrangements. "Therefore," argued Colonel Kean, "if we are to have base hospitals ready to take care of our soldiers when war comes, we must equip them in time of peace." Theoretically, it was undoubtedly the duty of the Government to provide base hospitals. The fighting branch of the Army had always lacked many things, however, which perforce had to be asked for in preference to base hospital equipment. "Rifles, cannon, munitions, tentage, clothing, transport service have to be provided before we can have an army and naturally take precedence over provision for the care of the sick and wounded." ^ Here lay a supreme opportunity for the American Red Cross, unhampered by lack of funds, possessed of flexibility of organization, blessed with popular appeal. Only the larger civil hospitals in the principal cities of the United States maintained stafi^s of sufficient size and specializa- tion to permit the organization of a base hospital. Many small institutions, however, were also eager to organize Red Cross units. To accept their offers of assistance which came di- rectly to the Red Cross or were referred thereto by the War Department, and to utilize the hospital facilities of the entire country, the War Department authorized the organization of smaller units of about one-half the size of a base hospital, to be known as hospital units. The Regulations Governing the Employment of the American Red Cross in Time of War (De- cember 18, 1916) stated in Paragraph Thirteen that "hospital units are intended to supplement and assist established mili- tary hospitals. Sections of hospital units may also be assigned to duty on hospital trains and ships and to other military sani- tary organizations." The staff of a hospital unit was made up of "a director ; an adjutant ; two chiefs of service ; four staff physicians ; one head nurse ; twenty nurses ; three clerks, who may be women ; and such numbers of orderlies as may be necessary." The method by which hospital units were organized was simi- lar to that used for their bigger brother, the base hospital. The equipment of hospital units included only instruments, medical and surgical supplies, basins, cushions, brushes, buckets, frac- ture apparatus, splints, and similar articles. As the purpose of these units was to supplement established institutions, all '"Soe A. R. C. Annual Report, 191G, p. 31. RELATION OF NURSING SERVICE TO THE ARMY 341 permanent articles sneli as furniture, refrigerating- and delous- ing plants and X-ray apparatus were omitted, lied Cross Chapters in the cities where hospital units were organized, pro- vided and stored their e(iuipment and prepared their quotas of surgical dressings. Perishable supplies were often purchased from the stock of the parent institution when the hospital unit was ordered into active service. Complete equipment for a hospital unit was estimated to cost approximately $2r)()(). iS'ational Headcjuarters organized nineteen hospital units which were assigned to active service with the United States Army during the European War. The nursing staffs of these units were composed of .'}*,)9 American Red Cross nurses, who served as reserves of the Army Nurse Corps. A complete list of these units may be found in the Appendix. Although surgical sections were a type of unit which Secre- tary Baker authorized the Red Cross to organize in the Regula- tions Governing the Employment of the American Red Cross in Time of War (December 18, 1916) only one such unit was organized by National Headquarters. It was designated as Surgical Section No. 1 and was organized under Dr. E. M. Quain, of Bismarck, North Dakota. Emergency detachments, made up solely of nurses, were the smallest and the most numerous of the three early Red Cross units. As early as .lune 22, 1916, Miss Delano wrote to all State and Local Committees on Red Cross Nursing Service, explaining the purpose of emergency detachments and charg- ing the State and Local Committee members with the responsi- bility of developing one or more of these units. The Regu- lations Governing the Employment of the American Red Cross in Time of War (December 18, 1916) stated in Paragraph Eiftecn that "emergency detachments of nurses arc organized to meet sudden calls from the sanitary service of the Army, or other emergencies. They will be used to supplement the nursing servi^ce of military hospitals already established, or be assigned to duty on hospital ships, hospital trains, or any service where groups of nurses may be needed. . . . Each detachment," conclu(l(>d the paragraph, "consists of ten nurses, one of whom niav ho designiated as head nurse and acts as such until the group is assigned to duty under the supervision of an Army chief luirse, when her duties will be the same as those of other members of tlie detachment.'' Oriiani/.atioii of ciiici'iiciu'v detnclnnents was llrst carried on 842 HISTORY OF AMERICAN RED CROSS NURSING by direct correspondence between the Bureau of Nursing at National Headquarters and Local Committees on Red Cross Nursing Service. This procedure continued until the fall of 1917, when the thirteen lied Cross Division offices were created ; the Divison Directors of Nursing then took over the details of recruiting which had previously been handled by Miss Noyes and her assistants.-^ With its absence of equipment, its ease of mobilization, its ability to respond immediately to duty upon the receipt of its orders into active service, the emergency detachment proved one of the most valuable methods through which nurses were se- cured. The first of these groups was ordered into duty on the Mexican border in July, 1916. Many others were assigned during 1917 and the early months of 1918 directly to the British and American Expeditionary Forces. Later, however, nurses from these units were sent to cantonments where they were prepared for overseas duty. Red Cross emergency de- tachments supplied 11,470 nurses to the War Department, half the entire strength of the Army Nurse Corps. No more bril- liant proof than this can be found of the soundness of the Red Cross Nursing Service committee system, nor of the untiring patriotism of these nurse-members, who, although already over- burdened with tasks of maintaining with inadequate personnel hospitals and training schools and other types of work, served as volunteers during every available moment on the Local Committees which brought these eleven thousand nurses into the military service. The youngest members of the nursing profession to serve with the American Army during the European War entered the Army Nurse Corps by joining training school units which the Red Cross organized within the senior classes of hospital schools of nursing. An unusually attractive group they were, young, adventure-loving, a brave and eager company of whom almost all were of recognized dependability and skill. Red Cross base hospitals and hospital units, made up of the members of staifs of major civilian institutions in all parts of the country, had drawn, during 1917, hundreds of nurses of distinguished positions from the institutional field. Local Committees on lied Cross Nursing Service were combing grad- uate nurses' associations, clubs, registries and other agencies ^' Sco letter written Xoveiiiber 1. 1017. Iiy C. D. Xoyes to all State ami Local Coimiiittees and ori^aniziii'' muses. RELATION OF NURSIxXG SERVICE TO THE ARMY 343 for private duty nurses to serve especially in emergency de- tachments. With these fields of supply almost exhausted in the spring of 1918, ^liss Delano and Miss Noyos appealed to members of the June gradiuiting classes of hospital schools of nursing, urging these young women also to join that continuous procession of reserve nurses filing into the Army Nurse Corps through the American Red Cross. Miss Delano presented in a letter written March 12, 1918, to all superintendents of schools of nursing, the first step of the Red Cross plan to utilize the services of young graduates for the Army : We have been definitely asked by the Surgeon General to supply five thousand nurses by June 1, 1918, for the Army alone, and it is estimated that probably not far from thirty thousand additional ones will be needed by January 1, 1919. ... It seems evident from the recent surveys which have been made of the nursing resources of the country that there are not more than sixty-five thousand registered nurses in the United States. . . . We believe that training school superintendents are most anxious to aid in every possible way to secure the number of nurses needed. One of the most practical methods of increasing the available supply of nurses is to advance some- wliat the date of graduation in training scliools giving a three years' course of training, provided of course that only such nurses slioidd be graduated as are willing to enroll promptly with tlie l?ed Cross and accept service at once with the Army or with the Xavy. . . . I should not feel justified in urging this shortening of the regular three years' course, if I did not believe that the experience in military hospitals would supplement their regular training and give them not only ex{)ericnce which will be of value to them in their career as nurses, but would give them as well the satisfaction of having served their country in time of need. On !\rarch 13, 1918, ^^Fiss Xoycs followed up Miss Delano's letter with a personal communication addressed to all superin- tendents, in which she urged them to undertake the organiza- tion of at least one training school unit. The undcrlyiug principle of organizing such units was a recognition of the chin instinct. AVar seemed less formidable when a nurse could go out with a former room-mate or a friend who had been trained in the same wards. 344 HISTORY OF AMERICAN RED CROSS NURSING Each training school unit was numbered, the designation beginning with a high number to avoid confusion with base hospitals and hospital units. The first training school unit was formed at Sara Elizabeth Hospital, Henderson, North Car- olina, and was designated T. S. Unit No. 500 ; the second, from the Methodist Episcopal Hospital, Brooklyn, New York, as T. S. Unit No. 501. Nurses other than the graduates of a given school which had formed a unit might join the unit of that institution if none existed in their own school, or if satis- factory reasons were presented, but this was seldom done. During the spring and summer of 1918, 1362 nurses volun- teered for war service in 307 training school units. A list of the units is given in the Appendix. Immediately following the declaration of war by the United States, General Gorgas organized within the Medical Corps of the Army, divisions of Mental Diseases, Internal Medicine, Orthopedics and Opthalmology, the directors of which were experts in these different branches of medical practice. These directors were charged with the responsibility of organizing such base hospitals for service in the United States and abroad as the treatment of such cases as might fall under the above classifications, required. The medical and enlisted personnel of these units was or- ganized entirely within the Surgeon General's office and the equipment was supplied by the Government, but the Army Nurse Corps called upon the Red Cross to supply the nurses. The first stop in securing nurses qualified for this service lay in the establishment of a classified list of nurses specially trained in pediatric, psychopathic and orthopedic nursing and in nursing mental diseases, contagious diseases, head and neck surgery and eye and ear work. After the establishment of this list, the procedure was comparatively simple. From time to time. Miss Tliompson notified Miss Noycs of the formation of special hospitals and she secured the nurses through corre- spondence with those whose names appeared on the classified lists. The development of physio-therapy, one of the signal de- velopments which the war indirectly brought to medical science, created a demand for expert masseuses. Miss Noyes prepared a form letter in Novemlx'r, 1917, to be sent to nurses wlio requested information of tliis type from National Head- (juartcrs, or to nurses whose enrollment showed special training. RELATION OF NURSING SERVICE TO THE ARMY 345 Regulations conccriiiiig enrollment as an expert masseuse were as follows : Applicants should be graduates of a recognized school of massage. The service is entered for tlie period of the war. It is to be performed in the wards of the reconstruction hospitals under the supervision of the head nurse of the ward. Applicants should be preferably between tlie ages of twenty-five and forty-five. Applicants should be endorsed by the principal of the school of massage from whicli she received her di])loma. Members of tbe service are expected to respond promptly to a call for service coming from the Bureau of Nursing of the Red Cross. A masseii.se will be paid $50.00 a month, with mainte- nance and transportation. [Here follow the same passport and physical examination instructions as apply to the Eed Cross iSTursing Service.] The Nursing Service assigned 193 nurses expert in the care of special diseases to the Armv Xurse Corps for service in the following special base hospitals of the Medical Department : Xo. 114, Orthopedic (assigned to service in the United States and later to foreign duty) ; No. 115, Eye and Ear (assigned to service in the United States and later to foreign duty) ; No. 116, Fracture (assigned to service abroad) ; No. 117, Psy- chiatric (assigned to service abroad) ; a mobile operating unit under [Major P. P. Turnure, M. P. C. of New York City. As the Selective Draft brought thousands of recruits to the cantonments, which had sprung up overnight in rows of un- painted barracks like clusters of enormous gray mushrooms, a problem in sanitation arose which presented an opportunity to the Ped Cross for vital service to the enlisted man. Within the military boundaries of each cantonment, sanitary measures were directly under the charge of Army ^Fedical officers. In the regions immediately surrounding the military district, this responsibility was divided between State, county and uiunicii)al health departments. Tlie ])liysical well-being of the new armies was intimately related, however, to these extra-canton- ment zones. Through the C()<")p('rati()n of the War and Treasury Departments, the United States Public Health Service had agreed to assigii an expei-ienced sanitarian of its stall' to super- vise health nu'asures about each cantonment. This olHcer was 346 HISTORY OF AMERICAN RED CROSS NURSING duly invested with such powers as the State and Local Boards of Health would transfer. Neither the Federal Public Health Service, nor local agencies possessed, however, sufficient funds to employ an adequate personnel to help this officer. Legislative action would have consumed valuable time. The Red Cross accordingly set aside an initial appropriation of over $10,000 to organize a Bureau of Sanitary Service under the Department of Military Relief and supplemented this appropriation from time to time to the amount of approximately $750,000 in the aggregate. Dr. Taliaferro Clark, Surgeon, United States Health Service, and one-time director of the Red Cross Bureau of Sanitary Service, stated in the Annual Report of 1917, the method under which this bureau operated : Assistance is given only on request from a State and on recommendation of the Surgeon General of the United States Public Health Service, under wliose direction a sani- tary survey is being made in the vicinity of each canton- ment. l^pon receipt of a report from the Public Health Service stating the conditions in a district and establishing the need for aid, the Red Cross promptly furnishes this supplemen- tary assistance by assigning to the district bacteriologists, sanitary inspectors and Rod Cross public health nurses, with an appropriation sufficient to provide equipment, transporta- tion and maintenance. Miss Xoycs wrote on August G, 1917, to chief nurses of all units and detachments, stating that the Xational Connnittee on Red Cross Xursing Service had voted the week before in favor of a special enrollment for public health nurses, exempting them from active military service, if they desired, so that they might undertake cantonment zone work. ]\liss i^oyes suggested that all nurses who were enrolled in base hospital and other units, yet who by training and experience were fitted for can- tonment zone service, should be withdrawn from the units then being organized for the Army and should be transferred to cantonment zone service. This particular phase of war nursing surrounding the can- tonments consisted in sanitary work in C(uinection with the public and private water sup})ly; the disposal of sewage and garbage; the drainage of mos(iuito-infested swamps; the in- RELATION OF NURSING SERVICE TO THE ARMY 347 spection of food supplies; and the control of communicable diseases. Miss Klla Tliillips Crandall, executive secretary of the National Organization for Public Health Nursing, assisted the Red Cross in the selection of public health nurses for this service, one hundred and fifty-four of whom were assigned to twenty-nine sanitary zones at the following localities : Alexandria, La. ; American Lake, Wash. ; Anniston, Ala. ; At- lanta, Ga. ; Augusta, Ga. ; Ayer, Mass. ; Charlotte, N. C. ; Chat- tanooga, Tenn, ; Chillicothe, Ohio; Columbia, S. C. ; Des Moines, Iowa ; ]\ranhattan, Kansas ; Fort Worth, Texas ; Green- ville, S. C. ; Hattiesburg, Miss.; Houston, Texas; Jacksonville, Fla. ; Leavenworth, Kansas; Little Rock, Ark. ; Louisville, Ky. ; ]\Iacon, Ga. ; Montgomery, Ala. ; Newport News, Va. ; Peters- burg, Va. ; Portsmouth and Norfolk, Va. ; San Antonio, Texas ; Spartanburg, S. C. ; Waco, Texas ; Wrightstown, N. J. By vote of the National Committee on Red Cross Nursing Service in ]\ray, 1918, the name of the Red Cross Town and Country Nursing Seiwice was changed to that of the Bureau of Public Health Nursing Service. To it were delegated during the summer of 1918 the responsibility for public health nurses assigned to extra-cantonment zones. Second in military importance to American combat troops in France were the essential war industries in the L^nited States, which furnished supplies to the American Expeditionary i'orces and to the Allies. For ten miles along tlie Ohio River, in whose dark, swiftly-flowing waters Vv-cre reflected at night the glaring throats of a thousand furmues, atreLched ihe L^nited States Ammunition Plant at Nitro, iu \aq West Virginia hills. From ]\[uscle Shoals, Alabama, came the nitrate for high ex- plosives. Various other centers for manufacturing essential war supplies were located in diflerent parts of the country and employed many thousands of workers. The health of these men and of their families was of paramount importance, for upon their labor depended the output of these manufac- turing centers so the Government established base hospitals to care for accident cases and illness which occurred there. The Surgeon (!(Miera] of the L^nited States Public Health Service, undiM- wh(s(> departmtnit these hospitals were main- tained, agreed to utilize for tliis s(>rvi('(> nurses who had been slightly below the physical re(|uirenH'nts of the Army and Navy, (ir those slightly above the miiximnm age limit, or married nurs(\s whose husbands were in military service, a group which 348 HISTORY OF AMERICAN RED CROSS NURSING was barred from joining the Army ITurse Corps. Eighty-eight nurses were assigned to this service. To Marine Hospitals and to special institutions maintained by the United States Public Health Service for the care of pellagra, trachoma and other contagious diseases, fifty-four Red Cross nurses were assigned before the Armistice. The develop- ment of the Nurse Corps of the Public Health Service is treated more fully in a later chapter. The first field service which American Red Cross nurses experienced as reserve members of the Army Nurse Corps was on the Mexican border. This type of duty began in 1911. In the spring of 1914, the Punitive Expedition was dispatched to Vera Cruz and occupied the city. Army nurses accompanied the military forces. Early in 1916, the Villesta forces killed several American miners and the United States Government demanded reparation. On March 9, 1916, Villa invaded Columbus, New ]\Iexico, killed seven troopers and several civilians and fired many buildings. President Wilson then ordered a punitive expedition under "Black Jack" Pershing to cross the border in pursuit of Villa, but to respect scrupu- lously the sovereignity of the Mexican Republic. Pershing, with the aid of Carranza's troops, drove Villa into the hills, but the chaotic state of anarchy existing in Mexico continued. In June, President Wilson changed his policy of "watchful waiting" to one of border defense ; in a note of June 2, 1916, sent to all factions, he warned them that they must adjust their differences and "act promptly for the relief and redemp- tion of their prostrate country" or else the United States would be "constrained to decide what means should be employed to help Mexico save herself." On June 12, two troops of U. S. cavalry (colored) approached the town of Carrizal, requested permission of General Gomez to pass, stopped at his suggestion to confer and were fired upon by the Mexican forces. A immber of soldiers, including the officer in command, were killed and twenty-four were taken prisoners. President Wilson imme- diately demanded that Carranza define his attitude and sur- render the prisoners. On June 18, he called out every militia- man in the United States to strengthen Pershing's line of 12,000 Regulars which extended 280 miles directly south to Nami- quipa. Sixteen battleships steamed to the Mexican coast. Congress officially authorized the President to draft the Na- RELATION OF NURSING SERVICE TO THE ARMY 349 tional Guard into Federal service and voted $26,000,000 for the emergency. Carranza then yielded and returned the pris- oners. Notes proposing diplomatic settlement of the differ- ences between Mexico and the United States were exchanged in July. At this juncture, Villa emerged from among the hills and the "cat and mouse" warfare that had been going on before began again. With over 200,000 Regulars and Militiamen in the field in August, 1916, the United States Army established during the summer five base hospitals, five camp hospitals and one can- tonment hospital along the ^Mexican border.-- Kathrinc Don- nelly, Lulu T. Lloyd, Alice B. Harvey and Nannie B. Hardy, reserve members of the Army Nurse Corps, had been in service with the border troops since 1914. When the rela- tions between Mexico and the United States became strained in the spring of 1916, Colonel Kean, then acting chairman of the Central Committee of the American Red Cross, wrote May 15 to the Surgeon General, offering the services of "such a number of nurses, not exceeding forty, as may be needed." The Red Cross at the same time offered to pay the salaries of these nurses and to furnish transportation for them to the place of service, but the Arnr\' to furnish maintenance. "It is presumed," concluded Colonel Kean, "that after July 1 these nurses can be paid from the Army appropriation if their ser- vices are still needed." Red Cross records show no evidence of a written reply to this offer. Colonel Kean took up the question again in a letter ad- dressed July 28 to Colonel Birmingham, then Acting Surgeon General. This letter contained interesting arguments of the three ways in "which the number of nurses available for the ^ledical Corps might be increased. The first way was to in- crease the number of nurses in the Regular Xurse Corps. The second way was to call reserve nurses, namely, American Red Cross nurses, into active service in the Army Xurse Corps. The third way was to employ contract nurses "who may or may not be enrolled Red Cross nurses," stated Colonel Kean, "but who are paid out of the Medical and Hospital Appropria- tion." Tlie first method, that of increasing the number of nurses in the Regular Xurse (^orps, was then being used to secure nurses for the Army base hospitals on the Mexican border. =^ Report of tlio Sur<,'eoii General. V. S. A.. 1917. p. 23. 350 HISTORY OF AMERICAN RED CROSS NURSING "I do not know," argued Colonel Kean in his letter of July 28, "what advantages it has which have led to its adoption in preference to the second method, in an emergency which is of a more or less temporary nature, but I think it is clear that it has the disadvantage of being much slower than calling out the reserve nurses. I understand that only 190 out of the more than 400 which are now authorized, have been obtained during the number of weeks since an increase was authorized. Also, I do not believe," he continued further, "that the best nurses in the country are as easily secured for a permanent engagement in the Army Nursing Service as can be secured by the selection from the Reserve. In the latter, as you know, a very large number is available from which to select, and there is the appeal of patriotic service which is not so much in evidence in the Army." Colonel Kean's argument next dealt with the third method, the employment of nurses by contract. In his opinion, it had several disadvantages. "In the first place," he stated, "the term 'contract nvirse' is one which was brought into discredit during the Spanish-American War by the employment in this way of untrained nurses and of women for matrons and other purposes than special nursing, and the term 'contract nurse,' like 'con- tract doctor,' is itself not an attractive one. Also, the fact that these nurses are paid out of the Medical and Hospital Appropriation, which is never too large, rather than from the appropriation for pay of the Army, is a serious disadvantage. I think, therefore," he declared, "that this method of securing nurses should not be considered." After a discussion of the probable number of nurses needed, which Colonel Kean estimated would ultimately be one thou- sand, he proceeded with directness to his conclusion : "I am writing to suggest that the additional nurses needed in the present emergency, due to the calling out of the National Guard and the mobilization of the Army on the border, be furnished from the nurses' Reserve, as is contemplated by the Regulations, and that this office be taken into the confidence of the Surgeon General's office as far as possible and notified as much in advance as may be practicable of the calls which may bo made upon it for nurses." On July 2!), IDK), the Surgeon General replied to Colonel Koan, requesting that "this office be furnished with the names of forty reserve nurses in groups of about ten, who are willing RELATION OF NURSING SERVICE TO THE ARMY 351 to be assigned to active duty in the Military EstaLlisliment and who can respond to an innnediate call." In this letter, the Surgeon General also stated that the physical examination required by the lied Cross for enrollment would be satisfactory, but he re(iuested that the credentials of each nurse assigned to meet this call should be sent to his office. Insight into the reasons why the War Department did not accept earlier the offer of Ked Cross assistance was contained in a letter written by Miss Delano August 10 to Mrs. William K. Draper: . . . The Red Cross offer, to send forty or fiftj nurses to the border, went to the War Department and after much discussion it was decided by the Secretary of War, I believe, that the xVrmy could not accept this contribution from the Red Cross except when war was actually declared. Their appropriation for additional nurses is now available and we have again offered to send nurses as they are needed. I believe that at present there is some question concerning quarters, but at any rate the nurses are ready. I began some time ago the development of what we call emergency de- tacliments of wliich we now have a good many available. Our base hospitals are well developed, nearly ready for serv- ice. 1 thank Heaven every day that we were fortunate enough in beginning the organization of the Nursing Service so long ago that now there need be no delay as far as the nurses are concerned. Four days later, August 14, the Surgeon General called upon the lied Cross for one hundred nurses, instead of forty, for l)or(ler service. As this was the first call of sizable dimensions which the Ived Cross Xursing Service had received, the rules and regulations handed down by the Surgeon General are of importance, in that they constituted the precedent which later governed the assignment of American lied Cross nurses to tli(! Army Xurse Corps during the participation of the United States in the European War. In his letter of August 14, the Surgeon (Jeneral stated that reserve inirses m\ist be citizens of the United States. Colonel Kean in his reply of August IG wrote : 2. The reciuiroment mentioned in your letter, wliich is a new one as far as reserve nurses are concerned, tliat rcs('r\e nurses must be citizens. may delay soniewbat tbe calling out of tbe emergency detachments, as llie question of citizen- 352 HISTORY OF AMERICAN RED CROSS NURSING ship has to be put to each individual nurse. The War Relief Board, of which the Surgeon General of the Army and the Surgeon General of the Navy are members, have considered the regulations for enrollment in the Red Cross Eeserve and have not considered this requirement necessary for reserve nurses, whose service is of a more or less temporary char- acter, although it is required of members of the Army Nurse Corps. They have always, of course, been required to take the oath of allegiance. This requirement seems somewhat at variance with the neutral and international character of the Red Cross. In his letter of August 16, Colonel Kean next dealt with two questions of only temporal importance. He suggested that nurses assigned to border duty be permitted to serve for a period of only six months, if necessary, so that they might return to positions which were being held open for them. He also requested that several reserve nurses from various base hospital units be assigned to the border, so that they might become familiar with Army paper work and other conditions peculiar to Army nursing. The last point made in this letter was one of vital importance. Colonel Kean wrote: 5. As the question of insignia for Red Cross nurses when on active duty has not been authoritatively settled, it is re- quested that a ruling be made that they shall wear the Re- serve cap with the Red Cross on the front and the Red Cross cape which is issued to them gratis. This is considered of importance on account of the international and well-accepted character of this insignia and its value in maintaining esprit de corps. In a letter written August 18, the Acting Surgeon General, Colonel Birmingham, answered these points in the following order and manner: 1. Your letter of August 16 is herewith acknowledged. 2. As there appears to be no law requiring the reserve nurses assigned to active duty in the Military Establishment to be citizens of the United States, so much of letter dated August 14 as pertains to this need not be regarded, though citizens, or tliose wlio have made declaration of intention to become such, will be given precedence. 3. You are authorized to inform reserve nurses volunteer- ing for active service that they may on request, be relieved from active duty and given transportation, to the place from RELATION OF NURSING SERVICE TO THE ARMY 353 which they started, at the end of six months' service, unless in the meantime, the need for their service ceases to exist or in case of misconduct. 4. In the case of nurses assigned to active duty, and who are enrolled for base hospital units, every effort will be made to transfer them to the unit of which they are a part, should the unit be called out, provided the Eed Cross will nominate other nurses to replace them. 5. There is no objection in this office to the use of the Red Cross cape and cap by reserve nurses. Immediately upon receipt of Col. Birmingham's answer, ]\Iiss Delano called out emergency detachments which had been organized by Local Committees in Alabama, Colorado, Georgia, Nebraska, Iowa, Louisiana, Maryland, Minnesota, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and Wash- ington, D, C, One hundred and forty-four nurses were first assigned to Camp jMcAllen, Fort Sam Houston, Eagle Pass, Laredo, Llano Grande, Brownsville and Fort Bliss in Texas; to Nogales and Douglas, Arizona ; and to Doming, New Mexico. Nurses w^ere also assigned to United States Army base hos- pitals from the base hospital units organized at Bellevue, the Presbyterian, the New York City, the Post Graduate, Mt. Sinai and the German Hospital, of New York City; at the Boston City, the Massachusetts General and the Peter Bent Brigham, of Boston ; at the Lakeside, of Cleveland ; at the Rochester Hospital, of Rochester, New York ; at the Harper Hospital, of Detroit, Michigan ; and at the Washington Uni- versity Medical School, of St. Louis, Missouri. Reserve nurses who went to the border were almost unani- mous in their expression of enjoyment of the service. The chief nurses were R(\gulars of the Army Nurse Corps. An eight-hour day gave the nurses ample leisure. The work in itself was light, but the Reserves found unending iiit(>rest in the routine of an Army General Hospital. ''The Military is so different!" they wrote ]\riss Delano. At Fort Sam Houston, Sau Antonio, Texas, the base lios- pital of ouc tliousand beds was always full. "The patients are mostly typhoid and operative cases and soldiers suffering from exhaustion due to the hot sun," wrote Ada Hayton, of the Washington, 1). C, emergency detachment, to !Miss Delano. Klizabeth K. O'Keefe, another r(^serve nurse, wrote of tlu^ attitude with which visitors and patients regarded the Reserve: 354 HISTORY OF AMERICAN RED CROSS NURSING We are quite amused at the terms applied to us by the soldiers and their visitors to designate us from the Army nurses. A young woman visiting one of the wards, stopped me to say "I want to ask you a question, and if you are not allowed to answer it, why just say so, won't you?" I nodded. Imagine my surprise when she drew a long breath, screwed up her courage and whispered confidentially: "You Eed Cross nurses aren't really all graduate nurses, now, are you?" A patient said to one of the Eeserves, as she was giving him a bath: "Do you find this work very hard to learn?" "What do you mean ?" she asked. "Why," he replied, "aren't you one of those society women who are doing this for fun and the good of humanity?" At Fort Bliss, Texas, the Army base hospital cared for an average of five hundred patients, the majority of them accident cases. Here as in other bases, the nurses were at first somewhat uncertain as to their exact dutiefs. "After we get better acquainted with the Army," wrote Ellen Thomas to Miss Delano on September 12, 1916, "I think we will be busier. The Corps men have done all the work until June of this year and it is now rather difiicult to know where their work stops and ours begins." Overlooking the low brush and cacti of the ]\rexican shore, directly on the bank of the Rio Grande, stood the Brownsville Hospital. In a letter written September 28, 1916, to Miss Delano, Edith L. Wood, reserve nurse, described their "quarters" : We are fairly comfortably situated here in a low frame building, just boards, with two of us in each room. Every- thing is screened against mosquitoes and we sleep under nets. Though the heat is intense during the day, the wind off the Gulf of Mexico, twenty miles away, makes our nights very comfortable. All the buildings are of the same construction. The wards accommodate about fifty patients each. They are so quickly and easily assembled that tliey seem to spring up overnight like mushrooms. A month ago there was nothing here but dust, sandfleas, cacti and heat. Xow it looks lilve a small village. No special disease prevails. We have something of every- thing, quite a bit of malaria, and a fever called "dengue," which the merry mosquitoes give us. RELATION OF NURSING SERVICE TO THE ARMY 355 One of the five camp hospitals which the Medical Corps maintained on the border was located at Llano Grande, Texas. A reserve nurse who had seen service with the British Expedi- tionary Forces during the early years of the European War wrote of the work at Llano Grande: Our experiences are quite different from those in an Eng- lish camp hospital in France. We were much disappointed at first to find our liospital so poorly equipped. Camp life in France was so very fascinating and the nurses were treated with great respect by the British Tommies. . . . We were later transferred to Fort Sam Houston, where everything is well systematized, with supplies in abundance. Here we found our boys quite as appreciative as the English and French and so full of fun ! The camp hospital at Douglas, Arizona, consisted of tents and wooden barracks. "Xurses' quarters," wrote Harriet Han- kins to Miss Delano on August 27, 1916, "are separate and are built of wood, with excellent floors, plenty of screened windows, running water, in fact are wonderfully comfortable. Each inirsc has a bed, a bureau and a built-in wardrobe." Miss Delano's reply was reminiscent of her own early experiences in the West : "Soon after my graduation," she wrote, "and almost my first work was in the mining camp at Bisbec, Arizona, not far from your present assignment. In those days, the Apache Indians were usually on the war-path and we never dared stir out without a revolver. I imagine things are more civilized no\y." The wooden buildings and tents at Douglas, which were comfortable enough during the summer of 10 10, were meager protection against the raw fall rains and the bitterly cold winters. The nurses stationed there then experienced more of tli(> rigors of open camp life, for a letter written by a member of a Local Committee on Bed Cross Xursing Service to Miss Delano gave a different picture: Their quarters were a small tent shared by five nurses. There Mas no way of heating it ; the weather was very cold. The nurses in the shacks had four blankets and a stove. When it rained, the water would run under the eots. The flooring of the tents was earth. One very cold night the wind blew uj) the top of the tent and the nurses gathered \ij) their hlaiikcts and clotlu's and si)eiit the rest of the night on the 356 HISTORY OF AMERICAN RED CROSS NURSING floor of the dining-room. They used to stand on their cots to dress so they would not have to put their feet on the cold earth.^^ This first field service with the Army which reserve nurses experienced on the Mexican border was of great value in acquainting American Red Cross nurses with military disci- pline. In her letters in reply to complaints which the nurses sent to National Headquarters, Miss Delano emphasized again and again the unofiicial connection which she held to Red Cross nurses after they had once been assigned to the Army Nurse Corps. The Red Cross could in no way interfere with the discipline of the Army and Navy and no one appreciated this fact more than did Miss Delano. To complaints, her answers were almost invariably as follows: In the first place, Red Cross nurses when assigned to duty in a military hospital become temporarily members of the Army Nurse Corps, subject to all rules governing that service. It is impossible for me to take up this situation officially. Any statement should be sent through the chief nurse and the regular military channels. May I urge, however, that you keep the nurses from dis- cussing this matter and ask them to accept without question any decision of the chief nurse? Be patient for a little while. You know how deeply interested I am in everything concern- ing Eed Cross nurses, but when it comes to a question of military authority, I am quite helpless. I can only count on you to do your best to keep things running smoothly. Though only a minor skirmish in comparison with the titanic struggle to come, the ^lexican border service of 257 reserve nurses remained an illuminating and, for most of them, a worth-while memory. Both from a utilitarian and from an aesthetic point of view, the uniform of the American Army nurse on active duty during the European War diifcred greatly from the costumes worn by nurses in previous wars. Volunteer and professional nurses of the Spanish-American War had gone to their posts of duty garbed in civilian dross or in the uniform of their school of nursing. The appearance of the Civil War nurses, in crinoline and shawl, is familiar to students of American military history. " Red Cross Archives. X;itional TTeadquarters, Wash., D. C. RELATION OF NURSING SERVICE TO THE ARMY 357 The description of the "grey tweed wrapper, worsted jacket with cap, a short woolen cloak and frightful scarf of brown holland" ^'* of Miss Nightingale's nurses calls up an awesome image. The uniform of the American Army nurse was both useful and attractive. It consisted of blue norfolk coat with the bronze letters U. S. and the caduceus of the Army Medical Corps with the initials of the Army Nurse Corps superimposed upon them, the short blue skirt above brown shoes, and trim sailor hat, or the white, one-piece dress worn with the scarlet-lined blue Red Cross cape and the winged white cap. A war correspondent once asked a doughboy from a Pennsylvania mining town, who had been brought into an American base hospital with a shat- tered leg, what he thought of the reserve Anny nurses there. ''It gives me," replied the Pennsylvanian, "bcneficient shell- shock to look at 'em !" The distinctive uniform of the American nurse was, however, a gradual evolution. The Manual of the Medical Department, 190G, the edition in which first appear regulations regarding the uniform of Army nurses, stated that "the uniform of the Army Nurse Corps shall consist of a waist and skirt of suitable white material, adjustable white cuffs, bishop collar and white cap, according to patterns and specifications in the office of the Surgeon General." ~^ At the first meeting of the National Committee on Red Cross Nursing Service, which was held in New York on January 20, 1910, a committee which consisted of Miss Delano, Miss Board- man, Miss Nevins and ]\Iajor Lynch (then in charge of Red Cross First Aid instruction) was appointed to draw up a cir- cular of information regarding enrollment in the Nursing Service. This circular was printed by the National Head- quarters on April 1, 1910, and contained the following regula- tions : Uniform and Badge Unless otherwise authorized, nurses called upon for service under the IJed Cross will wear plain wliite uniforms with bishop collars and caps, the ])atterns of which will he provided by the American l\ed Cross on application to the chairman of the National Committee on b'ed Cross Nursing Service. . . . [Address follows. | " "'^fcniorics of the Crini(>a." Sister ^fary Alovsius, p. 17. *> Manual of the .Medical Department, l!tO(i, p. 31. 358 HISTORY OF AMERICAN RED CROSS NURSING At the time of appointment each nurse will receive a badge with her name and the number of the badge engraved on the back and a record of the same will be kept in the National office of the lied Cross in Washington. Under the Act of Congress incorporating the Eed Cross, this badge cannot be legally worn by any other than the person to whom it is issued, and is owned by the American Eed Cross. It should be worn on the front left-hand side of the collar. In case of withdrawal from enrollment, the badge and certificate of appointment must be returned to the chairman of the Xational Committee on Eed Cross Nursing Service. . . . [Address follows.] In the event of war, the Eed Cross will provide all nurses called upon for active service with blue capes bearing the insignia of the Eed Cross. Miss Delano, with a rare sense of the dramatic and an ap- preciation of the power of sentiment, designed the cape referred to, which has since become perhaps the most distinguishing mark of the American nurse on active service during the European War. It was a circular garment of medium length, made of navy blue flannel and lined with scarlet, and it was usually worn flung back over the left shoulder. On the left side was a Red Cross and by reason of the high ideal of conduct which Miss Delano set for the enrolled nurses and the vivid appearance of the garment itself, nurses grew to honor and love the cape and to wear it with soldierly pride. It symbolized for them the romance and the sacrifice of war nursing. The use of the Ked Cross brassard was outlined in the original Treaty of Geneva and was defined in the revised Treaty of Geneva, which was signed July 6, 1900: Article 20. The personnel protected in virtue of the first paragraph of article nine and articles ten and eleven, will wear attached to the left arm a brassard bearing a red cross on a wliite ground, which will be issued and stamped by competent military authority, and accompanied by a certificate of ideiitity in tlie case of persons attaclied to the sanitary service of armies who do not have military uniform. In the Kogulations concerning the American Red Cross Xursing ScTvicc, as adopted by the Executive Committee De- cember 20, 1012, which superseded the Circular of Informa- tion issued April 1, 1010, the following sentence was incor- Outdoor miifonn of an Aincricaii \lvd Cross inirsc. Tliis uniform was also \vt)rn during; tin' Kuropcan War liy all nifniin'rs t)f ihe Army Nurse Corps, with the insiiinia of that Corps. RELATION OF NURSING SERVICE TO THE ARMY 359 porated into the section defining the Red Cross nurse's uniform : "Nurses are not at any time allowed to wear Red Cross bras- sards without special authority from the American National Red Cross." The next mention of uniforms is to be found in the Minutes of a meeting of the National Committee on Red Cross Nursing Service, held December 9, 1913, at which "it was decided to adopt a nurse's uniform for the Red Cross Nursing Service if a suitable material could be found. . . . Miss Delano was asked to get information about gray cotton crepe material, the cost, width, etc. and to send this information to all Local Com- mittees." At a meeting held at the Planters' Hotel, St. Louis, Mo., on April 24, 1914, the National Committee again discussed the question of equipment and uniforms and "it was suggested that patterns be distributed by Local Committees and that Local Committees be ready to help watli details in any way in order to relieve the Washington office. Samples of the uniform material were distributed, so that the nurses might begin their preparation. . . . The meeting was crowded with earnest, dignified, enthusiastic nurses ready to prepare for w^ork which might come." ~*^ When within four months, the first call for the mobilization of Red Cross nurses on a large scale sounded in the organization of the !Mercy Ship Expedition of 1914, the uniform was thus practically agreed upon. The nurses of the Mercy Ship, as it has been explained in Chapter IV, wore the gray cotton crepe uniform, with white collars and cuifs, a navy blue ulster and the Red Cross cap and cape. National Head- quarters allowed them to wear also the Red Cross brassard. In the meantime, certain small changes had occurred in the uniform of the Army Nurse Corps. In 1912, the Surgeon General had authorized nurses on duty in the Philippines and in the Hawaiian Department to wear low collars. In 191.'>, he issued regulations changing the "waist and skirt" to a one- piece dress similar to that worn by Army nurses during the European War. When Army nurses were ordered with the Punitive Expedition to Vera Cruz, Mexico, the question of laundry arose and Miss ^Mc Isaac, then superintendent of the Army Nurse Corps, decided that gray crepe uniforms would solve the problem. One of the nurses ordered there was Sayres L. ^lilliken, who later became assistant superintendent of the ^'' Miiuitos of the National Coniniitti'e, Vol. I, pp. 83-S5. 360 HISTORY OF AMERICAN RED CROSS NURSING Army l^urse Corps; she wrote, "I supplied myself at my own expense with gray crepe uniforms, made exactly like our white ones, touched off by white collars, cuffs and aprons. This uni- form, however, was so unbecoming and washed so poorly that the nurses wore them only a few weeks and then, by special permission from Miss Mclsaac, went back to the white uniform." As for the Red Cross nurses, the gray uniform for ward duty and the white uniform for dress wear, which were both worn with the Red Cross cape, remained the only distinctive uni- form of the Red Cross nurse until 1916. Then i^ational Head- quarters undertook the organization of base hospitals and other units for the Army and the question of uniforms arose again. Miss Delano was strongly in favor of using the gray uniform, because she thought it was highly practicable, but the Surgeon General's office did not share this opinion and Miss Delano was forced to coincide with their decision to continue the use of the white uniform, since nurses of base hospitals and other units, when turned over to the War Department, became mem- bers of the Army ISTurse Corps and as such would be required to wear the uniform of that Corps. On June 20, 1917, Miss Delano telegraphed Miss Koyes, then chief nurse of Base Hospital No. 1, that "to save pur- chase of additional uniforms, it has been decided that members of base hospital units may wear the uniform of their school, except caps. Brassards, capes and caps will be supplied with- out cost by the Red Cross upon assignment to duty." Formal authorization of the change from the gray to the white uniform was requested by Miss Delano in a letter written July IT, 1910, and addressed to General IMurray, then acting-chairman of the Central Committee ; this letter was returned approved by Gen- eral Murray, Colonel Kean and Mr. Bicknell under the same date. While the American ^Nurses' Association was holding its Twentieth Annual Convention in Philadelphia, ISTational Head- quarters wired ]\liss N'oyes April 29, 1917, of the impending mobilization of six base hospitals for service with the British Expeditionary Forces. ]\Iiss I^oyes returned post-haste to Wash- ington to look into the question of an outdoor uniform. The Army had not standardized an outdoor uniform for its Xurse Corps, but the Surgeon General's office concurred in the opinion of the Red Cross War Council that nurses of the units assigned to the British Expeditionary Forces should bo distinctively RELATION OF NURSING SERVICE TO THE ARMY 361 garbed as United States military personnel. Miss Noyes tele- graphed Miss Van Blarconi, then the representative of the Nursing Service in the Atlantic Division headquarters, New York City, to call together a committee composed of the chief nurses of base hospital units organized in the larger civilian hospitals of New York City, to consider the selection of a suit- able outdoor uniform. ]\liss Maxwell, of the Presbyterian Hospital, and the other members of this group had sample garments and prices ready to submit to the committee by the time ]\Iiss Noycs got over to New York. The committee selected an outdoor uniform consisting of a one-piece blue serge dress of distinctive military cut, a heavy blue ulster and a blue velour hat of campaign style and !Miss Noyes immediately placed or- ders for a large inimber of these uniforms with a New York manufacturing clothier. Base Hospital No. 4 (Lakeside) arrived at the port of em- barkation, however, before the uniforms were ready. The nurses of the unit sailed in civilian clothes, with only such accessories as capes, blankets, caps and other articles then in Red Cross supply rooms, but their measurements were taken so that the next unit scheduled to sail a few days later might take over their equipment. The Peter Bent Brigham Unit (Base Hos- pital No. 5) also embarked without uniforms. The third column to be ordered out was the Presbyterian Unit, and the nursing staff not only went completely uniformed but took with them equipment for the Lakeside and Peter Bent Brigham units. So hurried had been the embarkation of these three pioneer columns that many of the nurses, especially those who lived at a considerable distance from New York City, went di- rectly from the trains to the docks and ]\[iss Noycs, ]\[iss Van Blarcom, members of the New York County Chapter and the tailors' assistants, followed them in taxis and private limousines piled high with boxes of dresses, hats and other articles. The New York County Chapter, which had equipped the nurses of the Mercy Ship, acted as agents for National Head- quarters. Mrs. John S, Thatcher, Frances Anderson and Mary Magoun Lrown volniiteered their s(n'vi(*es. The Chapter as- sumed the immediate responsibility for the payment of tli(> clothiers' bills until National Hc^uhjuarters could secure a de- cision from the War l){^partnn'nt that the Government would furnish nurses' e(pii])nient, or until the Ked Cross War Council ((ul(l appropriate funds for tliis purpose. 362 HISTORY OF AMERICAN RED CROSS NURSING Miss Kojes notified the manufacturing tailor on June 1, 1917, to prepare to equip Base Hospital No. 17, of Detroit, and four additional Army base hospitals. Her letter also gave an important change in procedure ; Miss Thompson had consented to issue nurses' sailing orders several days in advance so that the nurses might have opportunity to be measured and fitted for uniforms after their arrival in New York. This was a great advantage over the former system by which the chief nurse had endeavored to secure and forward the nurses' meas- urements to the manufacturing tailor before the unit had left its home city. The ]\Iinutes of the National Committee on Red Cross Nurs- ing Service, which met June 16 at National Headquarters, recorded this action : The chairman stated that in order to equip Red Cross nurses assigned to duty as expeditiously as possible, it was necessary to appoint a special committee on uniforms, who would be responsible for selecting the uniform and issuing the equipment. As the time was limited, the chairman appointed this committee as follows : ]\[rs. John S. Thatcher, chairman; Miss Charlotte Stillman; ]\Iiss Frances Anderson; Miss Anna C. Maxwell ; ]\riss ]\rary M. Brown. The chairman asked that this action be ratified, as this Committee should be appointed by the National Committee rather than by the chairman. [Motion to this effect made and carried.] ]\rrs. Thatcher immediately began to look about for a suitable place in which to establish headquarters for the equipment di- vision. She visited the newly-established headquarters of the Atlantic Division, then located at No. One, Madison Avenue, and conferred with ]\Iiss Van Blarcom, who as the representa- tive of the Nursing Service in the Atlantic Division was an ex- ofhcio mendjcr of the Committee on Equipment. It was then decided to locate tlie equipment work there. Miss Van Blarcom at the same time secured the services of !Maude G. bloody to assist ]Mrs. Thatclier in the business details of the work. ''^frs. ]\roody has been recommended to us," wrote ]\rrs. Thatcher to ]\Iiss Noyes on June 14, "as an unusually capable woman, of good executive mind, tactful and of pleasing personality." ]\rrs. ^foody MTote of the expansion of the early division of nurses' equijmient: RELATION OF NURSING SERVICE TO THE ARMY 3G3 In June, 1917, the Atlantic Division took oflices on the thirty-second floor of the ^letropolitan Tower, and the Bureau of Xurses' Equipment was soon in actual operation there. On the twenty-eighth floor we had a little storeroom where our stock of all articles, excepting the ulsters and dresses, was kept. We carried tan gloves, aprons, etc., for the nurses to purchase at cost. Army Base Hospital No. 15 (Roosevelt Hospital) was the first unit equipped hy the hureau. As we had no assemhly room to which the nurses could come, we conveyed the equip- ment to them at the hospital. To transport those many packages, Mr. John Nieser of the Manhattan Storage and Warehouse Company offered us the use of his vans. Ellis Island in the meantime had hecn designated as the nurses' mohilization station, and it was not unusual to see the vans backing up at the ferry-house discharging their cargo of hundreds of boxes of all sizes, to be transferred to the waiting baggage trucks which husky corpsmen hustled aboard the ferry. Perilous indeed were those trips from Island Xo. One to Island Xo. Three, when we dashed from one truck to another trying to keep that precious equipment from falling under the wheels ! Once safe in the large many-windowed assembly room of Island Xo. Three, the hold-alls and boxes were arranged alphabetically and given out to the long line of waiting nurses, who signed their cards, had their hats fitted and went off laden with burdens almost too great to carry. Following the establishment of the Bnreau of iSTurses' Equip- ment at Atlantic Division headquarters, the next step in build- ing up efficient organization was the transfer of all responsibility for e(piipping nurses from the Xew York County Chapter to Division and Xational Headquarters. !Mr. Leo Arnstein was then Director of Military Kelief of the Xew York County Chapter and he was loath to surrender responsibility which he felt belonged in his department. jMiss Noyes announced this transfer in a letter written June 15 to jMr. Harvey D. Gibson, then chairman of the Executive Committee of i\w Xew York County Chapter. "This arrangement," connuented ]\Iiss Xoyes, "will centralize all nursing affairs at a given point, an arrange- ment never before possible owing to the fact that we have not had a direct representative in New York until ^liss Yan Llar- com's assignment there. I cannot l)egin to tell you,'' slu> con- cluded, "how grateful we are to the Chapter for the services which they have rendered in the past. We must have been a verv great trial at times." 364 HISTORY OF AMERICAN RED CROSS NURSING The cost of equipping these first units of nurses was increas- ing by leaps and bounds and iNTational Headquarters had already foreseen that financial responsibility for this work would far exceed the resources of the !New York County Chapter and would soon become a matter for decision between the War De- partment and National Headquarters. Miss ISToyes submitted a memorandum to the War Council in July, 1917, which recom- mended outdoor uniforms for nurses at an estimated cost of $35,580 per thousand nurses. "The War Council," stated the minute covering a meeting of the War Council held July 4, 1917, "decided to refer the matter to Colonel Kean, with in- structions to present it formally to the War Department. As the nurses, on going into service, come immediately under the War Department, it would seem that the War Department should decide upon the uniform and pay for same." At a meeting held July 10, Mr. Wadsworth again brought up the question of nurses' equipment. Mr. Davison stated that it was the policy of the War Council that Red Cross nurses assigned to service in Allied countries should always be uni- formed. The War Council accordingly voted that the "Chapters sending Red Cross units shall provide uniforms for nurses, that nurses whom Chapters are unable to uniform shall be uniformed by Xational Headquarters, and Mr. Wadsworth is directed to make arrangements accordingly with each Chapter." Early in July, Colonel Kean was placed in charge of the Ambulance Service of the American Expeditionary Forces and was sent immediately to Erance. John D. Ryan, of 'New York City, was elected Director General of Military Relief. Colonel Winford Smith, late superintendent of Jolms Hopkins Hospital, was detailed on July 18, 1917, to represent the Sur- geon General at Xational Headquarters and on August 31, he was elected Director General of Military Relief, following the appointment of Mr. Ryan to membership on tlie War Council. While the War Department, Xational Red Cross Headquar- ters and Local Red Cross Chapters were considering who should pay the bills for nurses' equipment, the fortunes of war took a hand in the matter. The S. S. Saratoga, on which Base Hos- pital Xo. 8 had ciiibarkod for Erance, collided on July 30 in Xew York Harbor with the Ciijj of Panama. The nurses had gone to their staterooms, had removed their heavy uniforms on account of the intense heat and in kimonos and niffht ffowns RELATION OF NURSING SERVICE TO THE ARMY 365 were resting or sleeping. Following the collision, all hands were ordered immediately to the life-boats. The nurses caught up capes and coats, flung them over their scant garments and, with admirable savoir fairc, took their places in the lx)ats, aban- doning not only their uniforms but other articles of clothing and their money as well. The Saratoga sank eighteen minutes after she had been struck. The life-boats containing the nurses were rowed some distance from the accident and held there for further orders. The men of the rescuing crews spread their coats over the shoulders of the nurses to protect them from the glare of the July sun. After a tedious cielay, the nurses were rowed to Ellis Island. The interned Germans and agents detained on the Island crowded to the wire fences to watch the American women come ashore. Wet and insufficiently clad, with their arms and faces burned and their nerves taut from a harrowing experience, the nurses, when they heard the jeering words of the enemy, conducted themselves^ according to the best traditions of Ameri- can womanhood. Up went their heads and they marched proudly to their dormitories with laughter on their lips. On August 1, Miss Van Blarcom telephoned Miss Xoyes that the nurses of the unit were stationed on Ellis Island with- out adequate clothing. ^liss Koyes went immediately to the offices of the War Council ; the members were holding one of their customary morning meetings. ]\[iss Xoyes presented the facts of the case and asked the War Council to appropriate funds sufficient to ree(;[uip the nurses, an appropriation which she estimated roughly at $14,000 or $200 per nurse. A member of the War Council suggested that !^Iiss ISToyes call the War Department to ascertain whether any Government fund was available for such purposes. !Miss Xoyes was referred to Colonel Birmingham, then Acting Surgeon General of the Army. He stated that the only possible way in which the War Department could reequip these nurses was by special Act of Congress ! ]\lis3 Xoyes again went to the War Council and within two hours after the time when ^liss Van Blarcom had first tele- phoned, Xational lI('ad(|uart(M's had appropriated $14. (>()( for the complete rc('(inipment of the destitute nurses at Ellis Island and Miss Xoyes had instructed ]Miss Van Blarcom by telephone to begin the selection and purchase of the various articles. 366 HISTORY OF AMERICAN RED CROSS NURSING When the nursing representatives of the Atlantic Division went over to Ellis Island to confer with the nurses regarding their needs, they found a chaotic condition. Mrs. Moody de- scribed it: Ellis Island showed us "stay-at-homes" to a small degree at least what war meant. Island No. 3 looked like a refugee camp in a war-ridden country. Spread over the lawn Avere water-soaked army lockers, stained and muddy clothing, here a white uniform streaked with the red of a cape which had lain near it, there a pathetic-looking shoe ruined beyond re- pair. Too much cannot be said in praise of the courage displayed by these women who after a harrowing ordeal during those torrid summer days met us with a joke and a smile. In the meantime, the six American base hospitals assigned to the British Expeditionary Forces had arrived in France. Xone of the British General Hospitals where they were detailed for duty were equipped with laundries and the nurses soon discovered that they would have to wash out the white uni- forms after they came off duty if they were to present a neat and professional appearance. Members of several base hos- pital units even joinec^ groups of French women who were pounding their clothes clean in convenient brooks ! "The white uniform is most unpractical," wrote Miss Stimson at Rouen, France, to Miss Xoyes. "The night nurses put them on with aprons and caps, then don raincoats and rubbers, carry an umbrella in one hand and a lantern in the other and start on their rounds from one tent or hut to another. By morning you should see the caps of those wdio have not brought rubber hats, after they have ducked in and out of the tents, and their white skirts, after they have gone splashing through the sticky yellow mud !" Dr. Richard H. Harte, director of Base Hospital Xo. 10, which was stationed with the British at Etretat, stated in a letter written to Miss Delano on June 17 that in addition to the impracticality of the white uniform, the nurses' equipment was sadly inadequate. "Each nurse," he declared, "should have a good pair of rubber boots, a mackintosh, and a rubber hat, preferably the ordinary sou'wester worn by sailors. Anything less will be blown off by the terrific winds prevailing here. It is also terrifically cold." Colonel Robert E. Xoble transmitted Aujnist 9 to the Di- fA a K P.O RELATION OF NURSLNG SERVICE TO THE ARMY 3G7 rector General of Military Relief a copy of the following regu- lation : Referring to information received in this ofTicc that the white uniform now used by members of the Army Xursc Corps is not practicable for service in Europe, 1 am directed by the Surgeon General to inform you that the use of a medium gray uniform and white apron has been authorized to be made in accordance with specifications enclosed herewith. This information is furnished so that reserve nurses going to Europe may have their uniforms made to conform with these instructions. This authority has been forwarded this date to the commanding olhcers of the United States Army hospitals now in Europe. A certain amount of well-behaved humor appeared in the Min- utes of the War Council for August 8, 1917: The chairman stated that in preparing Eed Cross base hospitals for service abroad, the white uniform for nurses was insisted upon l)y the ^ledical Department of the Army; that it now appeared that owing to lack of laundry facilities, white uniforms are impracticable in France and the Surgeon Gen- eral's ottice has decided to adopt the gray uniform ; that there are sixty-five nurses iu each of the six base hospitals with the British forces in France, all equipped with white uniforms purchased at the expense of the individual nurses, the same being true of the nurses in the six hospitals with the American trooj)s in France; and that no doubt many nurses of the hospitals not yet called have supplied themselves with the white uniforms formerly required. The chairman further stated that these nurses could not be expected to go to additional expense in buying more uniforms ; that the estimated cost of the gray uniform being about $1<) it would require about $1040 to equip the sixty-five nurses of each unit; and on the recommendation of the Department of ^Military Relief, he advised this appropriation. Wliereupon it was, on motion Voted : That from the Red Cross War Fund the sum of $14,000 be and is hereby aijipropriated for furiiishing iiray uniforms to the nurses of the twelve base hospitals serving with the British and American troops in France. ]\riss Xoyos then sot about furnishing tlu^ gray dross to nil nurses of base hos])itals and other units, both in this country and overseas, tlnvuiuh the Xcw York Bureau (^f Xurs(\s' Er\vear and pajamas were not in tlio first list of e(juipnieiit furnished by tlie Ked Cross witliont cost. These articles had to be supplied bv the nurses themselves (A. R. C. 702, December 31, 19171. Later. howevt^T, tliev were all added ( Septeml)er IS. 1918). RELATION OF NURSING SERVICE TO THE ARMY 371 The Bureau of Equipment at the Atlantic Division now set- tled down to the long pull ahead. Mrs. Thatcher had resigned in September, 1917, the chairmanship of the Uniform Committee. The efficiency of the organization of the bureau luider J\Iiss Van Blarcom and Mrs. Moody had relieved Mrs. Thatcher and ^liss Brown, the two most active members of the committee, of the heavy responsibilities which they had bravely borne since May, 1917. Mrs. Thatcher wished to turn her enthu- siasm and energy to more active expression than the chairman- ship of an Advisory Committee on Uniforms permitted. Xurses will long remember w'ith gratitude, however, her courteous, faithful assistance during the strenuous spring and summer when the base hospitals were embarking for France. Miss Xoycs wrote on October 16 to Mr. Harvey D. Gibson, by this time general manager at National Headquarters of the Red Cross,-'** requesting the first of the several extensive appropriations made from time to time by the War Council to sustain the Bureau of Equipment : 'T should be grateful," she stated, ''if the War Council would vote an appropriation sufficiently large to enable us to carry an adequate supply in our store-room, viz., five hundred sets at two hundred dollars a set. We find it exceedingly difficult to secure sleeping bags, steamer rugs, rubber boots and slickers on short notice. We now have four units waiting in New York for sleeping bags. All their other equipment was given by Local Chapters before they left home. To avoid such situations as this, it seems highly important that an adequate supply be kept on hand." The War Council appropriated on October 30, 1917, one hundred thou- sand dollars "for the purchase of equipment for xVrmy and Navy nurses, it being understood that in the case of hospital units, etc., which would ordinarily be outfitted by Chapters, the amount so spent shall be collected from the Chapter wherever possible." Tliis attempt to have the local Chapter include nurses' equip- ment in its appropriation for base hospitals was never satis- factorily worked out and was later completely given up. In order that Red Cross public health nurses working in the sanitary zones which the United States Public Health Service had drawn about the cantonments, might be properly uniformed, ^^ Tlic oflic'c of fU'iicral MaTiajror, National Headquarters. AmerieaTi Ixed Cross, was created liy the W'nv Coiiiicil on July 11, 1917. and Mr. Harvey D. (Jihson, late cliairTnan of tlu' Kxecutive Committee of tlie New York C'nunty Chapter, \Aas appointed to tiie ])osition. 372 HISTORY OF AMERICAN RED CROSS NURSING the War Council also appropriated funds to furnish uniforms and equipment to them. The following statement appears in the pamphlet, Information for jSTurses Called Upon for Active Service (A. R. C. 702, December 31, 1917) : Xurses assigned to sanitary zones under the Eed Cross for public health or other forms of service will be provided, free of cost, with the following articles: one or more outdoor uni- forms of dark blue serge ; detached waist with high collar ; one blue ulster; one cape, dark blue, lined with red, insignia on left side ; one hat, dark blue velour ; caps ; three gray uniforms. These articles will be issued upon the arrival of the nurse at her destination. When the Army was mobilizing its Psychiatric and Ortho- pedic Base Hospital Units, No. 117 and No. 114, Miss Thomp- son in a letter addressed on March 4, 1918, to Miss Delano, asked if the Red Cross would supply equipment to the civilian employees and the reconstruction aides of these units. National Headquarters ultimately shouldered the responsibility for equip- ping, through the Bureau of Nurses' Equipment in New York City, all nurses, dietitians, clerical workers and aides for all types of foreign service in the Army, the Navy and American Red Cross commissions. On January 15, 1918, Caroline Van Blarcom, who had rep- resented the Nursing Service at the Atlantic Division since the early summer of 1917, resigned and Florence Mcrriam Johnson w^as appointed as director of the Department of Nursing there. The Bureau of Nurses' Equipment w'as maintained as a branch office of National Headquarters, but Miss Johnson, representing Miss Delano and Miss Noyes, had general supervision of its activities. Now in March, 1918, began that long procession of women, which day after day passed in ever-increasing numbers through the port of embarkation for Europe. Mrs. Moody described the expansion that had been going on of the Bureau of Equip- ment; In October, 1917, the Atlantic Division moved across the street from its former home and our new storeroom seemed enormous. Only too soon did we outgrow it and packing cases lined the corridors. The overseas units began mobilizing thick and fast and we found it necessary to secure more RELATION OF NURSING SERVICE TO THE ARMY 373 trucks. The Peter Doelf^or Brewing Company came to our rescue and many were the smiles of amusement from by- standers when those brirown, establislied a charming cusloni of sendiniT a box of flowers to each unit, so that e\erv worker 374 HISTORY OF AMERICAN RED CROSS NURSING going overseas could have at least one blossom as a tiny per- sonal message, a word of greeting and a Godspeed. For nurses serving directly under Red Cross commissions to the Allied Powers, Miss Delano and Miss Noyes had adopted the same uniform as that of the Army and Navy Nurse Corps. Of the equipment of these nurses, Mrs. Moody wrote: Before they reported to the bureau for equipment, Miss Johnson saw individually every nurse sailing under the Eed Cross flag. How interesting it all was for us when a unit was being sent to so romantic a country as Palestine or Porto Pico and how eagerly we revised and planned their equipment to meet these particular services ! A nurse on active duty with Red Cross foreign commissions wore upon her hat band, upon her shoulders and upon the lapels of her coat, the symbol of the organization. Without consulta- tion with the Army Nurse Corps or with National Headquar- ters, the Red Cross Commission for France adopted in 1918, upon the authority of the Chief Surgeon, American Expedition- ary Forces, a distinctive emblem made by placing an enameled Red Cross upon the caduceus of the Medical Corps. The bronze letters "U. S." were worn with this device and insured for the wearer recognition and protection in the foreign theaters of war where the American Armies were operating. Previous to August, 1918, nurses serving in Army hospitals in the United States had been permitted to wear the uniform of their school, provided it was not extreme in cut, when on duty, but when off duty, they had worn civilian clothes. Fol- lowing an increase of salary for the members of the Army and Navy Nurse Corps from fifty dollars ($50) to sixty dollars ($G0) a month for domestic service and from sixty dollars ($60) to seventy dollars ($70) for overseas duty, the Surgeon General authorized that all members of the Army Nurse Corps should wear the outdoor uniform. On July 23, 1918, Colonel Winford H. Smith transmitted to the general manager of the American Red Cross, for the attention of the Nursing Service, the following regulations issued by the Surgeon General, regarding uniforms : Xurses who enter the service at this time are permitted to wear such wliite uniforms as tliey may liave. provided that thcv are not extreme in anv wav. AMicn it is necessary to RELATION OF NURSING SERVICE TO THE ARMY 375 replace these uniforms, they must then be obtained in accord- ance with specifications, with this exception : The uniforms of all reserve nurses must conform in all respects to that of the Army Nurse Corps. The use of the outdoor uniform is considered advisable and it is further directed that all members of the Army Nurse Corps, including the reserve nurses, purchase the suit, hat and necessary waists within three months after they enter the service. This uniform will be worn at all times when not on duty. The overcoat should be purchased if and when the weather requires its use. On August 15, 1918, the following ruling was sent by the Surgeon General of the Army to the commanding officers of all military hospitals in the United States : 1. I am directed by the Surgeon General to inclose here- with specifications, cap pattern and other data concerning the indoor and outdoor uniform of the Army Nurse Corps. Nurses who enter the service at this time may be permitted to wear such white uniforms as they may have, for a period of six months after their entry into the service, provided they are not extreme in any way. When it is necessary to replace these uniforms, those made according to specifications must then be obtained. With this exception, the uniforms of all nurses, including/ the cap, must conform in all respects to that of the Army Nurse Corps. As the use of the outdoor uniform is considered advisable at this time, it is further directed that all members of tlie Army Nurse Corps now in the service, purchase the suit, hat and necessary waists within three months, and all those who enter the service hereafter purchase those garments within three months after their entry into the service. Before ordering these garments, however, those nurses who are physically or otherwise unfit for the service should be informed to that effect in order to avoid placing them under any unnecessary expense in the purchase of these garments. This uniform is to be worn at all times when not on duty in the hospital. The overcoat shovdd be purchased if the weather requires its use. 2. The American Red Cross will omit from the equipment of nurses ordoi'ed overseas the alcove mentioned articles, but will continue to issue to these nurses exceptional equipment. Four months, however, will be allowed for adjustment. The Ked Cross has also signified its willingness to issue to all members of the Army Nurse Corps on duty at honie or abroad 376 HISTORY OF AMERICAN RED CROSS NURSING a dark blue cape lined with red, the use of which is hereby authorized. The insignia of the Army N'urse Corps and the letters "U. S." may be worn on the collar of the cape. The chief nurse should notify the director of Nursing Service, Atlantic Division, 44 East 23d Street, New York, in regard to the number of capes needed by the nurses at the hospital from time to time, giving their names. If sweaters are re- quired for additional warmth, gray ones should be obtained. Several months before, when the question of the Red Cross cape had been under lively discussion, the Surgeon General's office had contended that this garment when worn by reserve nurses of the Army x^urse Corps tended to differentiate them from the Regulars and thus to break down the esprit de corps of that body. When National Headquarters offered to furnish the cape, without the Red Cross upon the left side, to all members of the Army Xurse Corps, its offer was immediately accepted and the traditional blue garment with its scarlet lining was issued to all nurses assigned to foreign and home service. The ruling of August 15, 1918, which removed the Red Cross from the reserve nurse's cap, w^as made in the interest of dis- cipline, but evoked regret among the nurses. The following letter is typical of many received at Red Cross Headquarters; I am so glad we are to wear outdoor uniforms. We've always hoped that it would be so, but we who came into the service through the Ked Cross are disappointed and hurt to be deprived of all possible sign of the fact. It is not that we have any objection to the new cap; it is nice and neither gives nor takes anything from us as nurses. It is simply that we loved to be known as Ked Cross nurses. We volunteered for that organization and would have liked to retain somethixjg to show our association with it. A question of international Red Cross policy presented itself in reference to the habit and insignia of Catholic Sisterhoods. One of the specific duties of the National and Local Committees on Red Cross Xursing Service, was "to keep on file lists of Sisterhoods and other orders and women volunteers, available for Red Cross relief work involving the care of the sick and wounded, either in time of war or calamity." During the summer of 1!18, the Red Cross was especially anxious to utilize the services of Sisters of Charity, who had alwavs held nn hrmorcd place in military nursing. They, too, RELATION OF NURSING SERVICE TO THE ARMY 377 earnestly desired to serve. Miss Delano wrote on June 10 to Miss Thompson stating that some time before, she had secured a list of the Catholic Sisterhoods in the United States, but had never written to them asking for the probable mimber available for service in tim(> of need. "I shall be very glad/' concluded ^Miss Delano, "if you will tell me if you think it desirable for me to send out a letter requesting this informa- tion." ^liss Thompson replied on June 18: Eelativc to the use of Koman Catholic Sisters in Army hos- pitals, I have referred this matter to Colonel Smith of the Hospital Division with the result it is believed advisable to place on file the resources of the Sisterlioods of the couiitrv-, provided tiiey are graduate nurses and eligible for enrolhnent. Should it be necessary to use these Sisters, your office will be so informed at once. It is believed there might be some trouble in regard to accommodations for the Sisters. Many of the nurses are obliged to live in dormitories. Furthermore, in many hospi- tals, tlie nurses are obliged to wear a large white apron over their uniform, as well as a mask over their faces. This would be difficult for the Sisters. They are obliged in all cases, I understand, to wear the habit of their order. After some slight misunderstanding, Colonel Smith wrote on July 3, 1918, to !Miss Delano that "indeed there is every reason why enrollment should be made of all such nursing Sisters who are graduate nurses. It should be understood, however," he added, "that if ordered to active duty, they will come in on exactly the same terms and under the same regulations as to conduct, uniform regulations, etc., as all other members of the Army Xurse CVu-ps." The matter stood thus until the mobilization of Base Hos- pital Xo. 102 which had among its nurses ten Daughters of Charity. A special ruling was then made which permitted these Sisters to wear the garl) of their order but the Surgeon (Jen- eral's ofiwo again stated that if members of the Catholic Sister- hoods wer(> assigned in the future to the Army Xurse Corps, it would be with the understanding that they wear the regulation uniform of that Corjjs.-"' This decision promis(>d to inundate \lcd Cross H(\ul(piarters =" Sec iiitcr-dnicc letter written July !. I'.US. hy Miss Delano to -Miss Ken-, director of the Uiireau of I'-iirollinent. 378 HISTORY OF AMERICAN RED CROSS NURSING with criticism from the Catholic Press similar to that of 1917, before Sisterhoods clearly understood that the Surgeon Gen- eral's office and not the Red Cross Nursing Service was debar- ring them from active duty. Colonel Smith, however, wrote JMiss Delano on August 3, 1918: deferring to your recent letter relative to the admission of Catholic Sisters to the Army Nurse Corps, I am directed by the Surgeon General to inform you that a recommendation lias been made to the Secretary of War to the effect that chould the Sisters be admitted to the Corps, as graduate nurses, they must, when on duty in the wards, wear the uni- form of the Corps, with the exception of the head covering, which may be a modification of the nurse's cap which will satisfactorily meet the situation. It is further recommended that, when on the street, they be permitted to wear the habit of their order. Until a reply has been received from the War Department, a definite decision cannot be recommended. You will, however, be advised as soon as the reply has been received Service in the Army Nurse Corps was made possible for tLe Sisterhoods on September 10, 1018, in the following order transmitted by Colonel Smith to Miss Delano : Your attention is invited to tlie recent decision of the Adjutant General as quoted below. 1. Orders are being issued directing that Army Nurses who are members of Catholic orders, whose vows require the wear- ing of a distinctive garb, are authorized to wear the garb of their order while traveling on land in this country without troops and while traveling on transports. 2. You will prescribe a suitable device to be worn with this religious garb, wbich will clearly mark the wearer as a member of the Army Nurse Corps. 3. You will also prescribe a cap to cover the entire head which shall be worn by them while on duty. The device referred to in paragraph 2 will be the regular insignia of the Army Nurse Corps: the letters T'.S. and the badge or caduceus with the gilt letters "A.N.C." superim- posed. This insignia will be worn on the Sisterhood garb at such times when it is approved that they be worn. Tlie Super- intendent of the Army Nurse Corps will prescribe the cap to be worn. By direction of the Surgeon General. RELATION OF NURSING SERVICE TO THE ARMY 379 On Anj^ist 1, 1918, the Surgeon General of the Army re- quested the American Red Cross to make preparations through its !New York I^ureau of Equipment to fit out completely one thousand nurses a week for overseas duty. The staff of the Bureau of Xurse' Equipment then numbered twenty-two per- sons. "Airs, lloody and all her assistants," wrote ^liss Johnson to !Miss Xoyes on August 8, ^'are as anxious as we are to have the nurses ready, even though the Army may not be able to send them over as rapidly as we can equip them." Men and women who were doing war work in Washington and in New York during the oppressive heat of August and September, 1918, will appreciate in part the intense strain under which all branches of the Government were laboring. While the Xew York Bureau was stru^ling with the problem of equipment, the Chief Surgeon of the American Expedition- ary Forces notified the American Red Cross Commission in Paris that the Xurses' Equipment Shop there would probably be called upon during the early autumn to replenish at cost worn- out articles of clothing for ten thousand nurses and to furnish extraordinary equipment for nurses assigned to the zone of advance, especially those of forty mobile hospitals. The early base hospital units assigned to the British forces had sailed before the American Red Cross made its generous appropriation for equipping nurses. The London Chapter had sent them gray uniforms, aprons, boots, rain hats, rubber sheets, woolen knickerbockers and other necessities. Great need ex- isted, however, in France for some central agency through which inequalities in the initial supply of and replenishment of worn- out articles could be adjusted. Through the efforts of ^fartha ]\L Russell, first chief nurse of the American Red (^ross Commission to France, more ade- quate winter clothing and shoes had been forwarded to nurses in bases of the British and American forces during that first bleak winter of active service. But the Red Cross had never undertaken to relniuip nurses free of charge, nor was it then doing so. In a letter written Xovember IG, 1917, to !^[iss Russell, Aliss Xoyes stated _tliat the Red Cross "could hardly undertake the replacement of worn-out articles in any wholesale way. As nurses are on a salary," she pointed out, "there would seem to be no reason why they should not provide such ad- ditionnl articles as are required in the same way that they would do were thev in this countrv," 380 HISTORY OF AMERICAN RED CROSS NURSING An interesting comment on the equipment question was con- tained in a letter written June 13, 1918, by Miss Russell to Miss Delano: The equipment now given the nurses is generous and suit- able. I think there is some feeling among the nurses that they should be clothed all the time that they are in the service and 1 think that Major Perkins tliought 1 was a stingy person because I stood by the statement we had when I first went to France, that the Ked Cross furnished initial equipment and then the imrse attended to her own needs afterwards. I believe that there is a certain pauperizing effect in giving equipment. The British give each nurse a sum of money and require her to present herself with the regulation outfit for inspection. Now our way results in greater uniformity, but I have heard so much complaint that 1 would like to see each nurse made to feel more personal responsibility about her equipment. As to salaries, in the general emotional upset due to war conditions, it is highly difficult to adjust money matters. The service the nurses can render is priceless; yet 1 believe that every one who goes into the service really believes in her heart, as one of them said to a man who asked her if she was to get a bigger salary than she had been receiving in civilian work : "It is my privilege to serve my country and the allowance is sufficient for all my needs." I really believe that the nurses' pay of sixty dollars a month and maintenance is not so great a reduction in income for tlie private duty nurse, if taken in the average, unless of course she is depending on "gifts" as too many do. For a school nurse there must be a decided advantage in the sixty dollars salary and live hundred francs maintenance. However, the nurses complain now and then to the men in Paris, men whose wealth makes them think the sixty dollars is barely enough for an evening's entertain- ment, and they pity the nurses and encourage them to ask for further gifts in the way of equipment. ... - If the licd Cross could make possible a systematic, intelli- gent development of esprit de corps in the American military nursing service, it would be a far greater gift to the nurses themselves and to the profession than any amount of fur trench coats and })ianos for recreation houses. . . . Early in the spring of 1918, the Red Cross Commission for France felt that the establishment of an equipment center in Paris where nurses could secure articles of clothing iind equip- ment to replenish worn-out ones at cost, or nearly cost, would RELATION OF NURSING SERVICE TO THE ARMY 381 be a ^'cat convenience. The War Department and National llea(]([uarters concurred in this opinion and a Nurses' Equip- ment Shop was developed and maintained at the Paris Head- quarters, under the cliief nurse of the American lied Cross in France. A report of these activities will be found in a sub- sequent chapter. Tiie iirst definite movement of the Government to furnish equipment for Army nurses was made in August, 1918. Gen- eral Pershing then cabled to the War Department, re(]uesting that forty-three thousand pairs of shoes, rubbers, raincoats, sununer underwear, norfolk jacket suits in regulation sizes, coats, hats, etc., should be sent to France at Government expense, a recpiest which argued towards the possibility that the Ameri- can Expeditionary Forces contemplated the establishment under their own direction of a department for the replenish- ment of nurses' equipment and uniforms. At the crisis of the nursing situation, when the War Depart- ment was calling for fifty thousand graduate and student nurses by July, 1919, Colonel Winford Smith, Medical Corps, took up again in a letter written November 6, 1918, to the General Manager of the American lied Cross, the old question as to whether the Ked Cross or the Army should pay for nurses' equipment : I am directed by the Surgeon General to acknowledge the receipt of a recent letter from the general manager of the Eed Cross, stating that inasmuch as the War Council of the Eed Cross understands that the Government is to provide for the equipment of nurses for overseas service, the Red Cross is preparing'- to disband its organization which has had this phase of work in hand. The Surgeon General has again requested that the Govern- ment equip the nurses, but at this writing we have no assur- ance that favorable action will be taken on this request. Inasmuch as we believe that it would seriously interfere with the recruiting ot" nurses who are so urgently needed, if the Ked Cross stops issuing equipment and the Government fails to j)rovide for it, it is hoped that until definite arrange- ments have been made by the Government, the Red Cross will feel like continuing its custom of equipping the nurses as heretofore. General Peyton C. ^Farch, Chief of Staff, issued on December IT, 191S, (Icneral Orders No. SC, as follows: 382 HISTORY OF AMERICAN RED CROSS NURSING In order to enable them immediately to comply with regu- lations requiring the wearing of uniforms, a single initial uniform outfit is hereby authorized for issue to members of the Army Nurse Corps upon their first entry into the service, as follows: One navy blue norfolk suit; one navy blue over- coat; one navy blue flannel waist; one navy blue velour hat for winter; one navy blue straw hat for summer; two sets insignia, United States ; two pairs insignia, badge of Corps. When members of the Army Nurse Corps are ordered to duty overseas with the American Expeditionary Forces, the following articles will be issued to them : six gray cotton uni- forms ; one gray woolen sweater ; one gray woolen muffler ; one raincoat ; one blanket for use on transport ; one sleeping bag ; one steamer trunk. 2. Nurses who have been enrolled for service during the existing emergency and who have not been supplied with uniform outfits by the American Eed Cross without cost to themselves, will be entitled to the issue herein authorized. The Quartermaster General will supply the necessary articles of uniform for issue and sale at cost price, when issue is not authorized. The details of material, make and design will conform to the specifications prescribed by the Surgeon Gen- eral and no change therein will be made without his authority. By order of the Secretary of War. The American Red Cross at its New York Bureau Nurses' Equipment equipped between April 7, 1917, and December 31, 1918, the following personnel for overseas duty: Army 10,519 Nurses at an average of $180 each $1,893,420.00 266 Civilian employees at an average of $180 each 47,880.00 134 Dietitians at an average of $180 each. . 24,120.00 365 Eeconstruction aides, at an average of $180 each 65,700.00 $2,031,120.00 Na\'y 3<* 334 Nurses at $180 each $60,120.00 "These figures are inclii(l>cl here lo give an idea of the proportion of service rendered by the Red Cross to the Army in comparison to tliat given to the Navy and to Red Cross foreign commissions, also to give in one table a complete summary of the activities of the Bureau of Nurses' Equipment. RELATION OF NURSING SERVICE TO THE ARMY 383 Red Choss (Foreign Activities) 573 Nurses at $180 each $103,140.00 351 Nurses' aides at $100 each 35,100.00 4 Dietitians at $180 each 720.00 $2,230,200.00 " Of the equipment, Miss Noyes wrote in her request to the War Council for an appropriation to cover these expenditures: A maximum amount allowed for equipment was $200 per individual, but only in a few instances was this amount given, while in many other instances it fell below the $180. The average cost per nurse for the equipment was $180 each. The equipment for the nurses' aides was approximated at $100 each. Some of them were given entire equipment, others partial, while in a great many instances the equipment was provided by the nurses' aide. These figures do not include the equipment issued to the nurses in home service, which consisted of the cape; neither does it include the equipment issued to the nurses in the sanitary zones, as this is provided from a separate appropria- tion. The approximate amount of money spent for capes at the present time was $280,000.^^ The Red Cross appropriated more than three million dollars for equipment for nurses, nurses' aides and dietitians. The estimates which ]\Iiss Noyes gave above were based upon the ratio of $180.00 for each nurse. Equipment required for some nurses exceeded this amount and required the expenditure of $200, the maximum which the War Council allowed for an individual. Prices of materials and labor varied from time to time and these conditions caused equipment to exceed three million dollars.^" Clara D. Xoycs, Caroline Van Blarcom, Florence Johnson, Sophie Kiel, ^lary ^lagoun Brown and Claude G. Moody stand out prec'minently among the group of lied C^ross women whose interest and tireless effort made smooth the embarkation of those thousands of overseas workers. Sophie Kiel (St. Luke's Hospital, X. Y. City) was ^liss Van Blarcom's and ^liss Johnson's assistant in the Atlantic Division. Following her '' Sec Anu'rioan Red Cross War Council Kecjiu'st for Aiiprojjrialion No. 9!8, Fi'bniary 14, iniO. ^ "Tlu' Work of till' AiiR'rican Red Cross during tht- War," p. 33. 384 HISTORY OF AMERICAN RED CROSS NURSING return from Khoi, Persia, in 1916, she organized one of the Red Cross detachments for the Navy. Though her status con- tinued as that of a Navy chief nurse, the superintendent of the Navy Nurse Corps released her from active service to assist in the Atlantic Division until August 22, 1918, when she was assigned by Mrs. Higbee to the U. S. Army Transport George Washington. The attitude of mind which characterized the Red Cross executives and their assistants who handled the often vexatious details of equipment was described by Miss Brown, herself a member of Miss Johnson's staff. ''As I recall those busy days," she wrote, "one outstanding point remains freshly in my mem- ory. Miss Johnson and her associates drew so much vivid interest and enthusiasm from the new groups of nurses coming from all parts of the country, all fired by the same ideals of service, that they themselves seemed forever unmindful of personal fatigue and genuine labor and inconvenience." Mrs. Moody wrote, "Armistice Day found the Bureau of Equipment with an organization of thirty more than willing workers, a staff which knew no hours of service, its inspiration gained from that long line of nurses who, with never a thought of self, just marking time until their actual work overseas might begin, had come and gone before us." National Headquarters provided other comforts for the wel- fare of American nurses in Army service overseas and mention of them may be included in this chapter. The Minutes of the War Council, which record all appropriations made from the Red Cross coffers, briefly mention two other items. On ]\rarch 19, 1917, $77,500 was appropriated, "of which so much as may be necessary shall be expended for the purchase of 'safety suits' for the use of nurses and members of hospital staffs, with the understanding that should the War Department wish to reim- burse the Red Cross for these suits, it should be permitted to do so." ^^ The high seas were alive with U-boats. In addition to keeping a person afloat for an indefinite time, these particular safety suits afforded protection from exposure, "a cause of many of the deaths," stated this minute of the War Council, "follow- ing the sinking of ships." Before the declaration of war on Germany by the United States, the War Department had allowed forty cents per day for food for Army nurses and patients. This allowance could ^Minutes of the War Council, Vol. IIT, pages 787-789. RELATION OF NURSING SERVICE TO THE ARMY 385 not be changed without Congressional action. The Surgeon (ieneral accordingly asked the Ked Cross to assume the re- sponsibility of providing the ditlerence between the legal al- lowance and seventy-five cents, which was conceded to be a proper amount of subsistence. For a period of eleven months, these thirty-five pennies given daily for food for every Army nurse and every sick or wounded soldier in Europe amounted to well over $185,007. "('olonel Ireland," recorded the Minutes of the War Council for May 18, 1918, "stated that ample provision has now been made by the Government for the sick in hospitals and for the members of the Army Nurse Corps." The Red Cross furnished laundry allowance for nurses serving on the Mexican border, but did not make similar provision for nurses on duty during the European War in the cantonments or on foreign assignments because of the vast amount of clerical detail that would have been required. Whatever the American Red Cross did for the war nurse, were she of the Army or i^avy, the U. S. Public Health Service or the Red Cross, was given back indirectly in service by her to the American soldier. His comfort, often his very life, de- pended upon that gray-uniformed nurse who from time to time accommodated her own personality to the needs of her patients; she was sometimes cheerfully frivolous ; she was sometimes seemingly callous and unsympathetic ; she was sometimes the very reincarnation of that woman who sixty years ago walked, lamp in hand, among the wounded at Scutari. That nurses themselves were grateful for the gifts which American gen- erosity enabled the Red Cross to make them, is shown in this one letter chosen from among many of similar content: American Expeditionary Forces, France, September 27, 1918. Everywhere we look, everywhere we go. there arise evi- dences of your consideration and love. The wardrobes you gave us best manifest this. It is hard to determine which of the articles you chose arc the most useful and attractive. When we notice liow the peasant women eye us, we tliink it is our smart jackets and skirts, ^\'hen the weather gets cold and our ulsters fit snugly about our throats, we are sure we need these great coats more than anything else. Wlien it rains the next day, we exclaim. ''Mw wasn't it lucky for us that tlu> IJed Cross }ia\e us l)oo!:-. 386 HISTORY OF AMERICAN RED CROSS NURSING slickers and raincoats !" When we crawl into bed at night with hands and feet numb with cold, we bless you for giving us warm pajamas and sleeping bags. But when the gray morning comes all too soon, then our wool underwear cer- tainly feels best of all ! Many times when 1 have been lonely, heart-sick, soul-weary, the sight of my equipment and the thought of why it was given to me has brought me new courage, has made me into a better soldier. CHAPTER VII THE EUROPEAN WAB Cantonments of the New Armies EmharJcation With the A merican Expeditionary Forces in Great Britain With the American Expeditionary Forces in France The Zone of the Base, A. E. F. in France The American Red Cross Commission for France Nurses' Equipment Shop, Paris With the French Service de Sante Emergency Hospitaliza- tion, A. E. F. in France The Zone of the Advance, A. E. F. in France With the A, E. F. in Italy With the A. E. F. in North Russia THE United States entered the European War on April 6, 1917. Twenty days later the American Nurses' Associa- tion met for its Twentieth Annual Convention in Phila- delphia, with a record attendance. The Red Cross session was held on Monday evening, April 30, in the Academy of Music. Every one of the 3000 seats was filled and all available standing room occupied. In the red, white and blue of the Red Cross uniform, nurses sitting in the orchestra, the balcony and the galleries formed line upon line of color, splendidly vivid against the somber-hued furnishings of the auditorium. Their faces under the winged Red Cross cap were tense and expectant. Realization of the responsibilities soon to be placed upon them hushed the idle conversation which usually runs lightly through an audience before the program begins. On that night, the very air seemed charged with patriotic ardor. ]\[iss Noyes, Dr. Warren P. Wilson, of Columbia University, and Eliot Wadsworth, acting chairman of the Red Cross Central Committee, were the speakers of the evening, ^fiss Delano presided. Her introduction of Miss Xoycs was prefaced in part by the following words : It is eiglit years ago tbis month since T stood before tlie American Nurses' Association and begged of tbem to ratify tbe atliliation whlvh tlie l^ed Cross had offered to us and to 387 388 HISTORY OF AMERICAN RED CROSS NURSING pledge themselves to the organization of a J^ursing Service which I believed we should organize for the benefit of our country. At that time, so far as I know, all the nations of the earth were at peace. We began this work with no thought that within a comparatively short period, eight years, we should be called upon to meet the needs and service of the greatest and most horrible war that the world has ever known,^ After giving an outline of the development of war nursing, Miss Noyes voiced the responsibility confronting the American nursing profession: As I stand facing you to-night, sister nurses, under the shadow of war, we know not what we as nurses shall be called upon to do. We know, however, that our Eed Cross Nursing Service exists but for one purpose, the reserve of the Army and Xavy Nurse Corps in time of war. You may be called upon to give fully, to make great personal sacrifices, but we know you are prepared, we know that you are ready, we know that we can depend upon you to carry the spirit of Red Cross service, as well as its banner, wherever our Army and Navy may be sent, whether to the Pacific or Atlantic coasts, to the cantonments, to the frontiers of France or Eussia, or to far- distant Mesopotamia. It must be written upon the pages of history for all time that our Eed Cross nurses were prepared, that in this war our soldiers at least were not neglected and that they were properly nursed.^ Following an address by Dr. Wilson on Rural Nursing, Eliot Wadsworth, acting chairman of the Red Cross Central Com- mittee, spoke in part, as follows : In these days of alarm and excitement, when the whole country is thinking of war and when at every- cross-road and in every railroad train the people are debating as to the extent to which the country is prepared ... I have come here really to say a word of appreciation for what the nurses have done by their systematic organization, and what they will be called upon to do, n(jw that the need has arisen. The Rod Cross has enrolled for service more than 8000 nurses whose qualifica- tions are known, who have taken all the steps required by the Army Medical Corps to permit their immediate enlistment in ^23rd Annual Report, National League of Nursing Education, 1917, p. 223. ' Ibid. THE EUROPEAN WAR 389 this service. . . . And as a result, tlie Red Cross Nursing Service is ready at tliis hour, more ready than perhaps any branch, official or unollicial, of the United States.^ As Mr. Wadsworth concluded, the vast body of American women rose as one and pledged themselves "to give our best service to the nation wherev(!r called upon to render it, either in home or foreign field, in the daily routine of civil or military hospital, or in the equally great eii'ort to conserve, protect and strengthen the health and endurance of the civilian population, the men, women and children at home in our land." Even then, the call to the colors had sounded. Orders for the immediate mobilization of six Red Cross base hospitals for duty with the British Expeditionary Forces had been sent the day before, April 29, by the Surgeon General. One after the other, these and other Red Cross sanitary units were assigned to active foreign service, while at home the building of future American Armies, of which nurses were to form a vital part, began. History was swift in the making during that memorable spring and summer of 1017. Congress in special session passed the Selective Service Law on May 19 and the first registration on June 5 brought thousands of recruits to the cantonments of the new Armies. The building of sixteen camps for the Na- tional Guard and sixteen cantonments for the Xational Army had been authorized in ^fay; the last site for these temporary gray cities was secured on July 6. Accommodations were ready on September 4 for 4-30,000 men. This capacity was shortly increased to provide for the care of 770,000 men, an average capacity per cantonment of 48,000, l^ivisions of the Regular Army were trained both in camps and cantonments and at various Army posts. Training schools for the Artillery, Avia- tion, Engineer, Tank and Quartermaster Cor])s and for Chem- ical Warfare were established, with proving grounds and testing fields. Embarkation camps were built at Xew York and Xew- port Xews and afforded housing accommodations for more than 300,000 men.'' Each of the thirty-two camps and cantonments included as part of its organization the development and maintenance of a ^ \t)irrirnn Journal of \ursi(j. Vol. X\'IT. jip. l].");]-.")!. ScplcmluT. 1017. *"Tlu" War with Ccniiany. .V Statistical Sutntnary," T.conard P. Avres, (^)I()ncl. (u'lUTal StalT. V. R. Arniv, pp. 17-29. "Government Printing Olliee, Washington, 1). C, 1919. 390 HISTORY OF AMERICAN RED CROSS NURSING hospital of one thousand beds. The nurses of these hospitals were secured largely from Red Cross emergency detachments. In a letter written September 22, 1917, to all Local Committees on Red Cross Nursing Service, Miss Noyes stated that "we are being asked for many hundreds of nurses for cantonment duty. . . . Will you not 'round up' as many as possible for this work ? The physical examination of each nurse will, of course, have to be on file in this office before she can be assigned to duty, but it will not be necessary for her to complete immunity treat- ment." The Surgeon General also asked the Nursing Service to nominate chief nurses for several of the cantonment hospitals. Susan Hearle, Alice Beatle, of the Mercy Ship Relief Expedi- tion, Mary Roberts, Estelle Campbell and Sophia Rutley were appointed. ''Each chief nurse," wrote Miss Noyes in the Red Cross columns of the Journal of Nursing for November, 1917, "has been asked to organize groups of nurses as a nucleus for her personnel, but should she not be able to secure the required number by the time the cantonment hospital is ready for occu- pancy, it is expected to fill the deficit from emergency detach- ments." As rapidly as barracks could be erected in the cantonments, they were filled with recruits from the Selective Draft. Base hospital construction, including the erection of nurses' quarters, was deferred until after the barracks were completed. The need for medical and nursing service increased, however, with each new assignment of men to the cantonments. Immediately upon their arrival, the "rookies" were inoculated for various con- tagious diseases and many of them became ill. Others, long accustomed to more sedentary and luxurious habits of living and to food different from Army rations, were slow to become acclimated to the rigors of military life and so fell an easy prey to dipenso. Thus came about the acute need for nurses in the camps and cantonments, which Mites Noyes set forth in a letter written October 30 to all Local Committees on Red Cross Nurs- ing Service : We have just receivofl a definite call from the War Depart- ment for nearly TOO nurses for immediate cantonment service. Tlie National romniittee feels very strongly that this seri- ous need should be brought very forcibly to the attention of individual members of the Eed Cross Nursing Service. It is far from patriotic, far from the purpose of the Eed Cross to THE EUROPEAN WAR 391 have nurses continue to refuse home service where the need is urgent, in favor of foreign assignment, where the demand is not so great. Nurses whom the committees consider available for cantonments and who continue to refuse service should be reported at once to National Headquarters. The need is indeed pressing. There are from GOO to 800 desperately ill men in several of these hospitals, with an average of ten nurses on duty. Nurses themselves held back from volunteering for canton- ment service because they felt that foreign service would be more attractive, more interesting. In the January, 1918, issue of the American Journal of Nursing, Miss Palmer, the editor, soundly rated the nursing profession in an editorial bearing the title: *'Are we slackers f Appeals are being made constantly from Red Cross Head- quarters for the enrollment of nurses for home service. The situation is rendered difficult for the reason that nurses who are enrolled in base hospitals are being held back to some extent for foreign service, while many others are failing to respond because they are hoping for a chance to go abroad and desire to do tliat rather than volunteer for service in the can- tonments in their own country. The waiving of one of the requirements for enrollment in the Eed Cross, that of membership in the American Nurses' Association, will make large numbers of nurses eligible who have been debarred up to this time. We wish to call the attention of our readers again to Miss Delano's report in the last issue of the Journal, which showed that during tlie war period the age limit is abolished so that older women who are in vigorous health may be enrolled for liome service. It is going to be possible, also, for nurses from the smaller hospitals to be recognized under certain conditions. One reason given by nurses of all ages for not enrolling is that their families object to their serving. We want to say that if any woman is old enough to be out in the world sup- porting herself and perhaps helping iier family, she is old enougli to decide such questions for herself. Returns whicli are coming in from tlie survey of nursing resources being made tliroughout the country show that a comparatively small proportion of the registered nurses, in the twenty states that luive reported, are enrolled witli the Ked Cross. The percentages vary from one and three- fourths, which is the low<'st received, tliroui^h seven and eiuht. whit'h 302 HISTORY OF AMERICAN RED CROSS NURSING are the most common, to thirty-two and forty-one, the last being to the credit of the District of Columbia. Do not let it go down in history that when the young men of our country were called into service in defense of the democracy of the world, the nurses held back, because of financial reasons, or because they shrink from the hardships of war service. Among letters of sharp criticism which came to National Headquarters was one which had been written by a registered nurse fifty-eight years old. After roundly upbraiding younger nurses who refrained from offering their services, she asked for assignment in the Army Nurse Corps. In replying to her on February 28, 1918, Miss Delano gave the following reasons for the existing shortage of nurses: In the first place, camps were erected before the hospitals were built and I believe the hospitals took precedence over the nurses' quarters. Bringing hundreds of thousands of young men together in camp life made it possible for an epidemic of contagious diseases to develop, which came on in a great flood before adequate preparations had been made for their care. Jn some cases, quarters for nurses were not available. In other instances, there was temporary difficulty in securing an adequate number of nurses to meet an emergency. This was due to various causes, chief among them, T believe, being the fact that we had several hundred nurses mobilized and waiting for service. This fact was generally known throughout the country. It was, therefore, difficult to convince nurses at large of the extreme need when they knew that at the same time we had several hundred nurses mobilized at Ellis Island who were not called upon for cantonment duty. It was difli- cult to explain to nurses at large that these groups at Ellis Island might receive sailing orders at any moment. We have met all the demands of the Navy and the II. S. Public Health Service and, I believe, are meeting satisfac- torily today the needs of the Army. This is, I think, proven by the fact that we are enrolling over a thousand nurses a month and are sending large numbers into immediate service, both at home and overseas. I agree with you, however, that if we as a profession are to meet the obligations that this war has thrust upon us, the rank and file of the nursing profession must realize that noth- ing is more important than tlie care of our soldiers here in our own country. THE EUROPEAN WAR 393 After the adoption of the ruling that nurses should be "sent to cantonment hospitals in this country to determine their pro- fessional and physical fitness for overseas service," many nurses from the staffs of base hospital units were assigned to canton- ment duty. But the need for nurses in this branch of the service still continued. On May IG, 1918, Miss Thompson wrote iMiss Noyes that "in view of the fact that 550 'casuals' are to be rushed to Europe in addition to the base hospitals now awaiting trans- portation in New York, the ctmtonments will be in urgent need of nurses, I fear, in a short time. . . . Therefore, will you not do all within your power," she concluded, "to nominate as many nurses as possible for immediate duty? One thousand could be placed today without difficulty." Cantonment service was full of the hubbub, the change, the excitement of armies in the making. Emergencies made up the very fabric of the nurses' crowded days. Rachel Golzar, Re- serve Nurse, A. N. C, wrote from Camp McClellan, Anniston, Alabama : A few months ago, this region was a stretch of wilderness. The first division of men worked this place through to what it is at present. The hospital is perched on a hill-top and l)elow the hill are the drill grounds and tents. The camp ground occupies some seventeen thousand acres. The base hospital, extending over sixty-two acres, has at present thirty-two wards ; more are in process of construction. Surgical wards, a medical and dental department, X-ray room, nose, ear and throat section, eye clinic, contagious and tuberculosis divi- sions ; one ward for mental cases and one ward for sick officers, comprise our line-up. Each ward is a barracks by itself. We have now between six hundred and seven hundred patients and a wide variety of cases, perhaps more than in any large hospital of a city. When we seven arrived, we found ourselves the first group of nurses that ever trotted these grounds. We were not ex- pected so soon nor was anything ready for us. No department store in New ^'ork, liowever. delivered things more ra])idly than the (Quartermaster Cor])s brought us beds, furnisldn^s and other comforts. In our wooden barracks, acrid with tlu^ pungent odor of raw pine, our rooms already have (h'essers and little rugs. Small rockers, shades and scrim curtains have arrived. We expect our own cook and two maids later to attend to the nurses' home. 394 HISTORY OF AMERICAN RED CROSS NURSING The American Journal of Nursing published in May, 1918, a special Military Number, which was made up of articles which had been written by nurses in various types of war nursing and which described their personal experiences. As Miss Delano took a large part in securing these articles, extracts from them are quoted as primary sources in this history. Of the cantonment near Boston, at Ayer, Massachusetts, Jane G. Mo Hoy (City and County Hospital, San Francisco) wrote: Camp Devens, named after General Dcvens of Civil War fame, is in the iSTortheast Division. Its development, spread over ten thousand acres, is a feat of engineering. Twenty miles of road were laid ; four hundred miles of electric wiring were done; sixty miles of heating pipes were connected, all in less time than is ordinarily taken to erect our municipal buildings. It is a small world that you must see for yourself. The hospital itself is a little town. Its corridors measure tliree and one-half miles. They are enclosed and each is named as are streets in a well laid out village, each ward numbered as are houses in a city block. Patients who filled the wards of cantonment base hospitals during 1917 and during the spring and summer of 1918 were generally medical and contagious and accident cases. Soldiers wounded in active service in France had not yet begun to come back to the United States. However, the jiurses who were assigned to cantonment duty worked very hard, especially dur- ing the epidemic of contagious diseases to which Miss Delano referred in the letter of February 28, 1918, -quoted above. The virulence of this epidemic and the need which it caused for expert nursing service was described by Eleanor Hall, Army Nurse Corps, in a letter written from Camp Taylor, Louisville, Kentucky : On April 1, 1918, I was assigned to day duty on "7C," a pneumonia ward. We seem to work in a treadmill here; we riish from morning till night and yet, in spite of all we can do, the boys get sicker and sicker and we have had several deaths. The other day we lost one, measles, bronchial pneumonia and meningitis. It seemed as if his head was filled with pus which oozed from his eyes, his ears, his nose and mouth. . . . When one gets measles here, it is serious, for the infection which causes measles also causes abscessed eyes, ears, throat infections, and then it goes to the lungs and w^e have pneu- THE EUROPEAN WAR 395 monia, bronchitis, erysipelas (there are four cases in the ward now) and pleurisy. Between the last day of health till the first day of "at the point of death" is sometimes only thirty- six or forty-eight hours. Ethel Haigitt (St. Michael's Hospital, Toronto, Canada), reserve nurse, wrote in the Military Number of the Journal of her work at Fort Riley, a Regular Army Post, near Junction City, Kansas: They were very busy on the wards, so we were asked to be ready for duty by nine o'clock. The large gray stone build- ings, which had been previously used as barracks, band quar- ters, prison, mess hall, etc., were fast being cleaned, painted and remodeled ; also a very good plumbing system was being put in. As we walked along Cavalry Drive with the chief nurse, she requested us to wait for her while she took one of our number into one of these buildings known as sections, where she assigned her to duty. So we passed on until it came my turn and 1 was ushered into a section marked "C," "Isolation," ".Measles." Here I found two nurses and a head nurse, but the one whose place I was taking was to go on night duty. This section, though full of patients, probably 140, had only had nurses there for about two weeks ; there were none to put there before. Here, as in other sections, the carpenters and plumbers were at work. As you may judge, we were very short of nurses through all the Fort. We decided to put all the sickest patients and those requiring the most treatment in one large ward, thereby saving time and steps. We found the ward masters and corpsmen invaluable helpers, many times willing to do things out of their province. During the first two weeks I must admit I was very tired and the bed looked good to me at night. We, the day staff, had only eight-hour duty; that usually meant four hours on and four hours olf. The night nurses worked twelve hours. When 1 had been in this section three weeks, the chief nurse informed me that she wished to open another building (by that she meant to place nurses in it) and wanted me to take charge of it. Being still short of nurses, she could give me only one, but promised more as soon as they could lie obtained. When I left, 1 had nine nurses for day and three for night duty. So you see she ke])t her promise. . . . Within a few weeks, th(> epldennc was checked and the pressure of work lightened j)roporti()nately in the cantonment 396 HISTORY OF AMERICAN RED CROSS NURSING hospitals. Then the nurses enjoyed an eight-hour day, which gave ample opportunity for rest and recreation. Jane Molloy wrote of the facilities for recreation at Camp Devens : Do not believe that a nurse is always "over-worked" in the Army. When she leaves the wards, she is completely and gloriously "off duty." This total freedom from all responsi- bility means an opportunity to relax and enjoy the interval between hours of duty, rarely possible in other vocations. Xor is there dearth of entertainment. Something is going on at all times. Though it is work for the company to drill, it is entertainment for the observer. I have yet to see a com- edy staged that can compare with the "Awkward Squad." Many of the best plays of the season have been produced at our camp theater. The Boston Symphony Company gave one of its fine concerts here during the winter ; and the movies are always to be seen. And above, around and behind all this, the great, stupen- dous work goes on the training of brawn and muscle, of mind and will. The Army changes no one; it simply proves what we are. In its professional phases, military nursing differed greatly from institutional or private duty nursing. In a letter written from Camp Taylor, Louisville, Kentucky, Eleanor Hall de- scribed these aspects: The nursing experience we get here is invaluable. We learn much in various lines which is not essential in private duty nursing but which is very necessary in Army service. The nurses have come from all types of schools, from all states and from all walks of life. They are thrown together here and must quickly accustom themselves to the Army discipline. Lengtli of service at a given post, and that alone, puts one nurse above anotlier. The head nurses for the wards are selected entirely from among the nurses who have been longest at Camp Taylor. In a ward, the head nurse rules, except that each nurse is free to do her work according to her training, provided, of course, that she does it correctly. When a ques- tion arises, however, the nurse who lias been on duty for the greatest length of time in the ward has the greatest amount of autliority. We must learn to accept this. . . . We must learn to close our eyes to many things which we would like to do, and stick instead to the essentials. We must refrain especially from doing anything or everything that the orderlies or the patients can do, because there is so much to THE EUROPEAN WAR 397 be (lone that a nurse alone can handle, such as hypodermics, medicines of a danrs and tlieir fiMcnds and families wlio gatlicrcd tlicrc was among the last things which tired nurses wanted to see after eight or t<'n hours on duty in the wards, ^'et these places and 398 HISTORY OF AMERICAN RED CROSS NURSING the rooms in the nurses' quarters, shared by others with nerves equally taut, were their only refuge until the Red Cross built special recreation houses for nurses. The following letter from a nurse at Camp J is quoted to show the need for these buildings: ... If we could in our hearts wish you such luck, we would wish you were here ; for our sakes, though, and not for yours. Miss , who has been in the service for about a year, is our chief. At first we hoped for some sort of home life. . , . Our quarters are built probably like those at every other cantonment. As you enter, there are small rooms on either side of the hall. Our chief nurse insists that there is no provision for a sitting room in these quarters for nurses, though the rooms are not yet all filled. I told her that I never would believe that anybody meant to set fifty nurses down in the woods without some place to receive a guest. Several people have called whom we could not invite in and several more have asked to call. It hurts my feelings to have to say "no." We have five hundred patients and work on the wards goes smoothly. When we get off duty, we go to bed to get warm and because there is no other place to go. The Army deplored the lack of recreation rooms and other facilities and in almost all cases later supplied attractively furnished living-rooms for the nurses, but in the interim the Red Cross recreation houses filled a great need. At a total cost of $245,000, the American Red Cross built these recreation houses for the exclusive use of the nurses in thirty-seven camps, cantonments and training centers. Though outwardly these structures resembled in their monotonous gray- ness an ordinary barrack, within there was quiet and comfort. Each had a large assembly room, bright with cretonne hangings ; at one end of it wicker chairs stood cozily about a deep-throated fire-place. In the rear of the building was a small kitchenette, in which the nurses might prepare afternoon tea for their friends. Nearby was a laundry. A balcony encircled the assem- bly room and afforded the nurses a sewing room and small alcoves where they might read, write letters or serve supper. There was a library and many of the books brought welcome relaxation to nurses wearied of bandages and the care of sick men. Encircling the military boundaries of the cantonments were areas in which the many types of people who follow an army. A Kocreation House built l)y tlio Amprioan Ecd Cross for tlie iiursinjr staff of the U. S. Army i5ase Hospital at Fort Mcllenry, Maryland. Xurst's' Mess. Camp Dt'vens, Massacluisetts. THE EUROPEAN WAR 399 gathered to ply their trades. The sanitary conditions prevailing in stalls where food and soft drinks were sold, in dance-halls, in shooting galleries, in motion-pictnre theaters and in houses where soldiers, eluding the sharp discipline by which the Army endeavored to check such practices, met immoral women, di- rectly affected the fighting strength of the new Armies. The United States Public Health Service, therefore, drew cordons of sanitary protection around the camps and cantonments, calling these outlying districts extra-cantonment zones, and, in cr)peration with the Army and with the Red Cross, assigned trained sanitarians and public health nurses to these areas to safeguard the health of the soldiers by bettering the general health conditions in these localities. While sanitary officers of the U. S. Public Health Service supervised the drainage of malaria-infested swamps and ditches, condemned the venders of dirty or tuberculous milk and rigidly ferreted out the carriers of communicable diseases, Red Cross public health nurses assisted in clinics, dispensaries and isola- tion hospitals, or "followed up" cases into homes surrounding the military areas. Varied and interesting indeed were the duties of nurses assigned to these health zones. A nurse wrote in the ]\Iilitary Is^umber of the Journal: Our district, covering a territory of five miles about a camp, consisted of the city of Spartanburg, South Carolina, of about twenty thousand inliabitants in normal times, but now of at least double that number. Tn the numerous cotton-mill vil- lages outside the city, the population comprises about twenty- five hundred. There were a few farms with small groups of negro laborers and tenants. Our unit was part of the U. S. Pul)lic Health Service. The director and the larger part of the unit was U. S. Public Healtli Service personnel, but we know no difference save that of the uniforms. We had a car for the use of tlie nurses. Tlie city had a board of health, a full time director of health and one public health nurse who acted as quarantine officer and clerk : slie investigated cases of illness and gave instructive care. There was no county health officer, no free hospital beds or clinic facilities. A local ])hysician made charity calls on a fee basis. There were good scliools with an enrollment of about four thousand children. Xo systematic medical inspection of schools was beinfj done, b\it volunteer inspection had been made. Xo follow-up work had been undertaken. 400 HISTORY OF AMERICAN RED CROSS NURSING During the second week after the arrival of this unit, several cases of typhoid fever were reported in nearby cotton villages. The Red Cross public health nurses immediately visited the cases and gave instructive care. The sanitarians investigated the water and milk supply. The water came largely from shallow wells, all of which were found to be contaminated, some to the extent of ninety-eight per cent bacillus coli. The director of the unit immediately closed the most dangerous wells and initiated other forms of health protection,, with such success that neighboring villages also having typhoid cases, asked for similar service. How effective the unit was is shown in the nurse's short state- ment of accomplishment : Before we had been in the field two months, we had as our nursing staff the supervising nurse and assistant, paid by the Eed Cross; a school nurse, paid by the U. S. Public Health Service; and the city health department nurse. This co- ordinated all the nursing service in this zone. We organized a council of social agencies and had regular monthly meet- ings. jMary E. Lent, supervising nurse for the V. S. Public Health Service, suggested rules which were approved by our medical director. Often the work was of the most primitive type. Mary Pritchard (Poli-clinic, Chicago) wrote in the Military i^umber of the Journal, the following account of her work in the canton- ment zone at Charlotte, ^NTorth Carolina : When I came here on short notice six months ago, I had visions of doing general visiting nursing. Upon arrival they informed me that I was to do tuberculosis work. The one visiting nurse in town, who was supported by the churches, gave care to l)edridden cases when she had time. An indus- trial nurse looked after insured cases. I had to cover a city of fifty-five thousand inhabitants, besides the mill villages. We often walked ten and twelve blocks at a stretch to make a call. Outside the lieart of the city some of the districts do not know what a sidewalk or a bit of pavement is; the soil is red, sticky clay. Snow, rain and mud makes you stick and slip and sink over your rubbers, ford creeks, climb up embank- ments and hurdle ditches. The population included mill-hands, foreign and native, white and colored. ^liss Pritchard's report continued: THE EUROPEAN WAR 401 The colored districts have small separate houses or cabins, usually old and dilapidated. About half of these have no sewer connections and those which have are very poorly equipped with the outside flush toilets, so often out of order. Tiie only means of lieating in most cases is the old-time fire- place. . . . When a nurse wants hot water, all she has to do is to set a pan of water into the fireplace. The mill houses usually have four or five rooms; they are better constructed and kept up than the houses built to rent, but are terribly cold in winter. Only one of the eleven mill villages has sewer connections. Two mills have put in aseptic tanks for the outside toilets; the others will be compelled to do so this sjjring on account of the camp being here. We have the problem of the lodger, both male and female, in the mill homes as well as among the colored people. ]\riss Pritchard described some of the difficulties under which the unit set to work : I first called upon the local physicians. Three had their office girls inquire very carefully if I were soliciting funds for the Ked Cross before they would consent to see me. Most of them thought that there was a great deal of tuber- culosis here which was only being reached by the physicians after the liopeful stage was past. The state sanatorium had such a long waiting list that such patients as would consent to go so far away from home usually died before there was a bed for them. As tlicre was no system of follow-up work, home care had ])r()ven very unsatisfiK'tory. Tbe colored physicians were deeply interested, speaking especially of the problem of house infection. One tuberculous family would move out and a healtby one move in only to become infected, and this process would he repeated over and over. Susceptibility, ])oor living conditions and the fact that ])atients were so loath to admit that they had the disease, as it kept them from getting emjdoynient, made their work most discouraging. A young negro man came to the dis])ensary about three weeks ago. referre(| hv bis doctor for a diagnosis. He ))r(,)ved to be an dpen case of tuberculosis and seemed intelligent and cociperat i\e. I tuld his motlier what his trouhle was and made quite satist'actDry sleejjing arrangi'inents for him. On my next visit, the oh! hidy int'ornied me that she never heard of such foolishness and she was going to take iicv hnhy (who is twenty-six) and mo\e away frc)m here; he nuly had a cold and I *"n(>edn"t tei- come interroiratin" round dar any morel" 402 HISTORY OF AMERICAN RED CROSS NURSING Contact between carriers of communicable diseases and the soldiers in nearby cantonments was often direct. Miss Pritchard wrote : This work, done primarily to protect the troops, has brought out some interesting facts. Two colored women came to the dispensary, one an old lady going blind and the other with a cough of long standing. One was found to be syphilitic and the other an open case of tuberculosis. Both had been doing soldiers' washing. In another squalid home I found the mother of two tuberculous children ironing the soldiers" clothes and putting them on a filthy bed. I was also assigned to the venereal clinic, maintained by the U. S. Public Health Service. Two physicians of this service are in attendance. A nurse, formerly connected with the medical social service department of a large city hospital, was assigned by the Eed Cross to do dispensary and "follow- up" work. A male nurse assists in the clinic. It is estimated that forty per cent of the colored people, who comprise one- third of the population here, have venereal infection ; the per- centage is almost equally high among the whites. Emily C. Snively (W. C. A. Hospital, now Jennie Edmonson ^lemorial Hospital, Council Blnfls, Iowa), supervising nurse of the Red Cross Sanitary Unit No. 5, wrote in the Military Number of the Journal: When necessity demands, as it did in our extra-cantonment zone when a typhoid epidemic was raging, the U. S. Public Health Service or the American Red Cross sends a laljoratory car all equipped to take care of all bacteriological work until the local laboratory can be established. The laboratory test is the only positive proof of diphtheria. . . . The taking of throat aiul nose cultures by the nurse is a very important part of her work, both in diphtheria and meningitis. The actual k'lowledge that is obtained in regard to milk is invaluable. Samples of milk are collected regularly from the local dairymen while on their routes and systematic examination is made in the laboratory to determine the chemi- cal and bacteriological contents and value for infant feeding. Examiiuitioji is also made to detect any adulteration, ])rescrva- tives or coloring matter, which are so detrimental to the health and life of innocent babies. ... It did not take long to convict a man for adding formaldehyde to his milk, when the baby of the chief of police was ill from tliat cause. May the day be hastened when those who are in ])ower will l)e as THE ELliOPEAN WAR 403 interested in protecting the babies of the unknown mother and father as they are their own ! The analysis of specimens in the laboratory car, which led to the diagnosis of venereal disease, was one of the most im- portant phases of extra-cantonmeut zone work of this type. Miss 8nively wrote : In the sanitary zone, liquor, vice and disease are tlie three foes which are fought. The liquor prol)lem is handled by the police, but vice by both police and health departments. Any prostitute can be taken by the police to the health officer . . . and in a very short time it is known positively whether that girl is diseased. If |the reaction is| negative, she is released; if positive, she is put away so as to safeguard the soldier. The farm adjoins our city, so the deputy state health officer . . . defines tlie farm as tlie place of isolation. Medical treatment is given and no one is released until three smears are taken which prove negative. A splendid woman is superintendent of this farm ami these girls are surrounded with such good wholesome environment that many have more home life than they have had for years. When the War Council of the American Red Cross went out of office in Februarv, li)10, its chairman published a report giving in statistical form the finances and accomplishments of the society during the period when it was operated by this body, May 10, 1!)17 to hVbruary 28, 1 !)!!). This report' states that Ived Cross public health nurses assigned to sanitary zones paid a total of I34;5,943 nursing visits. The number of new patients visited were 53,G18; the nursing visits were 90,602; the instructive visits were 104,818 ; the school visits were 21,094 and the "follow-up'' visits were 73,811. In the field of school medical inspection, inspection work was done in 562 schools; 229,0.30 children were examined ; 81,983 children were found to be defective and 4389 corrections were reported to have been made. Public health nurses in extra-cantonment zones rendered yeoman service in the pandemic of Spanish influenza which swept the country during the autumn and winter of 1918-1919. Kupert I)hu\ tluui Surgeon (lencral of the U. S. Public Health Service, cited several h(>roic examples: At Muscle Shoals Sanitary Distriit, on the night of Octo- ber '2. a \1(h\ Cross public health nnrse, assisted by two en- 404 HISTORY OF AMERICAN RED CROSS NURSING listed men, received and cared for one hundred and thirty-nine patients, among whom there was only one death in three days. In another instance a ])ublic health nurse worked for twenty- eight hours, though herself ill, and after five hours' sleep returned to duty. In still another instance, a public health nurse was on duty forty-eight hours with only two hours' sleep. This same nurse paid nine hundred visits in Florence, Alabama, in the period of one week. Within military bounds, the situation was equally desperate. Conditions at Camp Dodge, as reported by the Ked Cross Field Director, Department of Military lielief, were typical of other cantonments. On September 2!J, the total number of patients in the base hospital was 1204-, with 245 nurses on duty. On October 10, there were 7868 patients, with seven deaths and 442 nurses on duty. Six days later ,5000 patients had been admitted, 50 had died and 595 nurses were on duty. An increase of one hundred and fifty per cent in the cantonment nursing staff was sigiiificant of the great activity on the part of the Red Cross in securing nurses for such service at a time when the Army was also endeavoring through Ked Cross efi^ort to send overseas one thousand nurses a week. The nurses were mobilized for Camp Dodge through a nurses' registry in Des Moines and were brought out to the camp in vehicles of the Red Cross Motor Corps. They were housed in the nurses' dormitories and in the lied Cross recreation house. Many of these nurses had been sent from the Department of Nursing at lied Cross Central Division headquarters, Chicago. ]\liss Ahrens described the exodus: "At a few hours' notice, one thousand nurses, old ones, young ones, Ked Cross nurses and nurses not enrolled, nurses available for service later on and nurses who would lU'ver be eligible for permanent enrollment, packed their kits, Ix^arded the trains and proceeded like soldiers to the camps." The ofHcial suiiinuiry prepared by Colonel Leonard P. Ayres, chief of the Statistics Branch, General Stati', IL S. Army, stat(!d that "the hospital capacity in this country (112,220 beds) was exceeded only during the influenza epidemic, when it became necessary to take over barracks for hospital pur- poses."''' The fact th;it four deaths per thousand soldiers^ occurred each week in the United States during October and ="'Tli(' War with Gormanv," pp. 12!)-i:30. "Ihul., p. ]2(}. THE EUROPEAN WAR 405 November, 1918, shows t\w, vinilonce of the disease. This loss of life was, indeed, a tragic accompaniinejit of war. An interesting- experiment in the assignment of colored nurses to a military cantonment hospital was dcjveloped at Camp Sherman, Ohio, during the intluenza epidemic. The question of utilization of colored nurses had been the cause of prolonged discussion between the Surgeon General's office and the American Red Cross. At a meeting of the National Com- mittee on Red Cross Nursing Service, held in Continental Memorial Hall of the Daughters of the American Revohition on December 5, 1911, the following action was taken regard- ing the enrollment of colored nurses: Tlie question of the enrollment of colored nurses was dis- cussed at length and in the meantime a conference had been held with the Surgeon General in regard to the appointment of colored nurses as meml)ers of the Army Nurse Corps. Owing to the impossibility of securing proper quarters for them, it has never been the policy of the Surgeon General's office to consider the appointment of colored nurses. In view of this fact it was moved by ^Irs. Draper and seconded that for the present, at least, colored nurses should not be enrolled for service under the Red Cross. The motion was carried.'^ The ]\linutes of the National Committee on Red Cross Nurs- ing Service for a meeting held June 16, 1917, recorded a mo- tion made and carried which approved ''a plan for the utiliza- tion of colored nurses in connection with base hospitals, if such were organized for colored troops alone." This plan was modi- fied at the next meeting of the National Committee, held on June 20, 1917: The chairman stated : The next question is the assign- ment of colored nurses to duty. The understanding was that we should not open a general enrollment for colored nurses, but if the Surgeon (ieneral finds a way to use them (as seems possible in Iowa) we will enroll them for that special service, securing colored nurses as they may be needed, to go out in the uniform of the K'ed Cross nurse and to be given tlie Red Gross badge. It was not a general enrollment, but when enrolled tluy would ])e on the same footing ujjon assignment to duty as were other nurses. '^limitcs of Uu' Xatioiial Commit tee on Red Crows Nursing Service, Vol. 1, pj). 4.") 4". 406 HISTORY OF AMERICAN RED CROSS NURSING After some general discussion, the resolution in regard to colored nurses, offered at the meeting on June 16, was changed by the insertion of the words : "Wherever there is opportunity for assignment of colored nurses for duty, they be enrolled for that service and assigned to that duty." Motion carried. On December 18, 1017, Miss Delano asked Miss Thompson regarding the probability of the Surgeon General assigning colored nurses to duty. Miss Thompson replied the following day that there was no immediate prospect of calling upon them, but she stated that she thought it would be advisable to enroll them "wath the understanding, however, that their assign- ment is an uncertain proposition." During the influenza epidemic, the base hospital at Camp Sherman, Ohio, asked the Local Red. Cross Chapter on Octo- ber 10 to supply it with additional nurses. Among those re- sponding to the call was a registered colored nurse whose serv- ices were refused. Catherine L, Leary, then chief nurse at Camp Sherman, wrote Xovcmber 21, 1918, to Miss Thompson, giving the reason for this refusal : The evening this colored nurse arrived at Camp Sherman for duty, the response to the appeal through the Red Cross had been acted upon so quickly that we had many nurses at the time. I therefore had to refuse a numl}er that day, among whom was this attractive and intelligent young colored woman. She seemed much disappointed after having come all the way from Columbus. I offered her a bed for the night, which she accepted and later refused, deciding to return to Columbus as her services were not needed. I felt very sorry that she should have to go away disappointed, so I paid her fare to and from Cohinibus to the camp, telling her that wlien our quar- ters for colored nurses were ready, we would be glad to have her when we needed her services. An emergency dotachmcnt consisting of nine colored nurses from Frei^dman's Hospital, Washing-ton, D. C, and of one mirse from Battle Crock, ^Fichigan, was assigned during the early part of December to Camp Sherman. Aileen B. Cole, reserve nurse, wrote December 3 of their reception: We first interviewed tlie cliief nurse, who received us very cordiallv. We then visited the colored hostess house. Dr. THE EUROPEAN WAR 407 Amanda Gray, of Wasliinjjton, who is chief hostess there, introduced us to the f^uests. We also attended the colored Y. M. C. A. services that evening and it warmed our hearts to see how thoroughly glad those hoys were to have us with them and to hear them choer ! We are accepting conditions exactly as we find them. We have met with individual prejudice, hut, generally speaking, every one so far has hcen exceedingly kind. Clara A. Rollins, reserve nurse, described their quarters: Each nurse has her own room and everything to make her feel at home. Our living room is to have a piano, Victrola, desks, chairs and many other comforts to break the monotony of camp life. The work is very interesting. Our boys are in the same wards with the white soldiers. Members of our unit have been assigned to the accident and wounded from overseas ward ; surgical, ear, nose and throat ward ; the psychiatric ; the observation and contagious wards; and medical wards of various types. Miss Ball is the only masseuse in the hospital and they were very glad indeed to have her. ^larv ^r. Roberts, chief nurse of Camp Sherman at the time when the detachment of colored nurses was ordered there, wrote : Clara A. Eollins T hope I shall never forget, because of her splendidly cooperative sj)irit shown throughout her service at Sherman. No matter what ])roblem arose in regard to the colored group, 1 could always depend on Miss Eollins to think the matter through with me and to coo])erate with any solution I might have to offer. She was so well loved by the boys in a surgical ward that I never changed her from her first position. I recall one amusing instance which occurred when a change of personnel in the ward seemed logical and imminent. A request, signed by every man in the ward, was sent to my office begging that ^liss liollins l)o not taken from them. The boys always called her "the Major"" and the day before she left camp they bad a special corcniony and made her a "Lieu- tenant Colonel."' As I recall that group of patients, there were very few colored men in it. Of tlio living conditions and social life of the colored nurses, !Miss Roberts wrote : 408 HISTORY OF AMERICAN RED CROSS NURSING They had their own quarters with its dining room and kitchen. We very early made connection with the colored "Y" in camp and such other arrangements as we could for a reasonably normal social life. After their conference with me, they agreed that they would not expect to share in the social activities of the white nurses. It was to be understood that they were most welcome at all the "program" affairs. We were careful to reserve the Ked Cross recreation hut for their use occasionally, as we reserved it for other groups for special occasions such as parties given by the aides, the students or the graduate nurses. Of the value of the work rendered by the unit as a whole, Miss Roberts wrote : I do not mind saying that I was quite sure, when orders came for the colored group, that I was about to meet my Waterloo. ]\ry feeling now is that it was a valuable experience for them and for me. They really were a credit to their race, for they did valuable service for our patients and it was a service that the patients appreciated. I now find myself deeply interested in the problems of all colored nurses and believe in giving them such opportunities as they can grasp for advancement. . . , The War Department reported that the services of seven members of this detachment of colored nurses were satisfac- tory in every respect. Two were recorded as "Grade 2." This was highly creditable in view of the fact that the detachment was the first one of colored nurses in the service. A second detachment of colored nurses was organized and assigned early in December, 1918, to service at Camp Grant. Of tliis group, Anne Williamson, then chief nurse of Camp Grant, wrote: In the latter part of the year, 1918. our commanding officer. Colonel Tl. C. ]\Iichie, received definite information that we were to have a contingent of colored nurses at Camp Grant. Action to construct quarters for their accommodation was immediately taken and ])y the time that nurses arrived their home of about twenty rooms was in readiness. A colored cook and a maid were assigned to this group. One nurse was appointed housekeeper, ordered supplies, planned the meals and under the direction of the chief nurse conducted the household affairs. THE EUROPEAN WAR 409 The first nurse reported for duty December 3, 1918, and within a few days about thirteen nurses had arrived. Several of the nurses were from the Lincohi Hospital, Xew York City, one from the Freedman's Hospital, Washington, D. C, and several from Providence Hospital, Chicago. Since the white and colored patients were not assigned to separate wards, these nurses were assigned to the general wards under the direction of the head nurse. They were serious-minded, quiet, business-like young women, well quali- fied to take cliarge of wards, had our colored patients been segregated. For a time, colored troops were stationed at Camp (^.rant and the nurses liad opportunity for quite a bit of social life. They gave several dinners and dances, entertain- ing the officers from the troops mentioned. I believe that one nurse subsequently married an officer whom she had met at the camp. Colored nurses served with distinction during the influenza epidemic at Camp Sevier, South Carolina. Sajres L. Milli- ken, who was at the time chief nurse at Camp Sevier, wrote: At the peak of the influenza epidemic at Camp Sevier, South Carolina, about fifty per cent of the nurses were ofi: duty, sick, and the hospital contained about 3000 patients. It became necessary to employ locally every nurse who could be secured. A medical officer on duty at Camp Sevier who was from that section of the country said that there were several good colored nurses who could be secured in the vicin- ity of S{)artaiiburg, South Carolina. The idea of securing the services of colored nurses did not immediately meet with enthusiasm, as fully seventy-five per cent of the nurses were women of Southern birth and had very positive objections to working with colored nurses. The need was so imperative that it was decided to employ them, furnishing tliem quarters and a mess separate from the white nurses. About twelve reported for duty. They were assigned to the wards in the hospital in subordinate positions and with the exception of one or two who were not young enough to ada})t themselves to the trying conditions under wliich every one was working, these young women were found to be well-trained, quiet and dignified, and there was never at any time evidence of friction l)etween the white and colored nurses. They serv(Ml for a period of possibly three weeks. ... I should say tliat, although these nurses had no opjiortunity to display e\e(uti\e al)ility, they did and can fill a valuable ])lace in the nursing profession. 410 HISTORY OF AMERICAN RED CROSS NURSING Four types of assignment characterized war nursing service in the United States. At the base of the military pyramid were the barrack wards of the cantonments where the recruits of the Selective Draft were trained. The National Guard did not need so thorough a schooling, military theorists argued, and it was housed under canvas. Sometimes a nurse found herself in the shining tiled corridors of Walter Reed or Letter- man U. S. Army General Base Hospitals, permanent estab- lishments of the Reg-ular Army. Fortunate indeed was the nurse whose orders took her to an embarkation encampment ! Stella Godard, reserve nurse, wrote in August, 1918, from Camp Stuart, Newport News, Virgina: After the preliminary business of arrival and reporting my- self to the chief nurse, I was taken over to a long barrack-like building and found a bed allotted to me in a dormitory with about fifty other nurses. I must admit that this, for a first impression, was rather daunting. The place was littered from end to end with clothes, trunks and grips. Even the beds themselves were occupied, some by night nurses trying to sleep, others by day nurses, reading, writing, sewing and resting. I could see no possibility of the faintest trace of privacy for the undressing and the dressing hour. Neither was there any and later I learned there was no water for any purpose nearer than the main building. We had rough wooden shelves to put our things on and a few nails on which to hang our clothes. To get a bath we had to walk outside to the main building, two blocks away. At all times of the day, nurses were to be met a la negligee passing to and from their ablutions. When it stormed, the rain leaked down upon us from the roof; when it blew, the sand whirled in and ahnost buried us, and the flies were a veritable plague. But all this was, I am glad to say, only temporary dis- comfort, for now we have very nice quarters, all brand new and clean. I often look back and laugh to think of my chagrin and realize that it was not so bad as it seemed after all. Here in Haiupton Koads were the shifting sights and sounds of maritime traffic. ]\[iss Godard wrote: The hospital wards are built facing the fine water front. Both day and ni^ht its ever-changing beauty refreshes and charms one. During the day. we see the ships that come and go to and from tho busy ])orts around here. Transports, THE EUROPEAN WAR 411 battleships, coaling vessels and innumeral)le other craft lie at Hampton Roads, a groat air of indomitable purpose and mys- tery surrounding them. Then when night falls, stillness comes over the water and the long road of silver light made by the moon shimmers up to meet the stars. Then, too, there are the little birds that live in the reeds and long grasses by the water's edge, that all night long make weird, restless little noises, neither a song nor a call, but a sound that fills one with inexplicable longings. The romance of war, now^ doubly potent because of the ne- cessity for absolute secrecy, enveloped the constant movement of the troops. Miss Godard wrote: The troops are continually entering and leaving. For a few days the camp will be crowded with men busy about their drills, parades, exercises, a continually moving mass. Several times I have come off night duty to see a regiment leaving in the early morning. The colonel addressed his men in a few brief words, poignant with pride, hope and high courage. The emotion which he would have hidden was evi- dent only in tlie deep vibration of his voice. He saluted his men, his officers, then stepped up to the head of his regiment. The band struck up, the order rang out and they all swung forward with brisk tread, enthusiasm like a glory shining from their faces. When you stepped out on the front porch that morning, you would find the long rows of barracks, the water front and the camp streets empty, deserted and silent, a deathly and haunt- ing stillness over all, where only a few hours before there had been movement and laughter, song and banter, the playing of bands and the shrill call of bugles. From two hundred to two thousand men had been literally spirited away during the night on to the transports and it will be many a long day before the tramp, tramp of their marching feet will be heard upon this camping ground again. By noon, however the vacated barracks and parade grounds would be filled again. At the main gate new regiments would come marching in, fine l)odies of men, neat and trim, their overseas caps set smartly on the sides of their heads. Follow- ing them would come carts, wagons, trucks laden with para- phernalia for liorses and men, magnificent and inspiring, soldiers and equipment alike the best America has to offer. Twelve thousand, seven hundred and ninety-three members of the Army Xurse Corps, rc^gulars and reserves, scrvt^l in 412 HISTORY OF AMERICAN RED CROSS NURSING military cantonment and camp hospitals in the United States dnring the European War. A certain amount of gossip was whispered about regarding the discomforts, the unreasoning discipline, the overwork, the monotony and the loneliness of this branch of the service. In sharp contrast to the few nurses who complained bitterly yet humanly of their assign- ment to cantonment duty, there were many who looked behind the surface annoyances and inconveniences of camp life, the tedium of nursing accident cases and minor ailments and the lack of consideration on the part of some of their superior officers and saw the real meaning of cantonment duty, sensed its tremendously vital part in the war plan and accepted their assignment like the good soldiers that they were. This sports- manlike and altruistic spirit was well expressed in the follow- ing letter written by a reserve nurse: U. S. Army Base Hospital, Camp , May 25, 1918. And so the summons came and I answered. I am one of the one hundred and forty-eight nurses at Camp , an atom. For as I write, there march before me sixty thousand fighting men, undaunted, ready and supreme. Here we stand togetlier, one hundred and forty-eight nurses and sixty thou- sand of the youth of America. The number on my Red Cross pin is . In October, 1916, happy in safe aml)itions, in a gay loyalty to an idea which sprouts in cadets' training, I enrolled in the American Eed Cross. 1 still have a circular letter, dated March 18, 1918. It is an appeal, almost a prayer to sixty-five thousand regis- tered nurses of our nation. It asked for volunteers. And today there are one hundred and forty-eight nurses to sixty thousand men in Camp trying to accomplish the work of twice their number and more. Tomorrow they Journey on ilie great adventure and their footsteps nuist be followed by otlier women to wlioni the war means more than knitting socks and sweaters and using wlu^it substitutes. It seems to me tliat tiiis titanic militarv struggle lias be- come a test for our profession; a test of its faith in sacrifice; a test of woman's willingness and ability to share hardship; a test of woman's right to be heard in the councils which shall create new ideals from this holocaust of war. THE EUROPEAN WAR 413 From hospitals and from private homes, from camps and from cantonments, American nurses on their eager way to for- eign service went to New York and to lloboken, the embarka- tion port for tlie American Expeditionary Forces. From tliere they sailed when transportation could be secured. The attitude of the embarking nurses offered an interesting psychological demonstration of the value and eilect of dis- ciplined training. Nurses are taught to suppress their per- sonal reactions and emotions. They are primarily ministers to others in time of crisis and suffering and it is not for them to show feelings of fear, of hysterical sympathy, even of joy, when they are working in a professional capacity. This prin- ciple of nursing ethics is well illustrated by an incident which occurred during a recent disaster. The mutilated bodies of the dead were lying in an improvised morgue, awaiting identi- fication, and relatives were passing down the lino. A number of Red Cross nurses were on duty. As an attendant lifted tlic sheet which covered a body, one of the younger nurses grew dizzy at the sight. She turned to the nurse in charge and said, "I am going to faint." The older woman leaned toward her and whispered sharply: "Don't you dare! Other people have a right to faint. You haven't." The young nurse bowed her head for a moment, pulled her- self quickly together and went on with her work. This professional poise, which is attained only through dis- cipline and experience, is the first prere(iuisitc of the good nurse. Under it, however, must lie a fountain-spring of sym- pathy and altruism, without which no woman could stand the sights and render the services expected of nurses. War touched these emotions and stirred them deeply, but the dis- cipline of training led nurses to cover their real feelings with a crust of cool unconccn-n. They accepted the details of embar- kation with a sdvoir fdire which some observers called "hard- boiled indifference." So the ten thousand nurses went down to New York, donned their uniforms and boarded the trans- ports with an anin/.ing (piietness impossible of achievement had not the nurses themselves willed, by forc(> of their training, to go (juietly. No mere orders of the War Department could have silenced ten thousand women and have made them go to France to nurse the wounded under the conditions prevailing in 111 IT, without even a ripple of public acclaim. 414 HISTORY OF AMERICAN RED CROSS NURSING Embarkation was a tedious, a bewildering and a somewhat disappointing experience for these nurses, so many of whom had cherished since girlhood the hope of nursing the wounded in war J for indeed the name of Florence Nightingale had led more women into schools of nursing than had the remunerative phases of the profession. During long hours of night duty in city hospital wards and later in isolated cantonment bases, nurses had lived in anticipation again and again the day when they should at last set out for war service. Stories of physical hardships and exhausting work, stories told by American nurses who had served on the Western Front during the early days of the war, rumors of submarine attacks and veiled sug- gestions which were circulated in 1917 of atrocities committed on nurses, did not help to dispel any natural apprehensions which these women might have felt when embarking upon a service as precarious as war nursing. For most of them the old life, the old sheltered life within hospital walls, ended once and for all time. The Great Adventure, long-anticipated, had begun, but like all experiences which have been lived many times in anticipation, the actual going-out, thougli pictur- esque enough in itself, was less colorful, less dramatic than had been their conception of it. The first contingents of the American Army to sail for Eu- rope in May, 1917, were the six American Ked Cross base hos- pitals which General Gorgas assigned to the British Expedi- tionary Forces. The embarkation of the first two units was so hurried that the nurses were not even allowed to wait in New York until the newly-adopted Red Cross outdoor uniforms could be completed. They sailed instead in civilian attire, having received only such articles of equipment as were then immediately available in Red Cross storerooms. United States Army Base Hospital No. 4 (Lakeside) which had had a trial mobilization in Fairmont Park, Philadelphia, in the fall of 1916, was remobilized in Cleveland, Ohio, thirty days after the United States declared war, for immediate serv- ice overseas. Grace Allison, chief nurse, described the sailing of the unit: Sixty-two nurses from various parts of the Ignited States assembled on ^lay (i with the general unit at Cleveland and entrained for an unknown destination. Arriving in New York, wc were quietly transferred to the Cunard liner, Orduna. Here ]\Iiss Xoyes distributed our capes, caps and THE EUROPEAN WAR 415 other equipment. Miss Xutting, Mrs. Helen Hartley Jenkins, Mrs. Draper, Mr. Samuel Mather, president of the Board of Directors of the Lakeside Hospital and many others hade us Godspeed hefore ropes were loosened May 8 and we moved down the harhor. United States Army Base Hospital No. 5, of Peter Bent Brigham, Boston, Massachusetts, sailed on May 11 without the serge dress, ulster and velour hat which had just been standardized as the outdoor uniform for reserve nurses of Red Cross base hospital units assigned to foreign service. The sixty-tive nurses of the Presbyterian Unit, U. S. Army Base Hospital No. 2, which embarked May 14, were uniformed and equipped by the American Red Cross. On May 19, three other units, U. S. Army Base Hospital No. 121 (Washington University Medical School, St. Louis), U. S. Army Base Hos- pital Xo. 10 (Pennsylvania Hospital, Philadelphia) and U. S. Array Base Hospital No. 12 (Xorthwestern University Medi- cal School, Chicago) also sailed with outdoor uniforms and more complete equipment. ]Miss Xoyes in the August issue, 1917, of the American Journal of Nursing described the spirit in which the nurses of these pioneer units accepted foreign service : It is an inspiring picture to see the nursing personnel of a base hos})ital ready to embark. The dignified uniform of dark blue cloth, the scarlet lining of the cape, the caduceus and the letters "V. S." on the collar, em])hasizing the close relationship to the ^fedical Corps of the Army, are significant and impressive. Complete understanding of the nature of the mission is expressed in their faces. There is no laughing or joking, yet there are no tears. Courage is written on each comitenajice and service wlierever required is their purpose. During ^lay, 1917, ^liss Xoyes made as many as three trips a week to Xcw York, going over at midnight to see a unit sail the following day, returning again at night to be ready for work the following morning on the lists of personnel of other units th(>n awaiting assignment. By these trips, ^liss Xoyes started th( practice, wliich was later carried on by ^liss John- son, of explaining to the nurses sailing for Kuropi^ their new relation to the Army or the Xavy and tlie Red Cross, and a little of tli(> types of service whicli they might meet and the 416 HISTORY OF AMERICAN RED CROSS NURSING responsibilities they might be expected to shoulder. She im- pressed upon them the fact that they were privileged, above all other women, to work in the closest and most appealing re- lationship with the American soldier, the relation of wounded man and nurse, and she urged them always to remember that their conduct would not only bring honor or discredit upon the American Red Cross and the American nursing profession but as well upon American womanhood. Early in Jvme, 1917, the Army established a mobilization center for nurses on Ellis Island. Edith Agnes Mury was chief nurse. A Californian by birth and parentage, Miss Mury was graduated from the Waldeck Hospital Training School in San Francisco. Following institutional work in western and Philippine hospitals, she served three years in the Navy Nurse Corps and was transferred July 18, 1916, to the Army Xurse Corps. Later she was appointed assistant su- perintendent of the Corps and served in the Surgeon General's office for some time. In June, 1917, while she was on duty on the Mexican border, orders came directing her ''to pro- ceed to IS^ew York and report on arrival there to the Command- ing General, Eastern Department, at Governors Island, for duty as chief nurse of a mobilization station for nurses to be established at Ellis Island, Xew York Harbor." Mina Kee- nan, a regular of the Army Xurse Corps, was also assigned to Ellis Island as Miss Mury's assistant. Three large buildings on Ellis Island, which had been used as hospitals by the Immigration Department, but which had been empty since 1914 owing to the decrease in immigration since the beginning of the war, were turned over to the Army Xurse Corps. "On the day of our arrival," wrote Miss Mury, "we were faced with these three huge, empty buildings and with a telegram stating that sixty-six nurses would arrive the next day. . . . Beds, bedding and a few accessories were brought by Quartermaster tugs from the Supply Depot in Xew Voik. Infautrvincii from Governors Island cleaned the wards aiul set up the furniture. When those sixty-six nurses arrived the next day, they had clean white hospital beds but little else. . . . For a while it seemed as if we were not to eat," ^liss Murv coiK-hidcd, "but the Immigration officials hospital)ly threw open their employees' dining room to us." Within a few weeks, ^liss Mury and !Miss Keenan had de- veloped a smoothly-running organization. .Miss Mury wrote: THE El ROPEAN WAR 417 With the help of a female civil service stenographer and men from the Hospital Corps, I handled the ollice work while Miss Kecnan managed the housekeeping and looked after the comfort of the nurses in tiieir respective quarters. Our accom- modations at first were only for two hundred and fifty nurses. Later we took over a fourth huilding and could then accom- modate five hundred nurses at one time. The wards were converted into dormitories. The heds were placed close together down the sides of each room. There were no clothes closets and the nurses lived practically in their small steamer trunks. Although they were so crowded, we heard remarkahly few complaints. The procedure by which nurses joined the Army Nurse Corps through the Red Cross Ileserve has already been de- scribed. After the nurses of a base hospital or other type of unit had received their travel-orders, they executed their oath of office at home and served an apprenticeship in the hospital of a camp or cantonment, then went to New York for foreign service. The first base hospitals, however, reported directly to Ellis Island and there the Army absorbed them completely. Miss ]\Iury wrote: When we were informed of a unit's arrival in Xew York, men of the Hospital Corps who had been detailed to our station for miscellaneous duty met the nurses at the depot and escorted them to Ellis Island. ]\[en with Army trucks ob- tained the ba.ijcgage and sent it to us by boat. When the nurses arrived, they came single fde through my oflfice, where a sergeant, the stenogra})her and I received their papers and secured such information as was necessary for our records. Miss Kcenan tlien took them in charge and they were given beds and mess assignments at the Immigration dining room. Every morning at A.^r. roll call for all nurses of every unit at the station was held. Permission was never given to a nurse to be absent. Kach individual had to be accounted for once a (lay. After roll call, shore leave was granted to any one until nii(hiigbt unless a unit was being held under sailing orders. If u new unit had arrived the day before, tbey were held after roll call for an e.\])lanatiou of tbeir new duties, the Army regulations to which they would now have to ailbere. the local rules of the mobilization station and something of the traditions of the Army of which tbey were now an integral part. The next step in the preparation of a unit for sailing was 418 HISTORY OF AMERICAN RED CROSS NURSING the procuring of passports, which in the early days of the war were necessary. Of some of the details by which nurses secured their identi- fication cards and passports, Glenna L. Bigelow wrote in the Military il^umber of the Journal: We went this morning to Hobokeu, where we are to get our identification cards and finger prints. I surely feel as if my "fate was hung around my neck"' now. After this episode, we all filed into another room, small and stuffy, where were a glaring electric light and a huge camera. A fleissige Berthe would not have been more formidable. However, each one in turn sat down before the dreadful object while two dozen companions uncompromisingly criticized her camera expression. Then, "Smile and look at me," said the operator; click, and the thing was done. In exactly seven minutes the picture, dripping from its acid bath, was finished, developed and printed. And as the Scotch woman said when she saw her first photograph, '"It was a humblin' sight." Equipment was the next business in hand. Miss Bigelow described from the point of view of the individual nurse this phase of embarkation : Tuesday, February , 1918. Unit went en masse to the tailors to be measured for uniforms. The wonderful system of outfitting the crowds of nurses, ranging all the way from "small thirty-two'" to large "forty-four," seems perfect. The fitters were ver}- amiable until about lunch time when one of them insisted that a certain coat was all right. His client (a social service nurse who had picked up some stray phrases of the Ghetto), spoke to him in Yiddish and then he discovered that it was all wrong and marked it up and down and all .over with his chalk. . . . Friday our equipment arrived on the fern,- boat, great pack- ages and boxes from Xew York. We stood in line alpha- betically to receive our consignment and marveled at the order and dispatch with which that great pile of things was dissipated. Every person's name was on exactly the right box, in exactly the right place, so that there was no con- fusion and presently we found ourselves back in our dor- mitory, staggering under our load of gifts. It was like an individual Cliristmas tree all around and we were immensely grateful. We realize what really hard work it is and how monotonous the packing of those kits must become after the THE EUROPEAN WAR 419 novelty has worn off. It is true that we nurses have the excitement, the (han<;e, the danger perhaps, while they are getting the Jull, stay-at-home part. We bless them, every one, for these unnumbered comforts which will smooth our way over there. . . . Saturday night. The dormitory is the most amusing place in the evening, when all the nurses come back from town. It is a veritable Grand Street, with all the coats and dresses hung up on frames over the beds and bundles strewn about. Articles are bought, sold and swapped, appraised and depre- ciated. Shylock would find some kindred spirits in our little Kialto and his glittering eyes would certainly approve our spirit of bargaining. By the way, we have a feminine Harry Lauder among us, whose Scotch burr caresses the ether with a subtle touch. She is the most optimistic of people and when the conversation hovers about U-boats, her only concern is whether Providence or sticking plaster keeps the sailors' caps on their heads ! After the nurses had received their passports and identifi- cation tags, after they had donned their ontdoor uniforms and packed away the other articles of equipment, they entered into the most trying period of embarkation. Until Jidy, 1918, troops and supplies for the American Expeditionary Forces were given right of way to France and the nurses were often kept waiting on Ellis Island for weeks at a time until the trans- portation officer would supply sailing accommodations for them. During the tedious days of waiting, an Army sergeant drilled them in the rudiments of military formations. Ellis Island in 1917 presented a martial appearance. "As our build- ings were on the sea wall directly in front of the channel to the ocean," wrote !Miss ^lury, "all the activities of a harbor given over to war went on in our front yard. Also there were a thousand interned Germans and imprisoned German agents under heavy guard on Ellis Island and their presence produced rather a shadow of apprehension." Flora A. Graham (Albany City Hospital, New York), a nurse member of Ease Hospital Xo. 3.3, wrote in the Military Xumber of the Journal of the recreation facilities: On Island Xo. 1 there is also an innnenso hall wlicro the Y. l\r. C. A. ])rovides aniusomont three times each week for soldiers and sailors and Army nurses. These amusements consist of motion ])ictures. lectures, popular and ])atriotic 420 HISTORY OF AMERICAN RED CROSS NURSING songs and are largely attended and appreciated. On one occasion I noticed that the hoys were especially enthusiastic over the song, "IMother, Bid Your Baby Boy Good-bye." The screen picture that night was "Tom Sawyer" and it gave us all great pleasure. The chief nurse of base hospitals spent many hours in try- ing to master Army paper work. ''Chief nurses from civilian hospitals," wrote Miss Mury, "had had no opportunity to be- come familiar with the special duties of an Army chief nurse. It was my duty to instruct them in the methods of keeping rec- ords and preparing official reports pertaining to the Corps. I fear that the methods of routine that had taken me years to learn," concluded ]\Iiss Mury, "I often expected those chief nurses to acquire in a single day." In December, 11)17, the old Colony Club building in New York City was offered to the War Department by Mrs. Gene- vieve Walsh for use as a mobilization station for nurses await- ing transportation overseas. As the space on Ellis Island was limited, the offer was accepted at once and proved a veritable Godsend, as one hundred and thirty nurses could be accommo- dated there at one time. Its central location was an added ad- vantage. ]Mary E. vSheehan was the first chief nurse there and was followed by Minnie Winslow. The building was used until the spring of 1918. From the nurses mobilized in New York were drawn hun- dreds who participated in the Ked Cross parades which were beld during 1017 and 1918. Led by Miss Delano, Miss Noyes, Miss Thompson, j\lrs. Higbee, Miss Van Blarcom and other national executives, column after column of mirses, some clad in white with their scarlet-lined capes flung back, others march- ing row upon row in the smart blue uniforms of the Army and Navy, swung down Fifth Avenue in that first historic parade of Octol)er 9, 1917, the most spectacular pageanty of women mobilized for war that New York City had ever witnessed. The delay in the embarkation of nurses from Ellis Island was due principally to the acute shortage of American and Allied tonnage. The transportation of American combat troops and supplies was necessarily given the right of way over that of medical personnel and hospital supp]i(>s, especially after the German offensive of ^Farcli, 1918. The United States par- ticipated in the European War for nineteen months and dur- ing that period iiiove tliaii 2, 000, 000 American soldiers went THE EUROPEAN WAR 421 to France, 500,000 of them during the first thirteen months and 1,500,000 during the last six months. At first, the Army had only a few American and British troop ships which they chartered directly from the owners, but during the winter months of 1917-11)18 the German liners which had been seized were brought into use and the movement of troops gradiudly increased. Early in 1918, the British Cjovernmcnt agreed to assign three of its large liners and four smaller troop ships to the American Army and an increase of 5779 men in .March, 1918, over the preceding month resulted. Also in j\Iarch oc- curred the disastrous Picardy Drive, with results which threat- ened to end in German victory. "Every ship that could be secured," wrote Colonel Ayr(>s, chief of the Statistics Branch of the General Staff, "was pressed into service. The aid fur- nished by the British was greatly increased. ... In ]\Iay and in the four following months, . . . the transportation miracle took place. The number of men carried in May was more than twice as great as the number for April. The June record was greater than that of ^lay and before the first of July, 1,000,000 men had been embarked.'' ^ In July, over .300,000 American soldiers were carried to France and by October 31, 1918, 2,000,000 had sailed from the United States. During many weeks in the summer, 10,000 men embarked every day for P]urope. "Among every hundred men who went over," wrote Colonel Ayres, "forty-nine went in British ships, forty-five in American ships, three in those of Italy, two in French and one in Russian shipping under British control." " In the late spring of 1918, the War Department found it necessary to use the buildings on Ellis Island for hospital pur- poses, so the Knott chain of hotels in N^ew York C\t\ was taken over by the Army and mirsos were mobilized there. An ad- ministration center was established at Hotel Albert. Mary C. Jorgensen followed Miss Alury as chief nurse of the mobiliza- tion station in New York. She wrote: Soon the daily ri'ijorts showed nearly one tliousand mirsos housed in twenty dillVrent hotels, stretc hing from Wasliinuton Square to Seventy-Second Street. There, in America's largest city, it was no easy task to keep an eye on them all. . . . ^ ""The \\i\v with Gorinanv,'' pj). 37-.'58. "Ibid., p. 41. 422 HISTORY OF AMERICAN RED CROSS NURSING Confusion was necessarily present to a great degree. The corridors and the none-too-large offices provided in the hotels commandeered for mobilization stations seemed overflowing with swarms of women asking all sorts of questions dealing with equipment, War Eisk Insurance, allotments and pay. All were so truly eager to be of service that the objective was the proper functioning of the great machine centered in Washington. Units prided themselves on the correct wearing of the uniform and on proper drilling and a spirit of friendly rivalry existed between the various groups as to which were the better soldiers. As each unit became equipped, its mem- bers, earnest and intensely eager, with trunks packed, waited on the qui vive for orders to sail. The most scrupulous pre- cautions had to be exercised in giving out sailing dates; only the chief nurse was told when her unit would go. The greatest single problem encountered during the entire period of mobilization was the arrival of the five hundred and fifty "casuals" who were withdrawn from the cantonments in May for immediate assignment overseas. Their arrival in New York extended over a period of several nights and days and they were housed in seven different hotels. They had no chief nurse to assume responsibility. ''They seemed," wrote Miss Jorgensen, "to be in a chaotic state of disorganization. Finally they were all assembled at the Ylst Infantry Armory," she con- tinued, "one of their number was designated as chief nurse and she appointed five assistants. Conditions improved to a considerable extent." The six hundred odd Red Cross nurses sent overseas to work directly under lied Cross foreign commissions, found less rou- tine in embarkation than did those attached to the Army. They were mobilized at the house of Joseph A. Aucrbach on West Tenth Street. This house, which had been loaned to the New York County Chapter, was more than just a beautiful place for nurses to stay in until the Red Cross secured their pass- ports and passage. It soon became a meeting place for Army and Xavy reserves as well as for nurses destined for strictly Red Cross foreign service. After roll call in the morning, Miss elohnson usually gathered together the different units of nurses sailing each week and explained to them their new relation to the Army or to the Navy and to the Red Cross, her resolute, human philosophy of service often being the last message which the nurses received b(>for(! they embarked. THE EUROPEAN WAR 423 Solemn indeed for the nurses was the long anticipated hour when they boarded ship. Though her official duties concerned only nurses enrolled in the Red Cross, Miss Johnson saw almost every American nurse oif for Europe. She described the docks : Sometimes we'd crawl out of bed at three A.M. and drive down to the East River or over to Hobokeu to meet the nurses on the docks. Often it would be raining torrents. Again the cold sleet numbed us. Our arms were always piled high with every conceivable kind of bundle. We Ked (^rossers had great difficulty in getting supplies to the other side, so every nurse en route to the Paris office, went laden down with bundles and resembled an immigrant at Ellis Island. When our nurses went over on an Army transport we'd find the docks crowded with troops. The boys invariably had a friendly greeting for the nurses. The Red Cross Canteen women were there, too, no matter how hot or cold, how early or how late it miglit be. Sometimes we'd wait hours on sweltering docks, so hot that the pitch oozed out of the cracks and the boys, panting with heat and fatigue, would lie down to sleep as best they could. The "dazzle painting" of the liners and transports further heightened the sensations of weird unreality which the nurses experienced as they waited on the docks. This type of paint- ing, popularly termed "camouflage," made it more difficult for a subnuirine commander, peering through a periscope for only a few seconds at a tinu\ to determine the course of a vessel so decorated. "The Carpathm" wrote Priscilla J. Hughes, Army Nurse Corps, chief nurse of Evacuation Hospital Xo. :^2, "had the most fearful and wonderful camouflage, the design of which was supposed to represent large teeth encircling her bow and stern to show that she had sunk a submarine so they told us ! Each ship of our convoy of fourteen had a different fantastic pattern." Hiss ^lury summarized briefly the spirit of the ten thousand nurses who embarked through Ellis Island for service with the American Expeditionary Eorces: When sailing orders were received for a unit, shore leave was stopped, no coniinunication with friends or relatives was allowed; trunks were inspected and locked and the unit stood by for tlie tug which was to take them to tlie traiisjinrt. On arrival of the tug, the connuand "Fall in I" was given, fol- 424 HISTORY OF AMERICAN RED CROSS NURSING lowed by "Forward March !" and sixty-five silent, blue-clad, white-faced women with chins well up and eyes to the front marched down the dock and on to the tug in soldierly for- mation. Usually as the boat shoved off a lilting song came drifting back, "Pack up your troubles in your old kit bag and smile, smile, smile." One knew, however, that the wonderful spirit of American womanhood strengthened by hospital training enabled those nurses one and all to face so bravely the journey across the submarine-infested sea and the fur- ther unknown dangers of military hospital duty in a war- stricken foreign land. To the nurses watching and awaiting their turn, the depar- ture of a unit was full of tense emotion. Miss Bigelow wrote : The sky was blue and the sun shone brightly on the little procession of fifty nurses, so dignified and smart in their dark blue uniforms. They emerged from their quarters, marched silently along the quay of Island No. 3 and over the bridge to the chapel on Island No. 1, when we lost sight of them for a moment. Soon they came out and marched, two by two, toward the tender which was to take them out to their ship. Their leader carried the flag. That mass of color crushed in her arms . . . seemed like a dart of flame, an imprisoned thing seeking freedom. It happened that a company of sailor boys, out for morn- ing drill, was drawn up at "attention"' right at the gang plank wlien the unit embarked; their presence added tre- mendously to the impressiveness of the picture. But the silence was terrible, no fanfare of trumpets, no admiring friends, no flowers, only the grimness of parting. The little boat shrieked out a warning, warped away from the pier and silently disappeared around the Island. Great Britain, the gateway through which passed one-half of the two million American soldiers who served at the Western Front during tlie European War, was the scene of extensive American Jfcd Cross nursing service in the field. Early in 1!)14, it will be remembered, a grouj^ of American citizens resident in England had desired to express their sym- pathy for the Allied cause and especially for England by the establishment and maintenance of a war hospital. The Ameri- can Women's War Iieli(;f Fund was raised and the Committee responsible for its disl)ursenient opened "Oldway House" Hos- THE EUROPEAN WAR 425 pital, Mr. Paris Singer's estate at Paigiitou, Devonshire. When the American Red Ooss offered two medical nnits of the ;Mercy Ship to the British Uovernment in Angnst, 1914, the War Office assigned Unit F and later Unit D to Paignton and they remained there for one year. After their recall, the committee continued the maintenance of "Oldway House" Hos- pital and also estahlished a small officers' hospital at Lancas- ter Gate, Hyde Park, J^ondon. Upon the entry of the United States into the European War, memhers of the American colony in England desired to take a more active part in war relief work than was afforded them in the maintenance of these two hospitals. They accordingly pe- tioned National Headquarters to grant them a charter as an American Red Cross Chapter. Thus on May 24, 1917, came into existence the London Chapter of the society. Mr. Walter H. Page, then American Ambassador, was the first honorary president. ]\lrs. Page and Mrs. Robert P. Skin- ner were honorary vice-presidents ; Mrs. Whitelaw Reid was chairman; i\Irs. Irwin Laughlin, vice-chairman; Boylston A. Real, honorary secretary ; and Robert Grant, Jr., honorary treasurer. W. H. l^uckler served as administrative director. Six base hospitals organized by the American Red Cross were, it will be remembered, the first branches of the American Army to go overseas. The nurses of these columns were cordially re- ceived in London by members of the London Chapter. As other base hospital units arrived in England on their way to service with the American Expeditionary Forces in France, urgent need developed for a large central club where transient nurses might be housed and entertained. A committee of the London Chapter was organized, with Viscountess LLircourt as chair- man and this committee established in June, 1917, the Ameri- can Nurses' (Mub, at No. 42 Grosvenor Place. This club soon became so popular with Army, Navy and Red Cross nurses on their way to France or on brief holiday in J^ondon, that the Chapter furnished an annex to it on a floor of Forbes LLnise, the home of the Countess of Granard in Halkin Street. ^Mrs. Cavendish l^entinck opened an extensive suite of rooms in her house. No. 4 Richmond Terrace, and latin- the committee l(>ased another building. No. 4;") Grosvenor Place. Agnes Ijirtles, an American Red Cross nurse on duty in Great Britain, wrote that "]io one who has not been a stranger herself in London can realize what it has meant to us to have an attractive place to go 426 HISTORY OF AMERICAN RED CROSS NURSING to in a strange city. Everything, even to serving our break- fasts to us in bed, was done for our comfort." In the fall of 1917, two long-pending developments of the American military situation brought about an urgent need for more extensive American Red Cross operations in Great Britain than could be handled solely through the London Chapter. The first of these was the decision to brigade American troops with the British Armies in northern France ; this brought with it the certainty that American sick and wounded would be sent to Great Britain for care and treatment. American hospital facilities in England for these men would, therefore, be neces- sary. The second development was the enormous increase in the numbers of American soldiers who were being landed on Brit- ish soil while en route to France. Of the 2,000,000 American soldiers who served on the Western Front, 1,025,000 of them were carried across the Atlantic in British ships. Early in the spring of 1918, the British Government assigned three of its big liners and four of its smaller troop ships to the use of the American Army. These ships took on American soldiers at Quebec, Montreal, St. John, Halifax, Portland, Boston, New York, Philadelphia, Baltimore and Norfolk and dis- charged them at Glasgow, Manchester, Liverpool, Bristol Ports, Falmouth, Plymouth, Southampton and London. After a short time spent in American rest camps established by the American Army near these ports, the soldiers were transported to France by means of the Cross-Channel Fleet. Following the decision of the War Department to send American troops to France by way of the British Isles, the Sec- retary of War established in October, 1917, in England, L^nited States Army Base Section No. 3 and placed Major General George T. Bartlett in command. Brigadier General Francis Winter was assigned as Chief Surgeon of the American Armies in Great Britain. His office did not at this time include, how- ever, a representative of the Army Nurse Corps. Wherever branches of the American Army were sent during the European War, representatives of the American Red Cross followed to offer them the service which its charter of 1905 authorized the society to give. T^pon the arrival in Great Britain of large numbers of American troops, the need for Red Cross service increased to proportionate dimensions. This ser- vice entailed the purchase and distribution of vast quantities of THE EUROPEAN WAR 427 supplies to the American Army and the establishment, if the Army Medical Corps so desired, of Red Cross hospital facilities for American sick and wounded soldiers. Although tiie London Chapter was organized in JMay, 1017, it was the policy of the War Council to conduct activities of this nature through foreign commissions sent out from National Headquarters. Local Chapters, if such existed in the foreign field, lacked both the funds and the knowledge of national and international Red Cross policy to administer the diversified activities. The War Council appointed the members of each commission, appro- priated from the Red Cross General Fund the moneys neces- sary for their work and directed their activities entirely from National Headquarters. The first of these commissions, the American Red Cross Commission for Europe, as will be recounted in a subsequent section, arrived in Paris early in June, 1917, and set up its headquarters at No. 5, Rue Francois Ir, ^[ajor Grayson ^I.-P. ^furphy, of New York City, was the commissioner. Among the seventeen men who formed his staff w^as William Endicott, of Boston, Massachusetts. Early in July, a need was felt both by National Headquarters and by the Conmiission for Europe for an American Red Cross representative in London. The War Council voted on July 12, 1017, "that a Commission for Great Britain be immediately or- ganized." The need for a "direct representative in London" was echoed again in the Minutes of the War Council, meeting August 7, 1017, and on August 22, "Edgar H. Wells was recommended and appointed as deputy commissioner for Great Britain." During July and August, the Commission for Europe was ex- periencing its initial difficulties in securing supplies in France. Major Endicott was accordingly dispatched to England to act as "purchasing agent" for the Paris office. He hung up his cap September 10, 1017, in a room at tlu> Cha])ter h('ail(|u;ii' ters on Grosvenor Gardens which was loan(>d to him by the London Chapter, and in this office six we(>ks later, the Ameri- can Red (^ross Commission for Gi'cat IJritain came into exist- ence, with Major Endicott as connnissioncr.^" His office, thougli numbering seven persons, did not at this time include a repr(>- sentative of the American Red Cross Nursing Service. The first work of the Commission was the establishnieut near '"Si'c Minutes of the War Council, October 2:5, 1(117: Vol. II, p. 3.">(;. 428 HISTORY OF AMERICAN RED CROSS NURSING Liverpool of American Red Cross Military Hospital No. 4. On ISTovember 19, 1917, Major Endicott leased an English country estate, Mossley Hill, which was located within fifteen minutes by motor from the docks. The Red Cross immediately began the renovation and equipment of the fine old mansion house as a war hospital. Small numbers of American troops were then being sent to England in the available passenger space on commercial liners. They were concentrated at the United States Army Rest Camp at Winchester and the first American Army hospital in Eng- land was opened there. It was located on the crest of Morn Hill, two miles from the city and was designated as United States Army Camp Hospital No. 35. It was opened for pa- tients on December 15, 1917. Nine Army nurses, with Ada J. Allan as chief nurse, were assigned to duty there on Feb- ruary 22, 1918. The capacity of the hospital was gradually increased to 600 beds and the nursing staif raised to thirty members. ^^ On January 9, 1918, American Red Cross Military Hos- pital No. 4, Mossley Hill, received its first patients. Its ca- pacity then included only forty beds, but eight barracks were soon constructed within the spacious grounds, which brought up the total capacity of the hospital to 500 beds. An officer of the United States Medical Corps was placed in charge. The Nursing Service at National Headquarters, Washing-ton, sup- plied the nurses. Marion Weller (New York Hospital) was chief nurse ; she was installed by Major Endicott previous to the opening of the hospital and she and her nurses worked with great devotion to transform the old mansion into a hos- pital. One of these was Agnes C. Birtles. She wrote : j\ry first assignment to duty upon my arrival on Decomber 1, 1917. at r.iveri)()ol. was to a new Red Cross hospital tlieii being ])repared for the reception of American troops tak(Mi ill in crossing. As we were unable to secure any kind of labor, we seven nurses set to work cleaning, scrubbing, painting floors, un])acking furniture ;uul ])utting up beds. The beau- tiful old house had been empty for a long time. 1 shall ne\er forget our first patients, those ill, homesick boys wlio canie to us from other hospitals or directly from the docks. Some had been taken to English hospitals where " Soo IJcport of tlie Director of Nursinfr Service, American Expeditionary Forct's, p. 27. THE EUROPEAN WAR 429 they had received the best of care, but English people, kind as they are and English surroundings, clean and often luxu- rious, were not American. Our bare wards seemed like home. New buildings were soon erected and never a bed was empty. More than once we put our patients on mattresses in the halls while the erection of new barracks was speeded up. In July, 1918, this hospital was transferred from the Red Cross Commission to the American Expeditionary Forces in Ehig-land and was staffed by reserve nurses, Army Nurse Corps. Hospital Unit "T," which had been organized by the Red Cross for the Army, was transferred from Sarisbury Court for duty at ^Mossley Hill. Nellie Brookbanks was chief nurse. The capacity of the hospital was later raised to 500 beds, with a permanent nursing staff of forty-five.^- The Red Cross Commission for Great Britain next took oyer three hospitals in England which had preyiously been con- ducted by the American Women's War Relief Committee and by the London Chapter. The Commission assumed financial responsibility for these already successful hospitals, greatly ex- tended their activities to meet the new demands, centralized the management and brought about economy of personnel and funds. The largest of these three hospitals was "Oldway House," Paignton, which the American Women's War Relief Commit- tee turned over on January 1, 1918, to the American Red Cross. It was designated as American Red Cross Military Hospital iSTo. 21. Its sixty rooms accommodated 250 patients. By the acquisition of other buildings on the estate and of the Redcliffe and the Esplanade Hotels in Paignton, the Commis- sion raised the bed capacity of the hospital to 700. Like other Red Cross military hospitals in England and France, officers of the United States Army Medical Corps were in command. A British Matron was in charge of the nursing staff which con- sisted of English sisters, numerous V. A. 1). members, and American Red Cross nurses of the ^Mercy Sliip, who had elected to remain at "Oldway House" after the recall of the units. On August 17, 1918, twenty-five reserves of the Army Xurse Ct)rps, who had gone overseas as members of Base Hospital Xo. 40, were assigned to teni])orary duty at Paignton and all others were released. Mary Murpliy, a graduate of the Carney Hos- pital, South Boston, was chief nurse. " S(H> Report of the Director of Nursing Service, American Expeditionary Forces, p. 28. 430 HISTORY OF AMERICAN RED CROSS NURSING The other hospital formerly administered by the American Women's War Relief Committee was a small institution at Lancaster Gate, Hyde Park, London, which the committee had opened in March, 1917, for British officers. The Ameri- can Red Cross Commission for Great Britain took over this hos- pital, gave it the designation of American Red Cross Military Hospital No. 22 and expanded its original capacity of forty- eight beds so that it ultimately accommodated approximately 150 American officer patients. The nursing staff was made up of English Sisters and nursing members of Voluntary Aid De- tachments of the British Red Cross. A British nurse was Matron. The presence of three American Red Cross nurses added an American touch during the spring and summer of 1918, but they were recalled by autumn. The success of the Lancaster Gate Hospital was due largely to the efforts of Vis- countess Harcourt. The third hospital to be taken over by the Commission was St. Katharine's Lodge, Regent's Park, London. In June, 1917, Mrs. William Salomon, of New York, had offered her house, a rambling two-story lodge built by George IV in four acres of royal parks, to the London Chapter of the American Red Cross to be used for hospital purposes. The London Chap- ter accepted the gift and St. Katharine's Lodge was first main- tained as an auxiliary of the British Military Orthopedic Hos- pital at Shepherd's Bush. Upon its transfer on January 1, 1918, to the Commission for Great Britain, it was designated as American Red Cross Military Hospital No. 23, but its thirty- eight beds continued to be used for the care of British officers. It was staffed by eleven American Red Cross nurses, with Isa- belle F. Carson as chief nurse. In midsummer of 1918, St. Katharine's Lodge was militarized and became an American officers' ward of L^nitcd States Army Base Hospital No. 29, at Tottenham, near London. So successful was St. Katharine's Lodge as an officers' hos- pital that ]\Ir. Chester Beatty, an American mining engineer, and his wife offered in January, 1918, the use of their London residence, Baroda House, for hospital purposes to the Red Cross Commission. ]Major Endicott accepted tlie gift and on March 20, 1918, Baroda House was opened as American Red Cross ^lilitarv Hospital No. 24. ~Mr. and ]\lrs. Beatty con- tributed the funds re([uired for the maintenance of the hos- pital and tlie American Red X'ross Commission supplied the THE EUROPEAN WAR 431 professional staff, the orderlies and the medical and surgical supplies. Five American lied Cross nurses and four V. A. I), members, were assigned to duty there. In location and in execution, Baroda House was charmingly suited for use as an officers' hospital. Though in the center of London, it adjoined Kensington Palace Gardens and was removed from traffic, a quiet and soothing place. Its founder had been an Indian prince, the Gaekwar of Baroda, and the spacious, square, high-ccilinged rooms still contained in their furnishings a quaint and Eastern flavor. Tall windows on the ground floor opened directly upon lawns and a garden where convalescent patients in wheel-chairs and on beds, drowsed through the sunny afternoons. American Red Cross military hospitals in Great Britain thus on March 20, 1918, consisted of No, 4, Mossley Hill, Liver- pool ; No. 21, Paignton ; 'No. 22, Lancaster Gate, London ; No. 23, St. Katharine's Lodge, London ; and No. 24, Baroda House, London. The development of hospital activities in England, both of the Army and of the Red Cross, was greatly accelerated during the spring and summer of 1918 by the aid which the British Government gave the United States War Department in the transportation of American troops. The movement of Ameri- can troops for March showed an increase over February of almost 6000 men. During the same month, the disastrous Picardy offensive occurred and every available British ship was immediately pressed in service to transport American rein- forcements for the almost-exhausted Allied armies holding the Western Front. The number of men transported to France in April showed an increase over March of 33,000 and in May, the number transported was more than tw^ce as many as in April. By July 1, 1,000,000 men had been embarked and a great number of them passed through England. This increase in the number of American troops passing through England brought about a need for more extensive hos- pitalization in Base Section No. 3. The establishment of new hospitals requiring large staffs of nurses created a need also for a representative of the Army Nurse Corps to serve on Gen- eral Winter's staff. 'Vwo reserve nurses of the Army Xurs(> Corps, Nellie E. McGovern (^lanhattan State Hospital, New York City) and Nellie V. Brookbanks (Bellevue Hospital) were assigned on Felu'uary 22, 1918, by the Chief Surgeon, 432 HISTORY OF AMERICAN RED CROSS NURSING American Expeditionary Forces in France, to the office of the Chief Surgeon, American Annies in Great Britain, and into their hands was pLiced responsibility for the conduct of the Army Nurse Corps in England. During the early spring of 1918, General Winter estab- lished a camp hospital at Liverpool and an Army base hospital at Hursley Park, Winchester. The first of these, U. S, Army Camp Hospital No. 40, was located at Knotty Ash, Liverpool, and was opened on March 26, 1918, It drew patients from the big American Rest Camp at Knotty Ash, which then ac- commodated 10,000 troops. The initial bed capacity of Camp Hospital No. 40 was 250, but it was raised during the summer and fall of 1918 to 500 beds. Twenty-one nurses of Hospital Unit "W," which had been organized by the American Red Cross for the Army, were assigned to duty there on May 28 ; Amanda Metzger, a graduate of the Springfield (Illinois) Hos- pital, w^as chief nurse. The strength of the nursing staff was later increased to forty-five members and was maintained at this number by the assignment of nurses from various base hospital units to temporary duty there. ^^ The first United States Army hospital in England, No. 204, opened its doors April 23, 1918, at Hursley Park in south- eastern England, five miles distant from Winchester. The British War Office turned over to the American Army Medical Corps wooden barracks which they had built for the hospitali- zation of their own troops and Base Hospital No. 204 opened its doors to patients on April 23, 1918. The nursing staff was composed of twenty-two members of Hospital Unit ''I". Lora B. Roscr, a graduate of the Culver Union Hospital, Craw- fordsville, Indiana, was chief nurse. The capacity of the hospital was later raised to eight hundred beds and the strength of the nursing staff to fifty permanent members.^'* Hursley Park Hospital was repaired and reequipped by the Red Cross. The Red Cross Commission for Great Britain was permitted to take an important part in the establishment of the next hos- pital for American troops in England. In the spring of 1918, the American x\rmy Rest Cainp at Winchester overflowed, so the American Army in England took over a second camp six miles away at Romsey. Nurses will remember that one of the " See Report of the Director of Nursing Service, American Expeditionary Forces, p. 27. "Ibid. THE EUROPEAN WAR 433 Nightingale estates was situated near Romscy, in ITampshire, and the young Florence Nightingale especially enjoyed the sum- mers spent there. The camp at liomsey which the American Army took over had formerly helonged to the British Army and had accommo- dations for seven thousand troops. Its hospital facilities con- sisted, however, of a row of tents along one of the camp streets. These tents were equipped only with straw ticks laid upon boards raised about six inches from the floor. During the pleas- ant English suniuK^r, these quarters had been comfortable enough for the British sick and wounded to spend a few hours in before British ambulances transported them to nearby bases. A different situation confronted the American Army. They had only the one base hospital, at ITursley Park. Thus for the raw English winters, they needed permanent hospital facili- ties at Romsey. The Chief Surgeon called upon the Red Cross Commission for Great Britain to construct a permanent hos- pital of at least two hundred and fifty beds. The commission immediately undertook the work and Major Endicott set about the discouraging task of securing supplies and labor. While he was searching for wood or concrete or stone or any building materials, not necessarily the most desirable but those actually to be had, an Army lieutenant secured an option for some bricks and he turned it over to ^lajor Endicott, The necessary lumber was sawed by small portable mills in the New Forest and was swiftly transported by Army trucks to Romsey. Working scpiads of the American Armies were as- signed to bricklaying. Sometimes the hospital construction progressed uninterruptedly for as long as three weeks. Then the troops were ordered to Plymouth or Southampton, the transports steamed out into the Channel and the hospital walls, half-raised, stood undisturbed in the quiet camp until the next detachments came swinging down from Liverpool and con- struction began again. By June, 1018, the neat little hospital with long sunny wards, completely appointed op(>rating and X-ray rooms, diet kitchens, milk pasteurizing plant and gas and electric equipment was ready for occupancy, perhaj^s by some of those same whistling Yankees, who had lighthcnrt- edly laid a brick in tlu^ walls of this hospital in Eiighnid against the day when they or their "buddies" might be s(Mit back in mortal need of hospital care from the trenches which thev were then so eauer to reach. 434 HISTORY OP AMERICAN RED CROSS NURSING The hospital at Romsey was designated as United States Army Camp Hospital No. 34. Ten nurses, "casuals" and mem- bers of various base hospital units with Nellie McGovern as chief nurse, were assigned on August 4, 1918, to this hospital. The permanent staif was later raised to seventeen nurses. The next institution to be opened by the Red Cross Com- mission for Great Britain was a convalescent hospital for Ameri- can officers. This was opened June 1, 1918, at Lingfield, about thirty-five miles from London, on the country estate of Colonel Spender Clay and his wife, who was the daughter of Lord Astor. This convalescent hospital was designated American Red Cross Convalescent Hospital No. 101. The house accom- modated more than one hundred patients. Previous to May, 1918, the American Red Cross Commission for Great Britain had not included a representative of the Nurs- ing Service. Many American Red Cross nurses were on duty, however, in the five American Red Cross military hospitals then being conducted by the commission for the Medical Corps. Also many reserve nurses of the Army Nurse Corps were in active service in England. On May 14, 1918, Major Endicott wrote Miss Delano : ]\Iiss Carrie Hall, who has lately been the Matron at Gen- eral Hospital Xo. 13. British Expeditionary Forces, Boulogne, is our newly-appointed Chief Xurse of the American Eed Cross in Great Britaiii, assigned to the position by the Chief Surgeon, American Expeditionary Forces [in France] . She will have entire charge here in Great Britain of the enroll- ment, assignment and direction of Red Cross nurses. We have asked her to report directly to the Bureau of Xursing Service of the American Ked Cross in Washington. This appointment was made without conference with Miss De- lano and Miss Noycs. A precedent for such action had already been established by the American Red Cross Commission for Europe and a detailed discussion of the policies involved will be found in a subs('(pient section. A few weeks later, the Chief Surgeon, American Expedi- tionary Forces in France, notified General Winter, Chief Sur- geon of the American Armies in England, that a permanent chief nurse of IJase Section X'o. 3, Grace E. Leonard, had been appointed. With her assistant, Annie C. Porter, Miss Leonard reported for duty on flune 19, 1918, on General Win- ter's staff. Miss Mc(jlovern was transferred to Romsev as chief THE EUROPEAN WAR 435 nurse of Camp Hospital No. 34 and Miss Brookbanks to ^loss- ley llill as chief nurse of American Ked Cross ^lilitary Hospital No. 4. The appointment of a chief nurse for the American Ex- peditionary Forces in England and the appointment of a chief nurse for the American Red Cross Commission for Great Britain marked the beginnings of an authoritative and per- manent nursing service in England. In her first report to ^fiss Delano regarding the Red Cross nursing situation in England, Miss Hall wrote on June 6 : Plans are under way for opening here in London a hospital of about sixty bels for sick and wounded American nurses. . . . There are now in England six hospitals nominally under the American Ked Cross. At least two of these are respon- sible directly to the British War Office and with regard to them, I propose no interference, except perhaps to withdraw slowly such American nurses as are now in them, replacing them witii English nurses and so leaving the nursing staff entirely English in character. By using the American nurses to fill in the ga]is in other more distinctly American hospitals, we can thus attempt to have complete American staffs and American methods in these later institutions. We shall need a good many nurses in England for our own Bed Cross work, apart from those assigned as reserves to the Army Xurse corps. ]\rajor Endicott informs me that some time ago be asked for fifty nurses ; I hope they will be forth- coming during the next few weeks. I am recommending to him today that he apply through the proper channels for fifty additional ones. Upon the authorization of the Nursing Service at National IIead(iuarters, ]\Iiss Hall organized a Local Committee in Lon- don to undertake the enrollment in the American Bed Cross Nursing Service of American inirses then in Great Britain. !Miss Hall estinuited that over one hundred nurses were enrolled thus through the London office. One of the most important things which ]\riss ILiIl accom- plished at London Heacbiuarters was the establisbnunit of a budget syst(>m and an ('([uipmciit section. !Miss ILilI wrote: I'revious to my tenure of office, nurses assigned to Ifnl Cross duty ly the conunissioiu'r ov l\v the London ChapttT bad been scantily equipped, the exj)ensc of wbicli bad tnen 436 HISTORY OF AMERICAN RED CROSS NURSING charged to the hospital where the individual was assigned to duty. I stated the case to the comptroller, showing that nurses should be enrolled and equipped who were not as- signed to any hospital in England but might be transferred to the Eed Cross in France or to the Army in England. He saw the need for a separate budget for the nursing depart- ment and immediately secured it. That enabled me to establish means for supplying equipment in London which was parallel to the equipment supplied to nurses sent from home. In June, July and August, 1918, 870,988 American soldiers were landed in France. A large portion of these troops passed through England. During this period. General Winter estab- lished another camp hospital and four additional Army base hospitals in Base Section i^o. 3. United States Army Camp Hospital No. 36 was opened July 1, at Southampton, the principal port of embarkation for France. This institution had a capacity of eighty beds but was capable of expansion to five hundred beds. United States Army Base Hospital jSTo. 33 was assigned to Portsmouth, England. This base hospital had been organ- ized by the American Eed Cross at the Albany Hospital, Al- bany. Xew York. Sally M. Johnson, superintendent of the Albany Hospital School of Nursing, had organized the nursing staff of the unit, but Mattie M. Washburn, her assistant, led the nurses into active service. Base Hospital No. 33 had waited two months at Ellis Island before embarkation. The unit sailed April 22, 1918, on the S. S. Carmania, w^hich also carried the entire 28th Division. Upon the arrival of the unit at Liverpool on May 15, the nurses were temporarily billeted at United States Army Base Hos- pital No. 204 at Hursley Park. On June 1 they entrained for permanent quarters at Portsmouth and were finally assigned to the Portsmouth Borough Asylum, three miles from the cen- ter of the city. This institution had been built and maintained by the Board of Asylum Control of London. It consisted of one main building of modern ])rick and stone construction and of several detaclied villas surrounded by eight acres of farm- land. The American unit took possession on July 8 and imme- diately began the tedious and irksome task of changing the asylum to a hospital. Like Miss Nightingale's supplies which, THE EUROPEAN WAR 437 buried under ammunition, had gone up the Bosphorus past Scutari, the equipment of Base Hospital No. 33 had been car- ried to France. The (listr(!ssed unit was able to secure only the most essential articles from the generous stores with which the Local Red Cross Chapter at Albany had supplied them. The asylum authorities, the British War Office and the Admi- ralty and the American K(m1 Cross Commission donated ma- terials until the bed capacity of Base Hospital No. 33 num- bered three thousand with an additional emergency expansion of one thousand patients. The Red Cross erected a theater, seating an audience of twelve hundred, and built tennis courts and the best baseball diamond in England. Miss Washburn wrote of their first patients : Surgical casualties which had arrived on hospital ships at Southampton were brought to us July 2-i by motor ambu- lances and hospital trains within thirty-six hours from the time they had been wounded. On September '22, we had seven hundred patients. Word was then received that the S. S. Olympic, with six thousand troops on board, tlie greater number of them suffering from influenza, had come to port in Southampton. Sixty-six tents were immediately secured from the British to set up in the court yard of Base Hospital No. 33. Convalescent patients and members of the detachment were immediately transferred to these tents and the wards were cleared for the reception of influenza patients. Within one week seven hundred and ninety-seven cases had come to us, one hundred and forty- four of whom were nurses and female members of the Signal Corps. Both pneumonia and meningitis developed. Of our one hundred and twenty-nine deaths among these patients, eleven were nurses and one was a dietitian. United States Army Ease Hospital Xo. 37, the largest American military hospital in Kngland, crowned the crest of a hill at Uartford, fifteen miles from London. It was located in wooden barracks and in brick buildings of a former con- valescent fever hospital of the .Metr()])olitaii Asylums I>oard and had a capacity of two thousand beds. In the valley below was a large overllow liospital where the Hritish Army cared for twelve hundred wounded (lerman prisoners of war. The nursing personnel of Base Hospital Xo. ."JT, which had been organized largely from the King's County Hospital, 438 HISTORY OF AMERICAN RED CROSS NURSING Brooklyn, New York, with Annie F. Mack as chief nurse, had arrived in England on May 31, 1918, and had been assigned to temporary duty at Hursley Park. On June 10, they were transferred to Camp Efford at Plymouth, but as the hospital there was not then completed, they were scattered on temporary assignments among various other hospitals. The entire unit of ninety-nine nurses was collected on July 18 and was assigned to permanent duty at Dartford. Meantime in the outskirts of London, at Tottenham, United States Base Hospital No. 29, organized within the Medical School of the University of Denver, Colorado, had established a permanent base in buildings taken over by General Winter from the Metropolitan Asylums Board. The nursing staff of this unit, which was composed of one hundred reserve nurses, was assigned to duty there in July. Laura A. Beecroft was chief nurse. Tottenham Base was one of the largest American military hospitals in Great Britain and had a ca- pacity of fifteen hundred beds. During the summer of 1918, the American Red Cross Com- mission for Great Britain established two additional convales- cent homes and one base hospital for the American Armies in England. One of these homes was located in Putney, Lon- don, at Colebrook Lodge, the estate of John T. Ryan, of To- ronto, and was used as a convalescent home for Army, Navy and Red Cross nurses and other American women workers in the Military Establishment. Colebrook Lodge was a three- story modern building, constructed on the three-hundrcd-year- old foundations of Putney Manor and the nurses thoroughly en- joyed their stay tliore, their walks among the gardens and over the downs of Putney Heath and Wimbledon Common. The Red Cross Commission took over on August 1.") the es- tate of Percy Chubb at Wimbledon, which the British had main- tained as a convalescent home for British officers. The Com- mission designated this house as American Red Cross Convales- cent Hospital No. 102 and maintained it for the British Army with the understanding that it should be used exclusively for convalescent American officers, if such a need should arise. Its capacity was seventy-five beds. The final and most ambitious project which the Commission undertook for the American Expeditionary Forces in England was the preparation for occupancy of United States Army Base Hospital No. 40 at Sarisbiiry Court, near Southampton. fiff Nurses on the l)alcony of tlie American Rod Cross Xnrses' Club, London, overlookin"' the Gardens of Buckiny AiiK>rica!i Ai'iiiy. \avv and l!i'd Cross 7Uirsfs establislicd at Putney, near London, hy the Aineriean Ked Cross. THE EUROPEAN WAR 439 The report of the Coniniission for Great Britain described the establishment of this base: In April, 1918, the Commission for Great Britain com- menced negotiations for the purchase of a large estate in Hampshire between Southampton and Portsmouth, known as Sarisbury Court. . . . The estate lies in the bend of the ITamble river, sloping down to the water on two sides. The manor house, a massive three-story building of severe Tudor architecture, stands on high ground and its tower is visible on a clear day from points twenty miles distant. Though built twenty-live years ago, the house provided an excellent nucleus for a hospital. Acres of hut wards, quarters for nurses, doctors and men, an administration building and store houses were immediately planned and construction was begun to raise it to its esti- mated capacity of three thousand beds. Speed was essential. American wounded from France were already pouring into England. The difficulty in obtaining lumber made necessary the establishment of saw mills on the property, so that timber from the woodland pastures could be utilized. Concrete for the wards was mixed in little fac- tories from sand and gravel found on the estate. To supple- ment the ward buildings in emergencies seventy large tents, double-roofed and with windows, were also erected. . . .^^ The problem of cows for the hospital farm was solved by the generosity of the people from the little islands of Jersey and Guernsey, located a few score miles out of Southampton in the English Channel. Sixty cows of their fine herds were offered as a gift to the American base. . . . The nursing personnel of Base Hospital 'No. 40 had been organized at the Good Samaritan Hospital, Lexington, Ken- tucky, and upon arrival in England on July 20, 1918, consisted of one hundred and seven m.embers. Elizabeth McCormack Bogle was chief nurse. The nurses of the Good Samaritan Unit were first stationed at Sarisbury Court, but as the hos- pital was not then ready to receive patients, they were distrib- uted on temporary assignments among other American military base and camp hospitals. Five of them were sent to Base Hos- pital Xo. 15 in France; seven others, "casuals" who had been attached to the unit only during the tri]) over, went on to France. When Sarisbury Court was ready for patients on "An inttTt'stiiip account of the diflicultios oncounterod by tlic Red Crosr^ in tlio cstablislinient of this base may be found in "Tlie Passin;: Lcrrions,'" by George Buchanan Fife, pp. 202-211; The Macmilhui Company, 1920. 440 HISTORY OF AMERICAN RED CROSS NURSING September 4, the nurses of the original Good Samaritan Unit were returned there for duty. Base Hospital Ko. 40 rendered yeoman service during the last week of September, 1018, when the influenza epidemic was at its height. The liner Olympic, with four hundred cases of influenza aboard, docked at Southampton on September 29 in a cold, raw mist. The six thousand troops which she had brought overseas came from southern states and were keenly susceptible to the change of climate. The medical authorities hesitated to assign even the well men^ exposed as they had been on shipboard to the influenza, to Southampton Rest Camp, where they would have to sleep in cotless tents on floors con- sisting of a layer of thin boards a few inches above the wet ground. The troops were detained aboard the Olympic for a few days. The influenza then became so virulent that the soldiers were finally disembarked and taken to Southampton Rest Camp. Pneumonia developed among full one-third of the men who had contracted the influenza on shipboard. Although Sarisbury Court was not yet equipped to receive a large number of patients, the Commission swiftly made ar- rangements so that the hospital could accommodate about three hundred men. Some of the personnel of Base Hospital Xo. 40 had already arrived there but many of the surgeons and nurses had been scattered on temporary assignments to other bases. They were (juickly recalled and they worked day and night without respite until the epidemic was checked. During the suniincr of 1018, an important change of policy was adopted l)v tlie Chief Surgeon, American Expeditionary Forces in England, whicli oreatly diminished the need for ex- tensive American Red Cross medical and nursing service in Great Britain. ]\liss Hall wrote ]\Iiss Xoyes on August 2: Tlif gpiioral poliry of tlio Army here in England at the present time is that all lK)S])itals shall be directly ujider the Army. The I'od Cross will therefore establish no further hospitals as se])arate l^ed Cross institutions. I hope, how- ever, that wo will still bo able to staff the ones already in existence with IJfd Cross nurses. Imt many of these will be transferred to the Army l?eservo. My work as chief nurse of the American Tied Cross in Great Britain now becomes quite secondary to that of the chief nurse, Army Nurse Corps, Base Section Xo. 3. THE EUROPEAN WAR 441 On September 18, ^liss Ilall commented again upon the ces- sation of Red Cross activities: The whole situation in England has undergone great changes during the summer months. In the early spring, the policy of brigading our troops with the British in France brought forth a big lujspital building policy in England. In pursuance thereof, much work has been done in starting Army hospitals. Then the Chief Surgeon continued consistently to take over these institutions, with the result that so far as hospital and nursing work are concerned, there will be no further developments in England for the American Hed ("ross. It has been decided that I am to go to Paris the latter part of this month to help out in ]\Iiss Stimson's office. Miss Stimson, at this time chief nurse of the American Red Cross in France, was in need of an assistant at the Paris Head- quarters of the organization and ^liss Hall was assigned to duty- there on September 28, 1!)18. After Miss Hall's departure, Rachel Torrance, whose name is familiar to readers of this his- tory in connection with ^liss Hay's work in Sofia and Philip- popolis, became Chief ]S^urse, American Red Ci"oss in Great Britain. On October 1, 1U18, fifty-seven nurses were on duty directly under the American Red Cross in Great Britain. By November 11, 1918, the American Red Cross Commis- sion for England had established six hospitals and three con- valescent homes for the use of sick and wounded members of the American ^Military Establishment in England.^" At the signing of the Armistice, the Chief Surgeon, Base Section Xo. 3, was conducting five base hospitals and four camp hospitals for the service of the American Armies in England.^'' Of the number of American Army nurses, regulars and ro- serves, on active duty in llase Section 'No. 3, in October, 1918, Miss Leonard wrote : The largest nuni])er of nurses on duty at any time was five hundred and forty-seven permanent jjersoniiel. supplemented by three hundred nurses belonging to groups A autl 1) and Base Hospital Xo. n7. en route to France, wlio werc^ jilaced on duty in ()etoh(>r. litis, to relie\<' the siluatimi duriiiir the epidemic of influenza. As even these additional niiises were insutlicient. liel]) was recpu'sted from the British War Olliee and one hundred members of the \'. A. D. Xur.-iiig Service "For a list of those hospitals, sec A|iji('ii(lix. 442 HISTORY OP^ AMERICAN HED CROSS NURSING were immediately placed at our disposal. During this time, there were more tlian one thousand emergency beds in use and every hospital was taxed to its utmost capacity. Twenty-four nurses, largely British subjects trained in America, have been transferred from the American Eed Cross to active service in the Army Xurse Corps through this office. Miss Leonard reported November 15 to the Chief Surgeon in Tours to serve as assistant Director of the Nursing Serv- ice, American Expeditionary Forces in France. Annie G. Por- ter followed her as Chief Nurse, American Forces in England. Immediately following the declaration of war by the United States, the British Government sent the Balfour Mission to Washington to confer W'ith President Wilson regarding the coordination of the fighting strength of the two nations. One of the members of this mission was Sir John Goodwin, Colonel, Royal Army JMedical Corps, and since 1918 Surgeon General of the Britisk Army. He had been detailed by the British War Office for duty in the Surgeon General's office, United States Army. Upon the arrival of the Balfour Mission in Washington on April 22, 1917, General Goodwin requested that the Surgeon General assign immediately, if possible, six American base hospitals to service with the British Expedi- tionary Forces in France. The German submarine blockade, then tightening about the British Isles, made it inadvisable for the British War Office to attempt the transportation of their sick and wounded to England and this decision created press- ing need for additional British hospitals in France. More- over, some of the nurses and surgeons who had seen three years' continuous service on the Western Front, were greatly exhausted and casualties from disease were growing more fre- quent among their ranks. General Gorgas called upon the American Red Cross to nnister into active duty six of the twenty-iive base hospitals which were, on April 0, 1917, prac- tically comph'te in organization, e(]uipment and personnel. I'he Lakeside Unit, Base Hospital No. 4, on April 28 was sent notification of impending mobilization. The Surgeon Gen- eral did not call out tlie nurses' aides who had been attached to the base hospital units, but authorized that fifteen additional nurses should be selected from the reserve nurses already authorized and should go forward in their place. All nurses werc! instructed to report either to the J^akeside Hospital or to THE EUROPEAN WAR 443 Red Cross licaJquarters in New York City, if tlicv were then located nearer the port of embarkation than Cleveland. The reasons as understood by the Nursing Service of the Surgeon General for not assigning the twenty-tive nurses' aides attached to each base hospital unit to active service were given in a lett(^r written by ^liss Xoyes August 9, 1917, to Major Fred T. ^lurphy, director of J^ase Hospital No. 21: The decision against the use of our nurses' aides in France was rendered | by the representative! of the English Govern- ment. Their arguments appeared to us well-grounded. Briefly, they amounted to this: although the utilization of lay women of French and English birth was necessary be- cause of the lack in France of a professional nursing body and an inadequate su])i)ly in England and although tliey luul per- formed good service in many instances, tlieir assignment had been considered upon the whole an unsatisfactory way of meeting the situation. Constant changes were necessary. I\rany of the nurses' aides, unused to hardships and long hours of work, had to be returned home. xVs the hospitals were not far removed from either Great Britain or the aides' homes in France, this was not dillicult. It became, however, a differ- ent problem when the nurses' aides would need to be trans- ported over three thousand miles of ocean. This, briefly, is the reason for the decision as rendered by our Government ui)ou the advice of the French and English. Tlie chief nurse of Base lIos])ital Xo. 4 was Grace Allison and this history is indebted to her for an excellent report of the experiences of her unit. ^liss Allison was born in Port Austin, ^Michigan. Following her graduation from the Lake- side Training School f(U' Xurses, Cleveland, Ohio, she was for one year superintendent of the iSTorth I'acific Sanatorium, Portland, Oregon. In 1909, she matriculated at Teachers Col- lege, New York, but interrupted her work there from 1910 to 1911 to tak(> the position of assistant principal at tlw Lakeside School for Xurses. She returned to Xew York in 1!>11 as su- ]>(U'intendent of nurses at the Polyclinic Hospital and remain(Ml in that position for two years. In 191."5, she again took up her work i\t Teacliers ('oll('g(% reccMved her P. S. d(>gree in Jun(\ linf), and went back to Cleveland as ])rincipal of the Lakeside School for Xurses. From this position, she was ordered with her unit into active service. Dr. Crilc, it will be remembered, wa.s tlie director of this unit. 444 HISTORY OF AMERICAN RED CROSS NURSING Base Hospital No. 4 embarked May 8 ; Miss Allison reported the arrival of the unit in France : From Southampton we were transferred to the hospital ship Western Australia. Morning came and we lay at anchor in the Seine Kiver. The fog had disappeared and the sun shone brightly. . . . L^p to this time war seemed remote. As we passed small villages or lonely, thatched cottages with their groups of aged peasant folk with perhaps one or two young children or in- fants, we realized keenly how the three and one-half years of warfare had deprived them of their sons and fathers. Young women had gone forward to munition plants and factories. From a German prison camp hundreds of soldiers gazed with interest through a barb-wire fence upon us but I doubt if they comprehended the significance of the entrance of America into the war. Later one remarked, when seeing the insignia of the United States upon the uniform of an American officer: "America! And are you with us at last?" At the close of the day. May 26, we approached Rouen. As the ship steamed toward the dock, great throngs of people crowded to the wharf. Women dressed in mourning and children, with pale, emaciated faces and black aprons, pre- sented a sad picture. Their cries of "Vive VAmerique!" we will not soon forget. After debarkation came a two mile march through the deep- ening twilight, then a trip in dusty ambulances and the unit finally reached its destination, No. 9 General Hospital, British Expeditionary Forces, liouen, France. No. 9 General Hospital was located in twenty-five long brown-stained wooden huts and many dun-colored tents lying in parallel streets. The buildings were surrounded by neatly- trimmed lawns and vegetable gardens. Near the administration building was a flag pole froin wdiich, upon the arrival on May 27, 1917, of this first contingent of the American Expedi- tionary Forces upon Allied soil, the Stars and Stripes floated for the first time with the Union Jack and the Red (Jross flag. No. 9 General Hospital was of twenty-two hundred and fifty bed capacity, with an emergency expansion which allowed for three hundred and fifty additional patients. The medical di- vision consisted of ten large huts, each accommodating about forty beds. Potatoes were planted between the parallel rows of brown wooden buildinas. This vegetable was hard to secure THE EUROPEAN WAR 445 in the French markets. The administration bnildings, the operating-room pavilion, the patient's recreation and mess halls and the Quart(n-master's department occupied the center of the hospital gi'onnds. To the right was the snrgical division, sitnated in fourteen tents and in ten huts similar to those of the medical division. The wards differed from those of the American military hospitals chiefly in the type of furniture and supplies. Miss Allison wrote : The iron beds are painted black with a short head and foot piece so attached to the legs of the bed as to permit their being doubled under, making a flat surface which may be con- veyed easily from place to place. The sheets are one hundred and five inches long. They are turned back over the blanket at the top of the bed and also folded u])permost at the foot of the bed for twelve inches. When a sheet is soiled at the top from coming in contact witii the patient's food, it may be reversed, to provide a clean space at the head of the bed and prevent the soiled part, still turned uppermost at tbe foot, from coming in contact with the patient's feet. This device is necessary, not always because of the shortage of linen, but because of the great laundry problem. In many places in France, laundry is done on tbe stones adjoining a creek. Hot water seemed almost impos- sible to procure on account of the lack of fuel. Our soiled linen had to be transported forty miles by two large Army trucks. The British Red Cross Society equipped the recreation hall with reading-tables, books, desks, newspapers, magazines and games; patients constructed a stage and painted the curtains and several "sets." The British Red Cross supplied soap, toothbrushes, treasure hags, buttons, washcloths, sweets, cig- arettes, socks, gowns, hinders, stationery, small pillows and other necessities to "Tonnny Atkins." During the spring of liUS, American troops were brigaded with the British and the wounded of both nations were alike sent down through British bases for medical and nursing care. As Anu'rican wounded thus occupied an average of l.")0 beds a month at Xo. !) Gen- eral Hospital, the American Red Cross established stores nearby and scu'ved these patients with cigarc^ttes, chocolate, stationery and other comforts and luxuries furnished by tlu> American Red Cross to American troops wherev(>r they were detailed. 446 HISTORY OF AMERICAN RED CROSS NURSING After a few days during wliicli the Americans were learning the well-established routine of Xo. 9 General Hospital, the British sisters were withdrawn. On the morning after their departure, the bewildered American nurses found of the furni- ture which had formerly been in the nurses' quarters only a few boxes and some neatly-stocked bedding. It was their first intimation that the camp kit which the British War Office supplied each of its nurses was carried by them from one post of duty to another. This kit was composed of three army blan- kets and a large canvas bag containing a folding cot, a cork mattress, a washstand, a small table, a chair, a canvas pail in which to carry water, a lantern, an enameled plate, a drinking cup, a knife, a fork and a teaspoon. The practice was different in the United States. The American Army furnished the quarters of the nurses, rather than issued the articles direct to each nurse. But General Pershing's First Division had not yet landed in France and there was no one to furnish the quar- ters of these first American nurses assigned to British bases. However, the British Government came immediately to the rescue and supplied the necessary articles for the American nurses both at No. 9 General Hospital and at the five other bases to which American nursing personnel had been assigned. Mrs. Whitelaw Reid, of the London Chapter of the American Bed Cross, sent each nurse articles of personal equipment, notably aprons. The practice of the British Army and the great need in the harsh climate of France for extra articles such as boots, sou'westers, ponchos and sleeping bags were im- portant factors in convincing the War Council that the Ameri- can Red Cross should issue complete equipment to nurses as- signed to active service overseas. Miss xVllison commented upon the comfort and cheerfulness of their newly-furnished quarters : They consisted of five long wooden buildings, each accom- modating eighteen nurses, and se\cral small canvas-covered Armstrong huts. The night nurses' hut or "red-curtained hut*' had crimson liangings cleverly arranged to shut out the light and to serve as partitions. In our cheerful living room, with its chintz-(C)vored wicker furniture, piano and ahundance of fresh flowers, afternoon tea was served daily. "Nurses' ^Niess,'' where we hreakfasted usually on sardines, bread, hutter, jam and coffee, was much more attractive than one might suppose from the bare wooden walls and cross-beam THE EUROPEAN WAR 447 ceiling. The floors were covered with plain brown linoleum. Eight large windows with pretty creton draperies and large white covered tables contributed much toward the cheerful appearance of the room. The nursing staff of Base Hospital No. 4 was reenforced in. July, 1917, by the arrival of additional nurses. A second detachment of seventeen nurses from Cleveland, Ohio, joined the unit in September of that year. When the rigorous winter set in at No. 9 General Hospital, patients, surgeons and nurses suffered from the bitterly cold weather. !Miss Allison wrote Miss Noyes January 7, 1918: Our water pipes have all frozen and for three days we had no water, except that which could be carried from a distance of a quarter of a mile. Our huts are only summer buildings and there is scarcely a room that the outside cannot be seen through many cracks in the walls. In the nurses' quarters we have provided oil stoves and in the mess hall we have two coal stoves. We are now on fifty per cent rations of oil, which means only a pint a day for each stove. Tliis provides only about two hours of heat for our rooms out of the twenty-four hours. During the warmest part of the day, the temperature in the wards varies from thirty-two to forty degrees. The nurses are suffering from chilblains. The work at Xo. 9 General Hospital followed the theory of military procedure as set forth in preceding sections. The wounded were carried on stretchers from the trenches to the nearest First Aid dressing station, which was located in as sheltered a spot as possible just back of the firing-line. After they had received treatment there, motor ambulances trans- ported them to the nearest casualty clearing station. These stations were located from four to ten mil(>s behind the first line trenches and usually consisted of four separate hospitals grouped near one anotlu^r, each with its own complete organization. Patients whose wounds showed upon examination that immediate attention was not imperative, were rushed at once to the nearest base; others recpiiring immediate aid or operation were cared for at once at the casualty clearing station by surgical teams composed of two surgeons, an anesthetist, two nurs<>s and two orderlies, sent up from the various base hospitals nearest the station. 448 HISTORY OF AMERICAN RED CROSS NURSING From the casualty clearing station, hospital trains conveyed the wounded sixty to one hundred miles to the zone of the base. Ammunition trains, however, had the right of way, so that the wounded were often completely exhausted upon their arrival. Rouen was the clearing center for eleven British hospitals in its immediate vicinity. Here the deputy director, Medical Service, received information regarding all incoming cases, allotted as many new patients to each of the hospitals in his zone as their free beds would accommodate and informed each base of the type and number of cases they might expect within a given time. The reception of patients was described by Miss Allison : When the ambulance trains arrived at the station, they were met by automobile ambulances, to which the wounded were hurriedly transferred and taken to the particular hos- pitals to which they were assigned. The main roadway was often lined for a distance of three or four miles with ambu- lances coming and going. The procession continued for hours. The convoy bugle call at the hospital announced the ap- proach of tlie ambulances. Old sight-seeing ears, such as we formerly saw in our cities before the war, were usually the first to appear and were filled with the walking wounded. These patients, assisted by those less seriously wounded or by orderlies, hobbled out and were assigned to regular quarters as "walking convalescent patients." The dressing of their wounds was done in a separate department. With the assist- ance of orderlies and convalescent patients, 300 dressings a day were often done by three nurses. The arrival of stretcher cases necessitated intense activity on the part of nurses and orderlies. Miss Allison continued: From the admission hut, the patients were quickly de- spatched to the wards, where they were carefully placed on the beds, over which convoy blankets had been spread. These beds were screened off and the orderlies bathed each wounded man. Hot liquid nourishment was then provided, though the patient often had to be awakened from the sleep of utter exhaustion. Nurses cut down all dressings for the inspection of the surgical staff. Scjine ))atients, who had lain in shell holes without medical attention, came with wounds infected with maggots; others were admitted who had lost both legs, while THE EUROPEAN WAR 449 still others were found with great pieces of muscle and flesh torn away by shell and shrapnel. . . . With eyes swollen and discharging, the body covered with blisters-and ai)parcnt (iisconifort in the respiratory tract, the gassed patients presented one of the saddest sights. They expectorated quantities of blood and nearly all were unable to speak above a whisper. In a single day, seven hundred came to our hospital. A ward often admitted as many as twenty new stretcher patients at one time. Two nurses were usually assigned to the medical service and perhaps three to the surgical division of each hut. One of Miss Allison's descriptions brings up the picture of another woman who sixty years before at far-away Scutari ministered to England's wounded: Nursing at night was extremely diflficult; few lights were permitted, owing to the frequent air raids. The night nurse inspected the dressings, going from bed to bed with a lantern shaded to prevent the light from being seen through the win- dows. One nurse detected eight hemorrhages in a single night. Xot one patient at this base has met death for reason of delay in recognizing a hemorrhage. One instance occurred where the life of a Tommy was saved by a nurse who made constant pressure with her bare hand buried deeply in the wound until assistance arrived. Evacuation of convalescents occurred almost nightly. Each patient was given clean linen, warm covering, fresh dressings and hot food before his stretcher was hoisted into an ambulance for "Blighty." But the closing of the Channel to clear it of mines sometimes disrupted this smoothly running process by which Enghind cared for the wounded coming back from Ypres, Hooge, Loos, Amiens and the Somme. Xever at any time was the work light at Xo. 9 General Hospital. Air raids added to the strain of crowd(>d wards and s(>('mingly endless convoys. Miss Allison described the bomb- ing of the British bases: '& As the firing lino drew nearer, we often experienced five successive night raids in one week. When notice of an ap- proaching ]ilane was received, the electric power was entirely shut off. Kven smoking and the use of torches was strictly 450 HISTORY OF AMERICAN RED CROSS NURSING forbidden in all areas. The wailing siren or pop of an anti- aircraft gun was usually the first signal. All nurses were required to dress quickly and remain in quarters as a protection from the falling shrapnel, until ordered to the ahris. Eouen was well fortified with anti- aircraft guns and they contributed deafening sound during a raid. Often we were obliged to go to the ahris dug for our pro- tection. Only twenty-five per cent of our personnel were issued trench or steel helmets. Those having none sought the use of water pails, wash basins or similar devices, as a head covering. Wlien we arrived muddy and wet in the trenches, there was nothing to do but wait, watch and listen. In look- ing above and around the city, we could see in the distance pairs of sausage balloons suspended at different heights in the air. Between each a cable was stretched, cleverly devised to catch the wings of a plane which, if entangled, would drop to earth. Amid the sound of the anti-aircraft guns we could distinguish the destructive roar of an exploding enemy bomb. Each plane usually carried six bombs, so it was comparatively easy to follow its general direction. Occasionally a rocket illuminated the ground for a wide area. At other times in- cendiary fires in the petroleum tanks, thought to be the work of spies, burned for twenty-four hours. Some nurses did not even have the protection of a water- filled trench. Night nurses and officers remained on duty through all air raids to assist in any emergency. Each hut was barricaded with sand bags which protected it effectively in case a bomb dropped between the buildings. The sand bags were of no use, however, in case of a direct hit. Miss Allison wrote that "it was surprising to find how little fear was felt during the apparent danger. One learned to become a fatalist and to hold oneself in readiness for any happenings." As increased activities in the zone of the advance made neces- sary the presence of additional surgeons, nurses and sanitary sol- diers in casualty clearing stations and evacuation hospitals at the British Front, mobile hospitals and professional teams were organized from among the personnel of base hospitals in the rear. Happy indeed was the nurse whose skill sent her forward to the line ! Miss Allison described this type of service : During the summer of 1917, ]\robile Unit Xo. 5, consisting of about ten oiricers, twenty nurses and thirty corpsmen, wui THE EUROPEAN WAR 451 temporarily detached from Base Hospital No. 4 for service nearer the front. Betty Connelly, of Cleveland, was chief nurse. This unit, with its complete equi])ment for a live hundred bed hosj)ital. was transported from place to place by trucks especially desi^Mied for the purj)ose. At one time this supplemented the bed capacity of an over-crowded hos- pital and at another maintained itself as an independent in- stitution near the firing line. Canvas tents were stretched over a steel framework, which not only held the structure securely, but offered the advantage of having no center posts which so often obstructed the pas- sage way. Each betl was apportioned a 15" x 15" window. The wards were connected by canvas-covered corridors, which also joined all necessary departments of the hospital. The sterilizing plant was made stationary on a truck which farmed one wall of the operating-room. Permanently fixed on this truck was a fire l)ox, a boiler and instrument and dressing sterilizer. A small room adjacent was fully equipped for the necessary X-ray work and permitted the patient being wheeled in on the operating-room table and out again. A laundry was also established on two adjoining trucks. On the one was the firebox, boiler, washer and extractor and on the trailer was the dryer with a small stove in the rear. Hospitals are primarily places of life and death. The work of caring for the dead was as inexorable as that of caring for the living. !^Iiss Allison described the burial of soldiers who died at ^^o. 9 General Hospital : At the far corner of the base was situated a small building in front of which was a mound surrounded by flowers and an ivy vine which climbed up over the windows. A narrow pathway led into a small mortuary. Against the white board walls rested a flower-decked altar. Many of our Tommies and American boys found here rest after the days of battle. Burial services were conducted in the small chapel within the cemetery grounds, livery after- noon rough cotlins were carried there u])on the shoulders of eight British or American soldiers and lowei-ed into a deep trench, three collins, one upon another. Often a single rela- tive had arrived from l"]nghind and stood alone in her grief except for the nurses ;icconi])anying her. The chaplain read tlie sim]ilt> scr\ice, tlie three volleys rang out and the cadeiu-e of the "Last Post"' came echoing sweetly back. The aching of those lonely hearts was usually too deep for tears. 452 HISTORY OF AMERICAN RED CROSS NURSING During the first twelve months in which Base Hospital No. 4 was stationed at No. 9 General Hospital, 82,179 patients were cared for by the Americans. The largest single day's work was that of March 27, 1918, when 1125 patients were convoyed in and out. Overlooking the English Channel, midway between Calais and the mouth of the Somme, lay the French village of Dannes Camiers, the destination of United States Army Base Hos- pital No. 5, organized at the Peter Bent Brigham Hospital and at Harvard Medical School, Cambridge, Mass. The second of the lied Cross base hospitals to go overseas, this unit has been termed both the Peter Bent Brigham Unit and the Second Harvard Unit. It will be remembered that the first Harvard Unit had been organized without assistance from the American Red Cross and had been assigned during the spring of 1915 to service at No. 23 General Hospital, British Expeditionary Forces. To avoid confusing Base Hos- pital No. 5 with the first Harvard Unit, it will be designated in this history, when its military appellation is not used, as the Peter Bent Brigham Unit. Dr. Harvey Cushing had organized this unit and was its director. Colonel Robert Urie Patterson, formerly chief of the Red Cross Bureau of Medical Service at National Head- quarters, was detailed by the Surgeon General as commanding officer of Base Hospital No. 5 after it was mustered into the Medical Corps and he led the unit into foreign service. Carrie M. Hall was chief nurse. Following her graduation from the Massachusetts General Hospital, ^liss Hall was superintendent for four years of the Margaret Pillsbury General Hospital, Concord, New Hampshire. She then entered Teachers College for a course in training school administration. In 1912 she became superintendent of the Training School of Peter I]ent Brigham Hospital, of Boston, and remained in this position until as cliief nurse she was ordered with the Peter Bent Brigham Unit into active service. The personnel of Base Hospital No. 5 mobilized in Boston on May C and sailed from New York five days later. Upon their arrival at Dannes Camiers on Alay '31, they took over No. 11 General Hospital, ]3ritish Expeditionary Forces, a well-established British ])ase of two thousand beds. In organization and in work, No. 11 General Hospital chjsely resembled the type of institution which has been de- THE EUROPEAN WAR 453 scribed in the section which recounts the experiences of the Lakeside Unit. No. 11 General Hospital was housed, however, chiefly under canvas. Of the ten thousand American nurses who served with the American and British Expeditionary Forces during the Euro- pean War, only three were wounded in line of duty. One of the three was Eva Tean Parmelee, a member of Base Hos- pital No. 5. She descrilx^d the air raid which brought the first mortalities to the Americans at Dannes Camicrs: On a bright moonlight Tiight, September 4, came our initial experience with bombs. It was 10:30 P.^I. and my two long tents were absolutely quiet. Our lights, controlled by a cen- tral switch, had no sooner winked out than the siren of tbe cement factory blew its air raid warning. ]\Iy orderly, Oscar Tugo, came running from his supper; 1 met him in the road in front of our two tents. Suddenly above us we heard tlie hum of tlie planes, saw a sputtering streak of sparks drop from tbe sky and Tugo cried out, "Why, they're here!"' After a deafening report, 1 found myself in the ditch. The choking, sulphurous smell and the noise made me feel as if 1 were being stirred up in a great bowl of reeking gunpowder. Four more reports followed and I said to myself : "We're done for they're wiping us out !" Then I heard the calls of the wounded : "Sister Sister !" I jumped up and flashlight in hand (for we clung to our lights) ran to the tent door. A glance showed the nearest man to be bleeding badly. Doctors, nurses and men with stretchers were arriving. ... I crossed over to the other tent and found the whole front section had been blown up, beds, lockers, floor and all. Not a patient was in sight. Though wounded, however, they were all living and had been placed in other wards. In the officers' quarters and the reception tent, seven of the command lost their lives and several were gravely wounded. Tugo, my orderly, had been killed. I escaped with two tiny face wounds and a black eye, though shrapnel had torn my skirt and apron and cut away my wrist watch so that only tlic strap remained. The Peter Bent Brigham Unit was transferred November 1, 1917, to Boulognc-sur-^ler to take over No. V] General Hos- pital, British Expeditionary Forces. Here during the spring and summer of 1!)18, th(\v shared the hard service which all the British hospitals experienced. 454 HISTORY OF AMERICAN RED CROSS NURSING On the great cliffs above the fretful Channel at nearby fitretat, U. S. Army Base Hospital No. 2, organized as the Presbyterian Hospital Unit, New York City, took over on June 10, 1917, No. 1 General Hospital of the British Expedi- tionary Forces. Dr. George Emerson Brewer was director of the unit. Miss Maxwell had organized the nursing staff but Janet Christie, her assistant, accompanied the unit as chief nurse when it was ordered into the field. Mrs. Christie was a graduate of the Presbyterian School of Nurses and for thirteen years had served in various executive capacities at this institu- tion. She was among the first hundred nurses who had been enrolled in 1905 in the American Red Cross. Etretat, the Hamlet of the Setting Sun, had been a favorite resort for artists and authors, because of the beauty of its cres- cent-shaped beach and its high cliffs overlooking the Channel. The many hotels and villas were requisitioned during the war for use as hospitals. No. 1 General Hospital was located in the Casino and in various hotels. A large private house formed an ofiicers' hospital. A newly-built villa, charming both in architecture and in location, was fitted up by the British Army as a home for sick nurses. During the German offensives of March-July, 1918, this hospital received between sixty and seventy British and Ameri- can nurse refugees. As the German lines were advanced, many of the casualty clearing stations and evacuation hospitals of the Allies were bombed and shelled completely out of existence. The nurses and surgeons had been working night and day to care for the greatly-increased numbers of wounded and when the lines broke under savage assaults of the enemy, the nurses fell back to Etretat in a state of almost total collapse. United States Army Base Hospital No. 2 sent forward operating teams during 1017 and 1918 for service at casualty clearing stations on the British Front. Anne Penland, who had been anesthetist at the Presbyterian Hospital, was sent up with the first team and held the honor of being one of the first, if not the first, inirsc auestlietists to go officially to the British Front. Major Darracli, of tlie Presbyterian Unit, was one of the surgeons to take up a team and he told tlie incident by which ]\Iiss Penland won the cr)nfidence of the British officers. When they arrived at the casualty clearing station, the British officer asked, 'p)Ut whct'c is your anesthetist T' Major Darrach indicated ]\Iiss Penland, a small, quiet woman. THE EUROPEAN WAR 455 "But often there are eight or ten patients at once, big chaps," expostulated the Britisher, ''And they struggle !" "Wait and see," promised Major Darrach. During a lull in the work which followed, the British officer came back to Major Darrach, praised Miss Penland's work and concluded, "But she always seems to draw the quiet, peace- ful chaps." "Come and see why," suggested the American surgeon. They approached the table where Miss Penland was anesthet- izing a broad-shouldered Tommy who seemed inclined to fight the ether. ^liss Penland loaned over and murmured soothingly: "There, dear, it won't hurt you a bit, there, there." At the sound of her low, distinctly feminine, southern voice, the Tommy looked up in surprise, then gxinned with perfect confidence and "went under" without a struggle. So success- ful was her work that the British decided to train their own nurses for this service and thus relieve several hundred doctors for medical and surgical work. Several hospitals in the Rouen and Le Trcport areas, among them Xo. 1 General, were chosen as training centers for these British nurses. Other operating teams were sent forward during the winter and spring of 1918. Twenty-three nurses of Base Hospital No. 2, with Jane Bignel as chief nurse, wei'e detached from the staff at Xo. 1 General Hospital at Etretat and were sent forward to the American Front to form the nursing staff of Mobile Hospital Xo. 12, American Expeditionary Forces. Xo. 1 General Hospital drew patients largely from the Third Army Sector of the British Front and evacuated them by ambu- lance through Le Havre. French, Italian, Colonial, East In- dian, Arab and Portuguese wounded, and American wounded after the First Division had entered the lines, found rest and care in the seven hotels which the British Army had ccjuipped as hospitals. The personnel of liase Hospital Xo. 2 were always busy. In transmitting a connnunication to Xational Headquar- ters, Mrs. Christie suinniari/.cd their work in a few words which p()int(>d to the most worth-while service that war nurses can give: "Our exjx'riciices w(>re not spcctacuhir in any way. We occasionally heard gims and got our warnings, but the greater })art of the tinie we simply had steady, hard work." Thongh the Preshyterian Fnit was located well Ix'hind the lines, both casualties from air raids of the enemy and death from overwork and exposure brought to its members a realization of 4.56 HISTORY OF AMERICAN JRED CROSS NURSING the sadness of war. Beatrice Mary MacDonald, a member of this unit, was the first American nurse to be wounded in the European War. She had been sent forward as a member of a detached team to ^o. 01 Casualty Clearing Station, near St. Sixte's Convent, Belgium. Seven surgical teams, five British and two American, were on detached duty here during July, 1917; the two American teams had been organized from the Presbyterian and the Pennsylvania units. Helen Grace Mc- Clelland, a nurse serving with the Pennsylvania team, de- scribed the air raid of which Miss MacDonald was a victim: Miss MacDonald and I had been relieved at 4 P.M., August 17, 1917, and were expected to report for duty again at twelve. We had been asleep and were awakened by the hum- ming of German motors. I looked at my watch to see if it were time to go on duty, but it was only 10:15 P.M. Then the bombs began to drop. We reached for our tin hats which we always kept hanging with our gas masks on the cot. I put mine on the side of my head and covered up again. Miss MacDonald was slightly raised on her elbow when two bombs struck the cook liouse nearby and a piece of shrapnel came through our tent wall and penetrated her eye; another piece struck her clieek. Two English nurses were also wounded and the nurse in the tent next to ours was thrown out of bed by the concussion. Our tent was about twenty-five or thirty feet from the place where the bombs struck. In the field alongside our compound, there was a row of five holes where they had dropped their bombs. Even with my eyes closed I had seen the flashes from the explosions. The concussion was terrific and things came fiying through our tent, tearing great holes out of it. The cook, who had just returned that day from leave in England, was blown to pieces. The officers, who had been in their mess tent when the bombs struck, came over at once, calling: "Are any of the Sisters hurt?" I answered, "Yes," and two of them entered with flashlights. ]\Iiss ^MacDonald was then placed on a stretolier and taken to the o]:)erating-tent for a more thorough examination. As there was an ambulance train on the track then being loaded for the zone of the base, she was put on it and it was ordered to Boulogne, the ophthalmic center. Although ]\Iiss ]\lacl)onald lost the sight of her right eye, she returned to duty at Boulogne and remained in service with her unit until two months after the Armistice. THE EUROPEAN WAR 467 Fourteen base hospitals served during the winter of 1917- 1918 in France; six of them were attached to the British Ex- peditionary Forces and eight to the American forces. All of the nurses found the rigorous climate and the heavy work a more severe test of their stamina than the bombs of enemy raiders. First one nurse and then another, among the staff of one hundred in each hospital, grew sick during the bleak winter months and here and there in the British and American bases, a nurse died and was buried with military honors. The fol- lowing account of the funeral of Amabel S. Iloberts, a nurse and a member of the Presbyterian Unit, was published in the Military Number (May, 1918) of the American Journal of Nursing: At 6:15 P.M. on Thursday, January 17, 1918, Amabel S. Roberts, reserve nurse, Army Xurse Corps. . . . Xo. 1, Gen- eral Hospital, fitretat, France, gave up the life she had de- voted to the service of others. Her illness, one of the most deadly of infections, had lasted barely three days. . . . The services were to be held at the Blanquet, the nurses' quarters, and in a moment the narrow street was choked with troops who formed in a long double rank on either side of the street leading to the gate. For fifteen min- utes the men stood at attention while the simple services were being held inside the Blanquet and then the leaden casket was brought out and placed on a stretcher carriage covered with flags. The carriage moved slowly down the street between the two ranks of men who uncovered their heads as it passed. As it reached the end of the lines, the files telescoped on them- selves and fell in behind. It was an impressive procession. . . . The masses of flowers that buried tbe casket flamed against the somber back- ground. . . . The dark blue uniforms of the nurses blended with the blue and leather of tlicse of the aminilance drivers and both were relieved by the flowing white head-dresses of members of the Y. A. Ds. And then came the olive drab as the officers marched past, heading the solid ranks of men in a long column of fours, with the horizoTi blue of th(> poilu.'i following. One felt sure, somehow, that she would have been glad to know that the poihis were there. Th(y were all wounded and some of them hobbled alone: on sticks while one or two gave an arm to a comrade who had risked his strength to come. . . . More khaki as the British marched and then the patients. Some of them wore uniform coats. Inii most of tlicm were in 458 HISTORY OF AMERICAN RED CROSS NURSING blues, that strange ill-fitting garb of the convalescent. After these came all Etretat, women and old men unfit for serv- ice .. . in clumping wooden shoes, some leading little chil- dren, the lame, the halt and the blind, the old and the weak, they knew of bitter experience and they could sympathize. It was not an impersonal sorrow that the French gave. They had known her. . . . Some of us have felt from time to time that in this old world we have found only a land out-worn, devitalized and cold, but as the funeral procession of our sister passed through the narrow streets between the rows of Xorman houses with their gabled roofs, that feeling changed and there was com- fort in the change. One felt a sense of sheltering protection, the promise of a mother old in the ways of pain, that she would care for that which we bequeathed her until such time as we could claim our own. Through the outskirts of the town the column went, past the old Xorman church with its strong, restful lines, and into the cemetery. There, beyond the civilian portion with its crowded tombs and quaint head stones, upon a little slope above the rest is a phalanx of black wooden crosses which mark the resting places of those who have died that a better world might come into being. Here the procession halted. A grave had been dug in the center, between the two larger plots. Far off in one corner of the cemetery lay a German, a prisoner of war, and one felt that in the great democracy of death, all war had been forgotten. At the foot of the grave stood Padre Johnston; at the head and on the upper side were grouped the nurses. Further up were the officers and behind them and extending down behind the nurses were the enlisted men of all nationalities. The sun shone warmly and a soft wind came up from the sea. Tlie beautiful service of the Church of England was read through. ... At last the pall bearers stood clear and the buglers stepped forward. Taps were blown for the first time in fitretat over an open grave. We had become so used to the "Last Post'' that we had almost forgotten the real beauty of Taps but now its piercing sweetness struck home. . . . "Go to sleep. Go to sleep." It was an end and a be- ginning. A plain wooden cross will mark her grave, a cross differing in nowise from the crosses which surround it, except in the name painted in wliite upon its arms. It was suggested that some more elaborate memorial might be fitting but surely none could fit so well. It is a soldier's cross for one who died like a soldier. THE ET ROPE AN WAR 459 No. 16 General Hospital, British Expeditionary Forces, was located at Le Treport, France, an hour's journey by motor from Dieppe, and was the destination of U. S. Army Base Hospital No. 10. The personnel of tiiis unit had been chosen from among the alumnse and the staff of the Pennsylvania Hospital, Phila- delphia, Pa. ])r. liichard H. Harte was the director and Marg-aret A. Dnnlop was the chief nurse. Miss Dunlop was a veteran in war service. The daughter of a Connecticut clergyman, she was educated at Normal Col- lege, New York City, and at the Presbyterian Hospital, Phila- delphia, Pa. For ten years she was assistant directress of nurses at the Presbyterian Hospital. She became Matron and superintendent of nurses at the Pennsylvania Hospital in 1009. Immediately following the declaration of war in August, 1914, the American Ambulance called her to Paris as chief nurse. Upon her return to the United States in 1916, she organized the nursing staff of Base Hospital No. 10. Her strong, ener- getic personality, her initiative and her ready humor made her admirably fitted for war nursing. The Pennsylvania Unit mobilized on May 6, 1917, in Phila- delphia and sailed on May 19 from New York with the St. Louis Unit on the S. S. St. Paul bound for Liver])ool. Miss Dunlop marshalled her nurses in orderly formations which would have done credit to a veteran sergeant of the United States Begulars. The nurses of tho unit were divided into different groups, each with its group leader who received all orders for the nurses in her section directly from !Miss Dunlop and who was responsible to ]\Iiss Dunlop for the promptness of the nurses of her section, for the appearance on time of the baggage and for all other matters which related to her section. "Never during the many days of travel," wrote ]\Iiss Dunlop, "were we hampered by unpunctuality or disobedience." The Pennsylvania and St. Louis units were the third and fourth branches of the American Army to arrive in London and the reception which the British gave them was cordial indcM'd. Hospitable Londoners took the nurses sight-seeing in tlie day time and asked tliem to the theaters every night. Pedes- trians noticed the nurses' uniforms on the street, stopped them to point out places of historical interest and insisted on taking them off to tea. One of the doctors of the Pennsylvania Unit langliingly said that "from the time the employees of th(> P(Min- svlvania Railroad cheered tlicni in -lersev Citv until their 460 HISTORY OF AMERICAN RED CROSS NURSING arrival in France, the whole journey was one long glorification for the nurses !" This cordial reception helped greatly to unify the British and American groups. ^liss Dunlop wrote that ''the period in London seemed to us at first a wonderful joy ride, but later the wisdom of the scheme was understood. It brought the American units who were to work with the Allies into a bond of kinship and good feeling which perhaps could not have been produced in any other way." The Pennsylvania Unit left London on June 8, bound for Southampton and France. They arrived at Dieppe at one o'clock in the morning of June 11 and found waiting for them British "chauffeurines" with their ambulances. The Americans were driven through the mud and rain to Le Treport and arrived at two o'clock at Xo. 16 General Hospital, British Expedition- ary Forces. Miss Dunlop wrote Miss Noyes that "the Matron was one of God's own ; she and her nurses turned out and gave us their beds. We were a sorry lot, without even hand lug- gage." No. 16 General Hospital was composed of eight low huts which comprised the nurses' quarters, thirty-six long brown- stained wards, nine huts and seven tents called barracks where walking cases were housed and numerous temporary buildings of the isolation department. As it was located in one of the most forward points of the British Zone of the Base, it was always busy. During the first week the Americans were in charge, the hospital with a staff of sixty-five nurses and eighteen members of V. A. Ds. received fourteen hundred patients, many of them heavy surgical and mustard gas cases. The gassed soldiers evoked the keenest sympathy. Miss Dunlop wrote : These patients were horrible pictures of misery. They poured upon us in ^reat numbers, six hundred in less than forty-eiijlit hours, and their suff{'rin,rs were pitiful to see, but their Ijraverv, unselfishness and fortitude stiffened up our own courage at tliis our first soul harassing introduction to the indescribal)](' liarbarity l)y wliich war is inflicted upon the individual soldier. l^)einor untrained to the handling of such largo numbers of wounded and not yet inured to the immen- sity of tlie work, it was a tremendous strain on the minds, hearts and bodies of the medical and of the nursing staff. Of necessity, the nurses liad many dressings to do. They soon grew ex])ert. Our jiatient's one answer, when we asked even THE EUROPEAN WAR 461 the desperately wounded if they were in pain was always: "Not too bad, Sister." During that summer of 1917, we had our baptism of horror and work, but after a few months the wliole unit settled down to the inevitable. As we grew more efficient in handling large numbers of wounded, we grew less fearful that we would not prove equal to the tasks demanded of us. Late in July, 1917, the surgical teams, each composed of a surgeon, an anesthetist, a nurse and an orderly of Base Hos- pital No. 10 were sent forward from No, IG General Hospital for duty in casualty clearing stations at the British Front. Helen Fairchild ^^ and Helen Grace McClelland were the nurses chosen for this coveted assignment. The team left the base at six o'clock on July 21 in ambulances driven by British ''chauffeurines." Their first stop was at Abbeville; they then proceeded on to Hesden where they spent the night at a hotel which had formerly been a hunting lodge of one of the Bour- l)ons. The V. A. D's. who drove the British ambulances were not allowed to go to the front, so the surgical teams proceeded forward the next morning with new drivers. Miss McClelland wrote : After we had left ITesden, the ambulance ahead of us had some tire troul)]e so we stopped on the crest of a high hill beyond the forests and saw miles away a puff of blue smoke from one of the big guns and knew before long that we would see some of the destruction and agony which they were causing. We had dinner at Steenwoorde. The town was filled with Belgian troops and we soon caught up on the road beyond with great numbers of Portuguese soldiers. From this point on, we saw more and more of the tremendous numbers of men and the vast amount of material which are demanded by war. Here were thousands of pontoon bridges for use in the drive to cross tlie Canal at Ypres ; here were British Tommies with that tired, questioning look on tlieir faces, that look which we saw later in the eyes of all those who had bitterly come to know, as the Tummies said, that ''a bit o' war was on."' Tlie trallic now became more congested and we were al- 1o\\(m1 to tra\cl only on certain roads. Poperinghe was being shelled at certain hours, but we found everything cpiict ^' Died in line of duly; s('(> Ajipciidix : Doccasod Xurses. 462 HISTORY OF AMERICAN RED CROSS NURSING there. We proceeded on to Proven and finally reached our station, near St. Sixte's Convent in Belgium. Miss Fair- child went on with her train to No. 4 Casualty Clearing Sta- tion, and I to No. (51 Casualty Clearing Station. The next afternoon ^liss ^lacDonald, of the New York Presbyterian Unit, arrived. From the way we greeted each other, the British sisters thought we were old friends, but we had not known of each other's existence until we met there at the front. Surgical teams usually went up to casualty clearing stations for duty lasting about forty-eight hours. The nurses cared for men injured in a particular drive and then returned to the base. They were, therefore, instructed to travel with as little baggage as possible. Five weeks passed before the American nurses were able to get more than the forty-eight hours' supply of clothing which they had brought with them. During these weeks, they did their own washing after they came oft" duty and hung it to dry on tent ropes. The commanding officer hap- pened one day to notice what was happening and sent a special car to the base to get additional clothing and the nurses' mail. Miss McClelland described the work at No. 61 Casualty Clear- ing Station: There were seven surgical teams, five British and two American, besides the regular staff of officers and sisters. Four teams were assigned to day duty and four teams went on at night until a "push" began, when the schedule was changed and the teams would work for twelve hours, go off for eight and come on again for twelve. There were five operating tables in a Nissen hut and two others in a large marquee. The two American teams were on duty at the same time and our tables stood next to each other in tlie liut. When the first big drive came on, no one felt like going off duty while the men were still pouring in on us. One day we worked for twenty-four hours, stoppiiig only for some- thing to cat. After cleaning up our tables, we went to bed at 2 A.M., 1)ut were back on duty at 4 A.M. for another twelve hour shift. We wlio were new to the front were greatly impressed at the efficient way in which the work was carried on (luring the drives. Those needing operation went directly to the pre- operatiug tent; those suffering from shock were sent to the resuscitation tent; chest cases to their section; officers to their tents. . . . THE EUROPEAN WAR 463 During a drive there were always ambulance trains on the tracks waiting to be loaded. Only the worst cases were brought into the clearing stations; the others were taken directly onto the trains, which carried a certain number of cot cases and a certain number of "walkers." As soon as its quota was complete, the train was sent down to the l)ase. Bairnsfathers' picture of a casualty clearing station, show- ing the men on stretchers, most of them asleep, is very good. Even those who were horribly wounded slept the sleep of utter exhaustion. 1 shall never forget those men; they never had a word of complaint. When you asked them if they were suffering much pain, they would answer: '^It's drawing a bit, Sister." When a lad would say to the doctor who was examining him, "Do you think it will be a Blighty, sir?" the hope in that boy's eyes made your heart ache, you knew how badly he wanted to get back home, away from filth, agony and destruc- tion for a little while at least. Miss McClelland and Miss MacDonald worked together at ^o. Gl Casualty Clearing Station until Miss ISIacDonald was wounded August 17, 1017. After the latter had been sent back to Boulogne, Miss ^fcClelland was the only American nurse at Xo. ()1. She wrote of the consideration which the British nurses showed her: As soon as Miss ^MacDonald left, our team began work again. I missed her a great deal and it was several weeks before another nurse from her unit came to take her place. The ^latron in charge of Xo. 61 was most kind and thought- ful to me. She would say every day : "Well, ]\Iiss America, haven't you had enough and don't you want to go back to your base? ... I learned to understand and love the luiglish. !My previous ideas of them had been formed purely from American history of the Kevolutionary period. I shall never forget the unselfish devotion of those British Sisters to their work and their kindness to me. In the meantime, the nursing staif at Xo. 16 General Hos- pital at Le Treport had been augmented on September 22, 1917, by the arrival of thirty nursc^s \nider the lead(M'ship of ^larie Kdcn. ]Miss Dunlnp wrote that "during tlu> winter months, t\\o intense work slackened, the armies sitting tight in the trenches with only desultory lighting, and the number of patients in the hospital ran down as low as eight hundred on 464 HISTORY OF AMERICAN RED CROSS NURSING one day." The nurses then turned their attention to the amuse- ment of their patients. After the Treaty of Brest-Litovsk had been signed on March 3, 1918, the German High Command came into possession of huge quantities of material and large numbers of men which could immediately be transferred from the eastern to the western theaters of war. As a skeleton for the new divisions to be formed from the troops released from the Russian frontiers, the German High Command withdrew from Russia all the soldiers betw^een the ages of twenty-five and thirty-five and formed them into aporoximately sixty new divisions of 12,000 men each. This gave the Germans on the Western Front a numerical increase of about 700,000 men. The German High Command selected for the initial attack the point where the British and French lines joined in Picardy, between Marcoing, near Cambrai, and the Gise River. The British had taken over this battle-front from the French at the beginning of the year 1918 and were endeavoring to hold a line of about fifty miles in length with the British Fifth Army, which totaled about 170,000 men. With approximately 750,000 men, the enemy struck a supreme blow here at five o'clock on the morning of March 21, 1918. The line broke and the Allied cause hung in the balance while the fresh German divisions the following days swept down along the road to Peronne and Albert, along the direct route from St. Quentin to Amiens and down the Gise River valley along two roads, one of which led to Paris and the other to the south of Amiens. On March 24, the enemy took Peronne and crossed the Somme; on March 2."), he captured Bapaume, Xesle and other villages; on March 26, he crossed the old battle-line of 1916 in several places and captured Xoyon, Rove and Lihon. The next day saw the first perceptible signs that the German advance was slowing up, but by the 28th of !March, the Germans had established a thirty-five mile salient towards Amiens, the British base of supplies. 8ome sixty miles directly south lay Paris. With the Germans eight miles from Amiens, the situation of No. 16 General Hospital became threatening. The big base was crowded with patients, the great majority extremely serious cases. On one niaht, when there were 159 patients on the "dangerously-ill list,"' an evacuation occurred which may well serve as a splendid example of modern medical and nursing skill. Miss Dunlop wrote: THE EUROPEAN WAR 465 . . . With 2200 patients crowded in the hospital, we were notified that a train wliith woukl bring down 320 patients w^oukl be expected to take away 300 others. This meant re- moving many ill patients from bed, placing them on stretch- ers and getting the beds ready for the incoming 320. At midnight with rain coming down in torrents, with the floors of the wards covered with the stretchers of tlie 300 outgoing patients, with orderlies filing in with the first newcomers, with the friends of the 159 dangerously-ill patients arriving from England and with the lights suddenly going out all over the camp, our wards presented a scene never to be forgotten. By the dim glow of lanterns, in this chaotic time when order seemed to be an impossibility, through the steady, quiet routine of officers, men and night nurses, the camp grew quiet, order was restored and the work was accomplished by three o'clock, a feat that would have seemed appalling to us the previous year. Things that seem to stand out in my memory of that night are the fortitude and bravery of the severely- wounded coming down ; the patient, uncomplaining attitude of the sick men suddenly taken from their warm beds and sent out into the rain ; the efficient handling of the numbers of patients by the men and the nurses; the quiet, repressed attitude of the friends of the dying. On March 21, 1918, Base Hospital N'o. 10 sent forward Casualty Clearing Station Team Xo. 28, of which Isabelle Stanibaugh was the nurse member. After a hasty evacuation of the team from jSTo. 32 Casualty' Clearing Station at ^[arch- clcpot, near Peronne, ^fiss Stambaugh was assigned for tem- porary duty at 'No. 42 Stationary Hospital at Amiens. Here on ]\Iarch 23, 1918, she was severely wonnded by a piece of shrapnel during an air raid. The attack was described by the officer in command of her team, Captain Edward E. Hodge, who wrote as follows : We went back to the hospital, Captain McTvenzie of the Canadian team with us, as we had learned that our nurses, ^liss Stambaugh and Miss Patterson, liad been working there since leaving Xo. ;52 Casualty (bearing Station on Saturday. We found tliem just leaving to spend tlie night in Xo. 3 branch. . . . Tht' first l)()inl)ing fliglit had been over and it seemed a good time to move. Tlie ^latron herself was going. While walking along a broad boulevard about half way to our destination, more bombers came over and dropped four bombs in our block. 466 HISTORY OF AMERICAN RED CROSS NURSING After we had extricated ourselves from the fallen glass and plaster, we found every one had a wound in leg or foot, except Captain McKenzie. At first we feared that he was killed, he was lying so quietly in the gutter. Later it appeared he was only stunned. An ambulance took us back to the place we had just left. The chaplain gave up his room to the nurses, whose wounds were the most serious, and we found a place for Captain Dillard in a ward. Major Hodge arranged for removal of our casualties by ambulance convoy next day to Abbeville. The nurses were later evacuated to England. . . .^^ Meantime in the Le Treport Area, orders had come for trans- fer of all patients at Base Hospital Xo. 10 to Rouen. Miss Dunlop wrote: This meant the evacuation of over ten thousand men in two or three days. As many of the patients had but small chance of living under the best of conditions, it seemed a heart-breaking thing to do. However, orders must be fol- lowed and irrespective of condition, they were sent back, though nine died en route. An order came at ten one morn- ing that forty-five nurses should be ready, bag, bedding and baggage by twelve o'clock to be sent out of the area. Fifteen under ^Irs. Eden were sent to the Cleveland T^nit at Rouen and fifteen under ]\Iiss Gerliard went to the St. Louis Unit also at Kouen and fifteen under Miss ^McXeal fell back to the New York Unit at Etretat. After much hurry and bustle and much excitement, not knowing whether we should meet again or what might happen during their absence, they got off. The remainder of the nurses were ordered to l^e packed up ready to evacuate with heavy baggage, light baggage or no baggage. Anxiety was in every heart but we made little out- ward sliow. Time went on and the Germans were held. After two weeks' suspense, a few patients were sent to us and we were told to carry on without equipment. Little by little more patients came, more equipment was opened up until we were running full capacity again. Our nurses soon returned and a new peace crept into our hearts. The tide had turned and tlie patients coming down were no longer silent. . . . Even the badly wounded seemed in the best of spirits. March 2G had been the decisive day of the Second Battle of Picardy. French rci'nforceincnts came up along the southern front and united with the British at ^loreiul. The same day saw the organization of a new British Army, under General " "TTistorv of the Pcnnsvlvania TToppital Unit iu the Great War," p. lin. Paul n. Hoebcr, New Surk. 1!I21. THE EUROPEAN WAR 467 Sandeman Carey. This Army was composed largely of laborers, sappers and engineers and it was flung immediately into the trenches to hold the gup made by the Germans. For six days, it fought over unknown ground, with officers in charge of men they had never seen before, until reenforcements could be brought up and the line made permanent. The action continued during the first week of April, but the Germans failed to smash the sides of the Amiens salient and the Second Battle of Picardy ended with the German plan in the main frustrated and the British and French still united in strong defensive positions. Out of the disastrous Second Battle of Picardy and out of the subsequent demoralization and almost complete defeat of the Allies came the unity of command of the entire Allied and American forces under ]Marshal Foch, for the first time in the European War, the Allies were in a position to present, in the words of Painleve, "a single front, a single army, a single nation . . , the program recjuisite for future victory." ^''* During July, 1918, the Pennsylvania Unit received its first American patients, men of Pershing's First Division, who had been brigaded with the British. From that time on. Base Hos- pital oSTo. 10 shared in the heavy work incident to the Allied oifensive. United States Army Base Hospital Xo. 21, organized from the stall' of the Washington University Medical School and several other hospitals of St. Louis, Missouri, arrived in Rouen on ffunc 1(\ 15)17, and took over Xo. 12 General Hospital, British Expeditionary Forces, a British base hospital which had been established in August, 1914, outside Bouen. The ancient city of Bouen was the center of the southern line of British base hospitals in France and the Rouen area supported fourteen hospitals and convalescent camps which maintained a total of twenty-five thousand beds for the British Expeditionary Forces. Ko. 12 General and two others of these bases, Xo. 1 Australian and Xo. 10 General, were lo- cated on the race track two miles from the center of the city. Xo. 12 General Hospital, which the St. Louis Unit took over, was the largest of this group. Dr. Fred T. Mur])hy, of St. Louis, was director of liase Hospital Xo. 21 and flulia (\ Stinison was chief nurse. ^lajor J. D. Fife, .MiMlical Gorps, Reguhir Army, was com- ^""A Rfforoiicc llistdiy ..f the War." T. S. (Jucrnsoy, p. ST: Dodd. Mead and Company, New \(irk City, 1!>20. 468 HISTORY OF AMERICAN RED CROSS NURSING manding officer. The original nursing staff of sixty-five mem- bers was augmented in August, 1917, by the arrival of thirty additional nurses and in April, 1918, by Hospital Unit '^D," which had been organized by the Red Cross in the City Hospital, Louisville, Kentucky. One hundred "casual" American Army nurses, sent overseas during the early months of 1918 for temporary assignment as need arose in British bases and evacua- tion hospital in the area between Boulogne and Trouville, had their headquarters at Base Hospital No. 21 and the records of assignment, the reports and the expense accounts of each nurse while on various assignments were kept there. British soldiers of the Imperial and Overseas troops con- stituted the patients of No. 12 General Hospital. The number of British wounded, light during the summer of 1917, increased swiftly during the Ulanders offensive on Passchendaele Ridge in October of that year. \Yhile the English Armies doggedly held the muddy Somme trenches during the winter of 1917- 1918, medical cases filled the wards. The German drive on Amiens in March, 1918, placed intense strain upon the nursing staff and Miss Stimson wrote of the heavy service : We were all so hard pushed physically that Major Murphy wired for help and we received a mobile unit from the Ameri- can Expeditionary Forces. The fifteen nurses were soon lost in the slniflfle. They were all young, inexperienced, little things from Kentucky, who had not seen a patient since they had landed. Some of them were only twenty-one years old, fresh from small hospitals. It seemed a heart-breaking thing to thrust them into this unbelievable hell of a hospital. . . . A little later I had occasion to go down the lines and I looked in one of the huts to see how one of the little new nurses was coming on. Just before I got to the hut, a pro- cession had come out of the door, two men carrying a stretcher covered with the I'nion Jack, then a second stretcher also covered by a flag, then our supervisor accompanying them to the mortuary. People along the line stood rigidly at atten- tion and sahitcd as they passed. I went into tlie hut. The odor was terrific, for most of the cases in this hut have pene- trating chest wounds which drain. The little nurse was standing by the stove stirring something in a cup. She was green-white and looked utterly nauseated. 1 did not dare to speak to her, for fear she would lose what control she had left.-o ^' "Findinj,' 'J'hcinsclvcs,"' Julia C. Stimson, pp. 215-210; The Macmillan Ci)., 1918. THE EUROPEAN WAR 469 In July, 1918, Mobile Hospital No. 4 was orp^anized from tlio personnel of Base Hospital No. 21 and went forward with the advaneing armies through the St. Mihiel and Argonne- ^leuse offensives of September and October. A unit of twenty n\irses with Ivnth ^Eorton as chief nnrse comprised the nurs- ing staff. Other nurses were detached from the big hospital on the race course and were sent forward for duty at casualty clearing stations. During the eighteen months that Base Hospital No. 21 served at No. 12 General Hospital, 21,543 patients were ad- mitted. Of this number only 288-3 were American casualties and they came from the 27th and 30th United States Divisions which were attached during September and October, 1918, to the British Fourth Army. United States Army Base Hospital No. 12, which had been organized by the American Red Cross from the nurses and surgeons of the Northwestern University Medical School and of Cook County Hospital, Chicago, was assigned to No. 18 Gen- eral Hospital, British Expeditionary Forces. Dr. Frederick Besley, attending surgeon in 1916 at Cook County Hospital, was director of the unit. Daisy D. Urch was chief nurse. As was true of many other women holding executive positions in the nursing profession. Miss Urch had been educated as a school teacher. For nine years she had been principal of a public school in ^lunising, ]\[ichigan. She en- tered the Illinois Traiuing School for Nurses in 1910 and after graduation was engaged in private duty nursing and later institutioiuil work at (\)ok County Hospital. Tliis history is indebted to h(>r for the reports which give the experiences of Base Hospital No. 12. ]\nss Urch wrote of the embarkation of the Northwestern Unit : The entire unit sailed Saturday, ^May 19, 1917, at 2 P.M. on the S. S. Mongolia. There were tlie usual precautious, no hghts. ])()at drill with life preservers, assignment to life hoats. lu spite of unrestricted suhuiarine warfare, every one was in good spirits. Sunday UKU'ning word went throu_irh the hoat that a gun drill would take ])hi(e at "2 l^^^. All ])asseiig(>rs assenihle(i on ih(> deck to witness it. a merry care-free grou]). War seemed remote, except fir tht> three grim guns on the MongoUa, silent and nni/.zlcd in the sunshine on i\w calm sea. 470 HISTORY OF AMERICAN RED CROSS NURSING A target was thrown overboard and the drill began. Sud- denly a defective shell exploded prematurely. Edith Ay res and Helen B. Wood were instantly killed. Emma Matzen received two serious flesh wounds. The nurses showed presence of mind and self-control; there was no confusion, no hysteria. Enough nurses to take care of the immediate situation helped carry our dead and injured into the nearest cabin. The others kept quietly out of the way. Instructions by wireless for the Mongolia to go back to New York to exchange the ammunition made it possible to send our dead ashore. Miss Matzen was taken to a hospital in New York and two months later rejoined the unit in France. The Mongolia sailed again on Tuesday, May 22. Except for a submarine attack at noon on June 1, the trip was uneventful. From London, the unit entrained June 11 for Folkestone, crossed the Channel and from Boulogne traveled by lorry to No. 18 General Hospital, British Expeditionary Forces, at Dannes Camiers. No. 18 General Hospital was located on a hillside in Picardy, within a quarter of a mile of the British base then being main- tained by the Peter Bent Brigham Unit, and was housed largely under canvas. Of its total capacity of eighteen hundred beds, only one hundred were placed in wooden huts. Units of four large tents, nuirquecs, grouped together to form a ward ac- commodating forty-four patients each, housed the balance. Both the tents and the huts WTre lighted by electricity, but running water was available only in the kitchens, operating- rooms and wooden buildings. A single telephone served for the entire camp. Cinder paths bordered by neat rustic fences led from one tent to another. The ''Swiss Navy" of the l^ritish Army, comparable to the Fatigue Squad of L'^ncle Sam's troops, kept the grounds in order, pruned the old-fashioned English rose bushes and cultivated extensive vegetable gardens. In the wards, the American nurses preferred Scotch orderlies because Jock made a more careful and systematic helper than did Tommy Atkins. The irrepressible British soldiers were, however, a constant source of annisement to tlu" American nurses. ]\[iss Urch gave in a re])ort bits of the dialogue between the laughter loving patients and nurses: THE EUROPEAN WAR 471 Tommy : "Sister, your brogue is rippin' !" Sister: "Oh, 1 thought it was you who had the brogue!'' Tommy: (after listening to a long dissertation on how to win the war) "Yes, you Americans will win, all right. You'll talk Fritz to death." From the records available at National Red Cross Headquar- ters, this general deduction may be drawn about the British sol- diers : they keenly enjoyed writing verse. This tendency may be attributed to the fact that they possessed either more natural talent for rhymed expression than did the wounded of other nationalities, or less reticence in showing the fruits of their ready pens. Miss Urch's report contained the following ex- ample : Who put me in my little bed. Then placed nice dressings on my head And "Have sweet dreams tonight," she said? The Sister! Who talks to me in cheery tones Till I forget my aching bones. Until I cease to utter moans ? The Sister! Who tries with all her might and main To make me strong and right as rain, That 1 may fight the Hun aijain? The Sister! The location of Xo. 18 General Hospital possessed many advantages. The sloping hillside afforded excellent drainage, the wards were well ventilated and the view, moreover, was one of great beauty. On one side were the sand dunes and the Channel, on the other, the orchard-studded hills and rich pasture lands of Picardy. In the winter, however, this location was less pleasing. The patients and the personnel of No. 18, housed under canvas, were mercilessly exposed to the cold winds and rain of the harsh Flanders climate. One gusty morning, a breeze came over the hilltop which threatencMl to blow the entire hospital into the sea. It carried away fifty-five tents, scattered tlu^ equipment broadcast and exposed tlu^ sick and wounded to the drenching 472 HISTORY OF AMERICAN RED CROSS NURSING rain. "In their zeal for their patients," wrote Miss Urch, "the nurses seemed endowed with superhuman strength. I saw one, single-handed, drag bed, patient and all over the rough ground to the nearest shelter." The location of No. 18 General Hospital possessed a second grave disadvantage, though the nurses were not prone to regard it as one. The big British hospital camp was only forty miles from the front and enemy aviators often visited it. Miss Urch wrote of the air raids : In the early spring of 1918, persistent disquieting reports of the Boche's intent to destroy our camp were afloat. Great preparations for such an attempt were made. "Ahris" in the shape of trenches were dug by German prisoners. The tents and huts were sandbagged. Special instructions were given as to what to do in case of a raid. Upon signal all helpless patients' beds were to be lowered to the floor by folding under the legs of each cot. One medical officer wrote in the order book, "Flatten all helpless patients." Other wounded, nurses and men were to go into the nearest dhri. One nurse stayed with her patients who were so tied up to frames that their beds could not be lowered. When the hum of Boche engines and machine-gun fire plainly indicated that they were over- head a Tommy with a fractured femur and one broken arm called, "Sister !" She hastened to his side. He pleaded with her to go to a place of safety. When she assured him she was not afraid, he tried with his one good arm to push her under the adjoining bed. Many of the nurses sat on the hillside at Dannes Camiers and watched the destruction of nearby Etaplcs. No member of Base Hospital No. 12 was, however, injured. Before summarizing the value of the service rendered by the six American base hospitals assigned to the British, it may be of interest to include a statement of the size and strength of the British military nursing service, both professional and volunteer. The official nursing strength of the British Empire during the World War was divided between three organizations : Queen Alexandra's Imperial ^Military Nursing Service; the Territorial Uorce Nursing Service; and Queen Alexandra's Naval Nursing Service. Florence Nightingale may well be called the first British Army nurse. Follov-ing her historic overthrow of military nursing traditions during the Crimean W^ar, the War Otticc THE EUROPEAN WAR 473 employed trained women nurses in the Boer War and in mili- tary hospitals at homo and abroad in time of peace. The Gov- ernment nursing organization in which these women served was called the Army Nursing Service. In 1902, the Army Nursing Service was reconstituted as Queen Alexandra's Imperial ]\lilitary Nursing Service under a Nursing Board of which the Matrons of two civilian hospitals and the ^latron-in-Chief of the (^ueen Alexandra's Service were members. The grades were Stali" Nurse, Sister, Matron, Princi- pal ^latron and Matron-in-Chief. Candidates were required to be within twenty-five and thirty-five years of age and to hold the usual three years' certificate of training, although the wording of this clause made this certificate not absolutely compulsory; a candidate might be admitted without certificate provided the ^latron-in-Chiof satisfied the Nursing Board that this applicant was fitted as regards education, character and social status for admission. Before Sisters could be promoted to the grade of Matron, they were required to pass an examination and to give practical evidence of administrative and teaching ability. Pen- sions were granted to nurses of the Service after twenty years' membership or at the age of fifty years. In time of war, the membership of the Queen Alexandra's Imperial Nursing Service was increased both by its own Reserve and by a Civil Hospital Ivcserve. Previous to the declaration of hostilities in IDl-i, the War Office had approached the civil hospitals throughout the Kingdom and had asked each institu- tion to employ a certain number of trained nurses who would also form a reserve for (}neen Alexandra's lni])erial Nursing Service. These nurses were called into the field in August, 15)14, and were later drafted into the otHcial Ivcserve. The Territorial Force Nursing Service was formed in 1910 primarily for home service in the twenty-three territorial areas of the British Empire. Nurses in each of these localities had pledged themselves to serve when their native territorial forces were mobilized. This nnister-roll was revised annually so that upon the outbreak of war, the members were ready for immediate mobilization. AVheii it was recognized during the first month of conllit-t that (^uccn Alexandra's Imperial Military Nursing Service^ was insuliicient in numbers to meet the de- mands that would be made upon it, the War OtHce permitted members of the I'erritorial Force Nursing Service to volunteer for foreign service. Many of them went abroad early in August, 474 HISTORY OF AMERICAN RED CROSS NURSING 1914, and their places at home were supplied by new recruits. The Territorial JSTursing Service was directed from the War Office in London and had its own Matron-in-Chief. It also had a Principal Matron for each territorial area, who was re- sponsible for the recruiting of the staff and for the conduct of all territorial corps which might be opened in her district. Queen Alexandra's Xaval Xursing Service was a small stand- ing service, with approximately a hundred nurses in times of peace. These Sisters acted as superintendents of nurses and trained corpsmen for sick bay attendants. This organization was augmented during the war. Dame Ethel H. Becher, G.B.E., R.R.C., was Matron-in-Chief of Queen Alexandra's Imperial Military Xursing Service dur- ing the European War. Her headquarters were located at the War Office in London and she worked in close cooperation with the Director General of the Medical Department of the British Army, Sir Alfred Keogh. Her position was one of dignity and power and at public and Court functions when visiting nurses were presented to Royalty, ]\Iiss Becher in her bonnet and scarlet cape was a commanding and picturesque figure. Dame E. Maud McCarthy, G.B.E., R.R.C., was Matron-in- Chief of the Q.A.I.]\LX.S., British Expeditionary Forces. She was considered a member of the Headquarters Staff and her offices were in close proximity to the headquarters of the Director General of the Medical Department, B.E.F. All orders for movements of nurses went forward signed by her and counter-signed by the Director General. She was furnished with a private car and in it she made supervisory visits from one hospital to another, but in the case of the six American base hospital units assigned to the British Army, she did not take up disciplinary or professional problems unless they were connected in some way to Jiritish Army regulations. In a letter dated ]\Iarch 1, *]018, to Miss Delano, Martha Russell, then chief nurse of the American Red Cross in France, wrote : The position of ]\ratron-in-Chicf, B. E. F., is one of great dignity and rosjxnisiljility. ^liss McCarthy's iiifiuenee is felt throughout the I)ritish Army, her lines of communication are clearly worked out and her opinion is considered final on all matters relatintr to the nursing situation. The British have maintained a hi,ir service for so long that they have outgrown nianv of the dillicnlties with which we are now struLTirlinLT. THE EUROPEAN WAR 475 On August 1, 1914, Queen Alexandra's Imperial Military Nursing Service had numbered only 468 ; its eifective strength on November 1, 11)18, numbered 7710 members, an increase of fifteen hundred per cent. The Territorial Force Nursing Service numbered in August, 1914, 2783 and in November, 1918, 5059, an increase of one hundred per cent. During the European War, 7710 regular members of Queen Alexandra's Imperial IMilitarv Nursing Service saw active duty, over 3000 of them at home stations and 2000 others in France. The remainder served at stations in Italy, Gibraltar, Malta, Saloniki, Egypt, East Africa, Mesopotamia and India. -^ The regular members of the Territorial Force Nursing Serv- ice on duty during the European War were distributed in proportionate immbers and in locations similar to those of members of Queen Alexandra's Nursing Service.-^ In addition to these 1:2,7()9 members, both the official nursing organizations for the British Army employed partially trained and untrained women whom the War Office designated as Mili- tary Probationers. They were recruited by the War Office and after a short experience in civilian hospitals, were assigned to assist IJritish Sisters in military establishments both at home and abroad. They totaled 10,897, over two-thirds of whom served at home stations."^ Including regular and reserve mem- bers of Queen Alexandra's Imperial Military Nursing Service and of the Territorial Forces Nursing Service, and including partially trained and untrained women employed in these or- ganizations, the numerical strength of these two governmental nursing services during tlie European War approximated 23.0(56 women. Miss McCarthy commented upon these mmibers : These figures deal with Queen Alexandra's Imperial ^lili- tary Nursing Service, (^)ueon Alexandra's Imperial Military Nursing Service liestTve. Territorial Force Nursing Service and untrained and partially trained women attached to the above c()r])s. The War Oflice was unable to give me any of the Overseas figures ami the Matrons-in-(diief have all re- turned to their Dominions. '''At tlic r('(|n('st (if tlu> Aiiicricaii I'crl ('i-os^ Xursiivir Service, llie Sii])er- intcndeiit of \hv Ari.iy Nurse Corps wrote to the Matrnn-in-C'hief of the Queen Ah'xaiidra's Imperial Military Xursini,' Service for these statistics, which were foiwanied ii\ D.nne McCarthy to .lulia C. Stinisou on Marcli tJ, 1!2(). 476 HISTORY OF AMERICAN RED CROSS NURSING The British Eed Cross had large numbers of nurses, both trained and untrained, in the United Kingdom and in many of the theaters of war.^^ The British military nursing system also included, a large service, both professional and volunteer, which was conducted by the British Red Cross. The trained nurses employed by this society were not members of the two official services, but did war nursing in hospitals and convalescent homes established by the British Red Cross and the Order of St. John of Jerusalem in England. In the matter of assignment of nurses, the British Red Cross and the St. John's Ambulance served in somewhat the same relation to the British Army Medical De- partment as did the American Red Cross in France to the Chief Surgeon, American Expeditionary Forces. At the outbreak of the war in 1914, both the St. John's Ambulance and the British Red Cross began to enroll nurses for work in France and Bel- gium. When the Joint War Committee, under which these two organizations were united for war service, came into existence, the two ^JvTursing Departments were put under one head and Dame Sarah Swift, late Matron of Guy's Hospital, was appointed Matron-in-Chief. A Principal ]\ratron, Nora Fletcher, was shortly appointed in France and all nurses pro- ceeding to France for service under the Joint War Committee were sent to her and were assigned by her to various hospitals and homes. -^ The requirements for services as nurses under the Joint Com- mittee were set forth in the Reports by the Joint War Com- mittee and the Joint War Finance Committee of the British Red Cross and the Order of St. John of Jerusalem in England: Rules for Xurses 1. You must liold a eertifloate of tlirec years' consecutive training of a (joiieral Hospital of not less than 50 beds and must be well recommended by your ^Matron. 2. Xurses not up to the required standard of training ob- tain posts as Staff Xurses at 40 per annum. (Staff Xurses, that is, tliose Avith two years" training, women's and chil- "Sce letter written bv K. M. McCarthy to J. C. Stimson on :\rareh G, 1020. " ."^ee Reports liy llie .Joint War C'ominiltee and the Joint War Finance Committee of tlie IJritisli T^'d Cross Society and the Order of St. John of Jerusah'm in Enfrhmd, ]r)]4-lf)19, pp. 80-84; Jlis Majesty's Stationary Ofhce, London, Erif'land. THE EUROPEAN WAR 477 dren's liospital and fever training, were paid at the rate of 40 per annum.) 3. Jf your hoaltii certificate and references are satisfactory, you will be registered on the list for either home or foreign service. For foreign service, a good knowledge of French is desirable. All nurses must be equally willing to serve on night or day duty at home or abroad. 4. If you are acce])ted, it will be necessary for you to lie inoculated against enteric and also to be vaccinated, if not done within the last seven years. 5. You will be required to sign an agreement to serve in a home hospital for a period of six months at a salary of one guinea per week, insurance, outdoor uniform, laundry at rate of :2s. (id. ])er week (unless otherwise provided) ; travel- ing expenses from London, board and lodging will also be provided. You will be lodged at a hostel between engage- ments. C). Y'ou must pro\ ide your own indoor uniform, blue cotton (or use what you have) and when on duty must wear the badge, which, will be jjrovided. [Here follow further details regarding salary, sick leave, ai)plication forms, etc.] -* After the candidate had filled out the "Form of Application," she was required to apjx^ar l)ef()rc a Selection Board. After a personal interview, her references were looked up and if she had passed all recpiiremcmts satisfactorily, she was engaged by the ]\latron. At this time, each nurse was given the option of signing a contract. Trained nurses to the number of Ol^S served during the European War under the tFoint Committee of the British Bed Cr(xss and the Order of St. John, 4730 of them in home service and the others in liospitals in France, Belgium, Egypt, Bussia. Siberia, Serbia, ^Montenegro, Boumania, Italy, Holland and Salonica,"'' In ('(tnipnrisou to the American Tied Cross Xursiug Service, it is interesting to note that 30,") of this total number of (H.^iS w(^re assigned to the Queen Alexandra's Imperial ]Mili- tary Xursiug Service.-'' The greatest numerical strength of the British Bed Cross Xursiug Sei-\'i('e wiis found by tli(> (Miipb^ytuent of nursing members of Voluntiiry Aid I )etaelinieiits. lu order to ])rovide ])ersoiinel to supplement the military me(lical organization of -' Ucpnrt of till' .loiiit War I'dininiltcc, pp. S4-S"). - lbiral Pershing had brigaded with the French troops, might be cared for by =H>ottcr written li\- Ciirrii' M. Hall. Sciitcnihcr "iO, 10:21. to tlic author. THr: EUROPEAN WAR 485 American nurses. As these several types of assi of the base. T)nrin<2; the first ei hospitals of the American F]xpeditionary i^orces along this line of communications. He assigned the first base hospitals to Bazoillcs, Chaumont, Vittel and Contrexeville as forward centers of the zone of the base ; to Limoges, Dijon, Vichy and Savenay as bases in the rear; and to Bordeaux and St. Nazaire as embarkation centers from which sick and wounded soldiers were to be returned to the United States. In difficulties met and in accomplishment, the experiences of the first eight American base hospitals in France were so nearly identical that a detailed picture of the first units will serve for all. In collecting the source material for this section, Xational Headquarters sent a request, oftentimes repeated, to all chief nurses of base hospitals, asking them for a sunnnary of the exiKM-icMicc^s of their units. Some of the chief nurses failed to respond : others sent in reports of unusual interest and marked liistorical value. In excerpts from these reports, to be quoted later in this portion of this history, may clearly be seen the general jiolicies of the ]\redical Corps in France. The effect of these policies upon the nursing situation in the United States will also be set forth. United States Army l^ase Hospital Xo. 18, organized at Johns Hopkins llospiral, Baltimore, Md., landed with the First Division of American tr()()])s at St. Xazair(\ June 2S, It' 17. The Xa\'y collier CijcIdjis, \\\v cruiser ('h(irh'sti)n and the transpoi't /^nihtm/ , oii wliicli the Hopkins I'liit sailed, in a zig- zag ])ass;ige of foMiieeii (hiys had dodgcil (iernuui r-uhniai'ines 486 HISTORY OF AMERICAN RED CROSS NURSING which were on their mettle to catch the first American con- tingent. l)r, Winford Smith had organized Base Hospital No. 18, but the Surgeon General claimed his services at Washington, Dr. John M. T. Finney led the unit into the field. Bessie Baker was chief of the sixty-four nurses and of a second unit of thirty- seven "casuals." Miss Baker was born in Maryland. Follow- ing her graduation from the Robert Garrett Hospital for Chil- dren in 13altimore, she entered the School of Nursing at Johns Hopkins Hospital. She later became assistant superintendent of nurses at the Women's Hospital in Baltimore. She returned to Johns Hopkins in 1912, as first assistant superintendent of the training school. Although much of her life had been spent in ]\Iaryland, her brisk humor, reflected in her twinkling brown eyes, her energy and her enthusiasm called to mind the Western rather than the Southern temperament. Miss Baker described the reception of Base Hospital No. 18 at St. Nazaire: During the afternoon we received a visit from the general then iu command of the Medical Corps of the American Expe- ditionary Forces [General Bradley). He remarked that up to twenty-four hours before he had not been aware of our existence, much less our expected arrival. An immediate survey of the surrounding country was necessary, if he was to find a place whereon we might lay our heads. The following morning brought the parting from the 18th Regiment, our companions of the voyage. It was hard to say the last word. IMany of them we knew we should never see again, unless they were brought to us wounded and miserable. To their cheers, we filed down the gang-pbank to the station and entrained for the village of Savenay. The quiet peaceful- ness of tliat first glimpse of the French countryside, with its old windmills and charming peasant homes! The wild flow- ers were riotous, crimson poppies, purple heather, yellow and white daisies. Until war made it a garrison of hospitals, the little village of Savenay, located on the orchard-covered hills of Brittany, had led a drowsy and peaceful existence. Tlie personnel of Base Hospital No. 18 was tcnnporarily assigned there until a permanent hospital could be secured for them nearer the front. U])on tlie arrival of tli(> unit at Savenay, the jiurses were billeted in a dorniitorv of a larm* normal school for bovs. THE EUROPEAN WAR 487 The democracy of field service soon established itself. "In our single public wash-room," wrote Miss Baker, ''high and low, those who had 'run' hospitals and those who had been 'run,' scrubbed crepe garments side by side." Miss Baker's report contained the following description of Army "chow" : On our way over, we had inwardly pitied the enlisted men with the tin plates and knives and forks and the long wooden tables. First mess-call at Savenay told us that we too were in the Army. There was war bread in heavy slices, there were onions and bacon. Heavy tin-ware adorned our cloth- less table and backless benches supported us while we fed. How we laughed ! Unless you sat near the end of the bench, you had to be a high stepper and bop over. Black coffee came around in huge galvanized buckets, which we drank humbly from receptacles ranging from a pint tin cup to a quart capacity dish-pan. Onions were witli us morning, noon and evening. What we could never puzzle out was why we were destined to eat in a few weeks all of that delectable dish meant to serve the entire American Army during the period of the war. Fifteen of the thirty-seven nurses who had come overseas with the Hopkins Unit were ordered back to St. Nazaire on July 5 to staff a small hospital which the French transferred to the American Army. Here were received acute cases of the infectious diseases that had attacked troops of the First Di- vision on their way overseas. This hospital, first known as United States Army Hospital Xo. 1, American Expeditionary Forces, was later designated as Base Hospital Xo. 101 and as such functioned until the end of the war. Members of the medical and nursing staffs of the original Johns Hopkins Unit who had been detailed to St. Xazaire, were returned to Base Hospital Xo. 18 before winter. The nurses and surgeons waiting at Savenay for the com- pletion of the hospital which they were soon to occupy, spent the days in attending French classes and in drilling. The routine of Army life and the discipline of divisional training sometimes proved irksome. Miss Baker wrote of these experi- ences early in July : It was bard to go to ])ed at 10 P.^f. when the sun liad just slipped below tlio horizon. From our back windows, tlic coini- trv stretched lazilv awav in tlic distance. Far below ifleanieJ 488 HISTORY OF AMERICAN RED CROSS NURSING the lights of St. Xazaire. The green vineyards sloped to the river Loire and on every hillside the quaint old mills now turned leisurely at their task, now stood silhouetted against the pastel sky, with a wee crescent moon and a lone star standing guard above. Xever could we have imagined a scene more symbolic of peace than this, our first experience of war. As the days rolled on, we struggled with our hopelessly poor drills. In vain did the Major endeavor to make us military women. He finally gave us up in despair. Many mornings, however, we spent in the old hay fields watching the men mop and drill and drill and mop in the hot July sun. The sky- larks flitted up into the blue sky and an occasional Zeppelin hovered in the distance far beyond us. . . . After a month at Savenay, the personnel of Base Hospital No. 18 entrained for their permanent quarters. Miss Baker wrote of the trip across France : Every inch of this wonderful country seemed under culti- vation. Hillsides were covered with vineyards. Buckwheat, rye, red clover, yellow mustard, asparagus and alfalfa car- peted the rolling country. Quaint little villages peeped out from the valleys or topped the hillsides. We left the windmills behind us overnight and came to great hillsides of rock, with houses dug out of them. We passed groves of chestnut and willows and stately spruces, "fox-tail" and oak. The poplars lined the fine white turn- pikes and, like tall sentinels standing on guard for miles and miles, crowned the crests of the distant hills. They arrived July 26 at Bazoilles, a village of two hundred inhabitants, situated on the headwaters of the Mouse Biver, in the Department of the Vosgcs. In this little town, the chateau and out-buildings of a private estate, supplemented by barrack- like wooden wards, had been made into a hospital of one thou- sand beds. Tliose buildings woro located on both sides of an avenue which stretched up a hillside. The avenue was roofed ov(>r and enclosed and through apertures in the sides, the nurses saw below them as they went to and from the wards, a beautiful valley threaded by small streams and beyond the foot- hills of the Vosges. Base Hospital Xo. 18 received its first patients on July 31, 1917; it served as a camp hospital during the summer for sev- eral divisions of American troops then in training in nearby THE EUROPEAN WAR 489 areas. The work was light, so between assijn^ments to duty the nurses had long intervals of leisure which gave them op- portunity to go on sight-seeing trips. Some of them went to Xenfehateau, four miles distant, others to Domremy which Miss Baker described: The valley blazed in a shimmer of blended color, the wild mustard tawny in the sunlight, the winding Meuse, the meadows bright with daisies, gentians, poppies. ... In that hnml)le chamber where Jeanne d'Arc first saw the light three hundred years ago, I could not help thinking today of the thousands of women, French, English, American, going to war for France, though not to the fanfare of trumpets that cheered the Maid to Orleans and Kheims. The rainy season set in about Bazoilles towards the end of September. The American troops were vinaccustomed to tho excessive dampness and the medical wards of Base Hospital No. 18 were soon filled to capacity with patients suffering from colds, sore throats, bronchial ailments and pneumonia. A nurse of the Hopkins Unit wrote of her charges: They are mostly l)oys from little towns and from every walk in life. On a ward of ten, we have an Irish policeman; an Austrian ])arl)er; a Philadelphia steam fitter; a marine with an Irish mother and Italian father; a trap drummer from the movies of Chicago; a big six-foot farmer boy from Xew England; a lad of fifteen years who ran away from school in Indiana; a ])resser from a tailor's establishment in Ohio; and a farmer from ^lissouri. So it goes, often a college man next to a tramp. To us they are just sick and lonely boys, whose life we could make a bit more cheery. The winter came early in Xovember with raw winds and clinging fogs. Eack of fuel accentuated the discomfort which tli(> prohmged (l;nn])ness ju-oduced. U]:)on their arrival at Bazoilles, the Americans had been told grim tales of patients who had been found frozen to death in bed the winter before. ''There came a time," wrote ^liss Bak(>r, ''when we began to f(H'l that there niiglit be some truth in these stories." On many occasions when she was making "rounds'' in the nurses' quar- ters, ^liss leaker would come u})(Ui a nurse who had been obliged to leave her duties in the wards, go to her rocun and sit with her numbed feet in ice water to relieve their aching enough to permit 490 HISTORY OF AMERICAN RED CROSS NURSING her to go on with her morning's work. "There was talk," con- tinued Miss Baker, "of starting a Chilblain Club, but such rivalry for the presidency arose between one of the surgeons and the assistant chief nurse that it had to be abandoned." Lighting also offered difficulties. The nurses were expected to provide their own lamps, but no sooner had they secured them than the kerosene gave out. As it was too cold to sit up, the nurses retired to bed to read by the light of a single candle stuck with tallow on the head of their cots. The picture suggested by Miss Baker's descriptions, of a shivering, blue-lipped woman wrapped in sweaters, ulsters and blankets is indeed a true picture of the American war nurse as she appeared many times when off duty during the harsh French winters. Of the work of the Hopkins Unit, Miss Baker wrote : Day by day our wards filled up rapidly with soldiers. At the same time the nurses began to fall ill in large numbers. We started with an eight hour day, but with many patients on the wards and sick nurses in the infirmary, the periods we spent on duty became as many hours as one could stand. At no time did the nurses work any harder than during these cold, dark days between Xovember and January, 1918. But the joy of being there ready and waiting to give to our incoming patients the comfort that good nursing alone will bring to a sick man ! Here we meant mother, sister and sweetheart to those shivering, lonely, homesick boys. What confidences we received ! One youngster, just a wee lad, told his nurse that if he ever got back to his mother she wouldn't have to beg him to eat the pie she had baked for him. On a dull, gray Sunday afternoon early in Xovember we received our first American wounded, the victims of that first Frencli raid, 16tli Infantry bovs who had been holding the Toul Sector. In commenting on the many delicacies with which the nurses supplemented rations for the soldiers. Miss Baker wrote: How like ]\riss Xiglitingale's experience with regard to diet, entertainment and many other mcidents, was our own I "Preposterous luxuries I'' one of the old doctors of her day contemptuously called the results of her herculean efforts fo furnish an adequate diet. To have recreation huts and the additional comforts and dainties which the Ked Cross and the nurses supplied the soldiers may have been "spoiling the brutes"' in the Armv vernacular, but it undoubtedly saved the THE EUROPEAN WAR 491 morale of our soldiers in 1917 and 1918, no less than Miss Nightingale's efforts in the Crimean War. One conunanding officer of Base No. 18 remarked: "These men don't need all this female nursing, they haven't been accustomed to it !" While we sat swathed in blankets around those miserable little French stoves and breathed upon our numbed fingers and waited for the monotonous hours to drag by, we nurses tried to puzzle out the meaning of war, of those sick boys on the wards, of our own ridiculous plight. We couldn't get very far with most of our discussions, but there was real comfort, to us at least, in one doughboy's words : "The last thing I knew, I was out and over the top. ... I opened my eyes and there above me was a nurse with a small lied Cross on her cap. 1 just turned over and went to sleep, because I knew then that everything would be all right." The New Year brought better times for the overworked nurses of Base Hospital No. 18. The medical and nursing staffs were supplemented in January, 1918, by the arrival of Hospital Unit "A," organized by the American Red Cross at the Presbyterian Hospital, Philadelphia, Pa. Katlierine Liddle, of Wilkinsburg, Pa., was chief nurse of the twenty-one nurses who composed this unit. Toward February the weatlior at Bazoilles changed from penetrating dampness to sharp cold ; and nurses and doctors alike found relaxation in winter sports. Organized recreation was developed by Oolali ]]urner, a secre- tary of the Young Women's Christian Association, who arrived in February. William Prescott Wolcott, the Red Cross repre- sentative at Base Hospital No. 18, succeeded in securing a nurses' recreation hut. A small nurses' infirmary, which later drew patients from surrounding posts, replaced the bare wooden barracks in which many Hopkins nurses had spent days of sick- ness during the winter. During the early spring of 1918, the American Expedition- ary Forces first shouldered the heavy responsibilities oi lutlding a portion of the Western Front. The entranc(> of American soldiers into the French and British trenches made necessary the assignnuMit of American professional teams to the /.on(> of advance to care for tlic AiiKU'ican casualties wliicli would inevitably occur there. These teams, tisually eompos(>d of two surgeons, an anesthetist, two nurses and two orderlies, were organized from among the personnel of base hospitals in the 492 HISTORY OF AMERICAN RED CROSS NURSING rear and were sent forward for temporary duty in evacuation, mobile and field hospitals. The nursing strength of Base Hospital I^o. 18, at times en- tirely inadequate to cope with the volume of work in their wards, was further reduced by the formation of these surgical, splint and shock teams. These units were often absent from the base during some particular drive, just at the time when the greatest number of patients wore being sent to the base hospital, and the depleted staff of nurses at jSTo. 18 were sorely overworked on such an occasion. The "gas convoys" were par- ticularly distressing. One night after eleven o'clock, ambu- lances discharged over two hundred and fifty blindfolded men, dressed in torn and dirty horizon blue uniforms, some of them stumbling along with their hands on their buddy's shoulders, others quiet on stretchers. "We thought they were French," a Hopkins nurse wrote in her diary, "but they proved to be our own men who had been brigaded with the French, gTcat stal- wart chaps now groping their way like small children, blinded, the tears running down their cheeks, their faces blistered and burned." Of corridors and pre-operative rooms crowded with wounded, Miss Baker wrote : As the long line of stretchers continued to be moved in hour after hour, each one holding what seemed to be a case more helpless than the last, we could only pray for the end of such brutality. As we went around the wards, stepping over the stretchers^ bending down to the floor with a hot drink, or with a match to light a cigarette for an armless man, we were almost ready to cry "quits"' at any cost. How savage, how inexpressibly futile has become this li2:ht valuation of human life ! One of the early projects of the American Red Cross in France was the establishment in the Vosges of a dispensary service for the benefit of the civilian population. The aims and general nature of this service was described by Ruth Weir, an American Red Cross nurse assigned to duty at Xeufchateau, the headquarters : In Xovember, 1917 . . . I was assigned to the American ^ledical Service for the civilian population, which had its headquarters at Xcufchatcau. I'liis service, whicli was de- veloped under Colonel H. TI. Young, chief neurologist of the American Expeditionary l-'orces, had two great ends, to aid THE EUROPEAN WAR 493 the poor people deprived of medical care and to prevent epi- demics in localities where our troops were billeted. The work was carried on in dispensaries located in all the outlying villages. A doctor and a nurse visited these dis- pensaries every two or three days and called on very sick peo- ple in their homes. In this way we successfully uncovered stray cases of scarlet fever, meningitis, diphtheria and other diseases and treated them, thus nipping in the bud the spread of contagion. Later on we had a perfectly-equipped hospital at Neufchateau where patients requiring special care and surgical cases were treated. From the moment of its opening, the sixty beds of this hospital were always occupied. The people flocked to us for treatment and also, it must be con- fessed, to hear les Americaines speak French. They were most grateful and loaded us with kindnesses. The second American Army base hospital to arrive in France for service with the American Expeditionary Forces was No. 15, organized by the American Red Cross from the alumna? and staff of the Roosevelt Hospital, New York City. Mary L. Francis, a graduate and assistant superintendent of nurses of the Roosevelt Hospital, was chief nurse. The Roosevelt Unit arrived in France early in July, 1917, and established a base hospital of three thousand beds at Chau- mont, in the Department Haute-Marne. During their first four or five months of service, they cared largely for French wounded, but later American sick and wounded soldiers came to them from all the surrounding sectors.^'* Bordeaux, destined to become the principal southern hospital center of the United States Medical Corps in France, was the destination of United States Army Base Hospital No. C, the third of the Red Cross columns to be called into active service with the American Expeditionary Forces. This unit took over late in July, 1917, VHopital Complementaire No. 25, in the Lycee dc Talence, situated in a beautiful park outside the city. Base Hospital No. 6 had been organized at the ]\rassachusctts General Hospital, Boston, Mass. Sara E. Parsons was chief nurse. ^liss Parsons was a graduate of the I^oston Training School of the Massachusetts General Hospital. After long executive experience in various New England institutions, she rounded out a broad education gained in this institutional work "Mention of the activities of the lloosevolt I'liit is necessarily liritf. because at the writing of this history Miss Francis did not have access to her papers and data regarding tlie experiences of her unit. 494 HISTORY OF AMERICAN RED CROSS NURSING and by foreign travel, by post-graduate training at Teachers College. She was in 1U07 and 1908 superintendent of the Shepard Pratt Hospital of Baltimore and in 1909 returned to the ^lassachusetts General Hospital as director of the Boston Training School. She enrolled in the Red Cross Nursing Service in 1910. She was a woman of practical and energetic temperament, with snapping gray eyes and a strong mouth, which bespoke humor and fearlessness. The nursing staff of Base Hospital No. 6 arrived at Talence on July 29, 1917, and were immediately installed in wards from which wounded Senegalese and French soldiers had been evacu- ated. The first patients to come to the Massachusetts Unit were sent in September from the nearby training areas of the Ameri- can Expeditionary Forces. Hospital Unit ^'0", of Charlotte, North Carolina, arrived March 10, 1918, at Bordeaux to reen- force the nursing staff. Heavy work for Base Hospital No. 6 began the following July and continued until the end of the war. On November 11, 1918, there were 4319 patients in the hospital with ninety-nine nurses on duty, an average of forty- four patients to each nurse. Miss Parsons wrote of the out- standing features of the life and work of the nurses during their eighteen months in the field : A universal enjoyment of actual bedside nursing character- ized the attitude of the nursing staff. Although thirty-eight of the original unit of sixty-four nurses had held executive positioiis before joining Base Hospital Xo. 6, they were al- ways glad to take subordinate positions where they could work directly with the patients. Xever did our nursing staff suffer from too many executives, a complaint of some other units. Nor were the nurses too tired or too busy to do extra kind- nesses for the patients. The hours off duty were spent mak- ing candy, pies, ice-cream for the boys. . . . ]\rost gratifying was the spirit of motherliness which pervaded the atmosphere and the respect which the nurses commanded. To sum up my impression, the advantage of knowing one's personiiel is tremendous, both from a professional and a physical ])oint of view. Some of our most valual;le women will do excellent work in an understanding and sympathetic environment, but could Jiever stand the strain in an uncon- genial situation. Dijon, below Chaumont in central eastern France, was the next hospital center to be established during the early summer THE EUROPEAN WAR 495 of 1917. In this city, United States Army Base Hospital No. 17 on July 29 took over from the French military authorities I'llopital Temporaire No. 77. This fourth Ked Cross unit to see service with the Ameri- can Expeditionary Forces in France, Base Hospital No. 17, had been organized at the Harper Hospital, Detroit, ^lichigan. Emily A. McLaughlin was chief nurse. Miss McLaughlin was educated in convent schools of Brooklyn and Detroit and was graduated from the Farrand Training School, Harper Hos- pital. During the Spanish-American War, she served at Lex- ington, Kentucky, at Columbus, Georgia and at Matanzas, Cuba. She remained in military service until November, 1901, when she returned to the Farrand Training School as night super- visor. In 1909, she became principal of the training school there and remained in that capacity until she was again called into military nursing as chief nurse of l^ase Hospital No. 17. The Harper Unit arrived at Dijon on July 29, 1917, and was, with the exception of an American bakery, the first branch of the American Expeditionary Forces to invade that ancient city. A French military hospital, VHopital Temporaire No. 11 , was assigned to them. The main building had formerly housed the School of St. Ignate and was a four-storied, ell-shaped structure. Fourteen wood(!n barracks of from thirty-tlve to forty-five bed capacity were later erected immediately behind the larger building. The normal capacity of Base Hospital No. 17 was eighteen hundred beds, but it was capable of an emer- gency expansion to two thousand beds. The nursing staff was billeted in houses located in various parts of the city. As was the case with the surgeons and inirses of other base hospitals assigned to the then embryonic American Expedition- ary Forces, the personnel of the Harper L^nit experienced at first the tedium of having too few patients to occupy their time. L'nits of inirses were sent early in August to Paris to help out at the American Ived Cross dressing station, whicli was then drawing on American bases for personnel. Others were ordered to an American hospital at liis Orangis to observe^ surgical methods. On several occasions those at Dijon assisted in serving hot food to the French hi esses as their hospital trains passed thi-(tugh the city. During the summer, however, tlie Ititli iMigi- neers and later the big (^imoufhige Camp, the United States Army Liiboratory and the iirst training bilh'ts of tlie >2nd Division wt're situated lu'ar Diion, and these branches of the 496 HISTORY OF AMERICAN RED CROSS NURSING American Expeditionary Forces sent many medical and acci- dent cases to Base Hospital No. 17. Hospital Unit "S," of l^ashville, Tennessee, of which Kath- erine G. Sennott was chief nurse, arrived at Dijon in February, 1918, to reenforce the nursing staff of Base Hospital No. 17. During the German offensive of March- July, 1918, heavy casualties occurred among the American and Allied Armies then holding the Western Front and many patients came to Base Hospital No. 17. Miss McLaughlin wrote: Our first big convoy of over three hundred Americans who had been brigaded near Soissons with the French arrived on March IG. From that time on, there was little respite for us. We functioned sometimes as an evacuation hospital, retain- ing our patients only a few days. We were told May 29 that a hospital train had arrived with about two hundred patients. This proved to be a train of nearly twelve hundred British soldiers from the Soissons sector, six hundred of whom were received at our base. Many were badly wounded; the only one we could not save was a terribly wounded Scotch laddie, sixteen years old, who kept crying: "I want tae gae hame tae ma mither!" On the 18th of June a convoy of our own terribly man- gled and gassed men was received from Chateau-Thierry, coming to us direct from the field hospital. Many of these were Marines who had taken part in that memorable fight and had done much in stemming the tide at this point. United States Army Base Hospital No. 8 was the fifth Red Cross column to embark during the early summer of 1917 for service with the American Expeditionary Forces in France. This unit had been organized at the New York City Post-Grad- uate Hospital. Amy Florence Patmore, who since her grad- uation from the parent institution of this unit had conducted a private sanitarium in New York City, was chief nurse. Base Hospital No. 8 set out on July 30, 1917, on the S. S. Saratoga. Miss Patmore wrote : Passing Staten Island, the S. S. Saratoga slowed up and finally dropped anchor off Tompkinsville. The day was des- perately hot and after luncheon most of the nurses removed their heavy uniforms and were lolling about in their cabins in all degrees of drsliahillc. Suddenly there was a crash and a terrific shock, the S. S. Panama had rammed into the Sara- THE EUROPEAN WAR 497 toga, tearing a thirty-foot hole in her side. The ship imme- diately began to list and orders were given to al)andon ship at once. There was no hysteria among the nurses. Half-clad as they were, they took their places in the boats. All the smaller craft in the harbor rushed to our assistance and we were picked up and taken to various large boats scattered about the Bay. A Government boat finally collected and carried us back to quar- ters on board the Finland, which was then lying at her dock in Iloboken. We learned that seventeen minutes after the last person had left the ship, the Saratoga submerged. With her went not only our own personal belongings but our entire hospital equipment. We were not allowed to hold any communication with friends on shore. . . . We were taken back to Ellis Island. The nurses of Base Hospital Unit No. 9 were mobilized there awaiting orders to sail and they opened up their luggage and divided their wearing apparel with our little band of refugees. The reequipment of Base Hospital ISTo. 8 has already been detailed in an earlier section. Eight days after the sinking of the S. S. Saratoga, this unit reembarked on the Finland, which was one of a convoy of five troopships. Rigid discipline was maintained on board. All passengers were drilled every day and were ordered to be fully dressed and ready to go on deck at 2, 3 and 4 A. ^L every night. The utter blackness of their own ship and the huge dim shapes of other ships of the convoy slipping along beside them in the darkness brought to the nurses realization of the danger of submarine attack. *'For the last three nights," wrote ]\[iss Patmore, 'Sve were not allowed to remove our clothing and our life preservers were always close beside us." German submarines in search of Allied ships bound for St. Xazairc combed the waters near Belle isle, just otf the coast of France. Several of them sighted the American convoy and attacked the Finland. IMiss Patmore described the encounter: Suddenly al)Out nine o'clock on "Monday morning, the sig- nal came, six short blasts and tlu' firing of a cannon. F,a( h hurri('(lly look her place beside the boat to wliich slic liad bt'cu assigned, and during a tense hour and a quarter watched the battle. The roar of cannon and the sluxk of (le]>th hombs brought to us a iirim realization of naval warfare. Out of the 498 HISTORY OF AMERICAN RED CROSS NURSING five sliips of the convoy, the Finland seemed to have been the target. Six torpedo destroyers and two aeroplanes came to our rescue. We were off the cost of France when the attack occurred. After the submarines had been routed, we proceeded on our way to St. Xazaire. When we arrived there at seven in the evening of August 20, the populace, who had heard the news of the battle by wireless, was waiting to bid us welcome and we docked amid round after round of cheers. The personnel of Base Hospital l^o. 8 was permanently as- signed to the same normal school building at Savenay, in the Loire District, in which the Hopkins Unit had been temporarily billeted two months before. During the first winter, the !New York Post-Gradnatc Unit cared for large numbers of medical cases sent in from training centers of the American Expedition- ary Forces. Base Hospital No. 8 expanded during the spring of 1918 to a capacity of 3470 beds. Large tuberculosis, isolation and psychopathic departments and a school for blinded soldiers were organized. Classes in administration of anesthetics were conducted for nurses. A diet kitchen was later developed which served 2200 patients each day with delicacies and specially- prescribed articles of diet. Hospital I^nit ''F," consisting of twenty-one nurses from the Harlem Hospital, Xew York City, arrived February 6, 1918, to supplement the nursing staff of Base Hospital iSTo. 8. Even with these reenforcements, J^asc Hospital Xo. 8 suffered from the shortage of nurses felt throughout the early summer of 1918 by the other base hospitals attached to the American Expedition- ary Forces. Patients came to Savenay from all parts of France. ]\liss Patmore wrote that during the major offensives patients sometimes were received from as many as three hospital trains in thirty-six hours, eafh train bringing between six and seven hundred wounded, fully one-half of whom were stretcher cases. On one "peak day"' the X'ew York Post-Graduate Unit had 5010 patients in the hospital and only eighty-four mirses to care for them, a ratio of 59.5 patients to each nurse. Overflow cases w(>re housed in buildings which later became Base Hos- pital Xo. 09. "J)uring thos(^ hectic months of the summer and autumn of 1918," wrote ^liss Patmore, "we found time for little but real life-saving service. Perhaps the most wearing work of all was night duty in the psychopathic depr.rtment and in those wards where the patients were running high fevers. THE EUROPEAN WAR 499 In their deliruim, these men lived over again the batth's they had fought, went over the top, kilk'd the enemy or fell back woniided on the tield, all of which was nerve-racking to the most experienced of nurses." By October of 1918, the bed capacity of Savenay Hospital (\Miter had reached 14,000 and even this number proved in- adequate to cope with the influenza epidemic. Miss Patmore wrote : "Flu'' first broke out in the prison camp at Savenay where over eighteen luindred (lorman and Austrian prisoners were stoekadeci. The very sick ones Avere brought into our medical wards. Caring for those poor souls was one of our tragic experiences of service. With raging fever, glaring eyes and purple faces, in their delirium they too w'cre back again in "No Plan's Land" or on furlough going home. On October i), 1918, we received a large convoy of our own boys from the boats at St. Nazaire. They had been exposed to the contagion at camps in the United States and were stricken on sliip-l)oard. Many of their comrades had died and had been buried at sea. The ISTew York Hospital Unit, Base Hospital 'No. 9, had sailed on the Finland with Base Hospital Xo. 8. This unit was assigned on September 7 to Chateauroux, Indre. which lay midway between Bordeaux and Paris. The French Govern- ment turned over to the American Expeditionary Forces new concrete buildings erected in 1914 as an asylum for the insane. Base Hospital Xo. i> immediately set up an excellently equipped hospital of five hundred beds. As with all the American bases, Base Hospital Xo. 9 soon trebled its original capacity. ]\Iary Vroom, one time superin- tendent of the Greenwich Hospital Association, Greenwich, Connecticut. w\is chief nurse of the New York Hospital Unit and she. wrote that "immediately after the arrival of the United States Engineers, barracks sprang up like mushrooms." When she was "makino rounds" one morning at nine o'clock, slu> saw some tindnu's and planking lying in a vacant space between two other buildings. By eight o'clock that night, a new barracks had been completed, the wards furnished and lifty-four beds neatly made with white sluH'ts and blankets folded back, JJeforc morning every bed was tilled. Ouriug 1!1S, (^liateauroux became an orthopedic cent(U' and the lirst Keconstruction aides assii*ncd to foreiy;n service demon- 500 HISTORY OF AMERICAN RED CROSS NURSING strated there the value of occupational therapy as an aid to rapid convalescence. The next American base hospital unit to go overseas was No. 27, which had been organized by the University of Pittsburg ^ledical School, Blanche S. Rulon was chief nurse. Miss Rulon was a graduate of the Women's Hospital of Philadelphia and since 1013 had been superintendent of the Eye and Ear Hospital, Pittsburgh. The nurses of Base Hospital No. 27 came from six hospitals in the same city. Base Hospital No. 27 sailed from New York on September 27, after a delay at Ellis Island of five weeks. The early ex- periences of the group of nurses connected with this unit illus- trated the entirely unforeseen kind of ability which Army chief nurses had to develop during the European War. When the unit arrived in Liverpool, the officers and men were separated from the group and the nurses were left to proceed to their destination alone. Without the help of any officer belonging to their formation and without any preliminary instructions or arrangements, the chief nurse saw to it that the members of her group with all their baggage were conducted in Liverpool from the hotel to the station, then later across London and aboard a train, for Southampton, in spite of the fact that the station master had told her that this could not possibly be done. After an unheralded and unprepared-for arrival at Southampton, she got them on to a transport and across the Channel, although they had to spend the night in chairs in the corridors or two in a berth on the lower decks. After five days at Le Havre, the men of the unit arrived and the whole organization was put aboard a special train which took them to Angers where they arrived without the loss of a single nurse or of a single piece of luggage. Only those who have been through similar experiences will understand how this feat was accomplished, without authority, without large sums of money and without knowledge of the French language. The Pittsburg ]\Iedical School I^nit set up permanent quar- ters in the !Mongazon, in Angers, in buildings which had for- merly housed a seminary and in American-made barracks huts which were erected aliont the beautiful older structures. Base Hospital No. 27 held the record of being one of the most satis- factorily 0(111 i])i)('(l American Ai'iny hospitals in France and of caring for the largest niiml)(n- of patients in any one single dav in anv of the AnuM'ican bases. The first nurses to be sent THE EUROPEAN WAR 601 for duty on a hospital train, Helen Burrey, Grace O'Donnell and Edna Cooper, were members of Base Hospital No. 27. Vittel, a little town of the Vosges, thirty miles behind the line and forty-five miles from the German frontier, was the destination of United States Army Base Hospital No, 36, organized within the Detroit College of Medicine and mobilized into active service in September, 1917. Dr. Burt E. Shurley was director and Mrs. Betsey Long Harris was chief nurse of this unit. A Xew Englander by birth and ancestry, Mrs. Harris was graduated from the New York Infirmary for Women and Children. She was for some years superintendent of nurses of the Episcopal Hospital at Brooklyn, New York. At the completion of post-graduate work in Teachers College, she served as an instructor in Harper Hospital and in 1914 became superintendent of the Children's Eree Hospital in Detroit. She resigned from this position to go with her unit for active service in Erance. The personnel of Base Hospital No. 36 mobilized in Detroit on September 6 and sailed from New York seven weeks later on the S. S. Orduna for Halifax, where they joined a convoy of seven other ships. They arrived at Vittel on November 18 and spent the first three weeks in putting five large summer hotels of this resort in shape to receive patients. ''With no stoves and little fuel to burn in the few tiny fire-places," wrote Mrs. Harris, "it was a bleak time for all of us." A glimpse of the manner in which the rigid climate affected the raw American troops who w-ere in training nearby was given in the diary of one of the nurses of Base Hospital No. 36. Twelve of the unit had been sent to Vaucouleurs on December 1, 1917, for service with the 42nd Division, and one of them, J ennie A. Abramson, wrote ; December 2 : Major Fairchild took us through the hospi- tal, situated in two portable buildings and in an old chateau built in 155"^. We found aljout seventy-live cases of niunins and measles in the loft of the barn. The French cots were very close together and the air was foul. A smoking stuve added to the closeness but the boys said they didn't mind the smoke as nuich as the cold. Decend)er S : A\'o sent seventy-five cases of nnimps and measles to \'ittel today. In this raw climate, our soldiers, esjieciallv those from the southern states, seem to develop very easily anything from whooi)iii^' cuu;ili to pneumonia. 602 HISTORY OF AIVIERICAN RED CROSS NURSING By the end of November, 1917, the eight American bases located at Bazoilles, Chaumont, Bordeaux, Dijon, Savenay, Chateauroux, Angers and Vittel, and the Yale Mobile Unit at Limoges, comprised the only American Army hospitals with the United States Armies in France. The nursing staffs of these nine units then numbered approximately sixty-five nurses each, these six hundred women thus comprising the entire nursing strength of the American Expeditionary Forces in France. The nursing personnel of the six Red Cross base hospitals assigned to the British Expeditionary Forces, reenforced by numerous hospital units, also numbered about six hundred nurses. The chief nurses of these early units had had little, if any, experience in Army administration before assignment to active duty. The mobilization station for nurses at Ellis Island had not been established when the six base hospitals embarked in May, 1917, for service with the British Expeditionary Forces, and Miss Mury had little opportunity in the crowded summer of 1917 to instruct in Army paper work the chief nurses of the nine units assigned to the xVmerican forces. Each chief nurse was responsible to ]\liss Thompson in Washington for the con- duct and discipline of her unit, but the standards of one chief nurse differed from those of another chief nurse and, moreover, Washington was separated by zealous censors and many miles of ocean from nurses on active duty in France. During the summer of 1917, the office of the Chief Surgeon, American Expeditionary Forces, was located in Paris. On September 1, it was moved to Chaumont and all the records of the American Army nurses then in France were kept there. No nurses served", however, on the Chief Surgeon's staff". As the winter of 1917 approached, the twelve hundred American Army nurses in France needed new and warmer articles of clothing and of equipment. Ivcquests for transfers from one base to another and from the zone of the base to that of the advance, came to the Chief Surgc'on's office and made neces- sary the keeping of various new records and accounts. ]\[ore- over, disciplinary problems regarding the conduct of nurses, ])oth on and otl" duty, constantly arose and a need was felt for an authoritative re])resentative of the Army Nurse Corps in France to whom cliief iind stall" nurs(\s of Ameri<*an l);ise hos- pitals might turn for decisions u})on these (piestions. THE EUROPEAN WAR 503 On N'ovember 13, 1917, Bessie S. Bell, who had formerly been cliief nnrse of Walter Kecd Hospital, Washing;ton, D. C, arrived in France on orders from the Surgeon General to act as Cliief Nnrse of the American Expeditionary Forces. Anna E. Coifey, Army Nnrse Corps, accompanied her as her assist- ant, ^liss Bell's office was placed in the Bnrean of Personnel, of which Colonel E. jM. Welles, Jr., was in command, and she and her assistant handled all nursing matters. The office of the Chief Surgeon was moved in January, 1918, to Tours and the headquarters of the Army Nurse Corps in France was established there.^^ Between December, 1917, and the launching of the German offensive on March 20, 1918, less than nine hundred additional nurses were sent overseas. j\Iany of these were members of Bed Cross hospital units which were assigned to re("'nt'orce the staffs of already-established base hospitals. Others were "casuals" who were assigiied to fill various vacancies caused by transfers, illness and death among the original staffs of base hospitals then on duty with the American and the British Expeditionary Forces, or to duty in new base hospitals and other sanitary formations organized by the Surgeon General without the assistance of the American Bed Cross. During this period, Bed Cross archives record the arrival in France of four additional base hospitals from among the fifty original cohnnns which the Bed Cross had undertaken to organize for the Surgeon (Jeneral's office. The tenth American Bed Cross base hospital to arrive in France was the Buff"alo Unit, United States Army Base Hos- pital No. 23, which had been organized from the alumiuie and staff's of various registered hospitals in Buffalo, New York. The personnel embarked November 22, 1017, from New York and upon their arrival in France, were assigned to duty near Base Hospital No. -SC), in the rapidly-developing hospital center at Vittel. Lawrie L. Phillips, a graduate of the Buffalo Gen- eral Ilos])ital, was chief nurse. During the summer of li)18. Base Hospital No. 2."3 was expanded to a bed capacity of 28(U) and it operated as an evacuation hospital during the St. Miliiel drive. Contrexeville, a well-known French water ing-placo in tlie Vosges, served also as an American hospital center during the -'Sec '"nistoty (if tlic Niirsiiiix Activities on the U'estern Front durii^t: War IV'ridd," Julia C Siiinsiui, p. lU. 504 HISTORY OF AMERICAN RED CROSS NURSING European War. United States Army Base Hospital No. 32 arrived there on Christmas Eve, 1917. This unit had been organized at the Indianapolis City Hospital, Indianapolis, Indiana. Florence J. Martin, a graduate of the Pennsylvania Hospital, Philadelphia, was chief nurse. Contrexeville possessed famous mineral springs ; it owed its reputation especially to the Pavilion Spring, the waters of which had been prescribed for King Stanislas of Lorraine. It was a favorite place for soldiers on leave and Miss Martin wrote that during the summer of 1918 the town "was thronged with French infantrymen in horizon blue, chasseurs in dark blue tarn o' shanters with gold bugles embroidered upon them, Algerians with scarlet fezzes and gold crescents, Czecho-Slo- vaks, British Tommies and Scotch kilties, Italians, Chinese, Hindoos and an Egyptian or two, to say nothing of the men in green with P. W. stamped on their backs, who marched to and from their work with an armed doughboy following them." Contrexeville was splendidly equipped from a sanitary stand- point, in distinct contrast to the meager provision at some of the other American bases. Miss Martin wrote : At our enormous bath-house, with its hundreds of tubs rented by the Eed Cross, dazed-looking, slightly-wounded doughboys lined up in the colonnade on dozens of benches waiting their turn for the warm, refreshing water. Here, where formerly only kings and the wealthy people of the earth bathed, any doughboy who could walk or limp enjoyed the bath to its fullest extent. On the American line of communications almost midway between Dijon and Bordeaux lay the city of Limoges, the des- tination of the United States Army Base Hospital No. 24, of Tulanc University, New Orleans, Louisiana. This unit took over on March 18, 1918, the buildings occupied since Septem- ber, 1917, by Base Hospital No. 39, the name by which the Yale Mobile Unit was known until it was sent in the spring of 1918 to the forward area when it became Mobile Hospital No. 39. Ethel A. Holmes (Johns Hopkins) was chief nurse of Base Hospital No. 24. The nursing staff was composed of graduates from twenty-six training schools located in all parts of the south. THE EUROPEAN WAR 505 Belleviie Hospital, New York City, had been the first insti- tution to complete the organization of its nursing staif and had been given the designation of Base Hospital No. 1, but this unit, made up of personnel of the big municipal hospital, did not arrive in France until March, 1918. They were assigned to the city of Vichy, in the Department of Cantal, destined to become one of the principal hospital centers of the American Expeditionary Forces, Beatrice Bamber, chief nurse of Base Hospital No. 1, wrote of the arrival of the unit: We reached Vichy about midnight of March 12, the pio- neers of the subsequent American invasion of this ancient city. Quarters and wards were immediately established in the larger hotels. Until the arrival of Base Hospital Xo. 19 [Rochester, X. Y.] in June, 1918, we maintained alone a hos- pital of six thousand beds. The University of California Unit established in May their base in the Ilotel Eoyal and in August, the New York Eye and Ear Hospital took over the Eubl Hotel as Base Hospital Xo. 115. Previous to March, 1918, the American Expeditionary Forces had taken little part in active hostilities on the Western Front. The War Department, it will be remembered, had been occupied chiefly in the training and transportation of troops and the shipment of supplies. Combat troops and supplies, it will also be remembered, were given right of way over medical personnel, consequently an acute shortage of nurses existed in tlie American Expeditionary Forces. Previous to March, 1918, the movement of American troops had been compara- tively slow, but the Army planned during the early summer to land an army of over two million soldiers on Allied soil and did send during the last six months of hostilities over a million and a half soldiers to France. Swift and substantial increase in the medical and nursing personnel during the spring and suninu^r of 1918 was paramount, if this contemplated army of two million men was to have adequate medical and nursing care. In her report as director of the Nursing Service of the American Expeditionary Forces, ]\Iiss Stimson stated that on March .'!(), 11)18, there were 2088 nurses in France, of whom approximately 7(H) were on duty with the British Expc^dition- arv Forces. According to (\)lonel Ayres' olHcial summary, tiiere were on ]\Iart'h oO, 1918, about 2."}l,-'>57 American soldiers 506 HISTORY OF AMERICAN RED CROSS NURSING in France.^^ The ratio of nurses to soldier was thus 110.8. In accordance with the estimate agreed upon in July, 1917, by General Headquarters, that the sanitary personnel of the Army should constitute 7.65 per cent of the total strength of the forces, it is evident that a considerable shortage of nurses existed during the spring of 1918. In her report, Miss Stimson fixed this shortage at lOO nurses.^" By the middle of xipril, approximately 300,000 American soldiers had been landed in France and the shortage of nurses was then estimated at 1121.^' ''About this time," wrote Miss Stimson, "the statement was made that 'a breakdown in medi- cal service was threatened' and on May 3 a cable was sent asking for the immediate dispatch of 555 nurses." This was the request, it will be recalled, which stripped the cantonments bare of nurses in May, 1918. It resulted in the immediate dispatch of many base hospitals, the nursing staffs of which had been scattered among the cantonments. Among these units was United States Army Base Hospital Xo. 20, organized at the University of Pennsylvania. The nurses of this Red Cross column had been stationed during the winter of 1917 in various cantonments; the chief nurse, Edith B. Irwin, had been assigned to Camp Taylor. The entire personnel of Base Hospital Xo. 20 was mobilized on Febru- ary 18, 1918, at Ellis Island. Great was the disappointment of the nurses to learn that, instead of sailing at once, they were detailed to take over the Immigration Hospital in New York Harbor. However, overseas orders finally came on April 20 and Base Hospital No. 20 sailed four days later on the Leviathan for Brest. Upon the arrival of the unit in France, they entrained for Chatclguyon, in the south-central part of the country. Miss Irwin wrote of the travel conditions: There were six nurses in oarli compartment. At night we put our suitcases in the center and slept crosswise. Tliere was no water on the train and two or three times a day we would stop, sometimes long enougli for us to wash up a bit. On tlie second day of the trip, the train stopped at a place where one hydrant and several tul)s of water had l)een prejxired for us. Armed with soap, towels and tooth-bruslies. everybody got off. The men sliaved and the girls combed; it really was a very funiiy sight. '"'The War witli CcrmaiiN .' p. 37. ^'"History (if Xursiiij: Activities on the Western Front durinfr tlie War Period," Julia C. Stimson. p. 7. THE EUROPEAN WAR 507 Chatolfniyon was a famous health resort ; its thirty-three mineral springs, which yielded daily one million, two hundred thousand gallons of water varying from seventy to one hundred degrees I''alirenlieit, had made it a center for invalids and tour- ists from all parts of the world. Upon the arrival there of the University of Pennsylvania Unit, Base Hospital Xo. 20, it was estahlished in thirty-two buildings, largely summer hotels and jx'nsions. The Iloicl du Pare, with a bed capacity of three hundred and seventy-five, was selected as the chief surgical building. Less serious non-ambulatory cases were established in the Hotels Splendid, Nouvel and Recjence, because of favor- able mess facilities. Ambulatory, slightly wounded and con- valescing patients were (quartered in the Hotels Castel-Ileyina, Castcl-Uuy, l)e France, Elizabeth, lion Accueil, Medeah and Thermes. ^Medical patients were first cared for in wards of the Hotel du Pare; later the two Thermalias, the Front Hermitage, the Bniijl'res, the Clirysantliemes, and wards of the Splendid, Nouvel and Recjence Hotels were used for medical patients. The nursing staff was permanently quartered in the Hotel I^iterna- tional, the officers in the Hotel des Princes and the enlisted men in the Villas Florence, Trianon and Palais Royal. In spite of their pretentious names, these summer hotels had meager heating, lighting find plumbing facilities and limited e(pnpment. Tt required herculean labors on the part of the personnel of Base Hospital Xo. 20 to clean and equip them as a base hospital. Seven hundred thousand feet, more or less, of floors, walls and ceilings of quarters previously occupied by eight hundred sick Algerian soldiers were cleaned by the en- listed personnel of the Buffalo Unit and ''after the men had cleaned the premises to suit the male mind, the nurses literally got down on tlieir hands and knees and with rag and brush, broom and mop, recleaned these floors, walls, wood-work and ceiling." ^^ Here as in other American sanitary centers in France, the acute shortage of nurses greatly overtaxed the endurance of tli(^ nursing staff". 'AVe never had more than the original sixty- fiv(> nurses," wrote Miss Irwin, "and at no time aftc^r the orga- nization of the hospital did we have even that number. When we wvvv busiest with twenty-two hundred and seventy patients, w(> had only forty-nine nurses on duty." Xo "casual" nurses ^' Ilistdiv (if r. S. Annv liasc Hospital No. 20." p. 37; K. A. V.'riglit {"nm])aiiy. I'liiladelpliia. I'a.', 1P20. 508 HISTORY OF AMERICAN RED CROSS NURSING were assigned to Base Hospital ITo. 20. The original number did all the nursing at No. 20, staffed Camp Hospital No. 44 and furnished nurses for various medical and surgical teams at the front. United States Army Base Hospital No. 46, organized at the University of Oregon, Portland, Oregon, embarked for France in June, 1918. Grace Phelps, chief nurse, and the other members of the nursing staff had seen service in cantonments in the United States. Upon its arrival in France Base Hospital No. 46 was assigned to supplement the bed capacity of Bazoilles Hospital Center. From the little peasant village which the Johns Hopkins Unit had found upon their arrival there in July, 1917, Bazoilles had developed by July, 1918, into one of the most important sanitary outposts of the Medical Corps. Eleanor Donaldson, a member of Base Hospital No. 46, wrote of the line of communications which passed below the nurses' recreation house at Bazoilles : One of our doorways faced a panorama of wood crowned hills, a river and three of the great roads in France. One road was tree-bordered, a silver line where trucks and motors passed up and down endlessly. The second was the railroad on which our boys went to the battlefields, singing, waving and cheering, and on which they returned to us silent, broken but undaunted. There was a special train known as "old 5G'' and when it was missing from the tracks, we knew the errand on which it had gone and anxiously watched for its return. It used to come around the hills so slowly that one could scarcely see it move, or be sure it halted until the three short whistles that meant "convoy in !" called us to our posts in the wards. The third road ran just a few yards from our tent door, with the river beyond, the last road of all for the boys we left in France. It was a short road, ending in a plot at the foot of the hill where the sunset light touched the white crosses, row on row. United States Army Base Hospital No. 13 arrived in France in June, 1918, and was assigned to Limoges to raise the bed capacity of that center. This unit had been organized from the staff and alumna^ of the Presbyterian and Cook County Hospitals. Chicago, Illinois. ]\Iabel K. Adams, chief nurse, had already served in the European War with Dr. J. B. ]\lurphy's Unit which was attached in 101 ."> to No. 23 General Hospital, British Expeditionary Forces, l^]taples, France. The THE EUROPEAN WAR 609 other inirsos of Base Hospital ]^o. 13 had seen duty at Camp Dodge, Iowa, and Camp Pike, Arkansas, before their mobiliza- tion for foreign service. Base Hospital No. 13 set up a hospital in the Champs de Juillet, Limoges, and immediately received patients who had been wonnded in the German offensive of June, 1918, upon Paris. Miss Adams wrote: In the long, low receiving ward, rude and bare, they were lifted from the floor onto the tables and their history was taken. "Kind of a rough ride, eh, Buddie?" Next came the "up cases," with their uniforms torn and caked with mud, their faces haggard and worn. Some of them still clutched a few precious souvenirs tied in a hand- kerchief or in an old rag. Many were so exhausted that they slept while they waited in line to be registered. Finally the last ambulance was unloaded, the last patient entered, the night supervisor had gone to the wards to help, the day nurses had turned the work over to the night shift, the secretaries, tired and stiff, left their typewriters and the officer of the day had started his night rounds. With a dis- tant rumble and a final honk, the trucks and ambulances were througli for the night and the drivers and stretcher bear- ers crawled into their wooden bunks. The early morning hours found the camp very quiet, with only the guards trudg- ing back and forth on their lonely posts. The rapidity with which combat troops w^cre sent overseas in June, 1018, has been described in a previous chapter. Large numbers of medical and nursing personnel accompanied these troops. On the Baltic which sailed June 4 were Base Hospitals l>[os. 19, 22 and 20, comprising three hundred nurses. The convoy of nine vessels, of which the Baltimore was one, with destroyers, aeroplanes, hydroplanes and submarine chasers, car- ried thirty thousand men and twelve hundred officers for the American Expeditionary Forces. Base Hospital Xo. 10 (Rochester Homeopathic Unit) re- ported at Vichy. Base Hospitals Xos. 115 and 110 which sailed later in June, were also assigned to Vichy. Base Hos- pital Xo. 28 ( i\ansas City) sailed during the last weeks in ,Iune and was assigned to duty at Limoges. July 15, 1018, saw the failure of the last German offensive on Paris. 'J'he (Mioniy had attacked simultaneously on both sid(>s of Ivheinis but his path was everywhere blocked by the 510 HISTORY or AMERICAN RED CROSS NURSING French and American armies. Three days later, July 18, Marshal Foch seized the initiative which passed from General Lndcndorif and launched the great Allied offensive, which was destined to break the Hindenburg Line and result in the final collapse of the German Army. Eighty-five thousand American troops of the Forty-second, the Third and the Twenty-eighth Divisions had been engaged in the battle of July 15 which checked the German advance across the Marne. In the counter-offensive of July 18, the First, Second, Third, Fourth, Tw^enty-sixth, Twenty-eighth, Thirty- second and Forty-second Divisions, together with selected French troops, went into action. At the beginning of the Allied offensive, July 18, 1918, the Medical Corps, American Expeditionary Forces, was main- taining forty-five base hospitals in France and England. Thirty- nine of these were units which had been organized and equipped by the American Red Cross. ]\liss Stimson summarized the nursing needs of the American Expeditionary Forces in France at this crucial time: "On July 27, reports stated that 'the recent fighting has been so severe that the resources of the Medical Division have been practically exhausted in so far as personnel is concerned." On August 10, General Headquarters, A. E. F., sent a cable which requested absolute priority for medical organizations, including 2312 nurscs.3 This shortage had been foreseen by the Surgeon General's office and General Gorgas had issued an order on August 1, 1918, that one thousand nurses should be sent overseas each week for a period of eight weeks. The Surgeon General re- quested the American Red Cross to prepare to equip these nurses as they came down to New York for embarkation. ^More- over, he called upon the Nursing Service, as the reserve of the Army Nurse Corps, to enroll one thousand nurses a week for the same period of eight weeks to fill the vacancies which would be caused in the cantonments by the withdrawal of nurses for foreign service. By the early summer of 1918, th(> ^lodical Corps liad finished the establishment of the principal sanitary centers of the American Fxpeditidiiarv Forces along the American line of communications. l'li(> additional base hospitals which arrived "'"History of Nursinp Activities on tlic Wcstoni Front diirinfj War Period," Julia C. Stinisnn. d. S. THE EUROPEAN WAR 511 in France between June and Xovembcr were assigned to these already established centers to raise the bed caj)aeity of the Medical Corps at that given point. The new units did not lose their identity in that of the original base hospital located there, but they formed instead individual units of a group of base hospitals. These groups were designated as hospital centers. One thousand nurses arrived in France in August. Among these was the staff of Base Hospital Xo. 14, organized from St. Luke's and Michael Keese Hospitals, Chicago, which reported August 16 at the hospital center at Mars-sur-Allier, to re- lieve nurses of Base Hospitals Nos. 48 and 08, then detached from their own units at ]\resves. Base Hospital Xo. 449 (University of iSTebraska), which had sailed August 26, was ordered also to ]\Iars-sur-x\.llier. As other base hospitals which had been organized by the Surgeon Gen- eral's office or the Ked Cross reported for duty in France in August and September, 1918, they were housed in wooden bar- racks and thus developed the great hospital centers of the American Expeditionary Forces at AUerey, Bazoillcs, Beau Desert, Mars, Mesves, Le Mans, Nantes, Savenay, Toul, Vichy, Kerhuon, Pan, Connnercy, Orleans, Beaune, Tours, Vittel- Contrexeville, Clermont-Ferrand, Limoges, Kimaucourt, Lan- gres, Vannes, Angers, Perigueux and the hospital, largely con- valescent, of the liiviera district. At the signing of the Armistice, the Medical Division of the American Expeditionary Forces was maintaining one hundred and fifty-three base hospitals in France and the nurses on active duty in these formations suffered in varying desirees from in- convenience and discomfort caused by cold, crowded and often meagerly e(}ni])])e(l (piarters. A difHcnlt housing ]n-ob]em con- fronted the C^hief Surgeon of the American Expeditionary Forces. Colonel Sanford H. Wadhams, representative of the c'hief Surgeon's office, (Jroup !>, (J. 4, on the General Staff of the American Expeditionary Forces, wrote: Buildings acquirod from the French l)cf()re it was iwssible to coiistnict hospitals, comprised French hospitals taken over intact, liotcls. lijirrai ks. schools and e\en stahh's. Avaihd)ie l)uildings ill France at this time which coidd answer tlie ])ur]iose of proxiiliiii: hospital facilities were very limited. The French. r)rili>li, F.diiian and Italian (io\('rniiients had all had their choice and there wt're also a lari:e mmiher of 512 HISTORY OF AMERICAN RED CROSS NURSING hospitals maintained by volunteer aid societies from different parts of the world. Consequently the buildings obtained were generally of a most unsatisfactory character, very expensive to maintain, difficult to administer and usually required an excessive number of personnel to operate them properly. Few school buildings had running Avater, sewer connections, or toilet facilities. The hotels taken over were largely summer hotels, without heating facilities and with insufficient water and very limited plumbing. This shortage of suitable buildings which could be secured for hospitalization purposes and the dearth of building materials in France made necessary the crowding of many nurses into limited quarters. Colonel Wadhams' report continued : Soon after starting their construction program, the Gen- eral Staff faced the prospect of being unable to have trans- ported to France, or to obtain there, sufficient building material to carry on the many construction projects con- fronting these forces. The first change in the plans prescribed by General Headquarters was to reduce the space in the living quarters allowed to officers, nurses and enlisted men (G. 0. 4G, 1917, A.E.F.). The Chief Surgeon's office was willing to make sacrifices as regards officers and enlisted men, but strenuously opposed, without success, reducing the modest allowances that had been prescribed for the nurses in these units. Despite our protestations and as adopted, the order pre- scribed that our nurses sleep in double-tier bunks, with scarcely sufficient floor space to get around. This subjected these wortby women to considerable hardship that seemed unwarranted. This inconsistent attitude on the part of the authorities who reviewed our plans was later changed, largely due to the individual effort and critical reports rendered by the Inspector General of these Forces. As amended, the nurses eventually were given living quarters and the same allowance as was prescribed for junior officers. * In many cases the cement floors of the barracks were con- stantly wet and trunks, bags, shoes and anything left on the floor mildewed immediately. Often the roof and walls of the barracks let in wind aiid rain. The most satisfactory type of building was the regulation brick or wood barrack with *"('.. (). r)8, litis, A. v. v.. ((,]. Uadliani'ri Report, p. 927, Surgeon Gen- eral's Oiliee, U. 8. A., Washington, D. C. o c - .= '". '^ '^ /: 5 ? ^ - " X 02 r; o ^ ~ -^ _S r^ X o ^ ^^ c tT ^ x; 'c ~ Y. r. X a r: ^ '>: CS ^ ;^ ~ ~ -/. ^ .^ *Tr c '^. w , ~- ~ ^ - X U - ^ ^_^ _c "/. :x -^ ' - ^ y. THE EUROPEAN WAR 513 separate entrance for every four rooms and with indoor toilet facilities and running water. A stove sufficiently large to heat all four rooms was located in each hallway. Generally not more than two nurses were quartered in each room. **The com- fort of these quarters," wrote ^liss Stimson, "compared to the large, hare, cold dormitories in French huildings which had to be used by from twenty to tifty women, which had no con- veniences and most inadequate toilet and washing facilities, was really all that could he hoped for in the field." Kations for Army nurses were the same as those allowed for patients and were on the whole varied and ample. Previous to 1917, Congress had allowed forty cents a day for food for patients and Army nurses, but experience proved this amount to be inadequate in view of the greatly increased cost of sup- plies during the war period. The Surgeon General accordingly asked the American Ked Cross to make an additional daily provision of thirty-five cents for each patient and nurse, bring- ing the allowance to seventy-five cents, an amount conceded to be satisfactory, until Congressional action could be passed affix- ing the legal allowance at seventy-five cents. The Red Cross appropriated funds for this purpose until May, 1918; the amount expended for food for patients and Army nurses was well over $185,000. "Colonel Ireland," recorded the Minutes of a meeting of the Red Cross War Council, May 18, 1918, "stated that ample provision has now been made by the Govern- ment for the sick in hospitals and for members of the Army ^urse Corps." The nu'thod in which nurses' meals were cooked and served depended largely upon local conditions. Sometimes nurses stood up in the "chow-lines" with their mess-kits, as did the doughboys. Sometimes they messed with the officers of their unit. In base, evacuation and camp hospitals, the staffs of which were large enough to make such an arrangement practica- ble, a separate nurses' mess was considered by Miss Stimson to be the most satisfactory plan. An excellent combination was to put such a mess under the direction of a nurse "whose duty it was to cooperate with the regular moss officer and in addition to give her personal attention to the cooking and serving of meals," and to employ Army cooks to cook them and French women to serve tlieni.^^ ""History of tlu> Nursinji Activities. A. E. .. on the Western Front during tJic War Period," Julia C. Stimson, p. 13. 614 HISTORY OF AMERICAN RED CROSS NURSING Perhaps the greatest single continued discomfort which nurses experienced on active service with the American Expe- ditionary Forces was the doing a large part of their own laun- dry work. Some hospitals maintained their own establish- ments ; others were able to send the nurses' laundry to com- mercial firms in nearby towns. But in the large proportion of hospitals, the nurses were obliged to wash their uniforms and other articles of clothing themselves, because there appeared to be no other way of getting it done. "Particularly during the times when the actual physical strength of the nurses was taxed to the very utmost in their care of the patients," wrote Miss Stimson, "this was a great hardship." A nurse wrote: "Wash- ing clothes at night after nursing all day wore us out." If recreation in a cantonment hospital in the United States was difficult to get, it was well nigh impossible at an isolated base in France. Mud and sleet made walking practically out of the question during the winter months. The nurses' quarters were usually so crowded that the nurses found little relaxation there. The Red Cross soon constructed in the principal base hospital centers recreation huts for the patients and the li- braries in these huts, as well as motion picture programs and other performances which were provided there, were open to the nurses. American Red Cross canteen and recreation hut workers were assignied to duty and nurses had reason to be grateful, indeed, to them for many services faithfully and sympathetically rendered. The American Red Cross also built in many hospital centers special recreation houses for the nurses and upon the recom- mendation of the Army chief nurses, invited the Young Women's Christian Association to send secretaries to act as hostesses at these liouses. The success of this work was due in large part to the tactfulness and administrative ability of ]\Iar- garet S. ]\Iorriss, who resigned from the faculty of Mount Holyoke College and went overseas in December. 11)17, as a Y. W. C. A. Secretary. She was first assigned to Base Hos- pital Xo. 27 at Angf'rs, where the value of the service which she had come to render to nurses was proven beyond a doubt. In the early summer of 1!18, she was sent to the Head(]uarters of her association in Paris and there took charge of this phase of the work of the Young Women's Christian Association in all the base hosjntals of rhc Aineriean Expeditionary Forces to which secretaries were assiuned. THE EUROPEAN WAR 516 Far more discouraging than the crowded quarters, the some- times unsavory food, the huindrv problem and the hiok of rec- reation was the exhaustive burden of professional work which the general shortage of nurses in the American Expeditionary Forces placed upon the Army nurses on duty in the zone of the base. This shortage has been emphasized in previous para- graphs but it should be noted that it still continued, due to the transportation situation and the dire military need for giving combat troops and supplies the right of way over medical per- sonnel. To stinuilate nurses to enter military service, General Ireland, then Chief Surgeon of the A. E. F., cabled National Headquarters on ISeptember 4, 1!)18, ''that the American Expe- ditionary Forces need at present four thousand nurses. We will need," he continued, "one hundred nurses with each addi- tional base hospital and there are four to each division ; forty nurses with each evacuation hospital and there are two to each division. In addition to this, we need a great mimber of nurses for camp hospitals and emergency calls we receive daily." The War Diary of September 9, 11)18, stated that ''base hos- pitals have been stripped of every a^^'a liable officer and nurse for the purpose of forming surgical teams and in the event of extreme activity of our troops at the front, there undoubtedly will be the greatest difficulty in taking care of patients sent back to the base hos])itals in the S. O. S. The situation," con- tinued this entry of the Diary, "was saved only by the self- sacrificing spirit of officers, nurses and men. During the period from fluly IS to November 11, the amount of work done was such that no })raise would be great enough. It was not at all uncommon for nurses to work fourteen to eighteen hours a day for weeks at a time. . . .'" *- Statistics of the "peak days" at hospital centers showed sharp contrast between actual conditions and the estimated ratio of ten-beds-to-one-nurse which the War Department felt in 11>1T would be a safe margin on which to reckon the nursing needs of the Army. In the six hospitals at Alars, there was on Xo- vember K!, Ill IS, aii average of 21). patients to each nni'se. In the seven hospitals at Toul, there was on November 2S an average of '.-A. 2 jiaticnts to each nui'sc. In the six hospitals at Allercy, there was on \o\-cnil)('i- 17 an average of 4 7.<) {)aticnt3 to each nurse. And at Mesves ("enter, in its ten hospitals, there ^- "1 1 istf>i-y of the Niirn though 518 HISTORY OF AMERICAN RED CROSS NURSING many of them may have been short at times in patience, even though a few of them broke under the strain, none who know conditions as they actually existed, may say with truth that their work was not bravely and well done ! Much has been written in eulogy of the war nurse, but to nurses, the thought- ful and well-weighed sentences of one who knew, William S. Thayer, are praise enough : Only tried women are suitable to go out into nursing, and especially into army nursing. Xo belter proof of this can be found than tbe prejudice which existed in 1898 among many excellent medical officers of the Army, against the introduc- tion of the trained nurse regularly into the Army service. Tliese officers could not conceive the presence of attractive young women among the someM-hat rough boys of tbe Army without complications and scandal. This prejudice still per- sisted among some Army officers after twenty years. . . . I remember well the conditions of the Spanish War. I remember the fine work done by nurses; but I remember also the difficulties, tbe anxieties and the obstacles in tbe way of those who endeavored to maintain the standards of tbe service and to show to tbe ^Medical Corps what nursing in the Army might and should be. Twenty years later . . . nearly eleven thousand regular and reserve nurses served in France alone. The anxieties and the danger of the voyage these women bore as calmly, and often more so, than the men. To their work in France I can testify as one who was among them. I saw them under all conditions. In the hurriedly improvised camp hospital of the crowded base port, and in isolated points in the base sections ; in spots removed from all that was interesting and stimu- lating, where, at times, refined women bad to sleep crowded together, twenty or thirty in a rough, open ward, without privacy, with tbe crudest and most insufficient sanitary ar- rangements, exposed continually in damp rainy weather, with mud so deep tbat one could navigate only in rubber boots. I saw them in balf-finishod base hospitals in tbe Vosges, under like conditiojis. in tbe Ijitter northern winter, where with fingers and toes numb and l)Iancbed with cold, one nurse had almost to care for a ^\bo]e. ill-heated ward. I saw them work day in and day out without rest, without recreation, in the darkened wards by night, and the fog and rain by day, and bear the strain every bit as well as men. . . . They served without fear, without flinching, without complaint. But one murmur did 1 hear, and this a nnirmur aiul not a complaint. THE EUROPEAN WAR 519 a regret that it miglit not be given to them to share more fully the duties and the responsibilities at the points of great- est danger. Wherever they went they brouglit order and cleanliness, and system and contentment and peace. Ask the doughboy what it meant to him to find himself at last in a ward presided over by a nurse. Try to say a light word about a nurse to a doughboy who has been under her care ! *^ While the United States Medical Corps was organizing sani- tary units in the zones of the base and the advance, the Ameri- can Red Cross Commission for Europe was setting np a supplementary medical and nursing service to take care of emergency demands which the less flexible structure of the Military Establishment could not meet. The American Red Cross in France served as an emergency arm of the Medical Department of the American Expeditionary Forces and the Nursing Service formed a vital phase of this service. An ac- count of its development and accomplishments constitutes a dramatic and complex chapter of military nursing history. The American Red Cross Nursing Service in France may well be compared to a small and sturdy ship in strange and troublous waters, a ship on which many masters strove for com- mand, a ship buffeted about by changing winds of European and American public opinion, threatened by perilous shoals of fundamental professional nursing, military and lay policy and strained by emergencies which demanded service in proportions such as have never before been demanded of women. That this ship came at last gallantly to port speaks well indeed for the stamina of those who formed her crew. To gain a true understanding of the nature and value of the nursing service rendered by the American Red Cross in France, an appreciation is necessary of French nursing progress, of French and American social conditions, of American Army and American Red Cross organization and of the military situa- tion which confronted the Alli(>s in 1017 and 1918. Each of these determining factors will be treated in turn. The French Red Cross unit(xl the prominent women of France in volunteer work in time of war. This organization ""Xursiiif,' and tlic Art of MciliciiU'" : An address delivered hy Dr. W. S. Thayer, late T^ripadier (ieneral, Medieal Corjis, V. S. A., before a meeting hold in memory of .lane A. Delano, Pliiladeljihia, !May 7. 1!)1!>: later published in the Amcricnn ,1ournal of Xurfiinij, December, ll'li*. 620 HISTORY OF AMERICAN RED CROSS NURSING was divided into three societies as follows: (1) Societe Fran- gaise de Secours aux Blesses Militaires; (2) Union des Femmes de France; (3) Association des Dames Frangaises. Each of these three societies had its own organization and direction and arranged for its own financing. The Societe Frangaise de Secours aux Blesses Militaires was directed by a committee of men, but the other two societies were managed entirely by women, with men serving only as consultants at board meetings. The three societies were united through a Central Committee which alone possessed the authority to main- tain official relations with the International Committee of the Red Cross at Geneva and with foreign Red Cross societies.^^ The Societe Frangaise de Secours aux Blesses Militaires was created in June, 18G4, and was recognized to be of public utility on June 23, 1866. It was estimated that in April, 1917, this society was maintaining eight hundred hospitals with a total capacity of seventy thousand beds."*^ The nurses for these hospitals were all members of the Societe Frangaise de Secours aux Blesses Militaires and had received instruction in nursing offered by the society. The course of studies was given at a large dispensary school in the Place des Peupliers, covered five months and led to the first diploma, or Diplome Simple. During the summer of 1916, Miss Maxwell and Miss Irene Givenwilson made the inspection tour of sixty-seven French, British and Belgian military hospitals, which has been de- scribed in a preceding section. A report of this tour submit- ted in October, 1916, by Miss Givenwilson to Miss Delano contained the following statement : All members of the French Eed Cross belong to the upper and middle classes and the whole service is voluntary for the love of country and humanity. There are about thirty thou- sand memljers at present enrolled as nurses. Some of these, owing to adverse circumstances, may require pecuniary assist- ance and this is graiited out of the funds of the society, but it is never looked upon as remuneration for services rendered. The Societe de Scours aux Blesses Militaires is the largest of the three associations. . . . The training school in Paris is known as the IIoinial-Ecole and is presided over by ]\Ille. " Spe "Report ui tlio Frcncli Kod Cross." written l)y William f!. Sliarp, Ambassador to France, to tlie U. S. State Department, April 27, 1917, filed Librarv, National Headquarters, Washington, D. C. " Ibid. THE EUROPEAN WAR 521 Genin. Here all aspirants to membership undergo a strict training daily for five months before they can present them- selves for examination and receive the first diploma which admits them to the society. To acquire the mental attitude necessary for service in time of war, three principles are strongly impressed upon the pupils during their training: (1) unity of action; (2) unity of thought; (3) unity of submission.*^ The training offered by the Societe de Secours aux Blesses MilUaires was described as follows by Mme. Edouard Krebs- Japy, in L'Infirmiere : Schools for Training Eed Cross Nurses : A. The Society for Assistance to Wounded Soldiers : I. Hospital School in the Square des Peupliers, Paris (XIII). Directrice, Mile. Genin. Prerequisites for admission: The applicants must be twenty years of age, must bring responsible references, must belong to the Society for Assistance to Wounded Soldiers and must promise to serve in case of war or public calamity. The subjects are arranged as follows: (a) A five months' period of instruction, entitling the applicant to appear for examination, for the purpose of obtaining a primary diploma conferring the title of nurse to the society. The nurse is entitled to a service book and may be assigned to medical or surgical sanitary units, civil or military, in case of war. (b) A second nine months' period of study and theoretical instruction will be required for obtaining the second degree. Only nurses having the primary diploma and who are from twenty-five to forty-five years old may be admitted to receive this supplementary instruction. The final examination will allow the applicant to obtain a second degree diploma, en- titling her to be known as a head nurse or supervisor. . . . II. In the provinces, the society trains its nurses in its numerous dispensary-sch ooh^ Miss Givenwilson's diary contained the following comment regarding a visit made by Miss Maxwell and herself to the IIopital-Ecole : *' "Report of tlie Voluntary Xursiiifj Services of Enjiland and France;" T. ^I. Givenwilson, pp. 7-9 ; Library, National Headquarters, Washington, D. C. *^ L'Infirmirre ; ^Nfnie. Edouard Krebs-Japy, pp. CO-Gl, Librairie Armand Colin, 1921, Paris, France. 522 HISTORY OF AMERICAN RED CROSS NURSING Miss Maxwell and I then set out for the Red Cross Training Hospital for Nurses in the Place des Feupliers, of which Mile. Genin, Chevalier of the Legion of Honneur, is the directrice. . . . We had a most interesting talk with Mile. Genin. She has a wonderful personality and the fine com- manding head and features of a leader. . . . The training school had been transformed into a military hospital of about seventy or eighty beds. We were conducted over the whole building by an infirmiere major and we were struck by the perfect cleanliness of the whole building and its equipment. What, however, struck us disagreeably was the closeness of the atiuosphere and the number of flies which worried and distressed the poor wounded. It is a characteristic of the French hospitals to keep nearly all the windows closed; their aversion to fresh air is remark- able. . . .5 The second society, Union des Femmes de France, was recog- nized to be of public utility on August 6, 1882. It was esti- mated that this branch of the French Red Cross was main- taining in April, 1917, 3G3 hospitals with a total bed capacity of 30,000."^^ The official circular issued by the Union des Femmes de France set forth the following information regard- ing the annual courses : Assistant hosirital-attendant's certificate: Pupils desirous of obtaining this certificate must take the theoretical course in anatomy, minor surgery, hygiene, care of the sick, pharmacy, bandages and practical exercises, in one of the different train- ing centers, and pass the examination. Ilosintal-attendant's certificate: To obtain this certificate, one must take the theoretical courses designated above; after reaching the age of 18, take a practical probationary term of three months (three attendances per week) in a dispensary school or outside consultation office of a civil hospital; and pass the examination. (X. B.) A term either in a consulta- tion office for babies, in a day-nursery or in a baby home, completed by practical instruction in puericulture, is strongly rccommendcfl to pupils until it becomes obligatory. Diploma for liospital allendant: After obtaining the infirmarian's certificate, one must take the theoretical courses, '""Diary of My Visit to France, June-August, 191G," I. M. Givenwilson, pp. 20-21;' 41. ^' Soo ""Report of the Froneli Red Cross." written by W'illiani G. Sharp, Ambassador to France, to liic L'. hi. .State IJepartmcnt, April 27, 1917. THE EUROPEAN WAR 523 and, only after reaching the age of 21, take: (1) A three months' term in the training hospital; (2) A three months' term in theoretical and practical massage; {'S) A three montlis' term in a civil or military hospital; (4) Take the courses in military administration and pass the different tests in each hranch. The third society, Association des Dames Franqaises, was recognized to be of public ntility on April 23, 1883. It was reported to be maintaining in April, 1917, 281 hospitals with a total bed capacity of 17,207. The instruction which it gave its nurses resembled that ofiered by the two other societies of the French I fed Cross. As to professional nursing service, only one school for nurses organized upon British and American standards existed in France : L'Ecole Frofessionale des Gardes-Malades Ilospitali- eres at Bordeaux, known as the Nightingale School^ (with the sanction of ]\liss ]S"iglitingale's executors). As to the nurses in French civil hospitals, Miss Givenwilson wrote in her official report to jSTatioual Headquarters: The professional nurses are comparatively few and do not receive the same exhaustive training as our own. They are drawn for the most part from the ranks of the religious sisters, or from women of the lower classes trained in the ci\il hospitals of the Assidance Fuhlique. . . .^- The following account appeared in Miss Givenwilson's diary : July 18, 1910. We went to visit the old civil hospital of St. Louis this afternoon. It was built in the IGth century as a hospital for the plague and was separated from the city by strong turreted walls and a moat. Some of the ancient build- ings still remain, hut the moat has disappeared and small buildings, mean streets and insignificant houses press close upon the old walls. It is now the chief hospital in the city I Paris I fur skin diseases and contains a famous library on the sul)ject. . . . The French nurses are seen at their worst liere. ... I think that this war will impress u])on the French the neces- sity of training nurses of higher social standing and greater intelligence for tfieir hospitals. The part of the hosj)ital ""Report of the \'olunteer Nursing Service of Englami and France," p. 12. 624 HISTORY OF AMERICAN RED CROSS NURSING which looked the most carefully tended was the beautiful old garden with its magnificent trees and neat flower beds. . . /^ Of the mobilization and service of the nursing members of the French Red Cross, Miss Givenwilson wrote in her report: On the declaration of war, all the members of the three societies of the French Red Cross were immediately mobilized and dispersed throughout the country wherever they were needed. And to their honor be it said that all nobly re- sponded to the call, leaving comfortable, often luxurious homes, to experience the rigid discipline and heavy responsi- bilities of a French military or auxiliary hospital for the duration of the war. For it has to be remembered that very few of these women are trained nurses, although they are often given the supervision of a ward of seriously wounded soldiers with only orderlies to assist them. This is the great defect of the nursing system in France . . . and this war has demonstrated the urgent need in France for the establishment of training schools for nurses on the same lines as those that exist in England and America. . . . The training of the French Red Cross for its first diploma . . . renders their members very capable "nurses' aides." But they are called upon to accept responsibilities far beyond their knowledge and this they do with a courage and devotion which is truly admirable. They are tireless in the accom- plishment of their arduous duties; they take no hours off for recreation or amusement; their free time, if they have any, is spent in making their wards more attractive by simple deco- rations manufactured by their deft fingers from the modest means at their disposal. They are full of cheerfulness and compassion and in the eyes of the wounded under their care is to be read the appreciation of these noble women, wlio have voluntarily sacrifi(;ed all with glad heart at the call of patriot- ism and humanity.'^* Of the French military hospitals, Miss Givenwilson wrote: Ilopitnl Central at Bar-le-Duc: This hospital accommo- dated tliree thousand beds and is situated in some barracks which were a])])roaching completion before the war broke out and were rapidly transformed into a hospital. . . . We first visited the surgical side, whose wards appeared to ""Diary," T. M. fJivcnwilson. pj). 72-73. ""Report of tlie Voluntary Nursing Service of England and France," pp. 11-13. THE EUROPEAN WAR 525 be beautifully kept, altliough there is only one nurse to each. This is one of the ])oints that has struck me forcibly; the French or Belgian nurse accomplished much more than the Englisli or American one, in sheer majuial labor. Her tech- nical knowledge is much less and her patients suffer in conse- quence, but she had a far larger number of beds under her charge without auxiliary heli) and yet she manages to keep her wards neat and clean. Everything in French hospitals is on a simpler scale and the P'rench poilu is neither given nor demands as much as the Britisli Tommy. In this huge hos- pital of three thousand beds, there were only fifty nurses and about one hundred orderlies and the wounded looked well cared for. . , . There is a terrible plague of flies throughout this whole neighborhood, in spite of all precautions to get rid of them. They swarm in thousands everywhere and the most seriously wounded have to be protected by pieces of gauze over their heads. There are camps of soldiers and horses everywhere, so it seems impossible to eradicate the pest. . . .^^ Miss Maxwell and Miss Givenwilson visited the French mili- tary evacuation hospital at Revigny. Miss Givenwilson wrote in her report to National Headquarters : The work of this great hospital was in full swing when we arrived early in the morning. The establishment consists of an evacuation hospital of eight hundred beds which is even now being increased to one thousand. The wounded are brought liere straight from Verdun by a little branch line of railway and it is here that the triage or sorting of the wounded takes place. Over one hundred thousand have passed through the evacuation hospital since the beginning of March. A colony of huts has been erected in a convenient situation adjoining the main line from Paris to Bar-lo-Duc. Toul and Nancy. The evacuation hospital is ]iractically continuous with the stationary hospital but is a complete unit in itself and possesses its own kitchen, oflices, operating and dressing rooms. There arc four categories for the wounded: (1) Those seriously wounded, who cannot he transported further witli- out risk of life: thes(> are carried immediately after (lamina- tion to the adjoining statioiuiry hospital (small compared to the evacuation h()S])ital itself). ('2) Those who are seriously "'Report of the \'oluntiiry Xursing Service of Knj,'laii(i and France,"' pp. 4.")-47. 626 HISTORY OF AMERICAN RED CROSS NURSING wounded and can be transported are taken by ambulance cars to the hospitals of Jean d'Heurs or to the British hospital of Faux Miroir, both situated a few kilometers distant. (3) Others who are less seriously wounded are sent by ambulance train to Paris or hospitals in the interior. (4) All those who are only slightly wounded are sent to hospitals within the Army Zone, so that on recovery they can be immediately re- turned to their companies. They are seldom absent for more than a week or a fortnight. The town of Revigny itself is a mass of ruins and the hospital is situated on the outskirts, among the fields.^** The following description of the evacuation hospital at Re- vigny appeared in Miss Givenwilson's diary: August 4, 1916. We started for Eevigny early this morn- ing. . . . The work of the great hospital was in full swing when we arrived. . . , We visited all the huts of the station- ary hospital and found them filled with very sick men. The mortality here is very great. . . . I shall never forget the ghastly sights in the wards in which the septic and gangrenous cases were lying. An attempt was being made to treat these by constant irrigation, but the awful discomfort of the men was horrible to look upon. They had no proper mattresses and those parts of the body not being irrigated were supported only by pillows and sacks. Yet such is the heroic endurance of these men, that no complaints were to be heard, only the restless, moaning delirium of those who were almost past help. The nurses were a nice set of cheerful, hard-working women, though their life is full of hardship and toil. . . . The surgeon-in-chief proposed that we should witness the arrival of the Yerdun ambulance train which was shortly due. We went to the little roadside station to find that tlie train was already there and was slowly unloading its gliastly bur- den. Skillful arms were there to receive the shapeless masses huddled on the stretchers and they were swiftly borne to the hospital. Soon the little operating-room became a shambles, the floor bloodstained, the pails overflowing with soiled dressings, the atmosphere thick with the smell of blood, disinfectants and human sweat. Doctors and nurses worked without pause, the only sounds being the click of the instruments and the low moans or sharp exclamations of pain of the wounded. One "'Report of the V'oluntarv Nursintr Service of England and France." p[.. -18-40. THE EUROPEAN WAR 527 by one they lay exposed to the keen eye of the surgeon, men with limbs fractured and battered to a pulp, with faces man- gled beyond recognition, with huge rents torn in their bodies. . . . And in the faces of all these wounded was a dumb look of wonderment that such things should be and an infinite trust in the skill of those in whose care they now were. . . .^^ From the report and diary submitted by Miss Givenwilson, which bore the endorsement of Miss Maxwell, it may readily be appreciated that in a modern system of nursing, the French nation was far behind the United States, where practically every town of over ten thousand population possessed, at the time of the United States' entry into the war, a hospital main- taining a professional school for nurses founded on the Night- ingale System. The heroism with which nurses of the French Ked Cross cared for their wounded needs no further eulogy here, but it is equally self-evident that the professional attain- ments of women who have had only five months' theoretical instruction gained through semi-weekly lectures and dispensary training, are not to be compared with those of women who have undergone two or three years' training as nurses while resident at a modern general hospital. In addition to the inhibitory influence of the French Red Cross, French social customs were potent factors in limiting the development of a French nursing profession comparable to that of Great Britain and the United States. To give a man a bed-bath was considered by nurses of the French Red Cross to be menial labor of a degrading nature; to remain on duty all night was, to them, an unheard-of breach of convention. Before taking up in detail the Paris situation, it must be understood that in a country where any woman who cared for the sick was officially rated as a nurse, public opinion would have little understanding and appreciation of the mean- ing and value of American nursing standards and ethics. A second determining factor of the nursing situation as it developed in the Paris Head(|uarters of the American Red Cross was the natural zeal of American laywomen then in France, the wives, daughters and relatives of prominent Red Cross officials and other influential Am(>rican women who ren- (l('r(>d distinguislicd service to the Allied and American troops in France, to share in nursing the wounded. The point of view of the American laywoman was natural and easy to understand. ''"Diary.'" I. M. Oivoiiwilson, pp. 154-15G. 528 HISTORY OF AMERICAN RED CROSS NURSING It may be said that since the beginnings of war, women have been urged by sympathies based on the maternal instinct and the tendency of womankind to venerate that which is strong and courageous, to desire to minister to the wounded. This principle may certainly be called one of the foundation-stones of the Red Cross ideal and in the twentieth century, the Red Cross nurse was, to the general public, the crowning symbol of the Red Cross organization, the fullest expression of this ideal ; hence the desire on the part of the laywoman to serve as a Red Cross nurse. Further, American laywomen argued, why was it so necessary for a woman, before she could go into the wards of a military hospital, to undergo a long training based on some elusive idea to which nurses constantly referred as "professional standards ?" Leaders of the nvirsing world had admitted that the number of trained women was limited. Better a partially trained woman in a ward than that men should die unattended ! Why should not they themselves be allowed to go immediately into this spectacular, this most appealing branch of Red Cross endeavor? The point of view of the American professional nurse and it has been shown that the American Red Cross nurse was the highest exponent of the American nursing profession was equally natural and easy to understand. It has been stated in a preceding chapter that one of the basic principles of the nursing profession was that "nursing education and administra- tion must be directed by nurses." The welfare of the patient was the fundamental reason for this principle. ^N^urses con- tended that an executive nurse, alive to the opportunities of nursing service by reason of her own personal familiarity with nursing theory and technique and her knowledge of the primary importance of discipline, could judge the needs of the patient and the work of the nurse better than could a laywoman, who knew little, if anything, of this theory, this technique and above all this discipline. In addition to the principle of the welfare of the patient, another determining social factor of the Paris situation, a factor which leaders of nursing would probably not have admitted at the time, was the natural desire of the professional nurse to reap the fruits of a hard won struggle. Previous to tlie decla- ration of the European War, a professional nurse did not hold so enviable a position as was accorded her immediately after the declaration of war, when to nurse the soldiers was the THE EUROPEAN WAR 529 romantic, the spectacular service to render. The American Army authorities permitted only professionally trained women in their hospitals and the American nurses in these instances reaped the reward, in this opportunity to serve, of long years spent in training and longer years spent in the practice of their profession. Through the American Red Cross in France, how- ever, another opportunity for war nursing presented itself and to this more yielding avenue of approach, lay women flocked, there to come up against the bars of "professional standards," the only bars with which nurses could strive for nurses in the majority have not wealth and social position to hold that which they considered rightfully their own. Conditions outside the Red Cross, as well, played a part in this controversy. The English system of Voluntary Aid De- tachments; the presence of untrained helpers in the wards of hospitals established by various other American relief agencies and later taken over by the American Red Cross, notably ]\Iili- tary Hospitals Xos. 1 and 2 ; the dictum of the French govern- ment that any woman who cared for the sick was officially rated as a nurse, all fanned the flame of volunteer zeal to such heights of enthusiasm that an American Red Cross Xursing Service established in France on a professional basis seemed in the early days of 1917 likely to be consumed therein. The organization of the American Red Cross in France con- stituted another shoal upon which the Xursing Service threat- ened to go agi'ound. On May 9, 1917, Henry P. Davison cabled to Herman H. Harjes, of the banking firm of Morgan, Harjes and Company, Paris, who was then head of the Ameri- can Red Cross in France, regarding the anticipated appoint- ment and persoiniel of the War Council of the American Red Cross. After outlining the proposed campaign for the first Red Cross War Fund, ^Ir. Davison's message continued : We now contemplate immediately after our organization having one of our council, Murphy, jjrocood at once with a personal stafT to I'aris. where he will go with full autlK^rity from the War Council to undertake ami do such things as may seem to hitn wise, ho hciiig necessarily governed by con- ditions ot)taininir hero from time to timo. (irayson M-1'. Murphy is a West Point graduate, was in the Army aliout nine years, retiring to go into husiiic-s. and is now sciuor \ icc-prcsident of the Xew York (luaraiity Trust Company, lie is a man uf ability and connnon sense, pet'U- 530 HISTORY OF AMERICAN RED CROSS NURSING liarly free from personal ambition, ... It is expected he will receive the line commission of major in the United States Army. He understands that you are at present the head of the American Red Cross in France and desires, as we all do, that your relations to this organization shall not only be maintained but strengthened.^^ This cable went on to outline the cooperation of the American Red Cross with Alexander Ribot, Premier of France, and with relief organizations then in France. It was contemplated that Major Murphy should be commissioner for Europe with his headquarters in Paris. On May 13, Mr. Harjes cabled, at the suggestion of the French Ministry of Foreign Affairs and General Retain, that "a competent man be sent at once, invested with the necessary avithority as high commissioner who would be the effective representative of our Government and Army and the link between the French and American Governments so as to make known at once and accurately what our friends here desire." On ^fay 10, 1917, President Wilson announced the appoint- ment of the War Council of the American Red Cross. A few days later, this body "recommended to the Executive Commit- tee of the Central Committee that Grayson !M-P. ]\[urphy, a member of the War Council, should be appointed the repre- sentative of the American Xational Red Cross in Europe and that a commission, of which Major ^furphy would be the head, should accompany him to Europe for the purpose of carrying out relief work in France, Belgium and other Euro- pean countries . . ." This action was later formally ratified by the Executive Committee at a meeting held June 15, 1!)17, and was spread on the Minutes of the War Council at a meet- ing held August 10, 1917. In the meantime, Afajor Murphy had selected a strong staff and the new Commission for Europe had sailed June 2. Major Murphy was commissioner; the deputy commissioners wore James H. Perkins, of Xew York ; William Endicott, of Boston ; Carl Taylor, of Xew York ; George B. Ford, of New York ; Ernest ^IcCullough, of Boston ; A. W. Copp, and Ernest P. Bicknell, Director General of Civilian Relief of the American Red Cross. Others who accompanied tlie commission, but whose names are not listed as deputy commissioners on the "'See Red Cross Arcliives, File No. 241. THE EUROPEAN WAR 531 Minutes of the War Council of August 16, 1917, were Fred- erick S. Hoppin, Kcvercnd Kobert Davis, Reverend E. D. Miel, F. K. King, Paul Kainey, Frederick Hoffman, Ralph Preston, Phillip Goodwin, C. G. Osborne, R. J. Daly, John Van Schaick and Thomas H. Kenny, The War Department detailed Dr. Alexander Lambert, Major, Medical Reserve Corps, U. S, A., to join the commission as liaison officer be- tween the American Expeditionary Forces and the American Red Cross. The American Red Cross Commission for Europe arrived in Paris on June 14, 1917, and set up the headquarters of the organization at No. 5 Rue Francois 1"". Ten days later, the War Department appointed Major Murphy to membership on General Pershing's staff. By this appointment, members of tli(> Red Cross Commission for Europe who were soon to become directors of important branches of Red Cross service, were placed in a position where they could easily consult officers of the American Expeditionary Forces who were heads of those departments in the American Armies in France which were particularly affected by Red Cross operations. The first work of the commission was accomplished through the generosity of relief organizations already existing in France. Dr. C. C. Burlingame, then Captain, Medical Corps, V. y. A., who was later the director of Hospital Service, American Red Cross in France, wrote : At tlio time the Eed Cross stepped into the field, the Ameri- can Eeliof Clearing House was already functioning to furnish efficient relief and avoid the duplication of various relief agencies. The director general of this organization was at the time IT. O. Beatty; J. H. Jordian was the chief operating manager. Atfiliated with the Clearing House were Ralph Preston. Herman Harjes, J. Ridgely Carter. James R. Bar- bour and others. Associated with tlie Clearing House were such organizations as the Xorton-Harjes AmhuUmce Service and tlie American l)istril)uting Service, organized by Mr. and Mrs. Robert W. Bliss, of the United States Embassy in Paris. '^^ The Committee of the American Relief Clearing House turned over to the American Red Cross their organization, ''"Military History of tlic American Ke(l Cross in France," C. C. Bur- lingame. J). '), [{ed Cross Library. 532 HISTORY OF AMERICAN RED CROSS NURSING their equipment and their personnel, which immediately gave to the commission a ''running start" for its new task. In September, 1917, Major Perkins was made commissioner for France; Major ^hirphv was forced to spend much of his time traveling in Belgium, Italy and the Balkans, preparatory to the initiation of American Red Cross activities in these places. The early days of the summer of 1917 were spent in estab- lishing contact with the American Army officers then in France, with the organizations already existing there for the relief of the civilian population and with the French authorities. The conferences which took place in July, August and September were attended by high officials of the American Army and the Red Cross Commission for Europe. Among the consulting officers were General Pershing, Colonel Bradley, Colonel San- ford Wadhams, Major Murphy, Major Lambert and Captain Burlingame, and recogiiition was given by these officials to the relationship, already provided for by law and Army regula- tions, that the American Red Cross should serve as an emer- gency arm of the ]\Icdical Corps in the field. Of the early organization of the American Red Cross in France, Major Perkins wrote: Within a few weeks after our arrival, IMajor IMurphy and I discussed with General Pershing the work which lay before us. . . . He felt that it would be many months before his Army would 1)0 an effective fighting force and that the Eed Cross must during those months carry tlie American flag in Europe. With this idea in view, we organized two departments ; one, the Department of Civil Affairs, whose duty it was to take \ip all the relief work in France, the need for whicli lun] been created by the war ; the otlier, the Department of ^lilitary Affairs, should iiandle our Ked Cross work with both the French and American Armies. " Dr. Alexander Lambert was straightway appointed director of the Red Cross ^Medical and Surgical Service, under the De- partment of ^lilitary Affairs. American Red Cross medical and surgical service to Ameri- can and Allied troops embraced two distinct types of hospitals. '"^ "Tlic First Year of tlie Anu'rican Red Cross in France," p. 4. THE EUROPEAN WAR 533 The first of these were designated as American Red Cross military hospitals and were established primarily to care for American soldiers. Of this type Commissioner Perkins wrote : ''Where the hospital is known as a Red Cross military hospi- tal, it means that we have installed the hospital and that its business aspects are managed by us, but that its medical direc- tion is turned over to the Army, which employs its own personnel." Captain Burlingame defined American Red Cross military hospitals: The term "American Red Cross military hospital" was used only by direction of the Chief Surgeon, A. E. F., a number being assigned only by his office. The word "mili- tary" in the title of a Red Cross hospital was never inserted except upon his order. It was for this reason that certain hospitals known as American Red Cross hospitals were operated under the same general plan as American Eed Cross military hospitals but not under that name. Again, certain personnel organized as base hospital units were moved into American Red Cross hospitals and operated on the same basis as the American Red Cross military hospi- tals. It seemed unwise to change the name of a base hospital unit even when operated on this plan. American lied Cross military hospitals were operated jointly by the l^ed Cross and the Medical Corps. In each instance there was some reason why it could not be operated to advantage by the United States Army independent of the American Ked Cross. These reasons were varied ; for example, when America first entered the war, Paris and its environs were not opened by the French to the U. S. x\rmy for hospitalization purposes. It w'as possible, however, for the Red Cross through various agreements, some of them in- formal, to take over or establish hospitals in and about Paris. Jt should he remembered that Paris was then out of the American and in the heart of the French Army Zone. As raj)i(lly as conditions changed, making it j)ossible for the I'ed Cross to withdraw, formations operating as American Ped Cross military liospitals were completely turned over to the ^Medical Corps to be operated as regular Army forma- tions. . . ."^ " ^lilitary Tlistory of nt over from this country to form the nursing staff. Margaret THE EUROPEAN WAR 637 Dunlop, of the Pennsylvania School, was the chief nurse. She and several of the original unit, however, returned in 1916 to the United States. As the needs for the Ambulance were in- creasing with every year of the duration of the war, the nurs- ing statf was enlarged by the assignment of whatever nursing personnel was available in Paris several British nurses, a number of the American Red Cross nurses who had elected to remain in foreign service after the recall of the Mercy Ship units, and especially untrained American volunteers who were then resident in Paris and who were zealous to serve. In tlu^ simnner of 1917, the American Ked Cross took over the Ambulance, enlarged and militarized it and assigned nu- merous American Ived Cross nurses to duty as reserves of the Army Xurse Corps. Differences of opinion arose between the old and the new regime. Esther Y. Hassan was the first super- intendent of the Xavy Nurse Corps. Later she was assigned as head nurse of a hundred Army "casuals" who went overseas in June, 1!>17, for duty in various American and British hos- pitals then in need of reinforcements. She drew a significant comparison between conditions existing in the English bases and at American Red Cross Military Hospital No. 1 : The fact that I was in charge of the unit on the way over and during those wonderful eight days in London came nigh to ruining an otherwise perfectly good nurse, for to be *'^ratron" in England is quite the most blissful experience that has ever come to me. I never knew before what a very important person "Matron" is. We have all come to love the British mightily. Their hospital administration is quite remarkable. . . . We found the British officers very nice also. They saluted whenever they came into the wards and wlien we met them outside and their attitude was just what it would he to a brother officer, but. alas and alack, here we are once more eating humble })ie with our own countrymen ! Tlio woi'k was hard in the British bases but always interesting. We nurs(\s did every dressing in tlie ward, chest cases, knee joints and ani])utati()ns, whereas the doctor does even the tiny scratches here, witli f()i'ce])s and all the pomp and fuss of the most extreme civil liospitals. Just at ])rcs(Mit this whole hosjiital is being reorganized and you will have to iningine what that means. We are trembling for the nursing standards. l)ut hope that things will turn out better when the smoke of battle clears awav. 1 would like to 538 HISTORY OF AMERICAN RED CROSS NURSING tell you more of the conditions here, but upon studying the posted rules of our energetic young censor I have decided to follow the counsel of one of our humorous publications which gave as advice to the young man about to marry, the single word, "Don't !" Of course, you must expect that we Ameri- cans, young in this game of war, would go to many extremes. Martha St. John Eakins was chief nurse of the Ambulance Hospital and Frances B. Latimer, one of the nurses of the Mercy Ship Expedition, was her assistant. The hospital was of one hundred and fifty bed capacity. Later it was enlarged. The second institution taken over by the Red Cross Commis- sion for France was the surgical hospital established in 1915 by Dr. Joseph A. Blake, of Xew York City. This hospital, which was subsequently designated as American Red Cross Military Hospital Xo. 2, was used largely for fracture cases. Of this institution, Mr. Patten wrote : Military Hospital Xo. 2 contains three hundred beds, of which one himdred are reserved for French wounded and the remainder for members of the American Army and the per- sonnel of the American Ked Cross. In this hospital is situ- ated our Researeli Laboratory Xo. 1, where a corps of bac- teriologists are making valuable records for the benefit of the medical profession working with the Army. During the past months, we have carried on in this laboratory a careful inves- tigation of some of the causes of trench fever. By means of the work of this laboratory we are making it possible to grasp more thoroughly the original causes of maladies common to soldiers. There has been no lack of attention given to the severely wounded. Through such information as our re- search l;i})oratories have given us, injuries and sickness which in the rush of war seem less important because less visible, can be watched in the first stages when they are more quickly and more easily cured. A third institution which the commission took over early in the summer of 1917 was tlie officers' hospital established in 1015 by Mrs. Whitclaw Roid in the Rue de Chevreuso, in the building which had formerly boused her Club for Girls. Miss Eleanor R. White, a reserve nurse, Army Xurs(> Corps, was the chief nurse; Miss Agnes F. James, Army Xurse Corps, was her assistant and was also chief nurse of American Red Cross Military Hospital Xo. 112, an overflow hospital, Mrs. THE EUROPEAN WAR 539 Reid's hospital was designated as American Red Cross Mili- tary Hospital No. 3. Additional hospitals previously maintained by individual Americans were also taken over during the summer and fall of 1917 by the commission. Of these, Mr. Patten wrote: In the interests of the French, the Red Cross assists four other hospitals situated at Annel, Cugny, fivreux and Sois- sons. It also supplies part of the personnel for these hospitals to wliieh we have given ambulances, beds, instruments and other medical and surgical materials. The hospitals at Annel, Cugny, fivreux and Soissons were existing institutions and are operated for the French soldiers. The hospital at Evreux was staffed by nurses of the original Yvetot Unit which National Head(piartcrs had sent in Febru- ary, 1915, to the Alliance Hospital. Dr. Ralph Fitch had been director and Mary M. Fletcher, supervising nurse of the unit. In August, 1915, Miss Fletcher had resigned to marry an Englishman and Mary K. Nelson had been appointed in her place. During the same month, the Service de Sante had requested that Dr. Fitch and the nurses take charge of ]\Iilitary Hospital No. 48'"" at St. Valery-cn-Caux. National Headquarters recalled its foreign units on Octo- ber 1, 1915, but Dr. Fitch, Miss Nelson, Josephine Clay, ^Marion M. Rice, Helen Spaulding and Helen Kerrigan elected to remain as volunteers at St. Valerv in the service of the French. During the following mouths ]Miss Nelson built up a strong nursing staff, com^posed of American and P]nglish nurses and nurses' aides. In September, 1917, the French Government moved the unit from St. Valerv to Evreux and placed them in charge of I'Hopital Complimentaire No. 2, of six hundred beds. When the American Red Cross Commission for France adopted its policy of coordination of existing relief agencies, it offered financial aid and supplies to Dr. Fitch's hospital. The work was largely orthopedic. Doris Petrola, an American Red Cross luirses' aide assigned to duty at Evreux, wrote: The two wards on wliich I am stationed have o8 French blesses and everything looks weird at night. There is no liliss, then acting Chief of Staff, T". S. A., under S})e('ial Orders No. KIT), dated July 18, detailed Major Smith to Na- tional Headciuarters.*'^ !Major Smith arrived at National Headquarters at a time of stress and because of the mobilization of Red Cross base hospitals into active service, found a heavy burden of work awaiting him. He occupied an office on the first iloov of the main building, dii'ectiy across the hall from that wliicli was "'Major Smitli was appointcil Dii^n'tor Cionoral of ilie lli'partnu'nt oi Military Relief at a ineetiiited the cable as a request for Miss Good- rich's aid in obtaining a proper chief nurse and as Miss Rus- sell had already sailed when this copy of Cable No. 190 came to her desk, she laid it aside, regarding the question as a closed one and neither she nor Miss Delano broached the subject with ^liss (loodrich. ]\Iiss Delano, as she later stated, did not then see a copy of Cable No. 19<). On the margin of a copy of this cabl(\ in the Ked Cross Nursing Service files, there now appears in Miss Delano's handwriting the words ''never saw this." Xo date is given as to th(> time when Miss Delano wrote this phrase upon 544 HISTORY OF AMERICAN RED CROSS NURSING the copy, but from events which later took place, it is probable that she saw it for the first time in October, 1917. Some time between July 21 and July 24, during one of the many conferences which took place daily between Miss Noyes and Major Smith, Major Smith asked Miss !N^oyes if a director of nursing for the Paris office had yet been selected. Miss Noyes replied that Miss Russell had sailed on July 21. Most unfortunately Major Smith did not mention to Miss Noyes the matter of his letter to Miss Goodrich, either then or later, else the sequel might have been different. On July 24, Miss Goodrich wrote to Major Smith : I beg to acknowledge your communication of July 20, relating to the message received by Mr. Davison from Dr. Lambert. This letter only reached me this morning, owing to my absence from the city. In order that there may be no misunderstanding, I am writing to say that I understood you to tell me over the tele- phone that Miss Martha Russell had already been sent to take the management of Red Cross nurses in France and therefore the matter was closed. Major Smith replied on July 27 to Miss Goodrich: "Your letter of the 24th is at hand, in which you say you understood Miss Martha Russell has already been sent to take the manage- ment of Red Cross nurses in France and that the matter is therefore closed. Your understanding is correct." At the time of this correspondence between Major Smith and Miss Goodrich, ]\Iiss Russell, in complete ignorance that she was embarking upon a task for which another woman had been requested, had already sailed for France. Martha JMontague Russell was born in Pittsfield, Massachusetts, and was an alumna of Mount Holyoke College. She received her training as a nurse at the iSTew York and Sloane Hospitals, jSTcw York City. She was for some montlis a head nurse in the Alanhattan Hospital, Xew York City, and later in the Norton Intirmary, Louisville, Kentucky. She afterwards did public health nurs- ing at Henry Street Settlement. She then became assistant superintendent of the Providence Lying-in Hospital. Provi- dence, Rhode Island, and later director of nurses of the West Penn Hospital, Pittsburgh, Pa. She then went to the Sloane Alaternity Hospital, Xtnv York City, as superintendent of nurses and remained there fur twelve years, until she accepted THE EUROPEAN WAR 645 Red Cross service. Her enrollment, however, dated back to the year 1908. Her nine months' service in the pioneer work of establishing the American Red Cross Nursing Service in France brought her the Florence Nightingale Medal of the International Red Cross. Miss Russell arrived in Paris on August 12, 1917. The following day she wrote ]\Iiss Delano: After a very pleasant interview with Major Murphy, he handed me over to Dr. Lambert, who is in charge of the mexist in American Red Cr<)ss hospitals. She immediately ])egan an elfort to standardize these services and to rer'iil'orcc thcni iy the assignnunit of nurses fnun the United States. CnchT Commissioner Murphy's or ^lajor Perkins' code-signature, she ('al)h'(l the needs to Miss Delano at National Ilea(ld to duty singly or in twos, not in large units as was the ])roee(!ure of the Army in reference to its base hosj)itals. Thi^ lied ( 'ross scale of sahiri(s followed that of the Army Xui'se Corj)s. Previ- ous to duly 9, 191S, statf nurses were paid lifty didlars a month, 546 HISTORY OF AMERICAN RED CROSS NURSING with ten dollars monthly increase for foreign service. Chief nurses received thirty dollars in addition to this base pay. By Act of Congress, July 9, 1918, the salaries of all members of the Army Xurse Corps were increased ten dollars a month and the Red Cross followed this ruling with reference to the nurses serving directly under its auspices overseas. In addition to pressing demands for graduate nurses, Miss Russell faced an insistent demand, from Red Cross officials, for nurses' aides. The assignment of nurses' aides to foreign service offered, however, opportunity for many differences of opinion in the War Department, at National Headquarters, among the members of the Paris office and among physicians and nurses in foreign service. The decision of General Gorgas rendered immediately before the mobilization of the first six base hospital units, definitely barred untrained women from the military hospitals of the American Expeditionary Forces. This decision was repeated in a second ruling transmitted September 20, 1917, by Colonel G. E. Bushnell to Miss Xoycs: The Surgeon General directs me to state that in view of the large number of graduate nurses available and the additional large number which are now being trained, it is not thought necessary to inaugurate any measures for the training of volunteer nurses at the present time. The views of General Bradley, the chief surgeon of the American Expeditionary Forces, seemed to correspond with those of General Gorgas in the desire to exclude nurses' aides entirely from military hospitals. General Ireland had faith that their services, if properly directed, might result in great benefit both to patient and nurse. In a letter written Decem- ber 10, 1917, Miss Russell reported General Winter's attitude: Just a line to tell you that at a meeting of the medical committee this evening, your old friend, Colonel Winter, quashed the plan that the people here had been concocting for getting aides for convalescent hospital work over here. He said that one good nurse who knew her business was worth twenty aides and. with the orderlies and convalescent patients to help her, would take better care of the patients than the aides. He said they could use them in the cantonments if they wanted to. but that they did not want them in France for the soldiers unless it was much more important than it appeared at present. THE EUROPEAN WAR 547 The first important development of the aide problem ap- peared in a cable (No. 450) dated August 21, 1917, in which Commissioner Perkins requested that a bureau to pass on all auxiliarv hospital workers to be assigned to overseas service be established at National Headquarters under the; director of the Woman's Bureau. On September 12 Major Perkins cabled again that the Nursing Bureau in France had been divided, ''Miss Kussell taking graduate trained nurses and Mrs. Munroe auxiliarv luirses not graduates of training schools." This plan of organization contemplated that Mrs. Munroe's bureau should be a sub-bureau of Miss llussell's department. The responsibility for the training and direction of nurses' aides had been intrusted, it will be remembered, to the National Committee on Ked Cross Nursing Service. Miss Delano and Miss Noyes therefore considered that the creation of this sub- bureau with an untrained woman as director, would present opportunity for possible division of authority and they made vigorous protest against it to the War Council. After some further discussion by cable, Mr. Davison on September 17 sent the following message drafted by Miss Noyes : Bureau Nursing feels strongly inadvisability separating hospital au.xiliary workers from Nursing Service. Establishes precedent contrary to Eed Cross regulations and policy of Surgeon Generals. Nursing Service recommends Martha Eakins, chief luirse of American Ambulance, if acceptiible to Aliss Russell, as iiead auxiliary bureau. Believe that this will accomplish purpose desired and insure efficiency of hospital service. The discussion then dragged along by letter and cable until ]\rajor Perkins suggested on October 15 that the whole vexa- tious question be "tabled" for the present. In the meantime, Miss Russell was organizing a Local Com- mittee on Ked Cross Nursing Service in Paris, which would undei'take upon antliorization from National Headquarters the enrollment in the American Bed Cross Nursing Service of American nurses then in Europe. The work she was doing in- cluded distribution of extra winter (Hjuipment to nurses of the Bed Cross base hospitals, then militarized and in service with the l^)ritish and American Expeditionary Forces: tli(> welcom- ing of nurs(>s coming abroad for assignment to the I". S. ^ledi- cal Corps; and assistance in the development of American Bed 548 HISTORY OF AMERICAN RED CROSS NURSING Cross relief to the civilian population of France and Belgium. In the bulletin published on I^ovember 13 by the Paris com- mission appeared a notice stating that fourteen chief nurses from base hospitals of the British Expeditionary Forces, the American Expeditionary Forces and the Red Cross attended Miss Russell's conferences. In addition to the American Red Cross military hospitals and American Red Cross hospitals, the Commission for Europe also established and maintained dispensaries to serve the American Expeditionary Forces. As United States troops were landed in France in increasing numbers, they needed dis- pensary service and the Medical Department requested the commission to supply it. The first dispensaries were estab- lished at the ports of debarkation, Bordeaux, Brest, Lorient and St. Nazaire and along the line of communications at TsTantes, Neuilly and Paris. A full list of these dispensaries may be found in the Appendix. An interesting system was worked out at Neufchateau whereby traveling dispensaries attached to a central hospital served United States divisions then in training centers in the surrounding districts. Of this service, which resembled the extra-cantonment work of the Federal Public Health Service in the United States, Mr. Patten wrote: Our dispensary service is one of the most valuable services developed by this division. With its center at Xeufchateau, where we have established a hospital in connection with it, the work has been planned to cover the surrounding territory wherever the French civil population required medical atten- tion, ^lost of the French doctors are in the service of the Army, so that in some of the smaller towns there is ]io native doctor or at best one too old to care for all the inhaljitants. Towns wliere there were sufficient native doctors and equip- ment were passed over in organizing our routes. Keeping tliis policy in mind, we drew up different itin- eraries so that our ambulances could visit tlie various dispen- saries at least once every other day. We have now forty of these dispensaries and a corps of eleven American Red Cross nurses in this serxice. I'he doctors are assigned by the United States Army and \v(jrk under the direction of tlie American Red Cross. Infirmaries for American troops at rest stations and at two aviation camps were also established and maintained by the THE EUROPEAN WAR 549 Commission for France. Convalescent and rest homes com- prised another type of American Red Cross medical service to American troops. At these homes, officers, enlisted men and Army nurses fonnd agreeable surroundings and healthy recrea- tion. One of these was established in the Hotel Regina at Biarritz, overlooking the sea. Here there was golf, tennis and bathing and owners of neighboring villas extended tlunr hos- pitality to convalescents, or to war-weary men and women on their precious fourteen days' leave. As the American Red Cross in France developed this exten- sive military program and the even more elaborate program of civilian relief and child welfare work to be described later, the officials at Paris headquarters grew more and more insistent in their demands for nurses. If large numbers of graduate nurses were not available, they argued, then send us the par- tially trained aides we have already recommended. They had already in many cases cabled directly to these women. On November 18, ]\lajor Perkins cabled to Xational Headquarters for thirty aides to be sent over as rapidly as possible, to be used in connection with Red Cross civilian relief in France. Again j\riss Delano and Miss Xoyes tried to strengthen ]\Iiss Russell's position and sent the following reply. Cable 6099, which was transmitted by Mr. Davison to Major Murphy : Nursing Service asks that Red Cross nurses and nurses' aides, paid or volunteer, be requested through ]\[artha Eus- sell as needed. In cooperation with prominent public health nurses, groups of public health workers have already been organized. We maintain list of selected and carefully prepared aides. It will be remembered that the aides trained for the first fifty Red Cross base hospitals were enrolled at Xational Ilc^ad- quarters. 1'he decision of the War Department not to utilize their services had already brought much derogatory criticism upon the Xursing S(>rvice. Should Xational Headadquarters in 1017 was thus manifestly unsound, and on December 1.3 Miss Russell recommended to ]\Iajor Lambert that a reorgani- zation he effected wherein- t^ie Nurses' Bureau would be trans- ferred from the Department of ^Military iVff'airs to the admin- istrative staff" of the Commissioner for France, where it would be in a position to serve all departments and bureaus. Fnfortu- THE EUROPEAN WAR 651 nately, Major Lambert was on receipt of this letter on the point of starting on a field trip, bnt he assured Miss Kussell that on his return her recommendation would be put into effect. "On his return," wrote Miss Russell to Miss Noyes, "his power was gone." Dr. Lambert in January, 1018, became director of the Medical Department of the commission and Dr. C. C. Burlingame, with Dr. W. E. Clark as his assistant, succeeded Major Lambert as chief of the medical and surgical divisions of the Military Affairs Department. The entire situation, both in Washington and Paris, was swiftly approaching serious misunderstanding, as may be seen in a letter written December IG, 1917, by ]\Iajor Lambert to Dr. R. M. Pearce, then chairman of the National Medical Board at Red Cross Headquarters. ... If I ask for nurses Xovember 9 and six weeks later find the national department in Washington still asking questions as to what 1 want nurses for, it strikes me that something is wrong with the Washington end. Will you not use your endeavor to make them realize that we are not ask- ing for people here unless we need them and we are not asking for nurses unless we need them as nurses to do nursing work ? It is a growing conviction with Commissioner Perkins, myself and all concerned that we must have a reserve of nurses to supply those who are sick and convalescing and to meet various demands that we cannot foresee. Therefore, please make a serious request to the national department in Washington that they cease to block the supply of nurses that come here. The first urgent need of the commission, as it has been said before, was for nurses to undertake the many projects, both civil and military, of the American Red Cross in France. The pioneer American Red Cross pediatric unit which had sailed for France early in August, 1917, had included in its personnel only one nurse, Elizabeth Ashe, who later became chief nurse of the American I^ed C^ross Children's 13ureau. The second pediatric unit had included among its personnel ten American Red Cross nurses especially trained in cliild welfare work; it embarked in September for France. A third unit of about fifteen public health nurses had sailed early in Xov(Mnber and a fourth unit of approximately twenty-five child welfare nurses was under process of organization in Xovcniber, at the time when 552 HISTORY OF AMERICAN RED CROSS NURSING Major Lambert's letter to Doctor Pearce, as quoted above, was received at National Headquarters. Miss Noyes and her co- workers were then combing the country for nurses to supply these and the military needs. The Army alone was asking for nurses to staff fifty additional base hospitals over and above the nurses of the first fifty base hospitals, was calling for hospital units and emergency detachments and large numbers of "casu- als" ; the Navy and the United States Public Health Service were looking to the Red Cross for their reserves. An extremely important responsibility confronted the Red Cross : If nurses should be recklessly drawn into military service from civilian hospitals and public health nursing organizations, these civilian hospitals and public health nursing organizations would be forced to close their doors and to discontinue their visiting nursing, with the result that the health of the civilian population would suffer. War conditions were already taxing the strength of the civilian population, yet upon them depended the manufacture of war supplies, the financing of war loans and the general economic stability of the United States and Europe. Unfamiliarity with nursing conditions in the United States led Major Lambert to use, in his letter to Dr. Pearce, the words "please make a serious request to the national de- partment in Washington that they cease to block the supply of nurses that come here," but the words brought a certain ironical amusement to Miss Delano and Miss Noycs when the letter was referred, to them. In a letter addressed November 22 to Miss Russell, Miss Noyes had already protested against the extrava- gant demands for luirses which the Paris office was making: We realize that you will have a great deal of work to do in organizing your forces, and please do not hesitate to call upon us for assistance wlien needed. We are securing nurses and nurses' aides, selecting them from the base hospitals which had prepared groups for service, as rapidly as possible. I ho])C tlie Red Cross Commission for France is not expecting us to supply nurses for all the French civil liospitals, for there is no nursiiig service in the world which could meet such a demand as that. We can, however, as we told you before you left, meet the military needs in France and in this country and supply public healtli and welfare workers, organizing nurses and those for base liospitals, but I do not see how we could possibly supply an unlimited number of nurses to civil hospitals. THE EUROPEAN WAR 553 May I state here that wo liave thirty-two cantonment hos- pitals in this country, each one calling for a stall" of from sixty-five to one hundred nurses, and these we are supplying at the present time. In addition we have all the regular Army posts and the hase hospitals on tiie horder. The more you know ahout conditions over here and the strengtli of our Ked Cross Nursing Service at home, the better prepared you will be to meet conditions abroad. On December 26, Major Perkins cabled Mr. Davison: ^^Sitnation makes it imperative Miss Goodrich of Nursing Service be sent to France as soon as possible." Two months before, ^liss Delano had learned for the first time and under embarrassing conditions that Miss Goodrich's services had been requested as chief nurse of the American Red Cross overseas. During a meeting of the National Com- mittee on Red Cross Nursing Service held on October 20, 1917, at the Atlantic Division headquarters in New York City, ]\Iiss Maxwell brought up a leading question regarding the appoint- ment of the chief nurse, American Red Cross in France. Miss Delano replied that this appointment was a Red Cross ad- ministrative matt(>r, not a problem of policy which belonged to the National Committee.*^^ Brisk discussion followed, dur- ing the course of which one member asked why ]\Iiss Goodrich had not been sent, especially in view of the fact that her services as chief nurse had been specifically requested by Dr. Lam- bert. ^Miss Delano and Miss Noyes looked at each other in blank bewikha-nicnt. Miss Delano was in complete ignorance of the entire situation. Miss Noyes had wholly failed to identify (^ible No. 1!)6 as a request for Miss Goodrich's per- sonal services as chief nurse. Further, she had not seen a copy of the cable until after ^liss Russell had sailed. Miss Lillian Wald remarked that it was sc^lf-evident that neither ^AFiss Delano nor ]\[iss Noyes knew anything about a request for JNliss Goodrich's services, or ]\Iiss Goodricirs and Major Smith's corresjjondence, and she accordingly told them the various facts in tlu^ case. ^Nfiss Goodrich h"rself stat(>d at this meeting that slie had first interpreted the cable, just as ^liss Noyes did, to be a request for her help in nominating tli(> chief nurse, not a recpiest for her personal services. S1h> later wrote that ". . . as I recall the discussion at the com- " For this reason, no record of tliis discussion is to be found in the ^Minutes of tlie Niitional Committee on this meeting'. 554 HISTORY OF AMERICAN RED CROSS NURSING mittee meeting referred to, the question was not so much as to why I was not appointed, but why the selection of the appointee for this important overseas position was not brought to the Red Cross committee on nursing for suggestions . . ." ^^ But it may be stated that the wording of Cable No. 119 was so per- emptory that, even if Miss Delano had agreed that the ap- pointment was a matter for the National Committee, she would have hesitated to delay it long enough to get in touch with the membership of this body. The Advisory Committee of the National Committee was not organized until two days after Miss Russell had sailed. However, Miss Delano and lEiss Noyes, had they previously been in possession of all this in- formation, would have had little reason to believe that Miss Goodrich would be interested in a more or less subordinate administrative position with the American Red Cross in France. She was then director of nurses at Henry Street Settlement, associate professor in the Department of Nursing and Health, Teachers College, and president of the American Nurses' As- sociation. Miss Delano and Miss Noyes had returned to National Head- quarters, considerably chagrined that nurses outside the Red Cross organization should have known more about Red Cross administrative correspondence than did they. After some deliberation, Miss Delano on November 20 wrote !Miss Good- rich and asked her if she would consider going to France as chief nurse of the American Red Cross. Under date of December 11, Miss Goodrich wrote Miss Delano: It seems to me important that you should have as clear a statement as possible of my attitude towards the matter concerning Avhich you wrote me November 20, and that I discussed with yourself and Mr. [George] Scott [then director of division orirani/ation at National Headquarters] in Washington last week. I beg you to believe that I deeply appreciate the honor of being asked ])y the Ked Cross to go to France in this capacity, but as I consider tlic matter, and I am sure you will under- stand that 1 have given it the deepest consideration, I cannot feel that I should be justified in severing lines of work, the important bearing of which on the present situation I do not believe I exaggerate, to assume for an indefinite period the "^'So,. k'ttcr written December 17, 1921, by A. W. Goodrich to Clara D. Noyes. THE EUROPEAN WAR 555 work in France as you present it in your letter, or even in its wider aspects as ])resente(l by Mr. Scott. I appreciate that a survey of the situation is important to enable a wise dcternii- nation of the policies of tlie lied Cross relating to the nursing care to be rendered by our women in France, but such a survey, I am convinced, would be of limited value if it did not include a study of the nursing situation in our hospitals on the other side as well as the public health field. I believe that only under the highest governmental authority would the task be possible. If the survey could be made under such authorization and it is felt that I am the person to be en- trusted with so important and difficult mission, I should, of course, be ready to go. Upon receipt of Major Perkins' request of December 26 for ]\Iiss Goodrich's assignment to the Paris ofHce, ^liss De- lano immediately submitted to ^Ir. Scott Miss Goodrich's letter, quoted above. To a general statement of the situation, Miss Delano added the fallowing recommendation : "I would suggest that a letter be sent the Surgeon General, including this statement of ^liss Goodrich's, thus placing upon him the re- sponsibility for a decision." However, the Jlod Cross did not ask the Surgeon General to empower ^Ihs Goodrich with governmental authority to make a surv(\v of military and Ived (Voss hospitals in France. Miss Delano stated the following reasons in a memorandum prepared January 1), 1918, for Mr, Scott: Some time ago I requested ^liss Goodrich to accept service in France as tlie representative of the American IJed Cross ])ei)artment of Nursing. At the time she stated to me that if she were to go she would not wish to assume ]\Iiss KusselTs resj)onsibilities and should desire that either she or someone else remain in the Paris ollit'e. She ex])resse(l herself as willing to go ()\('r to make a survey of the nursing situation generally, including the military hos])itals. I requested Miss (Joodrich to send me a statement in regard to the nuitter and am sendiiig with this her letter. 1 have conferred with Dr. Ward"' and Mr. Swan""* concerning the " Dr. Kdwin St. John Ward, an assistant surfrcdn in tlic Department of Military AtTairs of the Anieriean Red Cross C'oinniission for France, then in the I'nittnl States; later ajipointed eoniniissioner for Palestine. "''Major .Joseph K. Swan, director of tiie I'aiis Hureau of Sii]i|)lies and an oxeentiv(> in various administrative capacities in the Department of Militarv Atfairs of the (umniission fur France. 556 HISTORY OF AMERICAN RED CROSS NURSING duties required of the representatives of the United States in Paris, and they both agreed that supervision or inspection of the nursing service in inilitary hospitals was not contem- plated. I have also consulted with Dr. Pearce as to the desirability of suggesting such supervision to the Surgeon GeneraFs office and he too thinks that it would be undesirable at this time. Under these circumstances and in view of Miss Goodrich's evident unwillingness to go to France for Red Cross work alone, I would suggest that a cable be sent, stating Miss Goodrich's position in the matter. We have recently sent Blanche E. Eldon to act as Miss Russell's assistant. Tliis fact might also be noted in the cablegram. I feel sure that both ]\Iiss Russell and Miss Eldon would be willing to accept any decision reached by the Red Cross. I have hesitated to select another nurse in this country for service in France, as I know of no one at the moment who would be in any way familiar with the situation. I am wondering if you might not think it desirable to suggest to Major Perkins that he request Mary Nelson's release from Dr. Fitch''s hospital. She has been there since 1914 as chief nurse and is spoken of very highly by people returning from France. Mr. Swan has met her and can give you further information regarding her ability. It is possible that Miss Russell or Miss Eldon might be acceptable to Dr. Fitch as her substitute. Mr. Davison cabled to Major Perkins January 11, 1918: "I^ursing Service suggest you obtain release if acceptable to you of Mary Nelson of Dr. Fitch's hospital to relieve ]\Iiss Russell who might be acceptable to Dr. Fitch to replace Miss Nelson. Unable to obtain services of Annie Goodrich." To Miss Goodrich, ]\Hss Delano wrote January 12: I have had several conferences with members of the Red Cross commission who have recently returned from France, in regard to the special matter in connection with our work there. It does not sc(>m (losiral)le at this time for the Red Cross to ask the Surgeon (ieiH-rars office to confer upon their repre- sentative in France defhiite authority in regard to the mili- tary hospitals. i greatly regret that you do not feel justified in going to Eur()])e for the Red Cross alone, but the members of the THE EUROPEAN WAR 657 commission who have recently been here assure me that the duties which they have in mind for this position do not involve any authority in connection with the military hospi- tals and that aJiy attempt to secure such authority would probably not be acceptable. Eegretting that it has not been possible to make satisfactory arrangements and appreciating greatly your interest in the matter, believe me, etc. On January 19, 1918, Dr. Lambert cabled directly to Miss Goodrich : "Have repeatedly cabled for you in last three months. Is there anything to prevent your coming? Answer me per- sonally." Miss Goodrich cabled to Dr. Lambert on January 21 : ''Work here for civilians and soldiers too important to justify abandon- ment unless given government authority to inquire into and report upon nursing situation there military as well as Red Cross. In November expressed willingness to go under these conditions." On January 22, Miss Goodrich wrote to Miss Delano: I had dictated a brief letter of acknowledgment to your communication of January 12, but in the interim between the dictation and transcription of the letter, a message has come from the other side that seems to indicate that my services are still desired. I am loath indeed to refuse to go, but I am also firmly convinced that I can only effectively render the service tliey have in mind through a governmental recognition that will clearly define my position and make my opinions in matters relative to nursing authoritative. 1 appreciate that this is a great deal to ask, but I believe that my experience in nursing, the importance of the work I shall be forced to relinquish and, above all, the problems I may be called upon to solve, justify this request. In order that there shall be no confusion or misunder- standing I aju writing to ^liss Thompson and ^Trs. Higbee and am enclo-iiig a cojiy of my letter. 1 am also enclosing co])ies of my letter of December 11 and this letter to them. I am leaving to-night for Cincinnati and shall hope to be back by Sunday. If for any reason you thought it desirable, I could return by tbe way of Washington if you telegraph me to do so. . . . The following letter was sent the same day to Miss Thomp- son bv ^^iss Goodrich : 558 HISTORY OF AMERICAN RED CROSS NURSING Some time ago I was asked by the Red Cross to go to France. I expressed my willingness to do so under certain conditions that are set forth in a letter dated December 11 that I am enclosing. The matter hung for some time in abeyance, was closed, but may possibly be reopened for the reason that my letter to Miss Delano of January 23 will explain. As head nurse of the Army, I desire you to know exactly how I feel in the matter in order that you may be in a position to express your opinion upon the question should it come to your attention. May I add that I am sending a simi- lar letter to Mrs. Higbee. The !N^ursing Service files show no record that Miss Delano replied to this letter from Miss Goodrich. It will be readily appreciated that an assumption on the part of the American Red Cross of any responsibility in con- nection with the conditions existing in and the conduct of United States Army hospitals would lie far outside its charter obligations and would, moreover, be contrary to all precedents and regulations of the highly organized and sharply disciplined Military Establishment. In this serious and unfortunate controversy, one of the most regrettable which appears in connection with the nursing his- tory of the war, both ]\riss Delano and ]\Iiss Goodrich were motivated by high though opposing ideals of duty to the sick. It is to be doubted if elements of personal interest were guid- ing factors on either side of the case, for both Miss Goodrich and Miss Delano were at this time holding positions which set them above the need of self-seeking. ]\riss Goodrich earnestly believed that only through complete comprehension of the entire situation both in military and Red Cross hospitals could she formulate sound policies for the Red Cross Nursing Service abroad. Miss Delano had seen the failure of the Volunteer Corps which the vSurgeon General had tried to organize in 11)05. She felt that the Red Cross Reserve was the only practical instru- mentality through which a large group of nurses might be held in readiness for the Army. However, her one aim was to serve the Army, even though it meant the total eclipse of the Red Cross Nursing Service. ''The chief aim of the Nursing Service," IMiss Delano had said again and again to ]\riss Noyes and her other co-workers, "is to serve the Army." For the Red Cross to put itself in the position of asking of the Army THE EUROPEAN WAR 559 any authority over the military hospitals in France would have been an offense to Aliss Delano's sense of clean-cut organiza- tion. Moreover, her knowledge of the Army, gained through the years when she was head of the Array Nurse Corps, had taught her the futility of asking for such authority, even if she her- self had been in sympathy with !Miss Goodrich's point of view. Miss Delano regarded this seething Paris situation as essentially an administrative problem and consequently saw no reason for taking it up with the National Committee. Differences in the outward expression of fundamental war nursing principles undoubtedly existed among the other members of the National Committee on Ked Cross Nursing Service, as well as between Miss Delano and ]\Iiss Goodrich. While the controversy was still going on, Miss Russell con- tinued her efforts to maintain a professional nursing service in France in face of the persistent tendencies toward lay control. On January 23, 1918, she wrote Miss Noyes: I think that it is desired to have a laywoman in charge of the women's activities, including nursing with the canteens, etc. This is ratlier vague and I trust will not materialize, but, between military and lay control, we have some reason to wonder how nurses can manage to hold the position they need in order to fulfill their responsibilities. I do not want to write discouraged letters. War is a savage state of society and it strikes at many things we have cherished. I really have faith in the ultimate outcome, though I think that we must be ready to go through a black period at first. Of lay control, ]\riss Russell alluded again in a letter to ]\riss Delano, January 21), 1918: "I confess to a very strong feeling that our standing as professional women is hard-pressei these days. They icant our hands hut not on?' heads for the work. Perhaps I am too tired to be hopeful to-day and I am ashamed to speak to you, who have labored so valiantly for years." After ^liss Goodrich had refused to go to France as chief nurse of the American Red Cross alone, ^liss Delano, as has be(Mi stated, had nominated ^larv K. Xelson, then chief nurse of American Red Cross Hospital Xo. 109 at I^^vreux, of which Dr. Fitch was in connnand, as a possible successor to ^liss Russell. Since August, 1915, when Miss Nelson had succeeded Mary Fletciier as chief nurse of Dr. Fitch's hos])ital. Ameri- can Red Cross nurses and lay assistants had worked together 660 HISTORY OF AMERICAN RED CROSS NURSING both at St. Valery-en-Caux and at fivreux in great harmony under Miss I^Telson. In February, 1918, Miss Morgan and Dr. Lambert requested that Miss Nelson come to Paris for a personal interview. Miss Nelson described the conference at the Paris headquarters : . . . The date was between the 18th and the 28th of Feb- ruary. . . . Dr. Burlingame telephoned our Chief and gave him to understand my experience with nurses' aides was the reason why I was needed in Paris to do it on a bigger scale. That same day Miss Morgan wrote me a very casual note in which she assumed I was seeking another position and invited me to lunch with her where we might talk over some work in which she thought I would be interested. . . . Immediately Dr. Fitch by telephone to Dr. Burlingame demanded an explanation. Then it was arranged that I report in Paris to Major Lambert and Dr. Fitch was assured that he was releasing me for a more important need. On entering Major Lambert's office, where I found with him Miss ]\lorgan and Dr. Burlingame, the atmosphere did not seem clear. They gave me the impression of not being quite ready for me. I was surprised to find Miss ^Morgan assuming direction of the conference. The first question, after the usual greetings, was something to this effect: "Tell us just how, when everyone else is having so much difficulty with aides, you seem to have no trouble?" Very quietly I went over the gradual growth of our group, how each aide knew from the beginning which nurse was responsible for her work and how with the spirit of the work paramount, it just worked well and seemed most natural. To this ^liss ^lorgan shook her head. My methods were too simple; they would not serve for Paris. Then followed a brief discussion, where 1 calmly insisted on the necessity of clear lines of responsibility. Dr. Burlingame appeared to agree with me; he liad visited us in ^Svreux and had seen it all in operation. It was then ^liss ^Morgan's turn to describe ^Irs. ]\Iunroe's difficulties and how they had hoped I might have come to help her. but with sucli definite ideas of professional relations, it would perhaps be wiser to think the whole matter over before going any furtlier. Whereupon I found myself being ushered out with some hazy plan of a future meeting which even then seemed a mere pretext. ... 1 never dreamed of anyone's even thinking of considering my rei)]acing Miss Russell.*'^ "See letter written September 23, 1921, by M. K. Nelson to the author. THE EUROPEAN WAR 561 The situation came to a climax on February 20. Miss Russell wrote Miss Delano: The responsibility that I feel for the standards and the accomplishment of our profession are so involved with condi- tions here and at home that I am afraid I have not heen ahle to keep as clear a head as is needed for the situation and evi- dently from your letter you are bewildered as to our needs : First : 1 will tell you about the demands brought to me yesterday and that may help you to see why the requests I send seem indefinite. Part of it is the 'Svar" atmosphere and the way we nuist expect to work. I had told you they were discussing convalescent plans, but I had no definite request till yesterday. They then told me that they would want ten or twelve nurses to do visiting nursing in two cities, Biarritz and Royen, where they had taken rooms in hotels for con- valescent men, one hotel for fifty to one hundred ofTicers and beds in each city for one to two hundred men. Their plan is to have the nurses live by themselves in some hotel and visit the patients when necessary. They said they wanted the nurses to go in about ten days. It seems to me that this calls for women of unusual dignity and character and I tremble lest they demand that aides be placed there to help. Then a little later, a telephone call came asking for four or six nurses to be sent to help in some of the French Army hospitals at the front. 1 begged that a conference be held before embarking on such a new departure, as I did not feel that we could accept an obligation like that without consid- eration. The Commissioner said that they must be sent at once. 1 suppose I did not protest wisely, but while I wish we could take care of all the sick, I wish we could also have a little clearer idea of our responsibility before we embark upon so new an undertaking. However, we have Florence Bullard, who can lead the expedition, and we will see who else can help. You will note that we asked in a cable for thirty nurses who could be here on call for emergencies. Second : The question of the use of aides is very acute, as I have previously written. It is ])robable that the situation will not be allowed to remain in our hands as comjiletely as we wish. War conditions in Paris were at this time grave. Air raids by night, shelling by the long range giin by day and the ])r('S('n('o of the German troops sev(>nty miles away were conditions hardly conducive to calnnu^ss. The Allies were well aware that the (icrniau High ("onunautl was meditating a tremendous spring 562 HISTORY OF AMERICAN RED CROSS NURSING offensive, using the troops and supplies released by the collapse of Russia from the eastern theater of war. On February 20, Major Perkins cabled Mr. Davison: Cable 2414 : Our whole relationship to Nursing Service here dependent upon competent leadership. We are losing our position with nursing profession, which, as you know, is one of our greatest assets. Believe head of our service should be possessed of great personality, character and recognized leadership. This one position so vital that no job at home should stand in way. Xeither Miss Delano nor Miss I^oyes considered just the person. Please select new head for our service, but before deciding finally wire name for our con- firmation. To this cable Mr. Gibson, of the War Council, responded (Cable 'No. 6979) : Dr. Clarke ' . . . just sailing has long story which desire you to consider, either cabling us further thereafter. If question so vital impossible [to] wait his arrival, cable us more in detail regarding just requirements of position. Strongly advise however seeing Clarke first. Miss Russell in the meantime was continuing her work as best she could. She wrote Miss Delano, March 4 : A lease has been signed for Pension Galilee, for use as a nurses' club for the duration of the war. The French pro- prietaire continues to run it as her own business proposition, the Red Cross undertakes to back the scheme by paying rent and a certain bonus to hold the house and each nurse will probably pay eleven francs without lunch, or fourteen francs with lunch. Before the price is absolutely settled, further conference with Colonel Winter is necessary. This amount will be covered for any nurse on detailed duty and that seemed a fair standard to me. The house is in the pleasantest residential district of Paris, near the Alma and Etoile stations of the "metro," and is a most attractive building with light rooms, each with hot and cold water, a fair number of baths and numerous balconies. One of its great charms is a garden opening from the saloon, where tea (if there is any) may be served. This will be a '"Dr. William E. Clarke sailed April 13, 1918, with rank of major, American Red Cross Coininission for France. THE EUROPEAN WAR 563 restful, pleasant spot when one comes in after work. 1 think the nurses who come on leave will enjoy it very much. We do not plan to try for much emphasis on the social side, as the nurses always want to spend most of their time here sight- seeing and resting. The Pension Galilee was entirely self-supporting. !N"iirses wore accommodated there at the rate of 14 francs a day and for this reasonable charge were given among other things sugar, butter and plenty of hot water and heat, luxuries almost impossibh' to obtain at the average hotel in Paris during 1918. To Kuth Morgan, a member of the Finance Committee of the CoTumission and a woman of unusual business acumen, nurses owe the establishment of the Pension Galilee. Miss Morgan was the daughter of ]Mr. and Mrs. William D. ]\rorgan, of Xew York City, and had for many years taken a prominent part in philanthropic work there. She had served on the training scliool and social service committees at Bellevue Hospital and had shown keen interest in hospital and civic reform. For many years she was president of the Xew York Colony Club. 81ie spoke fluent French and was familiar with conditions exist- ing in Paris. As she was the only woman to serve on the Finance Committee, she held a position of much influence and authority at Paris hoad(}uarters. Early in March, 1U18, the nursing situation at Paris head- quarters came to the crisis which had been imminent for some months. On March d, Miss Ilussell wrote personally to Miss Delano : Since I wrote you March 6, matters are practically in st((tu quo. 1 have learned tliat the plan is to have a depart- ment of hospital women, witli ^liss Euth ^lorgan at the head, and that they have cal)lcd for ^liss Goodrich to head the nursing part of it. I do not know if slie will come or whether they would give even to her adequate authority to accomjjjish things. When I came 1 was told ])y several of the commission that nurses ^\cre ready to tell how much they could do, but never ready really to work. I f<'lt that it was wise to go quietly and unostentatiously about the business of learning what the nursing needs were and what could be done to fill them. Evidently I overdid it, for the ]iowers-that-be liavc of late completely igiinri'd me. Of course, that does not matter l)ersonally, but it is not as it should be for our profession. So 564 HISTORY OF AMERICAN RED CROSS NURSING many fine, intelligent women are here. But defeat of one person is not necessarily disaster for the whole profession, and I still have hope for you and them, through the devoted determination among the nurses that they will let no personal grievances hinder them from giving our men the care they need. I shall continue to do what I can unless I am ordered to vanish. In a personal cable sent on March 13 to Miss Delano, Miss Russell reported : ' 'Resignation given by request of Commis- sioner." National Headquarters responded under date of March 19 : ''Sending successor to Russell on first available steamer." On the following day, however, Major Perkins wrote to General Bradley, then chief surgeon, A. E. F., requesting the assign- ment of Julia Catherine Stimson, then chief nurse of General Hospital No. 9, British Expeditionary Forces, as chief nurse of the American Red Cross in France. He did not, however, advise Miss Delano of this fact. On the same day Miss Delano offered Miss Russell foreign assignment in Italy or elsewhere in Europe, but Major Perkins answered on March 25 : ''Miss Russell will report to you about April fifteen. Lay control desired here." On the following day, he cabled again : "Suc- cessor to Miss Russell selected here. Miss Julia Stimson has been assigned by the Army for this purpose." Major Perkins cabled National Headquart'Crs April 2 of the reorganization of the American Red Cross Nursing Service in France: "Further modification of organization of Military Affairs Department takes Nursing Service out of this Depart- ment and makes it separate bureau under administrative bureaus for general service to entire organization." This cable meant that the Nursing Service, instead of being an independent department such as existed at National Head- quarters, was to be a sub-bureau of the Women's Bureau of Hospital Service, of which Miss Morgan was the director. Information as to Miss Morgan's position may be gained from the following personal letter written by her on March 27 to Miss Russell: There seems to he an impression in your mind that there was a usurpation intended by mc of nurses' functions, in fact, that you liavo already registered a protest in this belief. 1 am taking on direcrt lied Cross responsibility and author- THE EUROPEAN WAR 565 ity precisely as Major Fosl)urgli [Director General, Army and Navy l)ej)urtnient, American Ked Cross Commission for France] and ]\Irs. Whitelaw Keid [a member of the Ked Cross Commission for (ireat Britain] have done and this authority could be transferred at any moment to a Ked Cross man if it was the sentiment of nurses in general that no woman should represent the Ked Cross to them. 1 think the general cause of women would suffer by this view. As 1 have said to you, 1 consider that the chief nurse of the Ked Cross has been unduly hampered in two respects: One, because she was subordinated to one section of one de- partment of the Ked Cross; and the other, that she had no relation or means of communicating with the Army, This being her position, I think the whole position of the nursing profession is suffering, and considering that it is giving the biggest service rendered by women in the war and is only second to the men in the fighting line, tins is a matter of deep regret. ^ly plan purposed a more independent nurs- ing bureau in the Ked Cross with connection through me to the Commissioner and direct relation through the chief nurse to the Army. I have already put up the greatest effort of which I am capable to bring these things about, but have no personal interest in the matter so long as it is accomplished. I have deeply appreciated your ditliculties and your disinterested patience. The Paris interpretation which put the Nursing Bureau in the Women's Bureau of Hospital Service had one general theoretical argument in its favor, i.e., luirses were women and therefore nursing service belonged in the Bureau of Women's Hospital Service. This intca-pretation was in reality, how- ever, a direct blow at fundamental principles held bv the nursing profession that professional "nursing education and adminis- tration should he directed by nurses." True, the organization provided that Miss Stimsou should be chief nurse, but that ^liss Morgan shouhl be director of the department in whicli Miss Stimsou and her bureau functi(Uied. This faulty organization brought al)out a condition of aifairs in which nurses, on their {)ai't, were not prepared to take kindly the etl'orts of Miss ^lor- gan on their behalf, and in which all layworkers interested in the nurses, among them ^liss ^lorgan, on their part, might regard the whole nursing personnel as unappreciative and un- iii'ateful. 666 HISTORY OF AMERICAN RED CROSS NURSING When these questions of policy and administration were sub- mitted at a later date to Miss Morgan, she wrote : The position occupied by the chief nurse before the organization and formation of the independent nurses' bureau caused her to be dominated by the whole hierarchy of the Medical Department and Military Affairs, including the subordinate of these departments. No doubt there is a series of protests in the records of the Washington Bureau of Nursing against this domination. The profession of nursing is the greatest of women's pro- fessions and was founded by a woman. It was my opinion that there was danger that the professional dignity would go unrecognized and the professional opportunities for service be lost. I am quite content that any judgment in the matter be left to a history of the results. The reorganization of the Nursing Bureau in France pre- sented opportunity for a general analysis of the misunderstand- ing existing between the Paris office and National Headquar- ters, and Miss Noyes wrote on April 4, 1918, a strong letter to Mr. Case, of the War Council, a letter which enumerated in detail the six problems upon which confusion had resulted. All of these problems were of an administrative nature. A copy of this letter was immediately sent by j\Ir. Case to Com- missioner Perkins and resulted in a much better understand- ing between the two offices. The office and authority of the chief nurse, American Red Cross Commission for France, was finally outlined by Major Perkins in a cable sent April IG to National Headquarters: Bureau of Hospital Service is new bureau in American Red Cross which is responsible directly to general manager [Paris office I and commissioner. It concerns itself only witli nurses and nurses' aides and includes plans for their holiday, convalescent care, hotel and club accommodations, equipment, recreation, etc. IJuth ^Morgan is director of [this] bureau. This ])ureau has separate budget and power to requisition. Julia C. Stimson is newly appointed cliief nurse of the American I^ed Cross in France, assigned to this position by Surgeon Oeneral of the American Expeditionary Forces, and will in addition perform all duties heretofore per- formed by cliiof nurse of American l^ed Cross in France, includiniT enrollment, assiiriinient ami direction of Red Cross THE EUROPEAN WAR 567 nurses. She will report directly to Bureau of Nursing Service of American Keel Cross in Washington. Julia Stimson's first letter to ^fiss Delano, written April 16, 1918, explained the circumstances which led to her appoint- ment: A little over a month ago, ^lajor Alexander Lambert, chief Burgeon of the American Red Cross in France, telegraphed to mo to go to I'aris for a conference. I came and one of the first questions that 1 was asked was, could I explain what was Wrong with the j)resent position of the chief nurse of tiie American lied Cross. 1 told him that there was a very great dilHculty which had been obvious to many of us for a great many months past, and that was that they expected the chief nurse of the American Ked Cross to undertake very difficult duties with her hands tied behind her. They asked me what I meant by such a statement and I said that so long as the position of chief nurse had no official relation to the Army Xurse Corps, it would never have the authority, responsibility and dignity that it should have. After a considerable talk with Major Lambert and Miss Morgan and Commissioner Perkins, they asked me to put in writing my ideas on the subject. 1 prepared them at night and presented them the following morning, in the form expressed on the accompany- ing sheet. ... I left that paper with them and returned to Eouen. I must say that it was explained to me that Miss Eussell was returning to America and 1 was asked what 1 thought of the position foi myself. I told them very frankly that 1 was an Army nurse and under Army orders and that the scheme that 1 was proposing for the position was not made in refer- ence to myself in any way. as I could consider nothing that did not come as an Army order. I have since learned that the scheme which 1 had left with them was entirely approved by the l?ed Cross officials and was taken at once to Army headquarters and accepted by Ccaeral Bradley and Colonel Ireland and Miss Bell, the chief nurse. Four or five weeks later. 1 received an order from the office of the Surgeon General as follows: ":\riss J. C. Stimson, TJ. X., A. X. C. is relieved from further duty with Base Hospital Xo. 21 and is ordered to re]iort to the Chief Surgeon of the American Bed Cross in Baris for duty as chief nurse of the American Bed Cross in France." Since 1 have been here 1 have learned that both ^liss (loodrich and yourself have had similar ideas about a dclinite relati(uiship between this position and the 568 HISTORY OF AMERICAN RED CROSS NURSING Army Nurse Corps. It is too soon to know how the arrange- ment is going to work, or what snags we shall meet, but I am perfectly sure that the way is opened for a far greater co- operation and understanding than was possible before. I wish very much that 1 might have seen Miss Eussell before she left and could have explained to her my under- standing and sympathy with her in the difficulties she encoun- tered and my admiration of the spirit she showed in circum- stances that made her position intolerable. She has been through a most difficult time and gave of her very best, and anything that I am able to do will be but building on the foundation that she has laid. Herewith is quoted Miss Stimson's conception of the position as referred to above, a conception which was prepared, it must be remembered, after twenty-four hours' study of the situation from a point of view outside the Paris office : I. The chief nurse of the American Red Cross (in France) should be nominated by the lied Cross and approved by tlie Army. She should be given by the Army (if not already so graded) the grade of army chief nurse in charge of the American Ked Cross Nursing Service in France. II. She should be subordinate to the chief nurse of the American Expeditionary Forces. III. Duties. Supervision and control of all nursing activi- ties which have beeii or may be assigned by the Army to the American Ked Cross. A. Present activities: (1) assistance of nurses on leave; (2) supply of equipment; (3) assistance of nurses ordered back to tlie United States; (4) establishment and control of a bureau of American Ped Cross nurses not in tlie Army. B. Pr()])()sed activities: (1) formation of plans for the estal)lishnient and control of an American Ped Cross nurses' aide service in France; (2) establishment of an autboritative information l)ureau for nurses, authoritative because it repre- sents the chief nurse of the A. E. F. Peason for the need of an Army chief nurse in charge of the American IJed Cross Nursing Service in France: that a more efficient relation may be made possible by having in authority a chief nurse recognized by the Army and cognizant of Army nursing matters and conditions in military hospitals. In her answer written May 8 to Miss Stimson, Miss Delano said : THE EUROPEAN WAR 569 There are certain points which to me seem absolutely essential in \vorkin was on that foreign inspection tour which was her last work for the service which she had built up and loved : There is no doubt that ^liss ^Morgan was the nominal head of the Xursing Service in France. Apparently the question of assignmtMit to (hity of tlie nurses and their rcK^asc was left to the nurs(^ in charge, but theoretically there is no doubt that their lin(> of coinnninication with the higher autliorities was throuirh Miss Morgan. I do not know whether this situation existed wb(>n Miss Pussell was b.ere. as the civilian relief was not so cK-arly se])arated frtini the military service. A[)par(Mitly the separa- len- 572 HISTORY OF AMERICAN RED CROSS NURSING tion is still quite distinct, although nominally under the same jurisdiction. Miss Noyes wrote regarding the organization of the Ann can Red Cross Nursing Service in France: The jSTursing Service at National Headquarters consisted of an independent department which supplies nurses for all branches of military and public health nursing service, both within the Government and the Ked Cross. Miss Delano and I had personal contact with the various members of the War Council and we could make recommendations directly to them regarding the conduct of the service. The organization of the Paris office consisted of a Nurses' Bureau within the Women's Bureau. Miss Stimson had the title of chief nurse, American Red Cross in France; how- ever, the organization made Miss Morgan the official channel of communication between the Nurses' Bureau and the Commissioner. Miss Delano interviewed Dr. Lambert while he was on a trip to this country during the spring of 1918, regarding the nursing situation in France. I was present. Dr. Lambert denied that the Nursing Bureau was under the direction of a laywoman. I asked : "Did Miss Stimson have the power to make recommendations to the Commissioner for the conduct of the Nursing Service in France, or did these recommenda- tions have to go through Miss Morgan's hands ?" He replied : "They had to go through ]\Iiss ^lorgan." Why a nursing service, wholly different from that which existed at National Headquarters, should have been set up in Paris, was not clear to National Headquarters or to nurses in foreign service and it caused great anxiety and consider- able criticism among the Ped Cross nurses overseas, thus lowering their morale to an appreciable degree. The nurses themselves fully understood that the Nursing Service in Washington was directed by nurses who had easy access to the members of tbe War Council and needed no intermediary. They were suspicious of the Paris organization and many personal letters and personal protests to that effect were re- ceived by us. Tbey well knew that the organization at Na- tional Headquarters had already proven itself capable of administering the problems arising from the mobilization and equi])nu'nt of many tbousands of nurses, whereas the Paris office at tliis tiine dealt only with a few Innidreds. Why sbould not an able nurse in tbe Paris office, they argued, have attended to the business details of tbe Nursinfj Service THE EUROPEAN WAR 573 in France, just as the Department of Nursing at National Headquarters attended to the business details of the Nursing Service in the United States, even to the expenditure of thousands of dollars for equipment alone? Nurses were quite willing to concede that a women's bu- reau with a laywoman in charge, was essential in Paris, in order that the groups of non-professional workers might have full consideration. But they contended that a iiurscs' bu- reau, quite independent and on an equal plane should also have existed so that plans and recommendations involving the work and welfare of nurses might be presented directly to the commissioner through their representative, the chief nurse of the American Ked Cross in France. While information regarding the organization of the American Ked Cross Nursing Service was in their hands, it is possible that in the pressure of the time, the commission did not appreciate that they were setting up an organization in Paris which was directly contrary to that which had ex- isted for many years at National Headquarters.'^ The last word in this controversy belongs in chronological sequence to Miss Stimson, who thus defined her own position : After the reorganization accomplished by ^liss ^Morgan, Miss Stimson's position was entirely different from that occupied by iliss Kussell. ^liss Stimson was not in any way subordinate to the ^ledical Department or the Department of Military Affairs and she did have direct access to the Com- missioner, it must be remembered that Miss Kussell had been responsible to the Chief Surgeon and his assistant and also to the Director of Military Affairs. At the time ^liss Stimson was appointed chief nurse. Miss Morgan was actu- ally the liaison officer between the nursing activities and the connnission, as a member of the Fiiumce and Fxecutive committees and later of the commission. She was not known as tiie head of the nursing bureau but held a somewhat un- official position. The chief nurse's responsibility through a member of the commission freed her from the domination of tlie Medical Dei)artnu'nt and assured her the backing of the t'ommissioii and of the Chief Surgeon of the Army and did not in any way prevent her direct access to the Commissioner when slic desired it. Any nunil)er of instances can be enumerated to prove that fact. For example, there was no intermediary " ^roiiiorandum written by Clara D. Noyes, September 12, 1921, to the autlior. 674 HISTORY OF AMERICAN RED CROSS NURSING between her and the Chief Surgeon of the American Expe- ditionary Forces, a thing unheard of under the former regime and a fact which should also prove (if any proof other than her word is necessary) her freedom of access to the Com- missioners.'^ While this much discussed reorganization of the Nursing Service in France was taking phicc, the enemy had hiunched the first of their five major offensives of 1918 and during the entire spring and early summer, the fate of Paris hung in the balance. With the constant air raids and the shelling as well, it was not a time conducive to cool and judicious deliberation. When she first accepted the appointment. Miss Stimson knew little if anything of the standardized organization of the Nursing Service in the United States, which Miss Delano had been building up for eight years. Later the military situation gave her little opportunity to try to bring the organization of the Nursing Service in France in line with the organization of the Nursing Service at National Headquarters. Thus it may be stated that she accomplished her work not because of the organization but in spite of it, for fortunately she and Miss Morgan worked well together and she found Miss Morgan at all times an enthusiastic and sympathetic helper. This whole subject of organization may be compared to an imperfect tool. jNIiss Russell tried to reshape the tool to the pattern upon which she knew Miss Delano and Miss Noyes were insistent; Miss Nelson stated her opinions about the tool so definitely that it was not offered to her ; Miss Stimson took up the tool and worked with it as it was as well as she could and with her nurses accomplished a brilliant piece of work. Miss Russell was at this time returning to the United States, greatly discouraged and in almost complete physical exhaustion. However, it may be seen that her nine months' work in France was not without far-reaching results. Miss Russell had or- ganized, upon authority from National Headquarters, a Local Committee for the enrollment in the American Red Cross Nurs- ing Service of American nurses then overseas. She had furnished extra articles of equipment to nurses serving with the pioneer Red Cross base hospitals of the British and Ameri- can Kxpeditionarv Forces. She had secured long needed ac- commodations in Paris for American nurses. Further, the 'M-cUlt written ^Nlurcli 8, 11)22, by J. C. Stinibon tu C. D. Noyes. THE EUROPEAN WAR 575 development of a mobile service by which American Red Cross nurses could be sent immediately upon call from the American Expeditionary Forces to any emergency, and the first plans for later Ked Cross cooperation with the French Hervice de Sante had been initiated during her term of office. This situation has been set forth in some detail, not only in justice to the persons and principles concerned, but to show to the nursing profession that the Ked Cross Nursing Service was not without its internal problems. To Miss Stimson and her associates during the summer of 1918 came the opportunity to develop brilliant projects of military nursing service. Her first work was the establishment of a more complete system for supplying nurses with equip- ment. The first step was to secure and distribute to all the nursing stalls of the American base hospitals then in France such articles as had been omitted from their initial equipment. A second important step was to supply nurses who had been enrolled in Europe with the standard Red Cross equipment. A third step was the establishment in Paris of an organization through which nurses both of the American Red Cross and of the Army and Navy Nurse Corps could replace at cost worn-out articles of equipment. Another phase of the equipment problem which devolved upon the Nurses' Bureau was to supply the norfolk suit, after the Army Nurse Corps had adopted it as its regulation outdoor uniform, to the nurses who had been equipped with the serge dress, the original type of outdoor uniform sup- plied by the Red Cross. Marie B. Rhodes reported April 22, 1918, to the Chief Nurse of the Commission to France and was temporarily placed in charge of nurses' equipment. Of her, ^liss Stimson wrote : One day Miss Ehodes appeared at the office and asked how she could get into the Army Nurse Corps, stating that slie was a Kod Cross nurse and bad come to France with a women's unit which liad been disorganized. She was told how to a])ply for admission to the Army Xurse ror])s and her papers were forwarded to the office of the Chief Surgeon at Tours. In the meantime, while awaiting action on her appli- cation, she asked if she could be of any use and was told that she certainly couhl. right there in the Ked Cross ollice. She said she would he glad to do anything, so we gave her piles 576 HISTORY OF AMERICAN RED CROSS NURSING of correspondence and reports on the subject of nurses' clothing. She started to put them in shape, making tables of the equipment the nurses' units had already received and what they were asking for, to show what each unit should have to meet the minimum standard equipment which had then been worked out. The way in which Miss Rhodes undertook this extremely complicated task and compiled accurate tables and statements from which the Red Cross Commission could order thousands of dollars worth of contracts for clothing, proved her efficiency to such an extent that before her papers came through from the Chief Surgeon's office at Tours, the Chief Nurse of the Red Cross telegraphed to Tours, asking that Miss Rhodes be assigned to the Red Cross office in Paris. From that time until May, 1919, Miss Rhodes did a mag- nificent piece of work in charge of the equipment bureau and therefore made possible the efficient functioning of liter- ally thousands of nurses, because through her efforts these nurses all over France were supplied with equipment which was an absolute necessity for their physical welfare. A graphic description of the pleasing manner in whicli Miss Rhodes met nurses and supplied their needs was given by Sophia M. Burns, chief nurse of Mobile Hospital No. 9 : I have always believed that an efficient operating-room nurse would make a good business woman and in the Red Cross office I found proof that I was right. At her desk, Miss Rhodes was directing three orderlies, speaking French to a rather trying maid, answering an insistent telephone and dexterously meeting the demands of many visitors. She spoke to me briskly: "So you all are Mobile No. 9? That completes our chain of medical organizations. Have a chair and tell me what equipment you have and what you need." The result of our conference was that each nurse was completely outfitted with a trench coat, two jersey uniforms, rain hat, rubber boots, sweater, mittens with wristlets, two suits of genuine all-woolen underwear, black jersey tights, hose, woolen kimono, trench cap or bonnet de police, set of dishes consisting of cup, saucer, plate, folding knife, fork and spoon, cot pillow, four blankets, bed socks, wash cloths, bath and hand towels, duffle bag with padlock (trunks were forbidden) and the sleeping bag which we had brought from New York. THE EUROPEAN WAR 577 In Miss Rhodes' report of the Nurses' Equipment Shop ap- peared a paragraph with which many nurses and many men in all branches of the service will sympathize, in that it reflects their own experiences : We were very busy and happy, but I felt that 1 would like to be at my own woriv. A great many requests for anes- thetists came into headquarters. I offered my services at night and for two months went into the different hospitals iu Paris where they needed help. At two o'clock in the morn- ing the commanding officer sent me home by ambulance so that I got to bed by three-thirty. This was the reason why I never got down to the office in the morning before ten o'clock. I met so many people in the hospitals whom I knew and liked helping our boys directly so much that I found it hard to stick to Jersey dresses and trench coats, but every time I said anything about leaving, my Big Chief was kind and yet positive that 1 must jersey dress and trench coat a while longer. We had so many hurry calls for them that we got the idea that these jersey dresses and trench coats were winning the war ! The dress was made of gray jersey and in style resembled the gray cotton ward uniform ; it was warmer and could be worn for a longer period without being laundered. It was issued by the Nurses' Bureau in Paris, without consultation with National Headquarters and was not in conformance with Army regulations, but because of its practicability, no objections were raised. Of conditions at the line, Miss Rhodes wrote: We had many demands from the front. The only way to get them there was to deliver the things myself, by camion. I made many trips up the line. It always seemed one of the most wortb-wliilo tilings J could have done, ^lany of tiie nurses wore up there witliout their luggage; others had never seen theirs since thi\v left the States. One time I remember particularly was at Kvacuation lTos])ital No. L") at \'erdun. Here were twenty nurses witli only hand luggage, caring for thousands of patients. Tt was very cold and living condi- tions were most uncomfortable. When we fitted up those nurses from our camion, they almost cried for jov ! T visited all the hosjiitals in the forward areas several times, on each occasion tinding nurses badly in need, either due to fire or loss of bac:mand for nurses to render service of this type increased in proportions dependent upon the numbers of American troops brigaded with the French and the military activities which occurred during A})ril, ^lay, June and July. This type of assignment finally formed one of the most brilliant and appealing phases of military nursing servic(> during the European War. Of the position held by American Bed Cross supply units at the beginning of the Second Battle of Picardy, ^fajor James B. A. Fosburgh, Director General, Army and Navy Department, American lied Cross in France, wrote: As is well known, all the plans of our Army wore jirodi- cated upon the occupation by the American Ivxpoditionary Forces of the sector lying roughly between Toul and Tjolfort (1!)1T). The lino of conununicatioiis was taken ()V(m- iinnio- diatoly and dovolo])ed to extoihl from Bordeaux and St. Xa/.airo to Dijon and Is-Sur-Lille, and from there radiating ' 'Tlu' W ar witli (uTinany," p. 10(i. 580 HISTORY OF AMERICAN RED CROSS NURSING up through the area established for division training in the country about Neufchateau and adjacent to the Toul-Belfort sector. The hospitalization provided by the American Expe- ditionary Forces was entirely located along this line of communications. Large units were located at Bazoilles, Vittel, Contrexeville as forward bases, and at Dijon and points further toward the interior. In the entire area from Toul to the Channel, however, the other Allied authorities had specifically excluded all American hospitals. With the knowledge of the divisional training and hospi- talization plans of the Army, the American Eed Cross lo- cated the bulk of their warehouses in the Toul-Belfort area, at Dijon, Xeufchateau, Langres, Chatillon, to serve the di- visional area, and at Bar-le-Duc, Toul, Xancy, Rambervillers and Belfort, to serve the troops actually in the line. Fortu- nately as it subsequently developed, the bulk of our stores was centered in Paris. On March 21, the first of the series of German offensives started in the neighborhood of Noyon and Xan and with great rapidity the German forces overran the country lying to the south as far as Montdidier, sweeping aside the French and British forces occupying that sector. This resulted in the appointment of ^Marshal Foch as Generalissimo of the Allied Forces. General Pershing . . . turned over to Gen- eral Foch certain American divisions with the understanding that they would in all respects be cared for by the French. On or about ^May 1, the First Division was movefl across country from Toul to a point in the line just to the east of Montdidier, about forty kilometers north of Beauvais. While the division was on the move, we were advised in a general way of their destination and immediately took steps to secure a warehouse at Beauvais. We were told that they were mov- ing with only their field hospital equipment and that even this material was lacking in certain essential requirements. We therefore sent in advance to Beauvais two large double- walled Bessonneau tents with all the equipment for a small field hospital, also two Ked Cross nurses and other personnel with diet kitchens, etc. From long experience with French hospitals, we knew that those institutions to which our men would be sent would lack many items of equipment and supplies which American prac- tice considered essential for the proper care of tiie wounded. Before tbe arrival of the division, our French bospital sup- ply service had sent their inspectors to visit each French hospital in the area around Beauvais to see that they were provided with needed sujtjilies. . . , THE EUROPEAN WAR 681 Another provision was the assignment of American Red Cross nurses and interpreters to these hospitals. Within a weeiv after the First Division had gone into tlie line, Ameri- can wounded ap])earod in fourteen French liospitals. Had not American Ked C^ross nurses gone immediately into these institutions, some of those boys would have died without ever being able to speak to anyone who understood them.^'^ On May 6, 1918, Miss Stimson made a supervisory tour of the Beanvais area, which served the Noyon-Montdidier sectors. Of this tour she wrote : About half-past nine that night we arrived in the pouring rain at Beauvais. Some Ked Cross men took us to a little hotel, one of the gloomiest places I have ever seen in my life. All the electric lights had been painted dark blue, so that no one could possibly read. The hall and little salon were crowded with officers of all sorts, wandering disconsolately about. Our room upstairs was so dark we lit candles. Even the glass in the windows was painted deep blue against Hun avions. The next day we visited nine hospitals, some with our American niirses and aides, others with no English-speaking persons except the few American soldier patients. In every case where there was one, I talked to the iiifirmiere major. Each one said how glad she was to have the American nurses. Our women told us they were receiving every consideration. They all spoke of the wonderful devotion of the French nurses and nuns and were deeply touched by the eagerness of the French to learn American methods. Our nurses appreciate that the years of voluntary self-sacrificing service which these French women have given deserve great respect. If they, our nurses, are tactful and gracious enough in their dealings with the French nurses to be asked to teach these splendid women some results of the professional advantages so freely given us, then indeed no greater reward nor higher tribute could be ours. Our nurses looked shadowy-eyed and white-faced from their long hours. The Americans were pitifully glad to have tliem. The surgical care which our men get in these hospitals is excellent. During the second week of ^fay, 1918, the following per- mission for and instructions regarding the assignment of teams "Report of ^lajjor Foshurpli to H. P. Davison; Red Cross Arcliivos. 582 HISTORY OF AMERICAN RED CROSS NURSING of one American Red Cross nurse and one nurses' aide to go into every French military hospital where American troops were being cared for, were issued : From: The Under-Secretary of State for the Service de Sante Militaire. To: The Chief of the Service de Sante of the First Army by order of the General Commander-in- Chief. I have received from the American Eed Cross acting in connection with the Medical Department of the American Expeditionary Forces, a request for permission to detail American Eed Cross nurses to French hospitals of the Zone of the Interior and of the Army Zone which have admitted for treatment sick and wounded of the American Army. I consider that our desire to make it possible for our Allies to find English-speaking personnel in our hospitals makes us accept this proposition. I have, therefore, decided that nurses of the American Eed Cross in groups of two may be sent to all hospitals where French nurses are already present and which will have been reported to us as having received, or as expecting to receive, sick or wounded of the American Expeditionary Forces. To carry out these instructions, you will notify me at once by telegram sent to my central office Service de Concours Etran/jers as soon as the hospitals placed under your au- thority have received or expect to receive soldiers of tbe American Army. You will notify me also in the same man- ner when the services of these nurses are no longer required. All nurses on duty in the Army Zone will be militarized ; that is, they will possess the "red workers' permit" granted by the Adjutant General of the American Expeditionary Forces. In addition to this, the laws regulating the admission of this personnel into the Army Zone and as well as its stay there are those set forth in the Instruction 3993.SBA.1 of the 28d, 1917. During their stay in French hospitals, the nurses will be placed under the direct orders of the medecin chef who will assign them to duty with their countrymen or with the French wounded, if the emergency arises. The nurses will not he under the orders of the inflrmiercs principdJes, hut they will live with the other infirniieres under the same conditions and Avill conform to the same rules and regulations which govern the Frencli personnel. In case of serious disregard of rules, you will notify me hy wire in order that 1 may communicate with the American Eed THE EUROPEAN WAR 583 Cross and request the urgent removal of the nurse who has become undesirable and arrange for the detailing of a nurse to take her place. In a report of May 28, Miss Stimson wrote: The Service de Sante has asked [allowed] us to organize twenty-five teams of nurses and nurses' aides. I have ap- pointed Alice Fitzgerald to prepare and supervise these units. She speaks fluent French and is, as perhaps you remember, a Hopkins nurse of wide executive experience. Now that the offensive has commenced with renewed fierce- ness, this part of our work is bound to increase tremendously. We have had to take nurses from the Department of Civil Affairs as it is impossible to get Army nurses for this work. The Army officials, though heartily in favor of our work with the Service de Sante, state that their nurses are needed, or soon will be, in the places to which they have been assigned. Among the last group of nurses many possessed very special- ized training, but when they heard of the real military neces- sity they were eager to be used wherever needed. Heads of Eed Cross departments have been equally fine about giving over to this work nurses assigned to their specialized services. Alice Louise Florence Fitzgerald's first executive work with the American Red Cross was in the development of this service. The daughter of an American scholar who made his home in Florence, Italy, Miss Fitzgerald early gained knowledge of the language and peoples of France, Italy and Germany. This international background, coupled with her wide professional experience, commanding presence and native charm of person- ality have made her a romantic figure in American Red Cross nursing history. Miss Fitzgerald was graduated in 190G from the Johns Hop- kins School of Xursing. Two years later during the earthquake which devastated Messina, Italy, she did emergency relief nursing in that city. In 1911, when a reorganization of the operating-room system at Bellevue Hospital was effected, ^riss Xoyes, then superintendent of nurses, had chosen ^liss Fitz- gerald as head nurse, a post requiring the exercise of unusual tact and executive ability. After the new system had been firmly established, !Miss Fitzgerald left j^ew York to become superintendent of nurses at the City Hospital, Wilk('s-I>arre, Pennsylvania. She later became superintendent of the liobert 584. HISTORY OF AMERICAN RED CROSS NURSING Long Hospital, University of Indiana. In 1913 she enrolled in the American Red Cross Nursing Service. She was sent overseas in February, 1916, as the Edith Cavell Memorial Nurse from Massachusetts and she served as a member of the Queen Alexandra's Imperial Military Nursing Service Reserve at Boulogne-sur-Mer and at the British Front. In December, 1917, Miss Fitzgerald desired to join the American forces, so the committee of prominent Bostonians which had sent her overseas provided a substitute and Miss Fitzgerald reported on December 13 to Miss Russell at Paris headquarters of the American Red Cross. She was immediately assigTied to answer an emergency call for nurses at Rimini, Italy. In February, 1918, she was recalled to Paris. She wrote of her subsequent work: On February 18 I was sent down to Bordeaux where I was attached to zone headquarters. My work consisted chiefly of supervising the existing American Red Cross activities and of looking around for possible sites for future projects. Among other duties, 1 took over that of meeting the incoming boats and welcoming our nurses as they landed in France. I have heard many of them say that it was a great relief for them to see a fellow-nurse standing on the dock waiting for them. On May IG I was recalled to Paris and given charge of the work with the Service de Sante. This type of service con- sisted of placing American nurses in French hospitals to care for American sick and wounded ; it had begun in a very small and unofficial way as far back as ]\[arch, 1918, when nurses were sent to Soissons to care for our men in French hospitals. . . . The formal agreement with the Service de Sante had just been signed when I took charge of the service in May Florence ^l. Patterson assisted Miss Fitzgerald in this phase of American Red Cross nursing service. Born in Wisconsin, Miss Patterson received her A.B. from Northwestern University and was gi'aduated in 1907 from the Johns Hopkins School of Nursing. She was for some time assistant superintendent of nurses of the Allegheny General Hospital, Pittsburgh, Penna. After extensive j)ost-graduate instruction at Teachers College, New York, and at the Chicago School of Civics and Philan- thropy, she did medical social service work and public health nursing in Chicago and Boston. In June, 1917, she joined the THE EUROPEAN WAR 585 staff of Miss Noyes at National Headquarters, but was released the following month to act as chief nurse of the American Red Cross Commission for Roumania. The Roumania unit was recalled from the Balkans in June, 1918, and ^liss Patter- son was then assigned to the Paris headquarters to assist Miss Fitzgerald. Of the conditions which confronted the first American nurses who were assigned to French hospitals, Miss Stimson wrote Miss Delano on May 28, 1918: You already know that American troops have been placed with the British and the French forces. It has followed that when they were sick or hurt, they have been cared for exactly as were the British and French troops. With the British, this, of course, was a very simple matter ; the American wounded were sent right down through the British bases. With the French, the problem has been quite different because of two things; the difference in standards of nursing and the difference in language. In one hospital I saw a French sign in the corridor which said "All volunteer nurses will please leave their names and addresses in the office." In this institution, I was told there was no head nurse. I should tell you further details, were it not that I think it unfair to put in writing observations about women whose self-sacrifice and endurance have been so do- voted but whose professional opportuuities so limited. As for language difficulties, a large number of American boys soon came to French hospitals, where there was not one English-speaking person. When this was discovered, the Hed Cross received })ermission to put a few American nurses into these hospitals. Since so few of our nurses speak French, a French-speaking nurses' aide was sent with her in almost every instance. Thf^ reports that came back on the work of these teams were most satisfactory. 1 wish I had time to t<'ll you individual stories of our boys, who until an American nurse spoke to them, had thought they might he in the bands of the Germans, aiul of cases where am]uitalions had to he done when it was impossible to ex])lain to the hoy hcforeliand what was going to take place. . . . Some (lay the story will be written of the spirit of tliesf few nurses who went out into bomhod areas, into crowded French bosi)itals where they shared quarters with French vol- unteer nurses, or found rooms for themselves in slu>llcd vil- lages as best they could. Too high praise i-annot he gi\(Mi them. Some day i)erbaps those American hoys themselves 586 HISTORY OF AMERICAN RED CROSS NURSING will tell what it meant to them to have an American nurse when they were so badly hurt, and were in the midst of stran- gers with whom they could not communicate and under con- ditions the misery of which they cannot exaggerate. Miss Delano commented in the Red Cross Bulletin of August 26, 1918, upon the heart-appeal of this service: The sound of the mother tongue in a strange land has always been considered the sweetest sound on earth. A letter from a Ked Cross nurse in Koumania tells of being assigned to a ward containing a Hungarian, a German, a Bulgarian, a Prussian and a Turk. "The Turk had his leg in a Kussian splint but he certainly did smile when I asked him for the first time if something was T^hoke ginsel' (Turkish for 'very good')," the letter reads, "and was equally delighted when 1 counted for him in his own language.'' If the unspeakable Turk can smile with delight at the sound of his own lan- guage, what must it mean to our American boys to have someone near who understands when he refers to "Dad" as a "good old scout;" Xew York as the "Big Town;" who knows that a "cop" is a policeman ; a "hobo" a tramp ; that "Howdy" means "how do you do ;" and "look out !" means "be careful !" Medical men call it the striking of a normal balance, the destroying of the abnormal condition produced by unusual complexity of emotion and the sudden acquisition of almost a lifetime of experience in a few months. Sara R. Addison, an American Red Cross nurse assigned to duty in a French hospital, wrote of her service : Morale does not apply to the fighting men alone, but to the soldier who has fought, is wounded and is "down and out" for the present. I firmly believe that many a man would have felt it easier to die than to try to make his wants under- stood. I remember one incident, amusing after it was over, but intensely painful to the lad while it lasted. He had had both legs and one arm broken by an Army truck which had struck him. When he came to the French hospital where 1 was assigned, I liappened to be off duty. As I came on again I was met by a P^rench patient gesticulating wildly toward "le hiesse Americain." I was distinctly alarmed to find six Frenchmen and one Frencli nurse surrounding his bed. Hemorrhage, collapse, death entered my mind. The real facts were that he had sneezed while asleep and in some way THE EUROPEAN WAR 587 twisted one of his broken legs. The French nurse immedi- ately ran to him and succeeded in getting the leg in a more comfortable position but he could not make her understand it teas easier. She continued to change its position, with ex- cruciating results. To understand his relief u})on my arrival, one liad to see his face. His only exclamation was: "For God's sake, tell them I'm comfortable !" Of the nature of this service, nurses' letters speak for them- selves. Annie 8. Kathbone wrote : I was one of a group of nurses assigned in June, 1918, to February 3, 1919, to the care of American soldiers in French hospitals. The presence of American women, as well as the more familiar methods of nursing, seemed to sootln them greatly. One boy, weak and near his end, said: "Xo, I don't want anything. Please talk to me. 1 like to hear you talk American." Particular scenes stand out vividly, but it is sometimes the simple and less romantic details that one loves best to re- member. Perhaps my most precious memory in all those stirring times was that of half-delirious, dying boys calling me "Mother." This was by no means merely a nickname ; but it occurred so often in isolated cases as to quite astonish me, for in my nursing work at home it had never happened. I heard two other Red Cross nurses say that their experiences had been the same and they treasured the remembrance as I do. Of course as nurses in the war zone, we had the usual bombing raids. Sometimes (as at Creve-Coeur-le-Grand) it seemed, when bombs dropped all around our hospital, quite by itself in the open fields, and wlien window ghiss was sliat- tered over the patients' beds, that the enemy was really using the hospital as a target. We nurses generally found these raids more endurable when it was our turn to be on night duty with tlie patients tlian when we hatl to sit passively through long hours in tlio slielter of a cave. The American Kcd Cross supplied many articles of equip- ment and numerous luxuries to American sick and wounded in French hospitals. Miss Fitzgerald wrote of this phase of the service : Our nurses did not simply go out to give the patient tlio nursing care he required. They went to look alter his general 588 HISTORY OF AMERICAN RED CROSS NURSING welfare. They provided for him the food which was not obtainable in the hospital, the companionship which he missed, the small luxuries which our men were very apt to call necessities and in other words, anything or everything which the Red Cross could give. As soon as nurses left for a par- ticular hospital, I put in a request for certain standard sup- plies such as pajamas, socks, cigarettes, chocolate, games, writing-paper, magazines, books and newspapers. Wherever the hospital was not too far, I have taken these supplies out by motor. The average French hospital has very little equipment and it is surprising that the results are as good as they are. In all cases, we have been given all that there was to give and if any partiality has been shown by the French, it was in favor of the Americans. It has been necessary to greatly supplement the food, clothing, bedding and equipment in order to ap- proach the standards which we have set for ourselves in America. In one particular instance in a French hospital in Betz when I arrived there on a tour of inspection shortly after the nurses, I found that a room, in which ordinarily we would have placed two beds, then contained ten beds. In eight of these, very seriously wounded men were lying. In the other two beds, men had died but a short time before. The beds were so close together that you could not have stood between them. The nurses were absolutely at a loss through lack of equipment and the men were so sick that even then it seemed impossible for many of them to survive the night. I made a list of the supplies that they needed and at the same hour the next day, I had all these supplies out there and the grati- tude of the nurses and indirectly of the patients was a joy to behold. . . . ]\liss Fitzgerald made many trips of inspection. The fol- lowing extracts w'ere taken from reports written by her after these trips : June 18. 191S : I left Tours for Saumur. Here I found our nurses ou duty in a <-ontagious hospital in a wonderful old chateau overlooking the Loire. Xeither moat nor drawbridge were lacking. . . . The nurses are living in a private house just outside tlic cliateau walls and are very- happily situated. Our ])atieiits seemed contented and well cared for. . . . June "^0: Miss Ethel Swope [Connecticut School for Nurses, New Haven. Conn.] is working in the irojni-nl Au-ffredi. the oldest hospital in France except the original Hotel Dieu. THE EUROPEAN WAR 589 She is caring for the contagious. On arrival there, she found a colored man suffering from a very severe case of small-pox and his condition was so desperate and repulsive that he had practically been abandoned to his fate. Many were afraid to go near him. His joy at seeing an American who could un- derstand him was quite pitiful. The first thing which he asked the nurse to do was to write to his people that they would never see him again and that his one regret was that he was dying before even having been in battle. Miss Swope cared for him until the end and the man was given a most impressive and dignified military funeral, his coffin draped with the Stars and Stripes. June 28: Argentan-sur-Orne : Some of the patients were in another hospital in the city and the surgeon had them brought to the Ildjntal Murte in order to have them all to- gether. This removal caused much flutter among the French Red Cross nurses who are very anxious to keep our men. . . . A very ill patient is now being cared for in this hospital. He is lying on a hammock suspended to a wooden frame and with the help of many pillows is being made comfortable. A water mattress has been asked for him and was shipped immediately. IVIiss Adeline Rowland [Johns Hopkins School of Nursing], wlio has charge of this case, has been extremely devoted. She has bought food and dainties and the patient himself told me of a delicious chicken which lasted three days and of which he often thinks. It is a question if his life can be saved. I asked him what I could send him and his answer was "pies !" I fear it will be difficult to fulfil his desire, as there are no canteens nearer than Angers, but I will send tinned fruits and other delicacies from Paris. . . . Of the pressure under which the French hospitals operated during the last gTcat German offensive, Katherine Williams, a St. Luke's (Xew York City) graduate assigned to VHopital Militaire, Chalons-sur-]\rarne, wrote: Paris, July, 191S: . . . Tliat memorable holiday, July 14, I had dinner with some of the canteeners and went to a con- cert afterwards, returning home and getting to bed about 9 :30. Twelve midnight Bang with so great a concussion that it practically threw us botli out of bed, and we Averc sure a bomb had struck the house. The sky was blazing from horizon to horizon and the thundering roar of guns was so close and terrific that it made my blood run cold. That first bang on the dot of midnight was a long range gun that planted a shell very close to our house every five minutes 590 HISTORY OF AMERICAN RED CROSS NURSING regularly for two cla3's and nights. ... By the time this let- ter reaches you it will be no secret that the Huns had their eyes and plans fixed to drive through Chalons again. When it began, one of the first things we did was to pack up everything, ready to flee at a moment's notice. Of course we dressed and went over to the hospital and about 6 :30 A.M. the first French grands blesses began to arrive. I shall never forget the sight of that hall, litters from end to end, men blown to atoms but still pitifully hanging to a thread of life ; no noise, a sickening silence as the ambulances were unloaded, a litter lifted down to the ground, only to find that the journey had been too much and that in that lonely, ghastly ride one more soul had been released. We both turned to at once, to cut the clothing off the men and get them ready to go to the operating-room. In the midst of this, the chief surgeon, M. Tardary, asked me if I would operate with him; they were short on doctors and his assistant must work another room so that they could keep going two at a time. The French surgeons are marvelous. He asked me during the day if I were fond of surgery and added "But this is not surgery; it is butchery." . . . About noon that day we were told that we were going to receive Americans; there had been a dandy little field and mobile hospital unit establislied nearer the line, but they had been bombed and shelled almost out of existence and were forced to move back. . . . Four barracks on the lawn were set aside for the American unit when it should arrive and about 2 A.M. the patients began to arrive. . . . Sister Jean and M. Houlie, the eye, ear, nose and throat doctor, who was not very busy at the time, picked out the worst cases and pumped them full of camphor or morphine. ^liss Robins '^" too was splendid; how tliankful I was to have an aide v.'ho had had sixteen months of war work, who was possessed of a level head and a tactful French tongue ! About five that afternoon, two American surgical teams, four doctors, two anestlietists, five nurses and several order- lies arrived. . . . We established a triage, as the French call it, or a sorting-out hospital on the lawn and as the ainbulances arrived, one doctor was stationed to keep those men who were in so shocked a condition they could not go further (eight kilometers on was a large American hospital ready for a large number of men) and to send the rest on. The new arrivals were put in one barrack and as soon as possible vrere carried over to the main hospital building for operation and then back '" Margaret Robins, of Pliiladclpliia, an American Rod Cross nurse's aide who served witli !Miss Williams at Chalons. THE EUROPEAN WAR 691 to a post-operative barracks. All this went on under Boche bombs tumbling from airplanes, that five minute long range shell and anti-aircraft shrapnel falling like hail all over the place and much the most dangerous thmg of all. Surely God, in his protecting divineness, must have seen and felt our sufferings that week, for hajjpily no one was hurt or killed in our particular hospital all those terrible days. I've saved the piece of shrapnel that glanced off my tin lid. During nights such as these, the French and American nurses repeatedly came face to face with death and the memory of the agony which attended the last struggle burned itself into their consciousness and left scars which were to remain there for many nights and days to come. Miss Williams wrote : Miss Eobins, two of the Sisters and myself stayed in the barracks on the lawn. There were five nurses in the aperat- ing-room. I could never tell you about that night, it is burned into my memory as a horror never to be forgotten. Men died, it seemed to me, every five minutes ; every case was either abdominal or head and therefore practically hopeless. I did not know death could be so pitiful. All I've ever seen of death has really been a merciful release for some soul struggling against disease when the course of life was nearly complete, but God ! how hard it was for these strong young lives to give up, such a ghastly waste of human vitality, thought, happiness, everything worth having, snuffed out under the most exquisite suffering! And nothing to be done about it but try and make it bearable and thank God few knew they were going to die. That is the worst of all. . . . Friday night enemy aviators came again, so the patients were taken down to a cave which served as an ahri. Miss Williams described the bombing: At nine-thirty the Iluns arrived. They boml)ed until 3:45 A. M, around and around the hospital, blew open every iron shutter on the windows, came within ten yards of the conta- gious building so that all the contagious patients were forced to come over to our cave and halls. The concussion of one ])oml) was so terrific tliat it broke tlie leg of (^iptain M.. one of our oldest patients, whose two breaks had nicely knitttnl. The terror of the patients was simply ])itiful; those brave lads who had gone over the top so unthinkingly, found it almost impossible to bear the racket when tliev were bmuul 692 HISTORY OF AMERICAN RED CROSS NURSING helplessly to a bed. I kept thinking the next will surely get us, but evidently they were just warning us to get out, for their aim was perfect and they just went around and around us all night. We started at 4 A.M. to evacuate (that was Saturday) and after all the patients had gone we went over and packed. We started for Paris at 5 :30 P.M. Saturday and it wasn't until we got into that train that we realized we had not been undressed, to bed, or off duty since Sunday at midnight when the fracas began, and during the whole week I counted up four and a half hours sleep [in 137 hours' duty]. We got to a little town about midnight, where we had to change. There we had sometliing to eat and although we were half-starved we would fall asleep between mouthfuls. After that we sat on our bags on the platform until G A.M. waiting for the train to Paris, which was supposed to come through about 2 A.M. We reached Paris at 1 :30 P.M., Sunday, went to the Pension Galilee, had a grand lunch in our rooms and by 2 :30 we were sound asleep and never woke up until the following morning around 5 A.M. Of each day's routine in those French hospitals, a nurse wrote : Some years ago, a wild youth, the son of a titled family in Brittany, ran off to America. He had no money and helped to unload bananas at the docks in New York as his first job. Ijater ho was a waiter and almost everything else. In the course of twenty years he became very prosperous in iron and steel and was completely Americanized. Then when tlie war broke out, he volunteered in the French Army. For months he seemed to bear a charmed life. But after a while in one of his dare-devil voluntary services, he lost a leg near the thigh. The surgery was skillful but gan- grene had made headway. There was just one thing to do, long frightful baths of iodine. Those baths were my severest duty in this war. The agony afterwards, too ! With his face drawn and ghastly, he would joke in American slang. His strength was so wasted that his surgeon told him he must conserve it even to the extent of not changing his position. Watching the clock, he would lie on one side for five minutes, the extreme duration possible, then on the other for five minutes. With such a mighty force of will to live, he per- formed for a while the miracle of living. They told his mother from Brittany, whom he had not seen for tM'cnty years, that she could come if she would smile all THE EUROPEAN WAR 693 the time she was there. The frail little gentlewoman bowed. "I will come smiling," she said. She did. And in the days that followed, through the dressings, through the iodine baths, she sat near him, knitting and smiling. Then one day we brought him other news, the two su- preme messages of Iiis life. This French-American or this American-Frenchman, had been cited. ... At the appointed time, the doctors, the nurses, the directors came in. Then the General entered with his staff, to which were attached military drummers. The ceremony begins with the drums rolling a certain beat, never used except to announce this decoration. We stood at attention, the patients of the wards held themselves at salute, the General touched with his sword the shoulder of the trembling, uniformed man in bed, sa- luted his cheeks and attached the Medaille Militaire on his breast. The drums rolled thunderously. The surgeons didn't talk for a while. They knew. And we nurses dropped things and were awkward for the rest of the day. And the frail little mother kept smiling, with ener- getic nods over her knitting. She knew. Miss Fitzgerald had ample opportunity to see the French hospital and nursing service in operation. The reports of her inspection trips mention again and again the courtesy of the French surgeons and the willingness of the French nurses, handicapped by inadequate training, to do what they could for the Americans. j\liss Fitzgerald wrote: August 3: T visited the PI. 0. E. 18 at Meaux. Here I found one of our nurses in charge of the triage, or sorting- station. In one corner of this great admission tent, she liad established a little diet kitchen of her own and in her odd time she made broth, porridge and such diets for the j)a- tients in that hospital and in the other hospital at Mcaux whom she thought would be benefited by such food. In {\w hospital, the mfdccin chef spoke in great admira- tion of the nurses. The thing that struck him especially was the fact that our nurses actually washed and cleaned the pa- tients themselves and that they said they enjoyed doing this. This remark might seem strange to anyone wlio did not un- derstand the French methods of nursing, which consist purely in making surgical dressings, in taking tem})eratures. in giving the medicines aiul carrying out the treatments ordered by the doctor, and here the nursing ceases. The actual care and cleanliness of the ])atient and of the l)edding falls to 694 HISTORY OF AMERICAN RED CROSS NURSING the lot of the servant class, no matter how ill the patient is. The result is that a patient goes unM'ashed until he is well enough to get up and ambitious enough to do this for himself. . . . August 22 : Went to the H. 0. E. 13 at Chateau-Thierry and found one of the nurses had been called for by a French General in his own car to go and care for an American lad in a French formation nearby, who was not expected to live. Time proved this to be true and the man died very much the happier for having had -an American nurse with him who was able to take his messages and send them to his people at home. The courtesy of this French General should be much appreciated ; it was a very humane act on his part to go him- self and get the nurse whom he knew would provide the care and consolation which the boy needed. Molly B. Smith, an American Eed Cross nurse transferred from the Children's Bureau to a French hospital, wrote : We found ten severely wounded American boys at the Hospital Betz. The French moved them into a separate ward and put them entirely in the care of my aide and me. Four of the boys were delirious and two died almost immediately, the other two a few days later. The French at once sent four very ill poUus to fill the four vacant beds. At first we could not understand this, as there were still vacant beds in the French hospital, but we learned that they had sent us their worst cases because they had noticed the nursing care which we had been giving our boys and realized what it might accomplish with their own desperately wounded cases. We in turn marveled at the kindness and the attention which the French doctors gave ever}- man, regardless of his rank and the nature of his wound. And the hours that they were able to keep going, in a work which to them was already a very old story ! This was also true of the poilu orderly, so polite and so efficient. In September, 1918, Miss Fitzgerald inspected twenty-six French hospitals to which American Ked Cross nurses had been assigned. She wrote: Most of the formations that I visited at this time were barrack forniati(jiis and some of them were extremely well organized and administered. 1 found several of them being taken over by the Americans, who naturally were each day THE EUROPEAN WAR 695 taking over more in this particular region. The situation in a hospital which is changing hands is really rather curious: the medecin chef finds himself very much at a loss because he has no idea of his own personal status. All he knows is that he has lost a hospital and that the Americans have gained one and as our methods are so very different from the French, he does not quite understand at what stage of the game he is. The Americans arrive rather suddenly with a great many cars and conveyances and apparently need more space than the poor French ever had in four years of war, but after a while things settle down and nothing could interfere with the perfectly good feeling between the French and the Americans. I found that the American formations did not have any nurses with them. Upon asking the reason for this, 1 was told that an Army order had forbidden the presence of any woman in this area until the first gun should l)e fired, as the white cap and white uniform were considered to be too conspicuous. The roads presented an endless stream of convoys going in a direction north of Verdun and this endless stream continued for twenty-four hours out of the twenty-four. It did not seem possible that so many Americans could be in France ! Two hundred and five American Rod Cross nurses and nurses' aides wore assigned during the spring, summer and autumn of 1918 to the French hospitals of the Service de Sante. Miss Fitzgerald wrote: Our nurses have been in 151 French hospitals. The total number of the American Expeditionary Forces cared for is difficult to estimate, because the American wounded came in in such varying-sized groups, from 4 patients to as many as 600 patient:-. A fair average group, I think, would be about 20 patients to one hospital. At least 3000 American sick and wounded have been cared for in all l)y the American Red Cross nurses. When tliere were not enougli of the American Expeditionary Forces to need all of a nurse's time, she helped amoniT the French wounded. Perhaps the most spectacular service which the American Ked CVoss in France reiid(M'ed to the I'nited Staters Medical (\irps and to the wounded American soldier in j-'rance was the estai)lishinent of einergcMicy hospitals during tlie spring and summer of lOUS for the American Expeditionary l-'oi-ccs. At the beginning of the (lernian oiFensive of March Jl, 1018, it 596 HISTORY OF AMERICAN RED CROSS NURSING will be remembered that the sanitary formations of the U. S. Medical Corps were located behind the Toul sectors in the eastern and southeastern part of France. In the third offensive, the German High Command chose to strike, however, at the French trenches along the center of the Western Front. Of this blow, Colonel Ayres wrote: "For their next attack (May 27) the Germans selected the French Front along the Chemin des Dames north of the Aisne. The line from Rheims to a little east of Xoyon was forced back. Soissons fell. . . ." The First Division was at this time brigaded with the French in the Noyon-Montdidier trenches. On May 28 the Americans cap- tured and held the town of Cantigny and the casualties were sent back to Beauvais for evacuation to Paris. How the American Red Cross medical service fitted into this emergency is shown in Major Fosburgh's report: We consulted with the Army authorities and found that by agreement the French had promised hospitalization of our men and that for diplomatic reasons it would then be impos- sible for our ^[edical Corps to establish an American evacua- tion hospital back of our own troops in the French sector. If the American Eed Cross could accomplish this, however, it would be welcomed by the Army. The French Service de Sante was approached on the sub- ject. The American Red Cross proposed that they establish and operate an Allied hospital at Beauvais with the under- standing that if American troops were in the neighborhood, their wounded would be sent here. The proposal was imme- diately accepted and the French hospital located in L'Ecoh Profcssionclle at Beauvais was turned over to the American Eed Cross. It was our understanding with the French Ser- vice de Saiitc that the hospital would be transferred to us fully equipped. Our inspectors reported, however, that the existing equipment was deficient, so we made arrangements prior to the actual assumption of the hospital to re-equip it. expecting in tbe meantime to use temporarily the equipment of the French. Of the organization of the nursing staff for this hospital, later designated as American Red Cross Hospital No. 104, Miss Stimson wrote: A special meeting was held May 29 in the office of the general manager who in the absence of the commissioner for THE EUROPEAN WAR 59T France called the acting head of the Department of Civil Affairs, the chief nurse of the Children's Bureau, the di- rector of the Women's Bureau of Hospital 8ervi(;e and the chief nurse of the American Red Cross in France. After the discussion of the need for nurses to take care of Ameri- can soldiers not only in Paris but in hospitals nearer the line, this meeting voted that the Department of Civil Affairs should immediately call in at least forty nurses for re- assignment by the chief nurse to the Department of Military Affairs. This number was later raised to sixty. By three o'clock the next afternoon twenty nurses, most of them specialists in baljy welfare, tuberculosis and other forms of public health nursing, left for Beauvais while twenty others were sent to ])repare the hospital at Auteuil. Three doctors, the nurses and two orderlies were crowded with many supplies into two trucks. We reached Beauvais after 10 P.^I. The town was so dark that we could hardly keep the road; French sentinels at in- tersecting streets were the only human beings visible. Two American military police guided us to Red Cross headquar- ters. On the way, they pointed out the wrecked ])uildings in which many of the sixty civilians, killed the night before, had met death. Red Cross headquarters was in total darkness. When I told Captain Jackson that twenty nurses and Bishop Mc- Cormick had arrived, we got vigorous response. Tb.rough the streets now dark and congested by Army trucks heavily laden with troops, we threaded our way to L'Ecole Pro- fesmcmelle. As we drove into the courtyard we saw the dim outline of a quadranglc^-shaped building. Some voices were heard and several ])eo)de came out with exclamations of welcome. By this time, the siren was sounding and the guns boomed their reply. We nurses wert^ hurried across a cloister-like corridor into a pitch black room. It was impossible to see the faces of the people who were speaking and not even a lighted cigarette was ])ermitted. We soon got the situation: two huiulred American patients ;ind some French cases left in a wholly unequi))|>(Ml hospital. Th(^ severe raid of tlie day before had completely (lemorali;^ed the French civilian (Mnployees. (ias. electricity and water mains bad been ])ut (Mit of conimission. A large number of patients, after twentv-f(Mir houi's. still lay on the stretchers on which they had comi^ in from the fii^ld. fSix AmiM'icnn nurses. gathere(l up from surrounding places, hail been toiling night and day but were still as game as the .\merican otlicers in charire. 598 HISTORY OF AMERICAN RED CROSS NURSING They asked for eight volunteers from among the new arrivals. Every one of the twenty moved forward. The first eight whom we touched in the darkness were put to one side and the rest groped their way to an empty ward containing nothing but bed frames with metal slat-springs. In spite of tw air raid alarms, they went immediately to bed. One adventurous soul happened to look out of the window at 2 A.M. and saw in tlie courtyard our other truck containing their baggage. Out she went for bags and holdalls and those nurses at least had uniforms in which to go on duty. The eight nurses took off their hats and coats and went into the unlighted wards filled with heavily wounded men. What a tired group they were next morning, with their hair disheveled, without caps, with their faces and dresses covered with dust from their trip, with stained towels pinned up across the front of their cloth dresses ! One of the eight nurses who were selected for night duty was Anna J. Johnson. She wrote of her experience : Miss [Dorothy] Turnbull, the chief nurse, led the way through the darkness and we followed as best we could. Miss []\Iargaret F.] McLeod and I were taken to wards on the top floor; we thought we would never reach the top, as we had to feel our way up winding stairs and through dark halls. We were told that there were about sixty new operative cases and were instructed to watch for shock and hemorrhage. "Do not strike a match or turn on a flashliglit," were Miss TurnbulFs parting words. The barrage continued throughout the night, the Boche planes hovering above us and the shrapnel falling like rain on the roof. When there was a lull, we could hear our pa- tients moaning but we could not always find them. At 3 :00 A.M. the moon came out and wc could see after a fashion. At dawn, we discovered that we had liad patients and beds and dirt, but practically nothing else. We had oidy one centi- grade thermometer, three glasses, one basin, no towels, no wash-clothes. . . . Miss Turnbull took us to breakfast in a huge hall where Italian and French orderlies were screaming at each other. There were a number of long dark marble tables. Breakfast consisted of French military bread, date 1915 on the loaf. Each person cut his or her chunk ofP ; there was a streak of mold running through it. but one picked off tlie good bread and ate it. There were large granite ])itchers of coffee. . . . THE EUROPEAN WAR 699 The capacity of the Beauvais hospital, originally two hun- dred and fifty beds, was immediately expanded by the use of Bossonneau tents to four hundred, a number large enough to make necessary the establishment of a special evacuation train service running between Beauvais and an emergency base hos- pital established on the Auteuil race course near Paris. During the entire time that the First Division was in the ]\[ontdidier sector, American Red Cross Hospital No. 104 received and evacuated American wounded. ^liss Stimson reported the con- ditions on the morning following the arrival of the emergency imit : Patients were immediately evacuated and others admitted. Nurses in charge of the wards soon began to bring com- parative order out of chaos. Boxes of supplies were opened and equipment of all sorts distributed. A number of the members of the Smith College Unit were flying about on all kinds of errands. Some made beds, some went in their camions for food, others washed dishes. The kind of work they had been doing for days has been beyond all praise. Left alone in wards full of seriously injured men, they had nothing but instinct and common sense to guide them in their care. In leaving the hospital, the French had taken a great deal of their equipment. Eed Cross supplies from the warehouse in Beauvais were rushed over within a few" hours. A Eed Cross plumber and electrician appeared. Soon all the depart- ments of a smoothly running evacuation hospital were getting into line. "Tell them in Paris," said the Army ^Major in charge, "that we are marching on." "Tell them," said the nurses, "this is what we have come for, this is exactly what we have had all our preparation and all our training for, and we can't say how glad we are to be here !" Back in Paris on the Champs dc Course at Auteuil, just as splendid a piece of work was being done in the emergency erection of a Red Cross base. Dr. (\ C. liurlingame, director of hospital administration of tlu^ commission, rc^ported c(^n- cerning the establishment of this hospital, American Ked Cross ^lilitary Hospital Xo. ."> : On April S. 1918, Colonel S. P. Wadhams. :\redical Corps, presented to the Ped Cross the {wssible need for additional 600 HISTORY OF AMERICAN RED CROSS NURSING hospital beds in Paris; that the Army was forbidden to ac- quire them; and asked for a tent hospital in the Bois de Boulogne. This request was later confirmed in writing in the name of the Chief Surgeon. The Eed Cross undertook the establishment of a hospital capable not only of caring for convalescents, but to be used for general medical and surgical work. The construction was commenced on May 6. Twenty-one working days later, on Memorial Day, this hospital received its first convoy of one hundred and sixty-nine patients. At the beginning it was a five hundred bed hospital, but grew rapidly to twenty-five hundred beds. This tent hospital became the great sponge which absorbed all the overflow patients during the German drives toward Paris. American Eed Cross nurses composed the entire original nursing force. When the emergency arose, they were swiftly withdrawn from the Children's Bureau, the Tuberculosis Bureau and other Ked Cross civilian relief activities. Xever was there a better demonstration of the resourcefulness of American women than in this instance. Perfectly green in the military game, they filed in, formed a nursing force of an extremely active military hospital and accomplished their task as if they had been there all their lives. Harriet L. Leete, of the Red Cross Children's Bureau in Paris, an American public health nurse of ripe experience and great native ability, was chief nurse of the Auteuil Tent Hos- pital, American Red Cross Military Hospital No. 5. Miss Leete was a graduate of the Lakeside Training School for iSI^urses, Cleveland, Ohio, and was for many years superin- tendent of the Babies' Hospital disponsarv of that city. Her first afiiliation with the American Red Cross came in 1907, when she volunteered through the Rochester Cliapter for service as a nurse. She was one of the charter members of the iSTational Committee on Red Cross Xursing Service and was an enthusias- tic sponsor of the service during the early days of organization and throughout the period of w'ar and demobilization. She went overseas as a member of the U. S. Army Base Hospital Xo. 4 (Lakeside), but was transferred from her unit on Sep- tember 15, 1917, for duty with the American Red Cross Chil- dren's Bureau of the Department of Civil Affairs, Red Cross Commission for Franco. In her work with tli(> Cliildren's Bu- reau, she rendered brilliant service until her transfer to military duty as chief nurse of Xo. 5. THE EUROPEAN WAR 601 Miss Leete had as her assistants at the Tent Hospital, Susan Apted* Blanche Gilbert and Grace Kellerhouse. To Mrs. Apted (Connecticut Training School, New Haven, Connecti- cut) was entrusted responsibility for setting up and equip- ping the various tent wards, as the hospital was expanded during the summer to meet em(>rgency needs. Blanche Gilbert (Lakeside) had charge of the placement of nurses in the different divisions of the big base. Grace Kellerhouse (Methodist Episco- pal Hospital, Brooklyn, New York) was the head nurse of a unit of twenty Navy nurses which was assigned in August, 1918, from Navy Base Hospital No. 1 at Brest to Auteuil, to relieve the nursing shortage at the Tent Hospital. Miss Keller- house was placed in charge of the training of the orderlies at No. 5. She was given authority over the sergeants and by reason of this imj)ortant concession, as well as because of her native tact and ability and her previous experience in the Navy Nurse Corps for one of the chief duties of Navy nurses is the instruction of hospital attendants Miss Kellerhouse did bril- liant work at American Red Cross Military Hospital No. 5. At the height of the sunnner offensives, the nursing staff" of the Auteuil Hospital numb(n*ed nearly three hundred nurses. The hospital occupied a position of great strategic importance. Nurses who had arrived in France without any experience in military nursing were assigned to temporary duty at No. 5 and were there instructed in war-time surgery by Inez Cadell (Johns Hopkins), a surgical nurse familiar with the most modern phases of war nursing technique. After this intro- duction to military nursing in the Tent Hospital, where con- ditions somewhat resembled those to be encountered later in the field, the nurses wvrc sent on up the line to forward Ameri- can Red Cross and Medical Corps units. Of the recreational phases of American Red Cross ^Military Hospital No. 5, Dorothy Lewis Kitchen, who had aided !Miss Delano in the preparation of nursing publicity at National Headquarters until her assignment overseas as a hospital re- creation hut worker, wrote : American Red Cross ^lilitary Hospital Xo. 5 is a large tent hospital on the race course. The recreation hut. also under can\as. contains writing tal)les, a })iano and victrola and a canteen where cigarettes, etc., are sold. W'e came through the mud and ])ools of water with a i;uii(]i of hoy< dressed in hath rol)es. iroinir to hear a Y..M.('.A. concert 602 HISTORY OF AMERICAN RED CROSS NURSING there. The gassed cases are the hardest. Any man would prefer a heavy wound. These boys have a queer yellow-white color, are very thin and cough in a peculiarly rasping voice when they've had it in their lungs. The tent was jammed with soldiers. The concert singer, one I'd heard in vaudeville in the States, got them to singing. It's queer that they seem to adore the rather sad, sentimental songs like "Just a Baby's Prayer at Twilight" and "Home- ward Bound." She singled out a little darkey from Tennessee who ragged the piano, another doughboy who also played and several who whistled excellently. The audience really bright- ened up to hear one of their own crowd perform. Going back we passed the windows of the tent wards ; heads came popping out and they called: "Gee, real American girls !" "Anybody there from Missouri?" "Ain't California swell?" Some inside who couldn't lift their heads smiled at us through the windows. Elizabeth Crcadick, an American Red Cross nurse who wa3 at one time assigned to duty at No. 5, wrote : The little comforts and luxuries furnished the boys at Auteuil made a tremendous impression upon them. One night while on duty in a stalile which had been improvised into a semi-hospital, I overheard a boy say he hoped he would go to Ked Cross Hospital No. 5 in Paris because "you got ice cream there and it was some hospital, besides !" The other boys, all grievously wounded and lying on blood-soaked stretchers, forgot their suffering for a moment to dispute such a fairy tale. The lad got his wish because I went to see him at Hospital No. 5 a month later. During the first six months after its establishment, Ameri- can Red Cross ]\Iilitary Hospital No. 5 received 11,401 Ameri- can patients and maintained 18^},7'}-3 hospital days. The Beauvais and Auteuil hospitals were created out of the dire emergency caused by the enemy's possession of the Soissons Line. The need for Red Cross emergency hospitalization for American troops continued. Colonel Ayres reported the con- tinuation of the third great offensive of the German divisions massed on the Western Front: . . . Soissons foil and on ^lay 31 the enemy had reached the Marne Valley, down wliich lu' was advancing in the direc- American Red Cross Military Hospital Xo. 5, at Auteuil. near Paris. To the riglit appear tlie old betting-booths under the trees. The interior of a tent ward at Autriiil THE EUROPEAN WAR 603 tion of Paris. At this critical moment, our Second Division together with elements of the Third and Twenty-eighth Divisions were thrown into the line. By blocking the gen- eral advance at Chateau-Thierry, they rendered great assist- ance in sto{)ping perhaps the most dangerous of the German drives. The Second Division not only halted the enemy on its front but also captured from him the strong tactical posi- tion of Bouresches, Belleau Wood and Vaux. Major Fosbiirgh summarized the sanitary situation of the Second Division as it moved into the line at this grave crisis: It was reported to us that in the expectation that the French would provide all hospitalization, the Second Division had left in the Toul area everything except their regimental medical chests. Furtliermore, because of the suddenness of the drive between Soissons and Kheims, the French had been unal)le to salvage any of the hospitalization in that area and had lost in excess of 55,000 beds. They were totally unable to make provision for the needs of the Second Division. The day after their arrival in the Meaux area, Red Cross inspection cf their equipment found their entire hospitaliza- tion to consist of two field hospitals. One of these, located in a cow barn, had five stretchers and a small assortment of drugs and dressings. The second one, located in a small schoolhouse, luid twelve stretchers and a larger collection of dressings and equii)nient. Back of these so-called field hos- pitals, the divisional surgeon was attempting to establish at Meaux. a distance of twenty miles behind the lines, in a wrecked chateau, an evacuation hospital, using tentage and equipment previously loaned to the division by the American Eed Cross. Back of ^leaux, not a single bed was in readiness for the recej)tion of wounded, liourly expected, until Paris could be reached at a further distance of approximately thirty miles. The divisional medical otTicers and consultants ap])oaled to the Ped Cross for assistance. It was apparent that a hospital for evacuation ])urposes must be established at once and ar- rangements w(M'(' concluded over night for taking over the hos])ital at douilly. Scine-et-^Iarne. which liad been o])('ratc(l since liil4 by Mrs. 11. P. Whitney. At tliat tinie it had a capacity of '^'A-'y beds. Additional buildings and tentage immediately brought this up to eight hundred and lit^forc the ^Marines and other detachments of the Second Division made their great fight in Belleau Wood, this hospital was in full o])eration. The Ped Cross also furnisiied tentage. drcs.-ings, 604 HISTORY OF AMERICAN RED CROSS NURSING instruments, drugs and other supplies to the division for their field hospitals. Everyone of the eighty-five hundred casualties in a single week in Belleau Wood were brought down through American Red Cross beds to Paris.'^ Colonel Burlingame's report included the following com- ment upon the work accomplished by the little unit at Jouilly, Seine-et-Marne : Colonel Morrow, chief surgeon of the Second Division, suggested tliat the l?ed Cross take over the Jouilly hospital and tliat transportation of patients be made by ambulance from ]\Ieaux to this point. With no formality at all, the hospital was taken over and on the same night, June 3, it was filled. Within a few days its capacity was increased from two hundred and eighty to one thousand beds. On June 8 the Eed Cross personnel was augmented by the assignment to duty at this formation of personnel from United States Army Evacuation Hospital Xo. 8. During the days of its enlargement, installation of electric lights, etc., it received a continuous stream of supplies from Paris and at the same time was caring for its maximum ca- pacity of patients. On July 6 and 7, 1700 patients were handled by tbi'S small unit and 1183 were evacuated to Paris. The personnel of iMacuation Hospital Xo. 8 was withdrawn and for a time some of tlie personnel from a newly-arrived Army base hospital were assigned to duty there. The removal of American troops from this sector resulted in the witlidrawal of the ^Medical Corps from this formation and this unit was therefore discontinued as an American Bed Cross military hospital to function as American Red Cross Hospital No. 105 for the French wounded. '^^ The hospital at Jouilly, Seine-et-]\Iarne, was used as a medi- cal and surgical center throughout the summer of 1018, while American troops were in the vicinity of Chriteau-Thierry. Anna Johnson was assigned to diity there on August 22. She wrote : This hosjiital is located in an old college and the buildings have been used at three different times in history as military " A furthor iiccount of tlie work at Jouillv, Soine-et-Miirm>, appears in Chapter VIII. ""Military History of tlie American Red Cross in Franee," p. 44. Library, National Ileadcjuarters. THE EUROPEAN WAR 605 hospitals. ... I was put on night duty; influenza patients were coming in very fast from a veterinary camp at Jouilly. I had two tents about one half a block a])art. One orderly was on duty in one tent and another in the other tent and all night long in the pouring rain I plowed l)ack and forth through the mud between the two tents. The men were desperately sick. On the fourth niglit, the theater of this old college was opened to acconnnodate the great numbers. There were 03 new patients that night, be- sides the ones in my two tents and in the theater. 1 was told that at midnight more nurses would arrive to iielp me. Four of the doctors stayed on. The men were the sickest I have ever seen. They looked like gassed patients but none of them had ever been near the front and they had only been in France three weeks, taking care of gassed horses. If ever doctors worked with patients, those from Base Hospital No. 57 certainly did, but those boys in spite of all our efforts simply died. One night 13 were carried out of my ward. It was discouraging beyond all words to see those splendid specimens of manhood just pass out without a struggle. They were all big Western fellows; many of them had never had a sick day in their lives before. The last week in INFay, 1918, found General Lndcndorff in possession of two wedges thrust toward Paris, that in the northeast with its point at Cantigiiy and Montdidier and that in the southeast with its tip at Chateau-Thierry. In his fourth great offensive, he sought to smooth these wedges out into a single continuous front. Of the threatened blow which fell in June upon the French and American troops holding the Noyon- Montdidier trenches, Colonel Ayres wrote : The enemy had by his offensive established two salients threatening l^iris. He now sougiit to convert them into one by a fourth terrific blow delivered on a front of twenty-two miles between Montdidier and Noyon. The reinforced I'rencli Army resisted firmly and the attack was halted after an initial advance of about six miles. Throughout this ojiera- tion (June 1-15) the extreme left line of the salient was de- fended by our First Division. During the first week of June, 1018, American Ived Cross ^lilitarv Hospital No. 107 was organized at .Iduy-sur-Morin. Of its establishment. Colonel Ihirlinaanic wrility which she has, but she is so tre- mendously sincere and energetic that every persou about her works with the same spirit as far as it is in him.'. . . At Jouy-sur-^rorin, on the night of July 1,"), Jane Jefferv, an Anicrii'iM! Kcd Ci-oss nurse transferred from the Children's 608 HISTORY OF AMERICAN RED CROSS NURSING Bureau, was severely wounded. A French dispatch contained the following comment : Located in a quiet, remote spot three kilometers from the railroad, the hospital at Jouy-sur-Morin not only bears the distinctive marks of the sanitary service, but on a nearby grass plot there has been spread a huge cross made of white towels, its arms measuring thirty meters. Shortly after the inauguration of the hospital, one of the Allied planes flew over the spot taking photographs to show that the cross was plainly visible from a height of many thousand meters. During the night of July 15, two German aviators flew above the American hospital; volplaning, they descended to within a few hundred meters of the buildings and dropped four bombs. It was midnight. In the operating-room, the surgeons were at work. At the moment when the first bomb struck, Major McCoy held in his forceps the femoral artery of the patient on the table. The lights went out, two more bombs fell, the third failing to explode. In one room, an orderly was killed as he was giving a drink of water to a patient. Nine were wounded, . , . one of whom was an American Eed Cross nurse. We remember that recently sixty German prisoners were treated in this hospital at Jouy-sur-]\Iorin. where they re- ceived from perhaps the very nurse whom they have wounded the same care and attention which she was giving our soldiers.'^ Miss Stimson wrote Miss Noyes on July 19 : Miss JefPery was on night duty attending her patients when a fragment of shell struck her. She showed great spirit and was only concerned because she felt she was causing more trouble to the already overworked stafl^ of doctors and nurses. When T told her the next day we were going to bring her into a hospital lu-ro in Paris, she was greatly disappointed. She had hoped to be able to go on duty again in a few days. On July 31 the Paris Bureau of Nursing rushed twelve new arrivals u]) to Jony-sur-Morin to rccnforco ^liss Moirs' staif. Among these nurses was Edith Ambrose, a nurse especially trained in psychiatric work. Of her experiences, she wrote: '"Translated hv tlie Aniorif-an Rod Cross Department of PuLlicity, from Tablcttrs (Iff! Dcux-Churenie, July 23, 1918. THE EUROPEAN WAR 609 Upon our arrival at 10:30 P.M. three of us went immedi- ately on night duty. Just as we were ahout to go to our tent assignments, Fritz was announced by a siren. We happened to be in the corridor of the chateau whicli is headquarters for the staff and operating-rooms for the hospital. .Fritz's calling cards roared as they struck and bang ! bang ! bang ! came our welcoming response. Our exchange of amenities lasted for perhaps half an hour. When it was over, I tried to analyze my sensations, chiefly disappointment at not being outside to see what was going on and certainly amusement at our different attitudes. A timid voice whispered out of the dark- ness that she "wouldn't be so afraid if someone would -only hold her hand !" Every one must have grabbed for it, for I found both of mine firmly held until after the last gun was fired. They led us out in tlie darkness to the tents where each of us were given a candle and explicit instructions to shield it carefully. The tents had no floors, but by morning we had ever}' bed full. In an evacuation hospital like this we did as much as we could to make the boys comfortable for a few hours before they go on to the base. IMorphine of necessity became the standing order. We tried to give them a bath, something hot to eat and fresh dressings. In my tent was a lad from Xorth Carolina with both lungs pierced. As he was hemorrhaging quite frequently, we moved his bed outside to give him all the air possible. He said to me: "Would you tell me a fib if I asked you if 1 was going to die?'' I answered, "Well, you are a good enough soldier to know what a fighting chance means and you mustn't tliink for a minute you're going to lose." He groped for my hand in fear that 1 should leave him alone to face the weakness coming over him. Presently, T asked him if he would like me to write to his mother. "Xo," he said, "she's so scared now she'd die to s(>o a strange handwriting." After a little while he said again, "You all are certainly next to having her here herself." A hospital wliicli had previously hocn maintained in part by private American philanthropists and in part l)v subsidies from the American Tvcd Cross, was taken over entirely by the commission in duly, liUS, oxpand(Ml and operated as an American Ked (^ross hospital ; this formation was Or. Fitch's TFospital at Kvrcux, Vllnjufnl Comjil'uncntdirc Xo. J. which the French Scrrire de Smile had tnriu'd ov(^r to liini on September 4, 1917, after he and Miss Xclson and other nurses of the 610 HISTORY OF AMERICAN RED CROSS NURSING original Yvetot.Unit had been transferred from St. Valery-en- Caiix. Dr. Fitch's hospital at fivreux was given on July 21, 1918, the designation of American Red Cross Hospital No. 109, was greatly enlarged and was run by the commission until after the Armistice. The nursing staff was reenforced from time to time by additional nurses from Paris headquar- ters. Leila Halverson, an American Red Cross nurse trans- ferred from the Children's Bureau to Dr. Fitch's hospital, wrote : About May 1, the hospital had a capacity of 300, but soon four fifty-bed barracks were built and afterwards ten tents, containing from ten to fifty beds each, were put up. Most of the wounded were French, but we also had Americans, Eng- lish, Colonials and Boche prisoners. . . . The work done in this hospital was almost entirely ortho- pedic, with a great deal of bone plating and bone grafting. We were terribly rushed at times and were very short of nurses and aides. After the arrival of one American convoy, the surgical staff worked steadily for 42 hours, stopping only long enough to eat the meals that were served in the steriliz- ing room, then slept for four hours, then operated again for 20 hours. . . . From September 4, 1917, the date on which Dr. Fitch and Miss Nelson first took over VHopital Complimentaire No. 2 at vreux until January 1, 1919, 2194 patients had received care there from American Red Cross surgeons and nurses. Early in June, 1918, the use of gas by the Germans was increased to a considerable extent ; this increase brought about the need for a hospital in Paris which could be used exclusively for the treatment of gassed patients. The Red Cross Commis- sion for France accordingly leased the Pavilion BeUevue, at beautiful St, Cloud, near Paris, and on June 18, 1918, opened a hospital of 600 beds, which was designated as American Red Cross ^lilitary Hospital No. 0. This institution was originally intended as a center where both French and American physicians might study gassed cases, but the acute military need for beds for Americans wounded in the German offensives of June and July, 1918, and the subsequent Allied offensives resulted in the use of the Bellevue Hospital solely by the American Expedition- ary Forces. American Red Cross ^Military Hospital No. was staffed THE EUROPEAN WAR 611 wholly by forty American Hod Cross nurses and twelve nurses' aides, who had becni recalled from hospitals of the Cliildren's and Trberculosis Bureaus and reassigned to help meet the mili- tary needs. Lily B. Crighton (Illinois Training School for Nurses) was chief nurse of this hospital. She wrote: On July 10, 1 was assigned to a new gas hospital wliich the Eed Cross started at liellevue, St. Cloud. It was a very beau- tiful place and conunaiulod a bird's-eye view of Paris. . . . Our hospital was Mipposed to be of 50U bed capacity but during the rush, we had well over (JOG patients. The Red Cross sent us generously sup])lies of all kinds, so we could put cots in the halls on short notice. . . , We were also equipped with an electric blower ajul "amberine'' sprays. . . . The men would come in with hideous blisters extending from their shoulders down. The nurses would clip away all this blistered skin, i-lcan the then raw surface with antiseptic solution, dry it with the electric blower and spray on the "amberine." Burns treated in this manner healed in an incredibly short time. . . . Colonel Burlingamc stated that American Red Cross Military Hospital Xo. (J during the six months ending December 31, 11)18, maintained (Jl, ;')<)() hospital days and admitted 3052 patients. Paris was the receiving base for American soldiers wounded in the German otl'ensives, but, as has been stated before, the sanitary units of the U. S. Medical l)e])artnient were not then admitted to the French Army Zone, of which Paris was the center. Thus all American Ked Cross hospitals in and near the citv were crowded to capacitv during the sunnner of 1918. The American Ambulance which was greatly enlarged and two smaller sp(;cial hospitals which had been established in connection with it. were utilized for the wounded. I'^iirly in 11)18, a need had arisen for hos])italization facilities to care for sick personnel of the American Ued Cross and of other Anu^ri- can welfare organizations tlu'U o{)erating in Kurope and of women employees of the American Armies in and al)()Ut Paris. The Commission for France took over, re('.(iui])ped and main- tained a small private hospital at Xeuilly which they designated American Red Cross Hospital No. 101. Later a sepai'ate hos- pital, also at .\euilly. was secui'ecj and oierateil by the 612 HISTORY OF AMERICAN RED CROSS NURSING American Red Cross for auxiliary personnel of the American Expeditionary Forces. It was designated as American Red Cross Hospital No. 103. When, in June, 1918, the military situation became acute and the Germans seized Soissons, with the subsequent loss of French hospitalization, the beds of American Red Cross Hospitals Nos. 101 and 103 were used to care for overflow patients from the Ambulance, Military Hospital No. 1. Thus during the six months ending Decem- ber 30, 1918, Red Cross Military Hospital No. 1, with its allied hospitals Nos. 101 and 103, admitted 7437 patients and maintained 175,873 hospital days; 5553 operations were per- formed during this period. Red Cross Military Hospital No. 2 admitted during the period from July 1, 1918, to December 31, 1918, 2283 patients, performed 1294 operations, and maintained 64,478 hospital days. American Red Cross Military Hospital No. 3 during the last six months of 1918, admitted 1524 patients, of whom 27 died. The hospital maintained during this period 31,491 hospital days. The operation of this emergency hospital service in the zone of the base in such places as Paris and Evreux, and in for- ward areas such as Beauvais, Jouilly-Seine-et-!Marne and Jouy- sur-Morin called for extensive Red Cross organization to furnish personnel and supplies to the units. To meet the calls which they had reason to expect would continue throughout the sum- mer as the Allied offensive was developed, the Red Cross Com- mission for Europe had built up by June, 1918, an organization similar to that existing in the United States. In January, Major ]\Iurphy had resigned from the American Red Cross War Council to nndcrtake service in the American Army and on February 5, ^lajor Perkins was appointed commissioner for Europe. llai'vcy 1). (iibsoii, fornici'ly general manager at National H(;ad(inart('rs and later a member of the War Council, succeeded .Major Perkins as eoinniissioner for France. Com- missioner (lii)son divided France into nine zones, with head- quarters at Paris, Honh^aux, lirest, St. Nazaire, Havre, Mar- seilles, Lyons, Tones and Xenfchatean. The Paris otHee acted in relation to these; zones in much the same way as did National Headquarters in Washingtcjii to its divisions. The twenty a(;tivities of the commission wen; administered by seven de- partments : THE EUROPEAN WAR 613 I. Department of Requirements, wliich dealt with supplies, transportation, manufa(.'tures, personnel, jxjrmits and passes, construction. J I. Medical and Sur18. and steps were innnediately taken to lind a suital)le substitute in the south of b'rancc. A location at Cap d'Antibes, near Cannes, on the I''r(Micb Kivicra. was se- cured and on Januarv f!. IIUO. tlu^ hotel was taken over. 6U HISTORY OF AMERICAN RED CROSS NURSING Plans were made to receive 200 convalescent women personnel of the Red Cross and five nurses were sent to assist the nurse in charge, Mrs. Katherine Hough. The Convalescent Bureau provided all information and secured transportation and reservations. The personnel who were sent down on conva- lescent leave by advice of a doctor, were kept there free of all expense. The personnel on leave were charged reasonable rates, which they could not have obtained at any other hotel in this very fashionable neighborhood. Miss Morgan took a vivid interest in the establishment of the convalescent home at Le Croisic and did much to secure the funds necessary for maintaining it and the other nurses' homes in and near Paris. A list of these nurses' homes may be found in the Appendix. The later weeks of June were comparatively quiet while General lAidendorff massed his forces for what proved to be his last offensive. Colonel Ayres wrote : On July 15, the enemy attacked simultaneously on both sides of Eheims, the eastern corner of the salient he had created in the Aisne Drive (May 27). To the east of the city, he crossed the ]\Iarne but made slight progress. His path was everywhere blocked. In this battle, eighty-five thousand American troops were engaged, the Forty-second Division to the extreme east of Champagne, and the Third and Twenty- eighth to the west, near Chateau-Thierry. The turning-point of the war had come. The great Ger- man offensive had been stopped. The initiative now passed from Ludendorff to ]\Iarshal Foch and a series of Allied offensives began, destined to roll .back the German armies be- yond the French frontier. The moment chosen by Marshal Foch for launcliing the first counter-offensive was July 18, when it was clear that the German Champagne-l\Iarne drive had spent its force. Tlie place chosen was the uncovered west flank of the German salient from the Aisne to the Marne, The First. Seeoud, Third, Fourth, Twenty-sixth, Twenty- eighth, Thirty-second and Forty-second American divisions, togotlier with selected French troops, were employed. At the initiation of the counter-offensive of July 18, the Medical Corps had received permission from the French to bring up their own evacuation hospitals, so that the Red Cross hospitals subsequently developed acted in a supplementary capacity to Army formations. A small unit at Chantilly was, THE EUROPEAN WAR G15 however, an exception and was described by Colonel Burlin- game as follows : Just before the great counter-offensive on July 15 the American First and Second divisions were withdrawn from the Beauvais sector. It was generally believed that their des- tination was to be Meaux, where they were to have a much- needed period of rest. Less than twenty-four hours before the actual attack began on the morning of July 18, it was learned that the destination of these divisions had been abruptly changed and they were beingfswung toward the line south of Soissons. On the line of evacuation from this sector existed no American hospitalization. It so happened that the Ambu- lance St. Paul, then being operated in cooperation with the Eed Cross, was then located at Chantilly on this very line. With but twenty-four hours, the Ambulance St. Paul was selected as the meeting place and an emergency formation created to function as an annex to this little one hundred and fifty bed French unit. Fight surgeons, sixteen nurses and twelve enlisted men were detached from American Ked Cross Hospital No. 104 at Beauvais and directed to proceed to Chantilly, where they were met by additional Red Cross personnel from I'aris. Tents, operating equipment and all things necessary for a three hundred bed evacuation hospital were rushed from Beauvais and Paris to meet at Chantilly. The nursing staflF at Chantilly was made up of fifteen nurses who were withdrawn from American Kcd Cross Hospital Xo. 104 at Beauvais and twenty Army nurses who were sent up from Paris. Mary A. Burgess, formerly in service with the Red Cross Children's Bureau, was chief nurse. One of the nurses with- drawn from Beauvais, Elizabeth E. Cherry, wrote : On July 18, !Major ^Moorehead heard from Paris Headquar- ters that nurses and supplies were needed at Chantilly, that many French and American wounded were expected there at any time. In less than twcdve hours, he had split our per- sonnel, leaving a part in Beauvais. With the remainder of the personnel and with what sup])lies could be spared, we started for Chantilly. The Ked Cross was also sending us more nurses and su])plies from Paris. When we arrived, we found that the tents had already been put up. Mile. St. Paul [founder of the Anihulanee St. 616 HISTORY OF AMERICAN RED CROSS NURSING Paul] had managed to save them in the retreat from Soissons. . . . This unit remained at Chantilly for thirteen weeks and during this time received 1364 patients, many of them wounded men from the United States Marine Corps. The unit cared also for French wounded. One of the largest of the Red Cross evacuation hospitals to be established for care of the wounded of the American Expe- ditionary Forces was set up early in August at Coincy, north of Chateau-Thierry in the Vesle sector. Colonel Burlingame wrote : When the Americans were near Fere-en-Tardenois and Fismes, urgent need existed for an evacuation hospital. American Red Cross representatives went over the devastated area, found a pump capable of furnishing the water supply, ordered materials from five different points to be assembled at this pump, with a piece of charcoal designated it "Ameri- can Red Cross Hospital jSTo. 110" and stationed a man to guard it. Within three days materials were on the spot and within a week patients were being received. Of special interest was the method in which the supplies of this emergency evacuation hospital were assembled at Coincy. Colonel Burlingame stated : A part of this equipment was taken from the American Red Cross hospital at Beauvais, a part from the American Red Cross formation at Chantilly, a part from the American Red Cross hospital at Jouy-sur-Morin, with other articles from Paris wareliouses. At one time, these materials met at Coincy and became American Red Cross Hospital Xo. 110, a permanent and complete mobile unit. An extract from the report of the commanding officer, Lieutenant-Colonel John J. Moorehead, gave a vivid picture of this evacuation center : The location was chosen primarily because of the water, because the road passing our doors was the main artery to the not distant front and beca\ise a railroad soon to be repaired was not far from us. The farm buildings used for offices and store-rooms were wrecks, the ground on which we pitched our tents was full of shell holes, discarded ammunition and THE EUROPEAN WAR 617 other accoutrements of war. Great piles of refuse and debris made it a breeding place for myriads of flies. Not far away, enemy dead lay unhuried. The only pleasing outlook was the view from the hill-top, a wide sweep ending in a range of hills beyond which the sounds of war told us that the line was not far distant, told us also that in this sector there was need of a hospital. To this forbidding site we brought from Chantilly nine surgeons and twenty-nine nurses. Soon we were provided with an ambulance com})any with one hundred and ten enlisted men and the actual preparation for our new home began. After the American troops moved out of this sector, the Chief Surgeon, American Expeditionary Forces, ordered No. 110 to Villers-Daucourt for the Argonne offensive. During the four months ending Xovembcr 30, 1918, this hospital admitted 17,446 patients and maintained 23,179 hospital days. Another emergency evacuation hospital was American Red Cross Hospital Xo. Ill, of which Lieutenant-Colonel J. C. McCoy was commanding officer. Colonel Burlingame wrote of its establishment: At the request of the Army, American Red Cross Hospital Xo. Ill was estal)lished in the Hotel Dieu at Chateau-Thierry in August, li)lr .'in, 191S, it admitted -jn!!.-) patients and maintained St.Sl l.os])ital days. The following report regarding the cTnorgeiicv assignment nf Red Cross nursc^s to hospitals caring for wonndc^l of the Ameri- can Expeditionary Forces during the military crisis of ^lay, June and July, 191S, was submitted by Miss Stimson: All the following requests were met witliin forty-eight hours and in manv cases within twentv-eiirht hours. 618 HISTORY OF AMERICAN RED CROSS NURSING Beauvais : Since April 12, 59 nurses and aides have been sent to Beauvais and the vicinity. The first groups were assigned under the Red Cross representative to French hospitals where there were American men. On May 29, seven of these were assigned to the hospital which had just been put under the care of the American Red Cross and on May 30 twenty more were sent to relieve the urgent condition in that hospital. All the nurses and aides in this area can be moved about from hospital to hospital as the need for their services varies from day to day. Jouy-sur-Morin : On June 4, twelve nurses and aides were sent up to get this hospital ready for patients who were received within three days after the nurses' arrival. On June 18, eight more were sent up to help in the hospital, which is now running as an active evacuation hospital of 300 beds. Auteuil : To American Red Cross Military Hospital Xo. 5, 40 nurses and aides have been assigned to take care of patients who have varied in number from 100 to 712. The first patients arrived on May 31. The Army nurses who were asked for did not arrive until June 14. Service de Sarite: Beginning May 25, 21 teams of one nurse and one aide have been sent out at the request of the Service de Sante, which has given us not more than twenty-four hours' notice at any time. A. R. C. Hospital, 44 Rue Chauveau, Xeuilly, asked for tem- porary aid to assist in the care of American soldiers beginning ]\Iay 30. Five nurses have been sent for vary- ing periods of time. A. R. C. Military Hospital Xo. 2 : Five nurses have been sent here. fivreux : Major Fitch asked for help and on April 27 ten nurses and aides were sent there. Ris Orangis : A nurse and an aide were sent in response to an emergency call. Etc., Etc.', . . In a report written bv Miss Hall, later chief nurse of the American Red Cross in France, appeared the following com- ment regarding the work of Miss Eldon : During tlie Cbateau-Tliierry, the St. ^lihiel and the drive north of Verdun, all feverish times at Paris Headquarters, the Xursing Bureau owed much of its stability, its apparent facility in answering urgent calls for help and its good judg- THE EUROPEAN WAR 619 ment in sfelectiiifif nurses and aides to the assistant to the Chief Xurse |Miss I01don|. ... It was no unusual thing to find her at her desk in the morning with a blank list of waiting nurses and aides in one hand and a request for perhaps twenty or thirty for immediate assignment in the other. This meant the necessity of checking up every hospital in the neighborhood and asking for the release of as many nurses as it was possible to get, and before evening the neces- sary number would generally be produced. ...'*" Of the intense strain under which the American Expedi- tionary Forces and the American Ked Cross were then laboring, Major Fosbiirgh wrote Mr. Davison : The work referred to was done at the most critical period of the war, when" Paris, it would seem, was almost in the grasp of the enemy and when everyone was working under the greatest pressure, both physically and mentally. For periods as long as three weeks our offices were closed neither day nor night. Divisional representatives, messengers from division surgeons, headquarters medical consultants of tlie Army were coming in at all times to beg additional help or report progress. During one night between the hours of midnight and eight a. :m. over fifty requisitions were received and the goods sent out. To Dr. Burlingame (IT. S. A. Medical Corps) is due a major portion of tlie credit for what was done. His assist- ant, ^liss I'reston, by her unquenchable good spirit and enthusiasm, kept the whole organization going. Captain A. A. Pice, supply otTicer, unknown probably outside the depart- ment, worked williout thought of food or sleep, ^liss Stim- son, Chief Xurse, who used and re-used, shifted and changed our small personnel in such a way as to meet every real emergency, made })ossit)le the establishment and operation of all these hospitals. Drs. ^loorehead. Tarnowsky and ^IcCoy, in charge of individual emergency hospitals, cqui])ped and operated ellicient hospitals with probably more limited mate- rial and in a sliorter space of time than had perluips been done in this war. Dr. ^IcCoy, during the ])ombing of his hospital at Jouy-sur-Morin, standing above a serious abdomi- nal operation (iilmly holding with forceps a severed artery until candles could be ])rought by which to coin])lete the operation, is no more striking than numerous otlu'r instances of this kind, performed by our personnel during this jiast great sunmier. ""Report of the Xursinir l?uroau": Carrie M. TIall : l\t'rsed. Army nurses could then be moved more readily and with less delay than Red Cross nurses, so many nurses who had been serving before under the Commission for France, were enrolled as reserves of the Army Nurse Corps, but continued to serve in American Vied Cross sanitary units, \a\\o in July, the American Red Cross Commission for France submitted the following estimate of personnel needed bv the Nursing Bureau between August and Januarv, 1019: THE EUROPEAN WAR 621 Nurses and nurses' aides are used for two purposes: First, they are the only nursing personnel available to take charge of Eed Cross emergency hospitals until they become the re- sponsibility of the Army; also they are placed in French hospitals under the Sen'ice de Sanle in order that our sol- diers in those hospitals may have the care of some one who can speak their language. Second, they are used in connec- tion with the emergency work being done for the civilian population of France, particularly the children and the tuberculous. Up to the present time there have been about four hun- dred and seventy nurses and nurses' aides brought to France. They constitute an emergency force that can be moved from place to place as the need exists. In order to carry out our program of being able to assist the Military Establishment in whatever emergency may arise and in order to discharge the responsibility wiiich we have assumed toward the civilian population of France, it will be necessary to import up to January 1, 1919, the following personnel: Nurses, 250; nurses' aides, 300. Dietitians are used for organizing diet plans in American Eed Cross hospitals, for assistance to American Expedition- ary Forces' hospitals and for general use as mess officers. The Red Cross assigns them to such work and pays their salaries. They are also used to teach and work with the French civilian population and in French military hospitals. At the present time, notwithstanding the great use that could be made of the services of dietitians, only two have been brought from America and there is no supply of them to be secured in France. On July 31 Miss Stimson wrote Miss Noyes: The Red Cross is constantly being asked to take new hospi- tals for the Army. Into some of these. Army nurses are sent at once; in a good many instances, however, we have to take care of the emergency before the Army nurses arrive. 8omo of these nurses assigned by the Red Cross are often left on the staff with the Army nurses. You will be interested to know that the Chief Surgeon, American Ivxpeditionary Forces, has assigm^d iifty Army nurses to the Red Cross be- cause of this very need for moving nurses quickly in just such emergencies. When Army nurses are assigned to the Red Cross, it is possible for me to move tlieni within a couple of hours. We could use three times as many more, if the Arniv could siiare them. The Chief Suru'cou and his assist- 622 HISTORY OF AMERICAN RED CROSS NURSING ants are continually in our office and in the past two or three months they and the Bed Cross officials have worked together as though they were one organization. The last Red Cross hospital to be organized for American troops in action at the front was American Red Cross Hospital No. 114, which was established at Luxembourg, Toul, in the Asile Caserne J a former hospital and orphanage which had been maintained since December, 1917, by the American Red Cross Children's Bureau for French refugee children. The build- ings consisted of typical French wooden military barracks. The children were evacuated in August to Neufchateau, Nancy and Lyons, the hospital was enlarged from ninety beds for chil- dren to fifteen hundred beds for American wounded expected from the St. Mihiel drive. Martha S. Clark, an American Red Cross nurse sent up from Paris to help reequip the Asile Caserne as a military hospital, wrote : ... On September 11, a Eed Cross mobile unit of about 100 doctors and 45 nurses, with Major McCoy as command- ing officer and Linda Meirs as chief nurse, arrived and we began to set up the wards for patients from St. Mihiel. That day we made twelve hundred beds and almost within twenty - four hours they were filled; a few days later we had 1800. As this was an evacuation hospital, we only kept them for a few hours' rest after re-dressing their wounds. . . . Henrietta R. Reed, another Red Cross nurse on duty at the Asile Caserne, wrote : On the night of September 12, our first wounded arrived. By dawn about 1000 men had come in and Major McCoy's unit had twelve operating-tables running at full speed. . . . My first assignment was to a ward containing 63 wounded Boches, both officers and privates. They were covered with filth from head to feet and almost all of them were badly wounded. They were all undressed, bathed, given new pajamas and put to bed between the clean Eed Cross sheets and new blankets. They stayed with us five days. . . . The hospital consisted of sections which were lettered from A to K. Each section was made up of seven wards containing twenty men each. There were four private rooms to each section ; men who were dying or who could not live for 48 hours were placed in these rooms, thus sparing the other wounded the sight of a dying comrade and giving to the unfortunate man himself quiet and privacy to the end. f^iiiiinnl in Rid Crvss .Vhm iuu A I'dstcr l)y luibci-t IJcid. i)laniir(! iiv tlio Aiiu'ricaii Itcd C'rciss to -tiinn !:itc tlif .iirollinciit (if niir-r^ tdi- military scrvicr lint withheld Inmi di-- frilniti.iii at the rtMjucst of the War Depart mnit. THE EUROPEAN WAR 623 American Red Cross Evacuation Hospital No. 114 was in operation at the Asile Caserne de Luxembourg from September 12 to September 23. The American troops then advanced north of Verdun, so Major McCoy's unit was ordered to follow them as far as Fleury-sur-Aire. United States Army Base Hospital No. 82, which had recently arrived from the United States with surgeons and corpsmen but without nurses, was ordered to duty at the Asile Caserne de Luxembourg and the original child welfare nurses, "casuals" who had been sent up from Paris and several of Miss IMeirs' original unit remained there to con- stitute the nursing staff. Colonel Burnham was commanding officer of Base Hospital No. 82 and Sarah M. Morgart (Cone- maugh Valley Memorial Hospital, Johnstown, Pa.) was ap- pointed as chief nurse ; she had formerly been Miss Meirs' assistant. Henrietta Reed, who had remained at the Asile Caserne, wrote : On September 23, Base Hospital No. 82, with Colonel Burnham in command, arrived and the following day the ambulances began rolling in again, this time with 500 gassed and "flu'' cases from the Fourth, the Seventh, the Ninety-first and other divisions. At one time I had charge of 176 men with mumps, pneumonia and influenza. . . . Gladys H. Porter, a public health nurse who had been at the Asile Casei^ie since its establishment in December, 1917, and who remained there through its metamorphosis as Evacuation Hospital No. Ill and finally as U. S. Army Base Hospital No. 82, wrote: After !Major McCoy's unit had moved up to Fleury, we suddenly found ourselves being entirely reequipped by the American Ked Cross and converted into a base hospital of 2000 beds. ]\Iedical and surgical cases came so quickly that we had to resort to cots in the corridors and finally tents on the grounds. Our surgical wards had so many frames and so much fracture apjiaratus that the boys called them Farnum and Bailey circus lings, or "trolley-cars" and urged all visitors to take stock in the new corporation. In the meantim(\ ^lajor ]\lc(\)v's unit had cone on to Fleury-sur-Aire. Bessie A. Copelin, one of the nurses, de- scribed the trip up : 624 HISTORY OF AMERICAN RED CROSS NURSING We traveled in 35 ambulances, each one running twenty minutes apart. No one was allowed to stick her head out, as we were in constant danger of being bombed or shelled. On our arrival at Fleury, we found that our corpsmen, who had gone on two days before, had everything in readiness. On September 25, the wounded began to come in and we evacuated from 1200 to 2000 a day. At Fleurj, Major McCoy's unit was taken over by the Army. Colonel Burlingame wrote : This transfer of No. 114 to Fleury was largely a move- ment of personnel with but a small unit of equipment. Al- though financed for a time by the Ked Cross, they were largely equipped by the Army. On their arrival at Fleury, the formation became known as Evacuation Hospital Xo. 114 and was eventually taken over entirely by the Medical Corps, with the exception of certain Red Cross nursing personnel, who continued with the formation until the end. To quote from a letter of September 24 from the Red Cross (addressed to the Army) : "In view of the fact that the movement of this unit is one of personnel alone, it seems to be a hindrance rather than a help to the Army to operate it as an American Red Cross unit and we therefore propose to turn the per- sonnel of the unit to the United States Army." A few weeks after its designation as American Red Cross Evacua- tion Hospital Xo. 114, it disappeared from Red Cross history. For the thirty-two days of its Red Cross existence, the hos- pital received 14,771 and evacuated 13,809 patients. Another hospital, formerly maintained by the Children's Bureau of the Department of Civil Affairs but later trans- ferred to the Department of ^lilitary Affairs to serve the Ameri- can Flxpeditionarv PV)rces, was the Hospital Violet, at Lyons. It had been established in the spring of 1918 as a contagious hospital for refug'0(; children but when the influenza epidemic broke out among American soldiers in camps near Lyons, the children were evacuated from it and the medical and nursing staff cared entirely for American soldiers tak(m sick with the influenza. Susanne Hoskins, an American l{ed Cross child welfare nurse, wrote : In October, 1018, I was transferred to the Hospital Violet, which had just been taken over for the care of American boys. ^ly first week there was most unhappy; we lost three THE EUROPEAN WAR 625 of our finest boys with the flu. It broke one's heart to think of all that these boys had been through at the front, some of them had seen nine months in the trenches, and then to have them come back of the lines to rest and die like that. Our first patients were all from La Valbonne, an officers' training camp just outside Lyons. Most of them were ser- geants in line for commissions. Later on, we had many "casuals,"' boys passing through Lyons and getting sick in tiie hotels and even the railroad stations. Hospital Violet was also used to evacuate the boys from French hospitals. . . . The American Red Cross hospitals seem to give the boys the touch of home they crave. !N^o incidents illustrate the flexibility of Red Cross organiza- tion better than do these transfers of American Red Cross Hos- pital No. 114 and of the Hospital Violet. Hospital No. 114 was formerly a mobile unit but when need arose, it was estab- lished at the Asile Caserne de Luxembourg as an evacuation hospital to serve the wounded ; Hospital Violet had been a children's hospital, but it too was commandeered for the care of sick American troops. Through the summer of 1918, efiicient fulfillment of the needs of the American and Allied Military Establishments became the primary aim of the Paris head- quarters, even though this meant in large part a loss of identity of the American Red Cross Nursing Service in France. It has already been shown that nurses who had come over to work primarily with the civilian population were ^'militarized" as necessity arose. ]Miss Stimson explained some of the reasons for this transfer: At the time when tlie Red Cross nurses in France who came for work with the civilian pojjulation were plated in hospitals under military control during the great emergency of the sunnner of 11)18, they were all given an opportunity to become definitely attached to the military service. A nuinlier of them were sworn in as reserve nurses. Army Xurse Corps, and were paid by the Army. . . . It is doubtful whether at the time, wliich was one of great confusion, it was explained to these nurses that if they did not become a part of the Aimy they would not be entitled to compensation and licncllts should they become disabled. At that time such henelits were not generally known, if they had been authori/.ed. Oiu^ of the important reasons for urging the so-calle(I "militarization"" of IJed Cross nurses was the greater ease and speed in nioxing th-'ui from jjlace to place according to the 626 HISTORY OF AMERICAN RED CROSS NURSING need, than was made possible through Army orders. It fre- quently required ten days to secure the necessary papers to move Red Cross nurses not in the Army. Permission to move all non-Army personnel had been obtained through the French, but American Army transfers could be made in a few hours. This absorption into the Military Establishment of nurses as assigned under the American Red Cross involved an impor- tant question of Red Cross policy. Miss Stimson wrote Miss Nayes : I am very sorry if in our work in Paris we embarrassed you in any way by allowing Red Cross nurses, i.e., nurses as- signed to the Red Cross Commission to France, to join the Reserve Army Xurse Corps. We did not urge them to do so, but we felt that when they wished to we had no right not to allow them. Many of them said they had not had an oppor- tunity to join in the States and were even so misinformed as to think that when they signed up for the Red Cross Xursing Service they were joining the Army Nurse Corps. I did not realize the difference in paper work in preparing the two groups. As a matter of fact, the total number of Red Cross nurses who joined the Reserve Xurse Corps over here did not exceed forty-five. At the present time most of these are being given permanent assignment with various x\rmy formations, as the emergency needs to which the Red Cross devoted their services no lunger exist. ^ Here lay the crux of a situation which caused both Miss Delano and ^liss Xoyes embarrassment because of the position in which it placed the Red Cross in regard to the group of nurses who served with great loyalty and self-sacrifice in the cantonment hospitals in the United States throughout the war. Miss Xoyes answered this point as follows: There was no nursv^ who left this country who did not have a formal communication from me saying that it was definitely understood that she was accepting service under the Red Cross and that transfer to the Army would not be permitted. Some of these nurses stood out against accepting service in the military camps in this country, this being a preliminary preparation for overseas duty with the Army. I should never have assigned some of these women to France at all, except *^ Miss Stimson to Miss Xoves. Deecmbrr 2, 1018. THE EUROPEAN WAR 627 that the need for nurt^es was so great that we could not ignore any source of supply, but we considered them unpatriotic. If military training in this country for oflicers and soldiers in the cantonments was a prerequisite for overseas duty in the Army, then no patriotic nurse should have held out against the assignment to a military camp in this country. In their anxiety to get overseas in the shortest possible space of time, they would accej)t service directly with the Red Cross. It was made plain, however, to these women, not only by me but invariably by Miss Johnson in Xcw York, that this service was not for the Army. I fear the same traits whicli many of them showed in refusing service in the camps have been the controlling factor in leading you to believe that they were not informed concerning the military service. There is one thing I cannot quite understand, whether, for instance, ^liss Eldon and others need have gone into the Army Nurse Corps when they were to be left in the Paris office, which vas a Red Cross office. I mention this point, as many of the nurses who are returning to tliis country are speaking critically of the militarization of the Paris office and resent what they call the elimination of the Ked Cross. ^'^ The Nursing Service in France has already been compared to a small ship in strange and tronblons waters. If lay control in Ked Cross administrative matters may be called the Scylla which threatened her on the one quarter, then the absorption of the Nursing Service by the Army, as set forth above, may surely be called the Charvbdis ! This interesting and vital point of policy, bearing directly on the relationship of the Red Cross to the Army, may thus be summarized : Many persons might hold that by proclamation of the President and by regu- lations of the War Department, every enrolled Red Cross nurse is a reserve nurse of the Army Nurse Corps, provided she is willing to serve. When such a nurse has been detailed by the Ked Cross to a militarized establishment such as the Red Cross Commission for France, operating in the theater of war undcu* an Army chief nurse, it becomes a matter of interpretation of Article 10 of the Revised Treaty of Ceneva, July G, 100), as to whether she is "assimilated to the personnel charged with the removal, transportati(Ui and treatnu^nt of the sick and wounded." Before sunmiarizing Red Cross emergency hospital and nurs- ing service to the American Expeditionary Forces, it is well to include at this point a statement of Miss Stimson's appointment '^.Miss Novcs to Miss Stiinsnii. DcrcmlHT 21, THIS. 628 HISTORY OF AMERICAN RED CROSS NURSING as director of the Nursing Service, American Expeditionary Forces. As early as July 31, 1918, her report to Miss ISToyes mentioned the over-lapping of her duties as chief nurse, Ameri- can Red Cross, with those of the Chief Nurse, American Expe- ditionary Forces : During the great activity of our forces, we have placed almost the entire emphasis of our work on the military phases. My own position as an Army chief nurse, directly representing the Chief Surgeon, has had to be greatly devel- oped. Xot only are there countless numbers of Army nurses coming to our office for various kinds of assistance, but the Chief Surgeon has asked, since the Eed Cross supplies free transportation by automobile, that I inquire into the welfare of Army nurses at the front. It is very easy for me to com- bine my visits to the two groups of nurses and I have been able to be of considerable assistance to x4,rmy nurses in evacu- ation hospitals and on surgical teams. I am able to see that needful equipment from the Bed Cross is supplied quickly and I can also be helpful by acting as a go-between with groups of nurses to their own chief nurses at the bases, or with the Chief Xurse of the American Expeditionary Forces. I am also able to communicate very quickly with these nurses through our ambulances and automobiles which are con- stantly going between Paris and the front and this, since the mail service is so slow and difficult, is useful. It is because of the increasing importance of such duties as these that I have cabled to ask if Florence Johnson can be sent over to assist me. It is very necessary that I visit all the base hospitals to explain to the nurses what the Eed Cross is doing and what it stands ready to do for them. I feel that I could do no more important piece of work than to explain to the large numbers of Army nurses now in France the details of the work of the Eed Cross here. I was utterly ignorant myself until I was appointed to this office and I feel sure that many of the nurses in France are as unknowing as I was. You will remember that ]\Iiss Johnson was a class-mate of mine at the Xew York Hospital and is a very close friend. She would be exactly the person to under-study me and to share some of the tremendous burden and responsibility of the Paris office. 1 would not ask to have so valuable a person, were it not almost impossil)le to find her equal here. When !Miss Johnson was approached upon the subject, she decided to remain in New York. National Headquarters cabled to ^liss Stimson : THE EUROPEAN WAR 629 [Cable No. 10.027 j ^fiss Johnson is doing most impor- tant work in New York. Enjoys very close and harmonious relations with chief nurses stationed there representin<( the Surgeon (ieneral's oilice. Has full charge of equipi)ing, in- terviewing and directing all Army and Red ('ross nurses sailing from Kcw York. Looks after their comfort and morale, advises them of their duties and responsibilities and we feel that her removal at this time would result in serious dislocation of the entire service. This cable recommended other nurses then serving in the Paris office who were, in Miss Delano's opinion, well fitted for this work. Carrie ]\I. Hall, at that time chief nnrse of the American Red Cross in Great Britain, was finally trans- ferred to Paris to assist Miss Stimson. Miss Stimson's duties during August and September brought her in more and more close touch with the nursing service of the American Expeditionary Forces. In her last official letter to Miss Delano, written on jSTovember 6, Miss Stimson an- nounced her appointment as Director of Nursing, American Expeditionary Forces: By this time, you probably know that General Ireland has appointed me director of the xVrmy Xurse Corps. I am not definitely taking up the work, however, until Xovember 15. I do not know liow to explain to you how all this develop- ment has taken place, for the situation is so absolutely dif- ferent from what anyone so far away can imagine, or from what any of us have experienced before. General Ireland will be able to explain to you better than anyone else why he thought I could be of more use in this position than I am here. Miss Hall has a very complete understanding of the situation here. I caimot tell you bow strongly we all feel over here that you shoidd conic and se(> just what is happening. At the j)eriod of our great cnicrgcncies. we had no time for thinking out policies; but n13 were reported ''missing in action"; and 4434 were taken prisoner. '^^ During the twenty months ending February 28, 1910, twenty-four of the twenty-eight military hospitals which were operated in France by the American Red Cross cared for 80,787 patients of the American Expeditionary Forces. These men were largely wound cases because the hos- pitals where they were treated were organized for the specific purpose of caring for American soldiers wounded in the prin- cipal German and Allied offensives. ' Thus the American Red Cross, in addition to organizing and equipping the fifty base hospitals which formed the skeleton of the hospitalization of the Medical Department in France, may also be said to have pro- vided, through this emergency hospital service as developed by the Americnn Red (^ross Commission for Europe, hospital- ization to more than one third of the American battle casualties of the European War. "''Jlic War with ( lirinany." L. P. Ayrc?, p. 122. 632 HISTORY OF AMERICAN RED CROSS NURSING The greater flexibility of the Red Cross organization as com- pared to the necessary stability of the Military Establishment, the tremendous resources placed at the immediate and complete disposal of the American Red Cross in France through the gen- erosity of the American public as compared to the governmental routine of Congressional appropriation and expenditure, and the unofficial position which the society occupied in relation to the French Government, permitted the American Red Cross in France to render this signal service to the wounded of the American Expeditionary Forces. Thus the early policy which had been adopted by the American Army and the Commission for France that the American Red Cross in France should serve as an emergency arm of the Medical Corps was developed be- yond even the most earnest and enthusiastic hopes entertained by the society for the alleviation of the suffering of sick and wounded American soldiers. With the exception of the Red Cross evacuation hospitals described in the preceding section, the Medical Corps of the American Expeditionary Forces organized all American sani- tary formations operating in the immediate zone of the ad- vance. In these formations, however, many reserve members of the Army Xurse Corps served at the front during the iillied offensive of the summer of 1918. To appreciate as a whole the general type of service of these nurses, a brief summary at this point of the forward operations of the American Expedi- tionary Forces will throw liulit upon the fragmentary accounts of their experiences given later by nurses. Immediately following the failure of the German offensive of j\Iarch-July, 1018, ^Marshal Foch launched his first counter- attack on July 18 upon the uncovered west flank of the German salient from the Aisno tf) the ]\Iarne. By this operation, com- pleted August 6, the Allied line ran from Soissons to Rheims along the Vesle. A few days later, the British Armies began their offensive on the kSouime salient, which lasted until the date of the Armistice. With these troops were elements of three American divisions. Of the next movement, Colonel Ayres wrote : In the meantime, siniultanooup assaults were in progress at other })()i]its. Oil \u,i:iist IS, (ieneral ]\Iangin began the Oise-Aisuo ])haso of the great Allied offensive. A day later, the British launched the first of a series of attacks in the THE EUROPEAN WAR 633 Ypres sector, which continued with some interruptions to the time of the Armistice. [With tliese troops were four Ameri- can divisions. ] With the organization of the American First Army on August 10 under the personal command of General Pershing, the history of the American Expeditionary Forces entered a new stage. The St. Mihiel (September 12-1(5) and the Meuse-Argonne (September 2()-November 11) offensives were major operations planned and executed by American generals and American troops. . . . Two comparisons between this operation at St. Mihiel and the Battle of Gettysburg emphasize the magnitude of the action. About five hundred and fifty tliousand Americans were engaged at St. Mihiel; the Union forces at Gettysburg numbered approxinuitely one hundred thousand; St. ^lihiel set a record for concentration of artillery fire by a four-hour artillery prcparatio!i. consuming more than one million rounds of ammunition. In three days at Gettysburg, Union artillery fired thirty-three thousand rounds. The St. ]\Iihiel offensive cost only about seven thousand casualties, less than one-third of the Union losses at Gettysburg. ...*** The j\reuse-Arg(ninc campaign saw the collapse of the German Fifth Army. Of this engagement, Colonel Ayres wrote: "The object of this offensive," said General l^ershing iji his report of November "^0, 1918, "was to draw the best German divisions to our front and to consume them."' This sentence expresses better than any long description not oidy the object hut also the outcome of the battle. Iilvery available American division was thrown against the enemy. Every available German division was thrown in to meet them. At the end of forty-seven days of continuous battle, our divisions had con- sumed the (icrnian divisions. Tiie goal of the American attack was the Sedan ^[czicrcs railroad, the main line of supply for the German forc(^s on the major part of tlu' Western Front. If this line were cut. a retirement on the whole front would be forced. This retire- ment woulil include, moreover, evacuation of the liricy iron fields, which the (lerinans had beMi using to great a(l\antage to su])plenient their iron supply. The defense of the positions threatened was therefore of such imjiortaiU'c as to wai'i-ant the most desperate ineasures for resistanc(\ When the engage- ment w;is eviijently impending, the commander of the Ger- man fifth Army sent word to his forct'S, calling on them for *"The War willi (i.T!iiaii\ ," pp. 109-110. 634, HISTORY OF AMERICAN RED CROSS NURSING unyielding resistance and pointing out that defeat in this engagement might mean disaster for the Fatherland. . . . On the first day of American action, the 2Gth of September, and the next day or two after that the lines were considerably advanced. Then the resistance became more stubborn. Each side threw in more and more of its man power until there were no more reserves. Many German divisions went into action twice and not a few three times, until through loss they were far under strength. All through the month of October the attrition went on. Foot by foot the American troops pushed back the best of the German divisions. On November 1, the last stage of the offensive began. The enemy power began to break. American troops forced their way to the east banks of the Meuse. Toward the north, they made even more rapid progress and in seven days reached the outskirts of Sechm and cut the Sedan Mezieres railroad, making the German line untenable. In the meantime (October 2 to 28) our Second and Thirty- sixth divisions had been sent west to assist the French who were advancing in Champagne, beside our drive in the Ar- gonne. The liaison detachment between the two Armies was for a time furnished by the Ninety-second Division. ^^ From Cluiteau-Thierry to the Sedan-Mezieres railroad, the forward sanitary formations of the ]\redical Corps, American Expeditionary Forces, followed the advancing American armies. From the Chief Surgeon's office, moved in flanuarv, 1918, from Chaumont to Tours, ]\Hss Bell directed the nursing service of the American Expeditionary Forces, assisted until June 13, 1918, l)v Anna E. Coftey, Army ISTursc Corps. Upon this date Miss Coffey was transferred to another station and Xina Shel- ton was ordered from Base Hospital I^o. 24 to assist j\[iss Bell until Aliss kStimson's appointment took effect on November 15. Three types of assignment,- (1) to hospital trains; (2) to evacuation and mobile hospitals; (8) to professional teams characterized the nursing service of the zone of the advance. The following sections deal separately with these, the most forward positions held by any American women during the European War. Linking the front with the base were the hospital trains of the U. S. Army ]\ledlcal Corps. In her definition of this branch of the nursing service of the American Expeditionary Forces, Miss Stimson wrote: ""Tlic War Willi Ccrmany," p. 111. THE EUROPEAN WAR 636 Hospital trains, not originally intended for operative or other treatment, are designated for evacuation of the sick and wounded. Each train is a complete unit under the command of a selected medical officer. The regular staff consists of two medical officers, three nurses and thirty-six enlisted men, including a registered pharmacist, a clerk, a mechanic, two cooks, two assistant cooks, two men for each ward car and one man detailed to the staff coach. Of the assignments of women nurses to this branch of the service, Miss 8timson wrote: For the most ])art, those groups of two officers and thirty- six men were organized in tlio United States as hospital train units. On Trains Xos. 50 and 51 they were formed from casuals of the American Expeditionary Forces. None of these units, prior to the summer of 1918, included women nurses. On July 13, 1918, three nurses were detailed from Base Hospital No. 27 for temporary duty on Hospital Train No. 37 and a trial trip was made by them a few days later. Several officers of the Medical Department were present on this first trip to observe tlieir work and to judge the advisability of having them assigned permanently to this service. Three nurses of Base Hospital No. 47 were sent on August 4 to Train No. 52 and three others to Train No. Gl. Base Hospital No. 8 supplied others on August 5 for Trains Nos. 53 and 54, while Base Hospital No. 9 sent forward three to Train No. 55. As new trains came into the service additional nurses were assigned. Because of the unusual nature of this service, General In- structions issued to the officers of trains are herewith given, although they belong rather in a history of the Armv Xurse Corps than in tluit of its Reserve: Duties of trained nurse: The senior of the three nurses assigned to the train will act as matron. Nurses will carry out the orders of the medical officers and are to Ije obeyed next after them. (Quarters: Xurses will have quarters assigned them witliin the staff coiicli and they will not use other coni])artments. No visitors save women will enter tlieir quarters. Only the necessary personal articles will be kept on trains: all heavy baggage will be k(>pt at the nurse's home. Leave: Nui'st>s are never to be absent without the permis- sion of the coiunianding otlicer of tlie train. Tliev are not 636 HISTORY OF AMERICAN RED CROSS NURSING allowed more than two hours away from the train and per- mission to be absent is never given within the zone of the ad- vance. One trained nurse must always be present with the train, whether it is halted at a station or garaged on a siding. When trains are laid up for prolonged repairs or are other- ,wise delayed for a considerable period, nurses will not be kept on the train, but will be reported to the senior matron of the section, who will make use of their services temporarily. They will be returned upon the request of the commanding officer of the train. Helen T. Biirrey, reserve nurse, Army Nurse Corps, a graduate of St. Francis Hospital, Pittsburgh, Pa., and a mem- ber of the nursing staff of U. S. Army Base Hospital ^N^o. 27, was one of the iirst three nurses to be assigned to hospital trains of the American Expeditionary Forces. She wrote : Base Hospital 27, located at Angers, France, received the first official order dated July 14, 1918, to supply Army nurses for this service. Until this time, the Medical Corps attached to hospital trains were caring for the wounded. Through Miss Blanche Eulon, chief nurse of Base Hospital 27, Edna Cooper, Grace O'Donnell and I were detailed to Hospital Train 57. When told that we were to leave the next day to board this train which was then stationed at Port Boulet, France, we were certainly filled with a spirit of adventure. We arrived at Port Boulet July 15, found our train and made ourselves known to the commanding officer, Captain Goodwin, who had knowledge of our coming. He received us very kindly and immediately showed us to our quarters. We were agreeably surprised at the modern equipment. In our coach there were three compartments which consisted of a dining room and two sleeping rooms and a lavatory (tri- angular in shape) containing a small wash bowl and com- mode. Tlie sleeping rooms were made up of a private room consisting of one berth and a wardrobe and a second room which contained a lower berth and an upper berth. Of course, we all wanted the private room, but since it could not be private among three, we resolved to take "turns about" and rotate from upper berth to private room. The rule was one week in the private room and the next week in the lower bertli and tlio tliird week in the upper berth. As we had five months of this life, we had plenty of time for the private room. Tlio dining room, wliich was also used as a living A U. S. Army Hospital Train. Phdtns. hi/ Slijna! Cnrpa. I'. S. A. THE EUROPEAN WAR 637 room, contained a table and two chairs and a side seat fitted to the wall. Miss Burrey described the accommodations of Hospital Train No. 57: The rest of the train consisted of sixteen coaches, including one infectious car which carried eighteen beds; one staff car which carried eight beds ; one kitchen and sitting sick offi- cers' car which carried three beds and twenty seats; eight ordinary lying ward cars which carried 288 beds; one phar- macy car; one infectious case sitting car which carried fifty- six seats and fourteen upper berths; one kitchen and mess car with three beds for cooks; one personnel car with thirty beds and one train crew and store car; the total capacity of the train was thus 400 beds. Each moving hospital was equipped with electric lights, steam heat, electric fans, lavatories and racks for personal belongings and even ash trays for the patients' indulgence. There were eight ordinary ward cars for patients containing thirty-six beds arranged in tiers of three. These could easily be converted into seats to accommodate patients who were able to sit up; they (ould also be used for stretchers in emer- gency cases or folded against the sides of the coach when the cars required cleaning. Miss Biirrey wrote of the trial trip of Train No. 57, when for the first time American Army nurses were officially assigned to train service : Our first trip was to evacuate patients from different hospi- tals who were able to be moved to a point of embarkation for the United States. Since we were the first nurses, Colonel Howard Cfark, who was then in charge of the train service, made the first trip to these different hospitals; this was also the first trij) for transporting badly wounded patients from the hospitals near the front to the hospitals near the point of embarkation. We started July 17. passed through Tours, Bourges. Xovers, Dijon, Chaumont, Neufchateau, Contrexeville, Toul and Savenay, stop])ing at several base hospitals and filling our train with wounded who were to be taken to Base Hospital No. 8 at Savenay. After seeing our work. Colonel Clark con- gratulated us and recommended that all the trains be supplied with three nurses. We worked day and night with those patients: the ])atlietic condition of our bovs who were verv badlv wounded made us 638 HISTORY OF AMERICAN RED CROSS NURSING realize that being wounded was hard enough to bear, without the jolts, noit^e and dirt connected with traveling on a train. These patients were in our care for two nights and three days before they were unloaded at Base Hospital Xo. 8. I remem- ber two patients who had broken backs and had horrible be 1 sores. You can picture the special care such a case would require, but our time with each patient was limited and we gave the best attention possible. We also had many patients who had amj)utations of legs, or arms, and many other wounds that caused much pain and constant attention from doctors and nurses. One of the chief discomforts which we noticed that the patients met was caused by the tightening of bandages due to the restless position of the patient and by the moving and stopping of the train. This condition was also aggravated by the infected wounds and the patients were constantly calling for relief from the bandages, Anne P. Ilill (nco Peck), reserve nurse, who was assigned in August, 1918, from U. S. Army Base Hospital No. 9 to hospital train service, described the routine of taking on pa- tients : Our first trip was one which we would have chosen, to Chateau-Thierry. We arrived aljout ten o'clock that night, took on four hundred and fifty l)adly wounded and gassed patients and at midniglit started back for Chatelguyon. . . . Hot soup, coffee, beans and bread were prepared for the patients while tiiey were being assigned to various cars ac- cording to their condition. The commanding othcer tried to arrange all serious cases in the car adjoining the pharmacy car, for that was most convenient for emergency treatiuent. Gassed cases were put together, fracture cases together and so on. The oflicers directed, the corpsmen carried in the stretchers and lielped the wounded to their cots, and two nurses assisted in making them comfortable, while the other nurse tagged the beds with diet cards, liquid, light or regular, to make food service easier for the corpsmen and to make sure that a lifpiid patient did not get a big plate of beans. This imrse's routine was also to ])re])are a slip. ])laiidy show- ing the exact location of seriously wounded patients, or tlu)se on special treatment am] Tuedications ; copies of these slips were then given to the other nurses and to tlie doctors. r)nce on our wav. llio duties were so divided that each nurse had her own rfspousihilities and sections to keep her eye on. Afl'T n few trij)s we found it tlie better plan for all to stay THE EUROPEAN WAR 639 on duty during the entire trip if tliere were many serious or uneomt'ortable patients on Iward ; on the trip back to the front, our time was our own and we would tiien rest, do our laundry, or write and read. There is much to contrast in the careful movement of these wounded and the mutilated Serbian, Italian and Austrian wounded who were brought down to Vienna and Budapest in jolting ox-carts during the early days of the war. During the drives which centered in the Chateau-Thierry sectors, work on all hospital trains of the American Expedi- tionary Forces was heavy. ]Miss Burrey wrote: During the drive at Chateau-Thierry a great number of the hospital trains were mobilized at Pantin, a suburb of Paris, for duty into Chateau-Thierry. From Paris to Chateau-Thierry w^as about three hours' ride and Train Xo. 57 was ordered to make the trip. The train was sent to evacuate patients from Hospital Xo. 7, a mobile unit. These patients had received First Aid; major operations were cared for. Some had hardly reacted from their anaesthetic and most of them were in a pitial)le state. . . . In the station and surrounding it were litters covered with boys; mud-spattered and torn were the ujiiforms they wore. They were ])atic'ntly waiting to be taken, they did not care where, but some place where they could be given proper care. After we received our train load, about 400 ])atients, one of the things that bothered l)()th ])atients and nurses most were the countk'ss numbers of flies that infested our train. The odors from tlic wounds that had no care cannot l)e described but shall li\e in the memory of the nurses and orderlies. We made three trips to Ciiateau-Thierry. Tlie third one was to a small town outside of Chateau-Thierry. It was after dark when we got there and we immediately started to load our train with patients that had Ijcen gassed. At the height of our work, we had an alarm of tlie enemy airplanes wliich meant all liglits out and we had to work iii the dark getting as many ]iatients under shelter as ])ossib]e. We loaded our train without kce])ing count of tiie jiatients tliat could walk. After the train ])ulle(l out and we got to a ])lace of safety, tlie lights were turned on and we found we had patients every- where, in the l)erths, on the seats and crowded in the aisle. ^fiss I-)urrey's report contaiiu'd a brief ci^mparisou between the American. Britisli and I^'rench hospital trains: 640 HISTORY OF AMERICAN RED CROSS NURSING We also had opportunity to see the hospital trains belonging to the English Government. They were very much like our own as ours also were made in England. The English trains had nurses, whom they addressed as Sisters. . . . The Fren('h hospital train was an ordinary box-car fitted up with litters for patients. To pass from one car to another you had to wait until the train stopped to get out and on to the other car. There were no nurses on the French trains. The French soldiers cared for their wounded while on these trains. Both the French peasants and the soldiers of the Allied Armies evinced great curiosity regarding the hospital trains. Mrs. Hill wrote : The arrival of an American hospital train created as much interest among the French people and the U. S. men en- camped nearby as would a circus parade in a small American village. Our train was usually held on a siding with a plat- form on one side of it, and as we slept later than did the French we were greatly disturbed and embarrassed the first few mornings by being awakened between five and six o'clock by voices exclaiming over the grandeur of the train and by heads coming even inside our compartment windows. A guard was then ordered to promenade the platform until the nurses had awakened, removed curl papers and drawn the shades. Hospital train service formed one of the most adventurous and interesting branches of war nursing. Miss Burrey wrote : To get to a certain base hospital, which was in a moun- tainous dislrict, tlie train had to be divided; the engine could not pull tbo entire train up the mountain. We got no in- structions as to the splitting of the train, so it was just luck that all the nurses were not in one part of the train, I found myself on one hall' of the train, garaged in a railroad yard with about two hundred pati(!nts; the other half with two nurses was starting up the hill. While they were gone, an engine was attaclied by mistake to our train and soon we were rapidly moving away. We traveled about eight hours before we finally found the rest of our train. We were surely hapi)y to see them again, for they happened to have the supply and the kitchen car. Mrs. Hill wrote: THE EUROPEAN WAR 641 The middle of August found us traveling through the lovely country of Dijon and (^haumont. At (.'haumont, we got unexpected orders to garage at Vaucouleurs, south of Toul, and await further orders. We had passed through Bazoilles, where Base Hosj)itals Nos, 18 and ll(i were stationed. They were picturesquely spread out on the hillsides in barracks and tents on either side of the tracks, most conveniently arranged for the reception of the wounded. We arrived at night at Vaucouleurs to the humming of aeroplanes and learned that the village had been bombed the night before, wounding many of the peasants. Occasional signal lights went up into the black sky from the German air-dromes over the hill in the distance and occasional bar- raging made us thrill with the nearness to the activities of war. Our train, however, stayed in this little village for nearly three weeks before receiving orders. . . . Soon came orders to go to the Argonne and from then on we were very busy making trips from the first evacuation hospitals to the bases. On these trips we saw a great deal of the paraphernalia of war, big guns, tanks, thousands of sol- diers going to the front in camouflaged cars. These cars were chalked in every available space with all sorts of jokes. Some nights, when we were side-tracked near the front or when we were taking on wounded, were full of the sights and sounds of war. The constant roar of the guns and the inter- mittent whir of the Boclie ])lanes as distinginshed from the French or American scouting-planes over us filled us with excitable exjieetancy. When we had time during the day- stops at the front line or evacuation hospitals, we were some- times allowed to inspect the hospitals. They were all splen- didly equipped and systematized, but to ste]) out from a bar- rack of men, who tliongli badly wounded were so grateful for the care they were receiving and who were trying so hard to be cheerful, to the lu^arby hillside of hastily made crosses was tragic. Even now when the subject of war is brought up. I do not picture tbe horrors or suffering or hear the sound of the guns, but see those hazy ])atches of crosses where Ameri- cans were buried and those scattered graves on the o]ien bill- sides, marked by a solitary cross showing where a French soldier had fallen. Hospital trains wovo often side-tracked to make way for combat troops and suppliers. ^Irs. Hill wrote: During our first few trips, we were very impatient be- cause it took tliree or four times lonii^er to ixet our wounded 642 HISTORY OF AMERICAN RED CROSS NURSING to their destination than through service would take in ordi- nary times. Some were so badly wounded and were made so extremely uncomfortable by the jogging of the train that we wondered how they lived or endured it, but they did, and with the greatest patience. We soon discovered that this slow service was a part of war, that the trains coming away from the front had to be side-tracked to permit the rushing in of troops and ammunition and supply trains. At no time were there sufficient tracks to take care of the greatly enlarged train service. Miss Stimson stated tersely the difficulties which the nurses experienced in this precarious branch of the service: The most obvious were the constant motion, the restricted space which made it necessary for the nurses to walk long distances to get needed articles, the great irregularity of the hours and the uncertainty of the time of arrival and de- parture from the station. These trains could not be operated on any fixed schedule or over any regular route. In times of heavy fighting, even hospital trains with wounded must give precedence to men and supplies on their way to the front. It was, therefore, necessary to send the trains by roundabout ways or to hold them on sidings until arrival at their desti- nation was greatly delayed. Extra meals had to be provided and dressings changed. Though the average duration of a trip was about forty hours, it was often necessary to serve Army rations to as many as six hundred patients for from two to four days. Miss Burrey wrote: When the train was empty and we were moving, the scenery and tlie wonderful views of France thrilled us. but when the train stopped, we were garaged in some railroad yard and we might stay there an hour or maybe two days before our train was ordered to move. You can picture the average train- yard in America ; picture it in France in war times ! When we nurses would get ofi^ the train to stretch our legs. we were greatly amused at ourselves. We felt like tbree geese walking along, for we noticed we trailed one another. Did you ever see geese walking oiie in the lead and the others following? We used to do that till we realized wc were not on the train any longer but out in the street, and then we would chuckle to oursolvos. Our reason for doing this was that the aisle in the train was so narrow that wo had to walk single- file. THE EUROPEAN WAR 643 That only niirsos of liigli mental and moral caliber were 3uccessfiil in hospital train service is self-evident. Miss Stim- 3on stated the needed qualifications: Great professional skill and an ability to meet every kind of emergency were, of course, primary requisites. Excep- tional physical endurance and a willingness to abandon, if need be, the usual ideas of a routined, ordered life are also necessary. These requirements are not hard to fill and no difficulties would be encountered in having the most desirable type of nurses on tbe trains if the work was always heavy. But since there must be times when work is very light and the waits in garage must be long and tiresome, other qualities in trained nurses cannot be overlooked. The restricted area of living quarters and the close association of officers and nurses, the isolation from other groups of workers and from the diversions possible in hospitals also make this duty a severe test of the tact, adaptability and character of all in the service. It is greatly to their credit that there have been so few failures. In those which have occurred, the principal reasons appear to have been due to errors in selecting the individuals fur tbe work and to a lack of harmony and an unwillingness to cooperate with others. On Xovember 11, 1918, sixty-three nurses were on hospital train duty. The hospital train service was operated to transport sick and wounded from the evacuation hospitals in the zone of the ;ul- vance to the base units in the zone of the base. Evacuati(ui hospitals were developed entirely by the United States Army Medical Corps, with the exception of the American Ived Cross emergency hospitals already outlined. To each division of com- bat troops was attached two evacuation columns. Evacuation Hospital Xo, 1 was located at Sebastopol on the Lorraine Fnuit. At Baccarat, Xo. 2 occupied a hillside above the village of Xancy. Priscilla J. IIuglu\s, Army Xurse Corps, described the ever changing- pageantry of the front: From Le Havre we went to Paris and from Paris to Blois, the mobilization center for "casuals.'' From P)iois 1 was sent in a detachment of nurses to Fvacuation Hospital NO. '^^ at Baccarat in tlu^ Lorraine sector. The hosjutal was partly in a l-'rcncb liarracks and partlv in tents and huts. The vilbi're had hccn held by the (u^rmans for eighteen days in liMl and was now partially in ruins. 6U HISTORY OF AMERICAN RED CROSS NURSING We were about six kilometers from the line. The Forty- second Division had just left and the Seventy-seventh Divi- sion was coming in when we first reached there. When the Thirty-seventh Division relieved them later in July, the Boche certainly kept us on the jump. Sometimes when there was a quiet interval, we would steal to the window to watch the planes flying around, their lights like big stars and the sky ablaze with signals sent up from below and also dropped from the planes. The sky seemed as bright as if the sun was shining and the moon was the biggest and clearest I have ever seen. All through the night we could hear the men marching to and from the trenches, the rumble of the ammunition and supply wagons and ambulances coming and going, the noise of the motorcycles carrying dispatches. It certainly was wonderful that there were not more collisions. We used to fall asleep listening to the guns and awaken to their voices. The flashes from a barrage lighted up the walls of our dormi- tory. Our windows and doors were camouflaged. On dark nights, however, all out-doors seemed like the bottom of a deep well. Miss Hughes described the general type of service : As we are in a comparatively quiet sector, the patients were not evacuated as they otherwise would have been in twenty-four hours. We had some excellent surgeons and a well equipped operating-room and X-ray apparatus, so the men were given every chance possible. During July, August and September the Boche grew active again. As our patients were faste]ied up in slings and all kinds of surgical appli- aiices and therefore quite helpless, the night raids were very hard on them and their distress worried the nurses quite as much as did P^ifz. About the first of October the whole "Wild Cat" Division (at least so it seemed) came landing on us. One day we admitted four hundred and the next day about six hundred, all sick, cold, hungry and certainly jn iioed of nursing. They had mumps, measles, pneumonia and meningitis. There were only thirty-two nurses all told on the staff, so ambu- lances were sent to bring back the twelve that had been sent away on temporary duty. I have had seven and eight boys delirious at the same time, some of them doing "guard duty" and the otber poor fellows answering; others were at home talking witb "Motlier" or "Dad."' They were nearly all Southern bovs. W'bcn one of them would start sino-ing old THE EUROPE A x\ WAR 645 darkie chants, you may imagine the effect it had on the whole ward. Located near a shell torn wood at lilcury, Evacuation Hos- pital No. 4 formed a center for surgical teams and wounded during the German offensive of July, 1918. Helen Pratt, re- serve nurse and a member of Base Hospital No. 20, reported a few of the difficulties encountered here : The night of -Uily 14 was stifling; with l)lanket.s and pil- lows, the nurses went into the open wheat fields. All the next day, the wounded boys came back to us. That night heavy rain churned the broken soil into mud and a tornadolike wind blew down many of the smaller tents. At such times the veneer of one's disposition rubs off and you see the stark outlines of your own and your coworkers' characters. The day shifts and the wounded were tortured by flies. Each morning the orderlies broke off large boughs from the neighboring woods and tried to beat them from the tents. A night and a day at Evacuation Hospital No. 6 was described by Daisy Pirie Beyea, a reserve nurse and a member of Base Hospital No. 24: In an open wlieat field, wath an ammunition dump on one side and the artillery on the other, wliile the boys were throwing a pontoon bridge across the ]\Iarne in front of us, we began to get things in order for the drive t)eginning in forty-eiglit hours. Oh, the flies, the dead liorscs and the dead Germans ! At three a. m. the barrage started. Then the word came down the line : "The boys go over the top at five!" A flash of light, the roar of the guns and then the very earth rocking imder our feet as wo fumbled with our helmets and gas masks. Crash after crasli followed all day long until five, when the ambulances 'uegan jiouring in. The tents were overflowing, hut still the anihulaiices lined the roads. Darkness came, lit every few seconds with an explod- ing shell. Drivers shouted instructions: trucks nnnhled ])ast to the front and above the incidental noises roared the lu'avy guns. Mrs. Beyea described the stretchers and tluur blanketed oc- cupants : Now and again you hear, "Kasy there, Ruddv. I ;ruoss that leg is about oil'.'" A voice from under niv tVet called up: 646 HISTORY OF AMERICAN RED CROSS NURSING "Got a match, Sister?" A stretcher passed, the lad on it still under ether, screaming : "At 'em, boys I" And always the ambulances coming in, until we had three thousand before the night was over. Lights were on in the operating tents, nurses and doctors were working faster and faster. The strain grew intense. Suddenly above the din, a peculiar sound struck the air, the sound of a motor, once heard, never forgotten. Then the cry : "Lights out I The Boche !"' Pitch blackness, then the ex- plosions outside. A muffled shout from the surgeon across the table : "Someone bring a candle, I've got an artery here !" and then to me : "Xurse, can you hold the patient under ?" "Yes, Major." Then a yell, "Everybody flat on your faces, they're right over us !" "Hell," growled the Major, "we haven't got time !" There was a roar above, then "After 'em, boys it's the pursuit !" Back came the lights and the work went on. Maude S. Crawford, a reserve nurse and a member of Base Hospital ^o. 7, wrote of her experiences at another evacuation hospital : We left Paris at noon for a destination whose name will bring a shudder to the nurses who were there in the awful days of July. We reached Chateau-Thierry about five o'clock and waited an hour at the station until our officers found the evacuation hospital to which we were assigned. Finally we arrived at a camp of yellow tents, pitched on a recent battle field in "Xo ]\Ian's Land" near what was left of a railroad station. Beliind the station lay a town in ruins. Here we became acquainted with "bully beef," "goldfish," moldy black l)read and black coffee. ]\Iost people are familiar with the discomforts of ordinary camp life, but try and imagine tents pitched on ground that an army has left, the dead not all Ijuried, shell holes and trenches, mud and rain. Imagine always the sound of artillery, air machines and no sounds or signs of normal life. Our initiation into the advanced zone was made in fly time. It really seemed as if we could stand anything if the flies could be lessened. Oh, the moon that shone above Chateau-Thierry those August and Septeml)er nights I The searchlights that swept across the skies outvied any Aurora Borealis that ever flamed above the liorizon. "Jerry'" came over every night. Before we could distinguish the burr of his machine, we heard: "All lights out I" We sat in darkness until the bombing ceased. Night in these tents is unlike any other experience. THE EUROPEAN WAR 64T The cots were so low that the blankets drabhled in the mud. Down the center of the tent were loose boards. They never seemed so narrow as when the stretcher-bearers carried in their burdens by the light of a smoicy lantern. Poor as the accommodations were, the men were always glad to get under shelter and in bed. The devotion of these doughboys to eacli other was the only beautiful thing that we saw. If they had seen their comrades fall, they wept for them ; if they were uncertain as to their fate, they worried and fretted. How cold it was in September ! There were no fires in the damp tents, but there were plenty of blankets for the patients and always hot-water bottles. When the railroad track was put into commission and the first hospital train came in, "Jerry" kept watch for that train and we were always anxious until it got away. Evacuation usually took place at night, quietly, with very little light, the patients lying on the ground on stretchers waiting to be put on board. They would have cocoa and sandwiches from the Ped Cross tent, choco- late and cigarettes. The nurses who were able to do so would leave their posts and come down to say good-by and good luck. Very often the train would leave about three in the morning. It was always a comfort to see the three "red eyes" at the end of the train wink and disappear in the dark- ness. It seemed strange to us that the boys never wanted to go. They were perfectly satisfied to stay wliere they were, in their first bed, with American women to care for them. As the troops moved forward, the evacuation hospitals moved forward with them, keeping several miles in tlioir rear. The nurses were sent to a ncarbv base and when their outfit had been set up again, rejoiiuxl it. Weird moments of the trips for- ward during the night have etched their fantastic outlines upon the memories of many American nurses who waited through the long hours in the rain bv a railroad track, watching weary platoons stumble from belated trains, while fresli companies as silently climbed aboard. After combat troops had been moved, the sanitary units went on up through the soddcni grayness of dawn to the evacuation hospital with its shambles. Aliss Craw- ford's report continued: We bad sometliing to eat aiul got into uniform. How unreal that operating-room scorned ! The tables were placetl as close togelJKM' as ]iossible down the center. They were never empty, one patient waiting until the surgeon bad fin- ished with the other. The wounded man lies silent on the 648 HISTORY OF AMERICAN RED CROSS NURSING table. The nurses are too busy to do more than give him a smile or an encouraging pat as they pass by. The anesthetist has a better chance. I remember a midnight lunch beyond St. Mihiel. The kitchen was situated in the woods, well out of sight. It had been part of a German camp. The night was cold; it was raining and the mud was the best of its kind. There were no lights to show us the up-hill way. When we had pulled our feet through the stickiness and reached the cabin, it looked as if we had reached the lower regions. The oil lanterns tied to the tent stakes cast grotesque shadows. Dark figures flitted about with cups and plates in their hands. Officers and nurses were laughing away the discomfort and the wretched food. Anna J. Johnson, an American Red Cross nurse who was loaned to the Army by Paris headquarters, wrote : On October 6, 1918, I reported to Evacuation Hospital No. 9 at Vaubecourt, near Verdun. The chief nurse, Kuth Golden, assigned me to a tent full of desperately sick pneu- monia patients. We worked hard for them, but they died sometimes as many as four in less than an hour. . . . Vaubecourt was a frightful place. It rained every day and was very cold. We lived in wooden barracks; fifty of us nurses were in one of the large rooms which had been divided into apartments eight feet square. Two Army cots and a rough table Avere in each apartment. There was noise and mud everywhere, but we were glad to get into the barracks after our former quarters in tents. One night our tent had come down in the rain and the whole place had seemed like tents and cots in a sea of yellow clay mud. We took care of many patients with very little to do with. We got towels and pajamas from the Eed Cross. Dr. Clark, the l^ed Cross representative, established a diet kitclien witli ]\riss Elizabetli Witter in charge. She prepared cereals, cus- tards, toast, jellies r.nd many other dishes for our sickest patients. She did splendid work. Enough cannot be said in praise of the young women who did the Red Cross canteen work in this frightful place. They worked early and late, night and day, many times in the pouring rain in nind up to their knees. When the hospital trains were loaded, they were always there with hot drinks and blankets for tlie boys. We all worked hard and there was very little sloe]) at night; everyone talked or coughed. The wliole thing was depressing. . . . THE EUROPEAN WAR 649 Pare do Prince, near Paris, was tlie mobile liospital train- ing center of the United States Army Medical Corps. Here each unit was stationed for several weeks before their assign- ment to the field. Sophie M. Bums, Army Nurse Corps, of Mobile Hospital No. 9, described this period of training: Here we had opportunity to familiarize ourselves with the features of an efficient tent hospital. The corridors connect- ing the ten wards, the complete operating-room, the hot and cold running water, the camion sterilizer and the well equipped laundry all provoked appreciative admiration. The beautiful level grounds of the park afforded admirable space in which three mobile hospitals might practice setting up tent hospitals at one time. The officers found need for all the knowledge of arc-hitecture they possessed, for there are many different ways of putting up a hospital. Each way is the best way in some particular emergency. In the meantime we nurses were completing our preparation, making operating- room supplies enough to last at least three days and going through gas mask drill. Mobile Hospital No. 9 was sent forward into Belgium to serve American divisions participating with the British in the last stages of the Ypres-Lys offensive. Miss Burns described the trip up the line: Our train consisted of thirty-one cars, coaches for nurses and officers and box cars for the enlisted men. We were on our way to the front at last and every one of us Avas thrilled at the prospect. The British, through whose sector we passed, rather dampened our enthusiasm; they were so thor- oughly accustomed to this war business and so iieartily sick of it. We understood their attitude better later on. After passing through l^]taples and Calais, we reached Dunkirk, where we received new orders to proceed to Staden. On the way up we met some American regiments who shouted at us cheerful, comradely questions: "(ioing to the front?"' "We've just finished the Argonne !"' "'^Anybody from Ohio?" "What town?'' "^Fy brother lives there." The next nKU'ning we passed through "No Plan's Land." T rememher tliat my first impression was not of shell holes or devastated hinds, but of American soldiers sitting hefore deftly projijied trench mirrors, sha\ing with great enjoyment. ^lany of the l)oys bad gay, flowered Ked Cross hags which made bright spots of color on the ^eIleral drah-hued scene. 650 HISTORY OF AMERICAN RED CROSS NURSING Miss Burns' report contained a graphic description of the swift- ness with which these mobile units could be set up: We pulled in close to a site where the French labor bat- talion was busily constructing a French evacuation hospital. Before nightfall eight Bessonneau tents were up in the shell- riddled fields and accommodations for two hundred patients were in readiness. We had ample time to prepare for the drive. Two Bessonneau tents together formed the admission tent and pre-operative wards. In the admission tent a nurse, acting as dietitian, served hot coffee to all the incoming patients and prepared special diets. Patients were first car- ried here on stretchers and their dressings cut down ; then they went to the X-ray room and thence to the pre-operative ward of fifty beds where they were bathed and at last to the operating-table. After the operations, the patients were again lifted, still on the same stretchers, and carried to beds in any one of the six wards, which were connected by corridors. A short time later, the operating teams arrived and in three days we were in working order. When the drive came, we evacuated a daily average of a hundred patients. The speed with which a mobile hospital could strike camp and move back is described bv Yioletta C. Mercer, reserve nurse, of Base Hospital Xo. 2, in an account of the evacua- tion on the evening of July 25, 1918, of Mobile Unit No. 1, American Expeditionary Forces : The barrage seemed about as usual until 11 :30 p. m. We were watching the fire-works when at midnight the alarm of a gas attack sounded. All nurses were immediately ordered to the dug-outs, while corpsmen began to clear the wards of patients. Down I went accompanied by the other night nurses. With a sigh of relief Major Barclay and Colonel Brewer, standing at the doorway, saw us safely in. They had been counting nurses' noses and ours were the last. Let me say a word about this place of safety. It Avas a huge affair, lined with steel, like a great tunnel, supposed to hold a thousand j^eople. We had stayed here about two hours when ambulance after aml)ulance of wounded began to arrive. They decided to begin operating at once. Those who were ordered upstairs, were glad to go. To wear a tin hat and a rf'spirator durinp- an operation, however, is not the pleasantest thino- in the wnrld. The attack befran again about six o'clock that morning' and we all went to the dugout again. There the Hun pelted THE EUROPEAN WAR 651 us for two hours. I shall never forget that scene under- ground. Stretcher after stretcher was brought in, the poor men in hideous condition. We did our best, which was very little, but two died down there in the close darkness. About eight o'clock an order came for general evacuation. We weren't allowed to go back to our quarters. The corpsmen threw everything we owned in sheets and tied them up and so they traveled. Absolutely nothing was lost. We had break- fast and were packed into lorries, following the evacuation of the patients. We feel now we know the meaning of "an orderly retreat." After us came the rest of the personnel as fast as they could be loaded in the motors. In the meantime, the equipment of the mobile unit had gone on ahead. Within twenty-four hours they were again ready for their nurses, Miss ^Mercer continued: It seemed like heaven to arrive in this nice, clean, open field and see our own tents grouped together in one adorable little hospital and our officers and men so glad to see us and welcome us home. We certainly camped out, the officers' mess by day was their sleeping quarters by night and we all mess together. That very afternoon we received patients and did so all night until our place was full, but everything went like a breeze, the patients got immediate operation and good care, rest and food, even while the hospital was being put together I They were, however, an easy target for bombing planes. Miss Mercer's letter gave a grimly amusing incident : I forgot to tell you that in the area we were in there was much aeroplane activity. The night before our convoy started, the colonel of the division was on his way to see our commanding officer. After three hours he finally arrived with the astounding story that he had been chased by a Hun plane and had had to hide in a ditch, making three different attempts to get away, but each time l)eing ])ickcd up again by this TTun highwayman, who immediately turned liis machine gun on the car. At the end of three hours, the Hun grew weary and Colonel F. crawled out and hurried to us. AYithin five days they moved again. ]Miss Mercer wrote: We had to evacuate every patient, ])ull \ip stakes and be readv to move in twelve hours, but there was sdine delav in 652 HISTORY OF AMERICAN RED CROSS NURSING the arrival of our convoy so we did not get off until five o'clock in the afternoon. We started the whole circus parade again. We stopped on the road at seven and had cheese and crackers, which was dinner. It was a heavenly night, full moon and not a light to be used. We drove until one a. m., when orders came to stop, so we slept for two hours on the side of the road wrapped in bmucaup blankets. Sharp at three the whistle blew and we were soon on our way; we con- tinued without further interruption until we arrived at a French chateau with a nice park in which many troops were sheltered. It looked like heaven to us after the awful flat, dusty country we had come from. The next morning bright and early, our patients began arriving and are still coming ; our stay here has only lasted a few days ; the future is a sealed order. It may be months before we move again. Miss Stimson's report stated that at the signing of the Armistice there were sixty-eight camp hospitals functioning in the Medical Corps of the American Expeditionary Forces. Coveted above all forms of assignment within the Medical Corps was the professional service at the front, made up of "officers, nurses and enlisted men especially selected for their professional attainments and formed into surgical, 'shock' and gas teams, so mobilized as to permit them to be sent fully equipped on short notice to any part of the front where their services were needed." ^^ Of these units the most numerous were operating teams or- ganized from base hospitals. Two hundred and forty-four existed on December 31, 1918. The prevailing shortage of medical personnel in the zone of the base prevented, how- ever, the withdrawal of all these units, so that less than two hundred teams actually saw service at the front. Ninety-five additional operating teams were organized from among "casuals" of the American Expeditionary Forces. An operating team usually consisted of one surgeon, one assistant, one anesthetist, two nurses and two orderlies. Of the nature of the service, Sigrid H. Jorgensen, reserve nurse, of Base Hospital Xo. 15, wrote: On July 14 our troops were making the first big offensive by tlienisclvos. We were dumped off in the middle of a wheat field outside a small town called ficury. The hospital ** Report of tlie Director of Nursing Service, A. E. F., p. 16, Surgeon General's Oflice. THE EUROPEAN WAR 653 [Evacuation No. 4 J consisted of ten Bessonneau tents, a dozen large khaki tents and numerous smaller ones. This whole hospital was just twenty-four hours old when we arrived and from the time the drive began the day before they had ad- mitted over a thousand wounded. A dozen tired but cheerful nurses greeted us. Our operating-room was the usual Bessonneau tent con- nected with a smaller tent whieli served as sterilizing and supply room. Four tables were arranged down each side. The niglit teams relieved the day teams. There was no stopping for explanations. The faces of the wounded all around us on the ground, on the tables, everywiiere we looked, seemed to say: "When will my turn come?" About eleven o'clock that night the shelling of Chiilons, about four kilometers away, began. Now and then tlie ma- chine guns would be peppering about us trying to get the Boche planes. The next night the Boche came about ten- thirty and after circling about the camp a few times, dropped a large bomb about twenty feet from tiie nurses' tent and played al)out with liis machine gun. Many of the boys whose nerves were pretty well shattered, wanted to get away. We newcomers did not know enough to be scared. The work of the teams was the usual round of heavy surgery. Miss Jorgensen continued : Sometimes we were fortunate enough to have two tables for one team, wliich meant that we were al)le to prepare and anesthetize one patient ahead and in that way we could get on witliout stopping. By adding one extra surgeon and one anesthetist (hiring rush days, a team like this could handle from sixty to eighty minor cases or thirty mixed cases on one eighteen-hour shift. Sixteen or twenty hours in the operating-room is liard work. If we went off duty, though, it Tueant that for every hour we rested their wounds would become infected. And such bravery as those boys displayed ! I remember one young boy witli a fractured skull. lie was too badly slidckeil for ether and so the operation was performed under local anaes- thesia. For huge skull wounds, drills and all sorts of otlu>r instruments were used. ()iu> large ])i(Me of shrapnel was ex- tracted by a vei'V ])owerful magnet and never a whiinjier from the boy I When we ])raised his pluck, he told us that anyone who could stand the life in the trenches as it had been for the past week could stand anything. 654 HISTORY OF AMERICAN RED CROSS NURSING Another youngster about eighteen years old had gone to sleep on the table, waiting for his turn to come. Suddenly his voice rang through the operating-room : "Why, hello, it is an age since I've seen a woman like you !" The surgeon wanted to know if he was a friend of mine. Poor little chap, he was brave enough for anyone to be proud to claim him. I went up to examine his wound and found one hand com- pletely blown to pieces and asked him what he would do if it had to be amputated. "Do?" he joked. "Do without it, I guess." I told him not to look at it lest it make him sick. He raised himself up, eyed it and said, "Why, there ain't none !" I asked him how he could be so cheerful. "Why, nurse," he said, "it might have been the right one. This time it was only the left!" And his childish laughter rang through the tent. Ruth Cushman, reserve nurse, of Base Hospital No. 18, described the bombing of Chalons: Up until the night of July 14 everything was quiet save for the barrage which rocked our barracks. We were awakened at midnight by a shell exploding in our midst and the immediate order of "gas alerte." As the patients were pouring in, the night force went on duty in the operating-room and wards. The rest of us re- mained in ahris and dugouts. By six o'clock that morning, part of the hospital had been demolished, two patients killed and some of our personnel injured. Orders to evacuate came at eight o'clock from Headquarters. We rode for several hours (and the memory of the real refugees journeying along the roadside still remains). Some of the nurses slept on the floor of the trucks. We soon found ourselves attached to an evacuation tent hospital in a large open field. Our own team, however, was ordered back to Chalons to operate that night on the more serious cases which had been left behind. From our hospitals we watched the brilliant display made by the signals and shrapnel from the anti-aircraft guns. In the bright moonlight, we could see the Boche planes flyijig low, then the terrific explosions of the ])ursting shrapnel. Personnel and patients alike sought the wheat fields and to my dying day I believe a field of grain will hold a certain fascination for me. Our hospital train of over a thousand trucks moved by night, so our way along the main roads was lighted by burn- ing ammunition dumps set oil' by enemy bombs. We led a THE EUROPEAN WAR 655 gypsy life constantly in evacuated territory of the once beau- tiful ]\Iarne Valley about Chateau-Thierry. The devastated country lying stark in the brilliant moonlight grew to have a natural aspect, town after town in ruins, fields plowed with shell holes, roadsides lined with ammunition and graves.^ From ficury the teams moved forward. Miss Jorgensen continued : Soon Soissons had been taken and the Germans were driven back about thirty-five miles. On August C we were on our way, only this time it was quite different scenery to which we were introduced. Everywhere along the road we saw ruins, torn trees, dead horses, shelled roads, trenches and wire en- tanglements in every direction; but through all this misery we did not see one sad face; we were all going forward. Our entrance to Chateau-Thierry was five days after the Germans had left. The city must have been very beautiful before the attack. Such wonderful architecture and such scenery over the hills and the Marne ! Now almost every house was shelled to pieces ; furniture littered the torn streets. No civilian inhabitants remained. One beautiful home with damask curtains and tapestries attracted our attention. We peeked in and there were our boys peacefully asleep on the most comfortable divan. Olive I. Thompson, also reserve nurse of Base Hospital No. 18, described the historic advance: Our team with a number of others was moved after five days to Viilers-sur-Marne, where we were stationed with Field Hospital No. 148 in Mme. Huarde's chateau. The thoracic team on night duty at this hospital was called during the day only for emergency cases. As all of the boys had lain out on tlie ground for twenty-four hours before they were picked up, tliey were in very bad shape when they were brought in. Delay in reaching the base was due to the fact that the one- way road was congested by the trailic of the advance. During the lull in the offensive, we went with the surgeon in charge of our team to Paris to obtain supplies and instru- ments from the Ked Cross. Returning, we overtook our hos- pital on July 'U at Chateau de la Forret. The operating- room hero was in an old hunting lodge. All around the room were stuffed animals, whicli we were not allowed to touch, as *" T\oport written by Ruth Cnsliinan for tlie Johns Hopkins Alitmncc .Vayaci/ic, May, 1!M!<. pp. 75-77. 656 HISTORY OF AMERICAN RED CROSS NURSING it was feared that they had been wired by the retreating Ger- mans. The flies were horrible and a foul stench arose from dead men and horses which still littered the ground. Anne E. Schneider, reserve nurse of Base Hospital No. 6, wrote of Field Hospital No. 27: Monday, July 29, found us again on the move, this time in the direction of Chateau-Thierry, where we made our home in a deserted chateau with spacious grounds. Team 77 to which I belonged was placed on night duty, for which I will always be grateful. Our stay was destined to be a lively one. Early in the game I discovered that it was much easier to be busily engaged with one's mind on one's patients than to lie quietly in bed trying to figure out just where the next bomb was going to land. Here during our leisure hours we explored the surrounding country, visiting the dugouts so recently occupied by the enemy, made comfortable by the looting of the homes of Chateau-Thierry; crossing the river on the pontoon bridges thrown across by our brave engineers in that bitter struggle across the IMarne; climbing Hill Xo. 204 with its countless shell-holes; stopping by the way to examine a broken plane resting by the grave of its fallen hero; viewing from its height the beautiful valley of the Marne, at its base the utter destructioji and ruin of a once-thriving city ; through Belleau Wood where hardly a tree remains unscarred ; through many a valley where no stone remained unturned; and back through the poppy fields of France in all the glory of their brilliant hues. We watched the return of the refugees in groups and in single file by every train or wagon. Into Chateau-Thierry they came, some on foot with the old family cow and the faithful shepherd dog close on the heels of the bal)y carriage, heaped with all their pitiful worldly possessions. While the sound of the guns was still to be heard, these people returned to reestal)lish their homes and to rebuild the city and with their coming we again joined the mighty caravan of the road. Of the simnltanoons arrival of various types of forward sani- tary formations of the American Expeditionary Forces at a given point of evacuation, Kathervn A. Leverman, reserve nurse of Base Hospital No. 40, wrote: From Field Hospital Xo. 27 we were taken to Eed Cross Hospital No. 114 then at Chateau-Thierry to remain over THE EUROPEAN WAR 657 night, expecting to retuni to our base. After scrubbing all morning in our new quarters, we received our orders. While waiting for the ambulance to take us to the station there came a call for more nurses up the line. We were hastily shoved into ambulances and there followed a wild ride to Crezancy, where Evacuation Hospital No. 3 was stationed. Arriving at Toul one night, we were taken by ambulance to Evacuation Hospital No. 1 which was permanently located at Sebastopol, a good distance from Toul. After resting here for a day we moved on again, this time occuj)ying a large French military barracks barely outside of the city. A num- ber of tents were also set up and one of the large Bessonneau type was fully equipped for operating, containing eight ta- bles for that purpose, with two extending the entire length on one side to be used for sterile supplies. Other hospitals were arriving daily and all were stationed around this neighbor- hood and were designated the "Justice Group." 1 cannot now recall all the different numbers, but one was for gassed cases only, another for medical, one for the slightly injured and we were to take only the seriously wounded. It was here that Captain Cutler, our surgical director, organized the work so that this particular hospital handled an enormous number of cases during the St. Mihiel Drive. Those" of us who worked in the tent still shiver when we think of those cold September nights, when we were sterile nurses for several o})erating teams, our hands in wet gloves constantly, standing within a small space, handing out sterile supplies and setting up instrument tables. Although this organization was wonderfully equipped, there was no over- supply of aprons, or other articles, so we had to be especially careful. Each operating team had a "floating nurse," who was kept so busy that she did not feel the cold quite so much. There were just two of us to handle the sterile supplies for those eight tables and we did not dare to move outside of our own little sphere. About four A.^f. we felt more like wooden idols than human beings and oh I how unmercifully cold it could get ! After the St. ]\Iihiel Drive we went on to Flcury, where we worked with IJed Cross No. 114 for one week and were then ordered to the Champagne Front. When we arrived at Cuperly in the Champagne sector early that Octol)er morning, the ground was white with frost. Our hospital tents were pitched across the railroad track from the Mt. Fronet French hospital barracks. ... It was in this sector that we had to wear rubber boots so much and we ran a terrible risk of losing them comiiletelv. 1 reallv don't know of anvthiiiij that has 658 HISTORY OF AMERICAN RED CROSS NURSING the stick-to-itiveness that French mud has. The most popu- lar costume those days were raincoats over either a jersey or gray crepe uniform, rubber boots and sou'wester hat. Our boys told us we looked like the advertisement of codliver oil. Xo wonder the mademoiselles asked our soldiers: "Are all American women so homely?" Of their last stand at Fromerville, Sigrid Jorgensen wrote ; It was hardship, sacrifice and toil from the day we came there. Something seemed to tell us that this our last fight was to be the end. The tents were pitched on the top of a hill overlooking the ruins of the villages. The mud, alive with the filth of war, grew thicker in the cold rain. Instead of uniforms with such trimmings as white collars and caps, we nurses then wore high rubber boots, trench coats and rain hats and sweaters in several layers. Verdun, pounded by German guns, Avas about four kilo- meters from us, but we never dreamt for a minute that they were after our little camp. On November 3 they got our range and threw over thirteen shells. Headquarters was shelled down completely; some shells struck the tents and the shrapnel flew in every direction. Everyone rushed to the help of the wounded. Some carried stretchers, others wejit about with bandages and dressings and still others did their best to cover the boys up. Thirty "splint teams" w^ere organized by the Medical Depart- ment for service in the zone of the advance. The service which the personnel of this type of unit saw, closely resembled that experienced by the personnel of operating-teams. These ''splint teams" are of especial interest to members of the American Red Cross, because at the request of the Army and without any expense to the ^lilitary Establishment, the American Red Cross supplied more than 294,000 splints to soldiers of the American Expeditionary Forces. ''Shock" work at the front represented the most forv/ard branch of American military nursing service during the Euro- pean War. Seventy-eight "shock teams" were organized. From a professional point of view, their work demonstrated un- equivocally the value of expert nursing technique in the imme- diate zone of the advance. ElizalK>th Coombs Strode, res(^rvo nurse, of Base Hospital No. 20, described the nature of their work : THE EUROPEAN WAR 659 "Shock" is produced by loss of blood, destruction of tissue, exposure and privations of every kind. Patients had often lain undiscovered in the cold and wet for days in shell holes or some other exposed spot, under constant fire, where it was impossible to conduct rescue work. Life was sustained only by water from mud holes. Many others, desperately wounded, after receivinr from Karelia. The signing of the .Vrmistice with (Jermanv. contrarv to 684 HISTORY OF AMERICAN RED CROSS NURSING the expectations of many people, did not bring to a close the hostilities in Russia. No official declaration of war had ever been made against the Bolsheviki and consequently a legal state of war did not exist, although fighting continued. . . . The Allies advanced up the Onega River in the Archangel district, for a distance of fifteen miles on December 30 and recaptured Kadish and made their rather precarious position more secure. During 1918 and 1919 the whole situation in Russia and Siberia was still unsettled. Arguments were rife in Allied countries as to what should be done. Some contended that a large force should be sent into Russia and Bolshevism crushed, while others maintained that the armies should be withdrawn and Russia permitted to work out her own salva- tion. The question was for the Peace Conference to decide.^^ The American ISTorth Russian Expeditionary Force was re- called in the spring of 1919. The American Red Cross Hos- pital was closed in April and Miss Foerster and ]\Iiss Gosling returned to the United States as soon as the ice broke and the Arctic Ocean was open again to navigation. Moreover, eighteen British nurses had arrived for duty at the Interallied Base and the sick and wounded among the American troops were sent there until the American Force was withdrawn. The American Red Cross Hospital at Archangel had a record of six hundred and twenty-two patients. Four hundred and thirty-eight of these were medical and one hundred and eighty- four were surgical cases. Seventy-two operations were per- formed. Only three American soldiers died at this hospital just below the Arctic Circle. ""A Reference History of the War," p. 143. CHAPTER VIII SERVICE WITH THE NAVY Organization of Units Uniforms and Insignia Navy Nurs- ing Service in the United States Navy Nursing Service in Foreign Stations Detached Service of Navy Nurses FOUR outstanding accomplishments of the American Navy during the participation of the United States in the European War were the successful escort duty furnished to American troops and supply ships in home and foreign waters; American mine and patrol activities in the North Sea ; the re-fitting for transport duty of the interned German liners; and the accomplishments of the Marine Corps in France. For the combatant Navy, the most formidable dangers were German submarines and mines ; in addition there were the risks of collision and the natural perils of winds and sea. As for the Marine Corps, it faced and checked the ad- vancing enemy divisions in the Bois de Belleau during the third German offensive of May 30, 1918, on Paris; its accomplish- ment on that occasion and in the subsequent Inter-Allied offen- sive of July 18 to November 11 needs no further comment here. The accident and casualty list of the American Navy during the period beginning April G, 1917, and ending November 15, 1918, numbered 117 officers and 893 enlisted men; that of the Marine (\)rps totalled 201 officers and 5084 enlisted men.-^ Responsibility for the sick and wounded of the ^Marine Corps and the combatant Navy in home and foreign waters, and for medical and accident cases of the Navy personnel in training in the United States was vested in the Bureau of Medicine and Surgery, Navy Department. > Report of the SocTctary of the Navy, 1918, pp. 212-255; 310-322. ()S5 686 HISTORY OF AMERICAN RED CROSS NURSING By Act of Congress,^ during the year 1908, the Navy Nurse Corps came into being as part of the Bureau of Medicine and Surgery, of which Rear Admiral William C. Braisted was then Surgeon General. Esther Voorhecs Hassan was its first super- intendent. Though of New England ancestry. Miss Hassan was born in Maryland. Following her graduation from the New" Haven Training School for Nurses, she served both as staff and chief nurse in the Isthmian Canal Service, Army Nurse Corps. Her name has appeared previously in this his- tory in connection with the Spanish-American War. Katrina Hertzer, who represented the Navy Nurse Corps at National Red Cross Headquarters during the European War, wrote of Miss Hasson : ^Yhen the Xavy Nurse Corps was established, Miss Hasson was given the appointment as Superintendent, August 18, 1908, on account of the splendid service slie rendered under the Army during the Spanish- American War on the United States Sl S. Relief. When the Corps was first established no public quarters for nurses nor an appropriation to finance them were available. The nurses were allowed commutation for quarters and sub- sistence. Miss Hasson leased, furnished and financed quar- ters at 541 Twenty-first Street, N. W., Washington, D. C. These were the only quarters available in Washington until the present quarters on the Naval Medical School Reservation '601. Establishment of the Nurse Corps. (Act of May 13, 1908). "The Xiirse Corps (female) of the United States Navy is hereby established and shall consist of one superintendent, to be appointed by the Secretary of the Navy, who shall be a graduate of a hospital training school having a course of instruction of not less than two years, whose term of office ma}' be terminated at his discretion and of as many chief nurses, nurses, and reserve nurses, as may be needed: Provided, That all nurses in the Nurse Corps shall be appointed or removed by the Surgeon General with the approval of the Secretary of the Navy, and that they shall be grad- uates of hospital training scliools having a course of instruction of not less than two years. Tlie appointment of superintendent, chief nurses, nurses, and reserve nurses shall be subject to an examination as to their professional, moral, mental and physical fitness, and they shall be eligible for duty at naval liospitals and on board of liospital and ambulance ships and for such special duty as may be deemed necessary by the Surgeon General of the Navy. Reserve nurses may be assigned to active duty when the necessities of the .service demand and when on such duty shall receive the pay and allowances of nurses: Provided. That they shall receive no compensation except when on active duty. The superintendent, chief nurses, and nurses shall, respectively, receive the same pay, allowances, emolu- ments and privileges as are now or may hereafter be jirovided by or in pursuance of law for the Nurse Corps (female) of the Army." SERVICE WITH THE NAVY 687 were completed in 1910. She managed the quarters so well that when they were disposed of after the completion of gov- ernment quarters, the nurses realized from them not only all they had i)ut in l)ut a considerahle bonus. Miss Hasson designed the indoor uniform and the insignia of the Navy Nurse Corps. During her incumbency as super- intendent nurses were assigned to the Naval Hospitals in Washington, New York, Norfolk, Annapolis and Mare Island, California. She resigned from the Navy Nurse Corps in January, 1911, Lenah Sntclitfe Iligbce was the second superintendent of the Navy Nurse Corps. She was born in Chatham, England, but received her training at the New York Post Graduate Hospital, New York City. Later, she became a citizen of the United States. Before joining the Navy Nurse Corps, she was en- gaged in institutional nursing in Bellevue and Allied Hospitals (Fordham). Her enrollment in the American Red Cross Nurs- ing Service dated from ^fay, 1912. She was a w^oman of strong, quiet personality and her native English reserve was impregnated with a keen sense of justice and of proportion which greatly endeared her to the members of her Corps. Requirements for enrollment in the Navy Nurse Corps were set forth in the Circular of Information for Persons Desiring to Enroll in the United States Naval Reserve Forces as Nurses : A candidate for enrollment as nurse is first examined for enrollment in tlie provisional grade of nurse. United States Reserve Force. After her enrollment is accomplished, should she so desire, she may make request for active duty for con- firmation in grade and after the completion of a minimum period of three months, active service, she is again examined and if found qualified is confirmed in grade. A member must be a citizen of the United States. A member enrolls or re-enrolls for a term of four years. The minimum active service required for maintaining tlie efficiency of a member (Naval Coast Defense Reserve), is three months during each term of enrollment. This active service may be in one period or in periods of not less than three weeks each year. A member receives retainer pay of $1'^ per annum while enrolled in lier provisional grade. ]irovided she makes sucli reports concerning her movements and occupation as may be required by tlie Secretary of the Xavy. After confirniation in grade, ber annual retained pay is two months" base pay 688 HISTORY OF AMERICAN RED CROSS NURSING of nurse in the Xavy. Retained pay is in addition to any pay to which a member may be entitled by reason of active service. As noted below, numbers of the Volunteer Naval Reserve do not receive any retained fee. Enrollment of persons shall be made in the Naval Coast Defense Reserve, Class 4, or Volunteer Naval Reserve for duty in the Naval Coast Defense Reserve, Class 4, U. S. Naval Reserve Force. (Members of Volunteer Naval Reserve re- ceive no retainer fees or uniform gratuity in time of peace, but when on active duty receive the service pay of their grade and service.) A candidate for enrollment as above, must be between 23 and 44 years of age, and a citizen of the United States and unmarried. She must be a graduate of a reputable training school connected with a recognized general hospital giving not less than two years continuous training. Candidates for enrollment from states where State Board laws are operative, are required to be registered. A certificate of enrollment in the American Red Cross will be accepted in lieu of the above (professional) certificates.^ In three respects the Navy ISTurse Corps set up requirements of no little embarrassment to its reserve, the American Red Cross Nursing Service. First, it was required that a candidate for the naval services be a woman of the highest professional training and of mature judgment, because she was expected to have entire charge of the nursing education of the hospital apprentices of the Navy. When in the exigency of war the Red Cross Nursing Service let down its enrollment bars to admit young graduates of smaller institutions, the Navy Nurse Corps refused to accept these nurses, on the ground that they lacked the experience and the years which make for proficient instructors. The second point covered physical condition and was de- scribed in a circ\ilar letter sent in June, 1917, by Miss Noyes to all Committees on Red Cross Nursing Service : Perfect pliysical condition is essential. Overweight or im- perfect eyesight, unless corrected by glasses, will debar a nurse from enrollment. A chest expansion of not less than two inches and freedom from organic diseases of any kind is imperative. "Nav. 375, March 31, 1917, Govornmenf Printinfr Office, Washington, D. C. SERVICE WITH THE NAVY 689 The requirement covering eyesight proved particularly trouble- some. Miss Noyes once remarked to Mrs. Higbee : "Does the Navy contemplate making sharp-shooters out of your nurses?" But the most formidable recjuirement of the Corps was that its members be of American citizenship. However, when the pending shortage of nurses was foreseen in 1917, the Navy lowered this requirement. A statement covering this change was given in a postscript written by Miss Delano and attached to a letter written by Miss Noyes in June, 1917, to chairmen of State and Local Committees on Red Cross Nursing Service : Since writing the enclosed letter we have been advised that a law has recently been passed making it possible to enroll nurses who have taif nurses in selecting a staff, !Miss Noyes S(uit out circulars of information which defined the dlff'erent divisions of executive and other professional details of the nursing staff" and the number of nurses needed for each division. She recommended that at least three of the forty nurses should have had practical experience in the care of contagious diseases. Similar outlines relating to the nurses' aides were also issued. Nurses and nurses' aides desiring service in Navy bas(^ hos- pital units were recpiired to enroll in the American lied Cross. I>ocal Chapters undertook the raising of funds by means of *l'. .s'. Xaval Bullttin, Aprib 1!)18, p. 184. 692 HISTORY OF AMERICAN RED CROSS NURSING which equipment for Navy base hospitals was purchased and stored. After the declaration of war by the United States, the Navy called upon the American Red Cross to organize three more base hospitals in addition to the five original ones organized in 1916. Between April 4, 1917, and November 11, 1918, the Ameri- can Red Cross Nursing Service assigned 339 nurses to the eight Navy base hospitals organized by the Red Cross. A list of these columns will be found in the Appendix. Up and down the long coast line of the Atlantic seaboard were located numerous Naval stations. Upon the declaration of war, these were in need of Naval hospitals. Admiral Braisted in June, 1917, authorized the organization of ten naval station hospital units. A circular letter issued at that time by Dr. Richards gave more complete information : At the request of the Surgeon General of the Navy, the Bureau of Naval Affairs, American Eed Cross, has under- taken to organize a new group of units to be known as "Navy station hospital." These units are for the purpose of sup- plying in part the personnel for a number of new hospitals now being erected at various naval stations along the At- lantic Coast and at one or two points elsewhere within the United States, for care of the rapidly expanding naval per- sonnel. With a view to drawing as lightly as possible upon the civilian profession, only five medical officers will be required for each unit. Additional members to fill the complement will be furnished by the Surgeon General from young officers already enrolled in the Naval Reserve Force. No equipment will be required, but if funds are available for the purchase of X-ray or dental outfits, ambulances, etc., such donations will be gladly accepted. Naval station units called for an initial staff of from ten to twenty nurses, one of whom was authorized to act as head nurse until the unit was called into service. The same requirements of enrollment, physical examination and immunization existed for this service as for other military units. In size and purpose. Naval station units corresponded in many respects to hospital units for the Army. As did their sister formations in tlie Army, these units of organization proved exceedingly popular with smaller institutions, the staff's SERVICE WITH THE NAVY 693 of which could not provide the specialization or stand the drain of personnel necessary for such elaborate organizations as base hospitals. There was swift expansion of the Navy immediately after April (), 1917, and the Bureau of Medicine and Surgery found it expedient to authorize the organization by the lied Cross of ten additional Naval station hospital units. Twenty-one units in all were thus organized by National IIead(iuarters and 180 Red Cross nurses were assigned to active service in the Navy Nurse Corps through these units. A list of them appears in the Appendix. The smallest and most numerous of the three types of nurs- ing units which were organized by the American Red (Voss for the Navy was the Navy detachment. As early as October 6, 1910, Miss Delano wrote to all superintendents of schools of nursing in the United States : ... It is now our intention to develop Xavy units from among the graduates of various schools which have not al- ready been called upon to organize base hospital units, and have selected your school as one of the number to be respon- sible for maintaining such a unit for service with the Xavy in the event of war. These units will be called upon only in time of war aiid may I suggest tbat you consult with your Board of Managers and secure their permission to maintain at all times a "Navy detachment of nurses'' in connection with your school. While it is probable that Xavy detachments will be as- signed to duty in their own locality in hospitals established by the Xavy, they should be willing to acce])t service else- where. Preference should be given to nurses under forty years of age and to citizens of the Thiited States. Whenever possible these units should consist of twenty nurses including the head nurse. The majority of the nurses should he ex- perienced surgical nurses with one or two anesthetists. If absolutely unable to maintain a unit of twenty nurses in con- nection with your sctiool, arrangements can doubtless be made to authorize a smaller number. There will be no medical personnel attached to tliese units. . . . Following the severance^ of diplomatic relations with Ger- many on February .">, 1917, .Miss Xoyes wrote to the superin- tendents of lifty training schools then organizing Navy de- tachments : 694 HISTORY OF AMERICAN RED CROSS NURSING Under the present uncertain conditions, we believe that we should rush the completion of our Xavy detachments as rap- idly as possible. Should our country be so unfortunate as to become involved in war the Navy would probably be the first engaged. Under such circumstances large numbers of re- serve nurses would be required. In anticipation of these needs you were asked to enroll a group of selected nurses around your school. Will you kindly notify me preferably by telegram what progress you have made, the number of nurses enrolled and their names? The enrolled Red Cross nurse has always an- swered the call for service willingly and promptly. Let us not be found unprepared should our country need us now ! Five hundred and forty American Red Cross nurses were assigned to active duty in the Navy Nurse Corps as members of Nav^y detachments. A list of these units appears in the Appendix. Of the 1500 American nurses serving in the Navy Nurse Corps at the time of the signing of the Armistice, 1058 of them had been mobilized through the American Red Cross Nursing Service. This number was sixty-six per cent of the total strength of the Navy Nurse Corps. When the United States entered the European War, the Navy Nurse Corps, like that of the Army, had no distinctive outdoor uniform for its nurses. American Red Cross nurses assigned to the Navy Nurse Corps, when on duty in the wards of Navy hospitals, wore the white wash uniform of their school, with the Red Cross cap, brassard and cape. When off duty they wore civilian clothes. The first Navy nurses to serve overseas were those attached to United States Navy Base Hospital No. 1. This formation had been organized by the American Red Cross. When its nurses arrived in New York early in September, 1017, for embarkation overseas, they were furnished witli the blue serge dress, the ulster, the velour hat and other articles of equipment which the American Red Cross was then issuing to Army base hospitals assigned to foreign service. The following instructions were issued by the Surgeon Gen- eral and were forwarded November IG, 1017, by ]\Irs. Higbee to ^liss Delano : SERVICE WITH THE NAVY 695 Outdoor Uniform for Members of the Navy Nurse Corps Skirt and coat of heavy dark blue serge. . . . Wash waists, cotton cheviot, dark blue flannel, dark blue silk. . . . Top coat: dark blue heavy coating, smooth finish, similar to Navy "cap cloth." . . . Cape:^ heavy long cape of cap cloth. . . . Light cape, navy blue serge lined with flannel. Sweater of any weight desired ; color, dark or navy blue or . gray. Baiji coat: Coat of tan cravenette, or rubber, and rubber hat. Hat: Navy blue velour. . . . Boots or shoes: Black, heels not higher than "Cuban;" heavy soles; under certain conditions the Surgeon General may authorize tan boots for heavy walking. Hosiery: black with black boots or shoes; tan with tan boots or shoos; white with white boots or shoes. Rubber overshoes. High rubber boots. Corps Insignia: to be worn on duty always with wash uni- forms and on waists of outdoor uniform, when such uni- form is ordered. Collar device for outdoor uniform: The letters T^ S. for members of the Kegular Nurse Corps, and U. S. R. for reserve nurses and Nurses' Re- serve Force: to be worn % incli from collar openings on collar of coat or suit, top coat or heavy cape; Corps de- vice to be worn ^ iuf'h from letters 1" S. or U. S. R. ; collar devices shall not be worn except when in full out- door uniform or when top coat and heavy cape are worn over wasli uniform in hospital reservation. Nurses in the I'nited States are not obliged to obtain the entire outdoor uniform except when so ordered by the Sur- geon General. No part of this uniform shall be worn on duty in hospital or hos])ital reservation, uidess so ordered by the Surgeon General, except that the top coat, heavy cape or light cape or rain coat or authorized sweater, shall be worn over wash uniform for protection and warmth; and no other gar- ment shall be worn with uniform. (Signed) \\. C. Brai.sted. The collar (hn'ico referred to above consisted of a gold acorn on a gold oak-loaf, which was superimposed upon the characteristic gold anchor of the Xavy Df^j^artmciit. The letters N. N. C. in gold appear upon the oak-leaf and acorn. Iveserve nurses who had entered the Xavy Nurse Corps through 'Optional fnr duty oNorseas. 696 HISTORY OF AMERICAN RED CROSS NURSING the American Red Cross Kursing Service were allowed to wear the Red Cross cap and the Red Cross cape from which the emblem of the society had been removed. Specifications for the indoor uniform of members of the Navy iS^urse Corps were transmitted by Mrs. Higbee to Miss Delano on November 21, 191Y: White uniform: for members of the Navy Corps, Navy Re- serve Force and Reserve Nurses, U, S. Navy, who are not already equipped with uniforms, shall consist of a one-piece dress,^' as illustrated, with attached soft collar and attached belt. . . . When authorized by the Surgeon General, the wash uni- form shall consist of a gray chambray, one-piece dress, as illustrated, supplemented with white collars and cuffs, as illustrated, and with an apron of approved style. . . . While the Surgeons General of the Navy and the Army had been working out, during the early autumn of 1917, the specifi- cations for the distinctive outdoor uniforms for their respective Nurse Corps, the American Red Cross War Council had had under consideration the equipment of all Red Cross personnel for foreign service. As has already been stated in Chapter VI, National Headquarters felt that it was the responsibility of the Government to equip Red Cross nurses assigned to Federal service but the recommendation to this effect of the Surgeon General of the Army to Secretary Baker "was returned disap- proved, with the remark that it was not the policy of the War Department to make clothing allowances during the war." ^ Upon the request of the Surgeon General of the Army, the Red Cross undertook the complete equipment of both regular and reserve members of the Army Nurse Corps at an individual cost not to exceed $200.00 per nurse. This ruling was extended to embrace all members of the Navy Nurse Corps who were assigned to foreign service. Limited articles of equipment also were given to nurses assigned for duty on hospital ships. Early in August, 1018, a change in the insignia to be worn by members of the Navy Nurse Corps was made. General Braisted on August 9, 1918, sent ]\Iiss Delano a print of the " The gray chambray uniform must be included in equipment for duty overseas. 'See letter written Sept. 26, 1917, by the Acting Surgeon General, U. S. A., to Col. Kean, Chap. VI. SERVICE WITH THE NAVY 697 new design. "The device is supplied in pairs and is to be worn on either side of the colhir of coat or suit, top coat and cape, the anchor to be horizontal with point toward and one inch from opening of the collar. The use of the letters 'U. S.' and 'U. 8. !{.' as a part of the collar device of the Nurse Corps is herewith countermanded." In a letter written August 24, 1918, to Miss Delano, General Braisted pointed out that "the elimination of the letters 'U. S.' and 'U. S. 11.' materially re- duces the amount expended on the Collar Devices of the Navy Nurse Corps." In Augiist, 1918, after Congress had raised the pay for members of the Army and Navy Nurse Corps from $50 to $60 a month for service in the United States, and from $60 to $70 for service overseas, the Surgeon General of the Navy author- ized all members of the Navy Nurse Corps on duty in Naval hospitals in the United States to wear the outdoor uniform which had hitherto be(>n worn only by Navy nurses in foreign service. General Braisted on August 30, 1918, sent a copy of this ruling to Miss Delano : 1. The uniform ap])roved by the Secretary of the Navy fur members of the Xavy Nurse Corps will be worn by all mem- bers of the Navy Nurse Corps assigned to active duty; and instructions liave been sent to the Commandir^g Officers of Naval hospitals. Naval stations, hospital and ambulance ships and Xavul transports, that there shall be no distin- guishing marks in the uniforms of nurses otber than those which denote their othcnal status. 2. It is a])])reciate(l that the cajje, which is issued by the Equijunent Bureau to the nursses who have entered the Naval service through the American Ked Cross, is a satisfactory and desirable garment to be worn over the wash uniforms. In order to ])roni()te contentment and etliciency. however, it is inadvisable that tiiis garment should be issueil to some nurses who are on duty and not to others, it is sugirestcd. there- fore, that the American Ked Cross consider the advisability of giving this garnient to all nurses on active duty who sul)- mit a request for the caj)e. This ruling, as did tlie ruling made August IT), lOlS, by the Surgeon GciHM'al of the Army, rcmovinl entirely the licd C^ross emblem from the uniform of American lied Cross nurses as- signed to Naval service. 698 HISTORY OF AMERICAN RED CROSS NURSING Three hundred and thirty-four (334) members of the Navy Is^urse Corps were furnished full equipment for foreign service by the American Red Cross through the Bureau of Nurses' Equipment, Atlantic Division Headquarters, New York City, at a total cost of $60,120.00. Nurse members of Navy base hospitals which had been assigned to foreign service before the full list of equipment had been authorized on October 30, 1917, by the War Council, were furnished the supplementary articles due them under this later ruling, through the office of the Chief Nurse, American Red Cross in France. Navy nurses in for- eign service were allowed to replace worn out articles of wear- ing apparel by purchases made at cost from the Nurses' Equip- ment Shop, which was maintained at Paris by the Red Cross. On April 6, 1017, the United States Navy numbered 65,777 enlisted and enrolled personnel and had a complement of one hundred and ninety-seven ships in commission. Hospital fa- cilities for this peace-time Naval force had been provided by the erection and maintenance of permanent base hospitals situ- ated at the principal Naval bases along the Atlantic and Pacific seaboards and in insular and foreign waters. After the United States declared war, the Navy Department underwent an immediate and unparalleled expansion by the utilization of personnel of the Naval Alilitia, the National Naval Volunteers and the United States Naval Reserve, and by the construction of new ships and the conversion of pleasure and commercial craft to war uses. On November 11, 1918, the Navy Department numbered 497,030 men and women, with a complement of 2003 ships. The training of this enlarged Navy took place in camps in the various Naval districts in the United States and at schools for specialists. The Naval Academy at Annapolis was en- larged ; ^'officer material schools" were hastily improvised. Such a school for officers of the Pay Corps was established at Princeton, N. J. Deck and engineer officers for the merchant type ships were trained at a special school which was located at the Naval Training Camp, Pelham Bay Park, New York City, and at branches of the school in Chicago, Cleveland and at Stevens Institute, Hoboken, New Jersey. Officers for the Flying Corps were trained at the Navy Ground Schools at the ^Massachusetts Institute of Technology, the I'niversity of Wash- ing-ton, Dinwoody Industrial Institute at ^linneapolis and the SERVICE WITH THE NAVY 699 Naval Traiiiinji; Station, Great Lakes, Illinois. Flio;lit officers received post-gradnate instruction at Naval air stations at home and abroad; submarine officers at the Submarine Base, New London, (.\)nnecticut ; torpedo officers at the Naval I'orpedo Station, Newport, Rhode Island; turbine-engine officers at the Naval Turbine Engineering- School, Carnegie Institute, Pitts- burgh, Pa. Seamen, firemen and certain classes of petty officers and specialists were trained at the four Regular Naval training stations which had existed prior to the war. The total capacity of these stations which had originally housed six thousand re- cruits, was increased to well over one hundred thousand. To supplement these four principal stations, a new training camp was established in each Naval district, either at Naval stations or on land loaned on nominal lease to the Navy Department. Special schools for trained mechanics, artisans and cooks were also established. Naval training units, which offered college students '^opportunity to continue their education along the usual channels, at the same time electing Naval subjects and receiving military drill and instruction, were established in over ninety educational institutions of collegiate grade." '^ To care for the sickness which inevitably occurred among these large groups of men brought together under new and often more strenu(nis habits of living than the men had been used to, the liureau of ^ledicine and Surgery increased the hospital capacities of the Navy from three thousand to sevcn- te(>n thousand beds in the United States alone. Of the fifteen hundred members of the Navy Nurse Corps who saw active service during th(> European War, approximately eleven hun- dred of tlunii served in Naval hospitals in the Ignited States. Three hundred nurses, the nursing staffs of the first five base hospitals organiz(Hl and ecpiipped by the AmcTican Red Cross for the Navy I)t>pnrtment, were assigned to service in foreign waters and a brief account of their experiences will be given in a subse(iuent section. Previous to April. 1017, the Bureau of ^Medicine and Sur- gery, Navy Department, had established and maintained Xaval hospitals at the four pc^rmanent Naval training cam]>s. at Xaval bases and stations along the Atlanti(^ and Pacific S(>ab();n'(ls and iimong insular and foreign possessions of the Dnited States. Following the dechiration of war, the Navy Department greatly ' Aniuuil lleport of tlif Secretary of the Navy: Fiscal Year. I'.US, p. SO. 700 HISTORY OF AMERICAN RED CROSS NURSING enlarged the capacity of these permanent Navy hospitals and erected additional ones in the various newly established Naval training camps and stations. In the Annual Report of the Secretary of the Navy, for the fiscal year, 1917-1918, Jose- phus Daniels wrote : As an illustration of the hospital expansion in the naval service may be cited the case of the Naval Hospital, Norfolk, Va., wliich during one quarter of the year preceding the war, had an average of two hundred patients and during the last quarter of 1917 had 1,100 patients. In May, 1918, this hos- pital was caring for thirteen hundred cases, of whom five hundred were in a fully equipped camp of more than twenty buildings, complete in all matters of heating, lighting, water supply and sewerage.^ Elizabeth H. Dwycr was one of the nurses assigned to the Norfolk Navy Hospital. She wrote: Norfolk Naval Hospital, curiously enough, is situated in the town of Portsmouth on the Elizabeth River, which sepa- rates the two cities and the hospital is styled Norfolk in order to save confusing it with the Portsmouth, N. H., Naval Hospital. It was the first U. S. Naval hospital to be built and it was completed in 1828. Previous to the period of the European War, the hospital could take care of two hundred patients but during that time its capacity was increased to accommodate approximately three thousand patients. The Naval Hospital was beautifully situated among old trees. In the rear was a wide court and on either side of it were large sleeping porches. A circle of bungalows stood be- yond the court and were used as convalescent wards. The population in and about the Norfolk Naval Base in- creased during the war to one hundred thousand people. Little building was done, so the housing problem was an acute one. The Elks Club leased their clubhouse to the Government and the majority of the inirses w'crc (piartc^rcd there. The club was located at a twenty minutes' walk frtmi the Naval Hospital. One of the most interesting events in the routine of a Navy nurse at Norfolk was the arrival of the hospital ships. Miss Dwycr wrote : * Annual Report of the Secretary of tlie Navy, p. 87, SERVICE WITH THE NAVY 701 Often before we had been notified of lier arrival, we would see the good ship Mercy lying in the harbor, the Red Cross on her side symbolic of her mission. The Mercy was the hospital ship we knew best. She usually brought us about seventy-five cases of mumps, the disease which had perhaps always the largest group of sufferers; numerous measles cases and smaller groups of medical and surgical patients. Whenever the Mercij visited our shores, some few nurses always took advantage of the chance to visit her and see her in operation. A hospital ship is truly a work of art. Arrangement is made for good care and every possible space is used to such good advantage. One would almost think they were in a shore hospital, save that the beds are in the style of berths rather than beds. The operating-room could not be better equipped or look more real in a shore hospital ; there is plenty of room, tlie sterilizers are large and everything immacu- lately white. Afternoon tea was usually served during our visit. Early in May, 1917, Dr. Harriss ofTered the Kavy the use of his yacht Siirf. It was accepted by the Navy, was re- oqiiippcd as an American Red Cross ambulance ship and was used to transfer sick sailors from battleships in Atlantic -waters to Navy hospitals. Three American Red Cross nurses were assigned to duty on the Surf in July, 1917; others were sup- plied to fill vacancies which occurred from time to time. Nurses remained on duty on the ambulance ship until the use of the Surf was discontinued late in 1917. Navy nurses were assigned late in 1918 to several of the large transports to assist in the care of sick and wounded American soldiers being returned to this country. Another permanent Naval hospital to undergo tremendous expansion was the Naval Station Hospital at Gray's Ferry Road, Philadelphia. One of the first Red (^-oss units to be mobilized into active service was the Philadelphia General Unit and the nurses were assigned to the Gray's Perry Naval Hos- pital. Mary C. j\IcNelis, one of these nurses, wrote: Tmmediatelv after our country declared war we \V(>re sent to the Naval Hospital, (iray's Ferry Hoad, I'hiladelphia. At this hospital we had trying days and the memory of them will last as long as life. The work in itself was hard, and the ditficulties seemed harder because the work was so strange. . . . 702 HISTORY OF AMERICAN RED CROSS NURSING At the outbreak of the war this hospital was the only Naval base in Philadelphia and we saw this base of less than one hundred patients grow, in a few days, to one with more than six hundred patients. Many of these men were, like ourselves, new in the service. Add to this, the naval discipline which insisted upon sick call at 9 A.M., all medications, nourish- ments and treatments on time and everything in readiness for inspection at 10 A.M. This was usually made by the execu- tive officer accompanied by the chief nurse. Captain's in- spection with all its details occurred every Saturday morning. Miss McNelis wrote of the instructive phases which made nursing service in the American Navy different from Army or civilian nursing service: We were employed not so much as nurses but as instruc- tors and supervisors of the hospital corpsmen. These men were to serve aboard ship. They were to be the nurses in time of distress, and we had to work with this thought always in mind. Often when haste was imperative it would have expedited matters to have done the work ourselves; for exam- ple, to give a hypodermic. But no, we had to supervise the corpsman while he gave it ; otherwise present expediency, we knew, might interfere with a terrible future contingency. This reminds me that as yet no pen has been so facile as to describe in true worth the hospital corpsman. They were not at all children as one is sometimes led to believe. They were citizens, young men who immediately leaped to the defense of country and to them the Draft was all too slow. They knew no fear. The sea, perilous by nature and made more perilous by the machinations of man, did not trouble them. They came from e^'ery walk of life. At one time I had two lawyers, a seminarian and a registered pharmacist working with me. All longed to be off to war. To such as these we had to explain that working in the hospitals "at home" was vital participation in the war. To their credit, be it said they accepted our explanations cheerfully, worked industriously but longed patiently for other things. During the summer of 1017, an epidemic of contagious dis- eases broke out in the training camps and stations of the Navy. Miss McNelis wrote: in the summer of 191T, we liad epidemics of meningitis and scarlet fe\(T which kept us very busy. The scarlet fever (Ahovp) The Be- lief, of oOO \m\ ca- pacity, witli a fully equipped moliilc lios- pital of -ilKt licdsaiid ambulance, ready for immediate detaciied duty. (Ceuier^ A ward of tlie A'- li'j. (r.eldw) Nursing Stall'. rhoto.i. hii Siiri/ I)i piirlmcnt Tiie V. S. S. ]!eU(f SERVICE WITH THE NAVY 703 cases were transferred to the ^[unicipal Hospital for Con- tagious Diseases at I'liiladclphia, and details of nurses and corpsmen were sent to take care of them. Now, if you wish my idea of hard work, picture a nurse surrounded by men in quarantine for about six weeks. The country is at war, the ])ationts are sailors, eager for the allurement of war. ]t was almost more than she could do to maintain military disci- pline and impress upon these men that "They also serve who only stand and wait." A respite from many cases was obtained in the summer of 1917 by the establishment of naval bases on the reservation at League Island and at the ]\Iedieo-Chirurgical Hospital. An early opportunity for assistance to the ^Navy presented itself to the American Red Cross in connection with the hos- pital at Philadelphia. The ^linutes of a jMeeting of the War Council held on July 24, 1IJ17, recorded the following action: The chairman stated that in Philadelphia the Medico- Chirurgical Hospital owned by the city had been condemned in order tliat a boulevard might be cut through ; that the hosj)ital contained about two hundred and fifty beds and that its use had been offered to the Ped Cross for an indefinite term without rental, by the Mayor; that its usefulness was not seriously interfered v,ith by cutting through the boulevard, as it only nec(>ssitated tearing down some of the outl)uildings that house the laundry and refrigerating plant which must therefore l;e mo\e(l to a new location. He further stat(Ml that it was ])ro[)osed to use the hospital for the Xavy at the ])restMit time and reconnnonded appro])ria- tion for making the necessary changes in tlu> hos[)ital aiul for its maintenance which had formerly cost the city atjout $15, ()()() a month. Whereupon it was on motion voted that from the K'ed Cross War Fund the sum of $lt3.()()0 be and it is hereby appropriated for alterations and reconstruction of the Mcdico-Chirurgical Hospital. l*liiladel{)hia. Pa., known as IJed Cross Ceneral Hospital No. 1. Funds for the niaintcuiance of this hospital were also voted at this and suhsciiuent meetings of the War Council. National ll('ad([uar1cfs continued the maintenance of this institution for the Xavy until dune 1, 11)18; it was then surrendered to the city of Ph!hulelj)liia. because tlie Xa\y Department had by 704 HISTORY OF AMERICAN RED CROSS NURSING this time so increased its hospital accommodations at Cape May and at Philadelphia that assistance from the Red Cross was no longer needed. Nursing service in permanent Naval hospitals in the United States during the period of the European War was full of interest. The nurses had comfortable quarters and interesting work. Elizabeth Hoag, a nurse member of the Springfield (Massachusetts) Navy Hospital Unit, wrote: Early in May, 1917, sixteen of us nurses received orders to report to the U. S. Naval Hospital at Newport, Rhode Island. We found a warm welcome awaiting us. The hospital was then overcrowded with very sick boys and there were not enough nurses to care for them. I was assigned to Ward D Medical for duty ; I found seventy-six patients, most of whom were very ill with measles. A number of these patients had already developed pneumonia, while others had developed ear complications. One nurse had the supervision of this ward and the nursing care of these patients. She had as her assistants six hospital corpsmen. These hospital corpsmen had been carefully trained in the care of the sick and it was really wonderful to see how well most of them performed their duties and bow kind they were to their "sick buddies," as they called them. I remember so well one young boy, about seventeen, who was very ill with pneumonia. He said to me, "Nurse, won't you put some lard and turpentine on my cliest? If I was home, that is what my mother would do and I know it would help my pain." I asked permission of the doctor to grant his request. Two days later be left us, forever. Another case tbat conies to my mind was a boy of eighteen, whose parents were missionaries. This boy ran away from home and joined the Navy under an assumed name. He gave as his nearest relative tbe name of an aunt, whom he said he lived with and wbo later proved to l)e bis own mother. When the telegram arrived saying her son was seriously ill, tbis mother hurried to his bedside, but did not arrive until after be bad passed away. It was then we learned the sad story of this heart-ljrokcn mother and how she had searched months for her only child without avail; almost the first thing she asked was, "Did be leave me any message?" Miss Hoag was later assigned to Ward C, the ''pus surgical" division. She wrote : SERVICE WITH THE NAVY 705 Here we had fifty-six bed patients, suffering from em- pyema, gangrenous appendices, infected arms and legs and crushed hands and feet. Some of these patients had been in the hospital for months and had grown thin and pale, but still seemed happy and cheerful. . . . During the spinal meningitis epidemic, we had one building with thirty-six beds; it was divided into two sec- tions by a glass partition. In one half we had our bed patients and in the remaining half we had what were called carrier patients. These carrier patients had never had spinal meningitis, but they were carrying the germ in their nose and throat and transmitting it to other people who sometimes had the disease in its severest form. When the epidemic broke out and cultures were taken of every man's throat at the training station, these men were sent to the hospital for isolation and treatment. In some cases the germ could be killed in six weeks, while in others it took three months. Dr. K,, who specialized in this work, had the care of these pa- tients and was untiring in his efforts. He was just as cheer- ful when called at three A.M. to do a spinal puncture, as he was when called at three o'clock in the afternoon. His labor was well rewarded when in twenty-four hours after starting treatment, he would watch them come out of their delirium and in three weeks' time, leave the hospital to finish their convalescent period at home. Upon their return at the end of four weeks, they were well and strong again. Newport was a quaint and historic town and the view from the ocean cliffs one of great beauty. The nurses derived much pleasure from walking through the narrow crooked streets and along the cliffs overlooking the rolling surf. Early in July, 15)17, a group of nurses from the j^aval Hos- pital at Newport were sent to the City Hospital at Providence to take a two weeks' course in the technique of caring for con- tagious cases. Minnette Butler, a reserve nurse at Newport, wrote : This course was a great help during the months of epi- demics which followed. In July a hundred cases of diph- theria developed witb.in one week among the civilian popula- tion at Newport. Fearing that the contagion might spread to the training station, our commanding otlicer offered to assist the city health department. These officials furnished cars and a past assistant surgeon, a nurse and a corpsman were detailed to visit every hotel, bakery, ice cream parlor^ 706 HISTORY OF AMERICAN RED CROSS NURSING restaurant and dairy in the city and take cultures of all peo- ple handling milk. The authorities had reason to suspect that the trouble was coming from the milk supply. After the city had been "cultured" in this way, they made the rounds of farms outside the city and visited ninety fami- lies. In a Portuguese cottage, a seventeen-year-old boy, with a heavy membrane in his throat, was found ill in bed with diphtheria. His mother was caring for him ; she also milked the cows and was sending a supply of contaminated milk to many city houses. A constable was placed on the grounds to see that all milk was buried. No new cases developed but had it not been for the prompt and efficient work of the Naval culture squad, an epidemic might have developed which would have proven to be a real crisis. Fate, however, could not let Newport rest, it seemed, be- cause a terrific explosion occurred soon afterwards at the Torpedo Station. It caused many deaths and maimed, burned and blinded many others. . . . The permanent Naval Hospital at Chelsea, Massachusetts, was located in broad-winged buildings which crowned the crest of a hill rising from the water-front. Nora M. McQuade was one of the nurses assigned to duty early in the fall of 1917 there. She wrote : My first detail was to a busy surgical ward with a staff of one regular Navy nurse and six hospital corpsmen. It was a shock to me to see those young men doing the things I had been brought up to believe were the sole duty of a trained nurse. I felt sure the men were being neglected ; still, they looked happy and the ward was beautifully clean. I decided to defer judgment for a little while and it took but a short time for the nurse recruits to absorb the Navy spirit and to realize how important and far-reaching our work really was. Upon the degree of skill with which we taught the hospital corpsmen to care for the patients in our wards depended the degree of skill with which they would in turn nurse the sick men on the ships at sea. It was impossible to have women nurses except on the largest transports. The expansion of the Naval Hospital at Chelsea was similar to that at Philadelphia and Newport. Miss McQuade wrote: Day by day wo watched now pavilions going up 0]i tlio reservation. Thoy wore l)adly neodod. Then came the strike SERVICE WITH THE NAVY 707 and building was held up for weeks. Finally it was settled and the men went back to work. None were gladder than the nurses. The first weeks of our ])articipation in the war found the hospital with an average of 180 patients. Within a year the number had reached !)'^0, with 327 of them assigned hospitals outside the reservation. Extra beds were put in and then cots on which tiie men were cared for until space was available in the outside hospitals and they could be trans- ferred there. All during the winter of 1917, patients were transferred in this way as soon as the acute stage of their illness had passed. This system made the nursing service difficult all the time; we always had acutely sick men. During that first winter "Type 4" pneumonia with the complicating organism, hemolytic streptococcus, which proved so fatal, was prevalent. Many of these })atients who survived this infection, later develo])ed empyema and were in the hos- pital for months at a time. These men required infinite care and patience. Their appetites needed coaxing, their minds needed diverting, for they fretted against the length of inactivity, and their ))odies, especially their poor backs, needed and received (onstant attention. If we could have had the same corpsmen with us all of the time it would have been easier for us, but we were conducting a training school. As soon as we trained corpsmen to be very useful, they were sent to sea with the next draft. The Xaval Hospital at Chelsea received patients from the transports, from the smaller Xaval craft operating about the big Boston Harbor Yard and from the various training stations near Boston such as the Radio School at Cambridge and the Aviation School at the ^lassachusetts School of Technology. "One of my first troubh^s was with Xavy regulations and par- lance," wrote Miss ^IcC^nade. ''The Xavv 'paper work' was a new and ditHcult task and the lang-uage bewildered us. How were we to know that 's(iuil gee the deck' meant to polish the ward floor f Outdoor wards wvyo opened at Chelsea on June 1, 1018, and the transfer system was largely discontinued. ^liss ]\IcQuade wrote : The summer months were busy ones. The Xavv men who had Ijecomc ill en the other side were being returned to us. the training sclioels were growing larger and sending us inore ]iatit'nts. and the military situation in Iuir()[)e was daily 708 HISTORY OF AMERICAN RED CROSS NURSING becoming more critical. It was an anxious as well as a busy time for all of us. Ona day toward the last of August we were told an epi- demic had broken out among the men of the receiving ship. It was influenza, they said. The word did not mean much to us that lovely August afternoon as those of us off duty made beds in an empty ward. That night, during which sixty-seven sick men came in, was the beginning of the influ- enza epidemic that has become history. We worked as we never worked before. The influx of patients, the calls for extra nurses, the illnesses of the staff, the deaths, all were repeated later in other hospitals but to those of us who ex- perienced the initial outbreak when the disease and its treat- ment were unfamiliar to all, this tr^'ing period has left a memory that will not fade for many years. N^avy nurses were assigned in November, 1918, to the Marine Station at Parris Island, South Carolina, to nurse influenza patients. Myrtle Gilmore Chandler, head nurse of the Naval Station Unit No. 11, wrote: Parris Island is the most interesting one of a large group of islands in Port Royal Sound, South Carolina. It is a long narrow strip of sea-sand which is held in the wild rice and reeds. Bleak and desolate it looked Avhen we ten nurses ar- rived at the dilapidated dock; a few scattered buildings, thousands of tents and rough clay roads, with a covering of oyster shells, greeted the eye. The Xaval Hospital, which was a rambling, white, two- storied building on the water's edge, had had only corpsmen in attendance upon the patients and medical officers to direct their work. Being the first nurses ordered to this Post, we naturally felt it was quite an adventure and tackled the work with enthusiasm. Our first patients were suffering from influenza. x\fter some weeks the epidemic abated and we then had many surgi- cal cases. . . . During the spring a large addition to the hospital was built ; across the street the nurses' new quarters was com- pleted and it was a joyous day when we moved in. Instead of sharing a dormitory, each nurse had a delightful room to herself. ... Xumerous large barracks were opened, many officers' quarters and recreation huts were built, among them a very fine Red (h'oss building nicely arranged for reading, games, music and dancing. It seemed as if a veritable small city had sprung up almost over night. SERVICE WITH THE NAVY 709 Paving of the roadways was one of the most appreciated improvements. "The Island was so near 'the sea-level," wrote IMiss McQuade, "that previous to the road-making, small creeks had oozed their way here and there with every risin<^- tide and they left us no choice but to wade through them. Then when the tide receded, the mud was alive with a huge army of small crabs." Of the permanent ^larine Barracks, Miss McQuadc wrote: Tlie Marine I'ost had in 1!)19 a largo main station, a quarantine camp, a training camp, an aviation field and school and a sea-going depot, with thousands of Marines in training there. There also was maintained a large Xaval disciplinary barracks. Parris Island was a place of great beauty in the spring and summer. Miss McQuade wrote: The winter storms subsided and spring announced itself by covering the once barren and bleak island with a carpet of emerald swamp grass; here and there in profusion grew lovely swamp violets and lilies and later the wild honey-suckle trailed over the fences in masses of perfume. We explored the farther end of the island and found an ideal spot where palms and palmettos grew under the huge spreading oaks and the light gray Spanish moss hung and swayed in graceful festoons from the wide branches. We often had picnics here on summer days. Beaufort, the palatial old Southern town famous before the Civil War for its hospitable people and beautiful homes, still retains its old time hos{)itality. As it was only forty minutes by motor boat from the island, we spent many de- lightful hours there. We had many diversions of our own, tea at General Pendleton's every Friday; dancing and mo- tion picture shows ; tennis, for the ilariiies had hroiiglit clay in barges and built a court behind the nurses' quarters; swimming and horseback rides along the hard, white sand beaches. At one side of the island the Government had set aside a tract of land for the negroes wlio had previ(Misly biM'ii scattered about. Here tbey lived in their cabins amidst tlio cotton fields. As we cantered liy on horseback during the Southern twilight, we could hear the tlinimming on tlic ban- joes and the negro melodies floating out on the still air. At the Naval Training (\imp, Great T.akes, Illinois, was located one of the largest Xavy base hospitals in tlic Cnited 710 HISTORY OF AMERICAN RED CROSS NURSING States. Beatrice Bowman, supervising nurse of Unit D of the Red Cross Mercy Ship Expedition of 1914, was chief nurse of this Navy base. She wrote : This hospital went into commission in May, 1917, but drew its quota of patients from a comparatively small number of men at the training stations. Since last summer, however, it would seem that an electric button had been touched and as a result many units sprang into existence, over farms and the great plain. Prior to August 26, 1917, one large brick build- ing and a group of tents in which the sick were cared for, filled the park in front of the hospital; in January, a village of more than fifty building units was in full working order. Twenty-nine of these units are each a complete hospital, with quiet rooms, diet kitchens, offices and lavatories. In addition to the hospitals proper, modern laundries, nurses' quarters, hospital corps barracks, civilian employees' barracks, garages for ambulances, trucks and jitneys, a complete water and sew- age system and many miles of cement roads have been built. Bernice D. Mansfield was assigned in July, 1917, to duty at Great Lakes. She wrote : Eleven of us arrived at Great Lakes about midnight on July 7, and found that they had been looking for us for some few days, but had only that day succeeded in finding a place to quarter additional nurses. ... At that time there was the one hospital building, just as there had been before April 6, 1917. As the training station was rapidly increasing, the hospital was keeping pace and new buildings going up all about but as yet were in a state of mcompletion. To accom- modate the number of patients, all available space in work shops had been utilized and tents were in use all about. It had been a cold rainy spring and nnid was very much in evidence around the tents, as roads up to that time had not been completed. In one building which was later used for an ice plant, the patients had cots but no chairs or lockers or bedside tables. The first thing we saw on entering was the men's clothes lying among the sputum boxes and pus basins, just as they had been drojiped when taken off by the wearers. "Where shall I begin':'" was the nurse's first thought. The patients called to us: "Oli. nurse. 1 am so glad you have come, we haven't had any nurse before. Can I have this? Will you get me that?'' Tbe first thing we did was to have the clothes folded and tied togetlier. labeled with the patient's name and SERVICE WITH THE NAVY 711 tied to the head of liis bed ; when the clothes were all off the floor, the room looked as large again and we felt as though we could reach the patients to do something for them. An epidemic of contagious diseases broke out at Great Lakes during the summer of 1917. Miss Mansfield wrote: Into our already overcrowded hospital, we took in two hundred additional patients in twenty-four hours. ... A new colony of tents went up "on the front lawn" and the main hospital was emptied and made ready for tlie new comers. As long as they were in bed, we had no trouble but as soon as they were convalescent, eternal vigilance was required to see that they did not get out and into other camps with which the main building was surrounded. ]\[any of the hospital corpsmen were young and inexperienced and certainly the patients were young and inexperienced too ! In the meantime, new hospital buildings were being fin- ished and equipped. As soon as one ward was ready, patients were moved from tents into it. Evidently the infectious diseases of childhood had never gone through that body of recruits before they entered the training station, for there wore continually epidemics of measles, cbicken-jxjx and mumps. The tent colonies grew to accommodate the increasing number of patients. One group of tents was put u}) just opposite the cemetery. At 'first tliere were no liglits about the grounds here and the nurses on niglit duty would stumble over the ropes from tent to tent, keeping one eye on the cemetery. Even the bravest ones found it a bit lonely in a dark isolated camp with a spot light the oidy source of illumination. The sewerage iii the camps was taken care of as rapidly as possible, ])ut unless a nurse has gone through the ex])erience of caring for infectious diseases in a tem])orary camp where there is no sewerage and flies are abundant, then siie has something to look forward to! In the mess tents, there was an electric ]ilate wliicli was used to lieat water and nourisli- ments, but the task of washing dishes for forty or fiftv men who were ill with an infectious disease and oiily an electric plate to heat the water, seemed at first to be beyond accomplishment. Groat Lakes Training Station increased from a peace ca- pacity of two thousand incn to a war capacity of fifty thousand men. The Xaval Hospital was enlarged from one hundred to twelve hundred bed c-apacity. 712 HISTORY OF AMERICAN RED CROSS NURSING The Bureau of Medicine and Surgery maintained four Naval Hospital Corps Schools. The one located at Great Lakes was the largest of these ; it had a normal capacity of three hun- dred, with an emergency capacity of three times that size. The greatest number of students registered at one time was 2200. The three other schools were established at Newport, R. L, San Francisco, Calif., and the Naval Operating Base, Norfolk, Va. The Bureau of Medicine and Surgery received offers of as- sistance in the training of hospital corpsmen from various uni- versities and three of these were accepted. A four months' course for one hundred men at the Medical and Dental Schools, University of Minnesota ; a six-weeks course for three hundred men at the College of Pharmacy, University of New York; and a three-months course for one hundred and fifty men at the Philadelphia College of Pharmacy were given. Willard Connely, a nurse of the United States Naval Reserve Force, who was on duty at the University of Minnesota, Minneapolis, Minn., wrote: It is a new experiment for sailor students to be admitted to a medical college, as it is a new and essentially valuable war ^vo^k for nurses to assist in training these Navy men. . . . For the first month of the four months' course, the teach- ing is confined to the medical school, including the institute of pathology, the college of dentistry and the institute of anatomy. There are lectures and recitations, then supple- mentary experience in the laboratories and dispensaries. It is held that this preliminary knowledge is indispensable if the corj^smen are to grasp comprehensively the fundamentals of practical nursing as given at the University Hospital dur- ing the three final months. During this time, the men have a course of lectures and experiment action in pharmaceutical chemistry, minor surgery and first aid, anatomy (with weekly practice in dissecting), physiology', and hygiene, bacteriology, and tlic principles of dentistry in normal conditions. When tbe Jiursiiig instruction begins the advanced cor relative training in the foregoing subjects is given chiefly iw the mornings, wliilc one or more divisions of the sailors (five divisions of twenty minutes each) are engaged in hospital work. Througliout the afternoons this teacliing is directed by Louise M. I'owcll, superintendent of nurses, by Marion Vaimier, assistant supervisor, and Gertrude Thomas, die- SERVICE WITH THE NAVY 713 titian. They are aided by a staff of head nurses and under- graduate nurses, and the latter also help at the medical school clinics where the sailors obtain practice in diagnosing and treating cases in dermatology and eye, ear, nose and throat. The course in bandaging, conducted by Miss Powell, is in six lessons, each lesson covering one and one-half hours. . . . In a room at the University Hospital, Miss Vannier gives ten demonstrations in practical nursing. After observing each Monday the methods employed, the corpsmon put in the rest of the week in the class rooms or wards where, in sections of five or ten, they receive individual supervision, at the hands of the assisting head nurses. The demonstrations are given before fifty men at a time, in periods of one and one-half hours duration, and after some ground has been covered, demonstration quizzes too are held, to check up the work which has been carried on in the wards. The ten lessons in practical nursing included instruction in the theory and technique of the simpler methods of nursing proced- ure. The lessons were thorough and together with the practice gained in the wards of the University Hospital, gave future corpsmen an excellent working knowledge of the treatment to be given for all the common ailments and for emergencies aris- ing on shiplx)ard. Grace Kline, a nurse on duty at the N^aval Training Camp at Charleston, South (\irolina, wrote that one of her pupils had said, on completion of a detail given him to clean up a ward: "Gee, I'm glad my mother can't see me now, or she'd fire the hired girl when I get home!" On the Pacific Coast a larg(! JS^avai station was located on Puget Sound and another at Vallejo, jMare Island, ('alifornia. Annie ^filler was one of the nurses on duty at Mare Island Naval Hospital. She wrote : The sun was shining as it shines in few places outside of California, when from the deck of tlie Ferryboat, on a June morning, 1917, we caught our first glimpse of the shores of Mare Island. At A'allejo wo left the ferry. A Murine guard l()(k(>(l over our orders and allowed us to hoard the tug for the islanil. Arriving there, we were again accosted hy a guard and a>ked to show our passes. Another guard was instructed to take us to the ollice of the commandant. 1 rcnieniher thinking how nice of them to go with us and show the way instead of simply 714 HISTORY OF AMERICAN RED CROSS NURSING pointing it out. After having lived on the island awhile and grown more accustomed to the military routine, it dawned upon me that the guards had no thought of being "nice" to strangers, but we were simply under guard until passes could be secured for us. Arriving at the nurses' quarters we were shown to our room. Yes, I mean it in the singular. We had four other roommates besides. The room had once been used as a gymnasium for the nurses; but after war was declared the expansion at this station had been very rapid and all avail- able space had to be pressed into service to accommodate the overflow. So we dubbed our room "the tenement" and while nurses are supposed to be exacting, I have always been rather proud of the fact that we proved we could live together in those close quarters, not only amicably, but very pleasantly. During the European War, nurses rendered many types of service which differed greatly from the medical and surgical nursing they had expected to do. Miss Miller's assignment was no exception to this rule ; she wrote : I was told to take the place of housekeeper at the nurses' quarters. The rest of the nurses in the detachment with me seemed to find this quite amusing and to this day I am still addressed as "Housekeeper" by some of them. My experience with servants had been confined only to the colored ones of the South, so that I approached the Chinese here with considerable trepidity. I found them very willing to work, but also found they had to be handled with care. Old Louie, the cook, had a disconcerting way of saying, "No savvy, no savvy," when it was to his advantage not to under- stand the point under discussion. One Sunday we had planned, as a part of the menu, plain ice cream to be served in cantaloupes. 1 had tried to instruct Louie and while he pretended to understand, I had an uneasy feeling that all was not well, so came back later to investigate. Xot finding the cantaloupes in the refrigerator, 1 called to Louie to know where they were. "In the lice cream,'' he calmly replied. It was true. He had in some way contrived to reduce those cantaloupes to a pulp and combine them with the cream in such a way that it was smooth as velvet and delicious. After that, cantaloupe ice cream was a favorite with us. In Louie's own vernacular, it was "more better" than ordinary ice cream. SERVICE WITH THE NAVY 715 Though housekeeping on Marc Island must often have seemed only a monotonous routine of uninteresting details com- pared to fr(>nt line nursing in France, life on JMare Island was not without the thrill of danger. Miss Miller wrote: The day of the explosion of the black powder magazine stands out vividly in my memory. It occurred at eight in the morning, just as the day nurses had gone on duty and the night nurses were being relieved. The chief nurse and 1 had gone into the kitchen to in- struct as to the meni) for the day. I think I was more puz- zled tlian friglitened, even as 1 felt the floor rock under my feet and saw the swayiiig chandelier and falling plaster; for at that time, even if 1 knew there was a magazine on the island, 1 did not grasp the possibilities of what might occur. Louie caught hold of the table and began crying and, 1 presume, praying, in his own language. The chief nurse turned to me with an expression I have never forgotten and simply said, "The magazine !" We ran to the door, but finding it completely jammed, rushed to another and out into the yard, to see only a cloud of dust and smoke in the direction of the magazine that told the story. Everyone, including afternoon and night nurses, hurried to the hospital to render what aid they could in caring for the injured. Only I had to remain behind and try to keep the frightened Chinamen at their work. All that long morning I helped Huey, the house man, whose work that day was more than one person could have accomplished. I swept fallen plaster and broken glass, while he shoveled it up and carried it away. And together we picked up and re- placed books, pictures and other fallen articles and succeeded in cleaning the house, that the tired nurses wdio had done the actual work with the injured, could rest when they came to lunch. California is a long way from France, but even there one could have the satisfaction of knowing that their small bit was helping in the struggle. Often when we went dowji to the docks to watch a detachment of marines leaving, nurses would recognize among these sailor-soldiers who were afterwards to make liistory on the fields of France, boys whom they iiad helped back to health. Th(^ rigid entrance recpiircnuuits of the Xavv Xurso Corps, the limited size of th(> Xavy and tlie responsible nature of the nursing service demanded of members of the Nurse Corps, which consisted so largely in the training oi hospital cor{)S- 716 HISTORY OF AMERICAN RED CROSS NURSING men, tended to promote an excellent morale and esprit de corps among the nurses of the Navy. However, in many isolated naval stations life for the nurses was undoubtedly monotonous and lonely just as it was in the case of Army nurses at canton- ment and camp hospitals remote from recreational facilities. A ruling that members of the Navy and Army Nurse Corps should not associate with enlisted men a regulation issued in the interest of discipline was the cause of many complaints. The following letter was written by an American Red Cross nurse in Naval service on the Pacific Coast : Everyone liere likes the work, but we have no recreation except the movies or a trip to (the nearby city). Of course that costs so much that we can't go very often on a $60. a month salary. When you work only eight hours, you have got to do some- thing the rest of the time. I read and knit and sleep but that gets rather monotonous. If we could only play tennis or swim or do something ! We had a court but they built new wards on it. They are going to build us another when they get around to it. We are so entirely out of everything here. Of course, we are never allowed to go to anything where there are enlisted men, and the officers' families won't have us at their parties. We don't mind this, but we certainly would like to talk to some one who wasn't a nurse. Our chief nurse is very good to us and gets up little parties where we dance and sing with the same girls we work with all day. I have thought if I had happened to be a stenographer, I could have served my coun- try at Washington and still not have been a social outcast. There is such a grind of petty detail on the ward that we lose sight of the fact we're at war. We were invited to a big Christmas dance where even the commandant took his family, but we could not go because nurses must not asso- ciate with enlisted men. I am twenty-eight years old; I wonder how the younger girls just out of training school stand it I We haven't even thought of doing something ro- mantic to keep us going. There's nothing lieroie in caring for measles and nuim]^s. Now I'm not iroina' to resign. I'll stay here or any other place wlicre 1 am needed just u.s long as I am wanted, but never in my life have I been so blue and lonesome. Everyone is so nice to tlie "boys in the service." Why do they never think of the girls? " American Red Cross Bureau of Archives. SERVICE WITH THE NAVY 717 Reasons for this ruling were set forth by !^^iss Kline, an American Red Cross reserve nurse in service at the Charleston Navy Yard: The status of the nurse, officially, is that of a head nurse in a civil hospital. Professionally and socially she is rated as an officer. It is ditliciilt for the nurse to understand the jus- tice of this ruling at first, wlien some of the finest timber of our young manhood is of the enlisted personnel. Her own brother, friend aiul sweetheart may be among them, and why, when she has no rank, should she be subjected to officer's regu- lations? When she considers that the mere restriction is a recognition of rank, though ever so meager, she usually real- izes that it is of too much professional value to treat lightly. In civil life an intimate friendship is not desirable with one's patients; so in military circles, reserve is a safeguard. Most of the patients are of the enlisted personnel. Cordial rela- tions are desirable and possible, and the nurse is the confi- dant and advisor. The men are responsive creatures, sensi- tive to their environment, though stoical when "balled out" and appreciative of the least interest evinced in their welfare. The opportunities for personal influence are enormous and the nursing care is often a minor part of the nurses's duty.^" A fine devotion to duty, evident even in the letter of com- plaint quoted above, prevailed at the Naval hospitals. For almost all the nurses in the Navy Corps, war service meant far more than the mere routine of daily hospital duty and the nurses gave willing, skillful and patriotic service. Consciously and unconsciously, they derived inspiration from their sur- roundings. The infectious eagerness for ocean duty which was shown by the young boys who made up the greater part of the new Navy, the sight of gray battle craft anchored in the harbor at sunset but which went out again perhaps in the turning of a tide, the play of searchlights on the water, the hum and the crackle of the wireless, the very patients who came back sick from exposure to the rigors of the open sea, gave meaning and purpose to the life of Xaval training camps or station hospitals. Josephine Trippett, Xaval Reserve nurse in service at Pelham Bay Training Station, New York, wrote in the Military Num- ber of the Journal: . . . And then tlierc are times when one is deeply moved and is brought to a realization of the meaning of this and ^"American Journal of Xursing. Military NmnlH'r, p. 071. 718 HISTORY OF AMERICAN RED CROSS NURSING all other places of its kind. Watch the sailors being shipped. They pass out of the gate, their sea-bags on their backs. Xo one speaks ; their hearts are too full. We listen to the muffled sound of many feet marching solemnly along the road. For a mile one can see the wide, dark line and hear the rhythm and jangle of the rifles. On May 4, 1917, a destroyer and patrol fleet of the American Navy, under the command of Rear-Admiral William S. Sims, arrived in a British port. Admiral Sims had been appointed as the commander of American Naval operations overseas and this destroyer and patrol fleet was the first unit of the Ameri- can Navy to go abroad. Later, five thousand officers and sev- enty thousand enlisted men saw active service in foreign waters. During the spring and summer of 1917, the losses of mer- chant ships by reason of German submarine activities became so great that, at the suggestion of President Wilson, the United States adopted the convoy system of transportation. This meant that large numbers of troops and supply ships were gathered together and sailed at regular intervals along estab- lished sea-lanes, under naval protection. Armed cruisers, smaller cruisers and later old battle ships, accompanied the convoys to protect them from raiders ; destroyers went along to protect them from submarines. Of the 7,500,000 tons of cargo carried to Europe, the Army lost only 200,000 tons and no American troop transport was sunk on its voyage to Europe. The destroyer, with its depth bombs, proved to be an effective craft in anti-submarine warfare. A submarine attack which took place in July, 1918, was described by Dr. Howard Ken- nedy Hill, of Philadelphia, Pennsylvania, a surgeon who served under the American Red Cross in France : We were told that we vrould pick up destroyers at a certain hour. Exactly on the minute, although it was foggy and rough, we saw a little xVmerican flag emerge through the fog and we later counted seventeen destroyers in all, two of them the fast 42 -knot type. The next day at three o'clock in the afternoon, when the sea was as sunny and quiet as a millpond, we suddenly saw a tremeiulous explosion some four miles to the south and immediately felt the concussion of a bomb against the side of our boat, like the pushing in and out of a tin pan. The destroyers then began a systematic dropping of d('j)th bcunbs SERVICE WITH THE NAVY 719 which are supposed to at least injure a submarine if within a radius of four hundred yards. The rumor immediately spread through our boat that the destroyers had sunk five submarines. We were all sure that we saw one black mass rise in the air. That evening the British Admiralty officially confirmed the destruction of four. American destroyers and submarine chasers had their bases at Quecnstown, Ireland. Battleship Division Six was based on Berchaven, Ireland, in readiness to meet and escort transports and supply ships. A snbmarine patrol off the west and south coasts of Ireland was also maintained from Berehaven. A second major enterprise of the American Navy was its participation in Allied Naval activities in the North Sea. Bat- tleship Division Nine of the Atlantic Fleet under the command of Admiral Bodman, constituted for nearly a year the Sixth Battle Squadron of the British Grand Fleet, which was directed by Admiral Sir David Beatty. A mine barrage was laid by the Allies from Scotland to Norway. By thus closing the North Sea, the Allies denied enemy submarines free access to the Atlantic Ocean from German bases. Secretary Daniels wrote : ]\rore tlian 50,000 iVmerican mines have been laid in stra- tegical areas in European waters. The Xavy has taken part in and actively laid 80 per cent of the great mine barrage 230 miles long, from Scotland to Norway ; a total of 5(5,439 mines have been laid, all of which were designed and manu- factured by the United States and transported and laid by the United States Xavy. Rear Admiral Strauss was in charge of the American mining activities in the North Sea. Two mine bases were established overseas and a personnel of over G700 men were engaged in mining activities. Conveniently near the Sixth Battle Squadron and the ^line Bases was the American Naval coaling base at Cardiff, Wales, from which coal was secured for the Atlantic Fleet and for the American Expeditionary Forces in France. There were otluM* Anu>rican Naval activities in foreign waters. A force made up of destroyers, gunl)oats, cruisers, yachts and Coast Guard cutters which were based on Ciibraltar p(M'f(inned twenty-five per cent of the ocean escort duty l)etween (libraltar, Franci^ and Italy, and seventy per cent of the ocean 720 HISTORY OF AMERICAN RED CROSS NURSING escort duty between Gibraltar and England. A temporary American Naval base for submarine flotillas was established at Ponta Delgada in the Azores. The American Navy maintained four thousand hospital beds in Europe for the care of its personnel engaged in the various activities briefly mentioned above and also for the care of the United States Marine Corps in France. The major portion of these beds were furnished by the assignment to foreign service of the five base hospitals which the American Red Cross had organized and equipped for the American Navy. Two of these hospitals were assigned to duty near Edinburgh, Scotland, a third at Queenstown, Ireland, and the remaining two at Brest, France. Small hospitals and dispensaries were established in Great Britain and in France by the American Red Cross and were later taken over by the Navy. Other hospitals, dispensa- ries and sick-bays were staffed by Navy surgeons and hospital corpsmen at Plymouth, England ; along the French and Irish coasts ; at Ponta Delgada, Azores ; at Gibraltar ; at Corfu and at Genoa, Italy. This brief mention is all that will be made in this history of these dispensaries and sick-bays, as no American Red Cross nurses saw active service in them. Five American Naval hospitals were maintained in Great Britain during the European War. Three of these were United States Navy base hospitals and the other two were institu- tions established by the American Red Cross and later turned over to the Naval authorities. Similarly as with the Army, the American Red Cross in Great Britain formed an emergency arm of the American Navy ; its nurses rendered service to the first American soldiers to be torpedoed by German submarines. On the evening of February 5, 1918, His Majesty's troop- ship, Tuscania, with convoy and escorting destroyers, ap- proached the entrance of the North Channel, A German sub- marine pierced the ring of destroyers, fired on the Tuscania and the torpedo struck her on the starboard side. She immedi- ately listed deeply. The 2500 American soldiers who were aboard w^ere ordered to the boats and the British destroyers and patrols of the North Channel stood by and many hundreds of her company were rescued by them. The life boats on the Tuscania s port side had been unin- jured, so other American soldiers rowed away in them as she sank. The swift out-flowing tide and the bitterly cold wind caught the boats and life-rafts and drove them toward the SERVICE WITH THE NAVY 721 rocky shores of the Isle of Islay. The bodies of 182 of the Tuscania's company were filing ashore. Many of the lifeboats, however, were brought safely to land but the survivors were in a desperate plight from exposure. Along with other Ked Cross personnel, a detachment of Ked Cross nurses from American Ked Cross Military Hospital No. 4, JMossley Hill, Liverpool, were immediately hurried to Islay to care for these patients. This detachment arrived in record time, tended the soldiers and finally accompanied them to the Army hospital at the American Army Rest Camp in W^inchester, England. Soon after the sinking of the Tuscania, United States Naval Base Hospital Xo. 2 arrived in England; on ^larch 1, 1918, it opened a Naval base hospital of six hundred beds at Strath- peffer, Scotland,^ ^ This Naval unit had been organized by the American lied Cross from personnel of the Lane Hospital, San Francisco, California. Dr. Stanley Stillman was the director, and E. Elizabeth Hogue, the chief nurse. Miss Hogue was a gTaduate of the California Training School for Nurses, Los Angeles, California. After extensive executive experience in several California institutions, she became in 1!)14 superinten- dent of the School of Nursing of Lane Hospital. Two years later she organized the nursing staff of Naval Base Hospital No. 2, and in the autumn of 1917 went with her unit into naval service in the United States. Foreign assignment followed. The location of Navy Base Hospital No. 2 was in a pictur- esque spot, for the little Scotch town of Strathpeffer lay in the environs of Inverness at the head of the long fingerlike Cro- marty Firth. Navy Base Hospital No. 2 received patients from ^line Bases Nos. 17 and 18, and from the Sixth Battle S(piadron. The second American Naval hospital to be established in Great Britain was placed in London by the American Bed Cross for the care of officers and men of the American Naval JTead(inart(>rs at London and of naval craft from the inunediate vicinity. Aldford House, th(> residence of the lloiiorabK' Mrs. Frederick Guest, was taken over by the (\)nnnissi{)n to Great Britain and was opened as a hospital June l-"), 19 IS. The house, which covered an entire city block in Park Lane, had forin(>rly been used as a hospital for British wounded and had " lu'ixiii of the A. R. C. C'onimissinii for (ircat P>iitain, I'art I, llosjii- tals:" p. 12. 722 HISTORY OF AMERICAN RED CROSS NURSING a capacity of fifty beds. A ISTavy surgeon and staff were as- signed to duty there and shortly afterward the Navy took over its entire management, raised the bed capacity to seventy-five and maintained it as a Naval Hospital. Miss Hall, one time chief nurse of the American Red Cross in Great Britain, wrote : Catherine Taylor, a Canadian woman, an American Red Cross nurse and a graduate of St. Lukes Hospital, New York City, was chief nurse of Aldford House and remained in charge there until the hospital was taken over by the Xavy and staffed with a unit sent out from America by the Navy Nurse Corps on September 10, 1918. The third American Naval hospital to be established in Great Britain was U. S. Navy Base Hospital No. 3, which was assigned to duty at Seafield Leith, near Edinburgh, on the Firth of Forth. Like Navy Base Hospital No. 2, this unit had been organized by the American Red Cross from the per- sonnel of a western hospital, the California Hospital, Los Angeles, California. Dr. Rea Smith was the director and Sue Sophia Dauser was chief nurse. Miss Dauser was graduated in 1914 from the California School for Nurses, and for two years was head nurse on the surgical department. Anne A. Williamson, superintendent of nurses of the California Hospital, had organized the nurs- ing staif of Navy Base Hospital No. 8, but ^Aliss Dauser, after instruction at the Naval Training Camp at San Diego, led the nursing unit into foreign duty. She wrote: Fnited States Navy Base Hospital Xo. 3 nio])ilized at Philadelphia during the month of Decemljer, 1!)17. Until August 1, 1918, the nurses did temporary duty in and near Philadelphia. On August 1, 1918, we embarked from New York on the British transport H. ^I. S. Mdndingo for Kali- fax, where we joined a J-Jritish convoy of twenty-one ships. Seven of these ships were transports carrying troops; the rest carried freight. We arived at Liverpool, August 15, 1918, and by train arrived at Ldinlnirirh, Scotland, early the next morning. The hospital we took over had been under the British Ad- miralty for four years. In anticipation of the change, the British Admiralty transferred all the enlisted men patients to (rlasgow, but there remained about fifty officer-patients. SERVICE WITH THE NAVY 723 The building in pro-war days was a poorliouse. It was well built and so arranged as to adapt itself most conven- iently for a hospital, and afforded ani})le room for seven hun- dred and fifty ])atients. The British hosi)ital equipment was established in the building and all of our own equipment had arrived there before us. We installed our own and acce])tets wwr only a small \)vv cent of the nnndx^r of ])ati('nts we cnrtMl I'ov. Something like seventy-five per cent of the capacitv of th" hospital was held for the British Army; e\('n this did iidt scciu sutlicieiit and th(> wounded would over- flow tliis jxTcciitagc most of the time. These patients caTue to us in convoy trains. Tliey had been taken oil' the battlefields about three days h,'fore, ami had nothing more than l-"irst Aid at the field stations. Just as soon as we reported })a- 724 HISTORY OF AMERICAN RED CROSS NURSING tients on the convalescent list^ they were transferred to some convalescent home, and the space given to new patients arriv- ing from the Channel ports. During the entire stay of United States N^avy Base Hospi- tal No. 5 at Edinburgh, Scotland, we were extremely busy. Every nurse of the entire nursing staff seemed to completely lose herself to her ward and ward-work. The spirit of the wounded was a great inspiration. I do not remember of ever having heard a complaint, no matter how trivial, from a patient. The N^aval coaling base for the American !Navy in foreign waters and for the American Expeditionary Forces was estab- lished at Cardifi", Wales, as has been stated in this chapter. Seventeen American colliers carried Welsh coal taken from the mines near Cardiff to the Atlantic Fleet in the North Sea ; eighty-two other American government vessels which were known in the Xavy as the "Suicide Patrol" because of their constant trips through the mine-infested Channel, carried coal from Cardiff to Brest, Bordeaux, Xantes, and St. Xazaire for the use of the American Expeditionary Forces in France: Over two thousand bluejackets were based on Cardiff. To care for cases of influenza and pneumonia among these sailors, the American Red Cross established on October 7, 1918, a hospital and dispensary in Park Place, Cardiff. Three houses adjoin- ing a large disused aeroplane factory which served as a Red Cross Club and dormitory for American sailors, were fitted up. Six American Red Cross nurses were detailed to service there and with a Xavy surgeon and several hospital corpsmen, cared for a daily average of forty bed patients and one hundred dis- pensary cases. The following summary of their activities has been given : So active was the port of Cardiff that while the Eed Cro^.s was on duty there, more than 100,000 American bluejackets and Xaval officers entered, passed througli, or were attached to the base. Of these, the American l^ed Cross gave service of some tyjje, to more than eighty per cent. It cared for 374 patients 2^)0 of them "flu" cases in its own hospital, only nine of whom died, and for 2(u in the Xavy's sick-l)ay at base headquarters. At the Red Cross dispensary 3G00 sailors received trcatnicnt.'- ""The Passinfr Lt><:ioiis,'' G. U. Fife, p. 2!)9. The :Macmillan Co. SERVICE WITH THE NAVY 725 The American Ked (/i-oss Hospital at Cardiff, Wales, was taken over by the American Navy a few weeks after its estab- lishment. Its capacity was raised to two hundred beds and it was maintained as a naval hospital as long as Cardiff was used as a coaling- base. The last American Naval hospital to be established in Great Britain was United States Navy Base Hospital No. 4, which had been organized by the American Ked Cross from personnel of the Kliode Island Hospital, Providence, K. I. Dr. George A. Mattingly was director, and (irace Mclntyre was chief nurse of this unit. ^liss ^Iclntyre was graduated from the Boston Lying-in Hospital and for twelve years did private duty nurs- ing. She was a student of the Department of Nursing and Health, Teachers College, for two years, and then returned to her alma mater as superintendent of nurses. She later be- came assistant superintendent of nurses of the Khode Island Hospital and was subse([uently appointed chief nurse of Naval Base Hospital No. 4. After service in various naval training camps and stations in the United States, the nurses of Navy Ba,se Hospital No. 4 were mobilized September 12, 1918, in New York. Miss ]\laclntyre wrote: We sailed 8ppfenil)er 23 on an English ship, the Briton. The personnel on Ijoard consisted of 2200 troops and of GO women, including our nurses and a group of Ked Cross work- ers. A dirigible balloon and a group of airplanes accom- panied us out of the harbor until we met our convoy wliich consisted of fourteen troo]) ships, one cruiser which went ahead of us, one Ijattlesliij) which guarded our rear, four destroyers and eight or ten submarine chasers which left us the second day out. This convoy carried about 30, 000 troops in all. The })()siti()u of the ships was interesting. During the day they separated so that they were barely ])erceptibl(' to each other, but at retreat they came together like a hen with a brood of cliickens. On October 2, three submarines wer(> sighted. On Octolier f), a wireless was rC'clNcd aunouncin^iz that a submarine was after the Jlrilo/i. While at dinner that evening, we received a terribh> shock. One of our own sliips. the I'nuUiuj. rannned us. dc.-troying one of our life-boats and tcarinir awav a portion of the rail from one of the decks. When this happened, per- fect silence j)re\ailed in the dining saloon. A gcn<'i-al pale- 726 HISTORY OF AMERICAN RED CROSS NURSING ness was on everyone's face, as we all felt that we had been torpedoed. Our ship soon righted herself and happiness per- meated the room again. Spanish influenza broke out among the troops on the Briton and the nurses of Xavy Base Hospital No. 4 volunteered their services. Miss Maclntyre wrote : . . . The medical officer in charge of the sick men invited me to inspect the patients, men from the 319th Regiment of Engineers, from California. On the promenade aft deck were about thirty sick men, lying on the deck with nothing under them but a canvas hammock or a blanket serving as a mat- tress. They were so close together that one could hardly pass between them. Within forty-eight hours, one hundred and sixty cases had developed. Some of these men were running high tempera- tures and many of them M'ere in great pain. At first the very sick patients were cared for in the sick-bay, but were later taken to the decks of the ship where fresh air surrounded them and where more room was available. As the voyage length- ened, the weather grew more severe and the sea more rough. The decks were often washed by the waves and our sick men drenched to the skin. The patients were then moved into the officers' smoking saloon and into the main saloon of the ship, where we were able to make them more comfortable. Colonel Otwell, in command of the 319th Engineers, wrote: The sick report of the troops on board . . . jumped from 6 to IGO in forty-eight hours. Seeing the danger. Miss Mac- lntyre and her co-workers . . . volunteered their services, with the result that what was chaos (there being practically no accommodations or facilities on board to care for such numbers) was liandled in what I consider a most admirable manner under tlie circumstances. They have worked niglit and day in the cold and damp, on decks that were beiiig washed by seas, without any lights whatsoever, exposed to the dangers of contagion witli a deadly malady and they have rendered these services most cheerfully. . . .^^ The docking at Liverpool was impressive. Miss [Nfaclntyre wrote : "Report written October 7, lOlS. l)y C. W. Otwell. Commanding Troops on Board H. M. 'I'. Briton, to the Commanding Oilicer, U. S. Xavy Base Hospital, No. 4, Queeiistown, Ireland. SERVICE WITH THE NAVY 727 As there were twenty-oiic miles of docks, it took us several hours. We passed ships of men in our familiar khaki uniform who exchan<]^ed enthusiastic greetings. Many pleasant ac- quaintances had heen made during our troublescjme voyage, caused by the illness of our men and by the extremely rough weather. Colonel Otwell called our group together and spoke most feelingly regarding the work of the nurses, and when he had finished, . . . the ship rang w^ith applause from offi- cers and men. At Liverpool seven nurses of our unit were detached and sent to Leith, Scotland, and four others to Cardiff, Wales. The rest of us soon entrained for Queenstown, Ireland. . . . Our hospital was opened thirty hours after our arrival, to meet an emergency caused by the Aquitania, which cut the Shall', a destroyer, in half. Several men had been killed and about twenty, I think, injured.^* Dr. Carpenter, our com- manding officer, was much pleased with the manner in which the nurses threw themselves into the work after their strenu- ous voyages, both across the Atlantic and the Irish Sea, He said : "They all rebounded like rubber balls." TJ. S. ISTavy Base Hospital Xo. 4 was established at White- point, one of the most b(>antifnl and picturesque spots along the Irish coast. The hospital buildings were the familiar bar- rack hut which had been brought from the United States. The capacity of the seven wards was two hundred and fifty beds. The patients which came to i^avy Base Hospital ]^o. 4 were largely influenza cases. ]\liss Maclntyre wrote: Our patients came from the torpedo base just acroes the harbor from us, from the Air Station at Aghada, thirty miles from (Queenstown. from the Passage Barracks two miles north, from the Air Station and Pigeon Carrier Station at Widdy Island, eighty miles away, and from our own ships in the harbor. There Merc two large ships, the Dixie and the Melville, and many smaller boats stationed in the harbor near us during our stay in (Queenstown. Through the worst part of the e])i(lemic. we loaned a few of our nurses to the British Xaval lIos])ital across the harbor at Koulbowline. They had a hospital of eighty bods and only two graduat(> nurses. However, tlicy had twelve sjdendid Y. .\. D.'s. This li()S]utal had cared for our sick men before "'T. S. S. Shnir I'ollision witli llio Aquifania OctolxM- 9, lOlS: (lead, ton." Report of the Secretary of the Navy. IHIS. p. 249. List of injured not ^iven. 728 HISTORY OF AMERICAN RED CROSS NURSING we had arrived and we were only too glad to be able to be of service to them. We also sent two of our nurses to Widdy Island eighty miles away, to care for a few patients who were too ill to be brought to us at Whitepoint. . . . Three American Naval hospitals, in which Red Cross nurses, and regular and reserve members of the Navy Nurse Corps served, were established in France during the European War. The first of these to arrive in France was United States Navy Base Hospital No. 1, which was attached to the United States Marine Corps. When the Marines were brigaded with Persh- ing's divisions in the autumn of 1017, Navy Base Hospital No. 1 was assigned to duty with the American Expeditionary Forces at Angers, and later at Brest, France. The second Navy hospital in France was United States Navy Base Hospital No. 5, which served the American Navy based on Brest. The third was established by the American Red Cross Commission near Bordeaux for the care of patients from the Naval forces operating in the waters near the southern port. Sick-bays and dispensaries, staffed entirely by Naval Hospital corpsmen, were located at J^orient and Pauillac and at various Naval air sta- tions along the coast of France. Navy Base Hospitals Nos. 1 and 5 were mobilized in Sep- tember, 1917, and embarked for foreign service within a few weeks of each other. Although Navy Base Hospital No. 1 was the first to arrive in France, the experiences of Navy Base Hospital No. 5 will be recounted first because No. 5 was more typically a Naval hospital. As the sanitary unit of the Marine; Corps, Navy Base Hospital No. 1 became part and parcel of the American Armies when the Marines were assigned to land duty in France. United States Navy Base Hospital No. 5 was established in October, 1917, in Brest. The professional personnel of this unit was ccmiposed largely of nurses and physicians of the ^lethodist Episcopal Hospital, Philadoly)hia, Pa. ; Dr. Rob- ert LeConta was director, and Alice M. Garrett was chief nurse. Miss Garrett was graduated from the Pennsylvania Hospital, Philadelphia, and held various executive positions in the surgi- cal wards there, as head nurse of the operating room and as assistant to the snpc^rintendent of nurses, Miss Dunlop. Miss Garrett became superintendent of nurses of the Methodist SERVICE WITH THE NAVY 729 Episcopal Hospital in Philadelphia in 190G. She was enrolled in the American Ked Cross Nursing Service in 1911 and served as head nurse of the Red Cross field hospital at the Fiftieth Anniversary of the Battle of Gettysburg, 1913. Three years later, she organized the nursing staff of Navy Base Hos- pital No. 5. The nursing staff of this unit vi'ere mobilized in Philadel- phia in September, 1917. Miss Garrett wrote: On October 15, 1917, we were ordered to New York by special train. We went directly to the S. S. St. Louis and sailed the same afternoon at 5 P.M. We reached Liverpool, October 24, 1917; at 3 P.M. we left for South Hampton. . . . We reached Le Havre without accident and entrained for Brest, our destination. We spent two nio^hts and one and a half days making this trip which usually takes a few hours. Navy Base Hospital No. 5 was set up early in November, 1917, in an old Carmelite convent, at Brest. Miss Garrett wrote : The building, which was not adapted to hospital use, was divided into many small rooms. The plumbing was of the most primitive kind; water was often a missing quantity. There was no beauty and little comfort in the cold, damp place, yet the patients were happy, appreciating their care and treatment, and they mostly made good recoveries. With tents and huts in the grounds surroimding the hos- pital, there were accommodations for six himdred patients, the sick and injured of the Navy. We cared for the men composing the crews of the transports, destroyers, mine sweej)ers and Naval men stationed in and around Brest. It was (he Xaval llos])ital in France. . . . The work of the Navy Xurse Corps was perhaps not as spectacular as that of the Army, l)nt it was nevertheless just as needful. Our pntieuts were survivors from torpedoed boats or lads wlio were burned from explosions, or were almost ])hysical wrecks from the hard lives they spent on tlic smaller craft used as destroyers and convoys. It was always a pleasure to minister to them ; their bravery and their grati- tude were boundless. To find a hospital with (as the boys exj)resscd it) real .Vnicrican nurs(>s meant more to them than they could tell. Although there was alwavs enouiih to do. the work was 730 HISTORY OF AMERICAN RED CROSS NURSING harder at times than at others. Wlienever we heard of a boat being torpedoed, we prepared for the survivors; our Xaval Base was the best equipped on the French coast. Every time the boys went out they never expected to return, so the smaller vessels were lightly called the "Suicide Fleet." Miss Garrett's report contained the following extract from the diary of one of the nurses of Navy Base No. 5. April 18, 1918: This morning we had emergency call, sixteen burned cases. The Florence IL, a small freight boat belonging to the Steamship Company, was reported to have been torpedoed. The accident (which is now gen- erally believed was caused by a time bomb placed in the engine room) happened one hundred and twenty miles out to sea. The boat had anchored on account of the fog. The cargo consisted of over five hundred tons of ammunition purchased by our Second Liberty Loan. The entire crew was lost with the exception of thirty. ^^ These survivors were frightfully burned; some of them had the ends of tlieir fingers drop oif. All were burned on the face, chest and hands. About six are so ill that tbe doctors give little hope. It is a sad sight to see them all in such horrible pain. The explosion happened at ten o'clock at nigbt, and tbe crow which brought the survivors in said the explosion lit up the sky like daylight. July 14, liJLS: To-night twenty survivors were brought in from the Westover. Four were wounded and the rest were shocked and in a bad condition generally. The boat, carrying muniti(jns, steel, bospital supplies, locomotives, ambulances, etc., was making lier maiden trip. Sbe was with a convoy but one of licr engines became disabled and she was forced to lag behind, an easy target for German U-boats. Twice the \Vedover was torpedoed, forty minutes apart. She went down at once after the second shot. The crew took to lifeljoats and were afloat from Thursday morning, July 11, when tliey were struck, until Sunday night, July 14, when they arrived at our base. They were four hundred miles out from the French coast and never sighted a boat until a Frciicli sailing vessel ])icked them up ten miles off shore and hrouglit them in. The cajjtain of the WcHlovcr was an old salt: he had hecn in the Merchant ^larine service thirty-one years and in tlie first life boat be had guided them by tbe stars. "Seventeen men of tlie crew nf the S. S. Florence II. \vere lost. Report of the Secretiirv of llie Nav\-, l!tlS. ],. 240. SERVICE WITH THE NAVY 731 They had a little hardtack and a small amount of water, but as they did not know how long they might be at sea, they used very little of this supply. It had poured rain for two nights and days, and they had no protection whatever. They sang all the way "Pull for the shore, sailors, pull for the shore." They arrived at Brest, cold and wet to the skin and nearly starved. We fed them hot coffee, eggs and toast, gave them each a hot shower and put them in clean beds. Several had had scalp wounds which needed attention, two had been severely burned on the face, hands and feet, and one with a fractured hip had suffered intensely. Two were given antitoxin serum as they ran a risk of getting tetanus under the circumstances. Many were given sedatives for shock. Poor lads, it was sur- prising how cheerful they were. There are still three life boats missing; the destroyers have gone out for them at once. July 15 : This afternoon fourteen more of the Westover sur- vivors came in, and to-night fifty more, now making eighty- four in all. The entire crew, with the exception of about twelve,^" which were lost in the explosion, are now accounted for. We had to discharge a number of the survivors of the transport Covington to the receiving station to make room for them. It was well past midnight before we had them settled down. The mascot was saved and he was brought to the hospital and cared for. They would not leave the faithful dog behind. They were cheerful in spite of their wounds and so grateful for all we did for them. These last survivors were almost five days in the life boats. They will be fitted out with new clothing by the Eed Cross and when ready for duty will go back again at the old post. A second American hospital to be established in France for the care of sick and wounded of the American Xavy was Ameri- can Red Cross Hospital Xo. 100, which was established in January, 1018, in the picturesque Chateau Beaucaillon, on the Gironde Kiver, near Bordeaux. Lieutenant Colonel C. C. Burlingame wrote : Among the earliest of the hospital formations of the Pcd Cross was American Ped Cross Hospital Xo. 100, installed in the (^bateau Beaucaillon, near St. Julien ((Jironde). near enough to Bordeaux to be easily accessible to the Xavy. This " Kiplit men of the crew of the S. S. Westover were lost. Report of the Secretary of the Navy, 191S, p. 242. 732 HISTORY OF AMERICAN RED CROSS NURSING hospital was operated for the Navy, which supplied the actual medical personnel, exclusive of nurses. ... So great was the need and so effective the work done here that it was later expanded to one hundred and fifty beds by the erection of tents on the grounds, to take care of an epidemic which oc- curred among the Navy personnel. . . . A summarized report of this hospital for six months ending December 31, 1918, is as follows: Hospital days, 22,864; Patients admitted, 703; Patients evacuated, 197; Patients returned to duty, 440; Patients died, 295.^^ Convalescent patients of the American Navy were admitted to the American Red Cross convalescent homes already de- scribed in Chapter VI. Bluejackets were entertained largely at Convalescent Home No. 1, located in the Chateau de Beyche- ville, at St. Julien, Gironde ; at Convalescent Home No. 2 which had been established in the Hotel Regina, Biarritz ; and at Convalescent Home No. 3, which was located in the Hotel de la Source, Morgat, near Brest. Navy nurses were assigned to duty in Guam, an insular possession of the United States which was located on the direct water path between the Hawaiian and Philippine Islands and they experienced unusually interesting and picturesque service. Frederica Braun (Columbia Hospital for Women and Chil- dren, Washington, D. C.) wrote, in the Military Number of the Journal: The Naval Hospital in Guam differs from any other hospi- tal in the Naval service. Officers and their families, civilians, enlisted men, and the natives of the islands, all depend on the United States Medical Corps and nurses for medical care. There is a small private hospital, "Susanna," in part endowed and also supported by fees from the patients; a ward for enlisted men and two native wards, one for men and boys over ten, and the other for women and children. The hospital is situated in a beautiful part of Agana, the capital of the Island, with a population of five thousand natives and about one hundred Americans. The nurses' duty is varied and interesting and is an excellent field for the nurse who has or desires experience in public health and welfare work ; there is also experience in nursing tropical diseases. From thirty to forty children are always having the treatment; as fast as one set is ready to go out another comes " "Military History of the American Red Cross in France," p. 60. SERVICE WITH THE NAVY 733 in. The treatment lasts from ten days to three weeks, and while the children are there they are examined very much as we would school children in the States. When the Americans first took over the Island in 1898 the mortality from childbirth and among infants was appalling. A training school was started by the Medical Corps for native nurses; since the Navy Nurse Corps was established part of the duty of Navy Nurses in Guam is to train tiiese young women as midwives. They do remarkably well in this line, and if anything abnormal occurs they rush their patient at once to the hospital, sometimes by automobile, sometimes on a stretcher, very often in bull carts, occasionally in ilsh nets. As a race, the Chamorros are superstitious and have been taught that an evil spirit will get them if they leave window or door open at night. As the houses are most primitive, having usually but two rooms, with the entire family sleeping on straw mats on the floor, tuberculosis claims many victims. There are queer accident cases; such as injuries from being gored by caraboas and falls from cocoanut trees causing unusual fracture complications; also there are serious infec- tions from fish bites. Navy nurses stationed at Guam found ample opportunity for recreation. Miss Brann wrote : For amusement there is tennis, swimming, automobiling, walking, dancing and moonlight picnics. Every afternoon, machines run from Agana to Piti for swimming; the water at Piti is deep and still. Dances at Dorn Hall are held every week, with music by the ^larine Band. The picnics are the best kind of fun, with the moonlight shining on the white beach and the sea sounding on the reef. . . . The darkness comes quickly in the tropics, with no twilight, like a curtain let down. In the natives" houses appear candle lights or tiny lanijis, and the white roads and beaches gleam against the dark ])alnis a fairy land. . . . On night duty, one hears the sea all the time and every other sound is stilled; early in the morning, before it is light, the natives so slip-slip to churcii, a never-ending procession. Then quickly comes the splendid sunrise. As was previously stated, the first and largest Xaval hospital to arrive in France was United States Navy Base Hospital No. 1, wliicli was attached to the United States ^larine Corps. 734 HISTORY OF AMERICAN RED CROSS NURSING This unit was also the first base hospital which the Red Cross organized for the Navy Department. Its parent institution was the Brooklyn Hospital, Brooklyn, N. Y. Ur. William C. Brinsmade was director, and Frances F. Van Ingen, chief nurse. Following her graduation from the Brooklyn School of Nursing, Miss Van Ingen did private duty and institutional nursing in Ohio and Minnesota. She was a member of the Yvetot Unit which National Headquarters assigned to duty in February, 1915, at the Alliance Hospital, Yvetot, France. She returned to the United States in April, 191 G, and as superin- tendent of nurses of the Brookl^'n Hospital, organized the nursing staff of Navy Base Hospital No. 1. Navy Base Hospital No. 1 was ordered to mobilize on Sep- tember 11, 1917. Miss Van Ingen wrote: At noon on September 11th, while T was stationed at the United States Navy Hospital, Brooklyn, the commanding officer told me to have forty nurses ready to sail for France in two days. It's still hazy in my mind just what did happen during those two days. Kind people helped me 'phone, others loaned their automobiles or ran errands themselves, the Eed Cross stretched forth its mighty arm and the full equipment, including the uniforms, appeared. On September 1-1, 191T, the unit left Grand Central Station. Jt was early enough in the war for our uniforms to be new to the public. A regular officer of the Navy, Dr. L. S. Von Wedikind, with Dr. Vickery, took charge of the unit. Our destination was the Navy Yard at Philadelphia and we walked from the train to the U. S. S. Henderson. It was the first time ofHcers and crew had ever had women traveling with them and the nurses found things as interesting as the crew found us. The following Sunday evening, the Sixth Division of Marines came al)oard, al)Out 1500 men under Major Hughes. Comparatively few of this division lived to come back. Two- thirds of the officers were killed. After the Armistice Colonel Hughes passed througli our hospital on crutches on his way back to tbe I'nited States, a mere shadow of his former vig- orous self. Monday morning'- we slii)])ed from our moorings out be- tween the nien-o"-war. On every side couhl be heard the music of two or tbrce bands, tbo shrill- whistles of Navy and luuijor crafty tlie cheering of the Jackies. . . . SERVICE WITH THE NAVY 735 Miss Van Ingen wrote of the trip across: In our convoy was the Cruiser San Diego, ^^ with its great observation balloon which was up most of the time; two destroyers; a tanker; and two transports, the Finland and the Antilles, which was sunk on her return trip. 1 was told one morning to assemble all nurses in the mess hall for ''inspection/' Every one was to be in dress uniform, which included hats and gloves. At the appointed hour we gathered together very solemnly and proceeded to wait. After two hours, the inspecting party approached. All the othcers were dressed in blue and white and gold, with swords buckled at their sides, and white gloves on their hands. They filed tbrough one door, took a searching look at us, and each, according to his rank, filed through the other door and out of sight. It was awe inspiring ! I don't know what became of those swords and white gloves; they never graced another inspection. We surelv took ourselves seriously at first. We had -Quarters" at 9 :15 A.M.; "Abandon Ship" at 9 :30; deck drill at 10; with "Sick Call" at the same time for those not feeling well. The Henderson docked at St. Nazaire, France, on Octo- ber 4, and the personnel of United States i^avy Base Hospital Xo. 1 proceeded the next day to Angers in the Department ^larne-et-Loire, France. The ^I urines, to whom ^NTavy Base Hospital Xo. 1 was at- taclied, were brigad(>d in the fall of 1917 with the American Kxpeditionarv Forces and the unit, though still under the com- mand of a Xavv officer, was taken over by the Army. Hence this Xaval unit was temporarily assigned, until the end of Xovember, 1917, to staff the Mongazon, a future Army base hospital at Angers. Of their arrival there, ALiss Van Ingen wrote : It was extremely weird in that station at midnight. We were led through the small emergency hospital in one i)art of the building, where dim lights showed us soldiers and nurses in the French uniforms; everything crude and rather dirty. The only means of reaching our destination, two miles outside the city, was by walking. So we filed throu>:h the d.irk. narrow streets of Anders, and the shuttered houses and silent streets left a dream-like impression with me so unreal from the hustling Anirers by day. "Later tiuiik bv a (.u'linaii subiiuirine. 736 HISTORY OF AMERICAN RED CROSS NURSING We were given a great building, the Mongazon, formerly an old school for priests. The buildings and grounds were ideally situated for the splendid hospital it was afterwards made into. We nurses were apportioned to the top floor of one of the wings of the Mongazon. Here forty nurses found forty French beds, forty small bedside tables, forty chairs in one large dormitory, and cest tout. A small room was given me. Across the hall from it was a wash-room with a stone floor, a long narrow tin trough down the center and a pipe with ten tiny water taps suspended above it. And again cest tout. As I made my rounds, my heart froze within me. How could forty grown women, the sprightly and the silent, the tidy and the thoughtless, the tranquil and the turbulent, room here together? In answer to most of my requests, it was either "Now you must remember that this is war," or "1 hardly think that the nurses rate that." Xot that there was much complainmg, however ; the nurses were really very game and sporty. Baths were our greatest difficulties. On the ground floor at the extreme end of the building were two small rooms with a tin bathtub in each and a hot water geyser over one; this geyser was expected to supply hot water to both tubs. Everyone was warned to follow directions of operations very closely and all went well for two weeks. Then a nurse mismanaged, there was a loud explosion and the geyser was a wreck ! After that we walked about two miles to Angers with our own towels and soap, waited half an hour or so at a public bath and had a clean comfortable bath and walked back again. During the last week in ISTovember, 191 Y, the personnel of Navy Base Hospital No. 1 was ordered to permanent quarters at Brest. The Pittsburgh Unit, United States Army Base Hos- pital No. 27, had been assigned to the Mongazon at Angers and desired to take over their permanent quarters. ^Moreover, the twenty additional nurses of Xavy Base Hospital No. 1 who had been left in the United States when the majority of the unit sailed, arrived on the U. S. S. Von Steuhen and the nurs- ing staff of Navy Base Hospital No. 1, thus re-united, pro- ceeded to Brest. Miss Van Ingen wrote of their arrival : I will never forget my feelings when we marclied to the hospital whicli was to be ours for eleven months; it so closely resembled the Kaymond Street jail in Brooklyn. . . . The building had been used originally as a school for boys, the SERVICE WITH THE NAVY 737 Petit Lycee. Since the war the French had used it for a hospital and their evacuation to make room for us was de- layed until a young French lad made complete his great sacri- fice for France. The buildings covered about two hundred square feet and had been erected about two courts in which we afterwards put up tents and barracks to increase the number of our beds. The main part of the building had four floors above tlie ground floor. Besides isolation tents, sick oflicers' and sick nurses' quarters, we had seven wards in all, which accommo- dated from ten to one hundred beds each. The nurses of Navy Base Hospital No. 1 accepted their new quarters with the same good humored sportsmanship which they had shown at Angers. ^Miss Van Ingen wrote : In the far corner of the larger court, with its windows over- looking the court d'Anjou and the Bay, I was given a few rooms for nineteen nurses. Seven were in three unfinished attic rooms, with dormer windows. The other rooms held from one to two each. The lower part of a Convent, three blocks from the hospital, which included a large chapel, five fairly large bed-rooms and two or three small ones had been rented for the remainder of the nurses. Twenty-two nurses were crowded into the chapel, four and five in each of the bed-rooms, that should have held only two. The Ked Cross helped us out wonderfully in adding a few comforts ; they provided easy chairs, a number of screens, to furnish a little privacy, three wash basins and a bath tub, hot water heater, gas stove, sash curtains, hand basins and pitchers, a few mirrors, china dishes to replace the tin ones we were using, and a little later a })iano. The pleasant, free way in which the Ked Cross gave to us came as balm ; never once was it said that we did not "rate"' these comforts. l)ut rather "Is there anything else that you need?" The nurses were wonderful about making the best of trying situations and tliere were many of them. First and worst was the q\iestion of heating. . . . Another distressing circum- stance were the night prowlers cats, mice and men. Our rooms were on the ground floor. The windows opened right on the street and our entran(^e door on the garden, ^luch to the horror of the ]x^ople of Brest, we refused to slee]) behind those window shutters made of solid wood. Lattic(^ shields were put half way up the windows, but they failed to keep out the cats, who walked ofi' with delectable "eats,"' or to prevent the Frenchmen from climbing to the window ledges 738 HISTORY OF AMERICAN RED CROSS NURSING and attempting to scramble over. The garden entrance was rather more of a menace, for we many times had actually to turn out of our hall and bed-rooms intoxicated soldiers and sailors. Nothing even approaching a serious situation ever happened ; they were in fact often more ludicrous than alarm- ing, but I never retired at bedtime that I did not hope the night would pass without someone being dreadfully fright- ened. The mice and rats are, of course, a part of French housekeeping. An occasional shriek or squeal would be heard at night in the room next to mine, induced by the travels of some mouse across the pillow of a nurse or a too venturesome one getting his feet tangled in her hair. Our garden was our chief joy. It was a really French one, with all that implies, hidden behind a thick wall ten feet high with fruit trees and rose vines trained against it, wind- ing paths around rather neglected flower beds, splendid trees that gave shade or shelter and a little screen door that opened on to an unpaved lane. . . . Nurses and hospital corpsmen of the Brooklyn Unit imme- diately undertook the renovation of their new hospital. How- ever, Paris headquarters on December 20th ordered thirty nurses on detached duty to Camp Coetquidan, then the largest American artillery training center in France. Anna Burges was chosen head nurse. Of the heavy work which confronted the depleted nursing staff at Navy Base No. 1 at this time, Miss Van Ingen wrote : The demand on our unit to send these thirty nurses to Camp Coetquidan came just when our hospital was filling rapidly with stevedores and men from the transports, all, of course, medical cases. The States were sending over many of their colored regiments, and, as all the stevedores were of that race, two-thirds of our beds had black faces on the white pillows. The wards were not yet fully equipped, many very necessary articles were still unpacked in the store rooms; the galley was in need of stoves; half the nurses were doing detached duty and we had an average of ten sick in 7inrses' sick quarters. Add to this a hospital full of ])lack men, sick with mumps, measles, meningitis. . . . Our most serious cases were the measles and meningitis, especially tlie measles cases coming from the transports. The transporting of them from the ships to the hospital proved fatal to many. They were carried from the ship to the lighter, from the lighter to the dock, from the dock to SERVICE WITH THE NAVY 739 ambulance, from ambulance to hospital. It sometimes took from six to eight hours to accomplish this. At this time these lighters were uncovered boats, more l)arges, so that these sick boys were exposed for hours to the cold and rain. The work of the nurses and corpsmen was made exception- ally hard through the lack of elevators, dumb-waiters, toilet facilities and running water. The city of Brest had nearly three times its normal population to supply with water, so there was constantly a fear of a water famine. Sometimes, without the slightest warning, the water would be shut off for days. We would have to send out relays of French women and corpsmen with great varieties of pitchers and tubs to bring back all they could from remote public fountains. On each floor we had bath tubs placed near a tap, so that when the water was turned on by the city at night we could collect some and have it for the morning toilets and cleaning. It seemed the irony of fate that with the sky constantly pouring down water on our heads that the city pipes should be so 'often dry about the only thing dry in Brest. Our second greatest difficulty was the lack of good plumb- ing. Brest does not possess sewage; each building has its own cess pool. These had to be emptied by the city at our own expense; generally not until we had notified the authori- ties many times and waited until the cess pools were over- flowing and the toilets were backing up and out of use, would they pay the slightest attention to our demands. When tliis happened, and it seemed to be happening all the time, it made necessary the carrying down from the upper floors of all excreta. I am sure few corpsmen worked any harder than ours. All the stretcher cases had to be carried up and down the one, two or three long flights of stairs. Food, water, coal and refuse had to be taken care of in the same way. By comparison with the men in the trenches, their work was cliild's play, but for most of the boys with us the work was such as they had never done before and it was hard and not very pleasant. During tlio spring of 1018, the American transports began to take back to America the "Class D" men and Xavy Base Hos- pital Xo. 1, which was then the only American hospital in l^rest serving the American Army, was crowded with patients. An Army camp on the outskirts of Brest was opened in April, 1018, and lat(^r another was established at Kehuron, a town near I^rest, and later several of the largest base hospitals of the Army wer(> grouped here to care for troops of tlie American 740 HISTORY OF AMERICAN RED CROSS NURSING Expeditionary Forces returning to America after the signing of the Armistice. During the summer of 1918, Brest and its environs were crowded with American troops. Over 300,000 American sol- diers, it may be remembered, were carried to France in July, 1918. At the same time that the wards of Navy Base Hospital No. 1 were filled with medical and accident cases among these troops, the German drives on Paris were greatly overtaxing the medical and nursing facilities of the Army and the Red Cross. Nurses were at a premium, both in the zone of the base and of the advance, so operating teams were organized from Navy Base Hospital No. 1 and sent to Orleans, to Paris and to the front. Of the work which confronted the depleted nursing staff at Navy Base Hospital No. 1 at Brest, Miss Van Ingen wrote : It was during these months, when we were so short of nurses and corpsmen, that our work was heaviest. American troops were pouring mto Brest from May to November. Forty thousand were camped in and around Brest in the early part of June, 1918. Consequently our beds were filled with sick. If it had not been that nurses were being sent over on these transports at the same time, we would not have been able to keep up the high standard of nursing we had set our- selves. These transient nurses were detailed to help us while they waited for further orders. As it was, the hours were long. These transient nurses would just about have learned the routine and have gotten into the swing of the work, when their call would come and they would go, leaving us to face twelve, fourteen or sixteen hours without time off. In September we began to get the "flu" cases from the States. ]\Ien Ijrought in off the battlefields shattered and bleeding were not as tragic to nie as these that came from our own ships. ^len with the pallor of death on their faces, laborinfore liglits went on; the ground outside was not cleared of stretchers until the fourth day. About n V. ^\. ihat (irst niglit. a dying man was ]iut on my table. lie askeil nie to write home for him. ami one of the boys found a jiad for me. \)v. h'oss asked if I thought I could kee]) a record of ea( h case for him. I still ha\e that pad, the 750 HISTORY OF AMERICAN RED CROSS NURSING first entry being the address of the only man who died on our table, though the record covers over two hundred cases. The next morning other teams arrived and the tired Navy nurses were told to find a place where they could get a few hours' sleep. They stumbled to the nearest house. Miss Dewey wrote : On the second floor were two adjoining rooms with double beds, the bedding thrown back as if people had just gotten out of them. We four nurses got into those beds and pulled up the covers. Miss Dewey's team went on duty again that night. She wrote : The night of July 21 a bomb exploded in a garden about 20 yards from us and blew open the windows. Chief Shank stepped away from one, remarking, "That's too close, but thank God they let in a little air." Only the most urgent cases were operated at Xo. 12. The others were sent on to where facilities were better. Some of the wounds contained maggots and nearly all were gas gangrene cases, and the stench of that room was beyond words. The pluck of the men kept us at it. Most of them were conscious and told us they had the Germans on the run. One boy whose leg had to come off, said, "All the fun I had lying there in the mud was seeing the Germans beat it. Our boys couldn't get to me any sooner than they did." Some asked if we thought they could get back, because "I got to get a Boehe for this." The night of the 24th we operated on some Scotchmen, who had come up to relieve our 1st and 2nd divisions. By morn- ing their medical corps had come up and we were sent back, reaching Paris at 9 p. m. that night. Over 3500 wounded went through Xo. 12, between July 18 and July 24. About 300 non-transportable cases were operated upon there and the Xavy teams performed about 100 of those operations. On July 29 Dr. Ross's team, with ]\Iiss Dewey and Miss Hurst, was ordered to join Field Hospital No. at Chateau- Thierry. When they arrived they found that the hospital had not yet come up, but were told to report temporarily for duty at the College Jean ^lace where some operating was under way. They were promptly set to work there. ^liss Dewey wrote : SERVICE WITH THE NAVY 751 ;Miss Hurst was asked to hand instruments for three tables and during the night had three abdominal cases going on at the same time and, as Dr. Koss said, "got away with it with- out a hitch." It was a wonderful piece of work. How she managed to get all those needles threaded and with the proper sutures is more than I know, but she did. The following day we joined Field Hospital No. 6 and ^lobile 1, which was being put up in a field near Chateau- Thierry. We were taken there in a truck, crossing the Marne by a pontoon bridge. This was a large tent hospital wonder- fully equipped and the operating there, after Pierrefonds, seemed almost ideal in spite of the fact that we were boml)ed and fired over. We operated every day, and part of some of the nights, ending wth a stretch of twenty-four hours. . . . The other operating team from ISTavy Base Hospital No. 5, under the command of Dr. Jones, with Miss Fulton and Miss Thompson as nurses, had been detailed to Field Hospital No. 7 at Coulommiers. Miss Dewey wrote of the type of service which this team had seen : Field Hospital Xo. 7 was located near a small chateau, about a mile from the town. Tents filled the woods back of the chateau and eight beds were in a tent. The first few days after their arrival the work was very strenuous, and they had long hours and little sleep, then more teams arrived and the work was better regulated. One night while they were working all the lights in the operating tent wont out, and they had to finish their case by flash liglit. That was during one of the severe air raids, of which they had several. Both teams returned to Brest on August 15. ^Hss Dewey was commended^" as follows by the Commander of the U. 8. Naval Forces in France : She is a splendid nurse and a woman of fine character and exceptional executive ability. Her services while on duty with the operating teams at the front were extremely valu- able. She acted as anesthetist during most of her service there, in addition to which, when relieved from that duty, "It is not the policy of tliis history to publisli individual citations; space does not permit it. A list of nurses wlio have been decorated for frallant and devoted conduct may bo found in the Appendix. This citation is. however, i^iven in the text as an index to the general type of citation received by numerous nurses during the European War. 752 HISTORY OF AMERICAN RED CROSS NURSING she did extra duty in assisting the nurses in the care of the wounded with their dressings. On one occasion, under ex- tremely unsatisfactory surroundings, she gave anesthetics steadily for fourteen hours without leaving the table, and after this strenuous labor she visited the cases which had been operated upon. Following the return of Dr. Watt and his team members to Brest in August, 1018, l^avy Operating Team ISTo. 1 of Base Hospital No. 1 with Dr. Long commanding, was sent up to replace Navy Operating Team No. 2, at Field Hospital No. 112, Chateau-Thierry. Miss McCarthy, the second nurse on Navy Operating Team No. 1, had been ill and Jeannette McClellan, one of the Navy nurses of Navy Base Hospital No. 1, who had been on detailed duty at Paris, was sent for- ward to take Miss McCarthy's place. Navy Operating Team No. 1 set out on August 11 to find Field Ilospital No. 112, which had been moved that morning from Chateau-Thierry twenty miles closer to the fast advancing American Front. Miss Elderkins wrote: Twelve nurses attached to Field Hospital No. 112 were also waiting for ambulances to be sent to take them up to the next sit. An officer coming down from there said he feared it would not be possible for any of us to go on that night, as the Boches were shelling the roads and also sending over a great many gas shells in the vicinity of the hospital. Never- theless, the ambulance came and ^liss ]\lcCleIlan, the other nurses, Sexton and Brady and 1 started up. We were pro- vided with helmets and gas masks. That was a wild ride. We passed through village after village where ]iot a house had been spared, and the only signs of life were the military guards. Ammunition trucks were racing in both directions, and as no lights were allowed, the traffic was rather perilous. About a half hour before we reached camp, we were stopped and told that all masks were to be worn in the "alert" position. We had no more than adjusted th^m so, when the rfal gas alarm came. . . . Upon arrival at camp we found everything in pitch dark- ness. . . . We groped our way to the last tent, where four occupants Avore sleeping. Cots were brought for us . . . but we didn't slcfp. Gas alarms sounded continuously. You would hear the hoarse cries of "gas I gas I'' (oming down from the distance as the sentinels passe*] the warning. Tiicn our own guard would SERVICE WITH THE NAVY 753 take it up, five pistol shots would be fired and some one would start beating a huge shell strung up on a tripod. To hear the horses whinnying across the road, where some cavalry troops were spending the night, was pitiful. They also had to have the masks on and could not seem to understand it. In the morning, we found ourselves in a little town called Cohan. The hospital was at the foot of a hill ; from the top you could get a good idea of where the fighting was taking place. Fismes was only four miles away, and the Germans occupied the town on the opposite side of the river. At night it seemed like the battle was being fought just outside our tents. Army nurses have described the severe service at Cohan, and Miss Elderkins' report repeated some of the things which made that post of duty so arduous. She wrote: Our location was poor; we were right in the midst of things most desired by our enemy. The work here was not especially heavy, but conditions were such that every bit ol reserve force was needed. The days were intensely hot and the nights bitterly coid. The flies were unbearable. We had air raids niglit after night, with no opposition, for there were no anti-air craft nearby and seemingly very few French or American planes. When we were not operating at night, we spent the tini(^ from darkness to dawn in a cellar twenty feet under ground. It just held seven cots and thirteen nurses were supposed to sleep there. If we sat erect on the cot our head struck the rough stone above. Water dripped on us all night long. Huge black bugs crawled about and after we quieted down we could hear the rats. We, ourselves, felt like rats in some trap, for in case of a direct hit our chances of getting out were slim. I woidd have preferred the dugouts, or "graves" as we called thcni, that Dr. Long and the corpsmen had dug under our cots in the tent. The morning of the tenth day, the Germans had found our range. Tliev opened fire on us. or rather on their objectives about us. A\'itli shells falling all about us, we went back that night three miles. Then followed a series of moves, first to Evacuation Hos- pital Xo. "). outside of Chateau-Thierry, then across the ^larnc to lied Cross Hospital Xo. Ill, aiul a few days later to Vic-sur-Aisue. wliere we were attached to I'ield Ibisjiital X'o. l"iT of the -I'^ut] Division, who were serving with the French luuler (ieneral ^lanarin. 754 HISTORY OF AMERICAN RED CROSS NURSING The casualties were heavy. We worked a twenty-hour shift, which really became a twenty-four hour shift, and under the most trying conditions. The furnishings of the operating- room were of the crudest kind. Packing boxes were used for instrument tables and seats for the anesthetist, a stretcher on two carpenter horses was the operating-table, while we had to put our solutions, etc, in tin cans, cooking utensils or stray bits of china ware. A pie plate made a splendid con- tainer for our alcohol sponges for "scrubbing up." I think it is pretty generally known that only non-transportable cases were cared for in the field hospitals, which meant all major cases, abdominals, amputations, severe hemorrhages and head cases. When the 32nd Division withdrew, we went back with them, and by another series of moves and short stops at various field and evacuation hospitals eventually reached Base Hospital No. 15 situated at Chaumont. At Chaumont, Dr. Long's assistant, Dr. Pierson, was given a team of his own, composed of Miss McClellan and Hospital Corpsmen Brady. Dr. Long's team, with Miss Elderkins as the only nurse, was ordered, on September 24, 1918, to report to Evacuation Hospital jSTo. 8, then near Souiily, seven miles from Verdun. Miss Elderkins wrote: It was noon of September 26 when we arrived after a forty- hour trip with no sleep and little to eat. . . . When I went to the operating-room to inquire about the baggage, I found Dr. Long already "scrubbing up" and he asked me to start the anesthetic of the patient upon whom he was preparing to operate. It was necessary to continue giving them until 9 p. m., so I did not have an opportunity to get into my gray uniform. I do not believe there was a better organized operating room in the American Expeditionary Forces than that at Evacuation Hospital Xo. 8. It kept the sterile nurse on the alert every moment, for at times an operation would be in progress on all the tables. I remember one night there was a bad chest wound and a laparotomy on the first two of my tables. At the next Dr. Hanson was removing a piece of shrapnel which had entered through the skull and was lodged somewhere near the ethmoid, while the other three tables con- tained minor cases. Again, I have seen six surgeons all working on the same case, where a long anesthetic was counter-indicated. Each surgeon would take a section of the body and the multiple SERVICE WITH THE NAVY 755 wounds would be cared for very quickly. Practically all tiie work was done by speciali!^ts in their own particular lines. Colonel Lilienthal of ]\lt. Sinai Hospital did most of the chest work; a Dr. Hanson of Minnesota was a wizard at brains; Dr. Long did all of the abdominal work and took over the chest cases when Colonel Lilienthal left, and later the head cases. We worked twelve-hour shifts, changing from night to day and vice versa, about every two weeks. . . . At the signing of the Armistice, two hundred and ninety members of the United States Navy Nurse Corps were in service in Great Britain and France. CHAPTER IX. KUESIXG SERVICE TO THE CIVILIAN POPULATIOX OF THE ALLIES The Children's Bureau in France The Refugee Bureau in France The Tuberculosis Bureau in France The Com- mission for Italy The First Commission for Boumania The Commission for Palestine The C ommission for Siberia WHEN Major Murpliy and his staff of seyenteen men, who formed the first American Red Cross Commission for Europe, sailed for France in June, 1917, they went with the purpose, as supplemental to the military responsibilities of the commission, of expressing* in relief work the sympathy of the American people for the civilian population of the Allies. Upon its arrival in Paris, the commission thus immediately created two departments : the Department of Civil Affairs and the Department of ^lilitary Affairs, the organization of which has already been given in Chapter YI. This chapter will give an account of American Red Cross nursing service in connection with the civilian population in France and Belgium, Italy, Roumania, Palestine and Siberia, as it was administered through National Headquarters and through the American Red Cross Commission for Europe. France, the battle ground of the war, was the theater of the most extensive relief work of the American Red Cross abroad. Of the eighty-six departments into which the French Republic was divided, in the Xorth one was wholly in tlie enemy's pos- session and nine others were partially so. The ^larne, the Aisne, the Sommo and the Oise regions liad been sytematically devastated by the (rcrmans in their retreat to the Hindenburg Line. A million and a half refugees fi'om th(>se provinces in 1017 were scattered in the central and southern parts of France, wandering, di>;eased, spirit-broken, seeking shelter, food and livelihood as best tliey could. There were in addition three millions in the occupied territory, the women and children 756 NURSING SERVICE TO CIVILIAN POPULATION 757 who had stayed in their homes and tliose who had been deported to Gorman J but who from December, lOlO, on were flung back to France at the rate of from one hundred to twelve .hun- dred a day. The work which confronted the Department of Civil Affairs of the American Red Cross in France fell into five principal classes: child welfare work; the establishment and maintenance of homes for refugees, rapalries and other exiles of war ; par- ticipation in a well rounded and comprehensive plan for the prevention of tuberculosis throughout France; assistance to civilians returning to the devastated areas and training of miitiles to enable them to earn their own and their family's livelihood. The Commission for France created within the Department of Civil Affairs five bureaus to deal separately with these five problems the Children's Bureau, the Bureau of Refug(>es and Relief, the Bureau of Tuberculosis, the Bureau of the War Zone and the Bureau for the Reeducation of M utiles. Homer Folks, of jSTew York City, joined the Paris head- quarters in July, 1917, as director of the Department of V\\'\\ Affairs. He had previously been engaged in social service and child welfare work in the United States and was the author of a history and various pamphlets dealing with these subjects. ^Ir. Folks upon his arrival in France appointed experts as directors of the various bureaus of his department and relief work was immediately started. Perhaps the outstanding misfortune which confronted France, a misfortune which, if not remedied, would penetrate into lier future and en(lang(>r her existence as a capital nation, was the condition of her orphaned, homeless, sick children, her babies whose devitalized mothers were engaged in war indus- tries, her lowered birth rate. Assistance to the children and women of France ()ff(>red opportunity for far-reaching service of a type which a])j)eale(l immediately and instinctively to the sympathy of the American peopk'. whose avatar tlu^ American Red Cross strove to l)e. To the (liildren's Bureau of tlie Paris otHce was entrusted this responsibility. Pediatricians and child w(>lt"are and public health nurses were the first need of the Children's Ihireau. On Auinist 12, I'.'IT, a ])i<)neer American lied ( 'ross pediatric unit, which consiste(l (if seven physicians, diie child welfare nurse aud three lavwoinen, ari'ived in I'"rance and foi-nied the micleus of Y58 HISTORY OF AMERICAN RED CROSS NURSING personnel of the Cliildren's Bureau. Dr. William Palmer Lucas, professor of Pediatrics of the University of California, was, director; Elizabeth Haywood Ashe was chief nurse. The other members of the unit were Mrs. Lucas, Dr. and Mrs. J. Morris Slemons, Dr. J. P. Sedg\vick, Dr. J. I. Durand, Dr. N. O. Pearce, Dr. John C. Baldwin, Dr. Clair F. Gelston and Rosamond Gilder, executive secretary of the Bureau. Miss Gilder, the daughter of the American poet and editor, Richard Watson Gilder, afterwards wrote the most comprehensive re- port of the activities of the Children's Bureau to be found in Red Cross archives, a report which this history will from time to time quote. Before sailing for France^ Dr. Lucas had asked that the personnel of his unit should include twelve public health nurses, but the Xursing Service at National Headquarters advised Dr. Lucas to wait until his arrival in France, as it was felt that among the many American nurses already in France an ample number would be available for this type of work. A memorandum which was prepared by the Nursing Service for Dr. Lucas before he sailed, gave the names and addresses of Alice E. Henderson, formerly supervising nurse of the French units of the Mercy Ship Expedition, then in Pau ; IMary K. Nelson, Helen Kerrigen, Marion McCune Rice, Josephine Clay and Emma J. Jones, then at Evrcux ; Margaret Dunlop, then thought to be in England ; Grace Barclay Moore, at Dr. Blake's hospital in Paris, and Caroline Hatch, at Ris Orangis. Immediately following the arrival of the unit in France, Dr. Lucas undertook a complete survey of the child welfare situation. He found that cities, towns and villages had been drained of medical personnel by the exodus of physicians and surgeons from civilian practice to military service. Twenty- five to fifty per cent fewer physicians were available in the larger cities in 1917 than in 1914. St. Etienne, with a popu- lation of 180,000 in 1914, had had the services of 120 physi- cians; in 1917, with an increase of population to 250,000, it had the services of only 14 physicians. France possessed no group of professional nurses comparable to that which existed in the British Empire and in the L^nited States. Before the outbreak of the European "War, the birth rate of France had exceeded the death rate by a margin just enough to keep her total population at a slight increase. Two factors developed during the war and caused the birth rate to fall NURSING SERVICE TO CIVILIAN POPULATION 759 materially the presence of the men in the trenches and the entrance of women into indnstry. Previons to 1914, only five thousand women had been employed in factories; in 1917 eight hundred thousand were so employed. In the meantime, war casualties had increased the death rate to unprecedented proportions. ''With this increased death rate and with the inevitable diminution in birth rate," wrote Dr. Lucas, "the result to-day is that the birth rate is forty per cent lower than the death rate, a figure which no country has ever reached before except as it began to pass out from among the group of first-class nations . . ." ^ France, herself, was making heroic efi^orts on behalf of her children. Dr. Lucas summarized the maternity and child wel- fare legislation; . . . Certain definite steps had been taken to ameliorate the condition of women in the factories, most noteworthy among them being Paul Strauss's law of August, 1914, which allowed an allocation of one franc a day for a mother one month before tlie birth of her child and 1.5 francs per day for four weeks after the birth of the child. This had a powerful influence in increasing the birth rate and it was one of the objects of our cani])aign to see that this law was put into force throughout the country. The conditions of the Koussell law making it mandatory for factories to have chamhres d'aUaite- rncnt and creches for nursing mothers and babies, and the creation of factory inspectresses to see that these laws were carried out, showed the earnest intent of the government to right as far as possible tlie deplorable conditions created by the war. In the Academy of ^Fedicine throughout the whole period of the war, the discussion relating to infant mortality and the lowered birth rate ebbed and flowed. Every one is familiar with Pinard's firm stand against the employment of women in factories. . . . To save France, the women had to work and the French mother preferred to work, although it jeopar- dized the future to save the present. ... In conjunction with the Ligue conJre la MorhtlUe InfuntUe and the federal gov- ernment of tlie l)e])artment of tlie Interior, the Service de Sante. tlie ('hildren's Bureau of tlie American l\ed Cross worked out a definite ])rogram. In ih(> Ligue are the fore- most representatives of the niedical ]U'ofession in I-'rance ' "Uctl Cross liifniit Mnriality CaiiijiaiLrii in Fniriet'"; Dr. Win. 1^. T.iicas, la'pnrt (if tlu' C'liildrcirs liiiri-au. I'osaiinuKl (iildor, \'()1. III. p. 14!t; J.iliiarv National lifa(l(|uarters, W'asliiiiLrtoii. D. V. 760 HISTORY OF AMERICAN RED CROSS NURSING interested in women and childhood, as well as the most intel- ligent social workers, philanthropists and educators. Senator Paul Strauss, author of ftie beneficent law referred to above, is its president. Dr. Marfar, of international reputation as a pediatrician, is its first vice-president; Dr. Le Sage, another well-known pediatrician, is the secretary of the Ligue. With the advice of these experts, Dr. Lucas adopted simple but fundamental policies to govern the development of the Children's Bureau. He believed that preventive measures were far more forceful in lowering infant mortality than cura- tive measures and that "these preventive measures must start in the prenatal period and must reach every mother a long enough time before the birth of her child to insure as nearly as possible a normal pregnancy and a healthy child." He felt that "every baby should be followed up so as to prevent illness."^ Preventive measures for the infant had originated in France in 1891, when Budin had first established Nourrissons Clinics. In 1917 many of these clinics existed throughout France, and one of the first duties of the Red Cross Children's Bureau w'as to offer assistance to those in operation, to help reopen those which had been closed during the war and to assist in starting new ones where they never had existed. To secure a personnel to carry on the "follow-up work" which Dr. Lucas felt to be imperative, the Children's Bureau undertook to recruit and train groups of health visitors by giving short intensive courses of instruction to French women who had been working in French military hospitals and who had had Red Cross training of various types. With these policies to govern constructive child welfare work and with unlimited funds and supplies with which to render emergency relief, the Children's Bureau set- tled down in September, 1917, to its gigantic yet elusive task. ]\liss Ashe, the chief nurse of the Children's Bureau, was born in California. Immediately following her graduation from the Presbyterian School in New York City, she returned to her native state and became director of the Telegraph Hill Neighborhood Association in San Francisco. ]\Iiss Ashe was a woman of strong personality and resolute will and had had many advantages of birth and education. In her manner six; was direct, blunt, fearless and often impatient 'Gilder Roport, \o\. HI, p. 110. NURSING SERVICE TO CIVILIAN TOPULATION 761 always so of what she called red tape. She held the interests of the needy children of France and Belginm close to her big heart and she went abont her work of alleviation with a swift, fearless and brilliant power which entitled her to a goodly share of the credit which the American Ked Cross nursing service in the Children's linreau deservedly earned. During the pioneer months of 11)17, the organization of the Nursing Service in France, as had been said before, was im- perfect. Miss Russell, chief nurse of the American Ked Cross in France, was in the Department of Military x\ifair3 and ^liss Ashe, chief nurse of the Children's Bureau, was in the Department of Civil Affairs. The two departments had different chiefs and different policies. The division in organi- zation tended to separate the military nursing service from the public health nursing service, yet ]\Iiss Delano and ^liss Xoyes regarded ^liss Ashe's bureau as a subdivision of Miss Kussell's bureau. All American Ked Cross nurses sent overseas for military and civilian work were instructed to report to !Miss Kusscll ; she in turn assigned them to ^liss Aslie. ^liss Ashe felt that this organization w'as unreasonable and inefficient and made vigorous protest regarding it to the ^N^ursing Service.^ ^liss Xoyes explained to ^liss Ashe that "it seems only good and logical administration for us to send our nurses and nurses' aides to the Paris llead([uarters to report, as !Miss Kussell is the representative of tlie Xursing Service in France and as cablegrams for nurses come through Paris Headquarters. By assigning the nurses to the Paris office," she added, "there is on(> place in which a complete record is maintained of the arrival and assigniiient of all luirses to Europe." As has been suggested, ^liss Ashe was hampered in the de- velopnuMit of lier service by a shortage of public health nurses, but throughout the autunni and winter of l!17, and the spring and summer of 1!)18^ Xational llead(iuarters sent units of public licaltli nurses as rapidly as they could be withdrawn with safety from ])ositiins in the United States and could be trans- ported to Fi'anee. to Paris to supply civilian nursing needs. Harriet L. Leete, whose brilliant professional attainments have been outlined in the section which relates to her service as chief nurse of American Ked ('ross Military lliisi)ital Xo. ft, was the llrst nui'se to join Miss Aslu'\s statf. As _Miss ^ Sfi' IcttiT written Di'ccinhcr 1!>. I!tl7, by l-]. 11. Aslic to ('. D. Xoyes, with aiisuiT of C. U. N'o\rs attaclu'cl. 762 HISTORY OF AMERICAN RED CROSS NURSING Ashe spent much of her time in the field, Miss Leete was as- signed to the Paris office and upon her devolved the routine work of directing the public health nursing activities of the commission during the fall of 1917. The most authoritative nursing report of the Children's Bureau which Miss Delano and Miss Noyes saw until after the Armistice, was sent by Miss Leete to Miss Russell, under date of December 3, 1917, and was in due time forwarded by Miss Russell to National Headquarters. Early in 1918, Miss Leete was placed in charge of the instruction of visiteuses d'enfants at Paris. In May she became chief nurse of the Tent Hospital. Marie T. Phelan and fifteen public health nurses of promi- nence in the United States sailed for France on September 16, 1917. Miss Phelan was head nurse of this unit. She was a graduate of the Rochester City Hospital, Rochester, New York. She did public health and tuberculosis nursing in Rochester and was later assistant superintendent of the Child Welfare Society in Chicago. She was a woman of mature judgment and excellent executive ability and was recognized as one of the pioneers of the public health nursing movement in the United States. Her affiliation with the Red Cross had come through the Rochester Chapter in 1907. National Headquarters sent a second unit of child welfare and public health nurses to the Paris headquarters in Novem- ber, 1917. Dr. J. H. Mason Knox, of Johns Hopkins Uni- versity, Baltimore, who later became associate director of the Children's Bureau, was in charge of this group. A third unit arrived in Paris in December. From time to time during the following ten months, National Headquarters sent over addi- tional groups of public health nurses. Manifold difficulties attended the selection and assignment of nurses for service with the Red Cross Commission for Europe. Miss Delano and Miss Noyes were combing the country for nurses for the Army, the Navy and the U. S. Public Health Service. The exodus of nurses from hospitals, training schools and public health nursing organizations into military service, placed in jeopardy the health of the civilian population of the United States. The Nursing Son'iee was loath to ask public health nurses to volnntcer for civilian relief work in France or Italy or the Balkans when the need for their services was so great at home. The executives and physicians of the Commission for Europe NURSING SERVICE TO CIVILIAN POPULATION 763 controlled the policies of the American Red Cross in Europe and they were zealous of doing everything in their power to aid the Allies. Civilian relief was an immediate and natural expression of this desire and public health nursing was acknowl- edged to be an efficient instrument in civilian relief. The War Council at National Headquarters was resolute in its determi- nation to support the Commission and to carry out, as far as possible, all its requests; they thus brought pressure to bear on the Nursing Service. Miss Delano's opinion carried great weight with the members of the War Coimcil. She strongly questioned the wisdom of withdrawing large numbers of nurses from American institu- tions to assign them to extensive civilian nursing service in France. After the nurses arrived overseas, local conditions often did not permit their. immediate assignment to the highly specialized phases of nursing service for which they had been sent to France. Miss Uelano appreciated, however, that since she was not in the field, she must accept the recommendations regarding the development of public health nursing of those who were in the field, even though her knowledge of the public health situation in the United States led her to question the soundness of these recommendations. She felt that she could not go overseas and see for herself, because the chief duty of the Nursing Service was to secure nurses for the Army and she felt her presence was needed in this country to r.cccniplish that end. Uncertainty was present in her :.i:::J reg.;rJ".:;g the wis- dom of developing this extensive servic? fur tli: civr.Lin popula- tion and the resulting anxiety formed cue oT thv great burdens which weighed upon the shoulders of I'Ass Delano and Miss Noyes. The War Department established passport rulings which materially increased the difficulties under which the lied Cross was already laboring to secure nurses.'* Notable among these * Under date of February 2.3, 1918, the Secretary of State wrote to National Headquarters: "I deem it important to call your attention to the fact that this Department, upon request of the War and Navy Depart- ments, lias for some time been declininf; to issue passports for Europe to near femali' relatives (tliis is. wives, dau^diters. motliers and sisters) of Army and Navy ofhcers. Tlie Department considers it advisable to follow the same policy witli re^-'ard to the issuance of passj)orts to near female relatives of persons who are sent to luirope for the Red Cross." I'nder date of June 7. 1!)18, l?rif:adier (ieneral William S. Graves, assistant to tlie Cliicf of StafT. National Aiiny. wrote to the associate Director of tlu' Amci-ican Red Cross l?ureau of Personnel, in part, as follows: "The Secretary of War . . . has . . . ado])te(l the followinf;^ 764 HISTORY OF AMERICAN RED CROSS NURSING was the so-called "brother ruling," which forbade the issuance of a passport to any nurse who had a brother in military service. In one group of thirty nurses ready to sail eleven were held because they fell under this regulation. During the summer of 1918 the "brother" restriction was removed and the Nursing Service was able to send many more nurses to France. National Headquarters also sent over nurses' aides for serv- ice with the Children's Bureau. Thirty aides were called for by Dr. Lucas in November, 1917, for work in connection with children's hospitals and orphanages and the first group of them arrived in Paris on December 15. Other units were subse- quently sent. Nurses' aides were required to be able to speak French fluently and to have volunteered their services. Many also paid their own expenses. National Headquarters also re- quired that they undergo the training and pass successfully the examination for nurses' aides which has been outlined in a preceding chapter. They were instructed to report upon ar- rival in France to ^liss Eussell and to work under professional direction. They were usually housed with American Ked Cross nurses in the various children's hospitals, dispensaries and other establishments maintained by the American lied Cross in France. On the whole, they rendered excellent service. "Up to August 1, 1918," stated the Gilder Report of the Chil- dren's Bureau, "not one moral question had arisen in relation to any aide in this service nor had any complaint been received from any nurse or doctor as to the poor work or lack of discip- line of any aide. The Nursing Service at Washington should receive the credit for the high state of efficiency of this branch rules: 1. Under no circumstances will tlie War De])artmcnt approve the issuance of passports to go to Europe for the wives, mothers, sisters or daughters of the following classes of persons: Officers or enlisted men of the United States Military Forces: male civilians employed witli the Red Cross, Young Men's Christian Association or otlier organizations of a similar nature, that may Ije in Europe; civilians employed or attached to tlie American Expeditionary Forces. "'2. Any of the female relatives enumerated in paragraph 1. who liave recently been to Europe })ut at present are in tlie United States for any reason whatsoever, are now included in the restriction imposed by para- graph 1 abo\e. ' '3. It is quite useless foi- any one Ixdoiiging t(j tlie restricted classes, cited above, to request an e.\ce])tion in her case as no exceptions will be made.' "It is realized that this ]Hilicy may (kqirive the American organizations now cooperating with tlu' Army in France of desirable material from t'wf to time, iiut it is bclicvcil fnircr and wiser t(j adopt and announce a policy which will undoubtcdU be Uir the best interests of all concerntx'."' NURSING SERVICE TO CIVILIAN TOPULATION 765 of the service, as it was the result of their careful selection. . . . Untrained women as they were, the majority of them coming from luxurious homes, they never murmured at any task . . . and the nurses were unstinted in praise of them." The activities of the Children's Bureau looped France, from Toul southward down the valley of the Rhone, from Marseilles on the ]\iediterranean to Bordeaux on the Bay of Biscay, and northwards through Blois, Corbiel, Paris and liouen back to the devastated regions of the Manic and Aisne valleys. To recount all the activities of the Children's Bureau in the many diverse forms of child welfare work would lie outside the province of a history of the Nursing Service ; only the projects in which nurses participated have a definite place therein. However, this was no small part, as will be shown in the fol- lowing pages. The first call which came to the Commission to Europe was a children's call, from the Departement M eurthe-et-M oseJIe. The rich grain fields surrounding Nancy and the city itself, where mills were humming with essential war industries, were under fire from German asphyxiating bombs and shells. The peasants wore gas-masks and reaped the harvests but the children were too young to wear the masks and had to be cared for elsewhere. They were gathered together and taken to Toul, which lay immediately to the southwest of the Nancy district. On July 20, lUlT, ^1. ]\lirman, then prefet of the Meurthe- et-MoscUe, telegraphed to the Committee of the American Fund for French Woundcnl that three hundred and fifty children had suddenly been put in his charge and that he had nothing but a temporary shelter for them in some old barracks at Toul. He asked for assistance at once. Mrs. Isabel Latlirop, president of the Committee for the American Fund for French Wounded, to whom the telegram was addressed, brought it to the newly- established headciuai'ters of the American Red Cross in France. jMajor ^lurphy asked Dr. liobert Davis to answer the call. Within a few hours .Mrs. Lathrop, Dr. Davis, another physi- cian, a nurse, two aides, a bacteriologist, an administrative director and two women to look after supplies were on their way to Toul in cars loaned by the American Fund for Krencli Wounded. Another caniionette which carried milk and cloth- ing fdllowed tlieni. They ai'rived late that night and fmind the three hundred and tifty children, twenty-one of whom were babies under tweh'e inimths of age and the others young chil- 766 HISTORY OF AMERICAN RED CROSS NURSING dren less than eight years old, huddled together in an old bar- racks, which was dirty and practically unfurnished, with no sanitary arrangements whatsoever. "The sick children were crowded in with the well ones," wrote Mrs. Lucas, wife of Dr. Lucas. "Skin diseases were prevalent and vermin abounded." On the following day Prefet Mirman and the representatives of the American Red Cross set up a temporary organization. M. Mirman stated that the French Government would furnish new and sanitary barracks constructed of brick and cement, of a capacity for housing 800 persons; would provide lighting, coal, water and food in the government rations furnished to all refugees ; would assign soldiers to do the heavy work and em- ploy the necessary unskilled w^omen's labor, and would supply beds, bedding and clothing and all transportation of supplies from Nancy or Toul. The American Red Cross agreed to take over the complete direction of the center, to furnish doctors, nurses, drugs and all hygienic equipment, all extra diets and all supplies and equipment necessary for the recreation of the children. From this beginning the "Toul project" of the Children's Bureau developed, with the cooperation of Prefet Mirman, the Committee of the American Fund for French Wounded and the American Friends' Unit, into a children's home known as the Asile Caserne de Luxembourg^ with a capacity of 500 ; a Children's Hospital ; a Maternity Hospital ; a dental depart- ment ; a system of dispensaries, and a second refugee asile at Fellering, in the Vosges. At the children's home, the As'ile Caserne de Luxemhourg, the Red Cross set up and maintained a diet kitchen and the French Government established school and church services. Dr. John P. Sedg^vick was first in command of the Asile Caserne de Luxemhourg ; on December 1, 1917, Dr. !^laynard Ladd, of the Harvard ]\[edical School, was placed in charge of the work of the Children's Bureau in the Meurthe-et-MoseJle. "Miss Phclan," wrote Miss Lecte to Miss Russell on Decem- ber 3, 1917, "is in charge of the group of nurses at Toul and has been doing remarkable work under most trying conditions." Six Army nurses on detached duty and three American Red Cross nurses, Eugenia L. Acevedo, Helen Z. Gill and Laura E. Krcamer, scrubbed and painted the long, dirty barracks, set up and made the small white beds and got the hospital ready for tlicir young patients. It was opened late in October, 1917, NURSING SERVICE TO CIVILIAN POPULATION 767 and in the next two months admitted over 150 cases of measles alone. At first the hospital had only one operator, one assist- ant, two etherizers, one set of instruments, one stove ("very French," a nurse described it) and no running water. Later the lied Cross supplied excellent equipment. "In nine months," wrote Gladys H. Porter, one of the nurses later as- signed to duty there, "we operated on about eight hundred cases, a record of which the most modern hospital might be proud, much more one in the war zone. Our first big rush was a drive on tonsils." In a letter addressed to the American Journal of Nursing, Miss Plielan wrote of Toul : This is an old walled city and is wonderfully interesting with its crooked streets and narrow passages leading back to interesting looking courtyards. There is an old cathedral here, some parts of which date back to the twelfth century. The Caserne is located on a hill outside the city and was formerly used for barracks. I came up here to take charge of the nurses and my first commission was to prepare one of the long, ugly buildings for a hospital. It looked discour- aging five weeks ago, but to-day it is really attractive. We never could have done what we have if the Friends had not sent us five young men. The Friends are doing some of the best work that is being done in France. These boys are all college men, but they can do anything and everything and do not hesitate to undertake the most menial labors. We are having an epidemic of measles just now; we have fifty pa- tients to-day. Tliere is very little acute illness. Most of tbe children have scabies, impetigo and heads, just the conditions we find in some branches of public health work at home.-'' After the period of pioneering was over, Miss Phclan re- turned to Paris and the direction of the luirsing activities of tlu! Asile CdscDie was assigned to Josephine Ellet. Miss Ellet was graduated from the Johns Hopkins School in May, 1917, and had been in charge of a ward of the pediatric department there until she sailed in Xovember for France. She was a Viig'inian by birth and was a young luirse of intelligence and ability. In January the Children's Hospital opened a surgical ward for peasant women from t\w surrounding neighborhood. ' A))i( ri( an JdUDt'il of Xuraing. \(A. X\'III, p. 487. 768 HISTORY OF AMERICAN RED CROSS NURSING Exhausted from manual toil in the fields, privation and the sufferings of the past four years, these women were in great need of medical attention and the surgical division of the Chil- dren's Hospital averaged six major operations daily four days each week. Helen Z. Gill was head nurse. The hospital at the Asile Caserne received 1042 patients, of whom 12 died. Six hundred and forty-eight operations were performed. A Maternity Hospital was opened on March 1, 1018, at the Asile Caserne. The Germans had bombed a maternity hospital at Nancy the day before and Prefet Mirman telephoned to Major Ladd to ask if the Eed Cross would take care of the ex- pectant mothers and other patients. Major Ladd consented and several of the nurses, two French women and the Quaker orderlies converted one of the barracks of the Asile Caserne into a hospital in six hours. ''At four o'clock that afternoon," wrote Miss Ellet, "the patients arrived and our first baby was born two hours later." The Red Cross furnished clothing, if it was needed, to the mother, and supplied layettes for the babies. If a pregnant woman had children at home and if her husband was at the front, she was allowed to bring her children during her con- finement to the Asile Caserne, where they too were cared for until slic was well enough to go home. Before leaving the hospital, each mother was taught to bathe and care for her child and was shown proper methods of feeding it. If the mother was unable to nurse it, a supplementary feeding was provided and given under sterile conditions. When the mother was well enough to go home, she was given written instructions regarding the care of the child and was urged to rt^port at regu- lar intervals to the American lied Cross dispensary nearest her home to have the baby examined. This dispensary service which radiated out from Toul through the M curilie-el-Moselle and the Vosges was an im- portant pliase of child welfare work in France. In December, 1917, the American Fund for French Wounded and the Ameri- can Ked Cross entered into agreement to establish joint dis- pensaries in centers where none had previously existed or where there was a dearth of loeal medical care for the civilian popula- tion. The system consisted of seven base dispensaries wliieli operated twenty-six sul)-dispensarv units and two creches. The personnel of a base dispensary unit usually consisted of a doc- tor, two public licaltli nurses, an aide and a chauffeur to drive NURSING SERVICE TO CIVILIAN POPULATION 769 a camionctte. The doctor and the nurses established head- quarters at the base dispensary and then made the rounds of the sub-dispensaries in the camionette. Dr. Karlton G. Percy was the medical director of the system. Base dispensaries were located at Toul, Nancy, Luneville, Neuve Maison, Gerbeviller, fipinal and Foug. The Nancy group, which included seven sub-dispensaries, was entirely financed by the town of Winetka, Illinois. The Luneville group of six sub-dispensaries was financed in part by the Des- titute Babies' Aid Society ; the Gerbeviller group was supported by the American Fund for French Wounded ; fipinal by citizens of Baltimore, IMaryland, and Minneapolis, Minnesota; Neuve Maison by citizens of St. Paul, Minnesota. The dispensary service worked in close cooperation with the Asile Caserne de Luxeinhmirg. When children or women in need of operation or prolonged medical care were found in the radius of the sub-dispensaries, they were sent to the Children's Hospital or to the surgical or maternity wards. Early in March, 1018, a colony of nine hundred refugee children from the Nancy district were sent under the patronage of Prefct ^lirman to Dinard, where the warm sun on the beaches and the fresh salt air helped to drive tuberculosis from their emaciated bodies. They went under the chaperonage of French teachers and principals from the Nancy schools. Dr. 3\arlton G. Percy, chief of the Red Cross dispensary system in tlie M eurthe-et-M os"lJe , and several Red Cross nurses accompa- nied the convoy from Toul to Dinard and remained there until a permanent statl' was sent up from Paris. Mary (1 Nelson, a nurse who had gone to Franco in November, 1017, with the Rockefeller ^J'liberculosis Commission, was one of tlie nurses and she remained at Dinard as supervisor. Dr. !May Allen was the medical director. Dinard was practically deserted during the war. The HnfcJ BoijnJ was taken over for the girls and the boys were housed in another hotel at St. Lnnaire, on the seashore five miles west. Both of these hotels had been used by FrcMich troops and the military autli()i-iti(\'^ had left some Ix'ddiiig, l)eds. dishes and other (Mjuipnient. 'Flie walls were damp and in many places the pajx'r hung in tattered strips, but the floors were compara- tively cl(^in. Or. Allen secnred French women to clean the hotel's. Not the least of Dr. Allen's and Miss Nelson's dith- cnlties was the problem of lanndering some large, heavy and 770 HISTORY OF AMERICAN RED CROSS NURSING exceedingly handsome sheets which wealthy residents of Dinard presented to the colony. The Children's Bureau established a dispensary with a small infirmary at Dinard and treated from forty to fifty children every day, furnished all sick and anaemic children with nour- ishing food and provided clothing, linen and drugs as needed. The children suffered from tuberculosis and diseases due to malnutrition. Their hands were covered with sores, "which in many cases went as deep as the bone." ^ Some had scabies and at first vermin were a veritable plague to them all. During the month of May, 1918, the total attendance at the clinics was 2540. Eighty-one children were cared for in the infirmary. At this time three American Red Cross nurses and six aides were on duty at Dinard. A second colony which consisted of 110 girls was installed in a chateau at Damarie-les-Lys near Melun and the Children's Bureau supplied medical and dental treatment. Throughout the spring and summer of 1918 the Toul project expanded and flourished under the happy cooperation of Prefet Mirman, representing the French Government, Mrs. Lathrop, representing the Committee for the American Fund for French Wounded, and Dr. Ladd of the American Red Cross Children's Bureau. In September, however, the military needs engulfed the work for the civil* population ; American troops went into action at St. Mihiel and the Asile Caserne de Luxemhourg was converted into an evacuation center for American wounded. In August the children were sent to I^eufcluitcau, ]Nancy and Lyon. The Asile Caserne with its hospitals was transferred from the Department of Civil Affairs to the Department of IMilitary Affairs and was expanded in a week to a one thousand bed military hospital. The nurses already at the Asile Caserne were taken into the military service and "casuals" were ruslied up from Paris Headquarters. An American Red Cross mobile unit with j\Iajor i\IcCoy as commanding officer and ]\liss Meirs as chief nurse, took possession of tlie Asile Caserne on September 11 and established American Red Cross Hospital No. 114 and at dawn two days later one thousand American wounded had cora(> back from St. ]\rihiel. The Af city, tlu^ American lied Cross welfare station was abandoned. ^Miss Potts wrote: 774 HISTORY OF AMERICAN RED CROSS NURSING On March 23, the Germans for the second time advanced with lightning speed and a few days later left little Xesle a heap of ruins. On that twenty-third day of March we evacu- ated very hastily in a large camion with a hand-bag each and with what supplies we could gather together. We took with us an eight weeks' old baby, a girl of fourteen who had tuberculosis, several burned and several convalescent cases and hurried to Koye, southwest of Xesle. The noise of battle was quite as terrific there as it had been at Xesle and we soon evacuated again, with refugees from Ham, Xesle and villages all along the line. We started by camion for Montdidier, but progress was slow through the congested traffic of terrified refugees, carts, cattle, dogs, geese and pigs. Miss Brogan and I went to Amiens, to find the mother of our eight weeks' old baby Daniel. He had been fed at 7 a. m. but we could not find food for him until three that afternoon ; an infirniiere at a hospital at Amiens then gave him a little milk. . . . Dirty with camion and train dust, jostled and jolted, hungry, tired and sleepy, he had never whimpered through the journey. Complete records of the Red Cross child welfare station at X^esle were lost in the evacuation of the city. At Amiens, as at iSTesle, the work of the Children's Bureau was destroyed almost before its complete initiation. In August, 1917, a public health nurse, Annie A. Rathbone, had begun to do visiting nursing under the auspices of the Secours Ameri- caines j)our les Refugees. Her expenses were at first paid by Major Richard A. Cabot, but soon afterwards the work was supported by the American Red Cross and ^liss Rathbone was attached to ]\Iiss Ashe' service. jMiss Rathbone's duties at Amiens consisted in visiting from house to house among the 11,000 refugees. Until such time as the Red Cross could arrange to assign a pediatrician to permanent duty at Amiens, she distributed food and assisted at a clinic which was con- ducted by a French physician. The long anticipated arrange- ments were finally completed early in 1018 and Dr. Baldwin, of Xesle, held his first clinic about the middle of Marcli. A second nurse. Miss Flanagan, was sent up to assist Miss Rath- bone. However, at dawn on ^March 21, the enemy launched his offensive at the junction of the French and British lines near Cumbrai and the possession of Amiens hung in the balance NURSING SERVICE TO CIVILIAN POPULATION 775 while Gough's Fifth Army, cut off from the British at Arras and the French at Le Fore, struggled in chaotic disorganiza- tion until French and British reenforcements came up on March 26, filled the gap at IMoreiul and slowed up the German drive. Amiens did not fall, but the civilian population fled from the city on the sixth day of the offensive. Miss Rathbone, Dr. Baldwin and the nurses from Nesle, the members of vari- ous American colleges and the Friends' units fell back in the general evacuation to jMontdidier and Beauvais and thence to Paris. Records of the American Bed Cross child welfare station in Amiens were lost in the evacuation of the city, an account of which appears later. vian-les-Bains, the gateway through w'hich the Germans flung back to France inhabitants of the occupied northern provinces, who were too old or too young or physically unfit for military purposes, was a town with a normal population of about 2000, situated in France a few miles from the Swiss border on the slopes of the hills which rise above the southern shores of exquisite Lake Geneva. Nearby were the French villages Annemasse and Thonon ; the snow-capped ranges of the Bernese Oberland rose in the east. In peace times Evian had been one of the smartest and most expensive of the French watering-places. However, in 1917 and 1918, its two Ritz hotels, its casino with theater, gambling rooms, restaurant and music hall, its alkaline springs and bathing establishments, its parks and boarding houses were daily the scene of a woeful influx of rapatries. Tlie reception which the French Government extended to its rapatrie citizens was a cordial and efiieient one. Representa- tives of the Minister of the Interior established in the Kvian Casino a smoothly running system of reception, entertainment and distribution to other parts of France of all rapatries who entered Evian. Two convoys, carrying about six hundred and fifty people eaelij arrived daily, the first at six o'clock in the morning, the second at four o'clock in the afternoon. Two French nurses and a French physician attached to the goveu'n- ment service boarded the trains at Boub(>ret Station and r(^- ceivcd from the hands of the Swiss nurses who had aceonipanied the rapatries to the French frontier, a list of all the sick, in- firm and old on the convoy who nocdc^d attention. Fn route from Boubcrct to I-lvian, a numbered liai:" was uiven to each family and the rapatries were instructed to put their 776 HISTORY OF AMERICAN RED CROSS NURSING belongings in tliem. They were then given checks and the bags were stored at the station at vian until the owners claimed them upon leaving the city. A list of all the people in the convoy was also made out, to be given to the Commissaire Special upon arrival at Evian. With flags flying and a band playing, all Evian met the con- voy trains. Sometimes a train was made up of third-class carriages ; again it might be composed of cattle cars, but as it came winding slowly around to the station the windows or the apertures were black with outthrust heads and waving arms. On the platform nurses, ambulance drivers, rapatries, govern- ment officials and local committee members cheered and waved their flags in response and as the train drew in, stretched out eager hands to help the weary rapatrie dismount. Some cheering and singing, others with the easy tears of age running down their cheeks, still others dazed and silent, the old women and men, the sick mothers, the thin, curious-eyed children set foot again on French soil and marched down the narrow street to the Casino, with the band playing bravely at the head of the straggling line. In a big cheerful room of the Casino hot food was served to them and the prefet of the Dis- trict welcomed them home. The band struck up the Marseillaise and they sang, haltingly at first, then with a great cry "Mar- chons, MarchonsV^ that rang to the flag-draped ceiling.^" The next step was that of identification. A card was given each rapjatrie which enabled him to draw allocation and an efi'ort was made to act in touch with his relations. If clothing was needed, it was issued. Medical examination followed ; carriers of parasites were segTegated and treated ; those too ill to go on were detained at Evian for hospitalization. Those who were in good health, who had means of subsistence and who did not desire government assistance in traveling, were allowed to go, at their own expense, to whatever locality de- sired, exceptions being Paris and tlie war zone. Those who had been claimed by relatives and desired to travel at govern- ment expense were hospitalized at Evian for the moment but were allowed to leave either by the first convoy out or to go individually as soon as arrangements could be made. Those who were waiting to be claimed by relatives were cared for by "For an excellent ileseription of tlie ari-ival of rapntrir trains in Evian. see "Tlie Children of France and the Red Cross," Ijy June Richardson Lucas, pp. 111. Frederick A. Stokes Company, 1918. NURSING SERVICE TO CIVILIAN POPULATION 777 the government at flvian or at Thonon or Annemassc. Those who were not claimed after a due period of waiting \yerc sent to rapatrie centers which were maintained by the govern- ment. Early in September, 1917, T)r. Lucas went to l^^vian to ascer- tain if assistance from the C/hildren's Bureau would be needed, and if so, acceptable. He found that only thirty-five beds were available in the entire region for the hospitalization of children. Moreover, no systematic m(>dical examination was given to the children as they passed through ]^]vian, to find out if they were in fit condition to continue on their way, and already complaints had begim to come from various parts of France that rapatrie children were bringing in virulent contagious diseases. On September 27 Dr. Lucas took Dr. C. F. Gclston, of San Francisco, a member of the original pediatric unit, and ^Ir. W. C Stevenson, an administrator, to fivian. A conference was held the following day between officials of the French Department of the Interior, the Service dcs Rapatries of Evian, the Comite au.v Rapairies de Lyon and the three Americans. It was decided that the American Eed Cross should establish a medical service at the Casino for the examination of every rapatrie child immediately after its arrival in Evian and a hospital nearby to take care of the children who were not in condition to continue on their way.^^ In an alcove of the main hall of the Casino Dr. Gelston set up his examining booth. The equipment was simple, three chairs, an electric light, a table with toninie depressors, a stetho- scope. All the rapairies filed through this hall of the Casino and as the line moved forward an American Red Cross aide stopped all children under sixteen and led them over to the booth. Here another aide assisted the iVmerican doctor while he examined the child's throat. A nurse stood by to take sta- tistics and remarks on each child as they were called oil* by the physician. After examination another aide tagged the child for treatment at the American dispensary, at the dentist's or at the Children's Hospital. Healthy children were allowed to go on immediately with their parents or guardians to other parts of France. The nearby Ainerlcan Ivcd Cross Children's Hospital was established in the Hotel da Chatclcl, which had l)e(^ii built in "Report of the Pa>d Cross Children's I^ireaii. rvusaiiiond OiLler. Vol. TIT. p. IS. 778 HISTORY OF AMERICAN RED CROSS NURSING a handsome park on a sloping hillside above Lake Geneva. Several private villas nestled among the rose gardens and flowering shrubbery and these were utilized for various pur- poses, one as a dispensary where both dental and medical work was done, another as a temporary orphanage, a third as nurses' quarters. The Hotel du Chdtelet itself had many open bal- conies and long windows, so the large, high-ceilinged rooms were flooded with sunshine and fresh air. On October 19, 1917, nine child welfare nurses, with Miss Ashe in charge, went up to Evian and opened the Children's Hospital. Fifty children were admitted and twenty-one dis- charged during the first week of its maintenance. The mala- dies from which these patients suffered included measles, chicken-pox, scarlet fever, diphtheria and tuberculosis. Some of the skin diseases resulting from undernourishment were in advanced stages and very repulsive. Following Miss Ashe's return to Paris after the first days at Evian, Miss Helen King, a laywoman, was placed in charge at Evian, She became ill and a Red Cross nurse, Susanne Hoskins, was put temporarily in charge. In December, 1917, Helen Almy Bigelow, a Massachusetts nurse, arrived at Paris Headquarters and was immediately assigned to Evian as chief nurse. ^liss Bigelow was a graduate of the Children's Hos- pital, Boston. She had done public duty nursing in that city and had had institutional experience in the Cleveland City Hospital. She later was supervisor of the pediatric service of the JSTew York Xursery and Child's Hospital and resigned from this position to undertake work with the Children's Bureau. The number of nurses at Evian varied. On December 3, 1917, there were twelve. For the major part of the time the number was maintained at a strength of fifteen graduate nurses, four American aides and ten French aides. The employment of American aides on a comprehensive scale was soon found to be impracticable. Their lack of training in the care of con- tagious diseases made them of little use and, moreover, they were constantly contracting the diseases because they did not know how to take care of themselves. Dr. E. J. Lappo, of Portland, Oregon, was medical director of the Chatelct Hospital until January 15, 1918; he was then transferred to Xeslc and Dr. Crelston took over the direction of the Children's Hospital in addition to his work in exaniiiia- NURSING SERVICE TO CIVnJAX POPULATION 779 tion of children at the Casino. Dr. Florence Child was the resident physician at the Chatelet Hospital ; Dr. Dorothy Child was the dispensary and laboratory doctor; Dr. Raymond Mix- sell, of Pasadena and Dr. E. K. Armstrong, of Chicago, later were in turn medicin-chef of the Chatelet Hospital. Mr. W. C. Stevenson was in charge of administration. The rapatrie children who filled the sunny rooms had known to the full the hardships of existence in a country occupied by the enemy. Many of them came to the hospital with their stunted little bodies clothed in rags. Their eyes, which pecj-ed out big and black from pinched cheeks, were full of a wisdom and a hunger that greatly endeared them to the American nurses. The Germans closed their frontiers on February 26, 1918, and the convoys stopped, but on ^lay 21 they began again and continued uninterruptedly until August 3, 1918. Between Oc- tober, 1917, and August, 1918, 65,801 children were examined at the Casino; 1809 of them were cared for in the American hospital, 1824 were treated in the Red Cross dispensary and 2597 were treated in the dental dispensary.^- The convoys were resumed again on September 16 and continued until November, 1918. The Germans in November ceased to return the rapairies through fivian. The convoys were then scMit tlirongh Hoi hind and Dr. Gelston was instructed to organize at Dieppe a service similar to that at Evian. Eighty thousand rapatries were re- turned to France in November and December, 1918, tlnvMigh Holland and 1750 children were examined at Dieppe. Fifty- one of them received hospital care at a small pavilion which the Ilopiial Mixte loaned to the American Red Cross,^^ The work of medical examination and hospital care, both at Evian-les-Bains and at Dieppe, was perlia])s the most far-i-carh- ing in its professional phases and the most appealing in its human aspects of any of the projects undertaken l)v the Chil- dren's Bureau. "The Red Cross at I-]viaii."" wrote Leila Halverson, a nurse, ''saved many sick cliihlren's lives and pro- tected the lives of many otlun's who wer(> well, by segregating the sick from the healthy before they had had opportunity to spread the contagion." "r.ildcT Report. Vol. TTT, p. 22. "y/HV/.. pp. 41-42. 780 HISTORY OF AMERICAN RED CROSS NURSING Southwest of I^]vian lay the large industrial city of Lyons, which during 1917 and 1918 became a stronghold of Red Cross child welfare work in France. Evian was primarily a center of evacuation. The French authorities insisted that the rapatries be sent on to other localities as rapidly as possible so that this small border town would not become congested. The Children's l>ureau was forced to look elsewhere for a site on which to establish a convalescent home for children coming from the Chatelet Hospital at Evian. Dr. Lucas took over for the purpose the Chateau des Holies, at Ste. Foy I'Argentiere, thirty miles from Lyons. Later, the Children's Bureau de- veloped and maintained two large convalescent homes, two con- tagious hospitals and an extensive dispensary service in the Lyons district, all an outgrowth of this iirst orphanage at Ste. Foy I'Argentiere. Chateau des IlaUes had been the country estate of Monsieur Mangini, a French engineer who built the Riviera railroad. Upon the death of Madame jMangini he had presented the estate to V Hospices Civ Us de Lyon upon condition that it be used as a convalescent hospital for children. L'Hospices Civils de Lyon was one of the oldest charitable organizations in Europe. It had been founded about 900 A. D. by Queen Hiltrud and had been in continuous existence ever since. "It is heavily endowed and is very well managed," wrote Dr. How- ard Kennedy Hill, a pediatrician of the Children's Bureau, "and all the hospitals of Lyons are under its control." IJHospices Civils de Lyon- offered the use of the Chateau des HaUes to the Children's Bureau free of charge, provided that the American Red Cross would leave it equipped as a hospital after the war was over. It was then being operated by Dr. Ellen Cover of San Antonio, Texas, Mrs. ilcKinnon of Oklahoma City and ]\riss Louise Bybee. It stood high upon a hill, heavily wooded with old cedars, pines and redwoods. It was surrounded by a farm which furnished milk, butter, eggs and fresh vegetables in abundance. The Chateau had been built in 188;") with modern conveniences, but the Red Cross had to enlarge^ the heating and lighting facilities to hospital dimen- sions. !^Iuch of the beautiful carved furniture was left in the C^hatean, but the handsomely carved woodwork of the walls was covered for protection. However, the nuirals, the white marble stairway with its crimson carpet and the line mantels still aavc to the interior of the Chateau diu'iiitv and ciiarm. o c NURSING SERVICE TO CIVILIAN POPULATION 781 During the first days of November, 1917, a detachment con- sisting of a director and four Red Cross child welfare mirses were sent up from Paris headciuarters to prepare the Chateau des Ilalles for occupancy. Dr. Frances O'Neill, one of the physicians of the second pediatric unit under Dr. J. ^lason Knox, was in charge; Sophie C. Nelson was chief nurse. ]Miss Nelson was born in Copenhagen, Denmark, but was a natu- ralized citizen of the United States. She was graduated from the Waltham (Massachusetts) Training School for Nurses. In April, 1910, she undertook infant-welfare work for the board of health of Cambridge, Mass., and later became superinten- dent of the Public Health Nursing Association, Louisville, Kentucky. With this experience as a background and with a fluent knowledge of French, Miss Nelson proved herself an able organizer and executive. Moreover, she was possessed of an unusually winning personality. Frances B. Archer, Elmira W. Bears and Mary P. McCand- lish were the other nurses. [Nlrs. Florence Lee Holtzman, of Washington, D. C, a laywoman of initiative and business acu- men, first had charge of the financial details at the Chateau. By November 22 the nurses had cleaned the wards and set up rows of small white cribs in readiness for the arrival of ten children from Evian. Other detachments were soon sent in rapidly until there were seventy patients in the Chateau in February. The nursing staff, though recnforced by several aides, was limited and the heating facilities were very poor, so Dr. O'Neill did not dare for the time being to take a larger number of patients. Llie Chateau had some sixty rooms which were at first heated only by wood fires. The fall of snow around Lyons was heavier in the winter of 1917 and 1918 than it had been for forty years. ''The enormously thick stone walls made the Chateau a veritable ice-box," wrote Dr. O'Neill, ''and I have often wondered how those American nurses and aides stood the cold. Surely they nuist have sutl'ered.'' The professional work at the Cltafeau des Ilnllcs difi'ercd very little from that at other hospitals of the Children's Bu- reau. IIer(> were the same sick babies, the same thin, wistful young children to nurse and feed and bathe. ''A (Icpi'cssing thing," wrote Dr. O'Neill, "was the inability or ])ossiliIy fear of one child to play with another. Lhe IJoeln' rule liad hekl them down so long that they wotild simply sit wliei'e they had been put until they were told to move." To be always hungry, 782 HISTORY OF AMERICAN RED CROSS NURSING to be sick and frightened, to have seen their parents, their brothers and sisters killed, to have watched their homes burn down with "mes affaires/' which means everything to the French child, seemed to have choked the play instinct within them and they sat motionless and dumb. ''To me perhaps the saddest sight," continued Dr. O'Neill, "was the little Boche babies abandoned by their mothers as soon as they reached French soil again. I have seen several families where part of the children had French fathers and part had had Boche fathers." As soon as the children were fully recovered they were sent to the Societe de Secours aux Bapatries at Lyons, a well estab- lished French organization under the leadership of Madame Gillet-Motte ; she maintained two establishments in Lyons, one for boys and the other for girls, and a barracks where children suspected of exposure to contagious diseases were placed for observation. The Societe de Secours made efforts to return the rapatrie children to their parents or relatives. The Chateau des Halles had originally been intended for use as a convalescent home for children, but on account of the great number of children examined at Evian and the lack of space there in which to house children for the proper period of ob- servation, contagious cases slipped Vy to Lyons and were then taken to the Chateau, which caused it to be quarantined fre- quently. Another disadvantage was the location of the Chateau thirty miles from Lyons ; the railroad service from Lyons to Ste. Foy I'Argentiere was poor and the transportation of patients and supplies became a difficult problem. For these reasons the Chateau did not entirely meet the n(H^d for convalescent beds, so about ^fay 1, 1018, the policy which governed its mainte- nance was changed. Dr. O'^'eill was transferred to Paris, the nurses were reassigned to other more vital service and Chateau des TJalles was used as an orphanage where children were sent for summer outings. It was then filled to capacity. As lias been suggested, the primary need at Lyons was for a general hospital for children which would care for cases from Lyons and rapatrics who slipped through lOvian. On Febru- ary G, 1918, Dr. CliiTord Grulee, of Chicago, had arrived at l^aris headcjuarters for work in the Children's i^ureau. Dr. (irule(> had been assistant professor of Pediatrics at Rush ^ledical College and attendant pediatrician at the Presby- t(;rian Hospital and the llonu! for Destitute Crippled Children NURSING SERVICE TO CIVILIAN POPULATION 783 and his book on Infant Feeding was regarded as an authority throughout the United States. Upon his return in 1918 from France he became professor of Pediatrics of the University of Chicago. Early in February, 1918, Dr. Grulee was appointed medical delegate of the Children's Bureau for Lyons and ho immedi- ately went there to develop the work. Sophie Nelson, hitherto chief nurse of the Chateau des Ilalles, was appointed as chief nurse of the Lyons district and she and Dr. Grulee undertook the establishment of a contagious children's hospital in Lyons, Hospital Violet ; a convalescent home. La Chaux ; a dispensary service, and some months later a special general hospital, Hos- pital Holtzman. Before outlining the development of these institutions at Lyons a short statement of the educational work of the Chil- dren's Bureau is necessary, for to this phase of Red Cross endeavor was undoubtedly due in large part the success which attended the establishment of these hospitals and homes. The need in France for a strong public interest in child welfare work was vital ; in a country where two adults were dying for every child born, the life of that child became doubly precious. In conjunction with the Educational Service of the Rockefeller Commission for the Prevention of Tuberculosis in France, the Children's Bureau undertook an educational campaign early in 1918 to awaken public interest in saving the lives of babies and children. Philip S. Piatt was the first director of the Educational Service of the Children's Bureau. Ellen C. Bab- bitt, an American social worker, expert in preparing child wel- fare exhibits, joined the Children's Bureau on ^March 26, 1918, and assisted in the preparation of the exhibits. Health litera- ture was published and distributed in large quantities. Two traveling exhibits were set up and sent through seven depart- ments of France. Large cliild welfare expositions were organ- ized liy the American Red Cross in cooperation with the French ^Ministry of the Interior and the Infant ]\rortality League and were held in Lyons, ^Lirseilles and Saint l^ticnne. The exposi- tion at Lyons was, however, the first and largest of these. A detailed account^'* of this exposition lies outside the pro- vince of a history of the American Red Cross Nursing Service. "For siU'li sec Report of the Childroirs l')Ur('au. Vol. Ill, Infant Welfare Canqiaii^n, Hosanioiul (JiUler. Library, National IleacUiuarters, \\'a., 191 G, by Senator Herriot, then mayor of Lyons. Health plays enacted by pnppets, lectures, motion picture shows and charts illustrating all types of child welfare work formed the principal material of the exhibit. Among these were a series of some eighteen posters drawn in color by Anna Miles Upjohn, an American portrait painter. Demon- strations of dental hygiene and of the hygiene of the nose, ear and throat were held in separate booths. In the center of the pavilion on a platform surrounded by glass to keep it warm Susanne B. Hoskins demonstrated the proper care of a baby. ''While the French people whom I met personally were very pleasant to me," wrote Miss Hoskins, "and used to crowd around to see the jolly, kicking baby plunged into the tub of warm water . . . they said we were foolish in coming over and trying to teach them how to care for their children. My answer was : 'We are only trying to show you our way.' " The exposition at Lyons lasted from April 9 to April 30 and during these twenty-two days 173,155 people attended it, one- fourth of the population of the Lyons district.^''* On April 1 the doors of the Children's Hospital at Lyons were opened. During the early summer of 1914 Dr. Violet, a French physician, had started a private hospital at 142 Cours Gambctta, Lyons, but upon the declaration of war he had been mobilized into the military service. His hospital. Hospital Violet, had been closed. The modern hospital building in wliich it had been located was imoccupied until jMarch, 1918, when the American Ked Cross rented it for use as a general hospital for children. Ida F. Lutler was chief nurs(^ of the Hospital Violet. With ]\liss Butler's assignment to war nursing service in France came an interesting link with Civil War days. Her father, of jSi^ew England stock and northern sympathies, was severely wounded in Viruinia and was brought to the old Armory Square Hospital in Washington, 1). (\ Whil(> on duty as a volunteer nurse in this hospital, Ida do M. Fazio, a Washington girl of Castilian descent and southern sympathies, met him and they wei'c married at the end of hostilities. A direct link between ^liss Hiitler's family and the American Red Cross during the European Wai- was through her brother, who as president of a large; American insurance company, made possible the gen- "<;il.l(T Itcport, \()1. Ill, p. 158. NURSING SERVICE TO CIVILIAN POPULATION 785 erous arrangements by which the American Red Cross was able to insure the health and lives of its overseas workers. Miss Butler was a graduate of the Hartford Training School and was for twelve years head of tlie maternity and gyneco- logical department of the Hartford Hospital. She then became supervisor of probationers. By temperament, she was direct and fearless, with a vivid and droll gift of expression and an intense loyalty for her friends. Above all else, she was con- scientious, a good nurse who never forgot the old-fashioned ethics of the relation of nurse to patient. Hospital Violet was opened on April 1 and drew patients from three principal sources. "Refugees from the north who had been sent to the two Red Cross orphanages, Chateau des Halles and La Cliaux," wrote Miss Butler, "and rapatrie chil- dren coming from Evian were our emergency cases. Our con- structive work was done in connection with children sent into the hospital from two Red Cross dispensaries established in Lyons." The first of these dispensaries had been opened at 42 Avenue Berthelot in March, 1!)18, by Dr. Virginia Murray, of San Francisco. The dispensary treated rapatrie children then liv- ing in Lyons, and also children who had lived there since in- fancy but who because of the dearth of French physicians were in need of medical care. By July 1, 1918, this dispensary had treated over 19 GO new cases. A second dispensary, located at 2 Avenue de la Bibliothe(iue, was opened on July 22. As ^liss Butler stated, these dispensaries were one of the principal sources through which patients were sent to the Hos- pital Violet and a great number of them were nose, throat and dental cases. Dr. William E. Wiggin of Lowell, Mass., was chief of the nose and throat department; his wife Laura Wig- gin, a nurse, was his assistant and anesthetist. Dr. Raymond M. Watson of Waltliam, ]\Iass., was chief of the dental de- partment and treated from thirty to fifty children daily four times a week. Following the establishment of the Hospital Violet in April, 1918, a convalescent home. La CJLaiw, was opened early in ^fay. La Cliau.v was located on the RhuiH' River eiiiht miles from Lyons, and to this ])l('asaiit estate were sent three lniiHli'e(l chil- dren from Toul and two liundri>d and twenty children from Paris who had been hurried cnit of the city under the chapei'onage of Paris school teachers during the spring bombardments. Two 786 HISTORY OF AMERICAN RED CROSS NURSIKG nurses, Susanne B. Hoskins and Kathrjn Flanagan, opened the old chateau late in April and set np the several hundred beds for the reception of the children. ''The little brown cots neatly- spread with the charming, vari-colored afghans made by Ameri- can Red Cross Juniors," wrote Miss Flanagan, "surely were a joy to see. The entire chateau was surrounded by a terrace banked with wistaria, then in full bloom, and when those tired youngsters arrived from Paris, the first thing they saw were these vivid afghans and beyond the open windows, the fragrant flower-hung terraces." The children at La Chaux lived largely in the open air. Classes, drills and games were held and even meals were served on the terraces and in the gardens. Xeither the two orphanages. Chateau des Halles and La Chaux, nor the Hospital Violet, nor the dispensaries afforded exactly the specialization which the Lyons situation demanded, so on June 11, 1918, Dr. Grulee converted the Hospital Violet into a purely contagious hospital and sent Miss Butler to organ- ize a hospital for acute diseases of children in the former German Consulate, 37 Boulevard des Beiges. This was called Hospital Holtzman, in deference to Madame Holtzman's tire- less efforts at des Halles. The nose and throat department was transferred from the Hospital Violet to the new hospital, but the dental department was attached to the main dispensary in the Avenue Berthelot. The German Consulate, a "magnificent example of German ornate extravagance," had been built with the idea that the Kaiser would reside there whenever he chose to visit Lyons. It had seven bath-rooms, "each one finished in marble and onyx," wrote Miss Butler to Miss Xoyes. "It makes the finest kind of service room. The old rose halls and the grand salons, now covered with l)ro\vn paper to protect them," she continued, "are wards for children aged from two to four and the brilliant light from the magnificent glass chandelier dazzles their little eyes. The library is still f\ill of valuable books; the shelves have been boarded up and sealed and the room is used as an infants' ward." Dorothy Cox, of Terre Haute. Indiana, was business manager; she had assisted Miss Babbitt in the de- velopment of the Lyons Child Welfare Exposition and remained at Lyons after the exposition was closed. The Holtzman Hospital had a total capacity of one hundred and fifteen beds, but owing to the scarcity of nurses and aides due to the military needs, it admitted an average of only sixty NURSING SERVICE TO CIVILIAN POPULATION 787 cases. Lentil July, ^fiss Butler's staff had consisted of four American Red Cross nurses, three American aides and numerous French aides, hut hv the middle of 'fuly, only one o<:her nurse was left. One of the four had heen taken ill and Miss Ashe had recalled two others and the American aides for assi^imcnt to the Department of Military Affairs, so ]\Iiss Butler and the fourth American craduate nurse, a French nurse from the Nightingale School at Bordeaux and ten French aides did all the nursing at the Iloltzman Hospital. "At present we have nine bone cases," wrote ^liss Butler to Miss Noyes on July 30, "and fifteen daily dressings, little fingers and toes just slough- ing away. We also have several cases of pulmonary tuberculosis and feeding cases with complications of all kinds." In August, 50 per cent of the young patients at Hospital Iloltzman were tubercular. The policies of the Children's Bureau included, it will be remembered, the training of French women to do "follow-up" work in the homes. Tlu^se women were called visifcuses d'en- fants and the value of their service depended almost entirely upon the type of woman selected and the intensive instruction given them by the Red Cross. A committee was formed which consisted of five influential women of Lyons and of ^liss Nelson, chief nurse of tli(> Children's Bureau in the Lyons district. Lectures were delivered to the visiteuses d'enfants by prominent French physicians of the city. American Red Cross nurses at the' Hospital Violet gave them clinical instruction in the wards. Twenty-five women were chosen. The general ar- rangements were made by Elizabeth ^litchell, a nurse from Newport, Rhode Island. The course began in the middle of April and lasted until the first of June. It consisted of forty lectures, one of which was given each day. The practical in- struction in the wards of the Hospital Violet and at the Red Cross dispensaries was given by \\\v American nurses. Twenty- one women passed the examiiuition successfully and were able to give material licl}) in the Red Cross campaign against infant mortality. In addition to the maintenance of the two orphanages, the contagious hospital, the h()S])ital for acute diseases and the two dispensaries, the ('liildi'eirs Bureau at Lyons did nnich to co- ordinate local eliiltl welfare activities in Lyons. It also aave subsidies to I'^i^eneh charity oi'gani^^ations. ^foreover, a lied (*ross (lisj)ensary was established in Koanne and a rest home 788 HISTORY OF AMERICAN RED CROSS NURSING for pregnant women and a pouponniere at Vienne, both out- lying villages near Lyons. When the American Army planned its drive on St. Miliiel in August, 1918, the military authorities asked that the Asile Caserne de Luxembourg at Toul be converted into a military hospital. The five hundred children who were being cared for there were sent on September 2 to Lyons ; three hundred and forty of them were taken to La Chau^ and the others were dis- tributed in various hospitals in the city. Even Lyons, how- ever, was to share in the great need for hospital beds for the American troops during the influenza epidemic. A large reserve officers' training camp of the American Expeditionary Forces was located at La Valbonne, fifteen miles north of J^yons. Late in October, when the influenza epidemic became virulent. Colonel Alorrow, L^. S. A. Medical Corps, asked the lied Cross to find 10,000 hospital beds for American soldiers in and near Lyons. La Cliaux was converted into a military hospital, as has already been stated, and military wards were opened both at the Hos- pitals Holtzman and Violet to care for influenza cases. Twenty miles below Lyons on the Ilhone lliver was situated the industrial city of St. Etienne, "the Pittsburg of France," Dr. Kichard Cabot called it. Both within the city districts and in the outlying villages, the normal population was doubled by the influx of refugees from the Xorth, many of them the rapatries who had passed through Evian. Only fourteen physi- cians were available in 1917 to care for the medical and surgical needs of these 250,000 people. Early in Xovember, 1917, citizens of St. Ktienne asked the Children's Bureau to send them a pediatrician to undertake child welfare work. Dr. H. S, J]. Smith and Eva Louise Smythe were sent from Paris Headquarters and opened a Red Cross dispensary at St. Etienne on December .'51, 1918. Eva Louise Smythe had had wide experience as a public health nurse. She was born on the Island of St. Helena. She was graduated from the Massachusetts Training School, ]\ral- deii, and for sixj^een years was office nurse and surgical assistant to a Maiden pliysician. She then took up school nursing in J'asadena, C'alifornia. In 1910 slie joined the Bed (^ross Town and CV)untrv Xursiiig Service and for nine months did rural nursing in Doylestown, Pa. She went overseas with the first Harvard T'nit to do special work for Dr. Cabot and served with the Britisli l^xpeditif)narv Forces. She joined the Chil- NURSING SERVICE TO CIVILIAN POPULATION 789 drcn's Bureau in October, 1917, and was sent immediately to St. fitiennc. She was a woman of strong personality, an executive who did not shirk responsibility; she was honest, direct, sometimes to the point of bluntness, and possessed of good judgment. The mayor of St. fitienne donated a room e(|uipped with electricity, gas, water and modern dispensary equipment ; the American lied Cross furnished personnel, medicines, clothing and other necessary supplies. During the first months of her work at St. fitienne Miss Smythe assisted at the clinics held every afternoon at the dispensary and did visiting nursing in the mornings. Gradually Dr. Smith extended his work to the neighboring villages and established Red Cross dispensaries at La Talaudiere, St. diamond and at Roanne. As the dispensary service developed, the need for a children's hospital at St. fitienne became more and more evident. Ar- rangements were effected whereby the American Red Cross appropriated 175,000 francs for the purpose of establishing such an institution, and the citizens of St. Etienne raised a similar amount. This hospital, which was called Chautalonette and which was of 100 bed capacity, was formally opened on January 21, 1919, The American Red Cross turned it over entirely to the city of St. Etienne on ^larch 20, but during the two months of Rod Cross administration 267 cases were treated there and 231 operations were performed. Refugee children comprised 3.") per cent of this number; the others were children from St. fitienne and the surrounding villages. ^^ The nursing personnel for these dispensaries and for the Chautalonette Hospital was recruited and trained entirely by Miss Smythe. ]\Iiss Ashe summarized ^liss Smythe's work in the Weekly Report of the Children's Bureau ending July G, 1918: ^riss Smythe went to St. fitienne eight months ago, alone. She has never asked us for hclj> and she has organized theiT a group of 24 French girls. I asked lier where she got them, and she told nie slie went to the Xormal School and asked for volunteers who could speak Englisli to help her. Twenty- four women, all volunteers, responded and she has taught them, and right straight along these girls have gone witli her and have had s]dendid training. She asked for an American ^"CiMtT lU-port. \'i)l. Ill, p. 43. 790 HISTORY OF AMERICAN RED CROSS NURSING nurse to do the work at the child welfare exhibit, and I have sent her one nurse. I think that for a woman coming over alone, without a word of Frencli, to have developed a situation like this is really quite remarkable. Miss Smythe expects to get from her class enough nurses to put into the children's hospital about to open at St. fitienne, without asking us for American nurses. There were some school teachers of St. fitienne who came to Miss Smythe out- side of school hours for the training. One of Miss Smythe's first steps was to organize a little boys' club. St. fitienne is a manufacturing city, and is very dirty and crowded at the present time. The refugees have gone into abandoned hovises, which in many cases are simply filthy holes. By putting up a prize of a pair of rubber boots. Miss Smythe aroused competition among the boys, and got these dirty streets and alleys cleaned up. She also started sewing classes for the girls, and they made necessary articles for the dispensaries. St. fitienne was one of the three large industrial cities to be visited by the child welfare exposition of the Children's Bureau. The exposition was held in the Bourse de Travail between July 11 and July 28, and 80,000 people attended it. Margaret Frances McLeod, the single American nurse Miss Ashe wrote of who was sent by the Children's Bureau to assist Miss Smythe, described the attendance: The hall was filled; over 5000 people attended the opening. The next day 1 think the entire city, or at least it seemed that many, visited the exposition and displayed intense interest. School teachers came not once but several times and brought their classes. The French girls from the best families in the city donned the Ked Cross gown and cap and acted as inter- preters and assistants for the doctors at the different clinics. Literature was distributed and educational posters displayed everywhere. I have never seen such real enjoyment and appreciation anywhere else and it was genuine. ]\Iy small part in the exhibition was to bathe the baby and dress it in the American way. I don't think I ever enjoyed anything nwre than that in all my nursing experience. You really felt the people were taking an interest. The doctor and nurse at St. fitienne have accomplished more good in public health than any place in France. Their cooperation with the ])rominent city officials and the j)eople of St. TCticnne was truly remarkable. . . . NURSING SERVICE TO CIVILIAN POPULATION 791 Directly below Lyons and St. liltienne lay the city of Mar- seilles, the southeastern gateway to France. Like its sister in- dustrial cities in the north, its population had doubled. The housing facilities which had accommodated G00,000 in 1914 were wholly inadequate for the 1,000,000 and more who thronged the city in 1917. The war had practically inhibited new con- struction. The population of Marseilles was a transient, cosmopolitan one. Soldiers, refugees and merchants of every race elbowed each other in the dirty, picturesque streets. A colony of Greeks and a colony of 120,000 Italians had settled there. Although unique among French cities, this population resembled that of many American cities and in this respect did not offer a social service and public health nursing problem unusual to an ex- perienced American personnel. Both the native and the refugee child suffered at Mar- seilles and would have suffered more had it not been for the efforts of some sixty local philanthropic institutions, of all types, which existed in the city and which expended in 1917 over 8,000,000 frs. for child welfare. The Children's Bureau as well undertook extensive work at Marseilles. In January, 1918, Dr. and Mrs. Lucas, Dr. Oscar H. Sellen- ings, of Columbus, Ohio, and Miss Elizabeth Wallace visited the city and made a swift survey of conditions. Two facts brought out by this survey were: first, the need for relief work for the children ; secondly, the need for infinite care and tact in developing this work, because of the large number of already organized oeuvres. On February 6, Dr. Sellenings was assigned to Marseilles to develop child welfare work there. On March 1 a meeting was held, at which representatives of between 40 and 50 institutions asiTced to form an office central which would act as a "clearing house'' for child welfare work at ^larseillcs. This office was established at the headquarters of the Children's Bureau, 33 Boulevard de la Liberte, and the American lied Cross contributed the services of a secretary to this organization. Emily Hammond Smith arrived in ^[arseillcs on March 4 to assist Dr. Sellenings in the development of the dispensary and milk station, and to develop public health nursing, ^[iss Smith was a graduate of the Children's Hospital, Boston, ^Liss. She was for two seasons superintendent of the ^^'ortli Shore 792 HISTORY OF AMERICAN RED CROSS NURSING Babies' Summer Hospital, Salem, Mass. She later became assistant superintendent of the Children's Hospital, Boston, and resigned to enter lied Cross service early in 1918. The Bed Cross children's dispensary at Marseilles, which was called the Maison d'Enfance, was located in the Rue Tregance within the walls of old Roman ruins. On a rainy Saturday afternoon, March 10, Dr. Sellenings and Miss Smith opened the doors of the clinic and found the ante-room packed with mothers and babies. Clinics were afterwards held on Tuesdays and Saturdays from 2 to 7 P.M., and the average attendance was 40 cases. Dr. A. M. Gove was in charge of the dispensary. Only children under 2 years of age were admitted at the Maison d'Enfance. A canteen for nursing mothers was conducted in connection with the dispensary. Milk formulas for bottle-fed babies were prepared there, and follow-up work in the homes was done by the nurses. One of the principal aims of the Children's Bureau at Mar- seilles was to furnish assistance to Nourrisons Clinics. Dr. Gove, the American nurses and the French nursing aides gave medical and nursing care to babies at three such clinics ; this particular service was only for well babies. The Children's Bureau also furnished a doctor for the Dispensaire des Enfants Malades, Rue St. Sebastian and for another local dispensary at ]^o. 22 Roucas Blanc. Other miscellaneous activities included the establishment and maintenance at Aubenas, for three months of a dispensary for influenza cases, which was finally turned over to French physicians on their return from the front. During its 14 months at Marseilles, the Children's Bureau made formal donations amounting to 106,500 francs to eight local charities: Entre-Aide Feminine; Art et Charite; Asile ^t. Louis; Asile St. Joseph; Ahri Maternal; Dispensaire des infants Malades; Aide aux Veuves; and five creches.^'^ Following the establishment of the dispensary service, the Children's Bureau held a child welfare exposition at ]\rarsoilles from ^lay 27 to June 9 at the Maison de la Muiualite. In this building were tli(> ottiees of some .'jT) local oeuvres, so the exposi- tion was held in the very center of organized charity work of the city. It was arranged for by ^liss Babbitt and her assistant, Dorothea Baldwin, and .'>2,2;}1 people attended. One; Inindred and sixty-one motion picture shows were given and 290,250 "Gilder Report, Vol. Ill, pp. 48-49. NURSING SERVICE TO CIVILIAN POPULATION 793 pieces of child welfare and anti-tuberculosis literature were distributed. Marseilles supported only one local institution which hos- pitalized children under eighteen months of age. Children were boarded out and ''in one institution not manifestly inferior to many others in management, locale or equipment," wrote Miss Gilder,^** ''the death rate was 49 per cent." The local oeuvres were net at that time prepared to provide one, so the Children's Bureau established a temporary hospital and preventorium in some barracks on the seashore outside the city. The Barrack Hospital, as it was called, was opened on September G, 1918, with a capacity of Hfty beds. At the same time, a convalescent home for boys, at St. Louis, to which the Children's Bureau had contributed both personnel and funds, was opened. During the summer, the staif of the Children's Bureau at ^farseilles also rendered assistance in relieving an epidemic at St. Maxi- mun, and to two nour{s,-ions clinics. Early in Ocj^uber, 1918, Dr. Scllenings returned to the United States and Dr. May Agnes Hopkins took over the di- rection of the work at ^Marseilles. A general reorganization of the child welfare activities was brought into line after the Armistice and, under the leadership of the local organization, the Art ct Cliarife, the citizens of ^Marseilles formed a special com- mittee on child welfare, which was called the Franco-American Committ(>e and which agreed to act as a central clearing house for child welfare after the withdrawal of the American Bed C^ross. Tills committee took over the dispensaries, the visiting nursing and the )iuurisso7is clinics; in addition, they had a nine- years' lease on a convalescent home for children, San Joseph, which was located just outside the city. In Xovember, 1918, the American Bed Cross appropriated 150,000 frs. to be given to the Franco- American Connnitte(>, with the understanding that it was to be divided into three s(>])arat(> sums, of ."iO.OOO frs. each, to be spent for three separate projects. The first of these sums was to be used to maintain a permanent convalesccnit home for infants and children up to four years of age, at San Jose])li and was given on the conditicui that "an ('(jual sum be guaranteed to make a permanent fund of 100,000 frs. for the running and management of the San Jose])h Convalescent Home for Children, for a period of at 'M;ildrr Wvinn-t, \"ul. Ill, p. 4.1. 794 HISTORY OF AMERICAN IlED CROSS NURSING least three years," ^^ A second provision of this bequest was that the Home should be directed by a graduate nurse experi- enced in the care of children ; that she should have a staff of trained assistants ; and that the Home would be used as a teach- ing center for the training of visiteuses d'enfants. The second sum of 50,000 francs was to be used for the dis- pensary for infants and children at Xo. 1, Vieille Tour, and it was also given on condition that the citizens of Marseilles raise an equal amount, thus guaranteeing a principal foundation of 100,000 francs. One of the special purposes for which this bequest was made was for the development of health visiting and visitors in the dispensaries and in the homes of the children who attended the clinics. Like the Convalescent Home at San Joseph, this nursing service was to be under the direction of a graduate nurse experienced in child care and the dispensary was to be used as a teaching center for visiteuses d'enfants. The third sum of 50,000 francs w^as also given under condi- tion that a similar sum be raised by the French, with the un- derstanding that the total sum of 100,000 francs should be used for a school of visiteuses d'enfants. The course of train- ing was outlined by Dr. Lucas : The course of health visitors to cover a period of at least six months; three months are to be given in practical work at some cliildren's institution such as San Joseph, or some other institution controlled by this committee and by the medical and nursing staff appointed by this committee to carry on the theoretical and practical training of these health visitors. The other three months are to be given to teaching home visiting, using Dispensary Xo. 1, Vieille Tour, as a base, and the special district as the training place for prac- tical home care of mother and child. It is not intended, of course, to limit the places of training to these two institutions, San Joseph and the dispensary at Xo. 1, but simply that these two be used as the basis for practical and theoretical training, and, further, that a course of 3G lectures at least be arranged, covering the suljjects of pre-natal care, nursing and general hygiene, and feeding of the child, to be given by members of the medical profession cliosen by tiiis Committee, engaged especially with qualifica- tions and training for sucli teaching.^** 'C;ild(T Report. Vol. ITT, pp. 52-53. See letter of Dr. W. V. Lucas, a^ldicpscd Noveniher 2!). liHS, to the Franco-American Committee for Cliild Welfare in Marseilles. '"' Ihid. NURSING SERVICE TO CIVILIAN POPULATION 795 On Febnmry 1, 1919, the Children's Bureau turned over its activities to the OtHce Central and withdrew from ^larseilles. The local organization, Art et Charlie, took over the dispensary in the Rue Tregance. The Red Cross pledge of a gift of 150,000 francs for the subvention of the School for Health Visitors and the endowment of the St. Joseph Convalescent Home for Boys and Girls, was fulfilled. Toulouse lay midway between Marseilles and Bordeaux and here the American lied Cross held the last of its large child welfare expositions. The exposition was opened in the Halle aux Grains on October 20, 1918, and lasted until November 10. Eighty thousand people attended it. At the health clinics, G08 children received medical examination, 1362 were given dental treatment and 79 attended consultations on corrective gym- nastics, making a total of 2147 children treated. Mary C. Nel- son, the American Red Cross nurse who had been charge nurse of the Children's Colony at Dinard, was assigned to Toulouse and spent a month there doing pre-natal and child welfare work in connection with the exposition. A group of interested people in Toulouse formed a Children's Committee for the purpose of training French girls to serve as child health visitors. The American Red Cross offered to assist the Committee in the development of the course, but the offer was not accepted. Bordeaux was the principal southwestern seaport of France. Here the conditions of child health were as critical as at Mar- seilles. The birth rate at Bordeaux in 1913 was ten thousand and the infant mortality one thousand; two years later the birth rate had fallen to five thousand and the mortality remained at one thousand. Where the civilian population had had in 1914 the sei'\dces of twenty-two physicians, in 1919 there were only six. Although the American Red Cross developed an extensive program of emergency relief and left a foundation for con- structive welfare work at Bordeaux, no nurses were assigned to duty there until October, 1918. The military situation was too pressing in the summer of 1918 for th(Mn to be spared for work with the children. The medical work there had first been initiated l)y Dr. Philip Van linren Johnson, whom the ChildrcMrs liurcau sent to Bordeaux in ^lay, 1918. The Nigiitingalc School for Nurses of the ^['us()n iJc Sanfc rrofcsl'iiilc, which was the one professional school of nursing 796 HISTORY OF AMERICAN RED CROSS NURSING in France, was located at Bordeaux and Dr. Hamilton had de- veloped there a course in public health nursing. In August, 1918, Dr. Johnson recommended that the Red Cross present two scholarships to the Nightingale School in order that the services of two of Dr. Hamilton's pupils might be available for carrying on the activities of the Children's Bureau. These scholarships and eight additional ones were subsequently granted ^^ and Dr. Johnson thus had the service of ten French nurses in the development of the relief activities of the Chil- dren's Bureau. The emergency relief at Bordeaux was considerable. Late in June, Dr. Johnson established a twenty-five-bed hospital in the Bastide quarter near the Maison du Behe. At Bagatelle, an estate belonging to the Maison de Sante Protestanie, which afterwards became the site of the American Nurses Memorial building of the Xightingalc School, a barrack hospital for chil- dren was established by Dr. Johnson and 405 cases were treated there in July, 1918. In August, a preventorium was developed at Soulac. A new dispensary at the Maison du Behe was opened in September and twelve beds at iheMaison de Sante Protestanie were secured by the American Red Cross for permanent use by Bordeaux children suffering from acute diseases. When the time came for the Red Cross to withdraw in 1919 from Bordeaux, the Children's Bureau established a foundation of 10,000 francs to be used for constructive child welfare work at Bordeaux. A permanent nursing organization entitled L' Association Fran-co-Ameri^ne pour les Infirmieres Yisitciises was organized. Its aim was to "establish in the city of Bor- deaux an organization to cooperate with the training schools for nurses at the Maison de Sante Protestante and the Hopital TondiL (and other similar training schools as may be subse- quently decided upon) with the object of providing a special course of six months practical training in public health work particularly as applied to children." " The Board of ^Ninnagers of the Association included Dr. Hamilton, Evelyn Walker, ]\radame Gounouilhou, ^l. Charles de Luze, Lt. (^olonel Cliarh^s Cazalet, treasurer, and Doctcur ]\Iousseau. The plan of organ- ization specified tliat the superintendent of the Association *^Sco ]\rinutos of the Finance Committee of the Commission to France, September 17. 1018, p. ^^4S. ^Contract of Afjreemcnt lie! ween Association Franco-Americaine jioiir les Infirmieres Visiteiiscs and ll'e American Ixed Cross signed January 1, 191!. See Gilder Report, Vol. Ill, p. 58. NURSING SERVICE TO CIVILIAN POPULATION 797 should 1)0 an American graduate nurse ; Evelyn T. Walker was appointed in October, 11)18, to this position. Miss Walker was a medical social service nurse of experience and ability. Born at Cork, Ireland, of Irish parentage, Miss Walker was educated at private schools in Cork and London. Her professional train- ing was obtained at the East London Hospital for Children and Dispensary for Women; she took a post-graduate course in medical and obstetrical work at Bellevuc Hospital, I^ew York City, and in 1914 attended lectures at the New York School of Social Work. Erom 1 !)()() to 11)11 she was in charge con- secutively of the tnb(>rcul()sis, the male medical and the chil- dren's division at Ecllevue Hospital and later organized and directed the maternity social service work. Subsequently, she became supervisor of the Department of Educational Nursing and Eresh Air of the Association for Improving the Condition of the Poor. She went overseas for work with the Children's liureau in July, 11)18, did military nursing at American Red Cross ^Military Hospital No. 1, and on October 9, 1918, went to Bordeaux, where h(>r knowledge of French, her pleasing per- sonality and her professional attainments led to her appointment as superintendent of nurses of the district nursing association. On a direct line between Bordeaux and Paris lay the ancient city of Blois, in the valley of the Loire. Blois was another of the French cities which in 1918 were crowded with refugee children and the Red Cross opened a dispensary there on February 21, 1918, and continued its maintenance for ten months. Dr. Bertha B. Stuart, of Portland, Oregon, was in charge of the activities of the Children's Bureau and with the aid of specialists who came down from Paris, she organized eye, ear, nose and throat and dental clinics. ^Irs. ]\Iargaret P. Church, an American Red Cross nurse, assisted in the dis- pensary and gave anesthetics. ]\Irs. Church was a graduate of the Lee Private Hospital, Rochester, New York, and had had post-graduate work at St. Luke's Hospital, New York City. She joined the stall" of the Children's Bureau in February, 1918, and instructed risifcii.'^es d'cnfapis attending the Paris classes. Sh( was tlicn assianied to Blois. The visiting nursing at Blois was at first done by visifcuscs cVenfanis. In her monthly report for June, 1918, Dr. Stuart wrote : At iho (lispon-^ary. ^v(' ]inv(> trrnwn : we now liavo over TOO on our books. \V(' liavc establi.-lu'd a separate clinic for the 798 HISTORY OF AMERICAN RED CROSS NURSING feeding cases; each Saturday morning; the mothers bring in the babies, have them weighed and have their feeding super- vised. . . . We have a French visiting nurce, a vohmteer who does nothing but look after the small babies. She has a list of all babies born since January, 1917; she visits the homes, tells the mothers of the clinics and gets them to promise to bring their children. If the mother does not report the folloM'ing Saturday morning, she goes again to see why she did not come. . . . Miss Zimmerman, an "enfant visiteuse" from the May classes in Paris, has been added to our staff and she is doing fine work both in the visiting nursing and in the social work. . . . Early in the summer of 1918, the Red Cross established a pleasant summer home for children in a house loaned by the Marquise de Poitou, in the village of Chitnev, just outside of Blois. In August, 1918, Miss Ashe assigned Agnes R. Lenihan (Elizabeth General Hospital, Elizabeth, iSTew Jersey) to Blois to assist Mrs. Church. Miss Lenihan did general visiting nurs- ing and educational work. Early in August two visiteuses d'eii- fants from the Paris classes also were assigned to Blois. There was need in Blois for a children's hospital, but the American Expeditionary Eorces had taken over all the hospitals in the city and all vacant buildings suitable for use as tem- porary hospitals. However, officers of the Army Medical Corps^ were generous in aiding child welfare work and without their assistance the Children's Bureau could have accomplished little. "They took the X-ray pictures," wrote Miss Gilder, "did the laboratory work, operated on the general surgical patients, as- sisted with the orthopedic cases and loaned ambulances and camions." ^^ The establishment of a permanent children's hos- pital at Blois was made possible, however, in 1919, by American generosity ; the War Service Committee of the American ^[edical Women's Xational Association donated through the American Red Cross a sum of $25,000 which was used to erect a permanent children's hospital. A quaintly interesting and typical demonstration of the work of the Children's Bureau was developed early in 1918 at Corbeil, a small manufacturing town situated some twenty miles south of Paris on the Seine River. Here as in other cities, * Gilder Re))ort, Vol. Til. p. Gl. NURSING SERVICE TO CIVILIAN POPULATION 799 a dispensary was the entering wedge ; it was authorized by the Children's Bureau on February 0. Dr. Margaret \V. Farwell, whose original and energetic personality was reflected in breezy reports to Dr. Lucas, was placed in charge. Dr. C. D. Mosher, one time assistant professor of Hygiene at Leland Stanford University and in 1918 one of the staff of the Children's Bu- reau, and Mrs. Farrand, wife of the American health specialist. Dr. Livingston Farrand, took an important part in the de- velopment of the lied Cross child welfare work at Corbeil. The beginnings of the dispensary service are pleasingly re- counted in the following report written by Marion Postte- thwaite Greene, of Xew York City, an assistant to Dr. Farwell : . . . "We walked about the streets of the quaint little town, gathering groups of mothers and children on the street cor- ners to listen to simple talks on hygiene, to invite them to come to the dispensary when in need of help and to urge them to hriiig their babies there for weekly weighing and inspection. The dispensary was opened on ]\ray '20 and there was never a moment when it was idle. Nearly all the French doctors had been mobilized; the few who remained were overworked . . . and the poor of the town were in misery and despair. News from the front was always bad ; air raids harassed Paris by niglit and "Bertha" dropped her messages of death by day. Shortly after the dispensary was opened, Corbeil suH'ered an air raid and six people were killed and several wounded. One Amorican nurse was assigned to us, but stayed only a week be'nrc she was called to the front. For some time Dr. Farwell and I worked on alone, 1 ignorant of nursing but doing wliat I could under her instruction. We soon had another nurse. The first nurse to go to Corbeil was Amy F. Lowe, whose later work at the milk station at ^larseilles has already been mentioned. She arrived on 'May 2 but was recalled on May 30 for work at the Tent Hospital at Auteuil. ^Niolly B. Smith (Chicago Baptist Training School) was the second nurse men- tioned above. She wrote: . . . T was assigned to the l>ed Cross Dispensary at Corbeil. wliere my work consisted in doing visitiuir nursinir among the civilians. Tlicrt^ were only two old doctors in the villasre. so we eidnrirccl our ficbl fo include older cliildrcn. but our Work then became so great that we were forced to put an 800 HISTORY OF AMERICAN RED CROSS NURSING age limit on children, admitting only those below sixteen years of age. The town itself had about 20,000, but we also nursed in five other villages nearby. Our clinic had begun with only one patient, but it soon became so famous that we had sixty-five cases in an afternoon. We emphasized three vital points : fresh air, personal hygiene and daily washing of the hands and face. At night we took walks and noted the windows that were or were not opened and spoke of it the next day. . . . We encouraged bobbing the children's hair. It facilitated cleaning the children's heads from scurvy and other diseases. We did not empbasize its use as a prophylactic measure, but it became the style and was called the Jeanne d'Arc cut. A further extract from Miss Greene's report follows: We soon had another nurse, organized a "Baby Day," car- ried on two afternoon clinics a week, did dressings every morning from ten to twelve and between times visited from house to house preaching the gospel of fresh air and simple hygiene, cheering discouraged and war-weary women and trying to put a little joy into the drab-hued lives of the children, born and brougbt up under the sbadow of war. Frequent visits to the dispensary from tlie poilus on leave, to thank us for our work, made us always fresh and eager to do more and more, regardless of fatigue and long hours. "We fight with more courage now tliat we know you are taking care of our children," said one soldier in faded blue. And a mother who had carried her bal)y many kilometers on a suffocating August day said trustingly: "The babies of Corbeil do not die any more since the American ladies came, so I bring mine to be cured, too." The dispensary treated refugees and rapafries on presenta- tion of their cards of identity ; these cards were the ones which they had received at Kvian-les-Bains. All children under sixteen years of age and all persons who presented a special card issued by the mayor of (Jorbeil were also admitted. During the months from June through October, 191.S, 11,988 consultations were held. Eight risUensrs d'enfanfs' were eventually assigned to Corbeil to carry on the home visiting and clinics were opened at neighboring towns, Saintry and h]ssr)nnes. A unique phase of the Corbeil dispensary work dealt with the care of American soldiers from the American Coffee I'lant at Ivssonnes ; when- ever the doughbcys were ill in hotels at Corbeil or were taken NURSING SERVICE TO CIVILIAN POPULATION 801 sick at the station, as frequently happened during the influenza epidemic of October, 1918, thej were brought to the Red Cross dispensary. Another appealing outgrowth of the service was the Red Cross playground which Miss Greene organized in the fair grounds outside the city ; play afternoons were held twice a week. In some of the districts of Corbeil, the houses were built directly on the streets and the children had no place where they might play except on the cobblestones. "After school closed," wrote Dr. Farwcll in an August report, "we spent most of our morn- ings picking pieces of flint and gravel out of the hands of small boys and bandaging the legs of small girls who had lost much epidermis through falling on stone-paved streets." Miss Greene wrote of the playground : Our sole equipment was three rubber balls and boundless enthusiasm. A "gouter" was served, which consisted of a piece of bread and a tiny bit of chocolate or a bandful of raisins. At that time children under thirteen were allowed only 200 grammes of bread a day. Dr. Farwell and I each had four hundred and we were able to save about one hundred a day on our allotment and we begged tickets from any and every Red Cross acquaintance we saw and were able to accunnilate tlie necessary number of tickets from Tbursday to Thursday. A friendly baker often gave me more bread tban my tickets called for, asking me to say nothing or "the whole town would be upon my back !*' Paris was the heart of the American Red Cross in France and it sent life-^i>'iving aid to the Army in the form of supplies and medical, imrsing, hospital and social service; to refugees in the form of food, clothing and temporary shelter; to midUes through rci'ducation ; and to so many other typos of war workers and war sutterers in so nuinv different forms that its organization webbed France like a capillary system. Paris was also the heart of child w(>lt'ar(' work and Am(>rican Red (h'oss medical nursing and social service was woven into the fabric of existence in many of the arrnndisscmotls of the city. In addition to its norinal population, I'aris in the winter months of l!17-l!tlS was crowded with aliens, refug(>es and industrial wc^rkers brought tliere in the wake of war. 'I'hc iiativc population of tbe poorer classes sufTered most from this influx of newcoiners ; thev were sustainecj (>n lcar\ rations, lived in 802 HISTORY OF AMERICAN RED CROSS NURSING cramped quarters, often worked beyond the point of exhaustion, were harrassed by shells in the day time and by air raids at night, suffered disease and death from natural and war causes and were disheartened by the grave military situation on the Western Front, The children of this population were least able to withstand the strain of these conditions, so the Children's Bureau worked out an extensive program of medical and nurs- ing service in an effort to save their lives. Pre-natal and infant welfare work was also undertaken. "It seems the custom has been to send babies to the country for the first few months of their lives," wrote Mary B. Ross, a child welfare nurse of the Bureau. ''There they are nursed by a wet-nurse or given a bottle. This allows the mother to go out to work. And many babies die." The aim of the Children's Bureau to "save the babies" found expression in the establishment and maintenance of fourteen dispensaries in Paris. In these dispensaries were conducted consultations in pre-natal care for mothers ; clinics for the care of tubercular children and those in contact with tuberculosis ; dental, nose and throat clinics ; a diagnostic clinic ; a children's hospital ; an organization for the care and protection of the new born ; and a social service center. Dr. John B. Manning, of Seattle, Washington, was the first chief of the Paris dispensary work. In a report written May 1, 1918, Dr. Manning stated the method by which the Children's Bureau set to work : The first plan was one of cooperation with the Rockefeller Commission in the 19th Arrondissement. We began by operating dispensaries jointly with it. The medical work in those clinics is supplemented by courses in Avhich French women are trained as home visitors by Ameri- can nurses. It soon became evident that owing to unavoidable difficulties in securing labor under existing conditions, it would take months to carry out this program in the 19th Arrondissement. The Bureau then looked to other parts of Paris, from which numerous urgent requests for aid in the form of dispensaries liad already come. Without in any way interfering witli the Iioekefeller Commission, careful consid- eration A\as given to these requests with an idea of placing dispensaries, as far as possible, in established French oeuvres where no dispensary liad previously existed, or where because of the mobilization of its staff a dispensary had been aban- doned. NURSING SERVICE TO CIVILIAN TOPULATION 803 What we hoped to accomplish in our Paris work was : first, to supply equipment and personnel, doctors, nurses and nurses' aides, drugs and surgical dressings for these dispen- saries; second, to establish relations as far as possible with competent French nursing women and com])etent dispensary management; tiiirdly, to develop a system of medical social service, including a program which has as its object the demonstration that competent visiting in the home in con- nection with thorough-going dispensary work is absolutely essential in any attem])t to lower the rate of infant mortality. Marie Pholan was head nurse of the Paris dispensary system. Her staff consisted of public health nurses from the United States. Dr. ^Fanning wrote in his May (1918) lleport: The steady grind of the work of our doctors and nurses gives no opportunity for spectacular service, but I am firmly convinced that it is bringing renewed hope to hundreds of poor homes in Paris and is laying a permanent foundation of health and hygiene for the future of the city. Too much stress cannot be laid on the value of the work of home visiting by the nurses. Their tact and sympathy have brought to many homes the peace of mind and cleanliness of living that are the first aids to health. . . . The first dispensary was opened on December 5, 1917, in connection with a settlement house in Lcvallois, a large munition district just outside of Paris. Dr. ^^Fahel H. Bancroft was in charge of it. Pre-natal care was an important phase of tlie Levallois Dispensary work. The nurses visited the home, in- structed the expectant mother in the care of herself and in the preparation of a layette and recommended that the Ked Cross supply various necessities. Dr. Bancroft wrote: We have had some very delightful results, especially in families where there liave been a miml)er of ])revi()us (U'uths among the babies. In all cases. 1 seiul them to the hospital, thus avoiding Ibe complication of tlie midwife, which is a great evil. 1 have tried to make the idea of hospital care ])o])ular. . . . Once a wcM'k 1 have a conference of mothers. An average^ of twenty-livt" attend and we take up some one subject ]nT- taining to motluu' or baby, as baths, clotbing, exercises. They express great, appreciation of what wo try to do . . . and I tell them that whenev(>r ihev think of the Croi.r h''Jii'/f Antrri- 804 HISTORY OF AMERICAN RED CROSS NURSING caine to tliink "open your windows and nurse your babies !" I have a feeling that we have been very close to these simple folk and they have received open-heartedly our attempts to make life brighter for them. The next Red Cross dispensary to be opened was the Grenelle Dispensary, 17 Rue de I'Avere, in the 15th Arrondissement. Quarters were offered the Children's Bureau by the McCall Mission, a social settlement which had been conducted for some years by a group of American women. The American Red Cross took over the parsonage, reequipped it as a dispensary and on December 1 received the first patients. I^ellie Reed (Garfield ]\[emorial Hospital) was a public health nurse assigned to the Grenelle Dispensary. She wrote on March 6, 1918 : . . . Madame Gallinlau, the wife of the minister who for- merly ran this ]\IeCall Mission but who is now at the front, carries on his work. She has organized a Mothers' Club of 150 members, froin among whom I hope to get my babies. ... I had my first baby conference to-day. "Follow-up" work is not so simple as it sounds. The French are so formal that there is no casual dropping in to see a baby. Every visit is almost a ceremonial; there are always two or three to receive us and it seems as if I spend most of my time shaking hands. All school children must and will shake hands and their little fists are like all other little fists. Some of the homes look imposing from the windows; almost all of them have the loveliest lace or scrim curtains, but behind, just what we find at home, except tbat the setting is usually more artistic. I am entirely truthful when I say that 1 like the work very much and especially the French. The babies wear about the same kind of clothing that ours do and the mothers manage with little or much as the case may be. ^larch 13. This letter was interrupted by a raid. The Boche planes come frequently now, and when they are not actually here Ave are expecting them, so it is ratlier much the same thing. Naturally the people are very mucli frightened and they literally ])aek themselves like sanHnes into the cellars. 1 think the average cellar is more dangerous than tlie second or third floor. There is mucli discussion upon this subject and we liear nothing else. The raids are very upset- ting and disorganize everything: tliis week they had gotten the whole dispensary into a very nervous state. A group i)t patienta at an American Red Cross children's dispensary in Paris. An American Red Cross cliildreii's .jispcnsary in a small town in France. NURSING SERVICE TO CIVILIAN POPULATION 805 The Grenellc Dispensary developed extensive cooperation with French welfare organizations. Frances S. Hoppen, a vol- unteer who had helped to organize the dispensary, wrote : . . . Patients needing special treatment were sent to Red Cross clinics for tuberculosis, throat and dentistry work and to the French llopital des Enfants Malades and other French institutions. Our nursery cared for the children who needed special feeding. We had such satisfactory results that the work increased to such an extent that we added an American volunteer aide and two excellent French ones (paid) to the staif. We worked in complete harmony with the local Frencli authorities and charities, the tnaire, the Protestant Mission, the Catholic Sisters, J)rs. ^Marfan and Iloudre from the French Children's Hospital and about fourteen other homes and institutions and met everywhere cordial help and co- operation. The idea of a neighborhood house and district nursing in connection with dispensary work greatly inter- ested the French doctors. We trained two social workers foi the Children's Hospital and had many French visit eases d'cnfanfs sent to us to observe and learn. . . . We gave little money directly; our entire expenses, including the salaries of the French aides and the servants, came to about $300 a month. On December 20, 1017, the third American Red Cross dis- pensary was opened at 20 Rne Censicr, in the 5th Arrondissc- mcnt. This dispensary, which was known as the Censier Dis- pensary, was established in response to a reqnest from ^llle. do Rose, who had for some years maintained a large private charity there. U'he settlement consisted of a home for work- ing girls, a school for children and a largo apartment house for families. F>eda AI. CatKn (French Hospital, Xcw York City) was assigned to duty there. She wrote : . . . Dr. P)lair wa- in charge and Miss Phelan was lu'ad nurse. V\\]o ('(Misicr hold clinics for children of all ages, for women and also two night clinics for working girls and women. TIk^sc later ones had to he discontinued. howe\er. on account of the raids: it seemed that the Boche always chose clinic nights to cover ov(M'. About the end of March the French women who had taken the course for the ri-^itms)'.^ d'rnfiinlx began to arriv(\ two at a time, for instruction in clinic work and home visitinir. Thev staved two weeks, 806 HISTORY OF AMERICAN RED CROSS NURSING Another American Red Cross public health nurse on duty at Rue Censier Dispensary was Margaret F, McLeod. A fourth dispensary to receive aid from the Children's Bu- reau was La Coumeuve Dispensary, which had been maintained for some time by the Mutualiie Matemelle, an extensive and powerful French charity organization, which was described by Dr. Manning in his monthly report, February, 1918: Mutualite Matemelle de France gives to women, in return for three francs a day, care during confinement and other aid in the form of a woman to do housework for nine days, also laundry, milk at reduced rates, layettes as needed and medical service both to mother and child. They have thirty-two sta- tions in Paris, forty-three in the suburbs and others through- out France. They have 50,000 babies in their Consultations de Nourissons and there is the explanation of our baby free clinics. Mr. Proussineau was extremely willing to cooperate with the Children's Bureau and assured us we could in turn do nothing in Paris without their assistance, which we know to be true. An American doctor and nurse were assigned to the Dis- pensary at La Courneuve and the Children's Bureau finally built a temporary barracks to take the place of the old, mouldy build- ing. Dr. Reed, the physician then in charge of the La Cour- neuve Dispensary, wrote in the Weekly Report of the Children's Bureau ending August 31, 1918: Most of the equipment is now in place and the walls are covered with pictures explaining child welfare work. Xot- withstanding the holes in the roof and the cracks in the floor, some good work Avill be done here within the next month or six weeks. In tlie old dispensary, there were from eighty-five to ninety women and children each week; here there shoidd be at least a third more than that. We have permission to go to the factories and tell about the dis- pensary. Many children came to the various Red Cross dispensaries who were in need of operative Avork. On January 18, 1918, V Ilopifdl Mnr'u'-IIcJcuc, 77 line Arago, Puteaux, a French hos- pital of twenty-seven bt^ds which had been closed since 1914 on account of lack of funds, was reopened and patients needing operation were sent tlicre from the dispensaries. The American NURSING SERVICE TO CIVILIAN POPULATION 807 Red Cross paid five-eighths of the running expenses. An Ameri- can surgeon did the adenoid and tonsil work there and an Ameri- can dentist conducted a dental clinic. A second small French hospital to receive aid from the Red Cross was Vllopital Bicetre, 19 Rue du Pasteur. An American Red Cross nurse was assigned to this small municipal hospital and later, when the French doctor who directed its management was called to the front, an American doctor took his place. The Rockefeller Commission for the Prevention of Tubercu- losis in France and the American Red Cross opened their first combined dispensary on February 15, 1918, at the corner of the Rue des Mignottes and the Rue des Solitaries in the Quar- tier d' Amerique of the 19th Arrondissement. The rate of infant mortality in this section of Paris was 350 per every 1000 births, the second highest rate in the city. This joint dispensary, which was called the Dispensary des Mignottes, was opened late in February, 1918. Another French oeuvre to receive assistance from the Ameri- can Red Cross was Dispensaire Mari-e-Lannelongue, 129 Rue de Tolbiac. This dispensary held consultations for nursing moth- ers each week under the direction of a French physician, and the Children's Bureau assigned to it two public health nurses to aid in the clinics and to do visiting nursing. In the Report of the Children's Bureau, for ^farch, 1918, Dr. Manning wrote : Tliis dispensary received daily assistance from our Bureau during the winter in the form of condensed milk for 40 bottle-fed babies and food for forty mothers who are nursing their l)abi('s. Oiico a week, (>() bal)ies are l)rought to this clinic and weiglied. about 30 each clinic day. Those wlio are ill or underweight arc seen by the French physician in charge. Kach day tlie milk is sterilized at tlie dispensary and given in bottles to tlie mothers. At a conference lield this week, the ])resident of tlie Oeuvre consented to permit our nurses, provided they would take over the handling of the babies, to go into the homes aiui try to teach the mothers baby liygiene. . . . The MxitiudUe ^InferneJle had maintained a dispensary in the 19th Arrondissement at Xo. 9 Rm^ Kdouard Pailler(n. which was known as th(> Kdouard Paillenui I)isp(Misary. 'i'he Children's Bureau took over its maint(>nance in Ajiril, 1918, and held weeklv consultations for nursini'- mothers. 808 HISTORY OF AMERICAN RED CROSS NURSING The next Children's Bureau dispensary was opened in April G, 1918, at 41 Rue de Poteau in a settlement house maintained by Mile. Doillard. It was called the Poteau Dispensary. A special phase of this institution, which had been established by French women, was the garderie schoJaire, where children of working women were kept between school hours and the time when their mothers returned from the factories. The Poteau Dispensary came in direct contact with some five hundred chil- dren. The dispensary located at 40 Rue de Pre-Saint Gervais, also in the 19th Arrondissement, which was maintained by the Assistance Puhlique, was one of the largest of the dispen- saries aided by the Children's Bureau. One of the American Red Cross nurses assigned to this dispensary, Juliet Snyder, described the nature of the work: This dispensary was conducted entirely by French per- sonnel and it was in the nature of a concession that we were allowed to attend the clinics. At first we took names and addresses of only the worst cases and visited them, treating skin diseases and doing general public health and social service work. The dispensary was admirably conducted from a medical point of view. After several weeks, the French physician, who was at first not at all interested but always polite, began to ask us to visit certain liomes and do special things whicli he recommended. After a few more weeks, he requested us to visit and instruct all new cases admitted, as a matter of daily routine. . . . After four months, the French physician declared that, to him, the work of the nurses was indispensable. Located in the Rue de I'Argonne, 19th Arrondissement, was one of the pioneer dispensaries of the Rockefeller Commission. Here Dr. Manning conducted clinics for children. He wrote in his report for the week ending January 5, 1918, that the outlook is depressing unless the Red Cross is in a position to establish and maintain, together with or independent of the local school authorities, canteens for these children. ''They need food, not tonics." This recommendation of Dr. ^lanning's was the beginning of a project by which the American Red Cross supplied a supplementary daily feeding to 27,812 school children, ^lany French mothers worked all day in the fac- tories and the noon meal, the most substantial, was given to the children at school canteens. But it was not ample, so the NURSING SERVICE TO CIVILIAN TOPULATION 809 Children's Bureau supplied extra food to the amount of 35,873 kilos each month to the canteens. *'In the arrondissement where t)050 children eat daily in the school canteen," wrote Dr. ]\ranning, ''fifty per cent of the food is supplied by the Red Cross." The American Red Cross cooperated with the Rockefeller Commission and on September 23, 1918, a joint dispensary was opened at 21 bis, rue d' Argonne. This was also used as a teaching center for students who were taking the courses for risifciLses d'enfants which the Children's Bureau conducted. The work of the Children's Bureau in the 19th Arrondisse- ment thus included in the winter of 1918-1919 the maintenance of three large dispensaries, at Rue des Migiiottes, Rue Edouard Pailleron and Rue d'Argonne and the Social Service (Vnter at 3 Rue Clarel. Dr. William J. French had been appointed director of the work in this district in September, 1918, and Nellie Reed supervising nurse. One of the nurses on her staff wrote that ''lliss Reed proved an agreeable and capable head, welding the work and the personnel together into a good whole." The child welfare program as finally worked out in the 19th Arrondissement included clinical work, instructive nursing in the homes, school nursing, pre-natal work and social service. Olive Simons, Helen ]\1. Spalding, Juliet Snyder, Jeanette Hays, Katherine J^. ^Mackenzie, Donalda Lanctot, Anna M. Sundberg, Florence IsL Peters, Lotetta C. Quinn, Edith Young and ^fiss Fearn formed the nursing staff. They were assisted by two American nurses' aides, Katharine D. Exton and Alma A. Clark, and numerous French visiteiises d'enfants. Social service work was done under the direction of Frances Stern, of Boston. ]\nie. A. ^I. Ciodot, secretary to Dr. French, rendered enthusiastic service. Dr. French wrote of her, "'Always my tongue and ears when dealing with the French people, ]\nie. Godot has frequently been my mind as well and her judgment has been unerring." The last American R(>d Cross; dispensary in Paris was opcMied in Jannary, l!19, at 12 Manget, were assigned th(M-e. When the (Miildrcirs ]-)nr(nni closed its program in the spring of 1919, a French committee, of which ^Madame Raynioiid Poincare was president, was ctcd by ^Illc. Dienicr. "A few of th(> candidates had had experience as French Med Cross nurs(>s,'' ^Ill(>. Dicnicr wrote. 812 HISTORY OF AMERICAN RED CROSS NURSING "Others had already taken care of young children. Several had suffered from the war, being refugees, war orphans or war widows. All were eager to do their best and were grateful to the Croix Rouge Americaine which enabled them to earn their living as well as to help the suffering babies of their own country." The first lecture of the first course was given on February 20, 1918, at the Fondation Bvdin, the memorial erected to the founder of child welfare work in France ; the lecturer was Dr. Lesage, then executive secretary of the Ligue contre la Mortallte Infantile. Twenty-six candidates had been accepted. The course consisted of lectures, all given at the Fondation Budin, on maternity by Dr. Devraigne, Dr. Weill-Halle, Dr. Lesage, Dr. Dora Mantoux and Dr. Loude ; on children's hygiene, tu- berculosis and contagious diseases by Dr. Guinon and Dr. Besson; and on social laws and social charitable organizations for mothers and children by Madame Weill-Raynal, Dr. Lesage, M. Emile Leven, Mile. Bassot and Mile. Diemer. These lec- tures were given in the afternoon. The following outline of the lectures, an outline which appeared in the syllabus issued by the Children's Bureau, gave the general scope and subject mat- ter of the lectures: History (one hour) : Brief review of child welfare conditions and influences ancient and modern, showing the chang- ing attitude towards the child; infant mortality, its causes and remedies. . . . Motherhood (seven lessons): Pregnancy; lactation; confer- ences with practical demonstrations. Simple Anatomy and Physiology (two hours) : A study of the parts of the body and their functions. . . . Infarits (seven hours) : (a) The normal infant, its rest, exercise and food; lactation; bathing and clothing; proper handling; weights; special symptoms, their recog- nition and treatment; (b) the abnormal infant, diseases of respiration . . . and intestinal disturbances . . . care of excreta, ear, nose and throat complications; ))rain and nervous system. . . . Childrciv (seven hours) : Child life, the need for examina- tion, guidance, protection, recreation, food and rest . . . special diseases of importance, contagious infectious, . . . tuberculosis . . . venereal . . . respiratory ... of special organs. Hygiene and Sanitation (four hours). , . . NURSING SERVICE TO CIVILIAN POPULATION 813 Social Leylslalioti (two hours) . . . Oeuvres d* Assistance; Loi.s d' Assistance. Social Organization (one hour). . . . Practical Sociology (tliree hours). . . . II ou-seliold Economics and Dietetics (three hours). . . . Practical Demonstration in the preparing of artificial foods; varieties of artificial foods; milk and control of milk supply; milk modifications and mixed feeding. Statistiml Methods (three hours). . . . Child Welfare' (three hours). . , . Practical instruction was given by American Red Cross public health nurses at French institutions and American Red Cross dispensaries. These nurses were IMarie Baurle, Mary E. Bailey, (Airs. ) 'Margaret P. Church, Marie C. Ells and Eliza- beth G. ^Mitchell. Each of these nurses had under her care five^or six pupils. ^Ille. Diemer wrote: The pupils went in groups to I'llopital des Enfanis Malades, Creche de Convalescence des Infirmieres Visiteuses de France, Dispensaire de la Nouvelle Etoile, Jardin d'En- fants de V Amelioration des jardin oeuvres and others. Dur- ing the third month they went to the American Red Cross' own children's dispensaries and accompanied the nurses in home visiting. An examination followed the course of lectures and practical instruction. Of the twenty-six candidates who entered the first course, seventeen were graduated. Three of these joined the Association des Injirmieres de France and eleven entered the service of the Children's Bureau and were assigned to duty at Porchefontaine, Plessis-Piquet, Levallois, Bicetre, Blois and the American Red Cross Dispensary in the Rue des Mathurins. The nanu'S of these first visiteuses d'enfanis to be entered as French aides on the rolls of the American Red (^ross were Helene Desbons, Mile. Devingtmuid, ^Mlle. Duprat, ^Mme. Etcheberrv, Alice Frency, Alme. Henri-Jean, ]\rnie. Langlois, Edmee Plenelist, Alarie T. Plenchol, Jeanne Zimmerman and Mile. JSTouchet. The facilities for the practical instruction of the risilenses had not been wholly satisfactory, so early in April, ll>l.s. the Children's Bureau crt'ected an arrangement whereby part of the Pouponnicre de Porcliefoniaine, in the little town of Ver- sailles, was secured as a teaching center for the pupils. The 814 HISTORY OF AMERICAN RED CROSS NURSING Pouponniere was a large French sanatorium to which unmarried mothers were sent for treatment and care on the condition that each of them nurse her own child and an orphaned baby as well. Many difficulties attended the maintenance of the Pou- ponniere. Versailles was in the heart of the bombing belt and was also under fire from "Big Bertha." There were no modern conveniences such as Americans were accustomed to, in the buildings. The stables where the cows were kept, were connected with the house. Because of the scarcity of food and the result- ing exorbitant prices, the diet for the mothers was hardly ade- quate and the babies were as a result anaemic and sickly. Marie Baurle, one of the nurses who had instructed visiteuses d'enfants during the first course in Paris, was sent out to Porchefontaine to take charge of the pavilions secured by the Children's Bureau as a teaching center. Of her work there, Miss Ashe wrote: Miss Baurle, a graduate of the Boston Children's Hospital and one of the few nurses of the Bureau who spoke French fluently, was put in charge. When Miss Baurle took over the management of these two houses, each contained twenty-eight babies and seventeen wet-nurses. The conditions were most discouraging. The babies were colorless and flabby and though thoy were bathed regularly they were not kept clean. . . . Tlie windows were never opened and the odors in the building almost unbearalde. ^liss Baurle found children as old as eighteen months being fed from seven to nine times a day on soup and diluted milk. The difficulties of bringing about a change in this regime were great . . . but ]\Iiss Baurle was able to change the diet, open the windows and get the babies out of doors. The im- jV'ovement in their appearance after a short time was quite remarkable. They practically lived outdoors and had a fine, rosy, robust mien wliich rejoiced one's eye and heart to see ! ^liss Baurle was not able to bring about one very necessary reform which she felt was vital to the well-being of the babies. She l)elieved that tlie nursing mothers were not ])roper]y fed. Each one of these women who was an unmar- ried mother nursed one ])aby besides her own and the food was very inadequate to sujjply the nourishment required by two baljies. Intil ]\liss Baurle took possession, nothing what- ever was being done for the mental or moral betterment of these women. She met with a good deal of opposition when she essayed to introduce simi)le anuisements for their leisure. NURSING SERVICE TO CIVILIAN POPULATION 815 . . . From a tca(lii!i o.xtrcnicly ill with pneumonia. Tlie otlier nurses were worn out, so were very glad to see Miss Callin and me. The doctor, a Belgian oHicer, decided to keep the measles cases in the iniinnary already running and to put the other cases, thirty-live in number, in an impro\isi'(l infirmary. 1 was alone on dutv here for a week, wliile Mis< Catlin took 820 HISTORY OF AMERICAN RED CROSS NURSING night duty. It was mighty hard work to take care of thirty- five children in so many different rooms, with a scarlet fever case thrown in. I went on duty at six in the morning. j\Iiss Cafiin stayed on until about ten o'clock, so that we eould have the rooms half way fit for the doctor's morning inspection. After she came on at night, I would wash towels and such other things as any woman with such a family has to do. The diet was also a problem^ but with all the dressings on frozen feet and sore eyes, to say nothing of new patients, possibly nine at a time, all of them having to be bathed before they could be put to bed and their clothes tagged, it was "right smart" work for one pair of hands, without extra cooking. Anyone who has ever tried to boil a bucket of water on those French stoves which refuse absolutely to do anything but smoke, will appreciate how we felt ! The children at Le Glandier numbered about seven hundred. As soon as the measles epidemic subsided, Miss Caffin was re- called to Paris, but Miss Jennings was assigned to a nose and throat clinic which was opened in the permanent infirmary. Dr. Wiggin, w^ho was later assigned to Lyons, operated for tonsils and adenoids, and his wife, Mrs. Wiggin, gave anesthe- tics. An American Red Cross physician, Dr. Lillie A. Arnett, was also on duty at Le Glandier. She wrote of the dispensary there : Each morning we began work at 7 :30. There was a daily average of about 65 or 70 patients. Many of them were old ulcer cases, the results of frozen feet or hands, others were indigestion, aural abscesses, skin diseases of different sorts, afflicted scalps and scabies. It was necessary to finish with the children who attended morning school by nine o'clock, and care for the children after nine who attended afternoon school. After we had finished with all the children, we treated members of the personnel who were ill. Nearly every day two or three peasants from the neighborhood would come to the dispensary for consultation, and often there would be calls to be made in their homes, perhaps three such visits a week. Tlio life at T>e Glandier was pleasant. It was very interest- ing to live with the Belgian people and to know them inti- mately. They realized and often said that without doubt had it not been for tlie American Eed Cross many of the six hundred children of tlie colony would have died; instead they now promise to develop into healthy and useful citizens. NURSING SERVICE TO CIVILIAN POPULATION 821 Mrs. Laura Wiggiii wrote of the children: They tell me many little stories about their homes and in their turn ask questions about America. Two asked me to- day if the savage red men with plumes on tlieir heads lived in the woods near my house. They had seen Buffalo Bill in a circus at Liege ami Ihouglit America still full of Indians. They know of liulfalo Hill's death and spoke of it with regret. Bread cast upon the waters, or a rumor of it, came back to me when one little girl announced that she would not return to Belgium after the war "because,"' she said, "I had not enough to eat. Madame/' she confided, "we had but three hundred grams of bread each day, with no butter nor con- fiture, and for dinner we had but potatoes or turnips, with almost always no meat nor bread. For supper we had soup, but it had not much in it, only the soup and nothing else. But les Americains, ^ladame, they sent us milk in cans, so that children might have a cup extra each day, and in the afternoon at the end of school they served a cup of chocolate with the milk to eacli child. Mais, it w'as good !" Hereupon the children chimed in with smacking of lips and rubbing of stomachs and began to sing a song: "Vivent les Ameri- cains." Many of the children have referred to the fact of Americans sending them gifts and food and the proudest thing any of them can seem to procure is something with a Eed Cross uj)on it. Sonu^ of them have cut Ked Cross from envelopes and ])apers and have pinned or sewed them to their clothes in conspicuous places. In January, 11)11), the colony of children was returned to Belgium. From Xovembcr 28, 1917, to January 13, 1919, 133G children were cared for by the American lied Cross at Le Glandier. When it canu' time for them to be sent home, Queen Elizabeth asked that Miss llower be alhnved to escort them and to enter her service. "The real benefit to the children," wrote ^Miss llowei", "could be seen upon their ai-rival in their home city, Lirgc. They had rosy cheeks and were well and hardy looking, ^riie Red Cross had dressed each child com- fortably and given it an e.xtra sup})ly of clothing. The Aniei-ican Red Cross furnished aid to the Fi'ench-Ameri- can Committee foi- the Protection of Childi'cn at the Frontier. Two of the largest colonies which were maintained by this committee were located at Oulins and at Morangis. The Aniei'icaii Red ('ross Coniniission broui:ht one liundred 822 HISTORY OF AMERICAN RED CROSS NURSING and thirty-two children from Switzerland and sent them to their parents or relatives in various parts of France. The Commission for Belgium developed extensive public health nursing and dispensary service for Belgian refugee chil- dren at Le Havre, in the Salle Franklin. Mabel I. Wilcox was chief nurse. Miss Ashe wrote: In January, 1918, Dr. Edwards Park was put in change of the medical work at Le Havre. Miss Wilcox and an aide who acted as interpreter accompanied him. This work with the Belgian refugees was so much appreciated that the French Kefugee Committee asked them to extend it to the French children. The Salle Franklin was an old theater which was converted into a hospital and dispensary. They had in August, 1918, a twenty-bed hospital and a large out-patient department. Ex- cellent social service work was done here, and a small class of French women were trained as public health visitors. On August 1, intensive work against infant mortality was begun in the poorest district of Le Havre. The maire re- ported each day the births in the quarter. The visiting nurse immediately called and the baby was kept under close sur- veillance until it was a year old."^ The Report of the Work of the American Red Cross during the time the society was operated by the War Council stated that at Le Havre a total of 14,010 patients were treated at the dispensary, 2523 house visits were made by doctors and nurses and 195 hospital patients treated. At Lille and at Cambrai, the American Red Cross undertook extensive projects in school nursing for the benefit of children who had been living in these areas through the German occupa- tion and whose health had suft'ered. Miss Fitzgerald made a trip from Paris headquarters to these cities in June, 19 19, and she wrote : The work here has been the establishment of school canteens and the maintenance of public health nursing for the children in these areas. In Lille, Elmira Bears, the nurse in charge, has done a remarkai)]e piece of organization work. There were about sixteen thousand school children in the city and when I was tliere nine thousand of them had already been examined. ^UHl.lcr Itcport. \\>\. III. p. 92. NURSING SERVICE TO CIVILIAN POPULATION 823 The method followeJ is that employed in America, Tlie children receive a thorough examination which is given in co- operation with the French, who have entered into the scheme most whole heartedly. The children needing convalescence are sent to the seashore, or to mountain resorts, through the help of different committees; those needing hospital care are sent to the hospitals in the locality wherever possible. The canteen work consists in serving cocoa to all children and a meal to those needing extra food. This meal is served in the afternoon, after school hours, and consists of soup, meat or fish, vegetables and fruit. The Commission for Relief in Belgium and Northern France has endowed this work to the extent of nine million francs, which will enable the French people to carry it on. One very interesting part of the work consists in the care they have had to give to the many children suffering from scabies. They have been able to secure a portion of the public baths of the city, and here from early morning till late at night the children are bathed and scrul)l)ed and treated; they now have the situation well under control. At Cam])rai, ^liss Baurle is in charge of similar work and has again shown herself to be most efficient and competent. In the previous chapter it has been shown how during the sj)ring of 1!>18, the needs of the American Expeditionary Forces engiilfed American Red Cross activities for the French civilian population, ^fiss Ashe wrote: Following the first call for help from ^lilitary Affairs in March, 1!)1S. the strain on the nursing force was very severe. . . . Within the next two weeks, forty nurses and aides were loaned to the Department of ^lilitary Affairs by the Chil- dren's Bureau. A hospital was opened at Beauvais, the personnel of which was composed entirely of nurses from tlie Department of Civil Affairs. In July, the nursing force was again called u])()n to helj) when the advance of the enemy to the ^larne entirely disrupted for a time the ^ledical Service of the Army and the Ked Cross . . . rushed nurses to llie front. A h(is])ital was established at Jouey-sur-^lorin. with a personnel conqiosed almost exclusively of infant welfare and public health nurses and aides. The adajitability of these nurses to war needs was a sur- prise to e\eryone. Their training in the poor homes \v]ier(> they had been obliged to make the best of what was at liand. was of value to them in this emergency woi'k. where they were conipelled to do manv thinirs with which a re^Milar bos- 824 HISTORY OF AMERICAN RED CROSS NURSING pital nurse is not accustomed to work. The Children's Bu- reau felt much pride in them and great happiness in that it had been able in the time of need to make vital contribution to the care of American wounded.^* August, 1918, marked a crucial month in the history of the Children's Bureau in France. Dr. Knox, Dr. Manning and Dr. Baldwin, three of its strongest pediatricians, returned to America. The organization of the entire Paris headquarters was also effected and the Children's Bureau became a part of the newly-created Medical and Surgical Department of which Colonel Fred Murphy was director. September and October were months spent in definition of future policies and readjust- ment of present actiyities of the Children's Bureau. Miss Gilder in the official report of the Bureau, summarized the close of the work : By the middle of January, 1919, the personnel of the Bureau numbered 228 against 541 of the preceding August, the highwater mark of the staflf. This was approximately the minimum with which the Bureau could operate and was only slightly reduced before the final wind-up of the work on May 1. This was to occur after the hospitals at Limoges and at St. fitienne were turned over to the French ; after the dispensaries at St. fitienne, Blois and Corbeil were taken over by French doctors wlio were demobilized ; and after the per- manent child welfare organization in Paris was completed. On January 1, 1919, Dr. Lucas received a cable from Eed Cross Headquarters confirming a gift of $100,000 from the American Junior Ked Cross to the children of France. The gift came as a memorial of the sympathy that expressed itself in small gifts, the dimes and quarters out of children's pockets, and was used to endow a hospital and health center in Paris, to be inscril)ed "From the Children of America to the Children of France" and to be administered by a French Committee composed of the ]\Iedieal Faculty of Paris and of representatives of the leading child relief and child welfare organizations of France. On January 1, 1919, the Children's Bureau completed a little over sixteen months of work in France. It had in thia period given assistance, in medical service, money and relief materials to at least 250.000 children. . , . "When the Children's Bureau closed its books on May 1, 1919, it left behind it four permanent hospitals, in St, * Gilder Report, Vol. Ill, p. 92. NURSING SERVICE TO CIVILIAN POPULATION 825 fitienne, Fou<{, Kouen and Paris, and four important Franco- American child welfare organizations whose object it was to carry on the training school for nurses which the Bureau had inaugurated, and to do general child welfare and public health work. It had established at least twenty-eight per- manent institutions; and by turning over the equipment, sup- plies and "good will" of its dispensaries to French manage- ment it had naturally helped and made lasting its work in 71 other medical estaldishnients.^'' A list of these principal hospitals and dispensaries may be found in the Appendix. In the Keport issued by the War Council on the Work of the American Ked Cross during the period beginning May 10, 1917, and ending February 28, 1919, it is stated that the Children's Bureau operated 25 hospitals and convalescent homes for chil- dren and in them treated 10,346 patients; operated 99 dispen- saries and clinics and in them treated 189,111 patients; served 32,000 children in school canteens ; taught 27,000 children how to play (in organized recreation centers) ; held 7 child welfare expositions which were attended by a total of 625,000 people and aided 519 children's institutions or societies.^'' And the comfort and happiness which this phase of Ameri- can Red Cross nursing and general relief service brought ? "The women and children who came to our clinics," wrote Mar- garet Wood, an American Red Cross nurse, "have had little glory, yet they endured almost unbelievable hardships without a murmur. Poor, little, neglected, underfed and silent children, whose seemingly small ailments had gone uncared for during years, were at last able to be treated through the American Red Cross." JMiss Leete summarized as follows this nursing service of the Children's Bureau: "Our nurses touched all parts of France, deft tender fingers seeking out and easing pain." One of the five major opportunities for service which ofTen^d themselves to tlu> American Red Cross in France in July, 1!17, was, it will be remembered, work for tlie alleviation of the suffering of F'rench and liJelgian refugees. This service was first cari-ied on through tlu^ Bureau of Ri^fugees and Relief in Paris, one of the five principal bureaux of the Department of Civil Atfaii's. ^largaret (Hirtis, of Boston, was its tirst "For complete details see the Cilder Report, pp. 131-14('). *"'Tlie WOrk of the Ainerieaii lied Cross During' the War: A Statement of Financfs and Aeeomplislimenls,'' p. (i3. 826 HISTORY OF AMERICAN RED CROSS NURSING director and she initiated varied phases of social service work for the refugees in Paris. In September, 1917, Dr. Edward r. Devine, of New York, was appointed chief of the bureau and directed the service work for refugees throughout all of France, except the war zone and Paris. Dr. Devine had been pro- fessor of Social Economy at Columbia University, director of the New York School for Philanthropy and for twenty years secretary of the New York Charity Organization. He had done emergency relief work for the American Red Cross during the San Francisco fire and the Dayton, Ohio, floods. The French Ministry of the Interior stated that the number of destitute refugees in March, 1917, was four hundred thou- sand. The problem of furnishing housing facilities and means of earning a livelihood to these numbers was one with which many French and American charity and war relief organiza- tions had been working since 1911. The American Red Cross Commission for France early adopted a policy of cooperation under which substantial gifts of funds, supplies and personnel were donated to these already-existing organizations and they were urged to continue and further develop their own machinery for relief work. "Do all the work you can in an efficient man- ner," the American Red Cross practically said to these organ- izations, ''and we will provide the funds." ^^ In addition the Bureau established and maintained hospitals, dispensaries, colonies and homes for refugees and developed a system whereby a trained social service worker was sent as an American Red Cross delegate to the different departements where large num- bers of refugees had been placed. The British and American Societies of Friends blazed the way in France for relief work among the refugees. The British Society of Friends had begun volunteer relief work in the Marne in Se])tember, 1914, and the American Society of Friends had iiiven them generous contributions of funds and clothing. In June, 1917, a unit of one hundred American Friends went into training for foreign service at a camp at Haverford, Pennsyl- vania, and tlie society sent two representatives to France to make a field survey. These men sailed on the same ship as did ]\rajor Murphy and his staff and were appointed to membership in the American Red Cross (\)mmission for France. The plan of cooperation which was later developed is stated in the Report of the First Year of the American Red Cross in France: "Sec "The First Year of the American Red Cross in France," p. 13. NURSING SERVICE TO CIVILIAN POPULATION 827 lender the ori^Miial plan of work, it was decided that Ameri- can Friends desiriii*,^ service in France shouhl not form a new unit hilt sliouhl unite themselves with the Rritisli organiza- tion which already had heen in the field nearly three years. The result was a compact group under tlie control of a single executive committee with a common treasury. The Ameri- cans, however. l)ecame memhers of the American lied ('ross, while the Britisli Friends retained their connection with the French Eed Cross. ... To the common treasury of the American and British Friends the American Red Cross donated money, transportation and equipment; it facilitated the movement of workers and the shipment of goods and supplies. The Friends, on the other hand, presented plans for extension of their work and new developments to the Red Cross for approval, thus enahling their personnel to cooperate directly with Red Cross workers. This plan was put into effect early in Septemher, 1917. The American Friends arriving then found that the British Friends already had estahlished three medical relief institu- tions for refugees in the department of the ^larne at Chrdons- sur-Marne, where there was a maternity hospital of twenty- eight heds ; at Bettancourt, where a convalescent home was being operated for fifty children, and at Sermaize, where there was a chihlren's and local hospital of twenty beds. Early in the fall of 1017, the numbers of volunteers among the American Friends began to exceed the immediate needs of the British Friends; so a second unit was formed which worked independently of the l^ritish Society. This unit was designated as Unit Xo. 2 whUc the earlier unit was known as Unit Xo. 1. On September 20, 1017, a bureau called the T3nreau of Friends was established in the Department of Civil Affairs of the Com- missi(ui for France and .1. Ilenrv Scattergood, one of the two rc^presenta fives who had gone to France to make field survey for the American F'l'iends, was appointed director and Charles Evans, of Ixiverfon, Xew Jersey, assistant director. Tlie per- soniu^l of Unit Xo. 2 worked entirely under the direction of the chief of the Fi-icnds Ihircaii and they aided in ihv ''construc- tion of hospitals, the refitting of buildings for dispensary pur- poses, the repair of house's in devastated areas, child welfare campaigns, varied relief activities for refugees and in the wliole American Ived C^ross program for the relief of civilians in F^rauce." ^'- As many of these young men had had sjx'cial tra';i- ^ "'llio First Year of tlu' Aiiiorieaii Red Cross in Friuice," p. 48. 828 HISTORY OF AMERICAN RED CROSS NURSING ing in automobile work, carpentry and agriculture and as their attitude toward service was one of earnest enthusiasm, it may indeed be said of them that no task was too hard, no emergency too trying to chill their unfailing cheer and good-will. After some months, Mr. Evans became chief of the Bureau of Friends and in the First Annual Report of the American Friends Service Committee, Bulletin No. 18, he wrote: We now liave one hundred and fifty-eight men and the twenty-six women in Unit No. 1 and eighty-three men in Unit No. 2, making a total of two hundred and forty-seven American workers. At least one hundred and fifty more men have been favorably passed upon for this service by our Philadeli)hia Committee and will sail as soon as passports and sailing accommodations are available. In giving these figures it seems api)ropriate to mention the loan of workers to other Bureaus of the American Eed Cross, quite apart from the plan of Unit No. 2. In addition to the work of o.ur Mission it has been our ])leasure to cooperate with various bureaus in the American Ked Cross by lending temporarily to them men and women whose qualifications clearly fitted them for the work desired. We mention the following instances: Belgian Conmiission, one; Italian Commission, four; Children's Bureau, Luneville one, Toul two; Bureau of Refugees and Relief, Aube (delegate) one, Eaux Bonnes four, Eure and Mayenne three; Bureau of the War Zone, two (chauffeurs) ; Bureau of Reeducation of JSIutiles, one; Historical and Edi- torial Division, two; jManufacture of Artificial Limhs, one. American Red Cross nursing service for refugees was carried on chiefly under the direction of Miss Ashe; although she was called chief nurse of the Children's Bureau, she also served as chief nurse of the entire Department of Civil Affairs, in that public health nurses assigned to her by Miss Russell were sent to do tuberculosis and infant welfare w(U'k and visiting nursing among \\w adult civilian population of France as well as among the children. Early in the fall of 1!)1Y, the commission made a grant of 993,000 francs to the Friends' Society and with part of this fund a hospital home for sick babies was opened at (^halous- sur-Marne, in connection with the Friends' Maternity Hospital already establislied there. This home was located at St. Remy- en-Bouzemont, Marne, and "was needed," wrote ]\lr. Evans in his First Aniuuil Report, ''for bnlu'es iKtru at the ^laternity NURSING SERVICE TO CIVILIAN POPULATION 829 Hospital at Chrilons-siir-Marno whose mothers were ineapable of takinjr care of them. A suitable house to the south of Vitry- le-Franqois was oifered rent free. The cost of fitting and equip- ment has practically all been paid by the American lied Cross." Miss Ashe assigned nurses and aides both to the Maternity Hospital and to the Babies' Home. A similar baby hospital was established at Chalons-sur-j\larne and rent and equipment expenses were met by the American Red Cross. A general surgical hospital was next opened at Sermaize- les-Bains. Dr. James H. Babbitt, a member of the Friends' Unit, was director. The French civilian hospital at J5ar-le-I)uc had been evacuated on account of severe air raids and the women and children of the district in need of medical care were left in dire straits. The American Red Cross hospital, which was called the Chateau Hospital, had at first a capacity of sixty beds, but by the spring of 1918 this was raised to one hundred beds. Several barracks were erected to house contagious cases and to afford acconnnodations for the staff; electric lights, im- proved water supply, a drainage system and X-ray and other apparatus were installed. "Practically the whole expense of this hospital," wrote Mr. Evans in his First Annual Report, "has been carried by the American Red Cross." The Chateau Hospital was partially staffed by American Red Cross nurses and aides. Dr. Babbitt's report for the week end- ing ^lay 11, 1918, showed that an extensive surgical service was maintained here for the Sermaize-Chalons district. The report of the past week will be given as combined report of the two hospital staff physicians and will thus in- clude the out-patient service at the Source Hospital, Bcttan- court and Chauniont. as well as the general visits in the villages. There are forty-two patients in the Ciiateau Hospi- tal and twonty-thrce operations have been jierformed there this week, 'i'lie staff has seen or visited seventy new patients and the coniljined out-patients service numbers one luindred and thirty-nine cases. On May first there were twenty-eight patients in La Source Hospital and fifty-three at Bettaneourt. Since December 27, we have performed three hundred and seventy-nine operations. Refugee relief work in Paris fell under two principal heads, economic n^habilitation and medical social service. The latter 830 HISTORY OF AMERICAN RED CROSS NURSING phase of work (and the only one of which an account belongs in this history) was first developed in 1917 under the Accueil- Franco-Americain, with Dr. Richard C. Cabot as director. The development of this service was described by Julia B. Norton, a nurses' aide and social service worker: December 1, 1917, found me in Paris, starting medical social work under the great master, Dr. Richard C. Cabot, Major, U. S. ^M. E. C, Avho had been loaned to the American Red Cross to start a program of good medical social service in connection with a refugee dispensary. ]\Iedical attention for the refugees was greatly needed. The out-patient clinics of the Paris civilian hospitals were so overcrowded that for the most part the refugees had little attention. The need for a central dispensary to which all refugees could go and be welcomed was very apparent. L'AccueU Franco- Am cricain had started in a small dis- pensary at 12 rue Boissy d'Anglas to take care of the medical cases which presented themselves along with general relief cases. Dr. Cabot took over this dispensary and started it on a much larger scale with the following staff: one children's specialist, one tuberculosis specialist, three general medical men, one dentist, some six or seven nurses and as many more social service workers. . . . The dispensary grew from seventy-five to one hundred cases a week and when it was moved to its new home at 32 Rue ^lathurins, to six hundred cases a week. The new location was more or less ideal, cen- tral, quiet and conveniently divided as to space into small consultation rooms, each with natural light and good air, and a few big reception rooms. The dispensary was essentially a temporary proposition, started as a temporary service to fill in chinks where the French lacked funds or personnel, so it will naturally be closed on !March 1, 1919, with the return of the refugees to their former homes. Tbere was a great amount of actual relief done through the dispensary. Besides free medical consultation and free medi- cine [and public hcaltb nursing service] for tubercular anaemic patients, we gave extra food, the kind of food con- taining carbohydrates and oils which they could not get for themselves and for which there was absolutely no existing French organization to supply them. Clothes we gave and medical appliances aiul furniture too. hut only after thorough home investigation through central oruvres of the American Eed Cross established to fill individ^ial needs. Besides the six hundred medical cases a v/eek. we gave material aid to NURSING SERVICE TO CIVILIAN POPULATION 831 about two liundred others a week. . . . Let me cite an example. On iS'ovembor 18, 1918, a delegate of the Croix Kose came to the dispensary and asked for two hundred and fifty kilos of medical supplies to take up in a camion to destitute Lille. Lille had then plenty of doctors but no medi- cines. The American lied Cross had the medicines but no transportation from Paris to Lille for the moment. The Croix ]{ose furnished the camion, the American Ked Cross the medicines and within two days the doctors of Lille were at work. The Bureau of Refugees through its departmental delegates undertook extensive relief work for the refugees in central and southern France. Food and clothing were issued in large quan- tities, farming implements were supplied and positions secured for trained workmen. The entire refugee problem was dependent upon the military situation. On ]\Iarch 21, 1918, the Germans launched the first of their five major oifensives and the refugee problem im- mediately assumed enormous proportions. Amiens did not fall, but the civilian population of the city and the surrounding villages and countryside fled. Annie S. Rathbone, the Ameri- can Red Cross nurse stationed at the child welfare station at Amiens, wrote : For five nights previous to the evacuation of Amiens, the enemy had systematically tried to break the city's morale by air-raids. ^leaiiwhile, Ifed (*ross workers and members of the Friends uiid the Smith College units kept coming in from points further east. Dr. Baldwin brought three small sick children from the Red Cross Hospital at Xesle, whom he had not been able to return to their parents. . . . On March "3(1 Dr. Baldwin took Miss Flanagan and the two Nesle cliil(lrci\ to Paris; tlu^y were afterwards reunited with their parents. I started across the city to return the Amiens bal)y to its mother. An American soldier carried her. I soon heard a (ierman plane overhead, so we dodged to shelter. Later, we tried again. The night was beautiful, with a i)hicid full moon. We gave the bal)y to her mother, who was half- mad with anxiety, supplied her with money and condensed milk and dodged l)a(k. The next morning 1 made rouiuls among mv sick. Some had already gone. Everywhere those remaining asked help- lessly: "Shall we fly or shall we stay?"" In my ignorance of the militarv situation, I could not answer them, could not tell 832 HISTORY OF AMERICAN RED CROSS NURSING them whether to risk death from the German shells or from exhaustion on the road. . . . The streets were already jammed with refugees staggering along under the weight of their bundles. . , . At noon, shells began to fall on a distant part of the city and it was time to go. While waiting at headquarters to get off, we women distributed Eed Cross chocolate, condensed milk, cheese, biscuits and blankets to some five hundred British soldiers who had lost their equipment. As the only nurse in our party, I was given the care of a young French girl who had an extensive shell wound in the lumbar region. She had come from the east, fleeing with her mother in front of the advancing Germans. Girls of the Smith College Unit had found her. I packed her in a stretcher with rolls of material and used my umbrella as a sort of splint for her body. The actual evacuation of Amiens was a tremendous sight, a city of 100,000 emptying itself frenziedly in one direction. The road to Poix was packed with refugees of every age and condition, tottering old people and young girls; women with babies and children scarcely able to walk hanging to their skirts; automobiles, wheelbarrows, smart equipages, donkey carts and baby carriages; animals of all kinds, cattle, sheep, dogs, poultry and rabbits ; domestic possessions of infinite variety, carried in an infinite variety of ways, a swollen stream of traffic which formed a dark unending line of misery over the unconscious smiling earth. Beauvais lay immediately south of Amiens, on the direct route to Paris and to this bombed and congested city the refugees fled. Miss Rathbone wrote : Late in the evening we pushed on our journey and reached Beauvais, where the Sisters at the Hotel Dieu took charge of our wounded and invited us to rest that night in their deli- ciously clean hospital beds. We women workers from Amiens and those who had joined us from points further east filled two wards. It was the first night's sleep we had had for nearly a week. In tlie morning, Captain Van Kemen of the American Eed Cross arranged for the use of a freight shed near the Beauvais station. There a canteen was started at one end by the Smith College Unit; mattresses thrown on the sanded floor at the other end served as resting places for the sick and wayworn. Later in the day, we nurses were joined there bv other nurses and doctors sent from Paris headquarters and two days later we moved into a house. This was the begin- NURSING SERVICE TO CIVILIAN POPULATION 833 ning of the Emergency Hospital for Refugees, which was carried on for about two months. Then the nurses and equip- ment were transferred to tlie Red Cross military hospital later established in the town | American Red Cross Hospital No. 104: L'Ecole Frofessionale], One of these nurses sent up from Paris headquarters was Anastasia Miller, who became head nurse of the Refugee Hos- pital. She wrote : During the spring offensive . . . the refugees were pouring in from Amiens, Arras and the surroimding villages. They suffered not alone from maladies but from shock and injuries received from shell fire before reaching places of safety. Families came in with one or two of their numbers missing; a child was brought to us who had been found in a cellar where she had stayed three days without food, her dead mother, who had been killed before her eyes, lying beside her. Horrors such as these we had to cope with, so it required a great deal more than nursing care. The food for the refugees was prepared by French soldiers and consisted of the usual boiled meat, with rice or potatoes in the gravy and a piece of hard bread. We undertook to supplement this by what we could cook ourselves on a two- burner gas plate. Tlie Red Cross had supplied us abundantly with evaporated milk, sugar, cocoa, rice, oatmeal, dried prunes and figs, gelatine, rggs and fresh vegetables. With these extra rations, we managed to keep them nourished and happy, although many a night 1 was cooking when the alcrte of an air round sounded. For a month we continued the work undisturbed. We held dispensary clinics every morning from ten to twelve, treating principally children. They were infected with scabies, ver- min or inijietigo. We became ade|)ts in hot baths given in a tin washtul) and followed by suli)hur inunctions, softening and removing the crusts of im})etigo with the subject almost in spasms meanwhile and the envelojmient of hundreds of heads in kerosene with shampoo following. It was all so worth-while! To see babies' faces coming out pink and soft from under the unsightly crusts of impetigo and the soft fluffy hair again free of vermin, with the attendant relief in those little ones' eyes, brought all the satisfaction in the world. Towards the end of ^lay, the Cantigny Drive, in which Americans first figured, began and simultaneously the Ger- mans started to hunib Beauvais. Tlie American Red Cross 834 HISTORY OF AMERICAN RED CROSS NURSING military hospital which was then being equipped to receive the wounded was not yet ready for occupancy; the medical and nursing stalT available for it consisted then only of three nurses and three surgeons. The wounded were then on their way to Beauvais from the front, so in order to help over the emergency I sent down from the Refugee Hospital all the nursing help I had, prepared myself a corner in the ward and stayed with my refugees on almost twenty-four hour duty for another month. Owing to the bombing which took place during this time, not a piece of glass was left in our windows and the low tongue-and-groove partitions which separated the beds were knocked apart by the concussion. I gathered up a candy box of shrapnel in the wards after the raids were over. Aside from slight glass wounds which I dressed after each raid, there were no injuries, a remarkable thing because the majority of patients were unable to go to the cave for shelter. One night a dog went mad during a raid and bit several people, tearing one man's hand severely. These I dressed by the light of a taper while a priest held a blanket up to block off its rays. Without windows or shutters, any spark of light was a risk. Finally, as the German advance continued, it was thought wise to evacuate our refugee hospital in the Ecole Normale, so the refugees and patients were moved further south. Paris was the next stop for the refugees on their journey southward. The American Red Cross established rest stations in the railroad stations of the city and gave the refugees food, clothing, medical and nursing care and a night's lodging and in the morning sent them on their way to the Midi. Dr. Mabel H. Bancroft wrote of the general phases of this work : We assisted with the refugees who in April and May were pouring in at all times at the various gnres. Sometimes they would come in all night long, old people, children, mothers with babies, many ill and half clothed, all hungry and tired and heart-sore. We gave a little medical attention to the most urgent cases, but what was most needed was food and rest. We fitted ourselves into any work which came to hand, whatever the need happened to be. I often wished that those at home who have worked so hard for the l^ed Cross and given so liberally could have seen the light come into those forlorn faces when tliey heard that it was tlie American Red Cross that was taking care of them. They wanted to give you all that they liad, their pet hen or goose which they liad picked up in their liasty flight, the NURSING SERVICE TO CIVILIAN POPULATION 835 most precious thing they possessed. We sent those who were too ill to travel further to hospitals and put on the train those who, in hope of hnding friends, lodgement and work, were going further south. The number of names on our books were about twenty-three luuulred. Le Gare du Nord was the scene of the first extensive Red Cross relief activity of this type. Katharine W. Holmes, a graduate of Smith College and of the Kewton (Massachusetts) Hospital School for Nnrses, was one of the first Red Cross nurses to be assigned to duty at this station. ^liss Holmes had done nursing at Henry Street Settlement and for seven years before her assignment to France, had been in charge of the boarding-out department of the New York Nursery and Children's Hospital. After her return from France, she be- came assistant to the director of the P)iblic Health Nursing- Service at National Red Cross Headquarters. Miss Holmes wrote of the Gare du Nord: The last of ^Fareh the refugees began to come through Paris in great trainloads. One day late in March, after our work in the Children's Rureau was over for the day, Mrs. William 11. Hill and 1 went over to the Gare du Nord to see if the Hed Cross could be of any use in handling the large numbers that were pouring in. We found the directrice of the French Military Canteen distracted l)y the double care of the French soldiers on the main floor and the hordes of refugees who had no ])lace to go except to a dark basement once used as a freight depot. Huiulreds were streaming down the narrow stairs from the crowded trains, with their children, baggage and animals, everything that they could take with them in their hurried fliglit from their homes. Some of them had been frightfully luirt by (icrman bombs. Children were brought in strapped to boards because their legs had been broken by bombs. Tiny babies a few days old were being carried by exhausted mothers. Old. old ])eople had walked sometimes 58 kilo- meters before they could even get to a train. After several days traveling under uns])eakable conditions, there was no complaining, no weeping, just a courageous acce])tance of it all aiul gratitude for what little was done for them. The Freiu-h Canteen, whose rcsoui'ct's wei'c e\liauste(l by four years of war and by feeding thousamls of soldiers and refugees, had only lu'ead and beer to gisc the refugees. They gladly accepted the American oH'cr of help. Those who scotf 836 HISTORY OF AMERICAN RED CROSS NURSING at the cumbersomeness of a large organization like the Red Cross would have done well to have been present at the Gare du Nord and to have watched the establishment of that emer- gency canteen. Through Mrs. Hill's initiative, Red Cross trucks were immediately sent to the warehouses for supplies and a com- plete personnel of volunteer workers was secured. In a few hours' time, the refugees were receiving steaming hot choco- late and coffee, American corned beef and their own beloved sausage, cheese, figs, beer, milk, sandwiches, eggs for the delicate and best of all, sterilized milk in sterilized bottles for the babies who up to that time had had only the choice of water or beer. IMedical care for those who needed it was given under the direction of Drs. Lucas, Knox, Manning; between profes- sional ministrations, they washed cups and yjassed sandwiches. I shall not soon forget the face of Dr. Knox, usually so digni- fied and at times almost austere, then shining with hajipiness over the menial task of washing tin cups in a basin on the top of an upturned beer barrel ! That niglit, two thousand refugees passed through the station and all of them were fed. Those who needed changes of clothing were given it. The Red Cross personnel was divided into night and day shifts; everyone gave as much time from their own particular work as possible. Everyone wanted to help in the canteen. We had workers from the Friends, the Y. ]M. C. A., the American Fund for French Wounded, British canteeners and many others. The second night, five thousand refugees went through and the Emergency Canteen became a fixture of the Gare du Nord. A temporary barrack was built to house the Emergency Red Cross Canteen at tin; (lare du Nord. It took only eight days to erect, equip and put it in running order. Great need existcid for ternporary quarters in which the refugees could spend a night. They could not all wait in the stations. Lcjdgings and hotel accommodations in Paris were well nigh impossible to secure tliroughout the period of the war. Moreover, prices were exorbitant. In the early days of the war Lc Sero^trs; de (hicrro liad taken over the old seminary of St. Sulpice, 05 rue Bonaparte, in the Sixth Arrondissement and tlie police officers converted it into a model hospice. When tlu^ great influx of refugees from tlie Aisne and Marne occurred in the; spring of 1018, the American Red Cross offered tlie French police assistance in the form of NURSING SERVICE TO CIVILIAN POPULATION 837 supplies and personnel. Doctors and nurses and vast quantities of linen and food were sent to St. Sulpice ; l)eds were set up in every corner; halls and auditoriums were used for dormitories, nurseries and information bureaus. In his report for June, 11)18, rej^arding the activities of the Department of Civil Affairs, Mr. Homer Folks wrote of Saint Sulpice : The difficult problem of lodging refugees who liad to re- main in the city overnight was solved by aiding Saint Sul- pice, which since the outbreak of tlie war has been used as a stopping place for soldiers en pertnission and as a refuge for Belgian and French families made homeless by the war. Beds, blankets and otlier supplies in large quantities were hurried from the warehouses, increasing the accommodations so that 2500 persons could be housed at a time. ... A hos- pital infirmary of twenty beds was installed and also a special infirmary where babies, besides receiving medical treatment, were bathed and fitt"d out with clean new clothing. Here an average of seventy children were cared for daily. Emergency canteens were also established in the stations at the Gares de VEst, Orleans, Mont par nasse, and d'Auterlitz and Miss Ashe assigned teams of nurses and nurses' aides to duty there. After a night's rest and refreshment in Paris, many of the refugees continued on their way southward. Limoges was the next large city where they stopped, either for rest or to seek quarters and employment until they could return to their former homes in the invaded northern provinces. Dr. !May E. Walker conducted a dispensary there during the sunnner of 1018 for refugees, but great need also existed for a children's hospital. A project to (establish an institution of this type was undertaken jointly in July, 1918, by the Chiblren's and Refugees' P)ureaus, but difficulties in construction debiyed its (Opening until I)e- cemb(>r. Dr. Walker was placed in charge of it and V(Mia ]\1. Woods, an American lied (^rpss nurse, was sent down from Paris as supervisor. She wrote: Tlie American Kod Cross Clijldren's TTos]ntal at Liniogos was of fifty bed caparity and also mniiitaiiuMl n large (lis])('n- sary service for refuuees. Between Xoveinber fS and Hectnu- ber 2(1, we ])ra(ticallv fed and clothed three hundred families, little children blue with cold and sick from hunger. The city 838 HISTORY OF AMERICAN RED CROSS NURSING could not care for all the refugees and had it not been for the quickness with which the Eed Cross furnished first aid, manj' would have died. Our hospital was ready on December 2G and then our real work began and continued until April 1, 1919. The Ameri- can Ked Cross then gave 50,000 francs and the city of Limoges raised 50,000, the hospital building was purchased and was operated as a Hospital for Children. The building was four stories high and was fully equipped for instance, three hundred children's dresses, two hundred and fifty gowns, one liundred and fifty complete layettes, three sheets and other supplies in like proportions. Thus the work done by American mothers through the American Eed Cross will not stop but its influence will be felt for years to come.^^ Xot onh' was our work in Limoges done for the benefit of French and Belgian refugees, but we supplied hundreds of sweaters, mufflers, socks and other articles to American boys returning from the devastated districts. Men of the Ameri- can Expeditionary Forces were constantly coming in and we never had a meal without some of them joining us. . . . Southwest of Limoges was the city of Angouleme in the Charente Department and here the American Red Cross estab- lished and maintained an extensive dispensary service for the many refugees who crowded the city. Dr. Lillie Arnett, the American Red Cross physician who had formerly been on duty at Le dandier, was transferred to Angouleme. She wrote of the establishment of the dispensary: On August 20, T arrived at Angouleme and met the refugee delegate, Mrs. Goodale, who had been in the city since April. The same day Drs. Knox, Planning and Baldwin stopped in the city a few hours on their way to America and Dr. Knox gave me his usual brief instructions: "Open a dispensary tlic following ^londay." It was then Wednesday. I returned to Le Glandier, packed, said good-by and reached Angouleme again Friday noon. ^Irs. Goodale had requisitioned a splendid residence in the best location of the city, biit the house was absolutely empty. A cor])s of scrub women cleaned it up, but my hopes of open- ing on ]\ronday were blasted because the women were then in full pc)ssossioii. We did o])en. though, on Wednesday. I had piirc'hased a few need(>d ])harmaceuticals at a local place. "For details of afrrccincnt bctweon \h.Q city of TJmofxos and llio Ainori- can I?f'd Cross regarding the Children's Hospital, see the Gilder Report, Vol. Ill, pp. 79-80, NURSING SERVICE TO CIVILIAN POPULATION 839 Mrs. Goodale sent in a table, chairs, towels, etc., and I had my own instruments, so Mile. LeGrand, my French nurses' aide, and 1 went to work and had seven patients on our first day. The dispensary was conducted in a beautiful sun-parlor about fifty feet long, with a mosaic floor and great windows which gave us ideal light. Each day saw an increase in the attendance. On September 20, we took in our first hospital patient, a baby very sick with indigestion and auto-intoxication. Other patients came and our household increased. Each morning I went about the city making calls and every afternoon con- ducted the dispensary service. Our maximum daily attend- ance was thirty-four. In all, we cared for fifty patients in the hospital. We tried to keep a cai-d system of the dispen- sary cases, but I could not always get the names of my morn- ing calls recorded. Our cards showed 575 patients. South of xVngoulenic, Limoges and Lyons lay the provinces rich in agricultural and industrial activities. To these provinces the French Governnient sent large convoys of refugees to live and work until the military situation permitted their return to the Somme, Aisne and Marne Valleys. Many of the refugees who were assigned by the French Gov- ernment to these southern provinces were the rapatries whose reception at Evians-les-Bains has already been described. The psychology of the rapaUne, an important factor in the refugee problem, was described in a French journal : After those of the arrival at Evian who are fortunate enough to have friends or relatives awaiting them and those who are sick and feeble are disposed of, there still remains a crowd varying from four hundred to six hundred ])ersons wlio are absolutely without resources, ])Ians or any ability whatso- ever to help themselves. They are sent by a separate convoy into the interior. The arrival at I*]vian brings to each train the joyous certainty that it is France that awaits them, that they will hv able to speak their native tongue again and to greet their brothers. The second stage of their journey, the arrival in an unknown jn'ovince. often works a reaction, a sensation of excessive melancholia, caused ])y the idea of being alone in tlxMr own country, so near and yet so far from their homes. The rdpafrif.-^ are people from the lowlands of the north, deseeiulants for the most part of l-'lemish ancestors. For them. France is svniboli/ed in the lonir stretches of roads and 840 HISTORY OF AMERICAN RED CROSS NURSING highways of commerce, populous villages and fields of wheat and beets, the ground rich in iron, the mines, as dear to them as the little Breton port into which come red-sailed boats the vine-covered hills of Touraine or the Pyrenees Moun- tains. . . . The arrival of these people for whom Germany has no use . . . has been for the French communes, impoverished by the drain of forty-two months of war, a heavy burden. Two epi- sodes of the villages of the Midi will show this : La G is a little village composed of a score of thatched cottages situated far from the main highway. The mayor is a "reforme." . . . When the first dozen rapatries arrived- in his commune and saw the land, encircled by low hills and trav- ersed by deep valleys with here and there small pieces of fertile ground, threaded with rocky roads along which ambled on market days droves of cattle and sheep, they returned at once to the city from which they had been sent. The mayor declared to a Red Cross delegate that they had only glanced at the banquet that the little village had pre- pared for them. Xo one was to blame. They had done what they could. The rapahnes had decided that there was nothing for them to do there "and that idleness would never help them forget even for a moment their incurable homesickness for the plains of Flanders ! At T the mayor is an amiable man with white hair and of courteous manners. . . . Since the beginning of the war, T has organized five ambulances, has supported the French Red Cross in the way of gifts of sheets, clothing, bed linen, etc., and now came the rapatries and the refugees. When the mayor found this new duty thrust upon him, he could not sleep for eight days. Xo place to put them, no work to give them ! The only place available was a hospital ward filled witli beds without covers ! ^* In nearly all the principal cities of the southern departements the Bureau of Refugees and Relief sent delegates to establish headquarters for refugee relief. Sometimes these delegates were nurses who had had social service training but they were generally social service workers. During the summer of 1918 there were more than TO delegates and assistants and their work covered fifty-eight of the sixty-six uninvaded departe- ments in France. The nature of the service rendered by them was described by Katharine Holmes : ^ La Croix-Rrmge Amrrirainc ft />a Popuhtion Civile Francaise, Jour- nal (Ics Ourraycs dc Danufi. October 1, 1918, pp. 198-109. NURSING SERVICE TO CIVILIAN POPULATION 841 On May 1, 1918, I went as delegate for the Bureau of Refugees to the Department of the Drome in southern France, where twelve thousand refugees had been placed. The refu- gee work in that department had already been unusually well organized by Miss Dewson, who gave up that department to become zone delegate. There was a warehouse well stocked with all the different kinds of furniture needed by tiie refugees in starting new homes beds, tables, chairs, bullets, blankets, sheets, quilts, stoves, mattresses, pillows and garden tools and seeds. Cordial relations already existed with the prefets du police and the mayors and various committees of French volunteers which had already been started in many of the bigger towns. Coal was being given out to the needy and knitting to mothers who wished to make money at home. Plans were on foot for the establishment of an American dispensary which was much needed. My work for the last eight months has been to carry on this work so admirably begun and to meet new situations and needs as they arose. About two hundred families a month have been provided with the furniture necessary for the establishment of a new home. This has meant that they have also had each one the friendly counsel and visits in their home of one of our committees in whatever part of the department they lived. One hundred and fifty-three volunteer French "home visitors"' whom we have trained help us in the Drome. Two American dispensaries have been started, one at Eomans and one at Valence. . . . They are run by Dr. Wright of California and two Eed Cross nurses, ^liss Freda ^r. Caffin and ]\Iiss O'Connell. They have a staff of French assistants who help with the home visiting and dispensary routine. About forty people are treated at each day's clinic and very careful work is done by the aides in following up w^ork for all cases. On the doctor's order we furnish extra food for all those whose physical condition demands it. We send each month ten of the most anemic children to ^liss Frick's country home at Chanay in the mountains of Ain. Three playgrounds were started in the sunnner, two at Valence and one at Komans. a crowded center for shoe manu- facturers. This idea, new to France . . . was taken up en- thusiastically by the French. . . . One of our most satisfactory activities was in finding sejia- rate lodgings for families who had Ix'cn lionlod togctlier in the big "cfntrcs dc truigrs" where the French were forced to put them on account of their sud(UMi and <)\crwhclniing arrival. The French committees in the different towns would 842 HISTORY OF AMERICAN RED CROSS NURSING hunt up tlie empty buildings, we would pick out the families most needing a separate home, see that they got permission to leave from the prefet and then send on furniture ^^ in advance so that their home would be ready for them. On their arrival, our representative met them, helped them with their luggage, took them to the mayor to secure bread tickets, and other services of like nature. The development of playgrounds, a project new to the French, was carried out at Valence. Six American normal school graduates were sent to Lyons for an intensive course and then assigned to different Valence schools. So successful was their work that when the American Red Cross withdrew the French school authorities retained the services of two of these workers permanently. Miss Caffin wrote of the establishment of the Red Cross refugee dispensary at Valence : On May 22 Dr. Wright and I arrived at Valence and found nothing. In twenty-four hours a building was located and arrangements for having it painted and having plumbing installed were begun. On May 31 we received our first patient, a young girl of twenty who had tuberculosis. Our clinics were held on Monday and Thursday mornings from nine to 10 :30 for children ; on ^londays and Thursdays from 6 to 7 :30 for tuberculosis patients and men from Valence; on Tuesdays and Saturdays from 1:30 to 3 for women. The infirmieres made 2492 home visits and visited 110 patients in the cantonments. On August 29 the second dispensary in Valence, at Bourg '' This single item of furniture illustrates one of a wealth of interesting incidents which from lack of space must be omitted from this history. When the refugees were pouring into Paris and the southern provinces, Dr. Devine asked the Finance Committee for some two million francs with which to buy furniture. The members of the Committee responded with the statement that he would not be able to buy furniture in France and that lack of tonnage made impossible its importation from the United States. He answered that the refugees could not begin to build even tem- porary homes without beds and chairs and asked for a provisional appro- priation with which to buy furniture, provided it could be secured. This provisional sum was granted liim. Dr. Devine then turned the entire problem over to ^Martha Spence, of Cleveland, a lay worker, and she and her assistants combed the small shops all over France, buying here a half dozen chairs, there a bed or two. A fahrifjuc too small to manufacture war essentials yet large enough to offer some facilities for tlie manufacture of simple furniture, was taken over and it turned out many tables and chairs. From this central supply, the departmental delegates drew furnitiu'e for the refugees. This incident is also a pleasing example of women's ingenuity, especially in the face of men's dictum that "it could not be done." NURSING SERVICE TO CIVILIAN POPULATION 843 de Peage, was opened. This dispensary was for all poor children under the age of sixteen. . . . On closing the Ameri- can Eed Cross work at Bourg de Peage the French lied Cross took over the work of the dispensary and are continuing it along the same lines. Arrangements have also heen made whereby the Societe de Secours aux Blesses Militaires will take over the dispensary at Valence, thus leaving our work in sympathetic hands. The Children's Bureau in cooperation with the Bureau of Refugees maintained a small hospital of 25 beds for children of Valence. The nvirsing ssrvice of the Bureau of Refugees was, like that of the Children's Bureau, limited and largely curtailed in the late spring and summer of 1918 by the nursing needs of the American Expeditionary Forces. Public health and child wel- fare nurses were recalled from refugee dispensaries and as- signed to Red Cross military hospitals. During the twenty months between May 10, 1917, and February 28, 1919, the American Red Cross in France aided 1,726,354 refugees ; pro- vided 99G dwellings ; operated 67 hospitals and dispensaries where 190,575 refugees received medical and nursing service; operated five dispensaries jointly with the French, in which 66,419 refugees were cared for; opened 8 refugee canteens and in them fed 66,419 refugees, and operated. 68 workrooms.^** The third major phase of the work undertaken by the Com- mission for France for the civilian population and the last one of which the nursing service formed a substantial and vital part was the work done by the Bureau of Tuberculosis. Much has been written regarding the tuberculosis situation in France during the European War, so the treatment of this subject in this history will be brief. Only such phases of it as touch upon American Red Cross nursing service will be included. Tuberculosis was a potent foe of all the Allied armies in France. In 1916 the American press published many stories, some exaggerated, others veracious, of the decimation of the French forces by this disease. Other armies suffered in much the same way, though little was said regarding them save in technical publications.^'^ '""Tlie Work of the American Red Cross During tlie War: A Statement of Finances and Accomplishments," p. 62. "See "Tile Worl<; of tlie I5ureau of Tuberculosis in France." W. C. White: The American Journal of the Medical t^cienccs, Vol. CTA'I. No. 3, p. 41G. 844. HISTORY OF AMERICAN RED CROSS NURSING At the beginning of the twentieth century the French De- partment of the Interior had formed a permanent committee charged with the problem of controlling tuberculosis. The French form of government divided France into departments, each department with its several arrondissements ; in every arrondissement was located at least one large city supporting a general hospital of considerable size. Many of these hospitals had special wards or pavilions for tuberculosis cases. Following the declaration of war, these and all other existing facilities for the care of tuberculosis patients were immediately utilized for tuberculous soldiers and new and beneficent laws were passed to supplement these provisions. After a year of war, the French Government established a new and more power- ful central committee to collect and distribute funds to care for discharged soldiers suffering from tuberculosis and also tx) coordinate the work of the departmental committees which had direct charge of these soldiers after they had been released from hospitals of the Army and the Department of the Interior. In the third year of the war, the Service de Sante established numerous special hospitals for soldiers suffering from tubercu- losis ; these were largely private sanatoria, convents and schools which were requisitioned and equipped as hospitals. They were called Hupitaux Sanitaires. In the fall of 1915, the Depart- ment of the Interior established a fund from which thirty Stations Sanitaires were maintained to receive soldiers dis- charged from the Ilopitaux Sanitaires of the Army. This fund was also used to assist the departmental committees in the home care of patients who had been discharged from the Sta- tions Sanitaires. This extensive federal organization was supplemented by a private organization known as the Tuberculeux de la Guerre. Mrs. Edward Tuck was the president, Mrs. Edith Wharton the vice-president and ]\Ir. Blair Fairchild the secretary. The special aim of the Committee was to provide sanatoria for soldats reformes. Late in 1*.)1G the Rockefeller Foundation sent Dr. Herman Biggs, Health Ofheer of New York State, to France to investi- gate the tuberculosis situation and to report whether or not the Foundation should undertake an anti-tuberculosis campaign in France. Dr. Biggs' report resulted in the formation of the Kockefeller Commission for the Prevention of Tuberculosis in France, with Dr. Livinirston Farrand as director and Dr. NURSING SERVICE TO CIVILIAN POPULATION 845 James A. Miller and Dr. Selskar M. Gunn as associate directors. The members of the War Council and of the Commission to France had early felt that one of the vital phases of service which the American lied Cross could render lay in the care of tuberculous soldiers and civilians. Upon the creation of the Department of Civil Atfairs at Paris headquarters, Mr. Folks appointed on August 13, 1917, as chief of the lied Cross Bureau of Tuberculosis, Dr. William Charles White, who had come to France several months before to serve as director of the Tuber- culeux de la Guerre. Dr. White was also appointed as an associate director of the Kockefeller Commission. Elizabeth Crowell was chief nurse of the Ilockefeller Com- mission for the Prevention of Tuberculosis in France. Early in the fall of 1917, a nursing committee consisting of Miss Crowell, Miss Russell, Miss Ashe and Miss Leete was appointed by the Commission to coordinate the nursing activities of the Rockefeller Commission and the American Red Cross. Dr. White wrote of the subsequent alignment of work : The first task was a division of labor between the Red Cross and the Kockefeller Foundation, so that their efforts would contemplate a uniformity of results. The Rockefeller Commission undertook a study of the conditions existing, the provision of dispensary service, an educational campaign and the selection of two units one an arrondissement of Paris and anotlier a de])artment of France in which it would pro- vide a model organization to be used as an object lesson in American methods. The lied Cross Bureau of Tuberculosis undertook the more innuediate fields of the work, such as the provision of hospi- tals, improvements of conditions in temporary hospitals, as- sistance to French organizations dealing with tuberculosis and a careful study of the whole tuberculosis situation in France, which miglit be used in conjunction with the Founda- tion's work for a permanent program and lasting evidence of the work of America.^* Clara L. Shackford was the first supervising nurse of the Bureau of Tuberculosis. A gTaduate of the University of Pennsylvania School, Miss Shackford was for some time super- intendent of nurses of St. Luke's Hospital. St. Louis, and superintcnd(Mit of the John Scaly Hospital, (Talv('st(Ui, Texas. **'"T1k> Work of the IJureau of Tuborculosis in Kianci'." p. 417. 846 HISTORY OF AMERICAN RED CROSS NURSING She went to France in December, 1917, and was appointed as executive nurse of the Tuberculosis Bureau. During the spring of 1918 she developed tuberculosis, returned to this country and spent some months at Saranac; there the disease was ar- rested, and in November, 1918, she entered the Army Nurse Corps and was assigned to Camp Devens. For some months Miss Ashe carried the work of the Tubercu- losis Bureau and in October, 1918, Sarah Adams Crawford was appointed as supervising nurse. Following her graduation from the Framingham (Massachusetts) Training School, Miss Crawford had had executive experience in various New Eng- land institutions and for three and a half years was superinten- dent of nurses and also dietitian of the Massachusetts State Sanatorium for Tuberculosis. Although she was enrolled in 1911, Miss Crawford's first work for the American Red Cross began in 1917, when she taught classes in Home Hygiene and Care of the Sick. She went overseas in the summer of 1918 and upon her return in 1919 to the United States did school nursing under the Visiting Nurse Association at Wilmington, Delaware. She was later appointed as a Red Cross public health nurse for the Wilmington Chapter. She died there on February 7, 1920, from double pneumonia contracted in line of duty. Both Miss Shackford and Miss Crawford typify the great rank and file of Red Cross nurses, women who have given the best years of their lives in unobtrusive service to others and many of whom have died in harness. The nursing staff of the Tuberculosis Bureau numbered about sixty nurses. They were chosen by National Head- quarters by reason of special training and experience. Upon arrival in France they reported to the chief nurse of the com- mission and were by her assigned to tuberculosis work. Miss Ashe in her capacity of chief nurse of the Children's Bureau had general supervision of this phase of nursing service to the civilian population ; ]\riss Stimson's time was almost entirely occupied with the military service. One of the earliest expressions of the Red Cross anti-tubercu- losis program lay in the provision of new beds in existing French institutions. In 1914 the French had undertaken the construction of a model sanatorium at Bligny, Briis-sous- Forges, near Paris, and had completed buildings in wliich two hundred patients could be cared for. The declaration of war NURSING SERVICE TO CIVILIAN POPULATION 847 arrested further construction and the timbers and structural iron still lay on the grounds in 1917 where the workmen had left them three years before. The Bureau of Tuberculosis arranged for a grant from the American lied Cross by means of which the other buildings of the sanatorium were completed during the spring of 1918 and some three hundred and fifty additional beds were thus made available. The new pavilions of the Bligny Sanatorium were staffed for a time by American Ked Cross nurses and aides. The Board of Managers of VHopital St. Joseph, which was located in the Fourteenth Arrondissement and which was one of the largest and most progressive hospitals in Paris, had pur- chased a convent adjoining the hospital buildings, which they planned to reconstruct to hospitalize men and women suffering from tuberculosis. An arrangement was finally made whereby the Ilopital St. Joseph contributed 208,000 francs and the American Bed Cross 285,000 francs for this reconstruction work and some two hundred and fifty additional beds were thus secured in Paris. The American Red Cross later made an additional grant. The tuberculous soldiers and reformes presented a picture of genuine pathos. ''Xothing is sadder," stated the Annual Report, 1918, of the Tuberculosis Bureau, ''than a ward of tuberculous reformes. A young soldier told us that he was alone in Paris ; that his parents had remained in invaded terri- tory ; that he received no letter, no remembrance from anyone. He asked earnestly for some clothes. In giving this assistance to him, wo know that he will never have the strength to put them on his hour had come but we hope to see in his already dim eyes a longing satisfied." In the same report a reforme wrote, ''We arc plague-stricken nobody comes to see us. If only we had lost an arm or a leg, then we should have a lot of people around us. We are the badly wounded of the war." The Assistance Puhlique of Paris had constructed seven sets of barracks in connection with large hospitals and almshousea of the city, with a potential capacity of 1052 beds, but only 174 of these bods wore in general use. The American Red Cross completed necessary construction, added diet kitchens and recreation rooms, su])pli(Ml additional clothing, bod covers and flowers and brightened up the general aspect of tlio wards; the number of patients was as a result increased to ^57. Ameri- can Red Cross nurses were assigned to duty in these barracks 848 HISTORY OF AMERICAN RED CROSS NURSING and the non-professional phases of the work were directed with marked success by Mile. Moufflard, a French woman. In addi- tion to affording an increased number of beds for reformes, these barracks also afforded hospitalization to tuberculous rapatries and refugees. Hopital Benevole lO"'^ was a small hospital of twenty-eight beds which was operated in Paris by the American Red Cross for French soldiers in the incipient stages of tuberculosis. Financial assistance was given by the Bureau of Tubercu- losis to many other French institutions. On April 15, 1916, V Hopital Ormesson, a hospital for tuberculous children, had undertaken the care of 150 tuberculous soldiers. The Service de Sante in return for this hospitalization gave the institution an allowance per patient of three francs a day, but a deficit of nearly 10,000 francs a month had resulted from this arrange- ment. L'Hopital Ormesson consequently notified the French Army that the beds would have to be discontinued. This fortu- nately did not happen, as the American Red Cross agreed to appropriate the necessary funds. Assistance of this type was also given to Mile. Chaptal for the development of a hospital of forty beds for tuberculous women. To the Sanatorium Lege, the departmental institution of the Gironde, two hundred thousand francs were given. To the Societe de Secours aux Blesses Militaires a similar gift was made which was added to a fund of one hundred and fifty thousand francs furnished by this organization ; the aggregate sum was used to purchase a property at Tours for a depart- mental sanatorium of the Indre-et-Loire. A total of 847 insti- tutions for the care of tuberculosis cases were aided by the American Red Cross during the European War and a total of 2078 new beds were added to already existing organizations.^'^ Early in the summer of 1917 the organization Les Tuhercu- leux de la Guerre had undertaken to remodel the Chateau de la Fontaine Bude at Yerres, near Paris, as a tuberculosis sana- torium. \Vhen the American Red Cross took over the activities of this organization, it carried on the work contemplated at Yerres and there maintained 80 beds for French men civilians in the early stages of the disease. Mary C. Ewing, a social ^ "The Work of the American Red Cross during the War : Finances and Accomplishments." p. 64. For a list of these institutions, see Annual Report, July 1, 1918. of the Bureau of Tuberculosis, p. 22, Chart 4, sup- plements 1-10. Red Cross Library. NURSING SERVICE TO CIVILIAN POPULATION 84.9 service worker and a nurses' aide, organized the sanatorium at Yerres. She arrived in Paris in November, 1917, to work under the auspices of Les Tuherculeux de la Guerre and was immediately sent up to Yerres. She wrote: In this hospital, we eventually had ten French nurses and the original plan was to make it as nearly like a French hos- pital as possible. All our patients were Frenchmen, save for a few American soldiers. The hospital was opened the middle of January, but from about December l"2th I thad been the only American there, so you might well say that I assisted in the equipment of the hospital and in establishing the routine which was afterwards carried out. Miss Ewing was next assigned to Miss Leete's staff at the Tent Hospital, was later placed in charge of the various nurses' homes in and near Paris and finally went to Koumania with Miss Patterson. Her service, a long and responsible one, is typical of that of many American laywomen who served in a semi-nursing and executive capacity with the American Red Cross Nursing Service in France, but who were classed as aides because they were not professionally trained nurses. Of Miss Ewing, Miss Leete wrote : "She came to No. 5 before it was opened and slie remained there until the line w^as far enough removed from us so that the responsibilities were not so gi-eat. She first took charge of the kitchen and when that was turned over to the x\rmy cook she took charge of the diet kitchen and later of the nurses' home and the doctor's quarters. When off duty she went into the wards. She rendered unusually effect- ive service, fitting herself into any department which required assistance." Even greater than the need for hospitalization for tubercu- lous soldiers was that for tuberculous rapatries, refugees and members of the French civilian population. All the private sanatoria and wards of the Assistance Puhlitjue were being utilized, it will be remembered, principally for tuberculous soldiers and reformes. The Bureau of Tuberculosis chose the two largest cities in France, Lyons and Paris, as the theater of activities in their behalf and established in each of these cities large hospitals and sanatoria for tuberculosis patients. Lyons, immediately behind I^]vian-les-Bains. was tlu^ first stopping-place of the rapatries. The General Hospital P)oard of Lyons had in its possession a central building given to Them 850 HISTORY OF AMERICAN RED CROSS NURSING by the Empress Eugenie and they turned it, and five newly erected barracks adjacent to it, over to the American Red Cross early in the fall of 1917 for use as a tuberculosis hospital for women and children rapatries. The Hospital Board provided all equipment, linen, food and other articles and factors of maintenance ; the American Red Cross paid a per capita rate per patient to the Hospital Board, for which the French Gov- ernment partially reimbursed the American Red Cross. The Bureau of Tuberculosis supplied all medical and nursing serv- ice and medical supplies. The hospital, which was called the Asile Ste. Eugenie, was opened on December 5, 1917, and on the first of April, 1918, was maintaining beds for one hun- dred and twenty-eight patients. This hospital worked in close cooperation with the children's hospitals and convalescent homes developed at Lyons by Miss Nelson, Miss Butler and Dr. Grulee. Madelaine Evans was the first chief nurse at the Asile Ste. Eugenie. She was loaned to the Tuberculosis Bureau by the Army, but only for three months, and was recalled to her unit. Base Hospital No. 2, early in March, 1918. Anne Carney was then placed in charge of the nursing service at the Asile. Her staff consisted of one American nurse, three Swiss nurses and one French aide. Lieut, (later Major) G. L. Bellis, who had been transferred in September, 1917, from Colonel Winter's staff, was in charge of the hospital and later directed an extensive dispensary service at Lyons for tuberculous rapa- tries and refugees. The lieadquarters of this dispensary service was at 87 Cours Gambetta. Lillian Bell Stuff was the public health nurse in charge and she was assisted by a Swiss nurse and an American nurse. An idea of the cooperation which existed between all bureaus of the American Red Cross organization in Lyons is contained in the following statement written by Miss Stuff: Our daily routine consisted of dispensary duty, of visiting sick refugees in their liomes and instructing them in sanita- tion, of furnishing lielp wliere needed for bedside care in advanced cases and of arranging for ambulances to take them to hospitals if hospitalization was considered necessary. When patients were found poorly nourislied. the physician in charge of the dispensary ordered food supplies such as cocoa, sugar, pnuies, rice, canned milk and macaroni and these were furnished by the American lied Cross. Lnsuitable housing NURSING SERVICE TO CIVILIAN POPULATION 851 condition? were reported to the Bureau of Refugees and co- operation with all other departments of Eed Cross service was established wherever it was needed. This dispensary was transferred on December 1, 1918, to the Rockefeller Foundation. Like many other American Red Cross hospitals and dispensaries, it also served individual sol- diers of the American Expeditionary Forces. At Plessis-Rohinson, six miles from Paris, the Tuberculosis Bureau established the largest of its institutions, the Edward T. Trudeau Sanatorium. Previous to 1914, the Department of the Seine had purchased two chriteaux, Hachette and Mala- bry, which were located just outside the city: on these estates, houses for working people were to be constructed under a plan known as the ''Garden City Plant." The declaration of war arrested the development of the project, but its originator, Henri Sellier, was so interested in the tuberculosis problem that he offered the two estates, rent free, to the Bureau of Tuberculosis. The two chateaux and their adjacent buildings and grounds covered one hundred and fifty acres. Reconstruction work was begun in aSTovember, 1917, by a group of British and American Friends working under the direction of Dr. James L. Gamble, of Johns Hopkins Hospital. Four additional houses of con- siderable size were secured in the vicinity and on Christmas Day the first patients were admitted three refugees suffering with tuberculosis. The institution was named after the pioneer expert in tuberculosis, Dr. Trudeau, an American of French origin whose name, the Commission hoped, would help estab- lisii a bond of unity and s\inpathy between the two nations. The Trudeau Sanatorium was soon developed into a model project for tli(> treatment of tuberculosis. Dr. White wrote : The future plans for this whole property eontem})late the following (lilfcrent ij;roiipings of {)eo])le : a sanatorium for women; a detention house for entering children; a hospital for tuberculous children; a preventorium for children of tuberculous parents; a colony for families with a tuberculous member from which the sick one cannot be separated. With the completion of the ])roject. approximately two thousand persons in which tuberculosis is a common factor, will be cared for. The work is b(>ing carried out in cooperation with the Department of the Interior of the French (lovernnient. the 852 HISTORY OF AMERICAN RED CROSS NURSING dispensary service is of the Eockefeller Foundation and our own Hospital Admission Bureau.*" Inez Louise Cadel, a Johns Hopkins graduate, was head nurse of the Trudeau Sanatorium, until the military crisis in May, 1918, made necessary her assignment to the Auteuil Tent Hospital. In March, 1918, the nursing staff at Plessis-Robin- son numbered five American Red Cross nurses, one graduate English nurse, one graduate Australian nurse, one French nurse and two American Red Cross nurses' aides. The Women's Hospital accommodated some eighty patients, the Children's Hospital about seventy. Miss Crawford, second supervising nurse of the Tuberculosis Bureau, wrote of the observation hospital: The patients are assigned to us through the Paris dispen- saries. About thirty children are admitted at a time to a building quite distant from the hospital and there they are kept for about two weeks. During this time they receive the necessary attention from our dentist or our throat specialist and they are under the constant observation of the doctor and nurse. At the end of two weeks, they are either trans- ferred to the Children's Hospital or to the Preventorium and thirty more children are brought in to the Eeceiving Hospi- tal. AVe have children of all ages at the hospitals, babies and children to ten years of age, but the older ones are transferred to the Preventorium as soon as possible. In some cases we will have the mother at the Women's Sanatorium and her children in the Children's Hospital and in the Preventorium. One of the American Red Cross nurses who was assigned to the Children's Hospital was Laura Blanche Bingham. She wrote : I went to Chateaux Hachette-Pobinson on August 16, 191 S. for general duty at the Children's Hospital. There our work was arduous, but we were all willing to do our bit for those half-starved suffering children of France. Wo began bathing children at eight o'clock in the morning; next came medical treatment, surgical dressings, irrigations, massage and bandaging. Then all patients were carried outdoors, ^'"Work of the liiiri-au of Tuberculosis in France," Dr. White. The American Journal of the Medical Hcicnces, Vol. CLVI, No. 3, p. 423. A tuberculous refugee child who died in an American Red Cross children's liospital in France. A c'hiia who lived. NURSING SERVICE TO CIVILIAN POPULATION 853 some on their beds, others in chaises-longues. We nurses were assisted by Frencli maids. We had eight bottle-fed babies, each of whom had six bottles apiece, so forty-eight bottles to be sterilized every day is quite a task. We were terribly understaffed all summer and the work at times seemed overwhelming, but we loved the children. During those strenuous months of August and September, bombing raids were of daily occurrence and the effect of them on those little mites was terrorizing. One night we had a tremendous thunderstorm. In one moment, it was pandemonium let loose; they thought the thunder was the Boclie again. The panic among the little ones during our last hideous raid in September was pitiful. South of Paris lay the old city of Blois and here the Tu- berculosis Bureau established a small Women's Hospital, of seventeen beds. A large Franco-American dispensary located here was also maintained by Dr. White's bureau. To sumnuirize, the Ilopital Benevole, 19 his, at Paris; the Edith Wharton Sanatorium at Ycrres ; the Asile 8te. Eugenie at Lyons ; the Edward Trudeau Sanatorium at Plessis-Robin- son near Paris ; and the small Women's Hospital at Blois were the hospitals maintained by the Bureau of Tuberculosis for the civilian population. These hospitals provided G()75 beds and nuiintained 17'2,\)A:-2 patient days. The two American Red Cross dispensaries for tuberculosis were those located at Lyons and at Blois. The Bureau of Tuberculosis developed extensive co<")peration with the Rockefeller Foundation in its two model demonstra- tions. The joint dispensaries of the two organizations in the Nineteenth ArrondissenuHit in Paris have been described. In the Department Kure-et-Loir, the Rockefeller Foundation with assistance from the American Jied Cross maintained tuberculo- sis dispensaries at Chai'tres, Chateaudun, Dreux, St. Ivcniy- sur-Avre and Nogent-le-Rotron. The Bureau of Tuberculosis provided hospital facilities at Dreux, at Chateaudun and at Chartres for advanced cases. The two organizations also carried on an extensive anti- tuberculosis and infant welfare campaign. Three traveling eqiiipcs were organized and sent out through the various de- partnu'uts. Dr. Frances Sage Bradley was at one time in chary-e of t)ne of these units. She wrote: 854 HISTORY OF AMERICAN RED CROSS NURSING This equipe consisted of an advance agent who arranged dates and suitable publicity, secured a building, hotel accom- modations, etc. ; a speaker from each organization ; a young woman who gave practical demonstrations of bathing the baby; a mechanician. The exhibit material included several cinema on tuberculosis and the care of children ; a series of panels on each subject; a small model of tuberculosis dis- pensary and a life-sized baby doll used for the bathing demon- stration; and much literature for distribution. American Red Cross nurses were assigned to this publicity work until the military crisis of 1918 made necessary their withdrawal and reassignment to Red Cross emergency hos- pitals. Then visiteuses d'enfants or French nurses carried on the nursing demonstrations. The Bureau of Tuberculosis undertook extensive relief work for tuberculosis patients among the colonies of Serbian refugees in France. The American Red Cross also provided liospitaliza- tio2i for acute cases among the American Expeditionary Forces. The fourth principal bureau of the Commission for France was the Bureau of the War Zone, which provided material relief of civilians still living in the fighting zones and assisted in making possible the_ return of refugees to the devastated regions and the areas evacuated by the forward-moving Allied troops. The fifth and last bureau of the Paris headquarters was the bureau for the Reeducation of French Mutiles. The American Red Cross Xursing Service did not share in the activities of either of these two bureaus. Italy declared war on Austria-Hungary on May 23, 1015. The American Red Cross immediately ofl'ercd to her the serv- ices of a unit of surgeons and nurses, as it had to the other belligerents, but the offer was declined. George B. ^IcClellan, one time mayor of Xcw York City, described in a personal letter addressed May 27, 1015, to ]\Iiss Boardman and Miss Delano, the popular feeling then prevalent in Italy: There seem to be very few trained nurses (in our sense) in the country. Since the Avar began last August, most of the Italian women have taken . . . courses in mirsing. All are called I'ed Cross nurses and are very enthusiastic ami willing. The work at the actual front is to be done by men. but the hospitals bcliind the lines and in tlie base are to be stalfed by the few real trained nurses there are and bv these amateurs. NURSING SERVICE TO CIVILIAN POPULATION 855 ... I have talked with a great number of Italians and with a few Americans who know Italy. With one accord, they have all discouraged the idea of sending American and Eng- lish nurses to Italy at the ])resent time. The Italians do not want our help. They are convinced that they are quite able to take care of themselves and do not want us to send them either nurses, surgeons or advice. All agree that supplies will be welcome. The nursing system in Italy resembled in many respects that which prevailed in France and other continental countries. The Sisterhoods had many nursing members. These nuns were seldom trained according to the Nightingale system, but long experience had made them able administrators and skilled nurses. They gave medicines, assisted in the operating rooms and had general supervision of the wards ; but they did very little bedside nursing and they rarely nursed men. The economic advantages of this type of nursing service were summarized by ^Mary S. Gardner, a pioneer American public health nurse who in 1918 undertook a special mission, to be described later, for the American Rod Cross in Italy : Their employment offers a number of advantages; per- haps most im[)ortant is the fact that the spirit of service actuates their work. It is also an inexpensive and convenient form of nursing service, for if a religious order staffs a hospi- tal the management is at no further trouble. There is usually an adequate STi])])ly and if one nun is sick another appears to take her place innnediately. The complete laicization in Italy would undoubtedly be a calamity. It would seem wise to offer a better and more general training to nuns. Even though a secular body of trained nurses may later be de- velo])ed, the nuns must continue to occupy an important place in the nursing economy of the country. Monks also care for the sick.*'^ The actual bedside nursing of the patient was left to un- trained attendants of the servant ty])e, called inferm'wre. Of this type of nurse !Miss Gardner wrote : This group, a large one. presents few possibilities for im- provement. Hours of work are too long, living conditions too hard aiul salaries too low to attract a fine ty}ie of woman. ^^ General Report of tlie Commission for Tuberculosis. American Red Crop;* in Italy, pp. 40-r)0. 856 HISTORY OF AMERICAN RED CROSS NURSING nor does the work stimulate ambition. The doctors give most of the treatments usually given by nurses in England and America and little attempt is made either to increase the skill of the infermiere or to secure a type of woman capable of such improvement. It may be generally stated that few infermiere would be capable of receiving a nurse's training, even were requirements reduced to the lowest possible mini- mum. One unfortunate custom also prevails which is de- moralizing to the infirmieras ethical standard and which does much to prevent a uniform and disinterested care of the sick. In many hospitals fees are taken by infermiere, which inevi- tably leads to neglect of the poorer patients who are unable to "tip" their nurses. The infermiera may perhaps have a place in the economy of hospital management, but she can be looked upon as nothing but an unmixed evil, if regarded as a substitute for a graduate nurse or pupil of a well adminis- tered training school. Nursing is also done by men infermieri, who are of about the same type as the women.*^ The infermiere were organized into a "union" called the Asso- ciazione Nazionale Italiana tra Infermiere, with headquarters at Rome. Midwifery was in a much more advanced stage in Italy than in the United States. Every midwife was required by law to have had two years of training and one year of practice before she was permitted to follow her profession. "In some of the small towns, particularly in Tuscany," wrote Miss Gardner, "midwives act as operating-room nurses." The modern profession of nursing, as developed to a high degree in the British Empire and in the United States, was non-existent in Italy. Very few foreigii-trained nurses were there and practically no modern training schools had been es- tablished. Potent economic and social factors were at the bottom of this situation. "Many have said," Miss jSJ'oyes often affirmed, "that thirty years ago in the United States girls entered schools of nursing for three principal reasons : to forget personal sorrow ; to bet- ter their matrimonial prospects; or to earn their living in the only way then open to women except school-teaching." Three similar reasons, however, cannot be said to have in- fluenced Italian girls to become professional nurses. As for Miss Xoves' first reason, Italian women who wished to forget *^ General Report of the Commission for Tuberculosis, p. 50, NURSING SERVICE TO CIVILIAN POPULATION 857 personal sorrow in altruistic service entered the nursing Sister- hoods. As for Miss Noyes' second reason, Italian girls did not consider becoming nurses to better their social condition through advantageous marriage because the social position of infermiere was inferior to that occupied by student nurses in American schools of mirsing. Infermiere were classed as servants and young Italian physicians were not apt to chose their brides from among them. In the United States, student nurses occupied a status which placed them on social equality with the internes in tlu; hospital. As to !Miss Noyes' third reason, nurses in Italy received a wage similar to that of the servant classes, not the thirty-five dollars a week and more which American nurses received for highly trained service. These economic and social conditions which existed in Italy greatly inhibited the development of a professional nursing personnel. In addition, "the hospital authorities," wrote Miss Gardner, "are not hospitable to the training-school idea. It is considered too expensive a form of nursing and a woman super- intendent with proper authority is thought undesirable. Even were plenty of pupils available, few hospitals are ready to open schools to receive them. . , ." "^^ Italian military nursing service was largely intrusted to the volunteer nurses of the Croce Rossa Italiana, the Scuola Sa- maritana and similar patriotic organizations. The Italian Ived Cross maintained a large body of volunteer nurses whose training covered intermittently a period of three years. ]\[iss Gardner described the courses : In the first year not less than twenty lessons and at least one montli in the hospitals with eight hours' daily duty are required. In the second year not less than twenty lessons and at least one month in tlie hosj)ital or amhulaiorio are required. The third year is a repetition of tlie second. Tlie second and third year may, under certain conditions, be com- bined. Diplomas are given after theoretical and practical examinations. Nurses holding diplomas must have at least two months' experience in a hospital each year, otherwise their grade is lost. . . .** The Scuoln Samarifana oflFered two courses, one in First Aid, which was composed of tliirty lessons and covered a period of "(u'Tipral Report of tlio Commission for Tuborculosis, p. ~)\. ** Ihid., p. 52. 858 HISTORY OF AMERICAN RED CROSS NURSING two months, and another in nnrsing the sick and wounded, which inchided fifty-four lessons and covered six months. The instructors who gave these courses were volunteers and any person, either man or woman, could take them upon the pay- ment of a small fee. The Italian volunteer nurses were both devoted and able, as may be seen from a letter written February 4, 1918, to Miss Xoyes by Sara E, Shaw, then representative of the American Red Cross Nursing Service in Italy: The people of northern Italy are very capable and their organization is really wonderful. They are proud and justly so of what they have done, but their nurses are also keenly interested in new methods. . . . The Italian women make splendid nurses. The volunteers really work and after two years of steady service are almost "'trained nurses." A defi- nite time schedule is kept for each volunteer on duty so they give really long hours of service. Their hearts are in the work. It is very important that our nurses who come here should not be critical. We need most capable women for this service, nurses wlio can do not only the technical skilled work but women of good personal appearances. Our nurses are watched with critical eyes. . . . Knowledge of Italian is almost imperative. Three hospitals maintained upon the British and American system were mentioned in letters and reports to National Head- quarters from American Red Cross nurses in Italy. One w^as at Florence and was directed by an English nurse. Miss Baxter. A small American hospital had also been organized and financed at Florence by an American teacher. Miss Sheldon. The third was the Ospedale Yolanda at Milan, which had ten pupil nurses. Previous to 1017 the American Bed Cross conducted practi- cally no relief activities in Italy. During the summer of that year the collapse of Russia permitted the transfer of many German divisions from the eastern to the western and southern theaters of war. On October 21, 1017, the Austrian forces, reenforced by tlie Germans, struck at the Italian lines on the northeastern boundaries of Italy, broke through at Plezzo and Tolmino, took Udine on October 30 and were advancing on to the Venetian phiins. The Italian Army withdrew to the Fiave River and tlicrc durinir November and I)eceml)er dog- NURSING SERVICE TO CIVILIAN POPULATION 859 gedlj held strong defensive positions in some of the bitterest and most gallant lighting of the European War. The Italian Retreat to the Piave River in the fall of 1917, caused, however, the evacuation of the civilian population from the entire northeastern thumb of Italy. Half a million refu- gees fled in complete demoralization to the central and southern provinces and to Sicily. From the invaded territory went 208,213 refugees ; from the areas cleared for the new lighting zone went 87,552 others and from the districts in constant danger from enemy air raids went 131,009 more. Among these homeless, sick and often wounded old men, women and children was opportunity for the American. Red Cross- to render assistance which was needed. During the summer of 1917 the American Red Cross had sent a commission to Italy under George F. Baker, Jr., of New York City, to ascertain whether or not American relief would be welcomed. This commission returned to Washington in October with a report which the military situation rendered out of date almost before their boat landed. When word of the Piave Retreat reached Rome, Mr. Page, then American Ambassador to Italy, cabled to the War Council and wired Paris headquarters for help. National Headquar- ters immediately placed half a million dollars at his disposal and Major Murphy, commissioner for Europe, dispatched to Italy an emergency commission under Major Carl Taylor, one of the original deputy commissioners for Europe. This commission immediately undertook temporary relief measures; in the United States the organization of a permanent commis- sion which had already been initiated with Colonel Robert P. Perkins, of New York City, in command, w^as speeded up. American Red Cross relief to Italy was confined chiefly to hospital, ambulance and canteen service to the Italian Armies at the front and to the relief of refugees from the Venetian plains. To the ^Military Establishment the Italian (\immis- sion distributed Or)l,000 articles of supplies, including ten complete field hospitals and more than one hundred field ambu- lances and drivers. Thirty-three canteens were operated in Italy for the benefit of Italian and Allied troops. In the field of civilian relief, five refugee colonies were established in which 2774 persons were cared for; three hospitals and throe dis- pensaries were maintained; SS workrooms were oporati^d in which 9057 persons were given employment and 1,411,105 860 HISTORY OF AMERICAN RED CROSS NURSING garments were produced ; 50 food kitchens were set up and an average of 28,664 rations were daily served from them. Un- cooked food supplies were furnished to 424,600 persons. This work extended to 141 Italian towns and to thousands of villages from the Alps to Sicily,"*^ American Red Cross nursing service in Italy was confined chiefly to work of an educational nature. Even if Italy had welcomed emergency nursing relief, the supply of American nurses was too limited to have rendered possible any extensive development of such a service. Early in November, 1917, the temporary commission called upon Paris headquarters for "an executive nurse for Italy" and j\Iiss Russell assigned Pauline Jordan, then in Paris awaiting a problematical assignment to Roumania. Miss Jordan was a graduate of the New York Hospital and had served as anesthetist with the Carrel Mission to Roumania early in 1917, an account of which will appear later. Miss Jordan arrived at Rome on December 2, 1917, and five days later wrote Miss Delano : From the nursing standpoint there is much work to be done. This includes the manufacture of surgical dressings and the opening up of new workrooms for this purpose ; a cer- tain amount of hospital and day nursery work ; the establish- ment of a hospital at Rimini for refugees threatened with various mild epidemics ; canteen work and visiting nursing among the refugee population. I expect to leave at once for Florence and Genoa to open surgical dressings workrooms. I have been allowed to tele- graph to Paris for two nurses to take charge of these and we expect them in a few days. Whether we shall be sent to Rimini in connection with the establishment of the Refugee Hospital remains to be seen. The policy of the acting American Red Cross officers is against the introduction of American nurses. Up to the present time, the policy has been to donate money and sup- plies to the various Italian women who are the nominal heads of Italian organizations. Alice Fitzgerald, whose name has already appeared many times in this history, was sent from Paris to open the Rimini Refugee Hospital. She wrote : "For further details see "The Story of the American Ked Cross in Italy." Charles M. Bakewell. The "Macmillan Company. 1020: also "The Work of the American Red Cross Durinnr the War: A Statement of Finances and Accomplishments," pp. ()8-72, Red Cross Lihrary. NURSING SERVICE TO CIVILIAN POPULATION 861 On December 19, with three other nurses, I started for Rome. Eight days later another nurse and I proceeded to Rimini, a town on the Adriatic Coast where the American Red Cross was carrying out an interesting experimental piece of work among the V^enetian refugees. The broad general lines of this work consisted in trying to keep families, relatives and friends together as much as possible and to remove with them their tools, looms or what- ever equipment or implements were necessary to their par- ticular means of earning a livelihood. These people were to be settled in such a way that they could continue as nearly uninterruptedly as possible their work as if they were still at home in Venice. When the military situation was so altered that they could return to their home, they would thus not have lost touch with their families, relatives, friends, and particularly their work. N^umerous committees had this scheme in hand and distri- bution of food and clothing was being made to them. The care of the sick was just beginning to take form and the Commission for Italy planned to start at Kimini a health center from which care could be sent to outlying districts either through visiting nurses and doctors or by the establish- ment of small dispensaries and infirmaries. My particular mission in the city was to help organize and start the Ameri- can TJed Cross Hospital for Venetian Eefugees. When we arrived in Rimini in the early morning, the snow was thick on the ground.^*' The next morning we were driven out to the hospital which we found had been established in a large building on the seashore. This building had been erected as a summer home for tuberculous children from the mountain regions of Italy , . . and was nothing but windows and doors. The cold poured in from all sides. There was absolutely no means of heating the rooms, either by stoves or fireplaces, and the patients already in the hospital were actu- ally blue with cold in their beds. Hot-water bags did not re- main hot long enough to take off the chill and the piling on of blankets scarcely added to the comfort of the sick man or woman or child. Conditions were indeed desperate and our very first effort was to obtain stoves and have them put up in as many of the wards as we could. The one other nurse was wonderfully })lucky and did not complain, but I know she suffered as much as all of us did. "Tliis tremendous ami for the Allies providential snowfall closed tlie open winter which had preatly aided the Teutonic offensives, impaired the German lines of communications and prevented the enemy from capturing vital new passes and emptyinjr their armies onto the Venetian plains through strategic positions already held. 862 HISTORY OF AMERICAN RED CROSS NURSING Little by little conditions adjusted themselves. The hos- pital ran to full capacity and our work spread to many miles around. On February 13, 1918, I was recalled to Paris. . . . The Rimini Hospital, which was known as the Ospizio Co- masco, had a capacity of one hundred and fifty beds. American Red Cross nurses served as supervisors and fourteen Italian girls who had been employed in the Venice Civil Hospital for some months acted as aides. Five male infermieri were on duty in the men's wards. On May 1, 1918, the professional staff was increased to seven American Red Cross nurses and a nurses' home was opened in the Villa Tonti. The Rimini Hospital had many acute cases, especially during the influenza epidemic, and about one hundred and fifty patients died. Dur- ing the year of its operation, Ospizio Comasco received 1533 patients. The permanent Commission for Italy arrived in Rome on December 20, 1917. Colonel Perkins had appointed Sara E. Shaw to membership on his staff. She had been in charge of the tuberculosis division of the social service department at Bellevue Hospital and he wished to utilize this previous experience in connection with giving temporary relief in Italy. However, the ISTursing Service at National Head- quarters was loath to allow a nurse to serve at this particular period in any but a professional capacity, so Miss Shaw was appointed chief nurse of the Italian Commission and Miss Jordan was recalled to Paris headquarters and assigned to duty in France. Miss Shaw was a graduate of the Bellevue School and had served as a Red Cross nurse on the Lampasas Expedition and also six months in Manila during the Spanish- American War. In a final letter of instructions written November 28, 1917, to ]\liss Shaw, Miss Noyes outlined the policies which were to govern the development of American Red Cross nursing service in Italy: Italy is a big country . . . and we do not know how you will approach a study of nursing conditions with a view toward making recommendationp to us in this country. You must liear in mind, liowevpr, that the demands now facing the Eed Cross Nursing Service to meet all the military needs of the base hospitals in France, the (antonnient hospitals in this country and the public health work we are doing in for- NURSING SERVICE TO CIVILIAN POPULATION 863 eign countries, with the least possible disturbance to civilian hospitals and other forms of nursing work in, this country, puts no small task upon our shoulders. It would be quite im})ossible, of course, for the American Ked Cross to assume the nursing in civilian hospitals in foreign countries. They might take up a definite piece of public health work, in con- nection with directors and supervisors of institutions, but there are not enough nurses in America to supply other coun- tries of the world with a professional nursing staff. During the first weeks of January Miss Russell sent nine nurses to assist Miss Shaw in Italy. National Headquarters organized a unit of sixteen others and they sailed from New York in April. Katherine C. DeLong, a Canadian woman and a graduate of the Johns Hopkins School, was head nurse of this detachment. Previous to the Italian assignment, Miss DeLong had filled many executive positions at the Johns Hopkins Hos- pital and had been superintendent of residence both at the Johns Hopkins and at the Bellevue Schools. Other nurses were sent to Italy from the United States and Paris Head- quarters until Miss Shaw's staff finally numbered thirty-seven nurses. Miss Shaw's first major project in Italy was the establish- ment of a Nurses' Center in Milan. On April 22, 1018, she wrote ]\Iiss Noyes: My activities have been varied. I have visited many mili- tary hospitals and liave been very cordially received. The ^Marchesa Cnstelnuovo, who is at the head of the Italian Kcd Cross for this section of the country, has been a good friend and advisor to me and so also have some of the Italian medi- cal ofliccrs. The need seemed to be more for hospital supplies than for nurses. The volunteer nurses are well organized and are really doing excellent work. There seems no place suitable for our trained women to render definite emergency service. ^riiis is the reason for our plan of a Nurse's Center and I have secured a peiisionc which is now in the throes of being cleaned and remodeled for this purpose. Tji one se[)arate division we have fifteen private hospital rooms and an operating room where we can efliciently care for our own American force or where we can have facilities readv for any special emergency. We have one floor for servants, linen and sup|dy rooins and a beautiful cellar where food can be stored. Another floor 864 HISTORY OF AMERICAN RED CROSS NURSING is used for the nurses. We have a reception room, lecture hall and library, demonstration room and dining rooms. There are balconies on each floor. We do not say we are establishing a training school; this would be objectionable to Italians who were prone to organ- izing work like this before the war. But the idea of confer- ences appeals very much, so we are to have conferences and lectures by prominent doctors. Tlie Italian women who are supervisors and heads of each hospital will come to the conferences. The demonstration room will always be open for demonstrating various American methods of caring for the sick. This plan for conferences will aid in the distribution of hospital supplies. Many things of which they do not under- stand the use are made in our workrooms and we will dem- onstrate the use of these dressings. By this plan it seems to us that we can be of greater help than if we were lost in one little hospital. The American nurses at Milan undertook many other types of war service in addition to that at the Teaching Center. Miss Shaw described them in her letter of April 22 : There is also big work to be done in the distribution of hospital supplies. We have cleaned up several rooms in a famous old palace and there seventeen Italian women sort dressings and fill hospital requisitions; two of our American Eed Cross nurses are on duty here. Each of our nurses is now preparing a suitcase of sterile dressings and necessary instruments and if a call comes for nurses for an emergency service, they can pick up their case and run. Xone of us have wasted time waiting for work ; we have certainly found plenty to do. We make up gift packages and distribute them in hospitals and every month we meet the prisoners of war returned on exchange from Austria. The uniforms of the American nurses were a source of keen interest to the Italians. The nurses had white tailored dresses made after the pattern of the one-piece serge dress and wore them with the cape and cap for dress parade, a combination which greatly appealed to the color-loving Italians. ''Our boots," wrote Miss DeLong to Miss Noycs, "seem an unending source of amusement to the natives and they cross the streets to read the lettering on our brassards." NURSING SERVICE TO CIVILIAN POPULATION 865 From the Nurses' Center at Milan, the influence of Miss Shaw and her nurses extended to other parts of Italy. In view of the attitude of the Italians and the limited number of Ameri- can nurses, they were placed only in hospitals and dispensaries where they would have a wide radius of influence. The Commission for Italy established and maintained six hospitals, two of them for refugees; the Nurses' Center and Hospital at Milan ; a hospital of twenty beds at Padua for the Air Forces of the American Expeditionary Forces in Italy; and an American Red Cross Hospital in Rome. The first refugee hospital which was established at Rimini, has already been described. The other was situated at Cani- cattini Bagni, in Sicily. This drowsy old town of fifteen thousand inhabitants was situated fifteen miles from Syracuse and received, as did all the cities and villages of Sicily, immediately following the Piave Retreat, large numbers of refugees from the Venetian plains. Need had arisen for a hospital, so the mayor of Syra- cuse asked an American woman physician, the wife of an Italian surgeon then at the front, to take charge of it. She moved into the improvised building, named it the Martha Washington Hospital and on March 1, 1918, the institution came under the direction of the commission. Additional equipment was given, the director was appointed as the Ameri- can Red Cross representative for that district and the commis- sion maintained it for a year, during which time two hundred and seventy-two patients were received. No American Red Cross nurses were assigned, however, to the hospital. The American Jlvd Cross Naval Hospital at Genoa was situated in a villa at Lido d'Albaro. Four American Red Cross inirses, three nuns and seven naval hospital attendants were assigned to duty there. Early in September, 191 S, the hospital was taken into the ^lilitary Establishment. During the period of its operation as a Red Cross hospital, forty-nine patients were received. The American Red (^ross at Padua, which was operated for American aviators from the various camps near Padua, was situated in a wing of an old university building. ]\Iiss Shaw sent a nurse to organize and operate it in October, 1918, but the influenza became virulent in the camps and six additional nurses were placed on duty to care for the hundred patients sent in from the aviation centers and the '332nd Reii'iment of 866 HISTORY OF AMERICAN RED CROSS NURSING the American Expeditionary Forces. The hospital was operated nntil April 1, 1919, and received a total of one hundred and thirty-two patients. Additional American Red Cross nurses were detailed to service in aviation and hydro-aviation camps at Foggia, Bolsena and Porta Corsini. The American Red Cross Hospital at Rome was established to care for all American workers in Italy who needed hospi- talization. It was beautifully situated on the two upper floors of a large building fronting the Pincian Gardens, and had a thirty-five bed capacity. Four American Red Cross nurses and two Italian aides composed the nursing staff. During the three months of operation following its opening on August 22, 1918, fifty-six patients were admitted. A convalescent home for sick children with a capacity of twenty-eight beds was established at Taormina and was known as the Casa dei C onvalescenti. It was staffed by American Red Cross nurses and Italian aides. A local Italian physician attended to the medical needs. The Commission for Italy operated nine dispensaries which were nuclei for public health nursing service and child wel- fare work. These dispensaries were located at Cesanatico, Bellaria, Chioggia, Genoa, Florence, ISTaples, Avellino, Villa San Giovanni and Taormina. In the establishment and main- tenance of these dispensaries the American Red Cross worked entirely through local Italian committees. Each of the mem- bers of the Died per Uno, the organization which sponsored the dispensary at Genoa, assumed responsibility for the care of ten children. At Florence, the dispensaries took the form of three Aiuti Matcrni. American Red Cross public health nurses were in charge and did district visiting, distributed eggs, milk, broth and layettes."*^ In June, 1918, the Italian Armies, strengthened by reen- forccments from the British and French, launched a counter- offensive against the Teutons which resulted on November 3 in the complete collapse of Austria-Hungary. With the changing fortunes of war came a substantial lessening of the need for emergency relief. The American Red Cross Commission for Italy then looked ahead toward the formulation of a more con- structive program. " For a complete list of the various assij^nnients of American Red Cross nurses in Italy, see "Reports of the Departments of Military and Civil AflFairs, American Red Cross in Italy, January, 1918-April, 1919," Red Cross Library. (AIi(i\-(>'i Ospizii) Miirliio. an Ainrrii'aii llcil (ro^H Tlo-pital fdi- cliildrcii ^ullVriiiL;- trinn Imuu' tuiicrru- l(isi<. a! \"al(l(iltra. near Iric-lc. Italx". (l!('l(i\\i A patient ut the Ospizin Mtirivo. NURSING SERVICE TO CIVILIAN POPULATION 867 During the '^'pring of 1918, Dr. Farrand, director of the Rockefeller Commission for the Prevention of Tuberculosis in Franco, and Dr. William Charles White, director of the Tu- berculosis Bureau, American Red Cross in France, made a health survey of Italy with a view toward the inauguration of an anti-tuberculosis campaign in Italy similar to that under- taken in France. Also Dr. Joseph Collins, Major, Medical Corps, U. S. A., and director of Medical Aifairs of the (\)m- mission for Italy, made an independent study of health condi- tions. As a result of the recommendations of these men, Na- tional Headquarters appointed in September, 1918, the Ameri- can Red Cross Committee for Tuberculosis, with Dr. White as the director and Mary S. Gardner as chief of the Section of Public Health Nursing. Miss Gardner needs no introduction at this point in this history. Full biographical material regarding her signal con- tribution to the American nursing profession may be found in the chapter on American Red Cross Public Health Nursing Service a more appropriate field for such an account than this section, which deals primarily with American Red Cross military nursing service. However, the military program in Italy was closed by the demonstration made by Miss Gardner of American methods of public health nursing service. Miss Gardner and fifteen public health nurses sailed for Italy early in September and initiated a special educational project. The emergency nursing activities, such as the opera- tion of hospitals, surgical dressings workrooms, were gradually broiTght to a conclusion. Miss Shaw", Miss DeLong and many of l^lie first detaclinients of American Red Cross nurses in Italy returned to the United States during the spring of 1919. The specialized phase of nursing service known as public health nursing was a development, purely, of the British and American luirsing professions. It did not exist in Italy. In the supplementary Report on Nursing, General Report of the American Red Cross Commission for Tuberculosis in Italy, Miss Gardner wrote of the Italian situation: Home vii^iting is done to a small extent by nuns and in some instances nursing care is given Ijy them to the ]ialients in their hdinos. rsually such care is made secondary to the dispensing of material relief and the giving of spiritual com- fort or instruction. Home visiting is also carried on from a number of dispensaries by groups of volunteers, many of 868 HISTORY OF AMERICAN RED CROSS NURSING whom do excellent individual work. Knowledge and skill are, however, gained only by experience and in all these efforts which have been studied the usual limitations of volunteer work Tiave been evinced : namely, an insufficiency of time spent, an absence of training and a lack of work caused by the call of other duties. In one group dealing with tubercu- losis patients, all work stopped during the influenza epidemic (a time when an added vigilance was required), not because the workers themselves were ill but because, being mothers and wives, it seemed unwise to run the risk of contagion for themselves and their families. The general policy of the Commission for Tuberculosis was that it should work only with Italian committees and only upon request from Italian communities and organizations de- siring American cooperation. The Section on Public Health JSTursing followed this policy. Italian and American public opinion hung on the outcome of the Peace Convention of Ver- sailles. Although enthusiasm for America and American ideas then ran high in Italy, the entire situation was one of extreme delicacy and continued so until the close of the Italian pro- gram. "The problem," wrote Miss Gardner, "seemed two-fold, the creation of a desire for the work and the creation of a group of workers. The former involved the stimulation of groups of Italians to a consciousness of the need for public health work, a stimulation which must be carried to the point of formation of committees. The latter involved the training of a few carefully selected Italian women to act as pioneers and teachers in the new field." In the selection of these Italian women who should act as pioneers, three fields of supply were open to the Commission the nuns, the infermiere and the Italian Red Cross and Samaria tana nurses. Among the volunteer nurses then being demobilized after a war service of from one to three years, however, there were many women who had loved their work as nurses and who were glad to continue it upon a remunerative basis. Miss Gardner summarized the work involved in the training of these women : In the first place an enlightened Italian committee must be formed, willing to work hard and capable of sufficient elasticity of thought to permit the grasping of unfamiliar NURSING SERVICE TO CIVILIAN POPULATION 869 ideas ; a committee also from whom permanency of work could be expected. A single course offered by American nurses, with no hope of successive courses, would avail but little. In the second place a group of workers must be found possessed of the pioneer spirit and the type of ability likely to insure success. In the third place Italian doctors and other lecturers must be secured and interehted in the new idea. In the fourth place a field for practical instruction must be developed by the American nurses under wholly Italian auspices. In the fifth place the market for the product must be stimulated that positions might be ready .for the newly edu- cated workers. Under these plans, three courses were initiated, the first at Rome through a committee organized under the auspices of the Federation of Women's Chibs ; a second at Genoa through a sub-committee of the Lega Antitubercolare della Provincia dl Genova; and a third at Florence. The school at Rome opened on March 17, 1918, with sixteen students and the school at Genoa on April 2 with fifteen. A plan for a school at Pa- lermo was initiated but later was given up. The school at Florence was begun on ISTovember 10 but the course was not completed. The instruction covered a period of four months. The first three were given up to lectures and to field and practical work ; the last month was spent entirely in field work. Miss Gardner described the nature of the instruction given: One American nurse is in charge of each school while six others in each city act as instructors in dispensary work, school and home visiting. All the educational work is under the direction of one educational head. Lectures are given by Italians, though American doctors also lecture through an interpreter. Conferences are held by American nurses. Die- tetics and invalid cooking are taught by l)oth American and Italian teachers, the Italian teacher being lent by the Minis- try of Industry. The courses of study differ somewhat in the different cities, but the following subjects are taught in all: history of ])ublic health nursing; theory and methods of public health work; tuberculosis nursing: child wel- fare nursing; school hygiene nursing; dietetics; obstet- rical nursing; diseases of the skin, of the eye, of the ear. 870 HISTORY OF AMERICAN RED CROSS NURSING nose and throat ; sanitation ; housing, with one or two lectures on Italian mortality and morbidity statistics. ... In Eome the course is held in two simple rooms for- merly stores, and in Genoa at the Tuberculosis Institute and at the University. . . . An interesting comment upon the courses in Rome was con- tained in the following letter, written by Winifred Terni de Gregory, president of the Lombard Branch, National Associa- tion of Italian Nurses, which was published in the open col- umns of the British Journal of Nursing: . . . Usually foreign Red Cross societies, while giving their nurses excellent scientific training and a great deal of prac- tice in operation theater and surgical wards, have so far never given real systematic teaching in the art of practical nursing. What our excellent Italian Red Cross nurses know on the subject, they have found out for themselves or learned from English books, never having had professional Matrons or Sis- ters to teach them, and until lately the subject of practical nursing was not included in the Red Cross curriculum. Now I am happy to say, a new curriculum has been compiled at Red Cross Headquarters which gives a prominent place to the teaching of practical nursing. But most foreign nurses (except those trained in English training schools) know very little on the subject and when a public health course for Italian Red Cross and other nurses was arranged in Rome by the American Red Cross, at my suggestion a great many les- sons on bed-making, washing of patients and other nursing details were included in the course, with great benefit to the students and ultimately, I hope, to the patients. The possibility of developing public health nursing in the small Italian hill towns was a project in which the American Red Cross took keen interest, owing to the pioneer work done in the United States in this field by Miss Clement, Miss Gard- ner and ]\Iiss Fox. A study was made of two typical Italian towns, Sezze and Piperno, situated fifteen miles apart above the Pontine ]\rarsh('s. ]\Iiss Gardner summarized the results of these studies : If Sczze and Piperno are at all ty])i(al of other small Ital- ian towns iiiid we have reason to b^'licNc that such is the case it seems probable for the small towns '^f Italy, NURSING SERVICE TO CIVILIAN POPULATxOX 871 That the services of a good public liealth nurse would be "Warmly welcomed by the people. That there is great need for such service for bedside nurs- ing, for dispensary and school work and for general home instruction on health matters, also for assisting the people to obtain for themselves more modern health advantages along various lines-. That it is going to be difficult to induce an Italian nurse to acce])t the limitations and discomforts of small town life. That the community as a whole would probably be quite as ready as the more backward American towns to cooperate in the nurse's efforts for improvement, though in this state- ment an understanding of the difference between Italian and American standards must, of course, be taken into account. The doctors will, as in America, prove the importance of the personal equation. Some will be found cooperative, the others the reverse. That the average small town will not readily understand the necessity of paying a sufficient salary to secure the right type of woman for public health nursing work. As may he scon from these results, the possibility of develop- ing rural public health nursing in Italy in 1910 was not a promising one. ''For the moment probably the most effective expenditure of money and effort for public health work," cx)n- cluded Miss Gardn(>r, "will be in the cities and larger towns. Later the small town work in Italy can undoubtedly he de- veloped as has been rural and county nursing in England and America, bush nursing in Australia and back block nursing in New Zealand. ]\reanwliilc, nothing can be done without the worker. The heart of the difficulty would, therefore, seem to be in the problem of nursing education." In ,Iune, 1919, ^liss Gardner returned to the L^'nited States and Edna Foley took her place as chief nurse of the American Rvd C^ross Tulxu-culosis Commission for Italy. ]\Iiss Foley was released from the superintendency of the Instructive Visiting Nurse Society of (^hicago to undertake this foreign service. As a member of the National Committee she had for nuiny years taken a keen interest in American lied Cross nursing service. During ^liss Foley's term of office, the school at Floi'cnce was opened and a second course at the Rome and (Jcnoa schools was completed. I'ublic health nurses were assigned to duty in Perugia, Sjjczia and Palermo. The work at Palerino was cim- 872 HISTORY OF AMERICAN RED CROSS NURSING ducted bj the Lega Antiivhercolare, a local society organized by Dr. White's commission. Mary Gallagher and Isabelle Hall were on duty at a tuberculosis clinic there. "Dr. Lazzaro, the chief of this clinic," wrote Miss Foley in her report of September 12-October 25, 1919, to the Commissioner, "said he considered the work of these two Red Cross nurses the biggest gift of the American Red Cross to Sicily." Miss Foley's re- port continued : Late in August Miss Hall succeeded in establishing a clinic for well babies. . . . There were more than forty babies the opening day and a large attendance at every clinic. Miss Hall left a young half-trained Italian girl in her place. She was much afraid that the clinic would not survive, for its Com- mittee, like all other organizations for social endeavor, is poor. We have seen poverty all over Italy, but that in Palermo seems to haunt the streets. The babies are par- ticularly starved and sickly looking. A visiting nurse was employed in a country district near Perugia and her round of duty covered three small villages. The American Red Cross completed its nursing activities in Italy on December 31, 1919, and withdrew from the coun- try. A final gift of 36,000 lire was made to carry on the schools; 9000 lire each was given to the Scuola Infermiere Visitatrice at Rome, the Lega Antitubercolare delta Provincia di Genova and the Scuola Infermiere Visitatrice at Florence; 4800 lire to the Lega Antitubercolare di Palermo and 2400 to the Lega Antitubercolare delV Umbria at Perugia. In a letter addressed on j^ovcmber 11, 1919, to the American Red Cross Commission to Europe, Miss Fitzgerald, then chief nurse of the Commission to Europe and herself a resident for many years in Italy, summarized the schools of nursing which were organized by the American Red Cross ; The work done by ]\Iiss Foley and her staff consisted of carrying on the course of instruction established by Miss Gardner for tlie purpose of training young women in visiting nursing and the care of patients suffering from tuberculosis. It has been very up-hill work to obtain the cooperation neces- sary for successfully carrying on these courses, particularly from the medical profession, which in Italy is still opposed to the hij^her education of nurses. NURSING SERVICE TO CIVILIAN POPULATION 873 Committees of prominent women have been formed in Rome, Florence and (Jenoa and these have fulfilled their obligations ... to the extent of providing class rooms for the course and interesting themselves generally in the work. However, this interest is not strong enough to influence the medical profession sufficiently to obtain for tiiese students the field work necessary to complete their training. Some dispen- saries have been willing to take these students for a certain number ot days a week, hut the doctors have refused to allow the nurses or the students to do any follow-up work oi* to visit the patients in their homes. This the doctors claim w^ould never be tolerated by the people, but as a concession they admit that later on an Italian nurse might be allowed to do the visiting work. This lack of cooperation from the doctors necessarily limits the scope of the training and this has been conspicuous in Eome. In Genoa the doctors have been more helpful and the graduates of the first course have found positions in dis- pensaries, clinics and schools. . . . From October, 1918, we have had in Italy Miss Gardner, Miss Thompson and IMiss Foley, all three of them women who rank high in our nursing profession and who are special- ists along public health lines. They have worked hard and have been deeply interested in their work. I feel, however, that educational work of this kind has not found appreciation in Italy, but I hope I may be mistaken in this. So far the work has resulted in educating less tlian twenty women . . . and the great difficulty is to obtain positions for them after their studies are completed. The medical profession is not ready for associates of this kind and naturally the demand for such workers must come from them. Miss Fitzgerald summarized the long struggle which had taken place in Italy for the higher education of nurses: The history of the attempts to educate nurses in Italy is one of great discouragement. . . . Attempts to run training schools along the lines of American and F>rilish training schools have been made by British nurses in Floreiu'e; by the Queen of Italy herself, at a big hospital in l^ome where sev- eral wards were given over to an English-trained nurse; by a graduate of the Johns Hopkins School, in Xaplcs ; and ijy the Italian Ked Cross in Milan. . . . The results are practically the same in ev(M-y case. The opposition of the doctors has continued; to this has been addeil the ill will of both men and women of the servant class of nurses who now do the nursing]: 874) HISTORY OF AMERICAN RED CROSS NURSING in Italian hospitals; and the well-established control by nurses. This opposition is represented by a very large body of people, none of whom wish the reform as each one fears a personal loss of prestige and privileges. It has been suggested at different times that the approach to the nursing problem in Italy and in France should come through the religious body. It is interesting to note that this was attempted in Florence; two nuns were sent to the train- ing school in Eome for the full three years' course. Upon their return to Florence, they immediately took sides against the trained women and went back to the opposition, thereby showing the uselessness of this mode of approach. The only ray of hope I can see is in the Italian Eed Cross, which, I believe, intends to start training schools and has already placed on a salary basis nurses who are now acting in an official capacity for that organization. This is already a step in the right direction, as the Italian Eed Cross formerly insisted that all nursing should be voluntary and in no way did the society recognize the necessity for trained and salaried personnel. It is very apparent that Italy needs no help from us in this line. Thus was ended the work of the American Red Cross in Italy. The seed of modern nursing which the American Red Cross attempted to plant in Italy at great cost fell into barren soil, but may in the future take root and bear fruit. Promise of this future development is contained in the following notice which appeared in the Foreign Department of the October, 1920, issue of the Aniei'ican Journal of Nursing: The three courses in public health nursing established by the American Ked Cross Tuberculosis Commission in Italy are meeting with well-deserved success. When the American nurses were withdrawn in January, people prophesied that the courses might be closed, but the carefully selected and organ- ized Italian committees have proved themselves more than able to meet any emergencies and the shorter courses in Eome and Florence are both to be repeated. A new course is being opened this month in IMilan by the Italian director of the Eome course and tlie more ambitious ten months' course which is being offered in Genoa closes this October. Letters from Italy tell us that the graduates of all three courses are in such demand that tlicre are constantly more positions than candi- dates. The nurses who saw the hardships of the primitive NURSING SERVICE TO CIVILIAN POPULATION 875 life in tlie southern part of the jx^ninsula will be interested in knowing that one nurse has been placed in Calabria, three in Sicily and more will be sent south as soon as they have completed the s|>ecial training. . . . Miss Gardner epitomized the Italian situation : "Italy must work out her own nursing salvation and it must be an Italian salvation worked out by Italians in an Italian way." Roumania perhaps suffered more during the European War than did any other nation, with the exceptions of Serbia and Siberia. She was faced on the south by the Bulgarians, who were smarting under the outcome of the Second Balkan War and desired to recover the lands of Dobrudja lost under the Treaty of Bucharest ; on the west by powerful Austria-Hungary ; and on the north by Russia, an ally in whom Roumania had little confidence. For two years she had remained an island in a whirlpool of war, but on April 28, lUlG, she joined the Allies. The kingdom of Rounuinia then occupied the great plain which sloped from the Carpathian Alps to the Black Sea, a plain covered with rich alluvial deposits similar to the famous Russian "black earth." The shape of the country resembled the letter "Y." The province of Dobrudja occupied the leg of the letter and fronted on the Black Sea. The principality of Wallachia formed the left arm and extended westward. The principality of Moldavia formed the right arm of the letter and extended north between Austria-Hungary and Russia. The country was chiefly agricultural. In 1900 Roumania was the third largest grain-growing nation In the world. She possessed rich oil and coal deposits and Iron, copper, lead, nickel, mercury and other metals In quantities sufficient to make mining profitable. However, the Roumanian tempera- ment did not Incline toward Industrial life. The oil fields of Wallachia had been developed to considerable extent by foreigii capital. Roumania's chief exports were timber from the oak, pine and beech forests of the Carpathian mountain slopes, petroleum and grain. She Imported metals, machinery, textiles and other manufactured necessities of modern life. In 1U14: the population of Rounuinia numbered ai)[)r(txi- mately seven and a half million people, of which six uiilliou were Rounuuiians and the others Jews, Tartars, Magyars, S(m-1>s, Bulgars and Armenians. The Roumanian ch'mcnt was sharply 876 HISTORY OF AMERICAN RED CROSS NURSING divided into two classes: the wealthy land-owning aristocracy who possessed a culture similar to and largely derived from the French, and the peasant group who were made up for the most part of simple uneducated folk who tilled the grain fields and herded the flocks. A middle-class industrial or merchant group similar to that in the United States did not exist. In 1914 Eoumania found herself in an extremely difficult political position. She had gone in 1877 to the rescue of Rus- sia, then hard pressed by the Turks at Ple\^ia, but was re- warded by the deprivation of the province of Bessarabia and was given a part of worthless Dobrudja as compensation. Rou- mania's independence from Turkish sovereignty was, however, established, and in 1881 the country was proclaimed a king- dom. Prince Charles of Hohenzollern-Sigmaringen was crowned King under the title of Carol I. During the thirty years' reign of Charles and his poetess-queen, ''Carmen-Sylvia," the era was one of national prosperity and economic and civil development. During the first Balkan War of 1912-1913, Roumania re- mained neutral. When peace negotiations were begun, Rou- mania claimed that she was entitled to territorial compensa- tion from Bulgaria for her neutrality and demanded cession of the town of Silistria, realignment of the frontier of Do- brudja and cession of a strip of coast territory on the Black Sea to permit her to develop a naval base. The Second Balkan War was declared before these claims had been settled. Rou- mania put her armies in the field, occupied Silistria and by July 13, 1913, had approached within twenty miles of the Bulgarian capital. An armistice was then signed and by the Treaty of Bucharest, Roumania obtained what she had claimed but also the enmity of her southern neighbor, Bulgaria. When tlie European War broke out, King Charles desired to join the Central Powers, but Roumanian public opinion was in sympathy witli the Allies, so the country remained neutral. King Charles died on October 10, 1911-, and two years later, his queen died. Tlie successor to the throne was Ferdinand, a nephew of Charles and a younger brother of Prince William of Hohenzollern-Sigmaringen. Ferdinand had married Marie, daughter of the Duke of Saxe-Coburg and Gotha and grand- daughter of Queen Victoria, a woman of unusual beauty and strength of character who had won the love and sympathy of the Roumanian people. NURSING SERVICE TO CIVILIAN POPULATION 877 Roiimania declared war in April, 1916, and in the summer her First Army invaded Transylvania, captured Kronstadt and Hermannstadt and by September 9 were holding nearly one- fourth of Transylvania. General Von Hindenburg with 450,- 000 veteran troops was then sent by the German High Com- mand to crush Koumania. The opposing armies met at Hermannstadt and in four days of fighting the Roumanian First Army was annihilated. General Von Falkenhayn made a rapid enveloping movement, came up in the Roumanian rear and cut off their retreat through the Red Tower Pass. The Roumanian forces were thrown into disorganization and re- treated in complete disorder and with great losses. On the south the Bulgar and German forces were also press- ing forward. General Von Mackensen entered the Dobrudja. Russian reenforcements failed to arrive and Roumania was then ''like a nut in the jaws of a nutcracker." ^^ Von Falken- hayn was pushing down from the north and Von Mackensen up from the south. By August, 1917, the Teutons were in complete possession of all of Roumania except Moldavia. In little more than a year Roumania had lost her two richest provinces and at least two hundred and fifty thousand men, forty per cent of her original army. ^luch of its equipment and ordnance had been captured by the enemy. Government and Army Headquarters and the Court evacu- ated Bucharest and fled to Jassy, the former capital of Moldavia. This city was also the headquarters for the Russian Armies operating on the Roumanian Front. Jassy had nonnally a population of about seventy thousand; this in 1917 was more than doubled. As also the refugees from the two occupied provinces had fled to ]\roldavia, this least rich of the Rou- manian provinces thus was called upon to support the Govern- ment officials, the R(uimanian Army of four hundred thousand, the refugees who numbered about half a million and the Rus- sian Armv which at one time agaregated about one million men. The winter of 191G-1917 was one of the most severe on record; the thermometer often registered thirtv degrees below zero. Cattle, horses and sheep died for want of food. P('o])le were found dvdd from starvation and exposure in the streets of the cities and in dugouts, stables and huts in the country. In December, typhus began to spread among the devitalized popu- *"'A Ri'foronec Tlistorv of the War," T. S. Guernsov, p. 162. Dotld. Mead &. Co., New York, 1!20. ' 878 HISTORY OF AMERICAN RED CROSS NURSING lation. During the winter and spring 230,000 persons died of disease and by the summer of 1917 Roumania had lost from war casualties and diseases seven per cent of her entire population. Both from an economic and professional point of view, Rou- mania was not prepared in 191G to give to her sick and wounded soldiers and to her typhus-ridden civilians sanitary service com- parable to that which prevailed in the British Empire and the United States. Three types of hospitals existed in Roumania : those established by the Roumanian Red Cross; those by the Roumanian Army, and those by Queen Marie. The hospitals of the Roumanian Red Cross maintained the highest standards in caring for the wounded. They were usu- ally of five hundred bed capacity and were generally located in a school building which had been taken over for use as a hospital. The equipment was the most liberal and the food the most adequate of any hospitals in the country. This superiority was due to the fact that the Roumanian Red Cross was a well- established and generously-supported organization. Also, the most prominent surgeons were associated with this group of hospitals. The nursing service was rendered by Red Cross volunteer nurses, untrained according to the English and American standards, but devoted and tireless in their ministry. The hospitals established by the Roumanian Army were gen- erally located in newly-constructed wooden barracks. The beds were of wood, the mattress of straw and one sheet and two blankets were furnished to each patient. The capacity of the hospitals located at important strategic points ran as high as 2000 beds. Xo women luirses were employed in this group. The hospitals of Regina Maria were usually to be found in the smaller villages and towns. They had been established and were supported by the resolute Queen ]Marie. In September, 191G, a French medical unit under the direc- tion of L)r. Dehelley was sent at the request of the Roumanian Government to Jassy, to demonstrate the Carrel trcatmen.t of wounds. One of the nurses was Pauline Jordan, the American Red Cross nurse who was later sent to Italy; she had been on duty since 1914 at the American Ambulance at ISTeuilly. The Carrel ^lission arrived in Bucharest in the fall of 19 IG and a letter written by ]\riss Jordan on April 22, 1917, to Miss Delano, gave an excellent picture of conditions existing in many Roumanian hospitals: NURSING SERVICE TO CIVILIAN POPULATION 879 We were given a pavilion of the best hospital at Bucharest but it was hardly ready for patients when the city was evacu- ated. Arrivinecial units and cannot leave them. In these Roumanian hos{)itals, practically any woman wiio wears a cap is allowed to do surgical dressings and operating-room work. All other work is considered un- interesting and is left to servants. One wishes that the nurses could be scattered about where the need is greatest. The Koumanians seem to have a profound respect for our training and look upon us as a new sort of doctor. The intense cold from which Roumania had suffered had been replaced by equally intense heat. Miss Jordan's letter continued : At the present time, the heat is almost unbearable, 107 degrees in the sliade yesterday afternoon at live o'clock. There has been an epidemic of dysentery and many people, enfeebled by disease and malnutrition, have died. Typhus has practi- cally disappeared and tlie body-louse also, but the flies have taken their place and are an abomination. Of the hospitals established in Roumania by foreign units, Miss Jordan wrote : We have been able to visit some prison camps, also a few well-equipped hospitals. One was managed by a French doctor who designed and arranged a splendid mechano- therapy room, also a home-made sterilizer made of cement and heated by wood, for quilts and mattresses. The British lied Cross has a very good hospital at Roman. Xearly all their furniture, beds, tables, chairs and sandals have been made by convalescent patients under the doctor's direction. At the present time his ])atients are building a sort of rough swim- ming tank. He was far-seeing enough to plant a garden in the spring and now their own table is well supplied with green vegetables, a rare luxury. Of the military situation in August, 1917, Miss Jordan wrote : For the past week, we have been ready to leave on an hour's notice. The Russians are refusing to fight and are rapidly retreating from Bukovina, which endangers our line of communication to Kief and Fetrograd. The rest of Rou- mania will then be captured, we fear. A train left yesterday with the I-higlisli civilian colony and one is leaving to-morrow 882 HISTORY OF AMERICAN RED CROSS NURSING with the French. The legations and the Court expect to leave in three or four days. We have received the order to stay on for a few more days and will evacuate with the Army, by rail if possible. The authorities have begun to give us the food supplies for distribution to the population. The greater part of the civilians have decided to stay in the country, preferring to be prisoners rather than to live with the Russians. . . . To such a situation, the American Red Cross sent its first Roumanian relief unit in September, 1917. The American Red Cross Commission for Roumania had been under process of organization in the United States since early that summer, under the leadership of Lieutenant Colonel Henry W. Ander- son, of Richmond, Virginia. Dr. Francis Peabody, an expert on internal medicine, Bernard Flexner, a sociologist, Dr. Gid- eon Wells, a pathologist, Dr. Robert C. Bryan, an expert in surgery, Dr. Roger G. Perkins, a sanitarian and Arthur G. Glasgow, an engineer, were the principal new members of the commission. It was the intention of the War Council that these men should make a survey of Roumania and then return to the United States with a report on W'hich to base future Red Cross relief work. The medical and nursing unit was to remain in Roumania for emergency relief work. Dr. Kirkpatrick, who served wdth Dr. Ryan at Belgrade in 1915, was the director. Florence M. Patterson was chief nurse. ]\Iiss Patterson's name has al- ready appeared in this history in connection with American Red Cross nursing service in Great Britain and France, but her Roumanian assignment marked the beginning of her subse- quently long and valuable field service. The nursing unit was composed of eleven nurses in addition to Miss Patt(n-son and contained among its members many re- markal)lc women whose names stand high upon Red Cross rolls Rachel Torrance, Linda K. Meirs, Katherine Olmstead and Alma Foerster. Other nurses of the unit were Adelaide Rowland, 3Iarv Mcliitire, Beatrice Gosling, Alice Gilbourne, Mary Brownell and Jennie Doiuild. The Roumanian Commission mobilized in Chicago on July 28, 1917, and sailed from Vancouver five days later for Yokohama, Japan. From -lapan the unit proceeded to Vladi- vostok, thence to Harbin and westward by special train over NURSING SERVICE TO CIVILIAN POPn.ATION 883 the Trans-Siberian Railroad to Moscow and tlionce to Jassy. Thoy arrived in tiie Ivonnianian capital on September 10, l'.)17, after a journey of fifty-two days. Supplies were sent by the American Red Cross via the Pacific route and a second considerable consignment to Archan- gel, Russia, for shipment southward to Roumania. After a month spent in surveying ^loldavia, live of the com- missioners returned to the United States and submitted de- tailed reports to the War Council of the economic and sanitary situation of Roumania. Colonel Anderson and the members of the commission who remained in Jassy immediately under- took emergency relief work. This fell into five general groups- hospital service, public health and sanitation, civilian relief, transport service, and miscellaneous relief. Carloads of food were brought down from Archangel, Petrograd and Moscow and were distributed to the Roumanian population. In Putna, Tekuchin and Bocan, 40,000 persons were fed daily by the American Red Cross, and a canteen was opened in Jassy where for two months meals were daily given to 2000 persons.'*'^ The Commission for Roumania maintained a hospital at Roman and dispensary service at Roman and at Jassy. The hospital at Roman was the former British Red Cross Hospital described by Miss Jordan and was known as the Prince Mercea Hospital. Major Kirkpatrick, director of the medical unit, gave the following reasons why the commission took over this institution : Firstly, the lio.nces : ^^ "Tho Work of tlic Ainorican Hod Cross during tlie War: A Statement of Finances and Aceoinplisiinients," i). 80. 884 HISTORY OF AMERICAN RED CROSS NURSING We took over the Prince Mercea Hospital on October 6, 1917, and until March 8, 1918, we were always sitting on the edge of a volcano which never erupted. We had to be ready to move within an hour provided the Huns came or if the Russians signed peace or (much more probable) if the Bol- sheviki attacked us for food supplies. We had, as you know, no offensive after we arrived but when we took over the hospital from the British Red Cross, we "inherited"' about 400 patients and from then until we left we had between 380 and 500 cases. Most of them were wounded who had been evacuated from hospitals nearer the front (an entirely imaginary term as far as the Eastern Front is concerned!). Also, we had civilians and even women and children when we had empty beds. As we had inherited the hospital from the British, it was more or less well equipped and, indeed, we should have had a sorry time except for the unstinted way in which the British and Eussian Red Cross helped us out all along. The equip- ment which was shipped from the American Red Cross reached Roman the latter part of November and even then v/as quite inadequate for any sort of a hospital. The nurses lived in two small wards of the Roman Hospital. Miss Patterson wrote: The nurses all considered their quarters quite comfortable, although they had nothing except their beds and one or two small tables and several chairs. The beds were boards with straw mattresses, but not at all bad. Of course the food proposition was much the most diflficult, for there was nothing to be purchased in Roumania. Fortu- nately the potatoes were splendid and we were able to get a good supply stored away for winter. We were able to get no meat after December 1 and had no canned meats, but in true Roumanian fashion, we had a small farm in our back yard, which we stocked in the fall with several pigs. Consequently, we went on mad debauches several times by having a pig killed, but wc always ate it with the fear that we might need it worse later on. We had macaroni, rice and plenty of but- ter which came from the Russian Red Cross and coffee from the V. S. A. which seemed really to save our lives. There was practically no milk in the country ])ecause there was no fodder for the cows and during the last few months we had about ten quarts daily for the entire hospital and some days none at all. We probably had an average of two dozen eggs for the entire hospital. The patients had meat NURSING SERVICE TO CIVILIAN POPULATION 885 twice a week hut in almost infinitesimal quantities and fear- fully bad, simply starved animals. Tiie otlu^r articles of food were beans, cabba^^e and potatoes. How those patients man- aged to recover on that diet is still a puzzle to us for we had nothing else even for the desperately ill men. It is quite impossible to tell how absolutely destitute the country is, with neither food nor clothing. For the peasants we have the utmost sympathy. They are splendid and are tlie one hope of Roumaiiia, except Queen Marie, who is wonderful. She and Princess Marie had Thanksgiving dinner with us at the hospital . . . and when we left she asked us in tears to tell the women of America how she had tried and how she would continue to fight to the end : "We English never give up." Early in January, 1918, the commission started an out- patient department at the Roman Hospital. Miss Patterson wrote : Our most interesting work was the out-patient depart- ment for civilians. We did general relief work in connection with it and also some nursing in the homes, an unheard-of thing there. The starvation diet and complete absence of soap among the civilian population, together with the general prevalence of venereal diseases, soon made our clinics known as the S. S. S. (soap, sulphur and salvarsan). I should say that every child and about 85 per cent of the patients had scabies. We distributed soap in small pieces, but of course the whole effort was futile under existing con- ditions. The peasants had practically nothing to eat except cornmeal, which constitutes a large part of their normal diet, so you can imagine the amount of resistance to disease they had. When a ])atient would seemingly be doing well, he would without any apparent reason run a fearful tempera- ture and just go all to pieces. So wr really never knew until they were evacuated whether tliey would go out of the front door or be carried out of the back ! Witliin three days at Christmas time, we had ISO hernia cases come in for operation (1 never did make out whetlier or not it was an epidemic), but these were ])ractically tlie only clean cases we saw while there and many of these weren't clean, because there wasn't enough vitality left in any of them. Late in 191 7 the commission developed ])lans for establish- ing an American Red (^ross hospital in -lassy. Several nurses 886 HISTORY OF AMERICAN RED CROSS NURSING of Miss Patterson's group were sent from Roman to organize it in a building loaned by the Government. Before it could be equipped, however, the Government decided to utilize it for military quarters. ''That project was ended before it began, fortunately for us," wrote Miss Patterson, "for to be perfectly frank, there was no equipment in sight !" The typhus epidemic in 1917 and 1918 was thought to be somewhat less violent than during the preceding years. Though the conditions favoring it overcrowding, filth, lice, exposure, starvation and lowered vitality persisted, the winter was less severe and this one factor saved many lives. The body louse continued to be a trying pest. "Bathing facilities in a Rou- manian village," wrote Major Kirkpatrick, "are almost non- existent. If you ask one of the peasants whether he has lice, he will probably look at you in surprise and say : 'Am I dead, that I should have no lice V " In October, 1917, the Russian Government under Kerensky was overthrown and the Bolsheviki came into power. The Russian Armies in Roumania collapsed and in December nego- tiations were opened between the Central Powers and the Rus- sian authorities with a view toward a separate peace. Rou- mania was violently and persistently opposed to a separate peace but national annihilation faced her. An armistice to continue for sixty days and to be terminated by seventy-two hours' notice was signed on December 9. By March 1, 1918, the Russian Army had gone out of existence. With her own small forces Roumania could not hope to hold her extended battle-front. General _Mackensen then delivered two ultimatums to Roumania : cither to enter into a separate peace or to be overrun by the German Armies and completely destroyed as a state. On March 8, 1918, Roumania signed a preliminary treaty of the humiliating peace which was subsequently forced upon her. One of the terms of this preliminary treaty was that all Allied relief missions should leave Roumania ; they were to be given three days' time for departure. On IMarch 9 the Ameri- can Red Cross Commission started, in a train composed largely of second-class sleeping cars, on their long journey from Jassy to ^Murmansk. During the flight northward, which lasted four weeks, and the time three weeks more at Murmansk waiting for a ship to carry them to England, the excellent morale of the nurses never flagged. Tliey did all the cooking, the cleuniug NURSING SERVICE TO CIVILIAN POPULATION 887 and washing and met the situation with equanimity. Miss Patterson wrote: Our experiences sound much worse than they really were, for we had the nicest people in our car, Colonel Anderson and ^lajor Kirkpatrick and our nurses. . . . We have lived in a peace and harmony which makes any hardship tolerable and every one has seen something funny in it all. We have had a wonderful service and incidentally a splendid school- ing in adapting ourselves to an entirely new system of valua- tion, a system which has taught us that one can be healthy, happy and more or less sane with very few of the commonly- accepted necessities of our normal American life. ... It has been, however, most disheartening to sit by and watch the steady breakdown of the Eastern Front and at the same time to get very little authentic news of the Western Front and none from the United States. The commission arrived safely in England in April, 1918, and the majority of the nursing members remained for duty there or were transferred to France. Miss Patterson wrote : We are all feeling quite like Eip Van Winkles, yet it is certainly nice to be back in civilization and above all else to find some of our Allies with the bit in their teeth. Many people here seem to feel that they are in rather desperate straits but to us the whole of England is a fairy-land and the English seem to realize it and are making little complaint. Their spirit is splendid and gives one an entirely new back- bone after living with Orientals for so long. Mary ^[clntire, another nurse of this unit, wrote Miss Xoyes : I cannot realize I am back where we have plenty of food, English literature and "green grass growing all around.*' It was wonderful to see our boys reviewed in London, to watch the convoy of twenty-three American ships on the high seas, to see the French dirigibles hovering over us. Never have I loved the l^uioii Jack so much as when we saw those destroy- ers speeding out to us in the Xorth Sea. This is a terrible time to live and the whole world seems just one great heartache, yet it is a wonderful time When we landed in luigland, we were stnuk by the silent and earnest enicieiuy of every man and woman. Eussia and Eoumania were so completely disorganized. . . . 888 HISTORY OF AMERICAN RED CROSS NURSING Syria, the key to the East and the Turkish province in which Palestine was situated, occupied in 1914 the long strip of comparatively habitable land lying between the Mediterranean Sea and the Arabian Desert. On the south it touched Egypt, on the north and on the east the Turkish provinces of Aleppo and Mesopotamia. For almost seven centuries Syria had been ruled by Turkish masters though they had always remained hated strangers to the polyglot Syrian population. Syria in 1014 was peopled largely by Arabs, Armenians, Maronites, Druses, Turks and Jews. The Arabs numbered some tliree million souls and occupied the whole of the country except for a few mountainous districts. By religion, the Arabs were followers of Islam and had absorbed into their faith numerous mongrel tribes. The mountainous regions of Syria, especially Lebanon, were held by some three hundred and fifty thousand Maronites, They were Christians and as Christians reconciled with Rome, had for some centuries been under the protectorate of France ; they had thus absorbed much of the French culture. Parts of the Lebanon and Damascus regions were occupied by the Druses, a fierce and predatory Moslem sect numbering perhaps two hundred thousand. The Jews were to be found in Palestine. Syria was comparatively a poor country, the soil outworn, the hills deforested, the rainfall meag(>r, the heat intense. She was poor in minerals and water power and the native indus- tries of textile-making had been practically swallowed up by the importation of cheap European-made products which had also destroyed the foreign market for the Syrian textiles. I^orth of Syria lay Kurdistan, inhabited by wild and lawless semi -named tribes, Mohammedans by religion and shepherds and robbers by trade. Xorth of Kurdistan were the lofty mountain ranges and plateaus, rich in undeveloped mineral products, and the fertile hill slopes and valleys of Armenia. Armenia Proper, as this mountainous plateau was called, was bounded on the north by the Black Sea and Transcaucasia, on the east by Persia, on the south by ]\resopotamia and Persia and on the west by Asia Minor. The Armenians were in pre- historic ages a sliort, dai'k, non-Aryan race. In modern times this strain still formed the basic peasant type, though Aryan conquerors had long since impressed their language on the country and their blood upon the upper classes. The true Armenians were mostly peasants and artisans, possessed of in- NURSING SERVICE TO CIVILIAN POPULATION telligence, adaptability, marked commorcial aptitude and a strong instinct for maintaining their racial integrity. In 1914 the Armenians living in the Caucasian regions numbered about one million two hundred thousand, those living in Persia about fifty thousand and those living in Asia Minor under Turkish rule about one million. The Armenians had suffered from massacres by the fanati- cal Turks since 189(1. In 1914 the Turkish Government adopted a policy of wholesale massacre and deportation of these people to the coast cities of Syria. In addition, thousands fled to these cities Aleppo, Beirut, Acre, Jaifa, Jerusalem and Port Said. Syria, a poor land, could not support them and they died in great numbers from exposure, disease and starva- tion. At the same time the native population suffered to an almost similar degree. Turkey declared war on Russia on October 30, 1914, and on England on ]N^ovember 5. Turkey occupied a position of stra- tegic importance in that as long as the Central Powers, of which she was one, controlled the Dardanelles, the Allies would be unable to get supplies to Russia from the south. Military activities in the southeastern theater fell into five principal campaigns the Turkish offensive in the Caucasus, the Gal- lipoli Campaign by British and French forces, the Turkish attack on the Suez Canal, the British advance on Mesopotamia, and the collapse of Turkey. Early in 1917 the British began a campaign from Egypt northeastward through Syria. On December 10, 1917, General Sir Edmund Allenby, in com- mand of British, Indian and "Anzac" troops, entered Jeru- salem. In 1915 Dr. Edwin St. John Ward, formerly of the J\rcdical Department of th(> Syrian Protestant College at Beirut, was asked by the Turkish Government to make a survey of the Jerusalem District and the barren regions to the south as far as Beersheba. He and his party found the country practically destitute of professional medical and inirsing service. The importation of foreign pnxlucts had practically ceased and tlie resources of the country were insufficient to support tlu^ tre- mendously inflated popuhition. Slow starvation faced both the native and refuaee })opulati()n, esp(H'ially in Palestine. On October 1, 1915, relief work in Asia Minor was initiated by a strong American eonnnittee calk'd the American Connnit- tee for Armenian and Syrian Relief. This comniitt(>e appealed 890 HISTORY OF AMERICAN RED CROSS NURSING to the American Red Cross during the early summer of 1917 for financial aid and the minutes of a meeting of the War Council, July 23, 1917, record the following action: The chairman stated that in a letter dated July 18, 1917 (D. E. P. 5()), Mr. R. S. Lovett, chairman of the Committee on Cooperation, had presented an application from the American Committee for x\rmenian and Syrian Kelief, dated July 5, 1917 (D. E. P. 59), asking that the Eed Cross War Council appropriate to that committee for its relief work in Western Asia, the sum of $300,000 per month for the re- maining six months of the calendar year. He further stated that the American Committee for Ar- menian and Syrian Eelief had during the period, October 1, 1915, to April 1, 1917, raised $3,400,000 to carry on its work and that as its administration expenses were met privately, the committee was unable to devote to distinctly relief work one hundred cents on every dollar received for the purpose; that at a conference held last February attended by Am- bassador oMorgenthau and the foremost authorities on Western Asia, figures were presented showing that there were no less than 2,144,000 persons in Western Asia whose death could be prevented only by direct and continued help and that on a minimum allowance of ten cents per day for food, $6,000,000 per mouth would be required to support these peo])le until they could be restored to their homes on a self-supporting basis. He further stated that Ambassador Elkus had reported that the Eed Cross was not allowetl by the Turkish Govern- ment to carry on relief work itself within the Turkish Empire and that the American Committee for Armenian and Syrian Eelief was the only organization outside of the Eed Crescent (controlled by the Turkish Government) in a position to administer relief to the starving Armenians and Syrians and certain portions of the Greek population in the Turkish Em- pire; that Amljassador Elkus had ascertained from the State Department tliat there was apparently no danger of inter- ference by the Turkish Goverimicnt for the present at least, with the work of the American Committee for Armenian and Syrian Eelief, and that in order to safeguard its interests the former assistant treasurer and three members of its Constan- tinople Commission had been made attaches of the Swedish Legation now representing American interests in Turkey. He further stated that the chairman of the Committee on Cooperati The taking of Jerusalem by the British in December, 1917, opened Palestine to the Allies and removed in the portions of Syria then under British military control the restrictions which the Turkish Government had placed upon independent Ameri- can Red Cross activities. In a letter addressed to the War Council on January 23, 1918, the American Committee for Armenian and Syrian Relief stated that ^'a considerable sum of money had recently b(H'n contributed to the above committee from Sunday schools for use in Palestine and that in view of the advantages that Avould accrue from having the work behind the British Lines conducted in cooperation with or under the name of the Ameri- can Red Cross, an early conference with that society was re- quested to consider some plan whereby the best results could be secured in relief work in Palestine and other countries." At a meeting of the War Council held on January 29, this letter was discussed and plans were approved for sending an American Red Cross commission and medical units to Pales- tine under the leadership of Dr. St. ,Iohn Ward, then serving as a member of the American Red Cross Commission for France at ]'aris headquarters. The Conunission for Palestine, with " "Tlic \\'ork of tile American Rod Cross during the War: A Statoinent of Finances and Accomplishments," p. 87. 892 HISTORY OF AMERICAN RED CROSS NURSING Dr. Ward as deputy commissioner, was appointed by the War Council at a meeting held March 7, 1918. On April 17, 1918, Dr. John H. Finley was appointed commissioner for Palestine. The personnel of the commission numbered fifty-four people ; ten of these were American Red Cross nurses, six were surgeons, three were sanitary engineers and the rest were social service workers, teachers and assistants of various types. "Twenty-three members had been either missionaries, teachers or persons with some previous experience in the near East," stated the Annual Report, 1018, of the Palestine Commission, "and sixteen had been stationed in Syria, Palestine or Egypt." The nursing staff was selected by the Nursing Service at National Headquarters. Edith Madeira was chief nurse. Miss Madeira was a graduate of the Hopkins School and a woman of wide travel and broad interests. She had gained administrative experience in her profession as superintendent of nurses of the Howard Hospital in Philadelphia and at the Mountainside Hospital, Montclair, New Jersey. ]\Ioreover, she was a public health nurse and had served as Superintendent of the Visiting Nurse Associations at Harrisburg, Pennsyl- vania, and at Watcrbury, Connecticut. The nurses of the Palestine Commission were Ellen M. Hamilton, Edith M. Haslam, Katherine Macklin, Frances ]\l('Quaide, Anne L. O'Malley, Jessie G. Patorson, Olive Ranger, Lillian M. Spolman and Emma M. Wood. In Sep- tember, 1918, five additional nurses who had all had service in the Near East and spoke Arabic, joined ]\riss ^ladeira's staff. They were (Mrs.) Lillian Cole Scwny, Beatrice Archer, a graduate nurse whom the British Red Cross loaned to the com- mission ; Ruth Eddy, Sara Kaisermann, a graduate of the Col- lege Hospital, Beirut, and a Mrs. Abramson, another British nurse. Relief work in a country as primitive and destitute as Syria in 1917 offered difficulties not to be encountered in countries where Occidental methods of travel and standards of living prevailed. In addition to the regulation equipment for medi- cal and nursing service and general relief, the supplies of the Palestine Conuuission inclndcd twenty motor transport vehi- cles, complete macliincrv for road-making, tra<'tf)rs, steam pumps, refrigerating and hoisting machines, plumbing, air- coinj)ressiiig and el(!ctrical materials, machines for purifying water and thou.sands of feet of galvanized and steel piping, NURSING SERVICE TO CIVILIAN POPULATION 893 sewing machines, plows, hand-cultivators, hoes, rakes and shovels. The Commission for Palestine sailed from New York City on March 13, 1918, on their long journey around the Cape of Good Hope to Ceylon, then across the Arabian Sea and north through the Ked Sea and the Suez Canal. They arrived at Port Said on June 11 and entrained for Jerusalem. General Allenby made his headquarters in June, 1918, at Ilamleh, thirty miles west of Jerusalem. General Sir Arthur ]\Ioney, formerly chief of staif under General Alaude at 13ag- dad, was chief of the Occupied Enemy Territory Administra- tion and Colonel Ronald Storrs was military governor of Je- rusalem. Colonel Storrs turned over to the commission the old Russian Hospital with its annex and half the large Men's Hospice within the Russian Compound and also a large resi- dence, the ''Lord Bute House," which was located just out- side the south gate of the Compound. These buildings had been used by the Turks as military hospitals but had been unoccu- pied since the British captured the Holy City. The members of the commission arrived in Jerusalem on June 18 and literally ''dug into" the accumulated filth of their new quarters. The "Lord Bute House" was used for adminis- trative headquarters and the former Men's Hospice for the liv- ing quarters of the personnel of the commission. "This is a picturesque old building," wrote Miss Madeira to Miss Noyes, "and has gardens and lovely corridors." The Russian Hospital was opened on August 22 after heroic labor. The engineers of the commission had been forced to go down into the sewer drains themselves to show the amateur plumbers how to work ; the skilled mechanics in Jerusalem were then sei*\'ing with the Turkish Army. Workrooms were established in the gardens and native women were set to work pulling out the stuffing of the mattresses for disinfeetion, then restuff'ing and resewing them. The nurses directed the work of scrubbing and whitewashing the wards of the hospital. In a report sent to j\liss Noyes on September 20, Miss Madeira wrote : The hospital ])uil(ling is two stories high and lias huge halls running the full length of the building with liigh, vaulted ceilings, 'i'he |)liarniacy, disiiensarv. doctor's otlice and a library are on the tirst floor, also two private rooms with 894. HISTORY OF AMERICAN RED CROSS NURSING bath and a large bathroom where all patients receive their initial scrubbing on admission to the hospital On the first floor are also the operating, sterilizing and dressing rooms. Wards accommodating fifty patients occupy the second floor. Altogether it is an up-to-date hospital and is being run as such. Miss McQuaide is in charge of it. Miss Eddy, Miss Kaisermann and Mrs. Sewny are head nurses. Miss Wood has the operating-room and Miss Archer is night supervisor. There are eight native nurses and three orderlies. The work of the Russian Hospital was almost entirely surgi- cal. Many of the native farmers and the refugees engaged in agricultural work in the Jerusalem District were injured through the accidental explosion of shells lost or left by the armies in the open warfare which was carried on in Palestine. This method of warfare as opposed to trench tactics, prevented close salvaging of the battlefields. During the seven months of its existence, the American lied Cross Surgical Hospital in Jerusalem treated a total of 668 patients, of whom 402 were surgical and 266 medical cases. The death rate was 3.7 per cent. One of the most complete and valuable phases of this hospital service was the bacteriological department, of which Nancy Hamilton was in charge. The British Forces had laid out extensive plans for the American Red Cross commission, even before Dr. Finley and his staff arrived. The work dealt entirely with the civilian, population. One of the first projects undertaken by the com- mission was the assignment of an American Red Cross nurse to the Turkish Municipal Hospital, of 65 bed capacity, at Jerusalem. Miss Macklin was detailed to duty there on June 24 and she gradually brought order out of chaos. Miss Madeira wrote : i\riss ^lacklin found disorder and filth to be the principal difficulties. Every hall and corner was packed full of rubbish intermixed with a thin layer of useful things that had to be sorted out. Tlie equipment was meager but has been su})ple- niented slightly by requisitions and largely by the redemption of {)itcliers, basins, cups^ plates and similar articles picked out of these rubbish heaps. The laundry was reported to be a week behind with its work, but it took more than a month and three laundresses to overtake that "week." Tins laundrv should be seen to be NURSING SERVICE TO CIVILIAN POPULATION 895 appreciated. It is a room in the basement. There is a device for drawing water and a curious depression where water ac- cumulates. The work is done by women sitting on the floor with huge, flat copper tubs, like round English bathtubs, in front of them. Here they dabble the clothes around in a little water and, from all ai)pearances, have never been in the habit of rinsing them. Miss ^Nlacklin has greatly improved con- ditions here and the clothes are assuming a less dusky hue. Cleanliness reigns in other departments, too, and the pa- tients are naturally res}X)nding. There are eight native nurses, with no training to speak of and no ideas of responsi- bility. Miss Macklin has found them ambitious to learn and very teachable. A native doctor is in charge of the hospital. Extensive dispensary and public health nursing service was maintained in Jerusalem and the outlying regions. Early in July, Red Cross physicians were assigned to visit the different deserted convents and other buildings where the refugees had taken shelter. Miss Ellen Hamilton, one of the nurses, was assigned to go with one of the doctors on his rounds, and to- gether they established the beginnings of a traveling dispensary service. This service was given at the Carmelite Convent on the Mount of Olives ; the Franciscan ^lonastery on the road to Bethany ; the Bucharloa, which often had six hundred inmates at one time ; the Greek Hospital and schools ; the Convent of the Holy Cross ; the Russian Convent ; Bishop Gobat's school, and David's Tower. ]\riss ]\Iadiera described the manner in which this service operated : The ]\[ukhatar, or head man of the place or of the par- ticular group of refugees, gathers together all the sick at a time and place designated by the doctor. When he and Miss Hamilton arrive, he examines them and prescribes treat- ment. She treats the eyes, makes the dressings and assists him, so tliat the service is just like that given in a dispensary. Any persons wlio are too sick to come to the appointed place are visited by the doctor and nurse. The Bucliarlea, a large group of buildings in the Jewish Quarter, is one of the principal centers of this type. As it seemed in a worse condition than the others and was over- crowded, we un(l(n"t()ok intensive work there. Two rooms were selcrti'd, a (i)uple of chairs and tables were secured and a nicaucr ('(|iii|)in('iit ])lace(l there. The social service de- partment lias also begun work and has large plans. 896 HISTORY OF AMERICAN RED CROSS NURSING The medical and nursing service provides in addition to the dispensary service, a place where milk can be prepared and fed to babies, thus preventing the father from drinking it himself or selling it. Miss Haslam has been appointed to serve here on full time. She has a native helper who also interprets for her. She distributes quinine, treats eyes, pre- pares milk and sees that the babies consume it. At the Franciscan Monastery the dispensary service was held outdoors. "There was no suitable place inside," wrote Miss Madiera. "In one room four goats and a donkey were found living contentedly with a large human family." One of the most ambitious undertakings of the commission in Jerusalem was the establishment in a building formerly oc- cupied by the Russian Consulate of a general dispensary, a children's hospital and a home for native nurses. The Chil- dren's Hospital was opened late in September and was of twenty five bed capacity. Miss Spelman was placed in charge of it. The daily attendance at the dispensary ranged from forty to one hundred patients, largely children suffering from malaria, measles and diseases due to malnutrition. Of the 2331 cases treated 1401 were Moslems, 618 were Greek Ortho- dox, 138 were Latin Catholics and the remaining 174 were di- vided almost equally between Armenians and Jews. Of the seventy-three patients who died, forty-three succumbed to malaria. Dental clinics were maintained at the Children's Hospital and by January, 1919, twelve hundred cases, including every type of patient from British Army officers to the most ema- ciated Moslem child, were treated there. A diet kitchen was established and milk and food given to babies and undernour- ished children. The final report of the Children's Hospital gave a vivid account of the types of patients treated: When the American I?ed Cross came to Palestine in the hot, dusty days of June. 1918, it was evident to the workers that a second slaughter of the innocents was going on in the land of the Infant (Mirist ... so a small room was fitted out as a clinic for cliildron of five years and under. The sun blazed down on the open court which the waiting patients sliared with fiftv women who were emptying and disinfecting a legacy of Turkish mattresses. Each long fore- noon a crowd of war-worn mothers came to us. There were Refunccs waitiii'' at thi' dooi's of a relief statinn in JtTUsali'in. NURSING SERVICE TO CIVILIAN POPULATION 89T wives of Turkish soldiers who had vanished in the retreat; there were wives of once thrifty artisans and tradesmen now penniless in their vain effort to ward off the draft; there were beggared refugees from "beyond Jordan" and "up Nabulous way" and there were peasant women in ragged, quaintly- embroidered costumes, women hunger spent and exhausted from a three-mile walk along stony, dust-choked roads, their foreheads chafed raw with the rope of the saddle-bag in which were carried their sick children. These mothers, gaunt from starvation and malarial poison- ing, would lie at length on the paving, taking what comfort they could from the liot stones when the ague-fit shook them. The children and babies also shivered and burned, strangled in paroxysms of whoo})ing-cough, squirmed imder the teas- ings of skin diseases or burrowed their tiny skull-like faces against the mother's empty wrinkled breasts in fruitless search for food. In all Jerusalem, the color of war prevails on the dust- peppered olive trees of the gray and dusty city, in the haze which envelops the lorries, the cavalry, the infantry always on the move northwards, on the thousands of camouflaged tents and the uniforms of the Tommies and over the bare parched hills and sterile valleys. All of Palestine, the land across which the chariots of Alex- ander's warriors had swept, and which in turn had been the province of Home, the Holy ground on which the Crusaders had pitched their gray-hued silken tents, the stronghold of the Turk, was again in 1917 the battle-ground of the East and the West. Miss ]\Iadicra wrote: The whole country is a camp and war the main business, yet in spite of the fact tliat we constantly hear the guns and that air])hines fly overhead, we seem to have lost all sense of the reality of war. The paraphernalia of war seems just a ]iart of the day's work in tliis barren land of stones and dust and we no longer think of it. Of course, we do not see any of the wounded oidy the civil population, but in traveling about from one station to another outside of Jerusalem, one is again and again imjiressed, almost overwhelmed, with the fact that the business end of modern warfare is tremendous. In addition to tlio relief work in the TToly City, the British Forces had included in their plans an extension of American Red Cross work southward as far as Port Said and later north- ward as far as the advancing front permitted. 898 HISTORY OF AMERICAN RED CROSS NURSING The Refugee Camp at Wadi Surar was one of the first places outside of Jerusalem to which American Red Cross nurses were assigned. Miss Madiera wrote: Our next venture was to take over the Tent Hospital at Wadi Surar, where the refugees, driven from their homes near the firing-line, and the Armenians were concentrated. When we first saw the camp, about 3500 people were there, half of them Armenians. Wadi Surar acted only as a deten- tion camp for Armenians ; here they were placed under obser- vation and if found free from infectious diseases, were sent on to the Armenian Refugee Camp at Port Said. All the refugees at Wadi Surar were living in bell tents and sleeping on the ground, as is their custom, even with the sick. The first impression of Wadi Surar was of sand and tents; tents and sand, with a wonderful view of the hills be- 3'ond. This view and a fine breeze redeems the situation, for it is hot and cheerless otherwise. Among the tents are shel- ters where the refugees in their picturesque rags assemble to cook and eat. Everything is very primitive. Lillian Spelman and Olive Ranger, both of them nurses, were sent to W^adi Surar on July 9 and found that the camp was being run by a young English doctor, "in appearance not more than seventeen years," wrote Miss Madiera, "but natur- ally he is much older and is doing splendid work." There were three other officers and the American nurses took with them three capable native women and two orderlies, also tents and full camp equipment. The Camp Hospital was composed of bell tents set up a little distance from the camp proper. Miss Madiera wrote : Here patients left at will, babies arrived without medical assistance which did not even seem to be expected ; people died without the doctor being sent for. The hospital equip- ment was poor ; there were no clean clothes or linen and very few utensils. Egyptian tomargies had previously done what- ever nursing had existed but they were discharged before our nurses arrived. The work was divided. Miss Spelman concentrated on the so-called Hospital and ]\Iiss Eanger took care of the patients with minor ailments who did not need hospital care. In the Hospital, native nurses were instructed in proper bathing and the care of the patients, with special emphasis upon gentle- ness. Soon the kinder care made the hospital much more NURSING SERVICE TO CIVILIAN POPULATION 899 poi)ular. With tlie advent of the social service workers and their supplies, the refugee women were given sewing to do and more adequate linen and garments for the hospital were supplied. Then camt' the larger tents and the whole hospital was moved to a hetter site and was enclosed by a barbed- wire fence witli one opening at which a guard was placed. He prevented the continuous visiting and mingling of sick and well. The prevalent diseases throughout the Palestine area were malaria, dysentery, ophthalmia, trachoma and skin diseases due to the starvation diet. In September, 1918, the Armenians at Wadi Surar were sent en masse to Port Said. Military activities in the north were resumed and as the ]3ritish Forces pressed on some refu- gees returned to the recaptured territory. Others sent to harvest the figs and grapes which were ripening in the groves near Jerusalem. Thus the population of the Camp on the sands diminished to eight hundred souls. However, the Hos- pital continued to draw its average of one hundred patients, ''due largely to the kind care they receive," wrote ^liss [Madiera. Northwest of Jerusalem on the Mediterranean sliore was situated the sea-town of Jaffa. During the first years of the war the population of the city was about 70,000. In March, 1017, the Turks had ordered the entire civilian population to evacuate Jaffa, on the grounds that it might suffer from British homhardmcnt. The Turkish and Teutonic military authorities loaded the poorer people into railroad trucks and started them south toward Honis, Ramleh and Ludd. INFost of the refugees remained in these neighboring towns but some of them fled as far east as Jerusaknn, Damascus and the small Palestine vil- lages. Of the entire civilian population of Jaffa, the Turks allowed some seven shopowners to remain to run their stores and the owner of an orange grove to stay on his property. This orange grove served as a place of refuge for two hundred others. With the city empty, the enemy stripped the houses and stores of timber and iron for defensive works further south. Looting was rife. On Xovember Iti, 1917, the 15ritish took Jaffa and in a week the refugees canie streaming back. Hut the economic and sanitary recovery of the city was slow. The P)ritish au- thorities gave eni})loyinent to able-bodied men and boys in 900 HISTORY OF AMERICAN RED CROSS NURSING road-making and set some of the women to work at laundering and mending and at making mattresses. The British also sup- plied food to the destitute until they discovered that at least 14 per cent of the recipients were professional beggars. Then they ceased and turned the situation over to the American Relief organizations. The Commission for Palestine undertook extensive social serv- ice work and medical relief in Jaffa. On July 2 Miss Pater- son was sent from Jerusalem to Jaffa to take over the Infectious Disease Hospital. The building had been used by the Turks as a quarantine station and was located on the beach. Motors could not get to it on account of the deep sand. Miss Paterson waded through the sand to the hospital and found there the usual dirty buildings and tents. Miss Madiera wrote : The institution was absolutely without system. Meals were never prepared at a regular time and the dirty dishes lay around from one meal to the next. The washing was done at the pleasure of the laundresses. When patients were dis- charged, the bed linen was not changed unless it was unspeak- ably dirty and the blankets were never sterilized or aired. And this an infectious hospital ! There was not a single clock in the whole place and no one had a watch that kept time. Patients were admitted in a very crude way by the ward maid or male servant. Two young and untidy Jewish girls acted as nurses. The em- ployees slept in any vacant bed in the wards and ate their meals in any part of the hospital. ]\riss Paterson moved into the hospital as soon as a room could be furnished for her, purchased a clock and started in. The laundresses were prevailed upon to wash five days and mend one. The hospital was cleaned and the kitchen reor- ganized. Patients were admitted by the nurse, and kept in tents until definite diagnosis had been made. A time schedule was arranged so that all employees were getting one-half day off duty a week and two hours daily. Comfortable sleeping quarters were provided for them and a dining room for the nurses, wlio were taught simple nursing care. Every one was given definite work and was held responsiljle for that work and that alone. On September 13, when IMiss Paterson was recalled to other work, she turned over a well-organized establishm(>nt to her successor. The question as to how long it would remain so was NURSING SERVICE TO CIVILIAN POPULATION 901 one of the genuinely discouraging questions which all Occi- dental workers experienced in the Near East. Nurses' letters record that the efficiency of the professionally-trained Ameri- can nurses throughout Palestine was a source of amazement and incomprehension to the Oriental mind. East of Jaffa lay Ramleh, the first stopping-place of the refugees. The Commission for Palestine sent a medical unit to Ramleh on July 15, li)18. They pitched their tents in a dust- gray olive grove behind the Crusader's Tower and went to work among the refugee and native population of Ludd and Kamleli. Emma Wood was the nurse of the unit and she took over the direction of a small hospital of twelve beds at Ramleh and a dispensary at Ludd, both of which had been started by ihe Medical Department of the British Occupied Enemy Territory Administration. ^liss Madiera wrote: The hospital deserves description. It is a roof, with a number of rooms around the outer edge, which are used for patients, nurses, operating-room, kitchen, laundry and store- rooms. The dispensaries are most interesting places. A room which was needed for one of them had been the lodging-place of an untidy but very contented donkey. At first the dispen- saries were hard to manage because the crowds, eager for care, were disorderly, hut eventually system was estai)lislied and they now draw ])atients from Ramleh. Ludd and many sur- rounding villages. The natives lay their sick at the doors. One man dying of tuberculosis was found lying across the threshold in extreme exhaustion ; he had walked four miles to get there, as he had lieard there was a great healer there. It was too late; he died that night. North of Jaffa was the seaport of Haifa, where on October 14 the American Red (^ross opened a hospital for civilians. The building was the former German Hospital which Inid been used, previous to its occupation by the American Red Cross staff, by the French, ^[iss Paterson and ]\Iiss Ranger were in charge of the nursing activities and the general re('(|uipment of the hospital. Of the type of cases treat(>d at Haifa, Henry S. Huntington, a Red Cross worker assigned there, wrote: The head doctor picked up flie lamp after su]i]mt to rrive me a look around. We came into the woiju'ir.s \\ard. Two women were sitting up in bed, one of them an aircdiouate- 902 HISTORY OF AMERICAN RED CROSS NURSING faced, hunch-backed Jewess suffering from tuberculosis and Bright's disease, the other a bomb case. In another bed was a woman and her ten-year-old son ; they had walked to Haifa from Beirut, one hundred miles away, and arrived here filthy and covered with scabs and sores. The mother's diet had to be limited and she cuffed her boy one day because he refused to give his food to her. We have to keep them in one bed no room for a children's ward. In the men's ward, we found men suffering with ^'amoebic dysentery," the doctor called it, cases of influenza and pneu- monia, wounded with their arms shattered by hand grenades. An out-patient clinic was maintained at Haija where an average of one hundred and fifty cases a day were treated. Mr. Huntington wrote: Before the door was opened, the patients had gathered there, mothers with gaunt, paper-gray babies; children with red-rimmed eyes sore Avith the world-wide diseases of bad parentage; Armenian refugees; malaria patients by the dozens; people with bandaged hands or feet. The costumes were mostly half European, but of course, it all takes one back nearly nineteen hundred years to other clinics held in Galilee. Jew and Gentile and Samaritan were still here in effect. In the busy room where the Greek doctor, himself a nomi- nal prisoner of war, prescribes for the patients and our Red Cross nurse attends to the dressings while the young Armen- ian clerk enters the cases on his cards, we picked out a man or woman to talk with. One family were Maronites from a Lebanon village formerly of one thousand people. Half of them are now dead of starvation. "Do you want to go back to your home country ?"' we asked. "There is nothing there," the man answered. "We had a hotel. One regiment came and took a little, another regiment came and took a little; so it went. It is beautiful here compared to wliat it was there." Another man to whom we talked was Balthasar Artin of Marash. 1I(^ awaited his fate witii calmness. "If you kill us,"' he said, "you kill us. If you save us alive, we live. We are your property." Xear him was a child who sat down on the floor and cried, for the ]iain in his foot. As his mother talked, the flics gathered on the dressings of the child's sore. The mother, too. had a finger to l)e treated. Her husband died in tlie army. The ]iusl)ands of a quarter of Haija wives are dead or missing. There also were hhick-veiled ^Moslem women who nursed their babies as they' waited, women wearing gold bracelets NURSING SERVICE TO CIVILIAN POPULATION 903 and variegated necklaces made in Beirut out of gold coin. They pay their fee of five piasters (twenty-five cents) and nurse their babies as they sit waiting. . . . In one corner were a Mohammedan husband and wife. His name was Victory-of-God Brass, as translated. She was an orplian. He had married her at the beginning of the war, doworless thougli slie was, in order to avoid military service; here was the Turkish law for the protection of women. How- ever, the Turks took him as a soldier just the same and he came back from Damascus with dysentery and hid about here to avoid going back to the army. . . . "Why do you think we come here?" we asked a Moham- medan woman carrying a baby whose head was covered with sores and from whose small ears heavy gold rings hung. "Because we needed a good doctor here and God willed it," she answered. Across the bay from Haija was Acre. There the American Red Cross established a hospital and clinical service in the former Bab's house which overlooked the old moat built by the Crusaders. The staff at Haija did the work at Acre until addi- tional doctors and nurses arrived in 1919. On September 23, 1918, General Allcnby's forces took Ti- berias. Several days later cholera broke out in the city and the Occupied Enemy Territory Administration called upon the American Red Cross commission to assist in fighting it. Miss Madiera wrote: On October 4, Colonel Ward, ]\[iss Ellen Hamilton and I went up to Tiberias. We were only a few days behind the advancing troops ; the dead lay imburied ; the shattered lorries were standing just where they had been bombed; papers and debris wore everywhere. We went first to Xablus and then on to J , where we stopped in an empty house in which one of our doctors had been working. We unpacked our cots and made them up, mosquito netting and all, and in the morning rolled up our beds again and were off. The Turkish and German prisoners were pouring in and while our things were being loaded on our truck we watched them receiving their rations. Then on we went to Xazareth, where we sto])pod at the Churcli of tlie Annunciation ; it was Sunday and we were present at the first service since the occupation. Then on to Tiberias. Such scenery you do not often see. The color was matj- nificent and the blue sea of Tiberias trulv beautiful. The 904 HISTORY OF AMERICAN RED CROSS NURSING heat was intense; Tiberias is 680 feet below sea-level and a sirocco was blowing. We went at once to the Governor's and he asked us to luncheon. He had been there three days and his table equip- ment and furniture were distinctly sketchy. The [British] doctor had been there two days and had had a [British] nurse one day. In the afternoon we went to see the hospital. Such a state of affairs ! Men, women and children lay on the beds or mattresses or on the tile floors, all mixed up and all half- naked. The filth was indescribable and there was no linen, no plumbing, no water supply. Tlie next morning we took charge, sent for nurses and supplies, had water carried in, locked up the brandy which the attendants had been consuming and worked like dogs. . . . Miss Madiera took over the reorganization of the hospital and Miss Hamilton assisted Captain Clark, the British military surgeon who was then spending all his time giving saline injec- tions which is the first treatment for cholera. Modern sanitary provisions at Tiberias were critically inade- quate. "The king of the fleas and all his court," an Arabian proverb ran, "live in Tiberias." Supplies of all kinds were meager. The British governor commandeered dishes and other essentials for the patients and told the Red Cross workers to "go down to the German dump and help yourselves." Out of these stores came tables, cupboards, more dishes and basins. A lorry was sent to Jerusalem for lied Cross linen, but when this linen had been put to use in Tiberias, it began to disappear; finally a valuable ring was found missing. So a search was made of the patients and under the loose Oriental clothes the missing sheets, pillow cases and towels were found wound about the patients' waists. The British themselves took active steps to break the epi- demic. One of the first measures was to forbid the use of the lake water and a Tommie was stationed to guard each of the streets that h'd down to tlu^ sea. "Part of the people approved," wrote ]\rr. Huntington, "part of them sighed and by night went down and stole the water, but most of them walked up to the new taps or to the places where safe well-water was pumped up to the roadside and awaited their turn for the chlorine water. Whenever tlie municipal doctor on his daily rounds discovered a case, the stretcbcr-bearers brought the patient to the Red NURSING SERVICE TO CIVILIAN POPULATION 905 Cross Hospital and the inspector's gan^ disinfected the house, burned up wooden dishes and replaced them with iron, de- stroyed old clothing unlit for further wear and disinfected the rest." City-wide vaccination was also carried on. Within five days after the arrival of Colonel Ward's first unit, the cholera was almost in hand and when a week later the hospital was turned over permanently to the Zionists, not a single case existed. On her way back from Tiberias to Jerusalem, Miss Madiera visited the two American Red Cross nurses who were then working in Es Salt, an isolated hill-town east of the Jordan River. Es Salt was greatly overcrowded with refugees and its population was seventeen thousand people. Health conditions existed there similar to those at Acre, Haija and Jaifa, so the Commission for Palestine had sent two American Red Cross nurses and a doctor on October 17 to establish a small hospital and dispensary. Mrs. Sewny was the nurse in charge. Miss Madiera wrote: The trip to Es Salt was a very beautiful one down by Jericho and across the Jordan and up the mountains for a six hours' climb. Although Es Salt was conquered by the British with the help of the Hejez troops, it lies outside of the Occu- pied Enem}' Territory Zone and is in the possession of the Arabs. It is situated on the steep sides of two high hills. Up to the very top the paths run and down to the valley below, through which a stream flows briskly along. Many of the refugees we have had all summer in Jerusalem came from Es Salt and I saw numerous old friends there. Many of the houses have no roofs, windows or any woodwork. [The timber has Ijeen carried away by tlie enemy and used for defensive works.] The hospital is high upon the hillside and is readied by walking over the roof of the cluirch. Doors and windows are being made for it and it is the craziest- looking place imaginable. Lumber is so scarce that the prices are prohibitive, so doors, windows, shelves, tables and otlier pieces of furniture are being made from scraps. The l)e Anuu'ienn R(h1 Cross was to continue its woi'k in Palestine until .Inly 1, 191 it, when all its activities and unutilized supplies on hand were to be turned over to the American Committee for lielief in the Near East. ""The Work of the American Pvcd Cross (luring' tlu' War: A Statfiiu'iit of I'iiiaiH't's and Acconiplislinu'iits." \). 87. 910 HISTORY OF AMERICAN RED CROSS NURSING Thus in the summer of 1919, American Red Cross service in the Holy Land was closed. Siberia, a land of magnificent distances held together only by a slender thread of rail and telegraphic communication, with a population swollen by the influx of refugees from Russia, harassed by guerrilla warfare between the Rod Guard and the remnants of a Czech and native Army and devitalized by famine and disease, was the scene in 1918 and 1919 for extensive, albeit at first somewhat disorganized, relief operations by the American Red Cross. The political situation in Siberia was the determining factor of American Red Cross activity there. After the Treaty of Brest-Litovsk had been signed in December, 1917, a consider- able number of Czecho-Slovak soldiers who had been fighting in the former Russian armies against the Central Powers and who were anxious to reach Vladivostok and rejoin the Allies on the Western Front, gained permission from the Bolsheviki to cross Siberia. The actual number of this Czech Army has never been definitely determined, but a conservative estimate placed the number at about fifty thousand men.^- Early in 1918, presumably at the instigation of the Central Powers, the Bolsheviki ordered the Czechs to disarm. This the Czechs refused to do and immediately active hostility to the Bolshevik regime broke out in the region of the Ural Mountains and later spread eastward along the line of the Trans-Siberian Railway to the eastern provinces. The Anti-Bolshevik armies were led by General Semenoff, Admiral Kolehak, General Gaida, Colonel Orloff and others. In addition small groups of native soldiers joined the forces of these leaders or operated independently. In ]\lay, 1918, the Bolshevik forces occupied the Trans- Baikalia and thus cut the Czech armies, leaving some forty thousand of them scattered along the line of the Trans-Siberian Railway from Irkutsk westward to Samara and about fifteen thousand others in Vladivostok, awaiting transportation to France. The situation was extremely precarious, because a Bolslievik offensive in the west was daily expected and the divided Czech armies found themselves, with only the most meager supplies of food, ordnance, annnunition and sanitary '^"A Reference History of tlie War," p. 142. NURSING SERVICE TO CIVILIAN POPULATION 911 service, facing this offensive and, within a few months, the severe Siberian winter. The Allies "determined upon a certain amount of military intervention in order to try to save something from the chaos which existed in Russia" ^^ and forces of Allied troops were sent in the summer of 1918 to Murmansk, on the North Rus- sian Front, and to Vladivostok, on the Siberian side, to reen- force the Anti-Bolshevik armies. The reasons for the despatch of American troops to Siberia were contained in a statement made by President Wilson on July 25, 1919, in reply to a Senate resolution concerning the American Expeditionary Forces in Siberia: . . . The decision to send American troops to Siberia was announced to the press on August 5, 1918, in a statement from the Acting Secretary of State. This measure was taken in conjunction with Japan and in concert of purpose with the other Allied powers, first of all to save the Czeeho-Slovak armies which were threatened with destruction by hostile armies apparently organized by, and often largely composed of, enemy prisoners of war. The second purpose in view was to steady any efforts of the Eussians at self-defense, or the establishment of law and order in which they might be willing to accept assistance. Two regiments of infantry, with auxiliary troops about 8000 effectives comprising a total of approximately 10,000 men, were sent under the command of General William S. Graves. The troops began to arrive at Vladivostok in Sep- tember, 1918. Considerably larger forces were dispatched by Japan at about the same time and much smaller forces by other of the Allied powers. The net result was the successful reunion of the separated Czecho-Slovak armies and the substantial elimi- nation in Eastern Siberia of the active efforts of enemy prisoners of war. A period of relative quiet then en- sued.'^* . . . The determination of the United States Government to send American troops to Siberia opened up the way for the American Red Cross. In fact, representatives of the society arrived in Vladivostok and began relief operations there previous to the arrival of x\merican troops. " "A Reference History of the War," p. 142. "See "American Assistance in tlie Operation of the Trans-Siherian Rail- way. Russian Series No. 4."' p. 5 ; Department of State, Government Print- ing Office, 1919, Washington, D. C. 912 HISTORY OF AMERICAN RED CROSS NURSING The war organization at National Headquarters included, it will be remembered, the Foreign and Insular Division, the so- called Fourteenth Division. This division was then composed of Red Cross Chapters in all parts of the world outside of the United States and Europe ; among these Chapters was a strongly-organized Chapter with ample resources at Honolulu, the Philippine Islands, and another at Tokyo, Japan. Officials of these Chapters were in constant communication with J. Otis Cutler, manager of the Fourteenth Division at National Head- quarters, who kept the War Council informed as to develop- ments in the Far East. On July 22, 1918, the American Ambassador called a meet- ing of the members of the American Red Cross Chapter in Tokyo, Japan, to discuss the question of furnishing aid to the Czecho-Slovak Army in Siberia. Four days later, a formal conference was held between the Ambassador and the Executive Committee of the Tokyo Chapter, and Dr. R. B. Teusler, a Virginian, who was then superintendent of St. Luke's Hos- pital, Tokyo, was authorized to go to Vladivostok to investigate conditions and report personally to the Tokyo Chapter the situation in Siberia and the opportunities for relief service. In company with two American business men who were also representatives of the Tokyo Chapter, Dr. Teusler left Tokyo on July 16 and upon arrival in Vladivostok, investigated condi- tions in that city and along the Trans-Siberian Railroad as far east as Nikolsk. After discussing the situation with repre- sentatives of the Czech Army and of the American Navy and State Departments there, he returned to Tokyo and organized a unit of Japanese doctors and nurses from St. Luke's Hospital for emergency service in Vladivostok. The nurses were under the direction of Alice St. John, an enrolled American Red Cross nurse who was then superin- tendent of nurses at St. Luke's. Mrs. St. John was graduated from and later became superintendent of the Hackensack (New Jersey) Hospital. She was a Canadian but had married a New York physician, Dr. St. John, and after his death, had gone out to Tokyo. ]\Irs. St. John was a woman of serene and gracious personality. She served as chief nurse of the Ameri- can Red Cross C\)nnnission for Siberia from the early inception of the work until the close of the program. Of the situation in Vladivostok in the summer of 1918, Mrs. St. John wrote Miss Noyes: NURSING SERVICE TO CIVILIAN POPULATION 913 Early in June, the 15,000 Czech troops collected in Vladi- vostok had five doctors and seven trained nurses to care for all their wounded and they were entirely without medicines, hospital equipment and surgical supplies. Owing to the blockading of the remainder of ihe Czech Army west of Irkutsk by the Kcd Cuard, the Czech authorities in Vladi- vostok decided in duly to send their contingent of 15,000 Czechs back over the Trans-Siberian Railway to drive out tiie Bolsheviki from the Trans-Baikalia. Definite ap])cals for military and material assistance were sent to the American (Jovernment by the Czechs. . . . On June 25, street fighting broke out in Vladivostok between the Czechs and tlie local Eed Guard and several were killed on botii sides. The fight continued west of Vladivostok at Xikolsk and Cssuri in early July. There were no hospital facilities in Madivot-tok for the care of the wounded, so emergency slielter was provided in a storage shed at the disposition of the U. S. Cruiser BrookJyn. This shed was temporarily fitted up by the officers and men of the Brookhjth to care for about one hundred patients. On July 20, a building capable of accommodating two hundred and fifty patients was secured on Russian Island, at the entrance of the Vladivostok harbor. Supplies and oqui])- ment were sent over from Japan and China by the American Red Cross and a unit of fifteen Japanese nur.scs and several doctors from St. Luke's in Tokyo were sent to staff the Russian Island liospital. Dr. Gill, senior surgeon of the Bruokhjn, was director of the h()si)ilal and 1 reported on August VI for duty as chief nurse. The Czecho-Slovak wounded who had been in the Brookhjn'K warehouse were transferred to Russian Island and several French and British soldiers, also wounded in the Ussuri campaign, were brought to us. Russian Island Hospital was thus the first American Red Cross hospital in Siberia and the Japanese nurses, in the face of meagtn' equipment and personal privations, kept it in operation until tiiey wci'c i-clieved by American rei'iiforcenients. Miss lyo Araki, for fifteen years head nurse at St. Luke's, was the leader of the -Japanese unit. In addition to the Russian Island Hospital, the American Red Cross in Siberia assisted in the ecpiipment of the (Vjh'Ii Xaval Hospital and gave aid to the Fortress Hospital in Vladi- vostok, where three hundred Czech patients suii'ering from 914 HISTORY OF AMERICAN RED CROSS NURSING venereal diseases were being cared for under the joint manage- ment of the local Russian authorities and the Czech leaders. Early in August, the Czech Army in Vladivostok planned to attack the Bolsheviki at Manchuria Station with a view toward driving them out of the Trans-Baikalia. They asked Dr. Teusler to furnish surgeons and nurses and to assist in organiz- ing sanitary trains. Mrs. St. John wrote of the sanitary transport situation facing the Czech Army: At this time, many of the wounded were being brought down from Nikolsk and Ussuri in filthy box-cars with no provisions for their care. Owing to the disorganized railroad service, the journey as a rule required two or three days. The wounded were fed with food purchased from the peasants at stations along the way and were without tbe service of either surgeons or nurses during the two or three days' trip. The Czechs had one small improvised hospital train made up of third and fourth class cars and several freight cars, but the train had practically no equipment for handling the wounded and was without drugs and surgical dressings. These the Red Cross supplied and at once began preparation to com- mission two more hospital trains for service on the Ussuri and j\Ianchuria fronts. The trains were to be supplied with American doctors and nurses and tiie first train, intended for service in the Trans-Baikal provinces, was ready late in August. The second was to be commissioned by Septem- ber 15. . . . Early in August, 1918, Dr. Teusler sent telegraphic appeals to the superintendents of American mission hospitals in ('hina and Japan, asking surgeons and nurses to volunteer for service in Siberia and to mobilize by August 20 at Harbin, the nearest point of safety to Manchuria Station. The response of the nurses was immediate. The first group of American nurses to arrive in Harbin was organized from among the staff of the IIunan-Yale Hospital at Cliangsha, China. One of these was Gertrude P. Carter, a graduate of the Hartford (Connecticut) School and formerly night supervisor of the p(>diatric department of Johns Hopkins Hospital. An- other group was organized from St. Luke's Hosjutal, Shanghai, China, and included Florence Farmer, a Canadian nurse who had been a member of Unit C of the Red Cross ^lercv Ship Expedition in 1014. She had seen service at Kief and later at NURSING SERVICE TO CIVILIAN POPULATION 915 Khoi, Persia. After her release from Ked Cross assignment late in 11)10, Miss Farmer had remained in China and had done private nursing duty among the English colony at Pe- king and Shanghai. Another nurse of the Shanghai unit was Katherine Steelman, a graduate of the Johns Hopkins School. Among ^liss Steel- man's papers is a copy of the original mobilization telegram sent to St. Luke's Hospital, Shanghai, by Dr. Teusler and it is of interest in that it shows the conditions which prevailed in this pioneering period: Vladivostok. Dr. Tucker, St. Luke's Hospital, Shanghai. Urgent call. Please report with Dr. Lee to American Consulate, Harbin, not later than August 10. Our unit leaves that day. Bring fifty pairs of blankets, sheets, pillows, two hundred towels ; also warm clothing for own use ; our khaki uniform with leggings or puttees; canned food for personal service. Also local Red Cross Chapter to advance cost to be repaid later. Bring two or three American nurses with you if possible. This is important. Have full authority Washington (signed) Teusler. The nurses and surgeons reported in good time at Harbin. Eight of the nurses were assigned to a surgical pavilion in the Harbin ^lilitary Hospital; the other seven were sent to Buch- aloo, a small village about ninety miles east of ^lanchuria Station. The only buildings available were Russian military barracks, which were not at all suited for hospital purposes; but with tru<^ American ingenuity the nurses organized a hos- pital of two hundred bed capacity. Later, the Buchaloo Hos- ])ital was maintained as a convalescent hospital for (^zech sol- diers suffering from tuberculosis. The political situation was highly unsettled so the nurses W(>re k(>pt marking time. Gertrude Carter wrote of the Buch- aloo Hospital : From narl)in. we bad gone for an eighteen hours' ride up the railroad to Buchaloo and had established a hospital there, but oidy received about thirty ])atients in all. Fifteen of these were Czechs. The Czech Front had suddenly changed and all troo])s wvrv moved on to the Fral Mountain region. ThrouLfh unforeseen reasons, we did not move willi them. . . . 916 HISTORY OF AMERICAN RED CROSS NURSING In a report submitted June 30, 1919, to Miss Noyes, Mrs. St. John described what had happened : Early in September, 1918, General Gaida with a few thou- sand Czechs completed his remarkable campaign through the Trans-Baikalia from Irkutsk eastward to Chita and with his staff came down to Olivinnaya. This expedition completely cleared out the Bolsheviki in the Trans-Baikal provinces and reestablished rail communications between western and east- ern Siberia. The expected campaign between Manchuria Station and Irkutsk vanished with the collapse of the Bed Guard resistance and the entire Trans-Siberian Railroad was thrown open from Vladivostok to the east-Eussian fronts near Samara and Perm, nearly^ five thousand miles away. Every station along the railway was in the hands of the Czechs and they were then the masters of the situation in Siberia. This campaign of General Gaida brought to an abrupt end the arrangements for First Aid and evacuation hospitals in east- ern Siberia and made necessary complete readjustment of all American Eed Cross plans. At this juncture, the question arose as to whether the American Red Cross was justified in undertaking assistance on the east-Russian fronts beyond the Ural Mountains. The definite policy of the United States Government stated that it should assist the Czechs only to leave Siberia and aid them to get to France, but not to give them military or other support along an east-Russian front. With the approval of the War Council, the representatives of the Red Cross in Siberia decided to give medical assistance to the Czechs in western Siberia and to investigate the civilian refugee situation beyond Lake Baikal. During the develop- ment of these plans, the nurses and surgeons were held in Harbin and thus closed the early phases of the pioneer period of American Red Cross service in Siberia. . . . The second period in the development of American Ked Cross ISTursing Service in Siberia began in I\"ovcmber, 1918, and was characterized bv the development of civilian relief work as well as medical service in the Vladivostok district and tentative expansion of Ived Cross activity into western Siberia. The first task was to evacuate the wounded Czechs to Prague. The journey was a long one, so the sick and wounded men were sent from Vladivostok to St. Luke's Hospital, Tokyo, where a ward in a building belonging to the hospital had been NURSING SERVICE TO CIVILIAN POPULATION 917 prepared to receive tliem. This ward was staffed by two Japanese nurses and two aides, with an American Red Cross nurse, Marion Doane, as head nurse. On September 17, 1918, sixty patients were received and from time to time others came. On April 9, 1919, the convalescent Czechs were evacuated on the S. S, Madras to go via the Indian Ocean and the Suez Canal to Trieste and thence by rail to Prague. Eight thousand destitute refugees were known to be living in Vladivostok in the summer of li)18 without medical or nursing attention of any kind. To care for the casual sick among these refugees, the American Red Cross took over No. 7 Marine Barracks, a building formerly a part of the Russian Submarine Base at Vladivostok, and e(iuipped it as a hospital of two hundred and fifty bed capacity. It was opened on November 15 and was staffed largely by Chinese nurses who worked under the direction of American physicians and nurses. Mary Hood, a graduate of the Scarritt Bible and Training School for Nurses, Kansas City, was chief nurse ; she had gone out to Foochow, China, to serve in the Mary Black Hospital, had been transferred to Shanghai, and had subsequently joined the Com- mission for Siberia. Thus in the fall of 1918, the American Red Cross was main- taining in Vladivostok Russian Island Hospital, the Refugee Hospital and, in Tokyo, a large ward at St. Luke's Hospital. In the Harbin district, the commission was maintaining a surgical pavilion in the Military Hospital and the hospital at Buchal()oand had under process of organization extensive relief activities for western Siberia. In October, 1918, five of the American Red Cross nurses who were stationed at Harbin were started westward on Sanitary Train No. 1 to establish a hospital in the West-Siberian prov- inces. Miss Farmer was in charge of the unit. The trip was a long one and during the journey the nurses had ani])le oppor- tunity to see the destitute conditions existing throughout the interior. Siberia was a beautiful country and to the luirses, as the sanitary train carrying them moved w(^stward through ]\ran- churia and tlu^ Trans-Baikalia and stop])cd at the diifcrent terminal cities along the line, the scenery seemed to grow more lovely, but the govcrnmont more unstable and living conditions more wretched 1\\' contrast. Marauding bands of BoLsh(>viki, made up of freed criminals, German and Austrian pi'isoners of 918 HISTORY OF AMERICAN RED CROSS NURSING war and the fierce MagA'ars held up the hands of the local Red Guard. Confiscation and re-division of property and livestock had taken place and production under the new regime had not begun. The educational and legal systems seemed paralyzed and starvation and disease, especially typhus, was abroad in the land. In ]*[ovember, 1018, the menace of a typhus pandemic be- came so threatening that an Inter-Allied Typhus Commission was formed by the Allied Armies in Siberia and a complete anti-typhus train, consisting of seven cars devoted to apparatus for bathing persons and disinfecting clothes, of twelve box cars carrying supplies and three personnel cars, was sent out along the Trans-Siberian Railway to combat the spread of the dis- ease. The train was furnished by the American Red Cross and its business manager was Rudolph Bukoley, of Honolulu. Captain F. A. Dallyn, of the Hydrological Corps, Canadian Expeditionary Forces, was director of the expedition and commanding ofiicer of the train. Captain Bukeley later wrote a report now on file at jSTational Headquarters, from which extracts are quoted in this history to show the environment in and the conditions under which the nurses worked. Of the famous tunnels of Lake Baikal, Captain Bukeley wrote: Now we are going through tunnel after tunnel; I believe there are forty-nine of them, mostly short ones, so we have had good opportunity to see the beauty of this Lake. On our left are the slate rocks through which the track has been cut and blasted ; below us and to the right is the Lake, at this point some eighteen miles wide; ahead of us as the roadway winds and twists we can see the next tunnel. To our riglit stretches the long expanse of ice, snow swept and wind driven, and on the other shore the undulating mountain range, beau- tiful beyond words and of all sorts of colors, with a grayisli purple predominating. . . . In the tranquil winter landscape, the paraphernalia of war seemed incongruous. Captain Bukeley wrote : ... At Verkhne-Tdinsk. I saw my first armored train; first comes a flat car protected on cacb side by arnior-})hite ; on this ear is mounted a ligbt gun swung on a circular car- riage so as to be able to swing from side to side. Then comes the engine, also armor protected, two ])asseiigc'r cars and NURSING SERVICE TO CIVILIAN POPULATION 919 fiually a box car, reeuforced in tlie usual maimer, with open- ings on each side for rapid-fire guns and above holes for rifle shooting. . . . huudentally, Ceneral SemenofT, from what I can gather, must be of the picturesque bandit type and one who is doubt- less worshipi)ed by liis soldiers. ... He was formerly the colonel of a Cossack regiment which made him a general. Now he travels in style . . . in his private car and is abso- lutely his own law as far as life and property are concerned. Usually he rides in his train de luxe with an armored train in front of him and another behind him, . . . dominating the countryside from Harbin and Chita. . . . Of the conditions and methods of travel which prevailed along the Traiis-Siberiaii railroad, an American engineer wrote: . . . This Chinese Eastern Eailway is the eastern end of the Trans-Siberian system and has a good permanent way and good ties, with concrete bridges and tunnels, all built as only they built in Russia under the Czar. , . . The station buildings all along the line are stone, or brick and stone, sub- stantial and of good appearance; the platforms of gravel with cut stone curl)ing; the station house situated at about the centers of the ])latform, at each end of which is a so-called toilet. The station house has the Chinese architectural roof, pleasing to the eye on the exterior but unspeakable within. . . . Then there is a building in which is a great kettle full of boiling water : from this the passengers fill their ever-present teapots. ... In Siberia, time is no object. There is also at most stations a Lavka or small selling store, where you can get the usual necessities, the chief of which is vodka. . . . Every station has also a military barracks and at every one hundred versts are long military unloading platforms and immense barracks with small private buildings and parks for the officers, and even now can be seen evidence of the joyous life which existed here in the days of the Czar and military predominance. At jtresent thev are all going to ruin . . . and the former trim })arks are now the rendez-vous of the village pigs. . . . The railroad is ollicered from highest to lowest with college men. as no one is considered intelligent enough unless Ik^ has a diploma from a colh'ge or technical institute; it seems to matter little what he has studied, so long as he has his diploma, which is a sort of oval medal and is always worn on the man's breast. The traveling enirineer is often a irraduate 920 HISTORY OF AMERICAN RED CROSS NURSING of the Naval college ; the master mechanic may have a degree in philosophy; the chief executive is often a general. In fact they seem to be everything except railroad men. All are so scientific that they are overtrained. . . . This is coupled with supreme ego and the remark: "We do it so in Russia." The Trans-Siberian Railway was in 1918 and 1919 the artery through which the demobilized soldiers and refugees from the Ural Mountains and the western provinces flowed eastward to Irkutsk and Amur. Captain Bukeley wrote: Siberia has almost unsurmountable conditions to face; her towns to-day have increased in population more than four- fold, so there is no means of housing the people except by the use of barracks, concentration camps and box cars. . . . This enforced crowding; the climatic conditions which make neces- sary the use of heavy, lice-carrying clothing; the impossibility of providing sufficient bathing accommodations; the paralyz- ing of her railroad so that she is unable to import from Vladivostok, all help to make Siberia's problem a despairing one. . . . A\'e feel as if we are trying to put out a fire by means of a teacup of water. . . . Every day trains come in with released war prisoners re- turning from German prison camps, gray, gaunt and feeble from the privations they have suffered. . . . They are travel- ing onward, always onward, trying to find the loved ones they left behind and who to-day are scattered somewhere in Siberia. Their homes are gone, their families disappeared without a trace, and on they go themselves from station to station look- ing and searching everywhere, no longer soldiers but plain men again, worn out and aged in the service of the most ungrateful employer of all, one's own country ; fathers seeking their children and wives; sons seeking aged parents; young men looking for the girl whom once they had hoped to make their wife. And the refugees: those countless thousands who at the approach of the war fled on a moment's notice, some just as they were; others carrying in a bundle their all, a kettle, a pillow or some other remnant of their former worldly treas- ures. . . . Their past life has vanished, their future, hope- less days of wandering, tired, frozen and worn out; dazed, broken and s]iiri1less. A\'it]i llif arogariousjicss of tlie human being, they herd together, in box cars, those few who are fortunate in finding one; they crowd the fourth-class waiting rooms of the sta- NURSING SERVICE TO CIVILIAN POPULATION 921 tions. The sides of the hox cars the very walls of the stations' toilets are covered with messages of all descrip- tions, in some instances only a name, in other cases a message, simple cries flung out by a father to his wife and daughter, by a mother and child to the father, written in the hope that some day the loved one may pass through that station and read the message. Individual suffering in Siberia, to judge from the reports on file at National llead(piarters, was more acute and on a broader scale than that which the American Ked Cross found anywhere except in the devastated areas of Serbia and Kou- mania and France. One of the most tragic cases which came to the attention of American Ked Cross representatives in Siberia was that of a train of twenty-one hundred political prisoners from Samara, men, women and children, who had been packed into box cars in September, 1918, and had been shunted back and forth along the Trans-Siberian line for two months. Thev were so crowded in the cars that they often had no room in which to lie down; they were under heavy guard and were not allowed to leave the cars. For food, they were largely dependent upon the charity of the peasants in towns through which the train passed. No water for washing them- selves was furnished the prisoners, nor brooms for sweeping out the cars, and the only sanitary provisions in each car was a hole from six to eight inches in diameter which had been cut in the floor. Captain Bukeley wrote of this train: I have seen men lying on the floor of the cars, with the death rattle in their throat, half naked, with lice and vermin crawling over them, visible to the naked eye, with matted, knotted hair, unkempt, filthy beyond description. Others 1 have seen, just lying there on the boards, half naked, in a semi-conscious stupor, and yet others . . . who hold out clawlike hands, with a whining ingratiating grin and beg for a few ku/ice.'i or a cigarette, grinning and chuckling . . . Ti])on I'cceiving the one or the other and making hor- rible, throaty sounds of glee, as they snatched their ])rize. . . . The woin(>n are t)etter treated than the men, eleven women in one car. near tlie guards' car. . . . Tliis morning we were told by the guards that tliree men had (lied (hiring the night. As we walked up the string of cars, we wcrt' hailed by the inmates of one and the guards informed that tliere were dead within. We insisted on the 922 HISTORY OF AMERICAN RED CROSS NURSING door being opened. Lying across the threshold was the body of a dead boy, not over eighteen or nineteen years old, no coat, merely a thin shirt in such rags that his chest and arms were exposed, and for trousers a piece of jute sacking pinned around him, nothing more in this bitter Siberian cold. . . . Of the twenty-one hundred, on November 21 only thirteen hundred and twentv-four were alive ; the other eight hundred had died of typhus, dysentery, blood poisoning and starvation. The officers of the Inter-Allied Typhus Train held up the prisoners' train as long as they could, bathed and gave medical and surgical treatment to as many as possible and furnished food and clothing, but the train was finally shunted along on its way eastward. In March, 1919, the officers of the Inter- Allied Typhus Train met another such train, this one of thirty-two box cars filled with Red Guard prisoners. Captain Bukeley wrote: Some of these men have been prisoners for months, but the greater part of them were captured on the Perm Front some six weeks ago. The box cars are indescribably filthy, as well they may be, not having been cleaned in any manner for six weeks. On the two tiers of wooden planks, without mat- tresses or blankets, wrapped in tlieir greasy, lice-covered furs, lie tliese poor wretelies, d3'ing of typhus, dysentery, pneu- monia, without drugs or medicine. . . . You can pass within twenty-five yards on the little sleigh- tracked road with its tumble-down shacks and the train ap- pears to be an ordinary striiig of empty box ears; there is no sign of life or movement, all doors are closed, as though the Russians had left it lliere and forgotten its existence. . . . As far as I can gather, the men are fairly well fed with bread, meat and water for their tea ; the food is brought to within a short distance of the end of the train. Here you can watch a man, in throes of fever, with chattering teeth and limbs half naked through his rags, staggering on between the cars with some kind of a container in his hand. perhai)s a rusty jam can, to get some of the food left at the end (jf the train. Kvery few stejjs he stoj)? and leans against a box car until he can gather enrsonn('l was taken forwaril as l)cst as and whenever we could, both supply and })ersonnel trains being 924 HISTORY OF AMERICAN RED CROSS NURSING always sent out under the protection of an American military guard. The nursing unit included five American nurses, two of whom were enrolled in the American Red Cross, Miss Farmer and Nettie Grace McBridc. During the second week in De- cember Miss McBride came down with typhus, and on De- cember 23, she died. "Six American soldiers," wrote Miss Farmer to Miss Delano, "carried her body to its last resting- place, in a small Russian cemetery where the Czech soldiers who had died in our hospital, are buried. It is a beautiful place, like a small woods. She was buried in her Red Cross uniform, with the American flag across the casket." Several of the American nurses at Tumen returned in Janu- ary% 1919, to their mission posts in China, and General Powell, of the British Expeditionary Forces in Siberia, assigned five British nurses to the American Red Cross Hospital at Tumen. Miss MacGregor, of the British Red Cross, a veteran who had served both in France and ^Mesopotamia, was in charge of them and of several Russian Sisters. The American Red Cross hospital at Tumen was maintained until July, 1919. On April 28, Miss Farmer wrote Miss Delano : We expect to increase our hospital shortly to 410 beds. Just now we have a Kiissian unit working with us. We still have some Czech patients but the majority now are Eussians, mere boys. 1 still like them as much as I did in Kief and, I suppose, always will. Of the Russian temperament, Captain Bukeley, who was at this time in the Ural Mountain area on the Inter- Allied Typhus Train, wrote : Eussia is essentially a singing country. On all possible occasions, the Russians sing: when they are tired, to rest them ; when they are miserable, to help them forget their troubles ; when they are hai)})y. because they are happy. . . . Their folk songs are beautifully sinij)le. often with a minor melody rumiing through the refrain. The boys and girls each have their own folk songs and it is delightful to listen to them. The girls, now that spring has come, wander through the villa<;e with their arms intertwined and sin lying about and with refugees wandering around and looking' very cold, dirty and buiigry . . . the women usually 'vitli an old shawl tied around their bead aiul shoulders, the men in filthy shee])skin overcoats and the children in rags, little, wan, skinny, ferret-featured creatures, always peering around for siuuetbinir tbat some one has thrown awav. . . . 926 HISTORY OF AMERICAN RED CROSS NURSING The American Red Cross established a hospital at Omsk and maintained it for some months. On January 11, 1919, Miss Carter wrote Miss Noyes : Our unit arrived in Omsk on November 10. By this time, the Czechs had started their hospital in Ecteunburgh , . . and all they wished from us were drugs and supplies. . . . They did not seem to need women nurses; in the field they use sanitars from the ranks of Austrian prisoners. . . . We had some difficulty in finding a building in Omsk suitable for a hospital. After eight weeks, the Agricultural College was turned over to us to use as a hospital for the Czechs, but it was grudgingly given. In fact, they imme- diately put 186 Bolsheviki into it for safe-keeping, but by December 30 we had our beds made, our scanty equipment in place and were ready to receive patients, and four French patients arrived and ten days later, two hundred Eussians. . . . Our hospital capacity at present is two hundred and fifty patients. The building is large, but is chiefly corridors. However, it is a fine building, but is located six miles from the city and about twelve miles from the railroad station. Of course the present unsettled conditions account for much delay, but . . . this is the way things go in Siberia. . . . In addition to the large hospitals at Tumen and Omsk, the American Red Cross maintained smaller ones at N^ovo-lS^iko- laevsk, Omsk, Petropavlosk and Cheliabinsk for the treatment of typhus cases. On account of the limited number of Ameri- can nurses, these hospitals were staffed by Russian nurses, but the result was not highly satisfactory. In her report of June 30, 1919, Mrs. St. John wrote: My experience with the Russian nurses has convinced me that one of the serious obstacles to their efficiency is their own lack of knowledge of personal protection. ]\rany go about in bare feet, exposing themselves needlessly to infection ; as a result, the percentage of nurse infection is very high and the mortality proportionate. In a Russian hospital which we were assisting at Ekaterinburg, five nurses and three doctors died of typhus during the first two months of its operation. Thus an opportunity for far-reaching service presented itself to the American Red Cross in the training of a corps of I^ussian nurses. NURSING SERVICE TO CIVILIAN POPULATION 927 The first exporiment in the field of nursing education was made at the Vhidivostok Refugee Hospital. In February, 1!)10, Miss Hood returned to her mission post in China and Janet Dewar succeeded her as chief nurse. Miss Devvar was a California nurse who had since 1909 served as superintendent of the Kanikeolani Children's Hospital at Honolulu, Hawaii. On April 1, 1919, a simple course of nursing was established by ^liss Dewar and twelve Russian girls, all of them nineteen years old and over and gTaduates of high school, were regis- tered as pupils. In a report addressed April 30, 1919, to ]Major Emerson, then acting medical director of the commission, ]\Iiss Dewar wrote: The curriculum includes weekly three classes of two hours each on both the tiieory and practice of nursing, also five lectures weekly from members of the medical staff of the hospital. The hours of work in the wards are from 7 :30 a.m. to 7 :30 P.M., with the usual time off duty, and the work is done under the direct supervision of the American nurses. Tlie students are clas^sed as nurses' aides and receive $30.00 monthly in addition to maintenance. We do not aim to give complete training such as is given in a good hospital in the States, but we do aim to give these girls thorough ground- work in the tlieory and practice of nursing. We have found these students more satisfactory help than the Russian luirses who have had more or less experience at the front. They are intelligent and loyal when once their confidence has been gained. They are not to be driven but are easily coiitrolltMl by kindness. They are willing to do the liard menial work of nursing but they seem to lack physical reserve strength. . . . The course was given up on June 20, the date when ^liss Dewar returned to her former position in Honolulu. Tlu> political situation in Siberia in the spring of 1919 favored the dcvelopnient of an extensive American relief pro- gram. In Fcbruarv, 1919, it will be remembered, the Allies d(>cid(>d to assume responsibility for the rehabilitation and di- rection of the Trans-Siberian Railway. In his reply addressed July 25, 1!19, to the Senate resolution mentioned above, I*resid(Mit Wils(ui wrote: Tn February. 1919. as a conclusion of negotiations begim early in th(> sinnmer of 1918, tlie riiitiM] Stales accepted a 928 HISTORY OF AMERICAN RED CROSS NURSING plan proposed by Japan for the supervision of the Siberian railways by an international committee, under which com- mittee Mr. John F. Stevens would assume the operation of the Kussian Kailway Service Corps. In this connection it is to be recalled that Mr. John F. Stevens, in response to a request of the Provisional Government of Russia, went to Russia in the spring of 1917. A few months later he was made official adviser to the Minister of Ways of Communica- tion at Petrograd under the Provisional Government. At the request of the Provisional Government and with the support of Mr. John F. Stevens, there was organized the so- called Russian Railway Service Corps, composed of American engineers. As originally organized, the personnel of this corps constituted fourteen skeleton division units as known in this country, the idea being that these skeleton units would serve as practical advisers and assistants on fourteen different sections of the Siberian railway and assist the Russians by their knowledge of long-havil problems as known in this coun- try and which are the rule and not the exception in Siberia. Owing to the Bolshevik uprising and the general chaotic conditions, neither Mr. Stevens nor the Russian Railway Service Corps was able to begin work in Siberia until March, 1918. They have been able to operate effectively only since the railway plan was adopted in February, 1919. The most recent report from Mr. Stevens shows that on parts of the Chinese-Eastern Trans-Baikal Railway he is now running six trains a day each way, while a little while ago they were only able to run that many trains per week. In accepting the railway plan (in February, 1919) it was provided that some protection should be given by the Allied forces. Mr. Stevens stated frankly that he would not under- take the arduous task before him unless he could rely upon support from American troops in an emergency. Accord- ingly, as provided in the railway plan, and with the approval of the Tnter-Allied Committee, the military commanders in Siberia have established troops where it is necessary to main- tain order at difPerent parts of the line. The American forces under General Graves are understood to be protecting parts of the line near Vladivostok and also on the section around Verkhne-Udinsk. There is also understood to be a small body of American troops at Harbin. The exact location from time to time of American troops is, however, subject to cbange by the direction of General Graves. The instructions to General Graves direct him not to inter- fere in Russian affairs, but to support Mr. Stevens wherever necessary. The Siberian Railway is not only the main artery NURSING SERVICE TO CIVILIAN POPULATION 929 for transportation in Siberia, l)ut it is the only open access to European Kussia to-day. The population of Siberia, whose resources have been almost exhausted by the long years of war and the chaotic conditions which have existed there, can be protected from a further period of chaos and anarchy only by the restoration and maintenance of traffic on the Siberian Railway. . . . The Russian authorities in this country have succeeded in shipping large quantities of Russian supplies to Siberia and the Secretary of War is now contracting with great coopera- tive societies which operate throughout European and Asiatic Russia to ship further supplies to meet the needs of the civilian population. The Kolchak Government is also en- deavoring to arrange for the purchase of medical and other Red Cross supplies from the War Department and the Ameri- can Red Cross itself is attempting the forms of relief for which it is organized. . . .^^ Partial responsibility for the care of American engineers and certain specified medical aid to the Russian Army was rested in the American Red Cross. Moreover, there was im- perative necessity of more adequate organization and additional personnel if the maintenance of the hospitals already estab- lislied was to be continued. The leave of absence which had been granted the original physicians and nurses of the early commission by their mission hospitals had expired and they were obliged to return to China, Korea and Japan. With their departure ended the pioneer period of American Red Cross service in Siberia, a period marked by sterling service in the face of gigantic needs, a chaotic political situation and general lack of organization. In jVIarch, IDII), while on a train in central-western Siberia, Mrs. St. John met with an accident which made necessary her return to the United States for treatment. At the same time, Dr. Teusler planned to come to National Headquarters to lay before the Executive Committee plans for the development of further American Red Cross activity in Siberia. In February, 1010, the Siberian Commission had cabled to National IIead(]uarters, asking for the assignment of one hundred and thirty nurses and fifty nurses' aides f(n" service in Siberia. Other types of personnel which were recjuested were sixty doctors, six dentists and a large clerical and account- " "Russian Scries No. 4," pp. ;)-(!. State Department. 930 HISTORY OF AMERICAN RED CROSS NURSING ing staff. The total number of persons recruited from America during 1919 exceeded six hundred, of which one hundred and fiftj-six were American Red Cross nurses and forty-three were nurses' aides. The first contingent of nurses and aides, with Grace Har- rington in charge, arrived in Vladivostok on April 24, 1919, thirteen days before Mrs. St. John left for America. Miss Harrington was appointed acting chief nurse of the Siberian Commission and for the first time the status of the JSTursing Service was defined. Hitherto, the nurses had had no repre- sentation on the Finance (the governing) Committee of the commission ; they had been assigned to service by the doctors and had had little voice in the determination of nursing policies. Upon the occasion of Miss Harrington's appointment, the gen- eral supervision of nurses and their assignment to duty was delegated to a separate Department of Nursing, of which Miss Harrington was made acting director. She was given a place on the Finance Committee and powers and facilities to organize the Nursing Service along the same general lines of office detail and administration prevailing at National Headquarters. Miss Harrington was a graduate of St. Mary's Hospital, Milwaukee, Wisconsin, and had done public health and indus- trial nursing in Seattle, Washington, previous to her Red Cross assignment. A second group of nurses arrived in Vladivostok on June 5, under the leadership of Ethel Pinder, a young and able nurse who after graduation from the Atlantic City (New Jersey) Hospital School, had had experience in medical social service at Bellevue Hospital and in public health nursing at Henry Street. Upon her arrival at Vladivostok, Miss Pinder was as- signed to duty as Miss Harrington's assistant ; she promptly established the records of duty and correspondence files for the nurses of the commission, in conformity with the system pre- vailing at National Headquarters. On June 20, Anna L. Tittman and a unit of twenty-five nurses and seven aides arrived in Siberia. IMiss Tittman had been selected by Miss Noyes as a nurse executive who would be particularly valual)le in straightening out the organization difficulties in Siberia. She possessed a penchant for details and with it a keen and well-balanced mind. She was graduated in 190r) from the Springfield (llliiiois) School for Nurses and had had post-graduate work at the Johns Hopkins and Dellevue American Red Cross nurses and snr,i;('oiis on route to Vladivostok, Siberia, visit the lyeysan Temple, Xikko, Japan. Nurses of the Siberian Commission po slioppiiig at a market of Manchuria Station. NURSING SERVICE TO CIVILIAN POPULATION 931 Hospitals. She later organized public school nursing in Spring- field and was for sonic years secretary and treasurer of the Illinois Board of Nurse Examiners. The activities of the reorganized Cominission for Siberia in- cluded medical and general relief in three principal zones: the Eastern Division which included the Vladivostok District and extended westward to ^lanchuria Station ; the far-Western Division, which included the territory extending from the Ural Mountains to Krasnoyarsk ; and the Central Division, which included the provinces of Irkutsk and the Trans-Baikalia. The account of the American Red Cross nursing activities in these three zones will deal first with events which transpired in the Eastern Division, then in the far- Western and Central Di- visions. Vladivostok was the port of entry for all American Red Cross personnel of the commission and relief supplies in Siberia ; all files were kept there and all reports of its activities cleared through the Vladivostok office to National Headquar- ters. The nurses and aides of the reenforced commission were housed in the Russian Barracks, "an international compound," wrote Miss Finder to Miss Noyes, "where Japanese, Chinese, French, Italian and British soldiers are billeted in the sur- rounding buildings." As the needs for their services developed in western Siberia, nurses were sent into the interior on Red Cross trains. Nurses and aides assigned to service in Vladi- vostok continued to live at the Russian Barracks or, if condi- tions permitted, were furnished quarters in the hospitals to which they were assigned. The first work of the Nursing Department in the Eastern Division was the reorganization of nursing activities in all Red Cross hospitals in this zone. This reorganization, with its im- provement in the quality of nursing care given the patients, had not been possible before because of the limited immber of nurses and the shortage of supplies. Russian Island Hospital was the first institution to undergo tlie reorganization. Mary ^larcy, formerly superintendent of the House of Mercy Hospital at Pittsfield, ^lassachusetts, was assigiu^d to duty at Russian Island Hospital as chief nurse and a large detail of American Red Cross nurses were stationtHl tliere to assist her. The capacity of the hospital was (H)usi(ler- ably raised and its scope broadened. In a letter addressed on ()et(ilier 12, lUlU, to Miss Nov(>s, Miss Marev wrote: 932 HISTORY OF AMERICAN RED CROSS NURSING In the summer, Russian Island is a place of great beauty. It is about seventeen miles long, has many inlets and is hilly and covered with small, rather stunted trees and quantities of wild flowers (we counted forty varieties at one time). We are a thirty minutes' boat ride across the bay from Vladi- vostok. The hospital itself is situated on a cliff overlooking the bay and consists of three one-story buildings. ^Mien I first came here in July, there were only Czech soldiers here, but since it has been changed into a general hospital, our patients repre- sent about ten nationalities. Our staff is made up of two American and two Russian doctors, fourteen American nurses, two Czech aides and eighteen Russian Sisters. . . . "Next to the Russian Island Hospital was an American Red Cross children's colony. In the summer of 1918, a committee of Petrograd parents, organized under the sanction of the De- partment of Education of the Soviet Government, had sent a large colony of Petrograd children, with their teachers, to western Siberia on account of the food shortage in Russia. Starvation and disease, however, had overtaken them in Siberia and finally the Russian woman in charge of the colony, Madame Vera Qvanovna Kutchenakaiga, appealed to representatives of the American Red Cross then in the Ural Mountain regions for aid. ''She told us," wrote Captain Bukeley, ''of the suffer- ing of these children who had trekked their way from European Russia, traveling many hundreds of miles on foot. . . . Many of them became little frightened animals who ran away at the sight of human beings who would have helped them, ran until they were free from pursuit, when they would eat grass and roots until exposure mercifully let them sleep without awaken- ing." Two hundred and seventy-two children were gathered to- gether by the American Red Cross early in 1019 at Lake Tur- goyal and were started in July upon their long journey east- ward. Others were collected from adjoining towns and villages ; three hundred arrived in Vladivostok in Augnist and s(>ven hundred more several weeks later. The entire colony of over nine hundred was established in barracks next to the American Red (h'oss II()S])it!i] on Russian Island. Two nurses, Aliriam Lewis and ]\Iau(le K. Moody, were the first nurses assigned to the colony to look after the children's physical welfare. The Vladivostok Refugee Hospital underwent the same gen- NURSING SERVICE TO CIVILIAN POPULATION 933 eral reorganization and expansion as did the Rnssian Island Hospital. Mary H. Jjethcl, a capable and energetic former chief nnrse in the Navy Nurse Corps, was assigned to duty there, first as dietitian and assistant chief nurse, later as chief nurse. A large and active clinic \Yas organized at the Refugee Hospital; Josephine Albright was placed in charge of public health mirsing and medical social service work in connection with it. Owing to the influx of Russian refugees into Vladivostok in the fall of lOlt), an inlhix due to victories of the Red Guard in the West, the commission took over on November 1 sections of the Morskoi (Naval) Hospital. Red Cross wards had a capacity of 220 patients and treated principally surgical cases. The nursing stait" consist(>d of twenty-eight American nurses and twenty Russian aides. ]\Iiss Bethel was chief nurse, a re- sponsibility added to her duties at the Refugee Hospital. On November 18, street fighting broke out in Vladivostok between the upholders of the Kolchak Government and local Bolshevik sympathizers, and numerous civilians were wounded. An emergency hospital was established in twenty-four hours' time by the commission in American Red Cross Barracks No. 7. Miss Tittman wrote Miss Noyes: During the revolution in Vladivostok, everyone at Barracks No. 7 worked hard and long. Our Red Cross men showed spirit and conrage in picking up and bringing in the wounded. The variety of our patients (there were 5(5 admitted to the emergency hospital) exemplified the true principles of I^ed Cross neutrality. There was a Korean who had been picked up from his sam])an ; two Japanese; (Jeneral Gaida's woman cook, who had been beaten with the butts of soldiers' guns; a Russian j^riest ; a British officer; soldiers of all the factions involved in the tight; railroad men; innocent bystanders; and even an American sailor. By November li). practically all the victims of the strcot fighting had been transferred to other Red Cross and IJussian hospitals or to their homes. Most of the military cases were taken to the Morskoi Hospital. . . . In November, 1010, :^rrs. St. John and Colonel Tousler re- turntMl to Vladivostok. ]\Irs. St. John rcsum(>d her duties ;is chief nurse of the Sib(>rian Commission and Miss Tittman con- tinued as chief nurse of the Kastern Division. 934) HISTORY OF AMERICAN RED CROSS NURSING In addition to the maintenance of the hospitals described above, the Nursing Service in Siberia took up again the edu- cational project initiated by Miss Dewar in April, 1919, and Helen L. Bridge was made responsible for its development. Miss Bridge had taken her B. S. degree at Teachers' College, had been an instructor at the St. Luke's (New York City) School for Nurses and had later served as superintendent of the Washington University School for Nurses at St. Louis. In a report submitted to Miss Tittman on December 17, 1919, Miss Bridge wrote: On August 4, 1919, a four months' course of study was initiated for Russian women serving as nurses' aides in the American Red Cross hospitals at Russian Island and Vladi- vostok. During the course it was planned to give sixty-four hours' instruction in elementary nursing and hygiene, includ- ing bandaging; discussion of the commoner medical and surgical emergencies and forty-eight hours' class work in English. The object underlying the course was to improve the standard of the nursing service in the American Ked Cross hospitals by giving the pupils a systematic training which could be coordinated with their practical work in the hospital Avards. ... In addition, it was felt that the organization of class work for Russian girls offered a splendid educational opportunity in itself; a national characteristic of the Russians is their passion for study. Two classes were organized, one at Russian Island Hospital and the other at Madivostok. . . . During the past four months, the theoretical instructor has taught four hours a day for three days a week on Russian Island and three hours a day for three days each week in Vladivostok. . . . The ward instructors . . . have supplemented the pupils' class- room instruction with bedside teaching. As there was no nursing textbook in Russian procurable, a digest of the text- book of Home Hygiene and Care of the Sick was translated and later published in Russian; the translator also served as interpreter during the classroom work. For the English instruction, no books were available until within a few weeks before the conclusion of the course. Then a sup])ly of Beshgeturians' "Foreigners' Guide to English'* was received from ^lanila. On Dcccnilicr 1. 1I1!, seventeen pupils were graduated from tlio Russian Island class and eleven others from the Vladivostok class. NURSING SERVICE TO CIVILIAN POPULATION 935 A third class was organized on November 6 and was com- posed of Kussian girls of over eighteen years of age from the Petrograd Children's Colony. Fifteen students entered this course and received their practical instruction in American Red Cross wards of the ^forskoi Naval Hospital. These three elementary courses had been initiated as an ex- periment to determine whether or not it would be feasible for the American Red Cross to attempt to develop in Vladivostok a permanent training school for nurses under the Nightingale System. Miss Noyes had been anxious for the Department of Nursing to establish one but to ^liss Tittman and Miss Bridge it had seemed wiser not to attempt it for the following reasons, which were contained in a letter written December 3, 1919, by Miss Bridge to Colonel Teusler: 1. The preliminary education of candidates is too uneven to allow definite methods of instruction or the giving of prescribed courses. 2. There is an inadequate number of candidates with satis- factory preliminary education. 3. Applicants come to us not because of a deep-rooted interest in nursing and a desire for training but because they are forced to earn their livelihood. 4. American nurses cannot teach without more of a working vocabulary of Kussian tlian tliey could acquire in the time spent here. It is not wholly satisfactory to teach through interpreters. The pupils, although eager and quick to learn Englisli, would not be able to use English textbooks. There are no satisfactory Kussian textbooks available. In addition to the courses offered to Russian hospital aides, Miss Bridge also organized, with the cooperation of the Kussian Red Cross, courses in Home Hygiene and Care of the Sick for laywomen. The first class was started on December 10; Vasliti Bartlett was the instructor. During the progress of this course a teaching center was opened at No. 10 Peter the Great Street and during December, 1919, and January, 1920, five additional classes of Vladivostok women were instructed there. Another class was started in December which included girls of the Petrograd Children's Colony fifteen years of age and ovtn-. An interesting phase of the (xlucational program lind taken place in August. Miss Uridgc described it in her tinal I'cport: 93G HISTORY OF AMERICAN RED CROSS NURSING - During the month of August, the Department of Nursing was requested to provide instruction to a group of Korean women in the city of Vladivostok. The Red Cross agreed to do this if an interpreter could be secured. It was necessary to send to Korea for one and she did not arrive in Vladivostok until December. A further delay was encountered by the necessity of preparing a Korean translation of the textbook in Home Hygiene and Care of the Sick. After having overcome these difficulties, the classes could not be given owing to the imminent withdrawal of American Red Cross nurses from Siberia. It was suggested, however, that the courses be given anyhow, the theoretical instruction by a Korean woman who is a graduate of a mission school for nurses in Seoul, and the practical demonstrations by a Russian nurses' aide who served as interpreter to Miss Bartlett and assisted in the con- duct of the classes for laywomen. An effort was made to extend the class work and the instruc- tion of nurses' aides to western Siberia but the military sit- uation in the summer of 1919 made the development of such a project impossible. When the American Red Cross closed its program in Siberia in the spring of 1920, fourteen classes had been organized, in- cluding the three for nurses' aides, and 21G pupils had been enrolled. Of the close of the educational program, Miss Bridge wrote: A plan has been formulated to continue the Teaching Center under the direction of Sister Selma Chepposova, a graduate Eussian nurse who will be assisted by Valentina Alexandrof, interpreter to Miss Bartlett. Miss Farmer, the American Red Cross nurse in charge of the Petrograd Chil- dren's Colony, will continue the classes among the girls of the Colony. As to the textbooks in hand, . . . the "Foreigners' Guides to Englij^h'' have been turned over to Miss Farmer for use in the Children's Colony. The Russian text of Home Hygiene and Care of the Sick was received from the printer early in February. Some of these will be used by the Children's Colony and the Teaching Center and others will be turned over to the Russian educational authorities and public officials. Immediately west of Vladivostok in the ]\ranchurian province of China lay the city of Harbin. Here in August and Septem- ber, 1919, cholera was epidemic. Five American Red Cross NURSING SERVICE TO CIVILIAN POPULATION 937 nurses of the Siberian Commission were assigned in August to assist American Red Cross doctors in their efforts to check the disease. The head nurse of this detachment was Vashti Bartlett, who needs no introduction here to readers of this history. On September 2, Miss Bartlett wrote Miss Noyes: The five of us arrived here in Harbin on the morning of August 2C and spent our first day being taken on a survey about the city. Ilarbin is divided into three principal dis- tricts; each district is a distinct city in itself. One is occu- pied by the Chinese, another by the Russians and a third by the Jews. Our first morning was spent in the Chinese city. There we met many people wearing masks. Lime is sprinkled every- where and we saw coffins in the streets waiting to be hauled off. We were told that in the beginning of the epidemic the bodies were thrown in any clump of tall grass, but that has been stopped. Now coffins are given to anyone who asks for one ; the relief societies and the American Red Cross here put aside a sum of money for this express purpose. The Chinese City Hospital has a most capable Chinese doc- tor in charge of it. Dr. Wu. Our American Red Cross doctors were also working here; on the following day, two of our nurses reported there to help with the transfusions. The cause of death from cholera, it seems, is due to the fact that so mucli of the fluids of the body are given off in the almost constant vomiting and stools that the blood cannot flow for lack of fluid. Thus transfusions supply the needed fluid, and under this treatment the death rate is lessened fifty per cent. Indeed, I have seen men brought in unconscious and half an hours later 1 have seen them walk out. One of the chief difficulties in treating the Chinese is to keep them long enough for the two or three transfusions needed. No one who liad not been liere can imagine the numbers of flies wliich swarm over the patients. At your approach, a black cloud of tbom will rise from the patients who lie about waiting their turn. As soon as the American doctors and nurses could get it done, straw sheds were made and the doors covered with net. The Chinese jirefer to sleep on the floor on straw, which is afterwards burned. Other than this, wc really did very little but give the transfusions, because the ])atients are soon able to look after themselves. I don't know what we would have done, however, if the disease bad not boon one from which its victims recovered quickly after treatment, as the epidemic was spreading from the Chinese City to the other sections. 938 HISTORY OF AMERICAN RED CROSS NURSING In the Russian section of Harbin, the situation was even more desperate. Miss Bartlett wrote Miss N^oyes : Our nurses are now working in two Eussian hospitals and a building of the Central Hospital has been turned over to us. This building houses about a hundred patients. In a Russian hospital, things are not done as we do them. For instance, I was in a ward to-day with three Russian doctors and several nurses; a patient was sick and they let her vomit three times and made no motion to get a basin or to clean up the floor, but did after the fourth time. The Russian nurses go on duty for twenty-four hours and then go off again for forty-eight hours. Men and women are put in the same room in beds next to one another and 1 have yet to see a screen. No attempt is made to keep the patient cotered and as likely as not the orderly will wait upon a woman patient and the nurse upon a man. I have seen them bring a patient the length of the building on a stretcher without anything on him; now they seem to know, however, that I insist upon a sheet. Patients used to be brought in, placed on any vacant bed and transfused right there with friends and other patients looking on. As I have not yet seen a rubber sheet, the beds were always wet and bloody. Xow we have a room with three long tables in it and the patients are laid on them and trans- fused there. I often lead them by the hand back to their relatives or friends. Things appear to be going excel- lently. . . . By the end of October, cholera had been stamped out in Harbin and three of the nurses, among them Miss Bartlett, were recalled early in Xovcmber to Vladivostok. The other two remained to assist in caring for American engineers in the hospital of the Russian Railway Service Corps. This hos- pital had been started early in 1919 and had then had a nursing staff of two American Red Cross nurses, (Mrs.) Gertrude C. Brandon and Mabel E. Doub, two British Red Cross nurses and one British aide. In November, Miss Tittman visited the R. R. C. S. Hospital, the Central Hospital, the City Hospital, the Chinese Hospital and the Russian Red Cross Hospital, all of them places in which American nurses had been stationed. ]\riss Tittman wrote ^liss Xoyes on Xovcmber 15 that she was "again impressed with the weak organization and meager equip- ment of Russian hos])itals in Siberia. The Russian Red Cross Hospiti'.l gives a two year course of training to nurses,'' she NURSING SERVICE TO CIVILIAN POPULATION 939 added, "and I mado an effort to secure data on their course of instmction but received oidy va^e comments." The educational projects and the nursing service which was maintained in the hospitals established or aided l)v the com- mission in Vladivostok and Harbin, constituted the nursing activities of the Eastern Division. Extensive civilian relief was also given in the Vladivostok District and throughout western Siberia. Barracks were erected to house the refugees and meals were served to them. Sewing rooms, a weaving and a tailoring shop was opened. Boots, pajamas, sheepskin coats, shirts, socks, sweaters and underwear to the number of 880,000 articles were distributed bv February 28, 1919.^** The nursing activities of the American Red Cross in the western and central provinces of Siberia were manifold and the service itself difficult and fraught with many hardships and considerable peril. To return to the summer of 1919 and the reorganization of the Nursing Service: Upon Miss Tittman's arrival at Vladivostok late in June, IMiss Harrington had been appointed chief nurse of the Western Division and in company with Major F. P. Mangct, then acting-commissioner and man- ager of the Western Division, had gone west in June to Omsk to supervise the establishment of an office from which nursing personnel could be distributed in western Siberia. It will be remembered that at this time the American Red Cross was operating a large hospital at Tumen, of which ^Fiss Farmer was chief nurse ; another at Omsk, of which Miss Carter was chief nurse; and typhus hospitals at various other towns and cities in western Siberia. Colonel Teusler and ]\Irs. St. John, it will also be remembered, had gone to the United States and ]\riss Tittman and ]\Iaj()r J. X. Strong were left in charge in Vladi- vostok during their absence. Among the Red Cross personnel who went west with ^liss Harrington and Alajor ^langet was a merrv-S})irite(l nurses' aide, Kdith Barnett. On July 3, she wrote from Omsk to Miss Binder: I wish I could adequately describe iliis sweet spot in wliidi we are waiting for our assignments. The husiiital itself is l)eaiitifully situated al>()ut five miles from town and we ai'e in ^ For furlluT details of tlic oivilinn relief proLrriim. see "'riie Work of the Atneriean lied Cross diiriiifi the War: A Statement of Finances and Aceomplislinients ;" also Annual Reports. l!)l!t and 1!)2(>: Red Cross Librar\'. 940 HISTORY OF AMERICAN RED CROSS NURSING a real Eussian log house set in a grove of birch trees. The song birds awoke us this morning and we lay on our cots on the summer sleeping porch and looked out through the quiver- ing birch leaves to the cobalt sky for the sky can be bluer in Siberia than anywhere else, it seems. We had a most beautiful trip on the train. We came by freight and stopped at all the wood piles and watering tanks. The scenery and wild flowers were indescribably beautiful. On the upgrades some of the men would jump off the train and gather flowers that filled our compartments and dining rooms. We were in a bower of purple iris, marigolds, yellow lilies, peonies, lilies-of-the-valley, blue columbine and wild roses. . . . On July 9, Miss Harrington with six American Red Cross nurses and three aides arrived at Cheliabinsk and found that the American Red Cross had taken over the Pereeelenchesky Punkt, or Government Immigration Station, two weeks before, but that they were not yet fully established. Miss Harrington wrote Miss Noyes: We gradually took possession of the buildings as they were freed from vermin, whitewashed and made sanitary. Eleven of the sixteen buildings were soon in our possession and our wards filled with patients delighted with the bugless beds and the fresh sheets and Red Cross pajamas. We had inherited three hundred surgical and seventeen typhus cases. Stephanie Pohle is chief nurse. A good -sized laundry and big bath were in the process of being made sanitary, also five other buildings to be used for patients. In addition, there was a good-sized Ambulatoryah or clinic where during a four days' observation five hundred cases were treated. When the hospital was first taken over, there was a large percentage of hand and foot or self-inflicted wounds. Under our regime, these cases were refused hospital care but allowed treatment at the Amhulatoryah. Taking it in all, the Punkt was an ideal location for a hospital. IVainloads of wounded from the front could be backed into tlie yards and unloaded with little effort; the grounds, though neglected, could have been made highly at- tractive, and the buildings usable. In a letter written ]Miss I^oyes on July 23, Miss Harring- ton, then en route to Omsk, described the fate of the Chelia- binsk Hospital : NURSING SERVICE TO CIVILIAN POPULATION 941 After we had been at Cheliabinsk for two days, we learned that the Bolsheviki were making rapid progress and tliat different Russian regiments which had been sent to the front had vanished in thin air. Major Manget, acting commis- sioner, decided to push on to Miass to interview General Suroff regarding true conditions, so our car was attached to an outgoing train heavily guarded by Russian soldiers and we made ^Iiass in al)()ut eight hours. Thus Major Maugct was advised to evacuate eastward the Red Cross personnel at Cheliabinsk and the Petrograd Red Cross Children's Colony then at Lake Turgoyal, about sixteen versts from the station at Miass. We three women, one an interpreter and the other a publicity woman, started out for the colony in the rain and arrived there about two o'clock in the morning. The next morning, a beautiful one, the children gathered with their treasures and . . . finally all were gotten started on their way eastward. We finally reached Cheliabinsk and were there for a day, then pulled out one train behind that carrying the Children's Colony. The conditions here seem hopeless now. The latest news from Cheliabinsk is serious and Ekaterinburg is in the hands of the Bolsheviki. Nothing in the world can prevent them from swooj)ing down on Omsk and where the front will be in three weeks is a matter for conjecture. On July 26, Miss Harrington wrote ]\Iiss j^oyes from Omsk regarding the evacuation before the victorious Ked Guard: We arrived at Omsk on July 24 and were astonished to find that our American ])ersonnel had already been moved down the line. Kkaterinburg is also evacuating, so Major Manget after a consultation with American Consul General Harris and our Army otlicials, felt that it would be well to get our personnel out before traliic is paralyzed and our people bottled up iiere indefinitely. The comjjlote personnel from Tumen will be moved to Tomsk to open a 200()-bed hospital there. The rest will go on to Irkutsk to await further orders. . . . All our j)laiis for the four months' intensive training for Russian aides have had to be given up. It is discouraging because the liussian nurses at the front are trying to use young women in the proper way to use them. Most of them art> just young rel'ngi'c girls who nnist luive enijiloyment nnil previous to their work with us have had no traiuiui; of anv kind. 942 HISTORY OF AMERICAN RED CROSS NURSING A second train carrying our personnel starts eastward this afternoon. There will be left only seven nurses in Omsk and they will evacuate with other American personnel on Consul General Harris' train when he feels that the proper time has come. We are sad, indeed, over the sudden change of affairs and we can only hope that within a short time we will be back in Omsk and even in Cheliabinsk. The success which had met the advance of the Red Guard in the Cheliabinsk district continued and on July 29, ^lajor Strong, in charge of American Red Cross activities in Vladi- vostok, wired Colonel Teusler, then in Washington : Owing to Bolshevik advances, Cheliabinsk and Tumen have already been evacuated. Omsk is being evacuated and the nursing staff has already left. The supply trains going west are being returned east. Irkutsk will have a three hundred bed hospital, but further extensions or storage impossible on account of the overcrowded conditions of the city. We are arranging store depots at Verkhne-Udinsk and Harbin as the most advisable western points for warehouse space. The personnel will be housed at Buchaloo until the situation clears. Further incomers are being stopped at Japan, as there is no space in Vladivostok. Tomsk w\HS the next large city located east of Omsk on the Trans-Siberian Railway and for some weeks it became the head- quarters of the American Red Cross in western Siberia. Miss Harrington detailed nurses and aides to the American Red Cross hospital w'hich had been established in 1918 with the cooperation of the Faculty, in one of the twenty-nine buildings of the Tomsk University. No American nurses had been as- signed to duty there in 1918, however, because they could not be spared, and, indeed, their stay in the handsome University Hospital during 1919 was short. The city of Tomsk possessed the beauty traditional to Russian and Siberian cities. The streets were broad and well kept and the stores large and, pre- vious to 1914, well stocked with luxuries of all kinds. The University, where ]\letchnikoff had performed some of his re- markable experiments, had made Tomsk the center of Siberian art, science and letters. It had also been the seat of the Kolchak Government. All American Red Cross women personnel were evacuated from Tomsk late in August and got out safely, all except Edith NURSING SERVICE TO CIVILIAN POPULATION 943 Barnett, who had died of typhus on August 15 and had been buried several days later at Verkhne-Udinsk. During the month of September, 1919, only three American Red Cross hospitals were maintained in the Western Division, the first at Omsk ; the second at Novo-Nikolanvsk ; and the third at Tomsk. American Red Cross physicians were still in charge but no American Red Cross nurses were on duty in any of them. The thousand-bed hospital which had been started in 1918 in the agricultural school at Omsk, was staffed by Russian Sisters, with Helen Domerschikoff in charge. Other Russian Sisters and Russian nurses' aides were on duty at Novo-Niko- lansk and Tomsk. The city of Irkutsk, some miles west of Lake Baikal, became in September the center of American Red Cross activity in the Siberian interior. Previous to 1014, Irkutsk had been perhaps the largest commercial center in Siberia and with its many stores, museum, the university and a military barracks capable of housing thirty thousand men, was still regarded in 1919, in spite of paralyzed trade, as the metropolis of Siberia. L^pon his return to Vladivostok from the United States, Colonel Teusler had proceeded west to Irkutsk to confer with Major Manget regarding the reorganization of the Western Division. Upon his arrival there in the fall of 1919, a third Division was created and its headquarters established at Irkutsk. Miss Harrington was appointed acting chief nurse. At Irkutsk, the commission established four large hospitals. One of the first of these was described by Miss Harrington in her September Report : The American Ed Cross Hospital on Xamanskaya Ulitza, with Christine Kemp in charge of it, is now caring for 2"-23 patients, most of wiiom are wounded soldiers brought down from the Western Front. As the shortest time in which we have received tiiem after they have started from the front is four weeks, the condition of some of them upon arrival is appalling. Even their bandages are alive with vermin and their garments in an untliinkable state. The surgical work done here (and our agreement with the Russian military authorities provides that we take only surgical cases) consists principally of re-amputations, amputations and drainage surgery of all kinds. The new Chapel ward of 4r)-bed capacity is reserved solely for convalescent Czechs and is a sunny, cheerful room, a joy 944 HISTORY OF AMERICAN RED CROSS NURSING to these men who deserve the best. . . . The American ward, reserved for male members of the American Eed Cross per- sonnel, the American engineers and the Y. M. C. A. and those of our Allies, holds an average of two or three patients, all grateful indeed for the homelike surroundings and the fa- miliar medical and nursing methods. A second American Red Cross hospital at Irkutsk was Di- vision No. 2 of the Russian Military Hospital. The commis- sion supplied here personnel and hospital supplies to carry on the clinic where 300 hospital patients and numerous out-patients had their wounds dressed daily ; it also operated a surgical ward of sixty-two beds and a medical ward of twenty-six. Stephanie Pohle was chief nurse and Harriet Hunt in charge of the clinic. But it was up-hill work; in a report submitted on October 11 to the Finance Committee of the Central Division, Miss Har- rington described the conditions existing in the Russian Military Hospital : On entering the hospital each morning, it is not the greatest inspiration to be greeted by the sight of dead bodies; then passing up the stairs and through the corridors thick with smoke and heavy with odors, to arrive at a floor where 300 patients are being housed. Ninety are in Red Cross wards, but two himdred and ten others receive hit-and-miss care; some of these have been lying for days without change of clothes on the floor in the same clothes which they had on over a month before at the front. Infected with typhus, carrying vermin as they are, they constitute a serious menace to the Russian and American personnel. After heroic labors, ]\Iiss Pohle and her nurses rid the Rus- sian ]\Iilitary Hospital of vermin and established more sanitary conditions. The third American Red Cross hospital at Irkutsk was maintained for the benefit of wounded soldiers from the Czecho- slovak Army. Lillian Craig Clark, an enrolled American Red Cross nurse, and throe Czech aides formed the nursing staff. The fourth hospital was located in five barracks at Military City, an encampment which lay some five versis from Irkutsk. Mabel Clare Blackmer, the former chief nurse of the short- lived Omsk Hospital, was chief nurse. The Military City Hospital, as it was called, was of four hundred bed capacity and NURSING SERVICE TO CIVILIAN POPULATION 945 cared for the patients who were being constantly sent eastward from the west Siberian provinces before the on-coming Bolshevik armies. An emergency dressing car was equipped at Irkutsk and set up in the main railroad station where from eighty to one hun- dred wounded soldiers and civilians en route eastward had their wounds re-dressed each day, Katherine Steelman and a Rus- sian nurse were later assigned to duty there. Directly opposite the main station at Irkutsk was established a large Red Cross dispensary, of twelve rooms, including a waiting-room, a small operating-room, a recovery room and an emergency typhus infirmary. Eva Smythe, the nurse who had organized Red Cross child welfare work at St. Etienne, France, was chief nurse and was aided by four other American Red Cross nurses. As the Bolsheviki pressed eastward from Omsk in their fight for the control of the Trans-Siberian Railway, train after train filled with wounded and typhus-stricken Czech and Russian soldiers and refugees pulled into Irkutsk. On August 10, an American engineer stationed at Irkutsk wrote one of the nurses of the Siberian Commission : As a nurse, you will be interested in the Eussian sanitary trains which run through this town at the rate of from three to six a day. P^aeh train carried fully five hundred wounded or sick soldiers in a few sanitary and many box cars. From personal observation, I know that five young Russian girls took care of this number of sick and wounded on one train. Many of the men sufi'er from tuberculosis, typhus and chronic dysentery. Through an instinct of cleanliness, most cases of the latter disease try to leave the cars at every stop and are then so weak that they faint, falling under the cars, and have to be assisted aboard again. Every train takes off dead at each terminal. The supplies are so scarce here that not even a rag or a piece of paper can be spared to cover the faces of the dead. It is needless to tell you that such a state of affairs lias been brouglit about by unsanitary conditions in the camps and the lack of suitable nourishment for the men. The Russian sanitary trains have no actual funds with which to buy supplies or foodstuffs and the officers have to rely entirely on the generosity of the public all along the line. The public has nothing to give. We are located in the very heart of the famine belt and see hungry men and lots of them. It's not })leasant to come face to face with this sort of thing, 946 HISTORY OF AMERICAN RED CROSS NURSING but it's tougher to see hungry women and it's plain hell to see hungry children. . . . One of the first projects of the American Red Cross in Siberia had been the equipment and maintenance of sanitary trains for the Czech and Russian forces. At Irkutsk, an in- teresting experiment was made in 1919 in the assignment of American Red Cross nurses to one of these trains. In her September Report, Miss Harrington wrote: American Eed Cross Sanitary Train Xo. 1 operates between Omsk and Verkhne-Udinsk and is made up of twenty-three cars. Two of our nurses, Vera Allen and Katherine Steelman. and ten Eussian Sisters composed the nursing personnel on its initial trip. They carried nearly three hundred cases and did forty major operations en route. Some of the patients were unloaded at Irkutsk and the others at Yerkhne-T'dinsk and the train made the return trip to Omsk and the front without the American nurses. The military situation, in Colonel Teusler's estimation, did not permit reassignment of American nurses to this precarious type of service. Irkutsk was located on the western shore and Yerkhne- Udinsk on the eastern shore of Lake Baikal. At Irkutsk were stationed some twenty-five thousand Czech soldiers and at Yerkhne-Udinsk about 500 versts away, were numerous com- panies of Japanese troops and the 27th U. S. Infantry, which then numbered about eighteen hundred men. Since August, Irkutsk had boon the dead-line for American Red Cross women personnel and, indeed, there were iow of them there. The majority had l)een sent east through the tunnels of Lake Baikal to Yerkhne-Udinsk. There was a possibility that the Red Guard nriglit any day blow" up the tunnels and cut the line of communication between the East and West. Of the military situation in the AVest, Miss Harrington wrote Miss Noyes in her October Report, dated, however, Xovember 28: Since last week, the Western Division has ceased to exist. Omsk has fallen and the Eed (luard has obtained a great deal of ammunition and sujjplies of all kinds. All of our Eed Cross supply trains are now on this side of Xovo-Xikolansk. Conditions here at Irkutsk were most serious last week and NURSING SERVICE TO CIVILIAN POPULATION 947 we have evacuated as many of our women as we can possibly spare, in order to ^iet them east of the Baikal tunnels. Thirty- nine nurses, aitles and clerical workers went east to Verkhne- Udinsk on a Red Cross special train and we have retained only enough here to carry on our work until the lUissian Sisters arrive from Omsk. Consul General Harris and his stall' are now at Irkutsk. His presence here reassures us, for he has his finger on the j)ulse of the political situation and now that Colonel Teusler has been called back to Vladivostok, he can advise us. Typhus is the great ])roblem and peril here. One of our interpreters informed us that ^5,000 cases of typhus had been registered among the sohliers alone in Innokentivskaya. just outside of Irkutsk. It is generally known that it was typhus among the white armv that gave the lieds their victory at Omsk. With large supplies at Verkhnc-L^dinsk and a considerable niunber of nurses and surgical cases, the commission in August established a hospital and a dispensary there. The American Red Cross Hospital was located in a one-story building which had formerly housed a department store. It was originally of two Inuidred and fifty bed capacity but was later increased to six hundred beds. (Jrace ^Iclntyre was chief nurse. In addition to Miss ^Iclntyre's Hospital, the American Red Cross in Verkhne-rdinsk took over and maintained the Provost Guard Hospital and established an emergency typhus hospital of KiOO beds in twenty-eight warehouses. ^'General Seminoff," wrote ^liss ILirrington in her October Report to Miss Xoyes, "wired that we could have the warehouses provided that we would take infectious cases. Typhus is everywhere." Flor- ence Farmer was chief ntirse of the Barracks Hospital for typhus patients. Practically the only nursing aid which the (\unmissi()n for Siberia gav(^ to the American Fxpeditionary Forces in Siberia was the assignment of American Red Cross nurses t<> aid in an influenza epidemic wliicli broke nut in the fall of linO among American tr()o])s at Verkhne-rdinsk. The American Armies in Siberia had their own hospital facilities. Kiglit nurses of the commission were loaned to the American Military I-!stablish- ment for duty at the V. S. Army Field Hospital at Verkhnc- Fdinsk. During th(> week of Xovemlx^- KI, twelve otlu^-s un- der the leaderslii}) of Sallie -I. Bryant were assigned to Be- 948 HISTORY OF AMERICAN RED CROSS NURSING rosvka, the winter quarters of the 27th IT. S., and served there in U. S. Army Evacuation Hospital No. 17, of which Major Robert E. Parrish, Medical Corps, was then in command and Katherine C Hannan, chief nurse. Of the work of Miss Bryant's detachment of nurses, Miss Harrington wrote Miss Noyes on December 16: At Berosvka, just outside of Verkhne-ITdinsk, the nurses found two hundred very sick boys and managed in less than twenty-four hours to transform the hospital. Young inexperi- enced corpsmen had been in charge. The boys seemed to regard the arrival of the Eed Cross nurses as a gift from Heaven, and under their care the epidemic w^as soon checked; not, however, before twenty-eight of our men had died. These new men are very young ! One little fellow of fourteen cried so hard for his mother before his death. Throughout the fall of 1919, the Red Armies had been gain- ing in the West and were pushing eastward toward Vladi- vostok. The American Armies were withdrawn from Irkutsk in December and with them went all American Red Cross per- sonnel. Miss Harrington in her Report to the Finance Com- mittee for the week ending December 30, 1919, wrote: On December 23, the Executive Committee informed the heads of all departments that they were to make preparations for the complete evacuation of their personnel. No definite time was set, but it was understood that we were to be pre- pared to leave within twenty-four hours. A communication was immediately sent to the American Red Cross Hospital on Xamanskaya IJlitza and the Station where our personnel were on duty on the Emergency Dressing Car and Dispensary. Tbe Divisional Manager stated in a communication dated December 24 that Russian Sisters who so desired would be taken on itcd (-ross evacuation trains as far east as Yerkhne- T^dinsk or Chita if they could prove that they had friends or relatives in cither place, but that they must be off the trains, with all l)aggage, two hours after arrival at either station. Christmas Day found us all monu^ntarily ex])ecting the storm to break but endeavoring to maintain a holiday spirit becoming to foreigners in this land which has suffered beyond description. As you entered the brilliantly-ligbted cba])cl wards of tbe Irkutsk IIos])ital and saw the trees, the gifts for NURSING SERVICE TO CIVILIAN POPULATION 949 everyone, the festooned walls, the three Czech aides who were Santa (Clauses, it was hard to realize that outside in the city proper there was neither electric ligiit nor water, and that it was doomed to fall. . . . On December 2G evacuation began at 9 :00 A.M. All American Red Cross nursing activities at Division No. 1 of the Russian Military Hospital, at the Czecho-Slovanska Hospital and the Czecho-Surgical Hospital were brought to a close. Baggage other than hand bags had already been sent to the trains in order that our departure might cause as little com- ment as possible among the Russian pooi)le, who were nearing the "panicky" stage anyhow. As the day drew to a close, only sixteen of our personnel had time to cross the pontoon bridge over the Angara, because of darkness, the rapid current and the huge cakes of ice brought down from the Baikal. . . . December 27 : Tiie rest of the nursing personnel were evacuated to-day. As the last boatload of Red Crossers pulled out from the western shore of the Angara, the battle around the telegraph station in Irkutsk, just back of our former personnel house, began. . . . For seven days, however, the American Red Cross evacuation trains waited in the Irkutsk Railroad Yards for final word from Consul General Harris to evacuate eastward. '^The atmosphere was tense and rumors wild," wrote j\liss Harrington in her Weekly Report ending January 7, 1920, "the yard workmen and railway employees had all been armed. Red Cross women personnel were recpiired to stay near their own track and coupe, for at the least provocation a volley of bullets would come and might prove fatal to those innocently taking an airing. The nurses busied themselves," added ^liss Harring-fon, "in sewing curtains for their coupes." On January ), the Americans evacuated Irkutsk, Consul General Harris' train went first, preceded by a (^zecli eschelon, or arni(^re(l train. Xext cam(> tiie trains carrying American personnel. Kach train left the yards at twenty-minute intervals and was preceded and followed by a Czech eschelon. The nurses did not stay long at Verkhne-Udinsk, ^liss Har- rington wrote : Hero wp met ^Frs. St. Jolni. wlio had coine up on Colonel Teusler's car and had already arraiiged for the evacuation of a large number of the Anicricaii Iicd Cross personnel there. . . . Plans were immediately made to evacuate the others. 950 HISTORY OF AMERICAN RED CROSS NURSING They left on January 6, the nurses under the leadership of Florence Farmer. The others came later, . . . On January 7, Mrs. St. John wrote Miss l^oyes from Verkhne-Udinsk, just before the departure of the last train: The complete dissolution of any stable form of government in Siberia has made it impossible for us to carry on success- fully any Eed Cross work other than the distribution of warm clothing and relief supplies; with the growing military activi- ties east of Baikal and the withdrawal of American troops from this section, it is impossible to keep our nurses or other women personnel east of Manchuria Station. This practically concentrates our work in Vladivostok, so far as the nurses are concerned. Because of this, I am instructing all the nurses from the west to prepare for early transportation home and have written Miss Tittman to ask that passage be secured for all excepting those needed for replacements in Vladivostok. You will be interested to know that apparently the Social Democrat movement in Irkutsk has been largely fostered by the Czechs and almost surely they are in more or less sym- pathetic contact with the somewhat modified Bolshevism of western Siberia. Here in Verkhne-Udinsk we are surrounded by Bolsheviki and this is true all the way east to the Amur Basin. With such conditions, the opposition ofi^ered by the Cossacks cannot be efl^ective much longer and probably by the time this letter reaches you either Social Democracy or Bolshevism will rule Siberia to the environs of Vladivostok. You can easily see that for at least the next few months it would be impossible for the l?ed Cross to operate here successfully. The people will see us leave with real regret, but we will withdraw at a time when the Russians will have the least reason to criticize us for this action, and I am glad, if the work has to be discontinued in Siberia, that the break has come now. The next terminal eastward from Verkhne-Udinsk was Chita and here the American lied Cross evacuation trains were held long enough for the personnel to distribute the supplies which had been brought into the city from the west on Train ]^o. 27. Margaret L. ^latthew, then acting director of the Depart- ment of Civilian Relief in the Central Division, was in charge of the work, with ^Irs. St. John and Miss Bridge as her as- sistants. Madame Semenoff placed at the disposal of the Red NURSING SERVICE TO CIVILIAN POPULATION 951 Cross an old cafo, with shelves along the walls and counters running around the room ; behind the cafe was a large courtyard which was well adapted for warehouse purposes and which could be easily guarded. The distribution began on January IG and lasted until the 2.3rd. "The entire American Red Cross staff," wrote Miss JNIatthew, "volunteered to help in the dis- tribution, doctors, nurses, clerical workers and even the Rail- way engineers and the American Guard." The militia was called in to police the crowds but even they could not control them. "The street became a seething mass of humanity," wrote ]Miss ]\ratthew, "and they crowded so as to endanger the glass windows of the cafe. It was then decided to allow the military to give out every day in each district headquarters fifty tickets for each of the six districts of the town, thus making three hundred tickets in all. This department gave out in the seven days 39,313 garments to 11,355 persons." A carload of goods was distributed to the Railroad employees at Chita and a considerable amount of general supplies fur- nished to German, Austrian and Hungarian prisoners then interned at three camps nearby. Private lists mimbering 253 needy families, which were sent in for Madame Semenoff's ap- proval, were also filled. "Madame Semenoff," wrote ]\Iiss St. John to Miss Noyes, "is utterly fearless in visiting the typhus hospitals and prisons and when she finds orphaned and destitute children, she ad()])ts them until they are claimed. She has a home for orphaned children opposite her own and when I visited it, I found it clean, well ordered and the children happy and, of course, devoted to her." On January 23, the trains pulled out of Chita, and thus was closed the work of the American Red Cross in the Western and C^entral Divisions of Siberia. The personnel had started out rich in supplies, plans and enthusiasm, but had been able to accomplish little in comparison with the true needs of the country. Thr nurses had had scant opportunity to do the work for which they had gone out, but they had met the changing situations with etjuanimity. "You would have been proud of them," wrote Miss Harrington to ]\liss Xoyes, "if you had seen their spirit and che(>rfnl willin^^l(ss to work throuuh the up- heaval, when the revolutionary forceps were steadily pushing us eastward in wave after wave of evacuation among the non- descript mixture of convict, typhus and the so-called sanitary trains and the hordes of refncees." 952 HISTORY OF AMERICAN RED CROSS NURSING By the first of April, 1920, practically all American Red Cross personnel had left Vladivostok, which was then under frank Bolshevik rule. Of the closing of the program Mrs. St. John wrote Miss ISToyes on March 4: Two weeks before the Morskoi (Naval) Hospital was turned over to the Eussians, the American nurses were withdrawn and it was then staffed entirely by Russian nurses and aides trained by us. I inspected the hospital during this period and found it well kept and reflecting in a satisfactory manner the training received under Miss Bethel's able administration. This hospital has been thoroughly equipped and is much im- proved since the Eed Cross took it over in Xovember, 1919. The American nurses in the Russian Island Hospital were withdrawn February 1 and the Russian nurses and aides are carrying on the work. . . . Miss Farmer has been appointed assistant to Dr. Coulter, chief of the Petrograd Children's Colony. She will probably be the only American Red Cross nurse from the commission who will remain in Siberia. ... I think the transfer of these children back to their homes in Moscow and Petrograd one of the important questions with which the commission has to deal. Plans are ready to be developed to give them safe trans- portation provided conditions in central Russia make their return advisable. [This transfer was accomplished in the summer and autumn of 1920 under the auspices of the Ameri- can Junior Red Cross.] ^liss Harrington and her unit arrived from Harbin on February (i on Consul General Harris' train and the majority of the nurses went immediately to the U. S. transport, which took them home. Miss Tittman left on February 28, but will remain in China and Japan for a few weeks. I will see her in Tokyo and ask her to bring you the final records and efficiency reports; slie will go immediately to AV'ashington. I expect to leave Vladivostok in about four days. The continuation under Russian auspices of the Teaching Center and educational phases of the nursing service pro- gram has already been described. Thus was closed American Red Cross nursing service in Siberia, a gallant attempt, all)eit somewhat chaotic and short- lived, to implant in a land not yet ready to receive and nurture them, the standards and traditions of modern American nurs- ing service. CHAPTER X AT NATIONAL HEADQUARTERS Auxiliary Kursiiig Service The Summer Months of 1918 The Influenza epidemic The Armistice is Signed UNDEK the main facts of history lie the human relation- ships of the participants and these relationships may be called the backiZToiind against which the actual events stand out like the principal motifs in the design of a Persian rug. This background, when viewed in a changeable and un- certain light, often appears blurred and even distorted to differ- ent observers and each observer sees the details according to his own position and his own methods of observation. Yet the back- ground as a whole forms a vital part of the pattern and must be taken into consideration if the pattern is to be described. Hence this chapter of this history will deal largely with these hunuui relationships and their bearing upon the nursing situa- tion of the European War. Yet it must be remembered that the true pattern of American war nursing, as developed and seen in the minds of American nursing leaders, was often blurred and distorted by war psychology. ''War is a savage state of society and it strikes at many things we have cherished," wrote an American lied Cross nurse serving in Fraiu-e. ''I really have faith in the ultimate outcome, though I think that we must l)e ready to go through a black period at first." VoY the Nursing S(>rvic(^, this black period l)egan to loom up early in 1!)18 and continued until the signing of the Armistice. Three ju-oblcms confronted ^liss Delano and ]\Iiss Xoyes during this imjxirtant time: the needs of the nurses themselves; the needs of the Aiilitary Establishmcmt ; and ultimately, the needs of the civilian p()])ulation, Tlie lUM'ds of the nurses themselves were the least perplexing. Existing regulations of th(> War and Xavy Departments and the Ived Cross nave to the Nursing Service the power to mobilize American Hod Cross nurses into tlu^ Army and N'avy and the 953 954 HISTORY OF AMERICAN RED CROSS NURSING War Council appropriated the funds necessary to equip them; after this had been accomplished, the responsibility of the Red Cross ceased. For nurses in foreign service directly under the Red Cross, Miss Delano and Miss Xoyes were concerned with organization difficulties previously described. The second and the genuinely distressing problem was the military nursing needs and in certain aspects of this question Miss Delano stood alone, facing on the one hand the professional group of which she herself was a member and on the other, the untrained women of America who clamored for opportunity, through the American Red Cross, for war nursing service. As the war progressed, the nursing needs of the Military Establishment and the available supply of graduate nurses grew more apparent to Army, Navy and Red Cross officials. The numbers of men in the Military Establishment were increasing to gigantic figures ; the activities of the enemy and the resulting numbers of casualties to the Allies, were also increasing to an alarming degree, especially after the German offensive of March 21. During the spring of 1918, public, professional and military opinion upon the nursing situation crystallized into two groups: those who felt that the Military Establishment should include only professional nurses, and those who felt that the ^Military Establishment should include professional nurses and assistants or aides working under professional di- rection. On February 9, 1918, General Gorgas wrote to the Director General of ^Military Relief of the American Red Cross that "in my opinion it is highly advisable that measures be taken by the American Red Cross to carry out the plans already formulated by them to provide a large number of nurses' aides who may be used to supplement the nursing force in military hospitals should need arise. . . . The aides Avill be classed as civilian employees of the ]\Icdical Department at large and will be given a salary of $30 per month, with quarters, subsistence, the laundering of their uniforms while on duty in hospitals and the necessary traveling expenses when traveling under orders." On ]\londay morning, February 18, ^liss Goodrich assumed her duties in the Surgeon General's office. Late that week, she heard about the plan for utilization of Red Cross aides in mili- tary hospitals and she immediately took up the matt(>r with Colonel Winford Smith, then chief of the Hospital Division on the Surgeon General's office, with the result that Colonel Smith asked the Red Cross to withhold the announcement re- AT NATIONAL HEADQUARTERS 955 gardiiig aides until !Miss Goodrich and her assistant, Elizabeth Burgess, had had "time to study the situation in base hospitals and could make recommendations." ^ On February 20, 1918, Colonel Smith wrote to Miss Delano: Eeferring to the request recently sent to you from this oflfice requesting that steps be taken to inaugurate short courses for tlie training of nurses' aides or attendants, I am directed by the Surgeon General to request that for the present no steps he taken to put tliis plan in actual operation in tlio hospitals; in other words, it is desired to withhold announce- ments and circulars for a brief time until a report has been made as to the possibility and desirability of modifying this plan, or of accomplishing the same purpose in a different manner. It is expected that this report will be available within the next two weeks. This is not to be considered as a definite abandonment of the polity as indicated by the previous request, but is merely a delay in its execution until additional data are available. Out of the study and recommendations of ]\riss Goodrich grew the plan for the Army School of Nursing and the question of utilizing the fifteen hundred aides already trained as per- sormel of the base hospital plan, and others to be trained by the Red Cross, was again "tabled," in spite of ]\Iiss Delano's efforts. The proposed plan for the Army School evoked many differ- ences of opinion within the medical and nursing professions. Discussion on this subj(H't came to a head in the Twenty-fourth Annual (/ouvcntion of tlie Xational League of iSTursing Educa- tion, which met at Cleveland, May 7-11, 1918. Three groups were represented at this convention : the nurs- ing group, jealous for the maintenance of hard-won professional standards ; the advocates for the supplementary volunteer nurs- ing service; and the vn- dent of ]\rt. Sinai Hospital and chairman of the Connnittee on Hospitals of the G(Mieral ^ledical Board of the Council of Xational Dcfens(\ was spokesman of the second group. In sunnning up the convention, ^[is& Palmer wrot(> in tli(> editorial columns (June, lOlS) of the American Journal of Xurshig: ' Sec Twcntv-fourlh -.Annual Report of tlic League of Nursing Education, 1918. ' 956 HISTORY OF AMERICAN RED CROSS NURSING The two papers which were of greatest importance were those presented by Colonel Winford Smith in which he sub- mitted plans for an Army School of Nursing, and by Dr. Goldwater, entitled "A Nursing Crisis," in which he advo- cated the employment of nurses' aides as they have been trained for the past three or four years through the education committees of the Eed Cross. . . . As the organization of the Army School of Niirsing has already been set forth in a previous chapter, Colonel Smith's paper will not be given herewith. Dr. Goldwater told of the Surgeon General's plans for three hundred thousand hospital beds, stated that during the past year, the Army and Navy, with the help of the Red Cross and the active support of hos- pitals and nursing organizations, had been able to secure only one-fifth of the number of nurses needed and made the state- ment that "the country cannot spare the number of graduate nurses that the Army requires, nor can the training schools produce new graduates in sufficient numbers to satisfy the needs of the military and civilian population." ^ After detailed discussion of the possibility of securing an adequate supply of graduate nurses from those already trained ; of increasing the supply of student nurses in schools ; of utilizing "practical nurses" in the Army ; and of the establish- ment of the Army School of Nursing, Dr. Goldwater made the following recommendation : I come finally to what appears to me to be the safest ajid best way out, in fact, the only way out, namely, the training of a large number of non-professional, voluntary, war nursing aides, enlisted for the period of the war only and composed of a class which will not take up nursing professionally under any circumstances, but which is willing to give gratuitous hospital service during the emergency. . . . Tlie women I have in mind belong wholly or almost wholly to the leisure class. They are now contributing nothing to the elhciency of the nation or to the success of the war; yet they are strong, healthy, patriotic and willing. Tliey are the onhj laJior reserrest tliaf the ronntrj/ possesses and theij can he hronght into the riurstiir/ field villi out lessening the available supply of workers for ani/ essential industry. . . .^ ^Twfiitvfoiirtb Annual Report. N. L. N. E.. pp. L32-T.3.3. ' IhUJ.. j>p. i:?8-i:!!'. AT NATIONAL HEADQUARTERS 957 On tliG following day ^fiss Delano addressed the convention on ''the lied Cross Aide Versns the Short-term Course" and her words are significant to every student of military nursiug ser- vice, both professional and volunteer. She said that the idea of Red Cross service had developed out of war experience ; that the "aim of Red Cross societies was primarily to cocJrdinate and develop the volunteer service of the world;" that the Ameri- can Red Cross had chosen to develop a professional nursing service thinking that this service would afford the most efficient nursing care to the American ^lilitary Establishment; and that the development of this professional nursing service had been entrusted in 1009 to the American nursing profession. The American Red Cross Nursing Service thus stood alone among the nursing sei'\aces of national Red Cross societies and this professional foundation evoked, it may be frankly ad- mitted, considerable criticism. Miss Delano continued: I confess that this attitude of the American Red Cross was viewed with more or less suspicion by many of the countries signatory to the Geneva Treaty. It was an innovation. . . . About five years ago [1912] there was held in the city of Wasliington an international conference of the Red Cross organizations of tlie world. I had the lionor to be a delegate to that convention. Xursing questions were discussed more or less throughout tlie entire convention, because the supply- ing of the service of nurses in time of war was always recog- nized as the clnef function of the Red Cross. . . . The fact tliat we built the service up entirely on professional service, which is of necessity expensive and wliicli is restricted in certain ways as it deprives the women of tlie country of the service which they have considered from time immemorial their riglit, this plan of ours was viewed with more or less sus})i(ion. especially by tlie women of France, who believed that their ]ilan was far superior to ours. ... In this inter- national ((inference the American Red Cross. not the nurs- ing depart nicnt but the American Red Cross of the Cnited States, ask(Ml itself whether it had done all that it should do to provide for the needs of war. . . . Here followed in ^liss Delano's words a description of the project which has been briefly alluch^d to previously, with referenc(> to ^liss Marion Oliver's work in organizing groups of lay workers, resembling the British system of Voluntary Aid Detachments. ^liss Delano continued: 958 HISTORY OF AMERICAN RED CROSS NURSING An oflficer of the Medical Corps of the Army then assigned to Red Cross service was sent to Europe during the summer following the International Convention to study the nursing service of the European countries, especially England. He came back in the late summer to recommend to the Executive Committee of the American Red Cross that an organization of women should be built up in this country along the same lines as the Voluntary Aid Detachments in England. The course was planned out, a circular concerning this work was printed and the whole plan was laid out, to be put into operation in this country. I felt tliat our nursing standards were absolutely threat- ened, that our Nursing Service would be of no avail with these groups of women unrelated to us, organized by physi- cians, taught by physicians, serving under their guidance, their own leaders . . . that our Xursing Service was seriously threatened and that our nursing standards might all go by the board. . . . Miss Delano then explained how she had called the National Committee together (on November 14, 1912, in New York City) and had laid the situation before them. Miss Maxwell, Mrs. Tice, Miss Nevins, ]\Iiss Nutting, Miss Goodrich, Miss Nichols, Miss Mclsaac, Miss Palmer and Miss Wald had been present.* ]\Iiss Delano recounted the results of that meeting: The whole question of the organization of the Voluntary Aid Detacliment was discussed at length and I stood then positively opposed to it. 1 told the Red Cross that if this plan were put through that I should at once sever my connection with the Red Cross ; that I believed that every member of the National Committee and every meml)er of the State and Local Committees would go out with me. That, to the Red Cross at tliat time, was an unanswerable argument and it was, I assure you. ... a difficult thing to convince tliem that this plan should be set aside and they should turn it over bodily to us to develop. AVe took from them that day the responsibility for the development of the auxiliary nursing service of the American Red Cross. I consider that practically a pledge, a promise, and for five years we have developed that auxiliary service. We have built up every step of the way. detail after detail. We never * For furtlier derails, soo ^linutes of the Xational Committee on Red Cross Nursing Service; also the American Journril of yursing, December, }912, AT NATIONAL HEADQUARTERS 959 had one single interference or one word of suggestion from the Ked Cross regarding the work. Absolutely no pressure has been brought to bear upon us to modify or to change or to alter one iota or one tittle of the plan. It has been our plan. It was indeed the plan of the Red Cross and in every step that I took in the development of the service I was guided absolutely by the Xational Committee, representing first the American Nurses' Association and second equal representation from the three national organizations of nurses. Even the name . . . A^olunteer Xurses' Aide, was selected by the Com- mittee after careful discussion . . . but more than that, the women of this country accepted our leadership.'^ Miss Delano then explained how the course of instruction in Home Hygiene and Cure of the Sick had been used as a basis of selection for the groups of laywomen and how the hospital training of nurses' aides for the base hospital units, had been the next step. At every move, the plans for the development of the service were discussed with leaders of the nursing profes- sion then serving as members of the National Committee on Red Cross Nursing Service. Miss Delano said further: I hold no brief for nurses' aides as such, but I do hold a brief for your obligations and giving your word and then standing by it. For I am absolutely in sympathy with any plan that will help meet the needs of the country to-day. The Eed Cross stands ready to cooperate, in any way possible, in any plan which the Surgeon General adopts to meet the needs of the military hospitals to-day. . . . But I do not believe that any plan suggested now would relieve us of the obligation w^hich we definitely assumed five years ago and I believe that the nursing profession will stand reproached by the ])eople of America if they repudiate the responsibilities which they fought to secure. I have expressed myself as entirely willing to put all the resources of the Eed Cross. and the resources of the Eed Cross to-day are not insignificant. ... at the disposal of the Army, to cooperate in any plan that the Surgeon Oeneral brings forward. We shall go forward with just as much zeal and help in securing a staff for training schools if this should be thought necessary to be done, as we were in trying to provide aides for this service. . . . Tt is not at all a question for us of one thing as against the other. We are willing to ' Twontv-fmirtli Annual Ilcport of the Loapiu? of Xursiiip Education, pp. i()2-it;;i. 960 HISTORY OF AMERICAN RED CROSS NURSING help in any way we can, in any way we possibly can. But I shall never, so long as I stand at the head of the Red Cross Nursing Service, repudiate the solemn obligation we have assumed. Miss Delano then stated her opinion of the proposed Army School of Nursing: Personally, I do not believe that the establishment of a training service will meet the needs. I do not believe it can be put into operation quickly and promptly enough to meet the need when our troops, who are now in service, are brought back to this country. I do not say by that that I disapprove of the idea of a training service or of trying it. I think it is worth while to try anything that will meet the emergency when it comes, because it is surely coming. If it be schools, in carefully selected places, I say let's try and get students for them. I feel that it is for the Nurses' Association and those who are more familiar with the influence of training schools to-day to decide whether this question of the Army training schools is going to be a greater menace than the selection of the nurses' aides for training. I do not pass on that. It is a technical question. . . . But I do feel that there is a place in the small hospital for hands and for feet more or less trained. . . .'^ Although Miss Delano was primarily a nurse and regarded herself as the representative in the Red Cross of the American Nurses' Association, she presented at this meeting in part the continental point of view and thus sponsored the cause of the laywoman. ''To help win the war and to give adequate care to the sick and wounded," wrote ]\Iiss Palmer in the Journal, "was her religion from the day that war was declared. Xext to that came her aspiration to have the rank and file of tlie American Nurs(>s' Association satisfied with her work as their representative in the Tied Cross. . . ." Miss Delano's next words expressed, in part, this intense and earnest patriotism which lighted her whole Red Cross service : What T want to-day is for the nurses of the country to forget everytliing except the importance of the need at this " Twpntv-foiirtli Annual Eeport, N. L. X. E., p. 105. ' Ihid., p. IGG. AT NATIONAL HEADQUARTERS 961 time. If we can meet it one way, let's move heaven and earth to meet it that way. If that is not enough, let us be broad- minded and meet it any way we can. Miss Delano then discussed the possibility of securing enough graduate nurses; the possibility of securing transportation over- seas for these nurses ; the wisdom and necessity of holding these nurses in military base hospitals in France, where they might perhaps be idle for months in order that when an unexpected drive occurred and the wounded w^ere sent back to the bases, they might be on hand and prepared to nurse the men. She next brought up the utilization of soldier-orderlies in hospitals. She said: No one speaks of the able-bodied men in the hospitals. Nobody tells you that to-day there are 115,000 able-bodied, strong men in the Army hospitals alone, doing work for which they are not in any way fitted or trained or prepared, 115,000 able-bodied men doing very hard work in military hospitals, running and waiting on patients more or less effi- ciently. We are talking about 10,000 nurses whom we have in the Army hospitals but we forget that for the 10,000 women we have 115,000 able-bodied men. The Surgeon General in my office the otlier day spoke about that very question. He said he was anxious for the number of able-bodied men serving in military hospitals instead of out learning to fight. And these men arc the pick of the nation, all young, able-bodied, strong, ambitious men, like a lot of running horses tied down to drawing carts. It is not right. Those men, I Ijelieve, should bo re])laced l)y women. . . . Now, 1 say, let us provide the super\ision of the finest women we can find, and let us supjjlemcnt that force with women trained or in ])rocess of being trained, so tluit these 115,000 men. or at least a large proportion of them, can be sent out to training and commissions. Doesn't that sound reason- able? ... For 1 cannot believe that we should use at this time the services of our graduate nurses to sit dowii and feed our help- less men in the war; I believe that women of common sense or judgment, a student or aide or whatever she is, could do those services acce])tal)ly and that a vcrv grave responsiljility will rest upon us if ultimately we prevent from drawing into the hospitals a sufficient number of women, trained students or aides, to meet the military needs.** * Twonty-fourtli Animal Ucport, X. L. N. E., ])p. IfiT-KiO. 962 HISTORY OF AMERICAN RED CROSS NURSING Miss Delano closed her address with a plea for the lay aides : As far as the Red Cross is concerned, we have nothing to recommend. We stand ready to cooperate with any plan brought forward by the Surgeon General. The only point that I think important, and 1 will make, is that we are not fair to the women of this country if we say absolutely after five years of building up a service for them and they are not yet accepted to-day, if we say, "we will have none of you." I think we have prejudiced our profession in the minds of the public by this attitude more than by anything that has ever happened. I have heard things that might never come to the ears of others and I know that there is underneath, in the spirit of the women of this country, a feeling that they have been dealt with most unfairly; and I assure you that I will not take part in anything that eliminates absolutely the women of this country whose loved ones are serving in France.^ Miss Delano left the platform and immediately the president of the National League of Nursing Education called upon Miss Goodrich to present her "Plan for the Army School of Nurs- ing." Miss Goodrich spoke with her usual brilliant powers. The chairman then called for discussion and a spirited re- buttal took place. Finally Miss Niitting threw her influence as a well-loved and trusted leader toward the acceptance of Miss Goodrich's plan. The nursing profession may well be said to have stood, on this May morning, at the cross-roads. Miss Goodrich beckoned at one fork for them to follow her, Miss Delano at the other. The tension of the meeting had grown very high. After further discussion, the chairman put the question to a vote. Miss Powell moved "that the Army School of Nursing as planned by Miss Goodrich be endorsed by the three organizations," the motion was amended to read "as planned by the committee" and was passed. This endorsement of the Army School by the three national organizations of nursing Avas sent to Washington, the Secretary of War approved the plan on ]May 24, 1918, and the development of the School was immediately begun.- Twenty-fourth Annual Report, X. L. X. E., p. lOfl. '"On May 10, 1018, a nieetint; of tlie Xational Committee on Red Cross Xursin^r Service was lield in Cleveland and tlii.s whole question was again discussed. The Minutes of the meijtijip record that Miss Xutting moved "tliat the jueinbers of tlie Xational Committee give their support to the AT NATIONAL HEADQUARTERS 963 On June 8, 1918, Miss Delano wrote to Miss Palmerj editor of the Journal: The discussions concerning the Army School for Nurses' Aides seems to liave developed into very much of a feud . . . with Colonel Smith, Miss (Joodrich and followers represent- ing one side and Dr. (Jolthvater and his foUowers, largely the American Hospital Association, on the other side. I am kept husy trying to steer my craft hctween the hreakers, helieviiig as 1 do that hoth si(U's are right and hoth sides are wrong. With your understan(iing mind, you will know what 1 mean. 1 I)elieve the school idea a good thing to try out and one more way to lielp meet the need and if carried out along ])retty definite lines and with definite affdiations with civilian schools, ought not to disrupt the training schools of the country. On the other hand, I helieve we are entirely justified in using women who are past the age for admissi(jn to this school for minor ])ositions in military hospitals, such as the care of linen rooms, serving diets, feeding of patients and a thousand and one details whicli our graduate nurses have no time to do. . . . On July 22, 1918, General Gorgas wrote to Mr. Davison: Understanding that General Noble told you when at Camp ^leade the otlu'r day something of our recently established Army School of Nursing, 1 am enclosing a report of the conunittce ajipointed to prepare the plan of the school, which may interest you. A\"ith comparatively little publicity, a very great interest lias been aroused and we have not only received over 1(),()(H) letters of inquiry from would-be candidates, but have actually on file over 1000 completed applications a large majt^rity of which meet our requirenuMits for admission. ^lay 1 say that we are indebted for this enrollment in no small measure to the various Ked Cross Divisions and Cha})- ters throughout the country that have constantly recruited for us. It is my belief that this hearty res])onse to the appeal of the school, together with the recruiting drive for a student reserve body of "jrj.ooo which, as you know, tlu' Woman's Committee of Xational Defense with the endorseiiuMit of the IJed Cross and this otlice is undertaking, to jirovide an in- creased munber of students for the civil bos]utals, as well as ])r()iii>s(<(l Army Sduicil in military hospitals ami that tlicN' bend all t>fTorts to hriiiLT it into cxistctK c. Icavinjr the (lucstioii of aides in abfViince until this is scttli'd." This motion was seconded and carried. 964 HISTORY OF AMERICAN RED CROSS NURSING the military, will meet our arising needs and that we need not further consider the preparation of aides through shorter and more superficial courses. It is obvious that should the supply of graduate nurses prove inadequate for the overseas service, this student group will render the most satisfactory service and will be the next to go. I understand that you are preparing aides to supplement the work of the public health nurses in France and Italy. In order not to deflect desirable students from the more con- structive and comprehensive preparation provided through the Army School of ISTursing, and also to avoid any mis- understanding and disappointment on the part of the young women taking these courses, may I ask you to direct those in charge of this branch of work, especially those who are con- cerned with the publicity, to make it clear to these students that these courses will not lead to a nursing service in the Army. By November, 1918, the Army School had 1099 students on duty in twenty-five military hospitals in the United States, 567 more waiting assignment and a total of 10,689 applications filed. The rejection of her proposal for the utilization of Red Cross aides, as contained in the endorsement of the Army School by the American Nurses' Association at the Cleveland meeting, may bo said to have marked the crisis of Miss Delano's pro- fessional career. For the first time, the rank and file of nurses had not followed her. Unquestionably, pressure had been brought to bear on the Red Cross from infiuential groups out- side of the organization. j\Iiss Delano's words show that she felt that the nursing profession, in its continued rejection of lay assistance, was not true to the trust which the National Com- mittee had assumed. In this meeting, Miss Delano had carried her cause into the open, had defended and lost it. On the other hand, the strong professional group may have thought they saw in ]\Iiss Delano's championship of the lay- worker a desertion of the fundamental principles of the nursing profession, a bending before the winds of Red Cross opinion. The principle of the sentimentalist versus the trained worker, as old as American war nursing, had raised its bead again and nurses may have; thought they saw in ]\Iiss Delano a recently won but powerful ally of the traditional influence of th(^ con- tinental Red Cross societies, so inhibiting to efficient nursing AT NATIONAL HEADQUARTERS 965 service. Miss Nutting and Miss Goodrich had spent their lives in trying to better the standards of nursing education; their words spoken at the May meeting show that they did not possess sufficient knowh'dge of the military and nursing situa- tion overseas to recognize the seriousness of the existing short- age of nurses, a shortage which was then estimated at 1121 nurses. This was the time when the statement was made in the Chief Surgeon's office that "a breakdown in medical service was threatened" and on May 3 a cable had been sent to the War Department asking for the immediate dispatch of 555 nurses, but even with these reC-nforcements, it is hard to conceive how the War Department could have thought that a nursing service overseas of some twenty-five hundred nurses would be able to care for the casualties of the then clearly anticipated offen- sives of May, June and July. Because of the Surgeon General's call for fifty thousand nurses by June 1, 1011), Miss Delano felt that it was highly unsafe to trust to a slow, constructive up-building of an edu- cational system like the Army School ; she felt that it was even then a time for emergency action. On the other hand, Miss Nutting and Miss Goodrich did not think the military crisis as imminent as it really was and in view of their long struggle for nursing advancement and standards, it can readily be under- stood how they should have continued to lay the greatest em- phasis upon phases of nursing education. As for ]\Iiss Delano, the Cleveland meeting marked her last public appearance before the nursing profession and in the memories of thousands of nurses her image as she appeared that day was indelibly stamped. For t\w remaining eleven months of her life, ^liss Delano kept her own councils. How- ever, it was not during these last months that she was first called politic. She had always been a silent woman, talking little to her sister nurses regarding her hopes and plans. Among them, however, a strong fraternal spirit of inter-relianct^ and confi- dence had developed; pioneers all of them and intensely eager, they had shared their hopes and the stories of their struggles with each other, but Miss Delano had never taken them fully into her confidence. Because they did not know her well, per- haps because they were not given the chiince to know her well, they distrusted her to som(> extent. However, it is undoubtedly true that the nursing and general pulilic did not sei^n to appre- ciate, in the spring and ^ununer of 1!>1S, the real and impera- 966 HISTORY OF AMERICAN RED CROSS NURSING tive need for immediate reenforcement of the nursing service as Miss Delano appeared to know or at least to sense it. The War Department could not make public the true sanitary situa- tion in France in May and June of 1918. Miss Delano, how- ever, had been for ten years a student of sanitary theory and practice and with that uncanny gift called vision, she was able to look ahead and visualize the conditions which later existed in military hospitals in the zone of the base and the advance, conditions already described in preceding chapters. Many of her listeners that ^May morning in Cleveland must have felt that she was taking an unduly pessimistic view of the situation. Yet on that May morning she was like a prophet crying in the wilderness with voice not heeded. To the student of history the whole controversy well illus- trates the irony and even the tragedy of war. On the days when the nursing profession was preparing to argue these theories at the Cleveland meeting, the Germans had struck their second great blow on the Western Front, this time in the Armentieres sector ; they had advanced seventeen miles up the Lys valley, had finally been repulsed and during the first three weeks of May were massing their forces for their third major ofi^ensive, an offensive during which the fate of Paris and the Allied cause hung in the balance. Knowledge of the extreme military crisis, however, was then not fully known or made public, and indeed neither student nurses nor Red Cross aides nor all the graduates then in civilian hospitals in the United States could have relieved the nursing shortage existing late in May and early in June in France for there were no ships available to carry them overseas. Throughout the last year of the European War and especially during the summer of 1918, many hundreds of nurses were kept marking time at Ellis Island, because precedence in transportation was neces- sarily given to combat troops and supplies. ^'We'll do it another way !" IMiss Delano declared after the Cleveland meeting had adjourned. Following the acceptance of the Army Scliool as a substitute for her plan of utilizing Red Cross aides to supplement professional military nursing service, tlic recruiting of a sufficient number of graduate nurses to meet the militnrv needs seemed to ^liss Delano the only way out. This was tlie first duty of the Red Cross J^Tursing Service and INIiss Delano knew tbat the executives at National Head- quarters would put no obstacles in the way of her purposes and AT NATIONAL HEADQUARTERS 967 plans. She knew that she possessed the complete confidence of the War Council, for once ]\Ir. Davison had said : "Do as you think best, Miss Delano. Keep us informed of your general plans and of the money you need, but go ahead yourself. Even if you make mistakes, you know more about Ked Cross nursing than any other woman or man we could get to handle it." Miss Delano and her assoqiates returned to Washington and to Division headquarters and during the torrid summer months flung themselves into the recruiting of graduate nurses. 8he and ]\Iiss Noyes built up an office force at National Head- quarters of over one hundred persons. The Division staffs wore enlarged and the entire Ked Cross ^Nursing Service, with its State and Local Committees, bent its energies almost solely to securing graduate nurses. The total number of nurses needed was divided into thirteen parts and a quota, based upon the nursing resources of each locality, was given to each Division Director of Nursing and she was charged with the responsibility of securing her quota. The following statistical table is of interest: Assignments First Assignments Allotment Allotment to August 1 Still Due Atlantic 5708 2000 3108 45% Central ,-5940 2311 1629 58% Gulf 8fi4 324 540 37% Lake 2748 1205 1543 43% ^Mountain 2G4 221 43 83% New England 3318 13G0 1958 41 7o Nortliern 11G5 598 567 50% Xortliwestern 641 386 255 60% Pacific 1030 899 187 87 7o Pennsylvania 2154 1302 852 60% Potomac 1300 764 602 56% Soutliern 1371 382 989 28 7o Soutlnvostern 2425 995 1430 41 7o The effects of the ^'nurses' drive" have been given in a previ- ous chapter. For the five months beginning July 1 and ending December 1, 11,118 luirscs were enrolled, an average of 2220 nurses a month. Tn one month alone of that historic summer, the American Red Cross secured and assigned to the ^lilitary Establishment over twice as manv graduate nurses as there 968 HISTORY OF AMERICAN RED CROSS NURSING were students supplied by the Army School during the entire period of hostilities. In July, 1918, the Comptroller of the United States Treasury rendered to the Secretary of War a decision of injustice to Army nurses. Information as to this ruling and its possible effect upon the nursing situation was contained in the follow- ing letter of protest written on August 31 by Miss Noyes, as president of the American I^urses' Association, to the Honor- able W. W. Warwick, comptroller of the U. S. Treasury : On July 16, you rendered a decision to the Secretary of War to the effect that members of the Army ISTurse Corps who may be taken as prisoners of war are not entitled to pay during captivity. I feel sure that you were not familiar with the history of the organization of the Army Xurse Corps and its legal relation to the Army, when you rendered this decision. As president of the American Nurses' Association, which is affili- ated with the Eed Cross and assumed with it the responsibil- ity of organizing the graduate nurses of this country as a reserve of the regular Army Xurse Corps, I was filled with dismay when I read your decision. Keudered at a time when the Government was appealing for a thousand nurses a week for service with the Army, your decision could not help but be destructive to their enrolhnent. It is therefore a vital IdIow at the welfare of our soldiers. Approximately fifteen thousand nurses are in service with the Army and Xavy. These nurses who have already entered the service and those al)0ut to enroll should liave every assur- ance that the government is ready to jirotect them in their hazardous work and safeguard them in their statutory rights. Will you not be willing to give them this assurance? On S(^ptembor 27 a decision was rendered by the Comptroller of the Treasury which reversed the ruling of July 16. It was addressed to the Secretary of War and contained the following paragraphs : In view of unusual conditions that have arisen, I am of the opinion tliat from the time any member of the Army Xurse Corps is a prisoner of war held ])y the enemy, without fault on her ]iart as to her capture, her absence from duty should be excused as unavoidable and she be treated as in a full pay status. AT NATIONAL HEADQUARTERS 969 The decision of July KJ, 1918, is niodided accordingly. As to field clerks and members of the Army Xurse Corps reported "missing," my decision is similar to that given in the cases of oflicers and enlisted men reported "missing" (25 Comp. Dec, 3(5) and is as follows: No definite general rule that shall cover pay of field clerks and members of the Army Xurse Corps reported "missing" in action or otiierwise missing shall be formulated. "Their pay should be withheld until their status can be definitely ascertained. In case no information estal)lishiiig their status can be obtained, indi- vidual cases must be considered on their merit and determined upon such evidence as may be obtainable." ^^ Another trying condition which Miss Noyes met was the refusal of wealthy chronic patients, some of whom were in health good enough to permit them to go to their olTices every day, to give up their private nurses. Another minor difficulty was encountered in the protests of doctors who refused to re- lease for military service office nurses whcmi they wished to retain to hold their practice together while they themselves went into the Army. Protests also came from owners of small private hospitals, who refused to give up their graduate special luirses. In this respect, however, many small private hospitals were patriotic enough to close their doors entirely for the period of the war. On August 1 the Surgeon General issued his historic call for a "thousand nurs(^s a week for a period of eight weeks." The strain at National Headquarters grew intense, ^[oreover, Washington was overcrowded and was suffering from record- breaking heat. In a letter addressed September .5 to Miss De Long in Italy, Miss Noyes wrote: The work at National Headquarters has never been so diffi- cult and is now overwhelming us. The demand for one thousand nurses a week by the Surgeon Ceneral has made it necessary for everyone to buckle down to work from one (Mid of the Ignited States to the other in order to rout out every possible nurse from her hiding jilace. We have done a tremendous piece of work, ^'esterday we sent the papers of '['24 nurses io tiie War DeiJartnieut. tlie day before l.'V2. and ibey average i^t! per dav. There will be no nurses left in civil life if we ke(>p on at this rate. . . . " Decisions of the Comptroller, U. S. Treasury, Arniv Field Clerks, A. G. ()., 221.51; p. 6. 970 HISTORY OF AMERICAN RED CROSS NURSING There seems to be an impression abroad that the war may end in 1919. At this critical moment an unfortunate newspaper article had a definitely inhibiting effect on recruiting. A personal interview with the chairman of the Committee on Nursing of the Council of National Defense was so written as to sound official and unduly optimistic. Lest the impression given by this article should deter nurses from entering military service, the Acting Surgeon General of the Army issued a public state- ment of the actual nursing conditions and also stated it in a letter written September 7 to ]\rajor Franklin Martin, then chairman of the Medical Board, Council of National Defense : At least 25,000 graduate nurses will be needed by January or as soon as they can possibly be obtained. There are at pres- ent somewhat over 1G,000 graduate nurses on duty at home and abroad. This number by no means meets the need of the present situation, owing to the fact that large numbers of troops are being sent overseas weekly. The Ked Cross reports that over 9000 additional graduate nurses must be enrolled before January 1 to meet this need. In the Atlantic Division alone, which includes New York City, 2452 additional nurses must be enrolled to complete their quota. It will be impos- sible for the Army School of Nursing to be of any great assist- ance in solving the nursing problem of military hospitals during the present year. Only 221 students have as yet been assigned to seven (7) cantonment hospitals and 105 additional are under orders to proceed, but they cannot be relied upon to take the place of graduate nurses, as they are expected to serve a four months' probation with only a limited number of hours in the wards of the hospital during this probationary period. It is rocjuested tliat such action as may be necessary be taken to correct this statement, in order that the public and the nurses may be informed of the true situation and that the work of recruiting nurses shall not be interfered with. . . . This incident was also of some importance in that it illustrated the danger of misunderstanding which may arise when two national committe(>s such as the Committee on Nursing of the Council of National Defense and the National Committee on Red Cross Nursing Scuwice were both operating in the field. In the fall of 101 S tlic n\irsing needs of the civilian popula- AT NATIONAL HEADQUARTERS 971 tion engulfed the American Red Cross. Late in August, Span- ish influenza broke out among the men of the Navy Receiving Ship in Boston Harbor and swept across the United States during September and October. The first call for Red Cross assistance came on September 14 from the United States Public Health Service, for nursing personnel for the Quarantine Sta- tion, Boston Harbor. Almost simultaneously, calls began to come in from all parts of New England and from Washington, D. C. Within a few weeks the infection had become pandemic in the eastern cantonments and spread from the soldiers to the civilian population and thence westward. One thousand nurses, it will be remembered, had been withdrawn from the cantonment nursing stafts and had arrived in August in France. True, the American Red Cross had sent the papers of 2700 additional nurses to the Surgeon General's office in August alone, but it took some time to assimilate these nurses into the Military Establishment. On September 7 the Army School had only 221 students on duty in seven canton- ment hospitals, according to the Acting Surgeon General's let- ter of September 7 addressed to Dr. Martin. These students were "green probationers" and it was estimated that it would take four months of training before their services would be of material value. The truly desperate condition which existed in the cantonment and Naval hospitals during that memorable September and October of 1918 has already been described. Colonel Ayres wrote : More than 40,000 died of pneumonia. Of these, probably 25,000 resulted from the influenza-pneumonia pandemic which swept through every camp and cantonment in this country and caused thousands of deaths in the Expeditionary Forces. Up to September 14, 1918, only 9840 deaths from disease had occurred in the Army and the death rate for the period of the war up to that time was only 5 per year for each 1000 men. During the eiglit weeks from September 14 to the 8tli of November, 31(),089 cases of influenza and 53.449 of pneu- monia were reported among troops in tliis country. The ex- plosive character of the epidemic is shown in diagram 50 : [83.G9r of the total deaths were from ])neumonia|. It reached its high ])oint the secoiid week in October, when four out of every 1000 troo})s under arms in this country died. . . .1- " " "Tlie War with Cerniany," pp. r2r)-12G. 972 HISTORY OF AMERICAN RED CROSS NURSING The situation among the civilian population was equally critical and responsibility for aid was vested in the United States Public Health Service and the American Red Cross. At National Headquarters a meeting was called at which were present representatives of the Surgeon Generals of the Army, the Navy and the Public Health Service and of the Red Cross and a preliminary plan for affording nursing relief was formu- lated. ]\Iiss Delano was then in Atlantic City attending a meeting of the American Hospital Association, so Miss Noyes drew up the plans for the mobilization of nursing resources and throughout the pandemic carried all national details re- garding nursing relief. National Headquarters was of course the center to which the nursing needs of the entire country came. National morale was already under a heavy war strain and the confessed lack of medical knowledge regarding the nature of the disease fanned the flames of public alarm. Many hundreds of nurses in civilian and military service themselves came down with the disease and the calls for nurses increased proportionately. By long distance telephone, by telegraph and personal interviews with Miss Noyes, State health officials. Army officers, heads of civilian hospitals and particularly men in charge of indus- tries, importuned National Headquarters: ''If you cannot send us nurses," they affirmed, "our men will all come down with the flu and production will stop." On September 24 ]\[iss Noyes wired the Division Directors of Nursing to mobilize all Home Defense nurses for emer- gency duty to meet tlie situation. The assignment to influenza w^ork of nurses who were being mobilized for military service was to be avoided as long as possible. No Division was per- mitted to recruit nurses from other Divisions without confer- ring with National Headciuarters. Nurses not enrolled in the Red Cross Nursing Service, attendants, practical nurses and laywomen volunteers who had taken the Red Cross course in Home Hygiene and Care of the Sick, were to be assigned to duty under the direction of enrolled Red Cross nurses. All Local Committees on Red Cross Nursing Service were to be called upon innnediately for recruiting nursing personnel. In every Division Department of Nursing, additional clerical as- sistance was to be secured and masks made in the Chapters for use in Army cantonment hospitals. Complete records of all assignments ^vere also to be kept. AT NATIONAL HEADQUARTERS 973 The need for nurses daily grew more imperative. On Sep- tember 27 Miss !Noyes telegraphed to all Division Directors of Nursing: We should like you to orfranize in your Division one or more mobile units of ten to iifteen nursing })ersonnel to be sent to other localities if necessary. IMace competent Home Defense nurse in char<(e and autiiorize her to secure assistants, under- graduates, attendants, or nurses' aides and prepare them for instant service. Several days later the general manager appointed a National Committee on InHuenza, which was composed of the directors of the departments at National Headquarters, with W. Frank Persons, then Director General of Civilian Kelicf, as chair- man. On October 1, Kupert Blue, Surgeon General of the U. S. Public Health Service, vested in the lied Cross the fol- lowing responsibility : In order that all available resources may be utilized to the best advantage in combating the present epidemic of influ- enza, 1 have the honor to make the following recommendation in regard to the ])articipation of your organization in this campaign : 1. That the Hed Cross assume charge of supplying all the needed nursing })ers()nnel and pay the salary and other ex- penses connected with the detail of such personnel for work during the present e})idomic. 2. That the l?ed Cross furnish emergency supplies, when it is found that local authorities are unable to furnish such supplies with the promptness required by existing circum- stances. On the same day, the War Council appropriated $575,000 for influenza relief and the entire Hed Cross organization, in Washington and in the field, set to work to combat this most virulent of any pandemic which had hitherto attacked the country. The coc'iperatiou between tlic Federal Pul)lic Health Service and the American lied Cross was outlined in the following Plan, issued October o : 1, That the lied Cross should assume charge of supplying needetl personnel and will ])ay salaries and other expenses 974 HISTORY OF AMERICAN RED CROSS NURSING connected with detail of such personnel for work during the present epidemic. 2. That the Eed Cross will furnish emergency hospital sup- plies when local authorities are unable to furnish such supplies with the promptness required by existing circum- stances. 3. The United States Public Health Service wdll gather facts about the spread of this disease and the adequacy of existing resources and will determine when and where to send additional nursing personnel and emergency hospital supplies and to what person the nursing personnel shall report and such supplies be delivered. 4. The Public Health Service will decide when any such nursing personnel and supplies have served the emer- gent purpose and may be transferred to some other place for further duty. 5. The Nursing Department of the Red Cross will have full charge of enrolling and assigning all nursing personnel as requested by the Surgeon General and will also determine their salaries and other compensation. In this connection it is important to add that the widespread call for nurses and the obligations of the Nursing Service to supply nurses also for the Army and Navy render it imperatively neces- sary that the Nursing Department shall, through its own officers and committees under the direction of the head of the Department, be and remain in full charge of this part of the program. 6. The United States Public Health Service will conduct all necessary dealings with the state and the local boards of health concerning all the above matters and the Divisional offices of the Red Cross will act in providing nursing per- sonnel and in furnishing supplies only upon the request of the Federal Public Health Service. 7. The United States Public Health Service will mobilize all needed doctors. 8. The United States Public Health Service will from time to time ask the Red Cross through the usual channels to distribute official statements issued by the former concern- ing means of prevention and methods of care of this disease. 9. All general publicity concerning the part of the Red Cross in this program raid all general directions concerning the use of the Red Cross resources except the enrollment and assignment of nursing personnel will be issued by tlie chairman of tiie Red Cross National Committee on Influenza. AT NATIONAL HEADQUARTERS 975 Development of this general plan for further mobilization of the Red Cross for emergency relief was authorized during the next few days. Each Red Cross Chapter was instructed to organize immediately a Chapter Committee on Influenza, con- sisting preferably of the chairman of the Chapter, a leading physician, a representative of the Local Committee on Red Cross Nursing Service where one existed, the chairman of the Chapter Committee on Nursing Activities, the chairman of the Home Service Section, and such additional members as were deemed necessary. This committee was instructed to work in close cooperation with the local public health officer, making a survey of available nursing personnel and hospital supplies within its jurisdiction. Only at request of the local health officer and in consultation with the Division office, how- ever, were these nurses and supplies to be mobilized to meet local needs. A Division Committee on Influenza was also appointed, made up of the Division ^lanager, the Division Directors of Civilian and ]\Iilitary Relief, Nursing, Supplies, Accounts and Chapter Production. After issuing this general plan for mobil- ization of all Red Cross resources, the National Committee on Influenza left its further developments, excepting- where ques- tions of policy arose, to the judgment of the Division and Local committees. The educational campaign was developed largely by the L'nited States Public Health Service. The medical and nursing relief afforded by the Red Cross to the civilian population in large cities, industrial centers, small towns, and rural and isolated communities was probably as extensive as has ever been offered by any Red Cross society in any country and is therefore of interest. The efforts of the Red Cross in the larger cities in the United States is well illustrated in the work done in Washing- ton, I). C. In cooperation with the United States Public Health Service, the Local Chapter equipped and maintained an influenza hospital on F Street. When it became evident that this hospital would be inadequate to care for the increas- ing number of patients, a second hospital was opened by the U. S. Public Health Service at Eighteenth and Virginia Ave- nues. Lucy ^linnigcrode rendered conspicuous service in or- ganizing the F Street hospital and Rachel Independence Al- baugh, whose name will appear numerous times in post-^^rmis- tice sections of this history, handled details of equipment. 976 HISTORY OF AMERICAN RED CROSS NURSING The U. S. Public Health Service divided the city into head- quarters and four main divisions, each of which was then sub- divided into districts. Each district had a headquarters to which all calls for influenza relief work should come. A cen- tral recruiting station for nurses was opened by the Red Cross Chapter at Fourteenth and F Streets, for the purpose of secur- ing additional nursing personnel. In this the cooperation of the school teachers proved of great value. As the schools throughout the country were closed during the most virulent periods of the epidemic, many of the teachers volunteered as assistants to the nurses and rendered efficient service. The work of lay volunteers, especially that rendered by women who had had Red Cross class instruction, was of great value. An enrolled nurse who had once taught classes in Home Hy- giene but who had had to give up active service on account of ill health, rallied to duty again during the pandemic. She wrote : Owing to my semi-mvalidism, I was not officially under the local organization, but my former students had enrolled with me and I called on them. We did what we could where we ourselves knew the need to be great and we were able to carry several hundred homes through to safety with only one death. Many refused relief, but we systematized our work so that the inexperience of the volunteer aides would not work hardship either on patient or aide. I sat at my phone day and night, backing tlieir orders with advice and instruction. It was the sweetest thing in the world to hear their responses come back when I called on them, "Why, yes, of course I will do what I can to help." To return to the District of Columbia, the District Chapter Canteen Service organized a kitchen in each of the four divi- sions, where food was prepared for those who could not secure it in other ways, because of the illness of members of their families or because of the crowded conditions existing on ac- count of the housing problems. From this kitchen in each division a hot lunch was daily served to doctors and nurses to save their time. The District Chapter ]\lotor Corps put its ambulances and other cars with their drivers to valuable use in carrying patients to the hospital and in transporting the nurses about the city. The organization which was developed in industrial towns AT NATIONAL HEADQUARTERS 977 is well illustrated by the work at Wilkes Barre, Pennsylvania. Mrs. Gertrude Williamson, the Ked Cross nurse in charge of the emergency hospital, wrote: For two days, volunteers mostly from Red Cross classes in Home Hygiene and Care of the Sick, worked like beavers, cut- ting draw-sheets, making up the Army cots, scrubbing hat- racks to serve as linen shelves and cleaning camp chairs to be used as bedside tables. The Armory was scrubbed from roof to basement and four wards were partitioned off with beaver- board and lavatories and sinks were installed in the only available rooms. The I^ed Cross Canteen Service took entire charge of the basement kitchen and, with a few paid employees, but mostly volunteers, served all the food to the nurses, the physicians, the orderlies and the members of the National Guard who w^ere always on duty, besides sending out food, broths mostly, to over 150 families daily, who because of the "flu" had no one well enough to prepare their meals. In small towns, where there were rarely any hospital facili- ties of any kind, the emergency was met in an equally efficient way. In Watkins, Xew York, the Ked Men offered the use of their hall to the Local Ked Cross Chapter as an emergency hospital. This offer was immediately accepted. The problem of equipment presented a grave difficulty but each housewife sent whatever she could spare a cot, a pair of sheets, a blanket. In the same way, the kitchen was supplied and the principal of the High School, released for the period of the contagion, took complete charge of the preparation of the diets. In rural communities, where no hospital facilities existed, the Local Chapters established temporary ones in schoolhouses or churches. Miss Barber, Director of Nursing of the North- ern Division, wrote : The houses are often half a mile or more apart from each other, so we used tlie rural and village schoolhouses for emergency hospitals, wiring them with electricity in many cases just for tliis iiurposc. We also sec-ured mobile kitchens, which had previously been used in the harvest fields, and attached them to the schoolhouses for canteen service. The result was highly satisfactory. To the most isolated countrv districts, we assiirned nurses' 978 HISTORY OF AMERICAN RED CROSS NURSING aides who remained in the houses of their patients as long as the need for nursing care existed. A nurse assigned to influenza relief work in Denio, Oregon, wrote: Our patients are mostly families of sheep herders ; they live in miserable cabins scattered in most inaccessible places, a house to a hill and each hill from twelve to fifteen miles apart. There is no food, no bedding and absolutely no conception of the first principles of hygiene and sanitation or of nursing care. I have taken over the hotel as a hospital' and the Big Boss, who employs the sheep herders, is having all who are not too ill to be moved, brought in here. The men are willing, some are intelligent, but most are sick, and if it were not for the grit and brains of the nurses who have been working here before and for the women of the community, God help us ! I am writing by fits and starts, as 1 can snatch a minute off to jot down our needs, hoping that the situation may be clear to you and that you will be able to get us some supplies before we get snowed in for the winter. Our greatest need (next to fruit and malted milk) is feeding cups and drinking tubes, which we can't get at Winnimucca, our nearest town. We also need lots of gauze or cheesecloth and cotton for pneumo- nia jackets ; also rubber sheeting and quantities of old rags, to be used and burned, also gallons of formaldehyde, if we are to stamp out the disease; everything is thrown on the ground and will thaw out next spring and release all these germs again, if we do not take precautions against it. Annie L. Colon, a Red Cross public health nurse on duty in Luce County, northern Michigan, wrote : Some of our patients lived miles back in the woods in the logging camps where not even a road could reach them. We would go after our patients in hand cars, mounted on the logging trains, and so saved many lives. We had gasoline engines on tlie most modern type of hand cars and we hitched a flat car to each one, usually with wire, put a board floor on it, laid mattresses over that and with a canvas cover to break the wind we carried our patients fifteen or more miles to a decent bed and a chance to live. With this equipment, we rode usually at night through the deep woods and over the rough roadbeds to the camps. Many AT NATIONAL HEADQUARTERS 979 times we would find thirty or forty eases, sometimes ten people all with fever over 104 degrees, huddled together on two or three beds in a tiny cabin, too sick to remove their clothes. Assignments of Red Cross nursing personnel (including en- rolled nurses, Home Defense nurses, pupil nurses, practical nurses and laywomen who had taken the Red Cross course in Home Hygiene and Care of the Sick), which covered only the first wave of influenza that swept across the country from September 14, 1918, to November 7, 1918, totalled 15,000 women. On November 2, 1918, the United States Public Health^ Service reported that 115,000 persons had died from influenza and pneumonia. The battle deaths of the American Expedi- tionary Forces were 48,900, less than half the influenza deaths, and the pandemic was not yet under control. The contagion continued to spread and Red Cross relief was carried on until late in the spring of 1919. In round figures, the number of civilian deaths from infiuenza and pneumonia totaled 150,000 persons. During the influenza epidemic, I^ational Headquarters had opportunity to test the efiiciency, as an emergency relief agency, of Red Cross national, division and local organization to an extent unequalod even by the opportunities for service coinci- dent to the European War. Moreover, JSTational Headquarters learned beyond doubt that this organization could and did function cfliciently. The influenza epidemic impressed upon the general public realization of two vital needs. The first of these was the need for organized public health nursing activities in every com- munity. "The only good which could possibly come out of an epidemic which has carried off a great number of our best as well as our poorest citizens," wrote Katherine La Prade, chair- man of the Xursing Committee of the Victoria (Texas) Red Cross Chapter, "is the proof to the public of the need and value of organized public health nursing service and also the absolute necessity for a county hospital in every rural community," A second need was that of health education. In many places a fear of the influenza prevailed which was akin to the terror of the Middle Ag(>s regarding the Black Plague, Amy Potts, Red Cross public health nurse in ^[onmouth County, New Jersey, wrote : 980 HISTORY OF AMERICAN RED CROSS NURSING One poor woman had nursed her husband and her three boys through serious cases of the flu and then came down with it herself. All she begged was to be left alone, she was so "tired." Her husband got up and tried to do his best. Not one of the neighbors would come in to help, I stayed there all night and in the morning telephoned to the woman's sister. The sister came and tapped on the window, but refused to talk to me until she had gotten a safe distance away. Finally I managed to pull her into the house and convinced her that she had to stay. When she heard that her sister's recovery was doubtful, she was ashamed, but we could do nothing for the woman after midnight, except send for the priest. The influenza epidemic and the resulting call for nurses came at a time when the entire Red Cross Nursing Service staff was already overburdened with the needs of the Military Establishment. At National Headquarters, Miss Delano and Miss Noyes had long since begun to show the effects of the responsibility and work they had been carrying. These were trying days, also, for Miss Kerr and Miss Deans, for the pa- tience of these two perhaps Miss Delano's closest friends at National Headquarters was often tried by their harassed and exhausted lady-in-chief. As August and September had passed wdth crowded, oppres- sively hot days and breathless nights, the contrast of tempera- ment between Miss Delano and Miss Noyes had daily grown more apparent. Dark circles deepened under Miss Delano's eyes, her usual kindliness of manner gave way now and then, deep lines appeared about her resolute mouth. But at no time in her entire Red Cross service was she less confident, less splendid in her sure and brilliant strength. If ^liss Delano carried the major responsibility for the poli- cies and ways and means of procedure, ]\Iiss Noyes carried the actual responsibility for and details of recruiting and as- signing nurses to military and influenza service. As her bur- dens increased, ]\Iiss Noyes grew more silent, more poised, in appearance more cool. Her unshakable control, the result of temperament and circumstances, seemed to render her impervi- ous to vexatious detail. Looking neither to the right or left, seemingly indifferent at times even to ]\riss Delano's extreme urgings for liaste, she forged ahead on the given task that was hers. Karly in the autumn of 1018, General Gorgas went overseas AT NATIONAL HEADQUARTERS 981 and Merritte W. Ireland, Chief Surgeon of the American Ex- peditionary Forces, was recalled to the United States and was appointed as Surgeon General. General Ireland was probably more familiar with the actual nursing shortage existing in the Medical Department in France than any other man and one of his first moves was to call upon the American Red Cross to recruit fifteen hundred nurses' aides for immediate service overseas. This request involved the initiation of an extensive drive for aides and plans were developed for securing them through cooperation with the Daughters of the American Revo- lution, the Association of Collegiate Alumna, the Professional Section of the Women's Employment Service of the Depart- ment of Labor and other organizations which were in touch with women who would qualify as candidates. The call for aides seemed like the '4ast straw." However, the beginning of the end was in sight. On November 6, a United States Army hospital train on which three reserve nurses were serving stopped at the station at Sommielle, France. One of these nurses was Anne P. Hill; she wrote: An officer in charge of the scliedule of trains passing through Sommielle told one of our officers that a special train was then on its way toward Verdun and that this train was carrying the principal Allied war generals to meet a dele- gation from Germany. The news spread like wild-fire through the train and greatly excited patients and nurses alike. xVt four o'clock on the afternoon of November 8, a special train drew up to ours on the next track and on it were those same war generals return- ing from negotiating an armistice with the Germans. All the country-side, too, seemed to sense that the end of the war was in sight. . . . The first word that an armistice had been signed and that firing had ceased, came to Washin<>ton and to Red Cross Head- quarters at eleven o'clock on the morning of Xovember 10, but was a false report. A conference was being held in ]\Iis3 Delano's office when Annie^ the small messenger girl, burst in, clapping her hands and crying: "Peace has been signed, ^liss Delano, peace has been signed !"' The nurses and office force rushed out to confirm the report, for newspaper boys were calling the extras. ^liss Delano and ]\Iiss Xoves stood looking at each other in the deserted, sunshine-fiooded room. 982 HISTORY OF AMERICAN RED CROSS NURSING An hour later Washington had gone mad with joy. Govern- ment clerks, soldiers, young stenographers, business men, offi- cers, had rushed out from the government buildings and swept in a screaming, waving hysterical mass to the closed and guarded gates of the Executive Office of the White House. Until late in the night, the celebration continued. On that same night in an Army tent of Evacuation Hospital No. 8, which was located at Souilly, near Verdun, France, a group of tired American Army nurses gathered about the stove in complete discouragement. They knew that the firing had not ceased, because they could still hear the sound of the guns. Among them was a Navy nurse on detached duty, Mary Elder- kins. She wrote : Eumors of peace had kept drifting in, but we really had little faith in them. The false armistice report made but a slight impression, as we could still hear the fighting going on. The night of November 10 we were sitting in my tent around the stove in utter dejection. We regretted that the hopes of those in America and of the rest of the world were being raised only to be disappointed, so sure were most of us that there would be no armistice. At 3 A.M., November 11, we were awakened by the most terrific barrage we had had in weeks. Someone cynically remarked, "That sounds like peace !'' At 9 A.M. the message came that the Armistice had been signed. At eleven al] ears were strained to see if the firing would cease. It did ! We operated all day long and received wounded men as late as eleven that night, but the usual ceremony of putting up tlie black curtains at five o'clock was omitted and for the first time we looked out on a camp ablaze with light. CHAPTER XI DEMOBILIZATION Miss Delano's Death The Close of the Military Program Overseas Bureau of Information for Nurses Nurse Corps, U. S. Public Health Service Caswilties Among Nurses Memorials to Nurses Red Cross Aides Educa- tional Projects Militarij Rank for Army Nurses A WEEK after the sig^iing of the Armistice, Miss Delano had presented to the War Council a plan for the de- velopment of public health nursing and class instruction throughout the United States and had won its approval. Full accounts of these projects may be found in subsequent pages. This chapter will relate the closing of the military program, the return of nurses from military to civilian fields, post- Armistice activities and the final termination of American Red Cross war emergency relief in Europe. The shutting-down of the military nursing needs was im- mediate. Three days after the Armistice had been signed, the Superintendent of the Army I^urse Corps had notified all nurses awaiting assiiiiiment that ''unless such steps had been taken by them toward entering the service as to make it in- convenient and a financial loss if they did not do so, they would not be given service in the immediate future." ^ The lowering of the standards for service in the Army Xurse Corps on ac- count of the urgent need for nurses, was immediately rescinded and all nurses whose applications showed that they did not meet the former peace-time requirements, were informed that they were not eligible for appointment. Four hundred of the nurses then awaiting transportation (n'ers(>as at the ^lobiliza- tion Station in New York and there were on November 15 some fourteen hundred of them were sent to France as soon as transportation could be secured to relieve the shortage exist- ing there. On Xoveniber If) Miss Thompson wrote ^liss Delano: * See Weekly Report eiulinir Xoveniber 15. IHIS. of the Superintendent, Army Nurse Corps, to the Surgeon General, U. S. A. <)83 984 HISTORY OF AMERICAN RED CROSS NURSING Since the signing of the Armistice within the past week, the need for the assignment to active duty of more nurses has ceased, at least for the time being, as it is thought there is a sufficient number for the present need. This office has re- ceived instructions to assign no more nurses to active duty and to notify the Eed Cross to that effect. It is thought wise, however, that the recruiting of nurses be continued in the event of a possible future need. In all probability, nurses' aides will not be called, either for duty in this country or abroad, but there seems to be no reason why the Eed Cross should not continue with the train- ing of these aides in cooperation with the civil hospitals, but it should not be with a definite understanding that they are to be called into service as soon as they have completed their training. On November 23 Surgeon General Ireland wrote Miss De- lano: The war being virtually over, I desire to take this occasion to express my appreciation and that of the Medical Depart- ment of the Army of the splendid service which you and your organization have rendered the government in supplying practically eighteen thousand nurses to the Army Xurse Corps alone. The group of women now serving in the Corps is, I believe, one of the largest organized groups of professional women in the world, and it is largely due to your efforts and that of the nurses of your organization that this has been made possible. The service of the nurses have been efficient in the highest degree and their work both in this country and abroad has been very highly recommended. I desire also to express through you, to the directors of the different Divisions of tlie American Eed Cross and their assist- ants, my appreciation of the remarkable service which they rendered the government during the influenza epidemic in supplying the military hospitals with hundreds of nurses and nurses' aides for tenrporary duty at a time of acute need. A statistical summary of the nurses in military service showed that the Army Xurse Corps had on duty on Xovem- ber 15, 1918, approximately 21, .'^44 nurses. Of this number, some nine thousand were serving with the American Expedi- tionary Forces in (iroat Britain and France; fourteen hundred others were in Xew York City awaiting transportation over- seas; the remaining eleven thousand were on duty in military DEMOBILIZATION 985 hospitals in the United States. The papers of five hundred more were in the Surgeon General's office, these nurses await- ing at home their travel orders. Of this total maximum strength of the Army Nurse Corps of 21,480 nurses, 17,931 were reserve nurses nurses recruited and assigned to the Military Establishment by the American Red Cross Nursing Service. Thus more than four-fifths of the members of the Army Nurse Corps were American Red Cross nurses. Of these 17,931 reserve nurses some 4400 had joined the Army Nurse Corps as members of base hospitals ; some 400 as members of base hospital units, some 11,500 as members of emergency detachments, about 1400 as members of training school units and approximately 200 as members of special units. During the nineteen months in which the United States par- ticipated in the European War, the American Expeditionary Forces suftered 280,330 battle casualties, of which 48,909 were of men killed in action. In the American Army 56,991 men died from disease and 6522 from accidents. Thus the total number of lives lost in the Army, including the Marines attached to it, from April 5, 1917, to May 1, 1919, were 112,- 432. Five out of every six men who were sent to hospitals were cured and returned to duty. In the toll of battle deaths of the European War, the United States stands third from the Ixjttom of the list of belligerents, as the following table will show: Russia 1,700,000 Germany l,fiOO,000 France 1,385,300 Great Britain 900,000 Austria 800,000 Italy 330,000 Turkey 250.000 Serbia and ^fonten^ egro 125,000 Belgium 102,000 l?()uniania 100,000 Bulgaria 100.000 United States 48.900 (JiH'ece 7,000 I'ortugal 2,000 Total 7,450,200 2 - "Tlie War with ritTinaiiv," p. 119. 986 HISTORY OF AMERICAN RED CROSS NURSING While the European War was undoubtedly the bloodiest in the history of warfare, the disease rate among the American forces was remarkably low. Nineteen out of every thousand men of the Expeditionary Forces died of disease. During the Mexican War, 110 per year of every thousand men had died of disease ; during the Civil War, 65 out of every thousand men, and during the Spanish-American War, 26 out of every thousand men. The causes of this remarkably low disease death rate among the American forces in the European War was due to ( 1 ) a highly trained medical and nursing personnel ; (2) compulsory vaccination of the entire Army against typhoid fever; (3) thorough camp sanitation and control of drinking water; (4) adequate provision for hospital facilities.^ On November 11, 1918, the total strength of the Navy Nurse Corps was approximately 1500 nurses. The maximum number of nurses actually serving in the Navy was reached on October 19, 1918, when 1460 nurses were on duty. Forty- three others had signified their willingness to undertake navy nursing service, had executed their oath of office and were awaiting travel orders but later resigned on account of the lessening of the needs for nurses due to the signing of the Armistice. Of these 1503 regular and reserve members of the Navy Nurse Corps, 1058 had been recruited and assigned to the Corps by the American Red Cross Nursing Service. Thus more than two-thirds of the members of the Navy Nurse Corps were American Rod Cross nurses. The total number of deaths in the Navy between April 5, 1917, and :\Iay 1, 1919, was 10,068 men. Thus the cost of life to the American jMilitary Establishments during the Euro- pean War was 122,500 men.'* The American Red Cross Nursing Service assigned 18,989 of its enrolled nurses to the ]\lilitarv Establishments and in addition assigned 284 to the hospitals and cantonment zones of the United States Public Health Service and 604 others to foreign service under American Red Cross commissions to the Allies. Thus the total number of American Red Cross nurses in military service during the European War was 19,877. The total number of American graduate nurses who served in the European War was 23,868. "'Tlio War with Gormanv," p. 125. *Ibid., p. 123, DEMOBILIZATION 987 Sinco 1012 Miss Delano had not left tho United States, as she had felt that her place was at National Headquarters. She had long desired, however, to see the conditions under which nurses were working in Europe ; the War Council also wished her to go overseas. On December 15, 1918, Miss Noyes was appointed acting director of the Department of Nursing, and Miss Delano left Headquarters and Washington to make a trip of inspection in France. In France the signing of the Armistice had arrested the flow of fresh casualties into American Army and Red Cross hospitals, but influenza patients and the numbers of men wounded in the Argonne, St. Mihiel and Verdun offensives crowded the wards to such an extent that the "peak days" for the hospital centers occurred late in November. The pressure of work quickly lightened, however, in the zone of the advance. After the casualties of the pre-Armistice drives had been evacuated to the zone of the base, no more patients came in and the nurses had ample time to look about at the paraphernalia of war. Priscilla J. Hughes, chief nurse of Evacuation Hospital No. 2, wrote : Five days after the Armistice, we went up to the trenches and across Xo-]\Ian's Land, climbed in and out of the shell holes and through the terrible barbed-wire entanglements into the German trenches. It was quite apparent that the Boche had at least thouglit he had come to stay. The dugouts were like summer bungalows ; some had beds and others had bunks with chicken wire for sj)rings and really soft mattresses. The walls were covered with a blue li'ore material resembling burlap, and bookcases and cupboards had been built. The windows were of glass and opened on hinges. We saw one of their "pill-boxes,'" made of concrete and iron. A small narrow gauge railroad ran right up to the doors of the huts. Outside were little rustic walks and steps and bridges. In one of the dugouts we found coffee in steins and broad still on the table, bread which quite answered the description we had beard that it was made of sawdust and chicken featliers. It certainly looked it! They also had carpenter shops fitted out with all kinds of tools. By November 1 T) the first released war prisoners began to straggle back to the French and American lines and many of them were brought to American hospitals. Miss Hughes wrote: 988 HISTORY OF AMERICAN RED CROSS NURSING On Xovember 15, some of our corpsmen were down in the village and they ran across two Tommies who had just wan- dered into Baccarat on their way back from a German prison somewhere in Alsace. Our men practically carried those boys to the hospital, gave them good showers, dressed them up in U. S. A. 0. D. and sat them down before the first good meal which they had had since they had been taken prisoners last ^farch. Each day the boys would come back to the hospital with more Tommies in tow and by means known only to the doughboy, had them admitted. To the credit of our C. 0. and the officers and the joy of the nurses, nothing was said until finally the French sent us word we were not to interfere with the British prisoners and that they were to go to the French barracks. Then our boys fixed up cans of IT. S. A. coffee, sandwiches and all the cigarettes, tobacco and chocolate they could lay their hands on, carried them down to the French barracks and bribed the guards with some of the food to let them pass the rest through the railings to the British boys. These Tommies were simply in rags. They told us that the Germans . . . had practically starved them, which was quite evident. Three hundred and thirty of them had been set at liberty from this particular prison and guards had gone with them for about thirty kilometers, then left them to find their way back as best they could. Over thirty of them had died by the road. How some of them ever managed to walk, espe- cially across Xo-Man"s Land, is a wonder, they were so sick and weak. On T^ovember 30 the German High Command telegraphed Paris headquarters of the American Red Cross that authority had been granted "for the American Red Cross to send at once to Treves, food, clothing and necessary supplies, with a mini- mum of personnel, to handle the distribution of same to the Allies' wounded in the Military Hospital at Treves." Six mobile units, each consisting of two doctors, four American Red Cross nurses, one camion of food supplies, one camionette of medical and cleaning supplies and a touring car and ambu- lance for transferring the personnel and their baggage, were organized and started on their way, "The plan," wrote Colonel Burlingame, "was to mobilize these six units near the border to precede the Army as soon as permission was granted. They were to move into Gernian hospitals and carrv on until such DEMOBILIZATION 989 time as the Medical Corps was allowed to advance and take over the patients." ^ These six units left Paris at dawn of December 1, and during their trip into Germany had an extraordinary opportunity to view conditions in the devastated regions. One of the units was compos(>d of Dr. (J. K. Wiseman, Dr. Baldwin and Rachel Torrance, Eleanor Beatrice Brown, ^lary Irene Kelly and Henrietta Altmau. Dr. Wiseman wrote : Sunday, December 1 : Up at dawn. At eleven-thirty wp left the Hue do IJivoli for Germany. The old applewoman at. the Porte gives me two apples and "God bless the Croix Rouge Americmne!" Over the muddy roads to ^leaux ; then the rolling country-side, beautiful in the glinting autumn sun- light. The big trucks break down. We lunch at ^leaux and the nurses talk of Chateau-Thierry and the Champagne and Evacuation Xo. ?>. The gun lieutenant with the Xaval guns hails us: "Hello, Americans!" The cold hotel, the cathedral against the gray sky, the dim old square with the movie filled with French poUiis, the American military police on guajd the endless sound of horns of passing motors and Army trans- ports ^leaux. ^londay : Vaux and the graves of the ^Marines on Hill 204, wet in the mist, the colors on the wooden crosses. The sand- bags in the torn and bloody woods, Chateau-Thierry and the smashed bridge across the Marne, in the valley overlooked by the heights the Germans held as the engineers built the pon- toon we cross on now, a pontoon built then under shell and machine gun and airj)lane fire, with a ('rashing city behind them. In the twilight and darkness T walk along the river M'ith a nurse wlio liad once served in the Plotel de Dieu Hospi- tal across tlie river. Tiie questions of the wounded to each other come back to her and reconstruct the fight: "ITello, Buddy! Did they get you along the danm railroad?'' "You got yours in tbat hellish river bed?'" The sliock nurse tells of the clieerfulness of the wounded in the Argonne. . . . T l)uy sausage and l)eg bread from an Army mess for din- ner and on we go. the white li,iihts of the cars throwing into ghostly relief the stark ruins of I)ormans. wliere the Germans crosscMl and were thrown hack. The shell-pierced chateau walls, the cut trees, ihe real." On ^farch l]l ^liss Hall again wrote to ^liss Xoyes regarding Miss Delano: Colonel Coulter started on Saturday, ]\Iarch 21, in a motor to find the l)est man avaihil)le for l)rain surgery. At Xantcs. he found Captain Tranter, a young man who lias had Dr. Ciish- ing's neurological service at the Brigham Hospital and who has since specialized in brain surgery, a very able and carclul man. He, with Captain Orr. operated on Sunday, Mar( h '2-k . . . Two days following the operation, the temperature was normal and her mind quite clear. . . . 1002 HISTORY OF AMERICAN RED CROSS NURSING I talked with her Saturday morning, March 29, for about twenty minutes, when she had quieted down from her dress- ing. She told me to tell you that it would be at least another month before she is able to start for home. She further said that she felt she would not be able to do any work during the coming summer; that at the present time she is not able to dictate any letters ; that she reads only a few, or has them read to her because it tires her to concentrate her mind on these matters. She selects the personal letters and lets the others go. She also said that in any questions that need deciding, you must go ahead and not depend on her for suggestions and advice because it will be a long time before she is able to be a help and she feels that there are many things which must not wait. When I saw her on March 21, I felt much depressed about her and found her four physicians also very much discouraged. At that time, I thought she would not live to return to America. However, on INIarch 29, the whole picture has changed and I believe she will rally and be able to go home, perhaps not in a month but surely m a reasonable time, con- sidering the three operations and all she has passed through. I do not know what you will decide over there to do about having Miss Kerr or some close personal friend come over. Over here, we feel, have felt, that we wanted to leave nothing undone tliat would in any way add to her comfort or happiness during this period of illness. !Miss Delano does not know that we have asked to have some one come over, but I feel sure she would be delighted to see some one who stands in the relation of family to her, for after all she is among most unattractive surrouiidings, although as I have said before, she is having everything that can possibly be done for her from the surgical, medical and nursing standpoint. There are now five nurses assisting in her care; three of them are the original three, on an eight-hour schedule of duty. . . . Anna Kerr, Miss Delano's closest friend, arrived in Savenay on Saturday afternoon, April 12. ]\Iiss Delano joyfully recog- nized her and talked with her for a few minutes before taking the anesthetic for the fourth operation. She recovered from the ether three hours later, again talked with Miss Kerr for a few minutes, and asked: "Who is doing your work in Washington while you are away ^" Miss Kerr's answer satisfied her, but in a moment she aroused herself, and with a flash of her old energy exclaimed: DEMOBILIZATION 1003 "But what about my work? I must get back to my work." She did not speak again. All day Sunday, ^Monday and Tuesday she seemed to rest (juietly; about eight o'clock Tues- day evening, April 15, she died. To Savenay during the following days went the thoughts of the nursing and Kcd (Voss worlds. The funeral was mili- tary in character. A nurse spectator wrote : On Friday morning at eight-thirty, the casket, borne by eight enlii-ted men and guarded by six nurses, was taken to the K'ed Cross auditorium. It was covered by a large Ameri- can flag and was placed directly before tlie stage. Behind and around were })lace(l . . . flowers in profusion, from tlic American Eed Cross at Paris, the nurses of the various units and many groups at home. By nine o'clock, the nurses began coming and . . . the service started promptly at half-past nine. Chaplain Gilbert 0. Miller, of the 3O0th Kngineers, read the Episcopal burial service. . . . After the address, the casket was carried l)y soldiers to a flag-draped caisson. A company of soldiers linijig the road presented arms as the body was borne to the gun- carriage. The procession then formed: the band of the 30yth Engineers, the military escort, the caisson with the ten pall- bearers, the four honorary pall-bearers, the nurses representing the American b'ed Ooss and the Army Xurse Corps, both in France and America, and Army nurses from nine base hospitals. . . . The line of march was up the road, through the grounds past the main hospital building and over a small incline to the mortuary. The band played Chopin's ]\Iarch and as the long line ])assed slowly by, every man in khaki and there were hundreds of them stood at attention ; small Freni-h boys in tlieir black school pinafores doffed their caps and stood at the salute; a French officer saluted and a poihi put down his heavy bundle before b.e did likewise. The flag before the main hospital building was at half-mast. Beneath it in the gateways and windows were crowds of wounded sokliers and convalescent patients. As we wound out of the gate and turned up the hill between high stone walls, we passed a typical Frencli scene, a row of small stone houses with thatched roofs, before which stood two old Breton peasants, in white head-dresses, and some boys and girls. Kard as it was to lose ^[iss Delano in tliis way. it seemed fitting that the nurses whom she had organized, tlie soldiers for whom tliev were enrollei]. and the iieople whom Imtii had 1004 HISTORY OF AMERICAN RED CROSS NURSING crossed the ocean to help, should have surrounded her at the last. Even the enemy for whom Miss Delano had labored in the days before the United States entered the European War was present. The account of the funeral continued : As the procession wound up the hill, it passed groups of German prisoners, who saluted. When it reached the mor- tuary, the guard presented arms and the band played "Nearer My God to Thee," as the nurses filed up to form a crescent- shaped group, just beyond the main building. As the casket was carried inside, the chaplain read part of the Committal Service and the brief rites were over. Soldiers will guard the house until word is received to send the body home for final burial in Arlington. , . . The whole service was singularly beautiful. The sun shone and the blue sky, the soft green of the trees and the brown, freshly turned earth of the plowed fields, seemed a part of our last tribute. . . . The rows and rows of one-story barracks and the canvas tents of the huge cantonments lie in the midst of peasant cottages and small farms. There are hills in the distance but for the most part, the landscape rolls with here and there trim gardens, walled-in fruit orchards or a short, lazily revolving Brittany wind-mill. The strictly American camp, lying in the midst of this peaceful French countryside, emphasized to us again the reason why we had the French Tricolor and the American Stars and Stripes side by side in our Ked Cross auditorium.'' On May 2 Miss Delano's body was temporarily interred in the American military cemetery at Savenay. Four or five nurses, three Army officers and two Army chaplains stood by as ''taps" were sounded over this the grave of an American war nurse. The white wooden cross which stood for many months at the head differed in no wise from the three hundred odd crosses which marked the other graves in this one section of Savenay military cemetery. "The dead," wrote ]\raeterlinck, "are dead only when we stop thinking about them." The American Red Cross appointed May 7, 1!J1!), as a national memorial day for Jane Dehmo and at National Headquarters in Washington and at Division head- ' "Last Honours," Edna Foley, The American Journal of Xursinff, Vol. 19, pp. G89-092. ' Ibid. DEMOBILIZATION 1005 quarters throughout the United States, nurses and civilians gathered in thousands to pay tribute to the nurse who, in the words of the editor of the Journal, "was, at the time of her death, the most eonspieuous woman of the war." Of the many words ^ spoken on these occasions, perhaps none better tit, in their simplicity and strength, her character and work than do those of an Army surgeon : To the cause of the sound education of the nurse and the extension of her s})here of activity in relation not only to hospitals and to private practice but to the broader fields of public hygiene and sanitary instruction, Miss Delano gave much of her life. She lived to see nursing generally recognized as an indis- pensable complement to the practice of medicine, as it must one day be recognized as an integral ])art of the art of therapy; she lived to see the trained nurse universally re- garded aiul employed as a vital agent in measures of public sanitation throughout the civilized world. To the affiliation and coordination of the important nursing agencies of the country, to the end that under the American Red Cross there might be established a force oi nurses prop- erly selected and organized, adequate not oidy for the de- mands of peace, but for the emergencies of war, she gave the latter years of her life. It was work well done. She lived to see the standards of nursing for which she stood recognized by the Government. She lived to see the nursing agencies of America united and cooperating with the Army and the Red Cross. She lived to know that the Red Cross was ready, and to realize tliat it had given to the Army a contingent second to none in the service, in character, in morale, in organization and in etliciency. She lived to see that the American Army nurse had stood the test. She gave her life freely and unreservedly to a noble service. She ac- complished that which she undertook. She died at the height of her powers, at work. She was a line figure, the figure of an American nurse. ^ Seventeen months after her death in Brittany, commitnuMit services were held at Arlington Xational Cemetery for Jane 'Trihutt's paid to Miss Dt'lano's iiu'iiKirv by i'resiiii'nt WiNmi. (Jfiicral Pershiiiir and other iiifiiihers of tlio V . S. Cox cniiiiciit -. by ollicials oi tlie Ainoricaii and other Wvd Cross societies; and Ii\ h'ach'is of tlie iiiedical and nursinrior Lane. To fill vacancies caused by death, three women were elected memb(M'S of the Board of Incorporators. They were ^^Tr:^. Leon- ard Wood, ^Irs. Joseph (^udnhy and Mrs. August Bolnioiit. ]\Irs. Belmont had served as an assistant to the War Ctumcil 1008 HISTORY OF AMERICAN RED CROSS NURSING and in her the IS^ursing Service found a powerful and sympa- thetic ally. On the eve of demobilization the American Red Cross had an adult and junior membership of over thirty millions. ''Al- most immediately following the Armistice," stated the Annual Report of the Society for the year 1919, "thoughtful American Red Cross leaders began to study the problem of utilizing the great Red Cross machinery developed by the war and the rich Red Cross experience acquired in the war, for peace-time needs, primarily in the United States; secondly for the welfare of humanity at large." ^^ Out of this study grew the League of Red Cross Societies and in the United States, the Red Cross peace progTam in the interests of public health, a field in which Dr. Uarrand was an acknowledged leader. The development of rural nursing and class instruction to women formed perhaps the most important and lasting phase of this program and ac- counts of these projects may be found in subsequent chapters. As to the American Red Cross foreign program of emergency relief, the personnel of the Commission for France had their fingers, during 1918 and 1919, on the pulse of European public opinion. On December 17, 1918, Miss Hall wrote Miss Xoyes: I wish I could make you miderstand how little the French either want or need us at the present time. In spite of the cordiality of their welcome to President Wilson, it is made apparent to us that they will be glad to have us leave their country. It is not that they do not appreciate what we have tried to do for them ; but if you could see this country, as it is overrun even to the remotest corners with Americans who are buying out the food, usurping the places on street-cars, trains and theaters everywhere in France, you would appre- ciate their desire to have their country to themselves. I think that all members of the Hed Cross organization have more and more the feeling that the sooner we can wind up affairs doing this in the spirit in which we began work the better it will be. Tlie work of the Children's Bureau and the Bureau of Tu])erculosis will be brought to a conclusion by the first of April. Tlie Commissioner tells me that the work in Italy is being closed as rapidly as that in France. It would appear tliat at the present time, the Army is not returning large numbers of its nurses home, so it is, therefore, able to take care of its own troops without the aid of the Red Cross to any extent. This means that our military program "Annual Report, li)l!), p. 13. DEMOBILIZATION 1009 is very rapidly being l)rought to a conclusion. Groups of nurses raiid that same month, brought the month's total to well over one-third of a million mcii.^- As the movement of American soldiers from the Western Front to the ports of embarkation began the American Ked " "'llio War with (iennanv."' pp. 47-4S. "Ibid., pp. 37-;W. 1010 HISTORY OF AMERICAN RED CROSS NURSING Cross ill France established a chain of infirmaries and dis- pensaries which were located along the line of communication and at the docks. ^^ In connection with this work Miss Fitz- gerald's name reappears, for to her was delegated the super- vision of American Red Cross nurses assigned to this phase of demobilization service. She wrote : Another activity for which I have been made responsible has been the supervision of the American Red Cross infirma- ries. . . . The following extracts from a report will give an idea of these activities : At Xantes, the infirmary seems to more than justify its existence. There are anywhere from 20 to 25 dispensary cases daily. In the infirmary of eight beds, patients can be placed until the ambulances are secured to take them to the hospital. If the beds are not used for this purpose, officers are allowed to sleep there at night, being charged a small fee to cover the laundrying of the bed linen. While I was there, an offi- cer came in who had evidently Just left the hospital. He was chilly and very miserable. He was at once told to lie down on the bed nearest the stove and was covered with blankets. Probably a couple of hours of rest would be sufficient to enable him to continue his journey. A corpsman is on duty at this infirmary every night, so that any accident case is cared for at any time during the twenty-four hours. The nurse in charge of the infirmary also looks after the dormitory where about seventy enlisted men may sleep either by day or night. Perhaps twenty-five exhausted men were sleeping there as 1 went through. The Red Cross infirmary at Dijon, which was located in one of the main railroad stations, was a busy place during the early months of 1919. Miss Fitzgerald wrote of it: This particular station has practically been given over for the use of Americans. The American special train from Toul to Chaumont stops here, so a largo number of our men are always to be found either just arriving or just departing from Dijon. The slightly injured find their way to the Ped Cross infirmary and there receive First Aid care. Besides these men, the district surgeon's office sends to this infirmary for observation, all tlie men who are not fit to be on duty, but who are not ill enough to be admitted to a base hospital. Often a couple of days in l)ed will enable these men to go "For a list of these infirmaries and dispensaries, see tlie Appendix. DEMOBILIZATION 1011 back to duty without beinf^ transferred to the hospital at all. The nurses in charge of the infirmaries are all most enthusi- astic about their work. They get very near to the men and are able to help them in many smail ways. At the dock infirmaries the nurses found perhaps the hap- piest work which they experienced during the European War. "Here," wrote ^liss Fitzgerald, ''they come in contact with men, some of them still ill, others convalescent, but all of them radiant at the thought of going home." Brest, St. Xazaire and Bordeaux were the three principal ports of embarkation. Miss Fitzgerald wrote of the infirmary at Brest : Its position could not be improved upon. It is on the dock from which the tugs leave to carry the patients to the trans- ports lying at anchor outside the breakwater. The Army has put up a new shed about four times as large as the one hous- ing the original infirmary which is still used to take care of the overflow. They have erected a new building also for the canteen departniQiiit; it is next door to the infirmary and hot drinks can now be served much more easily. I saM' the loading of one boat. Several hundred, sick and wounded, passed through the infirmary in good order and without confusion. They are classed in groups such as ''tul)ercular," "wounded," "casuals' and other types. The port authorities have their officers present checking them up and the system works well and quickly. Ambulances and ambulance trains unload the men riglit on the dock. If the weather is bad or there is much delay in loading the tug, all stretcher cases are ke})t in the infirmary hut, are given warm drinks and are made comfortable in every possible way. If the weather is rough, the ])aticnts are here transferred to the "snow-shoe stretcher." which is better suited for embarkation purposes. Extra Ijlankets are provided for the patients during their trip in the tugs to the transports and one or two nurses accompany each l)oatload. The patients are then settled comfortably on the ship, the extra blankets are removed to be kept for future use, the [)atients are given what they need in tlie wav of comforts and the l\ed Cross nurses and other workers finally leave tliem. Several times, on account of rough weather or late hours, the patieids liave not been allowed to come aboard the steamer and have had to he "jrought l)a{k by tug to the dock. In suc-h cases, they have been ke})t in the h'ed Cross hut until arrange- 1012 HISTORY OF AMERICAN RED CROSS NURSING ments could be made for their return to hospitals in the neigh- borhood. Meals are served them by the Ked Cross Canteen. Navy Base Hospital No. 5 had received most of the "Class D" men who were returned to the United States during the early mouths of 1018, but in April of that year Kehuron Center was developed and later Camp Pontason. During 1919 the "Class D" men were evacuated almost entirely through the hospitals of these camps to the docks. South of Brest was St. Nazaire, and here the American Red Cross established another large infirmary. A special dock was given over entirely for the sick and wounded. Near it was an enormous shed which had been divided into two unequal sections. The larger section was turned over to the Y. M. C. A., which looked after the welfare of well troops. The smaller section was assigned to the American Red Cross. Here Red Cross canteen workers set up counters, installed a dough- nut-baker and provided facilities for feeding large numbers of men. At the farther end several cots were set up and here the Red Cross nurses held sway. Miss Fitzgerald wrote: "I was much struck by the activities which were going on at Embarka- tion Camp No. 7, at St. Nazaire, where over three thousand men are daily bathed, deloused and entertained in Red Cross huts. . . ." South of St. Nazaire was the busy port of Bordeaux. Here the Red Cross dock infirmary was located in a large ware- house. Four nurses, Amarita Heath, Ida K. Neville, Emma Wilson and Ella Robinson, were assigned to duty there; Evelyn Walker was chief nurse of the Bordeaux zone and had. general supervision of the work. Miss Robinson wrote: We took care of about 30,000 sick and wounded men on the docks at Bordeaux l;et\veen December and ]\Iay. Early in 1911), we had the severely wounded men. To tliese we gave every possible attention we could, adjusting their helpless bodies or limbs to a more comfortable position on the stretch- ers, reinforcing a dressing, assisting them to eat, for many of theni were jaw or arm fractures and were not able to raise themselves to swallow. To each man on the stretchers, we gave pajamas, handker- chiefs, a waslicloth. toothpaste aiul brusli, cigarettes, gum and cookies and a\ e tried to fulfill any request he might make such as forwarding a cablcirram or mailin<;' a letter or card. DEMOBILIZATION 1013 To the walking eases, we gave small packages containing handkerciiiet's, cigarettes and cookies. In themselves these gifts seemed trifling and we sometimes questioned wiiether it was worth while, hut they were gladly accepted and many times the hoys would say as they took them, "Here's the Ked Cross to the end !*' The men were wonderfully appreciative and I think we received more than we gave. Emma Wilson wrote that ^'they are too happy to need much, these boys who are going home, but they are always ready to shout for the Ked Cross." A nurse always stood at the gang-plank to see the wounded and sick safely aboard. ''Thus the last thing they see as they are carried upon the boats," wrote Miss Fitzgerald, "is the American Red Cross nurse." The first units of the American Medical Department to re- turn home were the original six American Red Cross base hos- pitals, which as units of the American Army had been serving with the British Expeditionary Forces. The Presbyterian Unit, Xo. 2, sailed on January 25 and on March 13 the Peter Bent Brigham Unit, No. 5, embarked for home. The other four followed in quick succession ; the Lakeside L^nit, Xo. 4, sailed on ]\Iarch 22; the Pennsylvania Unit, Xo. 10, on April 2 ; the St. Louis Unit, Xo. 21, on April 13, and the Xorthwestern Unit, Xo. 12, three days later.^^ One by one during the spring of 1919 the personnel of American base hos- ])itals and other sanitary columns in France were returned through the port of Xew York to Army camps and cantonments in the l.^nited States and subsequently were mustered out of the Army. The home-coming nurses were not met with the popular ac- claim with which the home-coming troops were hailed. They were not greeted at the docks with waving flags, were not asked to nuirch in the parades. In the editorial columns of the Journal Miss Palmer wrote: We recently spent some time in Xew York, where the ar- rival of transports bringing our troops from l-'rance was a daily occurrence which was made much of hv the ])ress. . . . Practically all these incoming trans])orts had nurses aboard. Occasionally a newspaper mentioned when summing up tbe '""History of Xursinir Activities, A. K. V.. on tlic Wt'stcrii Front (liiriii<^ tlit> Will- I'i'iiotl." .1. (". Slinison. p. 4; Suig(>on (icnt'rars Otlicc, I'. S. A. 1014 HISTORY OF AMERICAN RED CROSS NURSING personnel of officers and men, "five or twenty or fifty women nurses" but none of them by name. . . . A few days ago, we saw a group of our nurses come off a big transport, carrying their heavy suitcases, wraps and bags, go down the gang plank that looked to be at an angle of forty-five degrees, and walk the whole length of the Hoboken pier, between rows of soldiers lined up on either side. There was not the slightest attention paid to them by any of the official groups who were there to welcome the men or by the public in general. Almost eleven thousand American nurses were in Europe during the early months of 1919 ; ten thousand were serving in the American Expeditionary Forces and some seven hundred others directly under the American Red Cross. In the military hospitals, in camps and cantonments in the United States, eleven thousand others were on duty. The return of these twenty-three thousand nurses to civilian life offered difficulties of adjustment of a nature wdiich the Red Cross, which had called them into military service, was well able to anticipate and understand. And, too, since the Nursing Service had mobil- ized the great proportion of these nurses into military service, Miss I^oyes and Miss Delano felt a responsibility for facilitat- ing their return to the types of nursing which had previously most interested them. On December 10, 1918, Miss Noyes, as president of the American Nurses' Association, had written to Miss Delano : In view of the fact that large numbers of nurses are about to be released from service in the cantonment hospitals of this country and returned from duty overseas, it seems im- portant that a bureau of information should be established in New York City, as the majority of the nurses will be re- turned through this port. The purpose of this bureau will be to serve as a sort of clearing-iiouse through which the nurses may be directed toward opportunities for service now existing and also advised as to their future. Such a bureau would, 1 feel sure, be of inestimable value to the Public Health Nursing Bureau of the American Ked Cross in recruiting nurses for the service. It will be equally valuable to the Visiting Nurse Associations and other forms of public health service, hospitals, training schools and other institutions which now appear to be in great need of nursing personnel. DEMOBILIZATION 1015 As president of the American Nurses' Association, it was first my idea that this work sliould l)c done under the auspices of the tliree national nurses' organizations, as it seemed to be a professional problem. . . . 'J'he fact that the Ked Cross has assigned the majority of these nurses to the Army and Navy and is in a measure obligated to continue its interest in them and render such assistance to them as seems possible, made your suggestion that the Eed Cross assume the imme- diate control of such a bureau, most opportune and desirable. It would further appear that such an agency would be of great value in helping secure nurses for the public health service of the lied Cross. On IVIonday, December 2, I presented the plan informally at a joint meeting of the Boards of Directors of the three na- tional organizations of nurses. They were deeply interested and all expressed their general approval and appreciation of the tentative plan and their willingness to present it to their respective I^oards of ])irectors. It was understood that the plan presented was about as follows (no notes being taken) : 1. That the Ked Cross was prepared to open a bureau of information in New York City for nurses released from war service and that the three national nursing organizations were invited to place representatives in this office to assist and advise upon matters affecting the branches of service repre- sented by the three associations. 2. It was understood that the Red Cross assume the ex- pense of rental, equipment, clerical assistance and manage- ment. 3. It was also understood that the Ked Cross would in all probability assume the management and expense during the period of demobilization. If upon the completion of this period, tiie Ked (.ross decided to withdraw, tliat the three national organizations continue the l^ureau under their aus- pices if such an oflice seems necessary. 4. That a small Advisory Council rejiresentative of the three organizations be asked to serve in a purely advisory capacity until such time as the Ked Cross should withdraw; then this Advisory Council might form the nucleus of a Board of Diroctors. On IVcembor 10 ^fiss Delano secured Kod Cross approval for the dcvolopnicnt of this plan and the fiirthcr details of organizatiini were turned over to ^liss Xoves. On l)('c(>inl)('r 1.'5 ]\liss Delano wrote to the presidcuits of the three national nursing associations. She outlined the geu- 1016 HISTORY OF AMERICAN RED CROSS NURSING eral purposes and organization of the Bureau of Information and then continued : ... It seems desirable to have the cooperation of the three national organizations of nurses, giving them the opportu- nity to place in the Bureau a representative who could ad- vise the returning nurses in regard to available opportunities. . . . The Red Cross will be responsible for all expenses, ex- cept the salaries of the representatives selected by the national organizations. It will of course be necessary to secure all possible informa- tion from training schools, hospitals, public health nursing organizations and other nursing activities in regard to avail- able positions and it is desirable that wide publicity be given to the establishment of such a bureau, so that the organiza- tions will naturally turn there for advice. May I request, therefore, that you place the matter before your Board of Directors, asking for their cooperation and giving them opportunity to place a representative in the office. It would also seem desirable to have a small advisory com- mittee which could assist in the development of the work. I would, therefore, suggest that in addition to the President of your organization, two additional members be selected to serve on the committee. The Joint National Committee of the Bureau of Information was appointed early in January, 1919, and was composed of Miss Nutting, Miss Francis and ]\Iiss Noyes as representatives of the American Nurses' Association ; ^fiss Goodrich, JMiss Clayton and Miss Hilliard as representatives of the National League of Nursing Education, and ]\Iiss Wald, ]\Iiss Beard and ]\[iss Crandall as representatives of the National Organiza- tion of Public Health Nursing. Florence Johnson was the office manager of the Bureau. She served also as a member of the Committee. ]\riss Noyes was chairman. During the fol- lowing months the Joint National Advisory Committee stood sponsor for the development of the Bureau of Information for Nurses. Florence Johnson was office manager, as it has been stated before, and she brought to this as to her other tasks in connec- tion with the mobilization and demobilization of nurses, the poise and rich personal charm which characterized her pre- Armistice and post-Armistice service. !Miss Johnson had had DEMOBILIZATION 1017 opportunity to go overseas, first ^astassistant to Miss Stimson and later as chief nurse of the American lied (Voss in Europe, but she elected to remain in Now York. When the homing transports came in she met the nurses at the docks with the same warm enthusiasm with which she had bade them Godspeed for France eighteen months before. "She still lives on the docks," wrote a personal friend to Miss Noyes in the spring of 1919, "and every night she comes home 'a dead dog.' Can't you use your influence to make her go a bit slower or at least to take part of Sunday ?" As the development of the Bureau progressed two divisions were created, one the Division of Institutional and Student Assignment and the other the Division of Public Health Xursing. Kachel Independence Albaugh was chief of the first-named division. She was a Maryland woman and had received her nurses' training at the Homeopathic Hospital at Baltimore. Executive experience in various Maryland institutions followed and later she was superintendent of the Grace Hospital at Xew Haven, Connecticut. For the next fourteen years she served as secretary of the Connecticut State Board of Xurse Examiners and from 1915 to 1919 as Inspector of Training Schools. In these capacities she conducted the valuable Connecticut State survey of nursing activities which was a precursor of the Bed Cross nursing surveys. Previous to her lied Cross appoint- ment she had been one of Miss Goodrich's staff in the Army School of Xursing. To jMiss Albaugh was delegated all detail in connection w'ith the placement of nurses in hospitals, schools of nursing, sana- toria and other institutional positions. The Bureau of Informa- tion had on January 1 taken over the work of student enroll- ment from the Connnittee on Nursing of the Council of Na- tional Defense and also of the Army School, so the placement of these students in civilian hospitals also fell to ^liss Albaugh. Yssabella Gertrude Waters volunteered her services for four months as chief of the Division of Public Health Nursing. Possessed of independent means and many advantages of birth and education, she had, like other women of her generation, found in nursing an outlet to her desire for altruistic service ami was throughout her long career a volunteer. Tu ISHT she was graduatcnl from the -lohns Hopkins School and soon aft<'r- wards went to Heiirv Street to assist Miss Wald. Duriiii:- the 1018 HISTORY OF AMERICAN RED CROSS NURSING Spanish-American War she did military nnrsing in the United States and Cuba. In 1899 she returned to Henry Street and remained there for thirteen years. In 1912 she undertook statistical work for the National Organization for Public Health Xursing. Her volume on Visiting Nursing in the United States ^^ ranks as a leading source-book on the subject. Patrician in appearance and winning in personality, she brought to the Bureau of Information keen intelligence and a knowledge of public health organizations and resources per- haps unsurpassed by any woman in the United States. After four months' organization work Miss Waters resigned and Jane Elizabeth Hitchcock followed her as chief of the Division of Public Health jS^ursing. Miss Hitchcock had at- tended Mount Holyoke College for two years and had taken special work for three years at Cornell University. She was graduated in 1891 from the New York Hospital and was for two years a head nurse of the Newton (Massachusetts) Hos- pital. She then went to Henry Street Settlement and for twelve years before her appointment to the Bureau of Informa- tion was superintendent of the Henry Street staff of visiting nurses. During the early period of 1919 the day's work at the Bureau of Information consisted largely in interviewing nurses returning from France ; often Miss Hitchcock and Miss Al- baugh talked to thirty or more nurses each, listed their previous experiences and future interests and catalogued the cards for future reference. Like the soldiers, the nurses were coming back physically and nervously exhausted and their one desire was to go home and rest. This attitude and the' growing dissatisfaction to re- turn to the comparatively narrow fields of private duty nursing was expressed by Laura Hartwell : The state of mind of some ex-members of the American Expeditionary Forces resembles somewhat the forlorn deso- lation of a homeless eat. While this is true of both men and women, it applies especially to tlie returned overseas nurse, not so much to those who return to the arms of admiring families to be petted and spoiled and urged to take a long rest, but to those who live in a trunk, as it were, and who make their homes wlierever their hat happens to be. . . . " Publislicd in 1900 under the auspices of tlie Russell Saye Foundation, bv the Cliarities I'ublication Committee, New York Citv. DEMOBILIZATION 1019 But at any rate, they were at homo. And the first private duty case, when one returned to the wliite uniform, l)rought a certain satisfaction, hut soon one's thou<^hts turned wistfully hack to the days when slithering around in the mud, wearing ruhher hoots, was the usual method of going on duty. As the days passed and the patient became convalescent, the longing for a wider sphere became more acute. . . . The present somehow does not seem to fit with the past and the future of useful and remunerative work seems very distant. This attitude is, of course, to a great extent the reflection of the world's unrest, hut the people who stayed at home have advanced along different lines from those who went overseas and they cannot see why the daily round cannot easily be taken up again. And then how one misses the comradeship of the life over there, wdiere the English language was sufficient introduction, the comradeship which by force of contrast makes the bustling life at home where each one is intent on his or her own busi- ness, seem cold and unfriendly. . . ^''' To nurses suffering from this natural psychological reaction, the Bureau of Information offered a channel of reentry into civilian life. By September, 1919, it had proven unequivocally its value. In the Division of Institutional Assig:nment the names of 2333 nurses had been registered for placement. On the other hand, hospitals and schools of nursing had registered 1710 vacancies in positions ranging from superintendents of hospitals, superintendents of schools of nursing, night super- visors, instructors, charge nurses, anesthetists, laboratorv and X-ray technicians, dietitians and general ward and pupil nurses. The total number of gi-aduate nurses placed in posi- tions by ^Fiss Albaugh's division numbered 805 ; this figure, however, includes only the placements regarding which ]\Iiss Albaugh had definite knowledge that the nurse had accepted the position to which she had been referred. Great difficulty was experienced to get the nurses to report back to the Bureau after they had accepted a position. The second major activity of !Miss Albaugh's division was student assignnKmt. Of 477 applications received from young wouKMi formerly enrolled in the Army School and desiring })hu'('m('nt in civilian hospitals, 398 were referred to accredited schools of nursing. In this connection ^liss Albaugh gave valuable information to ]\Iiss Wheeler in her revision of the ^"^ American Journal of Xursiiuj. \'ol. 20. jip. 2n4-2!>5. 1020 HISTORY OF AMERICAN RED CROSS NURSING list of accredited training schools, as published by the Ameri- can ^Nurses' Association and assisted with much of the clerical details of compilation. The activities of the Division of Public Health Nursing consisted in collecting and disseminating information regard- ing the general field of public health nursing ; in collecting and disseminating information regarding public health nursing edu- cation, especially with reference to post-graduate scholarships ; and in referring qualified public health nurses to agencies desir ing their services. From February 10 to September 15, 1919, three hundred and sixty-six different public health nursing organizations applied to this division for assistance in securing nurses. "Many of the requests," wrote Miss Hitchcock, "come in wholesale. iSTorth Carolina wants twenty-one nurses for town and country work; the Tuberculosis Association, of Springfield, Illinois, wants fifty; the State department of health in a middle-western state puts in a modest request for one hundred and fifty public health nurses." During the first seven months of its existence this division had registered the names of 1274 public health nurses or nurses interested in taking up this specialized phase of the profession and had referred 1255 of them to organizations desiring their services. Miss Hitchcock gathered some interesting data regarding the preliminary education of nurses enrolled in her division. Eleven per cent had had only a grammar school education, 20 per cent had had college, normal or private school educa- tion, Gd per cent had had high school training. As to their preparatory work in public health nursing, 117 had had public health nursing courses while attending a general school of nurs- ing; 75 had had post-graduate courses in public health nursing; 524 had had practical experience. The requirements of this division for registry were the same as those of the Kcd Cross Bureau of Public Health Nursing; Service. As the end of the demobilization period approached and the Red Cross prepared to close the Bureau of Information, the opportunity for launching a long-cherished project seemed ripe. "Almost from the beginning of our organization life," declared the editorial colunms of the Journal, "the need for central head(|uarters has been talked of, first by one gi'oup of members and then by another, but there has never seemed to be a time when aU the conditions were favorable," DEMOBILIZATION 1021 In October, 1019, Miss Noyes made the first move toward the transfer of the Bureau of Information for Nurses from the Ked Cross to the three organizations of nursing. At a meeting of the joint boards of directors of the three national organizations, ^liss Noyes, as presi(k'nt of the American Nurses' Association, was authorized to appoint a committee to consider ways and means by which the Ked Cross Bureau of Informa- tion could he transferred from the Department of Nursing to die three national organizations and used as the nucleus for central headquarters for the nursing associations. Miss Nutting was the chairman and Elsie M. Lawler, Mary S. Gardner, Katherine Tucker, Minnie H. Ahrens and Miss Noyes (ex- otHcio) were the members of this committee. They set to work and drew up a plan which was presented to the Board of Directors of the American Nurses' Association at a meeting held on January 15 to IG, 1920, in New York City. The report of this Committee on Transfer and of the new plan was, in part, as follows: The Bureau of Information for Nurses was established by the Eed Cross in February, 1919, largely for the purpose of assisting nurses who have been in Army or Ked Cross service. In this, it has l)een of notable service. . . . The time ap- proaches when the Red Cross will no longer feel justified in continuing it. It would seem inadvisable to continue it in its present form. It would, however, take its place in a larger plan the establishment of national nursing headquarters as a center for the work of our national associations. . . . The committee believes that the conditions are favorable for the establishment of such headquarters and that steps should now be taken toward that end. The definite work to be carried on in such a center would be limited at first to that most urgently needed. Tlicre should be : ( 1 ) offices for the secretaries of each of the three national organizations; {'I) a bureau of a])pointment and advice; (;>) a division of publicity; (4) an office for the American Jouviud of Xursing; (5) a library and reading rooms; ((>) the combined clerical forces of all these depart- ments. The e.\])ense of maintaining such a headquarters will un- doul)tedly be rather large, and in order to meet it much study of all our resources will l)e needed. It is our opinion that the needed iiicnnie can be secure(l and in pursuanci^ of this belief. th(^ coinniitte" submits the fdllowinLT resolutions: 1022 HISTORY OF AMERICAN RED CROSS NURSING A. That the three national associations of nurses take over from the Ked Cross the activities of the Bureau of Advice and Information. B. That this transfer be made as soon as suitable head- quarters can be obtained (if possible, be the building now housing the Xational Organization for Public Health Xurs- ing) and the necessary financial and other arrangements made to conduct the work. C. That the Bureau be taken over as a branch of a national nursing headquarters to be established in New York City, looking forward to decentralization at the earliest possible date. D. That national headquarters include the three nursing organizations with the cooperation of the Department of Xursing of the American Red Cross. Three ways are presented for the administration of the headquarters: (1) pooling the resources and personnel and vesting responsibility in a committee with proportionate rep- resentation; (2) A federation of the bodies concerned with a central committee which shall be advisory; (3) A combina- tion of these two plans by which certain interests and ex- penses shall be shared, others handled by each association, under the direction of a committee which shall act as a board of trustees. This is the plan recommended. . . .^" The plan was immediately hailed with enthusiasm by the majority of nurses. It would effect gi'eat saving of time and money, as under the old order duplication in the work of the three organizations had been unavoidable. As Xew York was the nursing and hospital center of the United States, it seemed the logical city for a headquarters. The American Xurses' Association met at Atlanta, Georgia, April 12-17, 1920, for its Twenty-Second Convention, and the new plan for central headquarters was presented on April 15. Miss Cutting, as chairman of the Committee on Transfer, read the report. The names of ]\Iiss Goodrich and Miss Clayton were added to the Committee on Transfer, which was later authorized to continue as the Committee on Xational Xursing Headquarters. After some discussion ]Miss ^lacMillan, of Chicago, moved that ''the Association accept the report of the Committee on Xational Headquarters and authorize the organi- zation of the headquarters." The motion was carried. "For further details, see tlie Anicrican Jounial of Xursing, Vol. 20, pp. 503-505. DEMOBILIZATION J1023 By Aupjiist, 1920, the details of transfer had been completed and the Central Headquarters established in New York City. Miss Albaugh was appointed office director representing the American Nurses' Association and the National League of Nursing Education. The Ked Cross financed the project dur- ing its hrst year. At the joint convention of the three national organizations of nursing, which was held in Seattle between June 20 and July 1, 11)22, Miss Noyes retired from office as president of the American Nurses' Association with the satis- faction of knowing that the National Nursing Headquarters would be maintained ; the revision of dues which provided for an increase from fifteen to fifty cents per capita for member- ship in the American Nurses' Association, accomplished at this meeting, made adequate financial provision. The establishment of a central headquarters marked the reali- zation of a need long felt by nursing leaders ; it ranked as one of the signal accomplishments of the nursing profession during the life of the Association. A second major development of the demobilization period was the organization of a third government nurse corps, that of the Ignited States Public Health Service. In this develop- ment the Ked Cross Nursing Service played an important part by giving its interest and support to the program of the Public Health Service for the proper establishment of a corps of ({ualified nurses and rendered valuable assistance in recruiting these nurst's for tiic new corps. The bruited States Public Health Service had been estab- lished in the year 1798 as the ^farine Hospital Service. Lender a reorganization act of July 1, 1902, this service was enlarged and its name changed to that of the Public Health and Marine Hospital S(>rvice. Again in 1912 different divisions which were still in operation in 1919 were established, and its name again changed to that of the United States Public Health Service. Tm'o of the nine divisions of the Public Health Service were the Bureau of Scientific Jlesearch and the Bureau of ^Marine Hospitals and Relief. American Jied Cross nurses especially interested in the care of trachoma, pellagra and other diseases had been assigned during 1918 to the special hospitals con- ducted by the Iinreau of Scientific Ivesearch. Other lied Cross nurses lind been assiuned to general institutional nursing in the 1024 HISTORY OF AMERICAN RED CROSS NURSING hospitals maintained by the Bureau of Marine Hospitals and Relief. Among these was the large base hospital at Nitro, West Virginia, which maintained an average nursing staff of some ninety Red Cross nurses. The Bureau of Marine Hospitals and Relief was charged particularly with responsibility for furnishing hospital care to civilian sailors, bpth native and foreign. During the fiscal year ending June 30, 1918, this bureau operated 20 such marine hospitals and maintained 119 other relief stations where hospital and out-patient relief was furnished to 71,806 patients.^^ Red Cross public health nurses were assigned to the sanitary zones maintained by the Public Health Service around Army cantonments. The type of duty these nurses rendered has al- ready been described. Previous to the post-Armistice period Miss Noyes had se- lected nurses for these various types of service and had her- self sent the nurses' papers directly to Dr. Rupert Blue, then Surgeon General of the Public Health Service. This arrange- ment was not satisfactory, however, because there was no executive nurse in the Public Health Service to W'hom these nurses might turn for advice and aid. "With the signing of the armistice and the cessation of hos- tilities," wrote General Blue in the Annual Report of the U. S. Public Health Service for the year 1919, ''arose the problem of taking care of the injured sailor and soldier after discharge from the military forces." The Bureau of Marine Hospitals and Relief was selected as the most promising machinery al- ready in existence, and plans for an increase of one hundred per cent in the capacity of the marine hospitals and the estab- lishment and maintenance of additional hospitals were formu- lated. One of the major phases of this expansion was the provision of an adequate force to staif these hospitals. General Blue appealed to the Red Cross Nursing Service in December, 1918, for additional nurses. An early step in developing the nursing force lay in the appointment of an executive nurse to develop and supervise the work and here the Red Cross provided salary and traveling expenses until the permanent appointment of a superintendent of nurses to develop this service was made; ''Anniuil Report. 1918. of tlie Siiruvon Cmcral of tlie Piil>lic' Tlcalth Service of tlie I'nited States. ]>. 2'MJ; Government J-'iinting Office, 1918. DEMOBILIZATION 1025 Lucy Minnif^crode was chosen to undertake a tour of inspection of the marine hospitals. On January 10, 1919, Miss Noyes exphiined to the general manager at National nead(iuarters her recommendation that Miss Minnigerode's salary be carried on the Xursing Service budget ; Some weeks ago, Surgeon General Bhie asked the Depart- ment of Nursing to appoint a nurse as inspector of the ma- rine hospitals. In view of the fact that we have been pro- viding nurses for tliese institutions, we felt very anxious to do this, in order that we might secure uniformity and im- prove the standard of nursing eare of the sick in these hospi- tals. I think ]\Iiss Delano spoke to you about this before she left. We engaged Miss ]\Iinnigerode who had previously been in charge at National Headquarters of tiie preparation of nurs- ing personnel for special overseas duty, for this purpose. . . . During January, 1919, Miss Minnigerode visited the marine hospitals at Baltimore, Savannah, Xew Orleans, ^lobile, ]\Iem- phis and Wilmington, North Carolina. She found that with the exception of the hospital at the Emigration Station at Ellis Island and the special hospitals such as the Pellagra Hospital at Spartanburg, Xorth Carolina, few nurses had been employed in the past in these institutions. There were no ade- quate nurses' quarters and the nursing care of the patients was given entirely by orderlies. Miss Minnigerode returned in February to Washington, was given a desk in the ofhce of the Surgeon General, U. S. I'ublic Health Service, and there she began to study the problems at- tendant upon the development of a nurse corps. On March 3, 1919, Public Act 320 was passed by Congress, which authorized the Secretary of the Treasury to ''provide immediate additional hospital and sanatorium facilities for the viwo and treatment of discharged sick and disabled soldiers, sailors and marines. Army and Xavy Xurses (male and fe- male), patients of the War Risk Insurance Bureau, and the following persons only: nuu'chant marine seamen, seamen on boats of the Mississippi liiv(>r (\unmission. oihc(>rs and enlisted men of the United States Coast Guard, oilicers and employees of the Pul)lic Health Service, certain keepers and assistant keepers of the United States Lighthouse Service. ..." and other specially named groups. "It will be seen," wrote General 1026 HISTORY OF AMERICAN RED CROSS NURSING Blue in his Annual Report for 1919, "that Congress thus desig- nated the Public Health Service as the medical agency of the Government through which beneficiaries of the War Risk In- surance were to be given the necessary hospital and sanatoria treatment. This legislative action is in line with the adminis- trative practice of the Public Health Service in endeavoring to have utilized by other Government Departments and Bureaus the sanitary and medical machinery which it has perfected." In a letter written on March 14, 1918, General Blue an- nounced to Miss Noyes that Miss Minnigerode had been se- lected as superintendent of the United States Public Health nursing service. In this position she immediately began to build up an office and field force. Obstacles attendant upon such pioneering were naturally encountered in the following months, but with the fearlessness and outspoken resolution which char- acterized her methods of work and with the firm support of the Surgeon General and the Red Cross, Miss Minnigerode cut her way through prejudice and conservatism and established a nursing service which employed the largest number of nurses utilized by the Government during the demobilization period. Hospital facilities to be used for the care of personnel enu- merated in Public Act 326 were to be provided through the ex- pansion of the marine hospitals ; through the maintenance by the Public Health Service of several former Army base hos- pitals, and through the establishment of new hospitals. The United States was divided into fourteen districts and offices for the examination and assignment to hospitals of beneficiaries of the War Risk Insurance Bureau were established in each district. Early in 1919 arrangements were cff'ected by which the ]*^ursing Service at National Headciuarters undertook to assign nurses to Miss ]\linnigerode's division. This arrangement was outlined in the official bulletin issued in April, 1919, by the Public Health Service : The XursG Corps of the U. S. Public Health Service con- sists of a superintendent of nurses, chief nurses, nurses and reserve nurses. Assignment to duty as chief nurse is made by the Surgeon General upon recommendation of the superintendent and after the candidate has furnished satisfactory evidence that she meets the requirements of such service. DEMOBILIZATION 1027 The position of chief nurse in a hospital of the U. S. Public Health Service, so far as conditions permit, is equivalent to that of su])erintendent of nurses in a civilian hospital. Slie will have nurses were referred to the Public Health Service Xurse Corps with recommendation for appointment rather than assigned directly, as had been the procedure under the initial agreement. Of the 1350 nurses apointed during this fiscal year, only 200 were recommended through the Red Cross; the other lOSl were r(>cruited through Miss Alinnigerode's office. However, the publicity given to the needs of the Public Health Xurse Corps by the Red Cross and the efforts of Red Cross Division Dii-ectors of Xursing wei'e instrumental in se- curing tlies(> nurses. During this period the further develop- ment of the Xnrsc Corps progr(>ssed, educational projects were launched and a far more satisfactory esprit dc corps was built up among the nurses. One-fourth of the inirses who resigned from causes otlier tlian ill-iiealth and nuirriage, asked i'or re- instatement. By ()rd(>r of the Secn^tary of the Treasury, on Aju'il 19, 192i, all the activities of the Public Health Service which 1030 HISTORY OF AMERICAN RED CROSS NURSING related to the beneficiaries of the Bureau of War Risk Insur- ance, except those activities rehiting to the operation of hospitals and dispensaries, were transferred from the Public Health Service to the Bureau of War Risk Insurance. The Sweet Bill, which was approved bv Congress on August 9, 1921, legalized this order and created the Veterans' Bureau. By an Executive Order of May 1, 1922, all hospitals caring for ex-service men and women were transferred on that date from the Public Health Service to the Veterans' Bureau and on July 1 all dis- pensaries, with the result that some thousand nurses of the Public Health Xurse Corps were automatically shifted from Miss Minnigerode's division to that of the superintendent of the Nurse Corps, Veterans' Bureau. The Nurse Corps of the Public Health Service continued, however, to be maintained to staff the hospitals and dispensaries of the former Bureau of Marine Hospitals and Relief and Reconstruction aides and dietitians were placed in Miss Minnigerode's division when the hospitals were transferred. On July 1, 1922, this division had a total strength of -150 nurses, dietitians and aides. The Nurse Corps of the Veterans' Bureau numbered in the summer of 1922 some fourteen hundred nurses those of the former Public Health hospitals, those of new hospitals of the Veterans' Bureau and those of the Federal Board of Vocational Re-education. ]\rarv Agnes Ilickey was the newly appointed superintendent. Mrs. Hickey was born in Ireland and was graduated in 1900 from St. ]\[ary's Hospital, Brooklyn, New York. She had extensive experience as a nurse instructor and as a school nurse. She went overseas in 1918 for service with the Red Cross Children's Bureau but in the military shortage was assigned to the Service tie Sante to nurse American wounded in French hospitals. She was transferred to the Army Nurse Corps late in 1918, returned to this country dur- ing the following year and in August entered the Public Health Nurse Corps, where she later served as Miss Minnigerode's assistant. At the present date of writing the organization of the Nurse Corps, Veterans' Bureau, has not l)een entirely perfected. However, tlie first indication that the Veterans' Bureau would look to tlie Red Cross Nursing Service as its reserve, as had the Piil)lic Health S(>rvice, was contained in a letter addressed to ]\liss Johnson on July 5, 1922, by Colonel Robert U. Pat- terson, assistant director of the Veterans' Bureau and formerly DEMOBILIZATION 1031 chief of the Red Cross Bureau of ]\redical Service in 1914. Colonel Patterson said in part that ''the Bureau desires to call your attention to the existing shortage of nurses for duty in the U. S. Veterans' hospitals and to rc(iuest that you do what- ever you are able toward recruiting nurses for this service. . . . To be eligible for appointment to this service," he added, "nurses must be citizens of the United States, graduates of recognized training schools for nurses, registered and able to qualify under the regulations of the Civil Service Commission. The salaries of nurses include quarters, subsistence and laun- dry, and are as follows: staff nurses, $960 per annum; head nurses, $1020; assistant chief nurses and acting chief nurses in hospitals of less than 200 beds, $1200, and chief nurses in hospitals of 200 beds or more, $1584 per annum. Vacancies in the higher grades are tilled by promotion from a lower rank, rather than by new appointments." During the European War the casualty rate among Ameri- can nurses in military service seemed high. The principal cause was disease. Xo nurses were killed in action. Four were wounded in enemy air raids. In view of the fact that nurses belong to the sanitary service and that the sanitary service is a non-combatant branch of the ^lilitary Establish- ment, a branch protected in previous modern wars by interna- tional agTcement and commonly accepted principles of hu- manitarianism, this figiire is unique in the history of American war nursing. The American nurses wounded in line of duty were Beatrice ^Fary ]\lacl)onald, a nurse member of Base Hos- pital Xo. 2, who was wounded Augiist 17, 1917, while on de- tached duty at Casualty Clearing Station Xo. (51, British Expeditionary Forces; Eva flcan Parmelee, of Base Hospital Xo. 5, who was wounded September 4, 1917, while on duty at her base, Xo. 11 General Hospital, British Expeditionary Forces, Dannes Camiers, France ; Isabelle Stambaugh, of Base Hospital Xo. 11, who was wounded ^larch 2;3, 1918, while on detached duty at Xo. 42 Stationary Hospital, British Expedi- tionary Forces, Amiens, and Jane fletl'erv, an American Bed Cross child welfare nurse assigned to military service^, who was wounded on July 15, 1918, at American Bed Cross Hos- pital Xo. 107, Jouy-sur-.Morin, France. Of the 2;}, 000 American inirses in military service fn)m April (!, 1917, to Xovcmbcr 11, 1919 (this figure^ docs not in- clude those assiancd to inthienza relict" nor those wt)rkinir at 1032 HISTORY OF AMERICAN RED CROSS NURSING Red Cross Chapter, Division or National Headquarters or serving npon Red Cross enrollment committees), over three hundred died from diseases contracted in line of duty, and 449 others suffered total or partial disability a total of some Y49 nurses. Thus three out of every hundred nurses either died or suffered temporary or permanent disability from war nursing service. The number of Army nurses who died during the participa- tion of the United States in the European War was 2C8 ; of this number 218 were reserve members and 50 were regular members. The number of Navy nurses who died during the same period was 28 ; of this number 24 were American Red Cross nurses, one was a reserve nurse but not assigned through the Red Cross and three were regular members. Thus the number of American Red Cross nurses who died in line of duty with the Army and Navy was 242. Forty other Red Cross nurses died in other types of war nursing, so the total of American Red Cross nurses who died in line of duty in the European War was 282. Four American Red Cross nurses died in line of duty with American Red Cross commissions or allied relief organizations overseas. The first of these was Nina Louise Seymour, who died from pneumonia on October 10, 1918, at American Red Cross Hospital No. 114, at Poule, France; the second was Nettie Grace IMcBride, who succumbed to typhus fever on De- cember 23, 1918, at an American Red Cross hospital at Tumen, Siberia. Jane Delano was the next nurse to die under the Red Cross flag, and on ]\[ay 17, 1919, Edith ^fay Winchester died from typhus at Erivan, Armenia, while on duty with the Ar- menian and Syrian Relief Committee. Three others of the 282 nurses were killed by accidents; one when the airplane in wliich she had been taken for a flight crashed, and the other two in the accident on the S. S. Monfjolia. A full list of the Red Cross nurses who died in military service may be found in the Appendix. Of the 449 nurses partially or permanently disabled, some twenty-five per cent suffered from tuberculosis.^'-^ The high "Tliis fitrure was taken from information fiirnisliod by American Ked Cross nurses wlio filled out tlie quest ionmiires issued by Division Depart- ments of Nursing to all ex-service American Red Cross 'nurses. According to a compilation ])repared in the statistical division of tiie Surgeon Gen- eral's office, the pei'centage of tuberculosis among nurses admitted as pa- tients in Army hospitals was much lower. DEMOBILIZATION 1033 rate of tuberculosis came, it is thought, from general lowered vitality due to the lack of proper heating facilities and the long hours of duty. On questionnaires later sent out by the Red Cross, disabled nurses stated that they had first suffered from heavy colds but had not stopped to report them and take the needed rest because they appreciated that their inactivity would place the burden of their work on the shoulders of their already overburdened sister nurses. While the Red Cross made every effort to secure a thorough physical examination before the nurse was admitted to the Red Cross and military services, this was not always possible ; some of the examining physicians were thorough but some were lax. Upon reexamination after they had seen service in the Army, there were nurses who were found physically unfit and discharged. Yet even with every effort on the part of the Army to sift out these nurses, it is quite possible that many nurses whose vitality was not sufficient were retained in Army service because of the acute shortage of nurses and the brief time within which the Army and the Red Cross was called upon to mobilize. Public Act 32G, which, it will be remembered, was the Con- gressional authorization for the hospital care and treatment of beneficiaries of the Bureau of War Risk Insurance, had espe- cially named Army and iSTavy nurses as eligible for its benefits. American Red Cross nurses on duty with the Army or the Xavy in this country or overseas were cared for in special infirmaries maintained for sick nurses by the base hospitiil to which they were attached. As reserve members of the Army and Xavy Xurse Corps, they were eligible to all benefits of Federal care, compensation and reeducation. During 1918 Army nurses convalescent in this country were sent to recuperate at Sea- bright, the country estate of ]\Ir. and Mrs. Jacob Scliiff, which the Xew York philanthropist and his wife had turned over to the Army. Scabright was located at Redbank, Xew Jersey, and "was not merely a house but just a big, beautiful sunshiny liome, with everything in it that the family had loved and en- joyed," wrote ^1. E. Ilines, an Army nurse. "It offers every comfort one could imagine," she continued. "It is more like a fairy tale than real life, for it is actually true that we felt the atmosphere of the liominess, the hospitality, the peace and rest as soon as we entered . . . and although we were sent by the Government, and some came reluctantly and almost in tears because tliev didn't know or couldn't conceive what kind 1034 HISTORY OF AMERICAN RED CROSS NURSING of a place it was, we left more reluctantly, because nowhere is there another place like it." -" Seabright was maintained en- tirely by the generosity of its owners, although the Army Nurse Corps had supervisory authority over the nurses sent there. The length of stay ranged from two weeks to three months, depending on the needs of each patient, and the nurses were entertained at no cost whatsoever to themselves. Mr. and Mrs. Schilf also gave much of their time and interest to the nurses. Seabright was closed during the last days of October, as the heating facilities were inadequate for the winter months. Early in January, 1919, a rest house for nurses was opened at Riverdale, New York, the former homestead of Grace Dodge, the New York woman philanthropist who did much for the establishment of the Young Women's Christian Association and the Central Club for Nurses in New York City. Mr. and Mrs. Cleveland Dodge offered the use of the Riverdale estate to the Army Nurse Corps and continued its maintenance until the spring of 1920. The interior of the house was charming and the grounds sloped down to the Hudson River. The manner in which sick Army nurses were cared for over- seas was described by Miss Stimson in her ^'History of the Nursing Activities, American Expeditionary Forces, during the War Period on the Western Front :" Sick nurses have been oared for in various ways. In some hospitals, such nurses were kept in quarters. This method is unsatisfactory and should be followed only when no other provision is available. Some hospitals have made a special ])art of the nurses' quarters into an infirmary and have as- signed nurses to duty there as though on regular duty in the hospital wards. This plan is second best. The most satis- factory scheme is to liave a ward or part of a ward of special rooms in the hospital proper set apart as a nurses' infirmary, to wliieh all nurses luiable to go on duty for any physical reason whatsoever are sent at once and where they receive regular care as patients. In some centers, it has been found advisable to have a center infirmary in one of the hospitals, to which all the sick juirses of all tlic hospitals of the center are sent. While this plan of concentration made for economy of supplies and nurs- ing stalT. it has not worked out satisfactorily in every in- stance, owing to the prejudice which existed in the minds of -"American Journal of Xitrsiiig, Vol. IS, p. 172. DEMOBILIZATION 1035 most sick nurses to being cared for in a hospital not their own and by nurses and due-tors who were strangers to them. Miss Stinison described the method by which sick and dis- abled Army nurses were returned to the United States irom. foreign service : The evacuation of sick nurses, after the usual classification by a medical board, was tlirough Base Hospital Ko. 8 at Savenay up to February, lUl'J, when Base Hospital ^o. 113 was made the place of collection for patient nurses. The following paragraph in a letter dated ]\Iarch 3, 1919, from the Superintendent of the Army Nurse Corps to the Director of Nursing, A. E. ., stated the plan for tlie dispo- sition of sick nurses upon their arrival in the United States: "Those who arrive in the United States as patients may go home if tliey themselves desire to do so, provided they make an official request for relief from service, stating at the same time that they desire to forego further treatment a-fc govern- ment expense. The ^ledical Department is most desirous of giving all nurses every opportunity to regain so far as possi- ble their normal health, so unless the nurses themselves de- sire to go home, they will in all cases be furnished with proper care as long as it is needed. When acutely sick and disabled nurses arrived in i^ew York they were, if they so desired, sent directly to Army base hos- pitals in this country for further care. Yet among the many home-coming nurses were women whose sickness and disability had not yet become acute enough for them to have requested hospitalization. They returned to Xew York, got their dis- charge from the Army and plunged into civilian nursing again, only to find that their health had been undermined and that they were unable to work. The nurses suffering from tubercu- losis offered examples of this type of incipient disability. They were, however, still eligible for Federal aid, but there was no provision for tlu'ir treatnuuit and care during the period when they were establishing their claims or during convalescence, after they had been discharged from hospitals of the Uublio Healtli Service. For nurses sick or disabled in lied Cross for- eign service, there was no provision whatsoever. The four women whose position best enabled them to befriend and aid sick and disabled luu'ses were Florence Johnson and Christine Xuno, at Atlantic Division Headquarters; Miss 1036 HISTORY OF AMERICAN RED CROSS NURSING Noyes, at N^ational Headquarters, and Miss Minnigerode, in the Public Health Service. Miss Johnson and Miss ISTuno met the sick nurses on the docks and their interest and sturdy labors did not cease until each nurse had claimed and received the care and compensation provided by Federal law for Army and Navy nurses or by National Headquarters for nurses under special Eed Cross service overseas. Christine Nuno was Miss Johnscn's assistant. She had been graduated in 1914 from the School of Nursing at St. Luke's Hospital, New York City. She was for some months chief nurse of the base hospital at Camp Meade, Maryland, and was then transferred to New York and served as chief nurse of Debarkation Hospital No. 5. In June, 1919, she was discharged from the Army and went to Atlantic Division Head- quarters to assist Miss Johnson in locating and caring for sick nurses, a task for which her unfailingly happy disposition made her admirably fitted. Beneath a manner bubbling over with sheer exuberance of spirits, she possessed a very real and deep sympathy for each and every one of the sick nurses whom she piloted through the mazes of Federal adjustment. Her good cheer seemed limitless, her enthusiasm could not be cooled by any amount of red tape and delay, and in her company the sick nurses took heart and laughed with her. Through the Red Cross Bureau of Information for Nurses, Miss Johnson and Miss Nuno came in contact with many sick and disabled nurses who were being held in New York pending investigation and hospitalization by the Public Health Service. These nurses needed good accommodations and supervisory aid in presenting their claims ; however, the prices existing in New York hotels were beyond their resources, especially since the majority of them had not yet begun to receive compensation from the Veterans' Bureau. The Atlantic Division accordingly engaged accommodations for ten nurses at an excellent hotel on ^[adison Square, and sick and disabled nurses were cared for there without charge until their claims were settled and they could leave New York. As soon as the numbers of sick nurses passing through New York decreased, these rooms were relin- quished. At the same hotel were quartered the students of the Army School of Nursing who were taking th(nr public health training at Henry Street Settlement. The Surgeon General of the Army had requested assistance from the Ked Cross to en- able these students to secure instruction in public health nurs- DEMOBILIZATION 1037 in^, and the Executive Committee on January 13, 1021, appro- priated a fund of $40,000 for their maintenance while they were at Teachers' College and Henry Street. The hotel on ^fadison Square provided comfortable quarters for sick nurses detained in Xew York City but did not meet the need for a convalescent home where nurses might live sev- eral weeks in the country at reasonable expense and in attract- ive surroundings. On July 1, 1920, *'The Evergreens," a twelve-acre country estate at Bay Shore overlooking Great South Bay on the southern shore of Long Island, Xew York, was leased and opened as a convalescent home. In the Annual Keport for the year ending June 30, 1921, Miss iSToyes wrote of the Bay Shore Convalescent Home: Its use was not restricted to Red Cross nurses alone and it has been patronized by the United States Public Health Serv- ice, the War Pisk and the Federal Boards. During the past twelve months, 294 nurses have sojourned there and have de- rived great benefit from the opportunities for relaxation and convalescent care. Mabel Fletcher, a Eed Cross nurse, is the hostess. L'p to June 30, 1921, the expenses of running the house had amounted to $12,917 but it is felt that the value of this convalescent home to the nurses and to the Red Cross cannot bo easily measured in money. . . . The majority of the nurses not only pay their way but frequently supplement their board bills with money donations of appreciation. In this way, much of the expense has been met. Throughout the period of demobilization, nurses were slow to report their disability to the field representatives of the Bureau of War Risk Insurance and to claim hospitalization and vocational rec'ducation. The following arrangement, as reported by ^liss ]\[innigerode, was finally effected: It should be a matter of common knowledge, from the wide publicity given this Act, that nurses also are eligible for treat- ment under the Bureau of War Risk Insurance. The Public Healtli Service in cooperation witli the American Ped Cross, has agreed tliat the Ped Cross Division Directors of Nursing may refer cases of nurses requiring treatment to the district supervisor of the Public Health Service, who will give in- structions as to the procedure required to obtain treatment and wlio will also uiakearrangements for tlie hos])italization of inirses iicedini,'' care. 1038 HISTORY OF AMERICAN RED CROSS NURSING In order to facilitate action, four Division Directors of Nursing in different parts of the country have been appointed as consulting officers in the Public Health Service, with authority to confer with district supervisors concerning treat- ment for nurses. These nurses are : Florence M. Johnson, New York; Jane Van de Vrede, Atlanta; Lyda Anderson, St. Louis; and Lillian L. White, San Francisco. Nurses are also eligible under the Federal Board of Voca- tional Education and can take any training they desire, in just the same way as do soldiers. . . . Any nurse physically unable to pursue her nursing work, as a result of her military service, should be eligible. Application for this training should also be made to the Red Cross Division Director of Nursing, who understands how to reach the Federal Board and how arrangements for vocational education should be made.^^ Still the nurses continued to hold back from claiming Federal aid. Now and then word of an unusually unfortunate case would percolate to the office of one of the four Division direc- tors and she would investigate the case, but this system was highly unsatisfactory. In 1921 Miss Johnson sent out a questionnaire to every ex-service nurse in the Atlantic Division and the information received proved of such value in locating disabled nurses that Miss Noyes authorized all the Division directors to send out similar questionnaires. The following is an example of the questionnaire used ; as filled in, it is typi- cal of the answers received from many nurses: Division : Pacific Questionnaire Date : April 20, 192.2 1. Name: W , Lucie M. 2. Address, Temporary : Permanent: 1215 ISth St., Sacramento, Calif. 3. Eed Cross Badge Number: 21Ji2 {Joined Bed Cross in 1912). 4. Date of appointment to service: December 21, 1917. 5. Date of discharge from service: March 21, 191S. G. Service with Army : Yes Navy Red Cross : Yes U. S. Public ITcaltli Service Sanitary Zone Emergencv, Infiuenza Epidemic, Disaster, etc. 7. Condition of hcaltli on diseliargo : pliysically e.rhau,sied. '^ Amrrirri)! Journnl of Xursing, Vol. 20, j). 81)1. DEMOBILIZATION 1039 8. Condition of henlth at present time: good. 9. Approximate date of illness, if any and where: October 1, 1915, in New York City. It was this illness of nervous erhaustion which rendered me unfit for extensive Army service. 10. Have you notified the Veterans' Bureau or the Ked Cross Nursinf;; Service : No. 11. Are you drawing compensation from the Veterans' Bu- reau : No. Date granted. Number. Hospitalization, if any. Name and address of doctor by whom examined. 12. Eemarks : See above. 13. Vocational training: Yes, at my own expense. Number. Where: Simmons College, Boston, Mass. What kind: Public health nursing course. Length of course: nine months. 14. Remarks: Have never asked benefits far myself from the American Red Cross. 15. Date granted. 16. Present occupation : Public health nursing covering Sac- ramento County binder direction of American Red Cross, Sacramc7ito Chapter. As an example of the further interest which the Red Cross took in the ex-service nurse, when the questionnaire came into Pacific Division h('ad(iuarters, ^[iss White, Division Director of Nursing, referred it to the Ked Cross Bureau of Post-War Service, wliicli was a continuation of Red Cross Home Service for ex-service men, and the director wrote the following reply to Miss W : ]\riss Lillian L. Wb.ite . . . has handed me your ques- tionnaire of A])ril 20 for acknowledgment and reply. We note that your present physical condition is fair, but that you were in poor health at the time of your discharge, probably caused by an aggravation of an illness suflPered prior to en- lishment. In order that your future interests may be safe- guarded, may w(^ state that the sub-district office of the Veterans' Bureau, ^lerchaiits National Bank Building. Sacra- mento tiiat branch of the (Jovernment res])()iisible for the administration of the War K'isk Act is autliorizcd to oxtoiid medical care, hospiializatioii, compensation ami vocational 1040 HISTORY OF AMERICAN RED CROSS NURSING training to former reserve members of the Army Nurse Corps, who may now be incapacitated with disabilities which are a result of military service. We are offering this information, should a relapse of the illness you suffered prior to your serv- ice with the Army N^urse Corps occur, which might make you eligible to the benefits of the War Eisk Insurance Act. If you have any unadjusted claims against the Government such as liberty loan allotment, adjustment of back pay, this office is available to serve you. Of the 449 disabled nurses, twenty-two were nurses who had incurred their disability while in active service under the American Red Cross. To care for them and for other members of its overseas personnel who became ill in line of duty, the Commission for France established a special hospital, American lied Cross Hospital ISTo. 101, at I*^euilly, near Paris ; it was arranged that sick members of other American welfare organi- zations could also be sent to Xo. 101. Owing to the exorbitant prices which prevailed in France in 1918, need arose for a convalescent home where nurses on Army, Navy and Red Cross service might go to recuperate when they no longer needed hospitalization. The Kurses' Bu- reau at Paris Headquarters in July, 1918, opened a convales- cent home at Le Croisic, a quaint little fishing village on the Brittany coast. The house was located on a stretch of sandy beach overlooking the ocean and had accommodations for one hundred nurses on convalescence or on leave. ''The good food, the frcsh^ bracing air, the fine bathing and the picturesque Breton peasant life," wrote Miss Hall, "combined to make La Croisic an ideal resting place for nurses and workers worn with the strain of war service. The rates of ten francs a day were most reasonable and brought the home within the moans of all." In November, 1918, the home at Le Croisic was closed on account of the climate, and the Hotel du Cap at the Cap of Antibes, near Cannes, in the Riviera, was opened January 6, 1919, as a substitute. x\ccommodations were developed to receive some two hundred convalescent Red Cross women per- sonnel there. Five public health nurses were sent down to do visiting and general nursing. Kate C. Hough was the super- vising nurse. Mrs. Hough was a graduate of the Xewark City Hospital School of Xursing and had done private duty, hos- pital, district and industrial nursing prior to her assignment DEMOBILIZATION 1041 in March, 1918, to the Red Cross Children's Bureau. For some six weeks during the military crisis of the summer of 1918, Mrs. Hough cared for American wounded in French hospitals under the special arrangement effected hy the Ameri- can Ked Cross and the Service de iSante. With this wide ex- perience and with native executive ability and initiative, she developed at the Hotel du Cap at Cannes a convalescent home which the nurses who visited her described as ideal. The location was one of rare beauty, the food was excellent and the atmosphere which permeated the hotel one of kindly interest and solicitude. Many of the nurses who served overseas with the American Red Cross were returned to the United States on Army trans- ports. When those who had been taken sick or had been dis- abled in Red Cross service arrived in New York they were temporarily cared for at the hotel on Madison Square or at Bay Shore until settlement of their Red Cross insurance could be effected. The provision made for them by National Head- quarters was the same as that made for all Red Cross workers in foreign service. As this arrangement was unique in the history of insurance, a brief account of it will be given. Previous to 1917 the Executive Committee had individually considered every case of sickness, disability or death of a Red Cross worker and had made specific recommendations on each, but with the large n\imbers of Red Cross personnel who were being sent overseas in 1917 it was seen that a more standard- ized arrangement would have to be effected. At a meeting held September 28, 1917, the Executive Committee instructed the War Council "to make an investigation of plans for providing insurance for persons engaged in Red Cross work in foreign countries . . . and to report to the Executive Committee for action." The War Council immediately appointed a National Advis- ory Committee on Insurance, the members of which were the actuaries of the foremost insurance companies in the Tnited States. Arthur Hunter, chief actuary of the Xew York Life Insurance Company, was the chairman; Hendon Chubb, ad- viser to the Bureau of War Risk Insurance and an authority on marine insurance, was one of the members. Among other mem- bers were R. Henderson, actuary of the E(iuital)le Life: A. A. Welch, of the Rhoenix ]\Iutual; George Woodward, of the Met- ropolitan Life; Henry ^loer, of the Home Life; WcMulell M. 1042 HISTORY OF AMERICAN RED CROSS NURSING Strong, of the Mutual Life; B. D. Flynn, of the Travelers Insurance Company, and J. H. Woodward, actuary of the New York State Industrial Commission. The Insurance Committee immediately began to investigate the possibility of having Red Cross overseas personnel included under the War Risk insurance laws as Federal liabilities, in that the Red Cross was a semi-governmental organization. Con- gress was approached on the subject but it was decided that if the benefits of the War Risk Insurance and disability laws were extended to Red Cross workers, they would have to be extended also to the workers of all welfare organizations, a procedure manifestly impossible. Moreover, commercial com- panies refused to insure Red Cross personnel going into foreign service; they felt the risk to be too great because Red Cross foreign service called for the assignment of nurses, ambulance drivers, outpost and line of communication canteen workers to points second only in danger to that of the front line. Hence with the doors of Federal and commercial aid closed to its over- seas personnel, the majority of whom were men and women of moderate means with one or more dependents, the War Council felt that the Red Cross must devise its own insurance. Accordingly, the Committee prepared several plans and sub- mitted them to the War Council, which recommended to the Executive Committee that the so-called "second plan," with various modifications from time to time, be accepted. The Executive Committee at a meeting held on December 6, 1917, approved the following plan, which was without cost to the workers : The Eed Cross has procured life, health and accident insur- ance for its workers abroad. . . . The insurance granted is substantially as follows : 1. A policy of life insurance on the term plan in the sum of $1000 for each worker, payable in event of death or in event of total ajid permanent disability from any cause, payment for total and permanent disability to be made at the end of two years from date of disability, and, in the meantime, the worker receives the weekly indemnity de- scribed in the next paragraph. 2. A policy of accident and health insurance which provides for the payment of weekly indemnities of $20 per week in the case of total disability resulting from bodily injury or disease, and, m addition, provides for the payment of DEMOBILIZATION 1043 $500 in the event of certain permanent injuries as men- tioned in tiie policy. Tlie weekly indemnity payments are to commence four weeks from the date of disability and continue until disability ceases, not exceeding a total period of two years from date of disability. During the first four weeks necessary medical care and attention will be furnished by the Eed Cross without cost. In a(lo])ting this phin the Red Cross appreciated that this sum of $1000 would not be adequate to provide for a bene- ficiarv totally disabled in Red Cross foreign service. Such a provision lay wholly beyond the powers of the society. How- ever, J^ational Headquarters felt that this health and accident insurance and this sum of $1000 in case of total disability lay within Red Cross resources and would prove of some real assistance to a disabled worker or to his or her beneficiarj. In developing this plan the Red Cross set up at National Headquarters in April, 1918, a Bureau of Insurance, of which Robert C. Rathboiie, of New York City, was the director. He was followed in October of the same year by Winficld A. Wilson. ]\rr. Wilson had been engaged previously in insurance work in Washington and he had charge of the seven phases of insurance which were used by National Headquarters to pro- tect the Red Cross in its many activities. The plan for life, health and accident insurance included the utilization of large commercial insurance companies to which the Rod Cross paid premiums, so that the Red Cross might profit by the field organization of the large companies. In the matter of the payment of premiums the Red Cross en- countered the first '*snag." State and Federal law declared that insurance premiums must be a fixed premium; tlie Red Cross, however, was loath to have any profits accrue from con- tracts which they were obliged to place, so the Advisory Com- mittee appealed to the Insurance Commission of the State of New York (the hub of the insurance world) to have an excep- tion made to embrace the Red Cross plan, which provided that all pr(>miums, minus actual losses, taxation and a small charge for service, should revert to the Red Cross. The Commissioner vetoed the appeal but the Advisory (\^mmittee carried it to the Legislature of the Stat(^ of Xew York, where the existing laws were amended, making possible the Jied Cross insurance on a non-profit basis, 1044 HISTORY OF AMERICAN RED CROSS NURSING The result of this ruling was seen when on December 1, 1919, the Red Cross by vote of the Executive Committee de- cided to self-assume the life insurance and permanent disability clauses of its insurance. This decision brought an accounting whereby the sum of actual losses, taxation and a small charge for service were deducted from the total amount of premiums paid from time to time by the Red Cross to the insurance com- panies, and the balance was returned to the Red Cross. This sum amounted to $264,000. Several months after the Red Cross had assumed this phase of its insurance, the Executive Committee, upon Mr. Wilson's recommendation, voted a change in the plan of payment of the $1000 due under the total disability clause of the life contract, to the disabled worker. The original provision called for pay- ment of the face of the contract amounting to $1000 if at the end of two years the disability was adjudged to be of a perma- nent and total character. This clause was changed so that at the end of the two-year period the worker having received the indemnity under the health and accident policy paid only for total disability, would, if disabled, be considered totally dis- abled within the definition of the provision, whereby the $1000 would be paid in weekly installments of twenty dollars each in- stead of in a lump sum. This change was made because of the obvious difficulty of determining, even by medical examina- tion, what constituted permanent disability. The new contraci; insured to the disabled worker a steady income for practically another year. After the expiration of this fifty weeks' allot- ment the case was closed. In the case of death of the insured, the sum was paid in a lump sum to the beneficiary. I^ational Headquarters continued, however, to handle its health and accident insurance through the Travellers' Insur- ance Company that it miglit be benefited by the assistance of the field stafi" of that company in preventing malingering. The provisions described above protected Army, Xavy and Red C^ross nurses assigned to duty with Red Cross foreign com- missions. Xo protection was, however, available for Red Cross nurses who became sick or disabled while temporarily assigned by the Red Cross to influenza relief in cantonment hospitals or in emergency hospitals established for the civilian sick. Cases of this type wer( mniierous and finally in 1920 ]\Iiss Noyes suc('(H'ded ill getting National lleadciuarters to include them among Red Cross responsibilities. But they were never in- DEMOBILIZATION 10 i5 eluded in the insurance plan, which was purely for the benefit of Red Cross workers in foreign service for the society. Such were the government and Red Cross provisions for sick and disabled nurses. Yet even in the best regulated and equipped hospitals of the Public Health Service, or in the lux- urious and sympathetic environment at Bay Shore, the plight of the disabled ex-service nurse was as pitiable as that of the disabled ex-service man. Mental cases could not be admitted to Bay Shore, and perhaps some of the bitterest agony of the war was endured by nurses in government hospitals imrses who were trying to regain their mental and nervous poise; like the shell-shocked ex-soldiers, nothing seemed worth while and they often ate their hearts out in long periods of extreme melancholia. i^ot the care given or not given to exceptional cases but that given to the rank and file will have deteraiined whether or not the Government and the Red Cross met their obligations to- ward the women who sacrificed health and means of livelihood in order that American men might have skilled nursing care in their hour of need. Cases of neglect may have occurred just as likely as cases of '"goldbricking," that term applied to soldiers and nurses pauperized by too much help. That the Government and the Red Cross did its duty generously and in kindly spirit to at least one sick and disabled nurse and that this aid was truly appreciated, is shown in the following letter written to a Red Cross Division Director of Nursing by a disabled ex- service nurse : Your very kind letter . . . came on ^Monday, and in reply I would like to say that I have been receiving full compensa- tion since my discharge from the Army. I must say, too, that nothing could exceed the kindness and consideration and good care with which 1 have been treated since I first took ill in October. lULS. I was in five different hos])itals in France and tliree in the United .States and in every one of them I was treated with the greatest kindness and I know I owe my life to the care I received. I wish I could make you understand how much I ai)])reciated it all. ^ly long illness, ])neun]onia, follow(>d hy einpyeiiiia, was made bearable and. between tlie ])ainful ])eri(Mls. \ery ph'asant. I have read and hi^ard many eoir.plaiiits frdin nurses regarding their treatment in tlie Army, but I hav(> absolutely no complaints to make. Xnthing could exceed the courte^v and kindness 1 ha\e recei\i'd from 1046 HISTORY OF AMERICAN RED CROSS NURSING every one with whom I came in contact. I am afraid my nursing days are over, hut I am glad to he home. The climate here is dry and cold and seems to be the only one that agrees with me. I have had several abscesses in my lung since the incision healed. Apart from that I feel fairly well. Thank 3'ou so much for your kind offer of service. The only thing I find any need of is reading matter. We are twenty miles from a town of any size and you may be sure I make the trip very seldom. I should be very glad indeed for books or magazines. One of the projects of the nursing profession during the demobilization period was the establishment of a memorial to American nurses who had died in military service. This was not a Red Cross nursing project ; it was undertaken by nurses and friends of nurses. However, the labors of Miss Noyes, in her position as president of the American Nurses' Associa- tion, and those of Red Cross nurses who supported the me- morial, and also the numbers of deceased Red Cross nurses whose sacrifice the memorial perpetuated, make necessary brief mention of the project in this history. In January, 1919, Dr. Anna Hamilton, the founder of the Nightingale School for Nurses at Bordeaux, France, visited the United States for the purpose of raising funds for the Nightingale School. The Maison de Sante Protestante, the hospital in connection with which the school was maintained, dated back to 18G1 and had long since outgrown its buildings and equipment. Owing to its location in a closely built quarter of the city, the housing facilities of the hospital and school could be expanded only by removal to a new site. In 1914 Mile. Elizabeth Eosc, of Bordeaux, had presented to the Maison de Sante through Dr. Hamilton, her home. Bagatelle, an estate of sixteen acres, located just outside the city, to be used as the site for the new hospital. Funds for erecting the building were, however, not available, and the war held up the project until the cessation of hostilities. When Dr. Hamilton arrived in New York City in January, 1919, she interviewed many nursing leaders; one of these was Miss Hilliard, then superintendent of the Schools of Nursing at Bellevue and Allied Hospitals. ]\riss Hilliard later stated to ^liss ^faxwell that she believed that the American Nurses' Association could raise funds to build the school if Dr. Hamil- ton could raise the funds to build the hospital. DEMOBILIZATION 1047 At a meeting of the Joint Boards of Directors of the Ameri- can Nurses' Association and the National Leaf^iie of Nursing Education, Miss Maxwell proposed that the American Nurses' Association provide a fund for a building which would house the Nightingale School, this building to be a memorial to American nurses who had died in war service, and especially to the hundred American nurses who lay buried in French soil. The other members of the Joint Boards felt that such a me- morial would be in keeping with the spirit and work of Flor- ence Nightingale, the founder of professional luirsing, who had said : "Let every founder train as many in her spirit as she can then the pupils will in their turn be founders also." The Night- ingale School was, it will be remembered, the only school in France giving training to nurses on the modern professional basis known as the '^Nightingale System." The question was then referred for action to the newly ap- pointed Joint National Committee (of tlie Bureau of Informa- tion for Nurses), the committee which represented the three national organizations of nursing from which had developed the Joint National Committee of National Nursing Head- quarters. At a meeting of this committee it was voted that the American Nurses' Association should undertake to raise by December 1, 1919, a fund of fifty thousand dollars ($50,000) to be used in erecting and equipping a nurses' home and class- rooms for the Nightingale School, this sum to be known as ''the ]\lemorial Fund to American nurses who had died in mili- tary service in the Kuropcan War." Immediately through letters, personal solicitation and edi- torials in the Journal, efforts were made to raise the sum. The Joint National Conniiittc^e was particularly charged with re- sponsibility for raising the amount; this committee, it will be remembered, was composed of ^liss Nutting, ^Fiss Noyes and ]\liss Francis, reprc^senting the American Nurses' Association; !Miss Clayton, Miss Coodrich and ^liss llilliard, re])resenting the Xational League of Nursing Education, and ^liss Beard, ]\Iiss Wald and Miss Crandall, of the Xational Organization for Pul)lic Health Xursing. Miss Xutting, Miss A11)augli and ^liss Noyes prepared the lit(n'ature. ]>y .lannary, 1921, the fund had been ()versul)scril)ed. Early in the spring of 1!l'(), when the fund was n(>arly com- pleted, a conuiiittee to take cliarge of it, l>otli in this country and ov(,'rseas, was aj)pointed. ^Irs. Henry 1\ Davison, of New 1048 HISTORY OF AMERICAN RED CROSS NURSING York, was chairman, and Mr. Robert Bacon treasurer. Miss Fitzgerald, who was then in Geneva, Switzerland, Mrs. Charles Tiffany, Miss Nutting, Miss Maxwell, Miss Ruth Morgan, Miss Noyes, Mr. Ethan Alien and Mr. C. A. Coffin were mem- bers. This committee was later enlarged to include Miss Hay, then chief nurse of the American Red Cross in Europe, Mr. Nelson D. Jay, of the Morgan-Harjes Company, Paris, and Dr. Kendall Emerson, of the Commission for Europe. As soon as the fund was transferred to the Morgan-Harjes Company in Paris the large New York committee went out of existence and disbursement of the fund was carried on through the smaller Paris committee. In September, 1920, Miss Noyes went to Europe to inspect American Red Cross nursing activities, and while in France visited Bordeaux and conferred with the Trustees of the school and with Dr. Hamilton regarding the terms of gift. The plans for the school were gone over and building immediately began. The Charter and By-Laws of the Nightingale School as finally drawn up included the following paragraphs: Article 3. Organization. In 1921, American nurses, desiring to perpetuate the mem- ory of their fellow-nurses of the American Army, Navy and Eed Cross who died while in active service during the great war, subscribed a sum of 775,000 francs, known as the Ameri- can Nurses' Memorial Finid. The Joint Committee of the three great associations of nurses in the United States (1. American Nurses' Association, president Clara Noyes; 2. National League of Nursing Educa- tion, president Lillian Clayton ; 3. National Organization for Public Health Nursing, president Mary Beard) decided to devote this sum to the construction of a boarding establish- ment for the Florence Nightingale School, for the sole pur- pose of facilitating better education for French nurses and the training of a larger number of superior nurses for France. An Advisory Committee, created with the approval of the Administrative Board, will act as a Board of Advisors in the management of the school. Its members will be chosen by the Joint Committee of the three great associations of American nurses. This Advisory Committee shall publish reports on the operation of the school. These reports will allow the nurses who collected the ^Femorial Fund to follow the progress of the Florence Nigiitiiifiale School. DEMOBILIZATION 1049 In response to the desire of tlie women who donated the American Xurses's ^lemorial Fund, the school shall conform more and more to the precepts of Florence Nightingale and consequently will always be directed by a hos})ital nurse who shall herself hold a "first-class diploma" preferably from this school. Tlie teaching of the school shall be constantly improved, and shall endeavor to approximate more and more closely the program published by the League of Xursing Education in the United States. . . . The members of the Advisory Committee of the Nightingale School were ]\Iiss Janmie, representing the ^Xational League of Nursing Education; Miss Anne H. Strong, of the National Organization for Public Health Nursing, and Miss Noyes, of the American Nurses' Association. The entire memorial fund amounted to 850,000 francs, of which 775,000 were expended for the erection of the building and the remainder for equipment and furnishings. In the central hall of the building a bronze tablet was placed, a tablet bearing the inscription : To the Florence Nightingale School In memory Of our comrades who died in service We Tlio Nurses of America Dedicate tiiis ]\reniorial To the Higher Education of Nurses For Ifumauity and For France. During the late afternoon of June 5, 1021, the laying of the corner-stone of the Florence Nightingale School took place. After several addresses, ]\Iiss Hay, acting as ^Nfiss Noyes' repre- sentative, placed in the corner-stone a box containing the stat- utes of the school and nanu's of th(^ Am(>rican nurses who had died in service ; then the first stone was laid. A year later, on ]\ray 12, li)22. the on(> hundred and second annivtu'sary of Miss Nightingah^'s birth, the Amei'ican Nurses' Memorial building, then completed, was dedicated. The ([uestion of a suitable memorial to ]\riss Delano was first raised iniincdiately after her death and American Tied Cross nurses in France subscribed a snudl fund of about six hundred 1050 HISTORY OF AMERICAN RED CROSS NURSING dollars for the purpose. National Headquarters authorized Miss Noyes to act as trustee of this sum until a decision had been reached regarding the form which such a memorial should take. At a meeting of the National Committee held December 9, 1919, the chairman appointed a committee to study and report upon plans for the memorial. This committee was made up of ]\Iiss Maxwell, Miss Kerr, Miss Gladwin, Mrs. Gretter, Miss Jamme, Miss Van de Vrede, and Miss Palmer as chairman. At the meeting of the National Committee held on April 14, 1920, at Atlanta, Miss Gladwin, in the absence of Miss Palmer, read the report of the Delano Memorial Committee. The sub- ject had been discussed with Mr. Powell ]\1 innigerode, director of the Corcoran Gallery of Art in Washington, and he had suggested that a mural decoration symbolizing Miss Delano's work be placed in the interior of the National Headquarters building. Other suggestions had been made that the memorial take the form of a building to house the Nursing Service and to be erected on the Red Cross grounds; a scholarship fund, with a tablet at National Headquarters commemorating Miss Delano's life and work ; a life-size figure in bronze representing a Red Cross nurse, to be erected on the grounds of National Headquarters; a life-size statue of ]\Iiss Delano herself in bronze, to be erected on the grounds at National Headquarters, and a clubhouse for nurses. Two weeks after the Atlanta meeting, on April 27, death removed from her many activities the chairman of the Delano ^Memorial Committee, Sophia F. Palmer. ]\Iiss Noyes then appointed Miss Minnigerode as chairman; she added two more members to the connnittee, .Miss Boardman and ^Ir. Powell Minnigerode, and developed extensive plans for raising a Memorial Fund. At a meeting of the National Committee held April 23, 1921, ^liss ]\linnigerode moved that the Delano ^lemorial Com- mittee be enhirged to include the Division Directors of Nursing and certain otlun- nurses and members of the laity in several parts of the United States; that the members of the National Delano ]Menioi-ial Committee be autliorized to form sub-com- mittees in their own localities, and tluit a general treasurer be appointed. The motion was carried. The rcorti-anizcd Delano ^Mcmoi'ial Commiteee had as its DEMOBILIZATION 1051 members Mrs. William Church Osborn, IMrs. Henry P. Davi- son, Mrs, An^ist Belmont, Mrs. Frank X. Ilammar, Mrs. L. E. Gretter, Miss Boardman, Miss Amy Alexander, Mrs. John Lynch, Miss Kerr, Miss Nevins, jNIiss Jamme, Miss Glad- win, ^liss Maxwell, Miss Stimson, Miss Hay, Miss Foley, Miss Albaugh, Miss Johnson, and Miss ^linnigerode, chairman. At the present date of writing, subscription to the fund is in process. Miss Delano herself had established a fund under which public health nurses were to be assigned in remote communities to conduct a service in memory of her father and mother. Of the twenty-two items of Miss Delano's will, nine of them con- tained legacies to nurses or nursing organizations. Four of these items named nurse friends as beneficiaries; the other five were in favor of nursing organizations as follows: the Alumna) Association of Bellevue Training School for Nurses, the Alum- nx Association of the Training School for Nurses, Hospital of the University of Pennsylvania ; the New York Eye and Ear Infirmary, and the following bequest to the American Red Cross : Item XXI : I give and bequeath the sum of Twenty-Five Thousand Dollars ($25,000), unto the American Red Cross in trust, the principal of said fiuid to be kept intact perpetually and the income only arising therefrom to be used for the support of one or more visiting nurses, under the supervision of that organization, in loving memory of my father and mother, such nurse or nurses to be known as the "Delano Red Cross Xurse, or Xurses." In addi- tion and for the same purpose. I give and bequeath unto the said American Red Cross the entire right and interest in and to any royalties to which I may be entitled at the time of my death, unto any book or books written or published by me. and I direct that such royalties, as paid to the said Americaii Red Cross, shall be added to the income from the aforesaid trust fund and used for the same purpose as hereinbefore provided therefor. At a meeting of the National Committee held on December 6, 1021, a plan containing the details of selection of the Delano Ived (^ross nurses and the nu^thods by which their work was to be supervised and the fund administered, was submitted by ^Liss Fox and approved by the National Conunittee. The first 1052 HISTORY OF AMERICAN RED CROSS NURSING Delano Red Cross nurse was Stella Fuller and she was assigned to duty in Alaska. Among the unsettled war problems which claimed the atten- tion of nurses during the demobilization period was the train- ing and utilization of Red Cross nurses' aides. Early in 1919 Miss Boardman, always a staunch advocate of the volunteer aspect of Red Cross nursing service, as well as the first friend of the professional service, brought forward a plan for utilizing Red Cross aides in connection with the care of the sick in com- munities where there was an insufficient number of nurses. In the plan it was specified that the service of these aides should be purely volunteer ; that the aides themselves should be required to have taken the prescribed course of training for Red Cross aides ; and that they should work under professional direction and should wear a distinctive uniform and badge. At the meeting of the National Committee on Red Cross Nursing Service, which was held at National Headquarters on December 9, 1919, Miss Boardman presented her plan; it was informally discussed. At an adjourned meeting held the fol- lowing day Miss Nevins, the chairman of a small committee which had been appointed to consider the plan, read a recom- mendation that the "National Committee on Red Cross Nursing Service recommend that such Chapters as so desire may organ- ize those who have taken the required courses (Home Hygiene and Care of the Sick, Food Selection and, if possible. First Aid) and are ready to volunteer their services for the sick . . , in cooperation and with the supervision of the Chapter Commit- tee." Miss Gladwin recommended that the plan be developed in the District of Columbia Chapter as an experiment and the resolution, with this and other minor amendments, was passed. The next mention of Miss Boardman's plan appeared in the Minutes of the National Committee of a meeting held April 16, 1920, at Atlanta, Georgia. Again the plan was discussed, and a report of the successful demonstration in the District of Columbia Chapter was read. j\Iiss Goodrich, ]\Iiss Van de Vredc, ^liss Johnson, Miss ^laxwcll and Miss Francis spoke of good work done by laywomen with which they were person- ally familiar. Miss Noyes emphasized the fact that the point of contact in carrying out the plan would be from the National Committee to Division Directors of Nursing to Chapter Com- mittees on Nursing Activities. -Miss Francis moved that they approve the plan and recom- DEMOBILIZATION 1053 mend that it be extended to such Chapters as were prepared to develop it, this extension to be decided by the Division Direc- tor of Xnrsini; in cooperation with the Division manager. The motion was carried. As the Nnrsin<^ Service swung toward normality again, a definite Red Cross peace-time program in the development of public health nursing, class instruction to women in Home llygien(> and Care of the Sick and in nutrition was undertaken. Each of these su})jects will be treated in subsequent sections. A final general nursing project of considerable importance (hiring the demobilization period was of an educational type and included two clearly defined phases: the dissemination of propaganda regarding general and public health nursing and class instruction, and the dissemination of propaganda regard- ing student nurse recruiting. The first of these projects, which was as picturesque and droll an undertaking as any in which the Eed Cross nurses had hitherto particii)ated, first embraced the utilization of Chau- tauqua platforms as a medium through which to reach the American public. Early in April, 1!)17, the Kadcliffe Chautau- quas had asked !Miss Delano to assign a nurse to one of their circuits to speak on the general Kcd Cross military and health program. Florence ^l. Desley, a former Ked Cross Town and Country nurse, was chosen and was the pioneer Red Cross troubadour of lu^alth. So successful was she in interesting her audiences in Ked Cross class instruction and general nursing activities that ^Ir. Ivadcliife a year later asked Miss Delano to reassign ]\Iiss Besley and to provide three other nurses for similar work. Elora Bradford, (Mrs.) ^Margaret 11. Cooper and Dolly Twitchell took the road as itinerant nurse-lecturers and instructors. Jmmediately after the signing of the Armistice, public in- terest in the I'nited States regarding overseas service ran high. National Ilead(iuarters was already swinging toward a broad health program and was zealous to find ways in which this pro- gram could be brought to public attention. The Xursing Serv- ice suggested to the Department of I'ublicity that Ked Cross nurst^ speakers, nurses who had had overseas experience, should ho assigned to the Chautau(|ua platforms and should tell the war and p(>ace story of th(> Nursing Service. The wholly American institution of Cliautau(iua was a de- v(>lopment of the Enivc^rsity Extension idea and was a com- 1054 HISTORY OF AMERICAN RED CROSS NURSING munity project by which American cities and especially towns and villages too small or remote to attract lecturers and enter- tainers of national prominence held a series of lectures and entertainments, usually for a week's duration, which combined educational and entertainment features. The method by which a community held Chautauqua was simple : the mayor and town council voted to hold Chautauqua Week, and signed a contract with a commercial Chautauqua company whereby the company provided lecturers on civic and literary subjects, mu- sicians and other types of theatrical entertainers, in return for a percentage of the gate receipts. Chautauqua Week was usu- ally held under canvas at the local county fair grounds and was attended by young and old alike. The financial basis of the Chautauqua campaign was a happy one for the Red Cross. The commercial companies paid Na- tional Headquarters a weekly salary rate for each nurse speaker and provided maintenance and traveling expenses. National Headquarters in turn reimbursed the nurses and fur- nished posters, newspaper plates, material for publication in the local press, and copies of two pamphlets, one promoting the Red Cross public health program and the other urging young women to take up nursing, for distribution to the nurses' audi- ence. The contact between the Chautauqua companies was made by Dr. Thomas E. Green, then director of the National Red Cross Speakers' Bureau. Details of the publicity material w^ere handled through the cooperation of the Nursing and Publicity departments and local interest in the nurse's lecture was aroused by Red Cross Division and Chapter efforts. The nurse speakers themselves had little idea, when they came to National Headquarters for a preliminary conference in iMay, 1919, of the vicarious and nomadic summer wliieli lay ahead of them, nor for that matter had ]\Iiss Noyes and her associates, else the Red Cross troubadours of health might not have taken the road with such fervor. The majority of the speakers had just returned from one to three years of foreign service; many of them had been "wp the line," but surely no Red Cross nurses were more brave than the thirty-one Chau- tauqua speakers who started out to try to hold tlicir own against artists who had spent their lives in public speaking and enter- tainment. And the difficulties of living at the front were oi'tcn no harder than those expc^rienced by these nurses, who spoke one day at a given town, then traveled during the night or the DEMOBILIZATION 1055 following morning to the next town, there accepted what local hotel accommodations they could find, spoke again in the after- noon and traveled again at night. The list of Chautauqua speakers held many names of nurses who had rendered gallant war service. Mary K. Nelson, of fivreux, was one of the most eloquent. Nurses preeminently successful as Chautauqua speakers were Edith Benn, Frances Maltby, Edith Ambrose, Ida F. Butler, Stella Fuller, Eliza- beth Hunt, Josephine Mulville, and Elizabeth Walsh. Flor- ence Bullard, tb" first nurse whom j\Iiss Russell had sent to care for American boys in French hospitals, had lived through the capture of Soissons in 1918 and her dramatic accounts of war nursing, followed by an appeal for guardianship of the public health, held audiences of from three to five thousand people tensely interested until she left the platform. Daisy P. Beyea was one of the nurses of Evacuation Hospital No. G, and became so successful as a "spellbinder" that she continued as a speaker after her Red Cross assignment was finished. Gertrude Bowling, the young Hopkins nurse whose accounts of ''shock" work at the front have been quoted in an earlier chapter, was another nurse who by reason of her experiences overseas and her great sincerity was able to speak amazingly well. In addition to the nurses already mentioned, the list of Chautau(|ua nurses included Lydia Breaux, Jane T. Dahlman, Anne Dailev, ]\label Fletcher, Eleanor Gregg, jMary Herring, Bree S. Kellov, ^Nfary jMonroe, Laura Phillips, Laura Roser, and ^lary Sedlacek. To nurses drilled since their probation days to avoid publicity and sensationalism, the Chautauqua atmosphere must have been at least an innovation. Miss Am- brose wrote ]\1 iss Noyes : You'd be quite entertained at the dramatic introduction T have. Our jirograni is worked out so that my speech is always preceded by music and our baritone, quite a wonder, gets up after tlie rest of the talent have left the staiie and sings a verse of "The l?ose of Xo Man's Land." When he retK'hes the lines, "]\rid the war's dark curse Stands tlie Ked Cross nurse," the curtains, whicli are covered on one side ])y an American flag and on the either hy a Hed Cross one, are drawn apart and 1656 HISTORY OF AMERICAN RED CROSS NURSING there I stand, in white uniform, cap and scarlet-lined cape. Then without further parley after the applause has died down, I begin. To some of the nurses assigned to Chautauqua circuits, the sea of upturned faces which confn^nted them as they stepped forward to plead their cause was a paralyzing sight, far more terrifying than had been nursing servi( e in an evacuation hos- pital or a bombed base. A nurse wrote : I used to come wabbling out on the stage so scared I'd hang onto the tent poles, until I looked around my audience and saw those sickly babies and their tired, gaunt mothers; those undernourished children, many of whom have rickets; those hard-working mountain fathers. Then I seemed to forget everything else in the world my stage fright and fatigue, that breathlessly hot, crowded tent, the hotel where my bed gets up and walks. All I remembered was that I am bringing to these people a message which may mean their future happi- ness and freedom. The unexpected formed a potent factor with which the nurses on the road and the executives at National Headquarters had to be constantly prepared to meet. Just before their first speech, three of the nurses assigned to large and important cir- cuits suffered nervous breakdown as a result of their foreign service. To keep faith with their contract the Nursing Service had to find and prepare substitutes almost overnight. Another nurse kept several speaking appointments, then found the itin- erant life and the uncertain hotel accommodations too wearing, and resigned. Another nurse suffered personal bereavement and was forced to leave her circuit. Two nurses found them- selves temperamentally unfitted for the work. Substitutes had to be found immediately for all these speakers. The twenty-five Chautauqua circuits to which the Nursing Service assigned speakers, looped the United States. ]\Iassa- chusetts, Khode Island, Connecticut, New Jersey, North Da- kota and Nevada were the only states where nurses did not speak. The majority of the circuits took the nurses into iso- lated rural communities where the barren soil yielded only a meager return for gruelling labor. In these regions living con- ditions were primitive and the people themselves of stoic and somber temperament; usually they sat motionless through the DEMOBILIZATION 1057 nurse's lecture and when it was ended left the tent without re- action of any kind. Now and then the nurse's words fell on fruitful soil. Miss Butler wrote: I give my lecture in the afternoon, always making the plea for the employment of a community nurse, the great need for more public health nurses and the need for young women to enter training schools. I make as strong an attack as I dare on the awful conditions I see with my own eyes all through this country, vile drainage and sanitation ; hithy stalls and pig-pens quite often only a few feet from a dug well. I plead for a revival of interest through the Red Cross as a vital memorial to the men and women who died in France. Usually the small Red Cross Branch or Auxiliary is the only organization in these communities outside a church and a school in the Paleozoic stage of education. But oh, it is such a forlorn country ! I never dreamed of people in these United States of ours living with so little knowledge of health and of decent and comfortable living. They fairly cat dirt and God knows they drink it! But they are touchingly eager for a community nurse, "some one to show us how." One woman came to me with tears streaming down her face. "I never dreamed," she said, ''that consumption could be cured; what you've said to-day is life to me." The day's work on a Chautauqua circuit held much of droll- ery as well as of hardship and pathos. One afternoon Miss Maltbv found her audience particularly difficult ; the children on the front scat tittered and squirmed and pointed. Finally she stopped and said sternly: 'Mf the child under the platform will come out I will finish my lecture." A youngster jumped up and answered: ''T'aint a child, nuss, it's a hawg." Miss Butler's assignment took her to the mining districts of southern Illinois. ''I got caught last night in a little town," she wrote, "where my experienced eye told me at one glance that here was a hotel where I should do little sleeping. I told the manager, however, that I simply must have clean sheets ; any one could sec that the ones on my bed had been sle])t on. '' ^Sure they have,' he replied, 'but the travelin' man in that room last night was such a nice clean man them sheets aint noways real dirty!'" One sleepy summer afternoon ^liss ^fulville was sitting on the edge of an Iowa railroad station platform waiting for the local accommodation train to wliccze in when a bairii'aire man 1058 HISTORY OF AMERICAN RED CROSS NURSING in worn-out khakis spied her and came over to talk. The con- versation developed the fact that both of them had had service in France, "I got mine in July an' was shipped back to Bordeaux," said the ex-service man. "I come to in a surgical ward of No. 6 an' there was a big red-headed nurse bossin' that shebang. Gosh, she was a bird ! She was usually too tired to talk much, but, Lord, how she could nurse ! She wasn't much of a looker though ; she was thin an' wore an ole gray sweater that hung down to her knees an' her skirt sagged an' " Suddenly he looked at Miss Mulville's smartly-tailored out- door uniform, then up to her already twinkling gray eyes. ''Gosh, lady !" he gasped, "You're her !" When the Chautauqua season closed in November, more than a million and a half people in all parts of the United States had heard the story of the Red Cross Nursing Sersdce in war and peace from the lips of a participant. Two thousand four hundred and two Chautauqua audiences, averaging from thirty to five thousand persons each, had listened to the nurses' lec- tures since tlu^ preceding January. In Nebraska, Red (^ross nurses had addressed 199, and in Ohio, 1Y9 audiences. Miss Besley and Miss JMaltby held the season's record; they had each delivered over two hundred and fifty speeches, six speeches weekly covering a period of nearly forty weeks. The Chautauqua campaign, as it was called at National Headquarters, gave marked impetus to the Red Cross public health nursing and class instruction program and offered a striking example of nurses' versatility. The Chautauqua campaign, with its posters, pamphlets and newspaper plate material, was the most ambitious publicity project which the Nursing Service had hitherto undertaken largely under its own auspices. True, Dr. Green of the Speak- ers' Bureau and John Mumford and Marion G. Schcitlin, in turn Red Cross Directors of Publicity, had guided Miss Noyes and her own publicity representative, Elizabeth Pickett, in the initiation of the campaign, but during the late spring and summer the Nursing Ser\dce itself carried the larger proportion of the work. The success which greeted the campaign instilled in ]\Iiss Noyos and the members of the National Committee con- sidoral)le confidence in general publicity methods and made them zealous to acquaint tlie public with the need existing from 1920 on, for young women to enter schools of nursing. DEMOBILIZATION 1059 One of the piiiiiphlets which nurses had distributed from the Chautauqua phitforms was a small folder, "How May I liecoine a Nurse C written in popular vein and with the intent to interest girls among the rural and small town audiences to enter schools of nursing. The distribution of this pamphlet formed the first special effort of the K(!d Cross in this field. A s<'('()nd experiment in publicity of this type was undertaken in 1!)20 in the Delaware-Pennsylvania Division. Miss Francis wrote : Upon the completion of the Roll Call last year, we realized that the interest of our Chapters in public health nursing was far greater than our ability to secure public health nurses who were prepared to establish these services. At the same time, the number of students in a large majority of the training schools for nurses was seriously below normal. Appreciating that we could never meet the dem?.nds of our chapters for public health nurses if the supply at its source was so seriously crippled, we decided to bring to the attention of the people of this division the need for public health nurses; to educate them to an appreciation of the op})ortunities offered to stu- dents through admission to a training school of nursing; and also to develop a better understanding of the principles con- stituting sound nurse education. With the endorsement of the Pennsylvania State Board of Examiners, Miss Francis worked out an itinerary based on the numbers and geographical divisions of Kcd (Jross Chapters, branches and Auxiliaries and assigned Elizabeth Walsh to speak at each town listed on the itinerary. Miss WalslTs success on a Redpath Chautauqua circuit the previous summer had already won luu- eager listeners in the Keystone State. During January rnd February, 1920, Miss Walsh addressed seven thousand two hundred and sixty-nine persons in thirty- one towns in Pennsylvania. Her audiences assembled in churches, business colleges, public and private secondary schools and factories. Through her efforts, thirty girls w(>re definitely known to have intcu'viewed superintendents of schools of nurs- ing with a view toward entering training. The experiment undertaken by ^Miss Walsh attracted consid- erable attention in nursing ranks and in the late spring of 1920, the Joint Xational (\)nnnittee on Nursing Headquarters ap- pointed a special committee which was charged with respon- 1060 HISTORY OF AMERICAN RED CROSS NURSING sibility for developing and conductino; a nation-wide movement to recruit student nurses. Major Julia Stimson was chairman and Miss Albaugh a particularly zealous member of this com- mittee. Plans were drawn up and Miss Noyes, herself a member ex-offieio of the committee, secured from the Red Cross Execu- tive Committee an appropriation of thirty-five thousand dol- lars ($35,000) "of which so much as may be necessary shall be expended by the Director of the Department of Nursing during the six months ending December 31, 1920, to provide for all expenses at National Headquarters and in the Divisions, in connection with the recruiting campaign for student nurses, as outlined in the plan developed by a special committee repre- senting the American Red Cross, the American Nurses' As- sociation, the National League of Nursing Education and the National Organization for Public Health Nursing." -^ The plan referred to above called for the organization in local communities of a student nurse recruiting committee, to be composed of representatives of such local groups as the Red Cross Chapter or Branch ; the governing and auxiliary boards of the hospitals ; hospital and training school superintendents ; medical and nursing organizations, physicians ; the board of education ; the press ; the chamber of commerce ; and women's clubs. The duties of the committee were outlined in full and included the slow and steady dissemination through a number of years, of propaganda directed toward interesting the general public, and young women especially, in the nursing profession. The publicity material included the distribution of an ef- fective poster, a pamphlet and application forms to be filled out and sent by interested young women to superintendents of schools of nursing. Four motion pictures on nursing subjects had been produced by National Headquarters and they were used also in the recruiting movement, especially one which was called 'Tn Florence Nightingale's Footsteps" and which visual- ized the training of a nurse. Newspaper "feature" stories were prepared and sent out to the local committees which were charged with the responsibility of having these appear in the local press. One of the aims of the movement was to bring to the general public better appreciation of sound nurse education and the special leaflet, which was called "A Challenge to the Young "See Advice of Appropriation No. 203, August 3, 1920, National Head- quarters, Washington, 1). C. DEMOBILIZATION 1061 Women of America," had this aim in view. On one side of the fonr-pag:e leaflet was printed a list of questions which every prospective student was urged to ask the superintendent of the school which she expected to enter; on the opposite page were the answers which should be given by the superintendent of any well-organized training school. The student was thus equipped with knowledge which would enable her to discriminate to some extent between a school of low or high educational standards. Copies of the *'plan" and full publicity material were sent, with appropriate letters requesting cooperation, to all presi- dents of State Nursing Associations; to the editors of medical and nursing publications ; to the presidents of American na- tional medical and nursing associations ; and to Red Cross Division managers for distribution to Chapters and Branches. The following letter written July 20, 1920, by Frederick C. Monroe, then general manager at National Headquarters, to all Red Cross Division managers, is illustrative of these letters of transmittal: As you are aware, we are facing a critical shortage of graduate nurses for all types of work, particularly public health. The increasing demands of modern medicine, the continuing needs of the late war and epidemics of disease consequent upon the war are taxing the nursing resources of the nation to the limit. In one nursing bureau alone, there were recently five hundred more requests for nurses to fill positions in institutional and public health fields than there were nurses availal)^. This condition will probably grow worse instead of bettor. . . . The Ked Cross is deeply concerned in this situation and has the traditional duty to help in every way possible to meet it. Xot only is tbis true, but if the Red Cross is to succeed in the public health field, it must liave a constant and ever increas- ing supply of well-trained nurses to carry on its nursing activities. The nurse training school is the only source from which qualified nurses may be obtained. We nnist. therefore, stimulate recruiting ior these schools. Yet the extraordinary conditions now prevailing are a serious handica]). Commer- cial and industrial life. l)y offering great and immediate rewards, is drawing heavily upon the young womaidiood of the country. localizing the seriousness of the situation, groups of nurses themselves have coiiporated with states, communities and bos- pitnls in local endeaxors to stimulate the enrollment of stu- 1062 HISTORY OF AMERICAN RED CROSS NURSING dent nurses. Eecently also the three national organizations of nursing , . . have joined with the Red Cross in developing a national movement for the enrollment of student nurses. It is this national movement which you are now called upon to assist in every way possible. . . . Then followed detailed administrative instructions. The Division Directors of Nursing took hold of the movement with interest and developed it extensively. In the following months, several ideas of considerable originality were put into use. Miss Van de Vrede of the Southern Division appointed Miss Maltby to initiate the movement in her office. On March 21, 1921, Miss Maltby wrote Miss Noyes of the work accomplished : We first sent each active chapter a letter with sample leaf- lets and one poster. To this there was some response. We are now approaching them through "Briefs" [the Division bul- letin] To all our public health nurses and local committees, we have sent two newspaper articles, with the request that they be published in the high-school papers through the efforts of the local publicity chairmen, or failing that, that they receive space in the local newspaper. These two articles have gone to ninety publications in the division. To college presidents and to Y. W. C. A. presidents in col- leges in the division, we have written and enclosed a poster and a recruiting article, asking that it be published in the college papers. Wo have also offered to send a personal representative to address the colleges on nursing as a pro- fession. The colleges are responding well to the suggestion and a representative will probably start in April. . . . In the Lake Division, Pearl Kamerer was appointed to develop student nurse recruiting; she organized committees in Kentucky, Indiana and Ohio in connection with the state grad- uate nurses' association. On April 8, 1921, she wrote Miss Albaugh : . . . The Ohio State Recruiting Committee engaged Miss Mary 1*]. CJladwin to speak for a period of three months, beginning March 1, to the young women in the different Oliio colleges and to as many high schools and groups of men and women as possible. To finance the speaker, the accredited schools of nursing were asked to contribute one dollar for each pu])il in training. A few of the larger Red Cross cbap- DEMOBILIZATION 1063 ters were also asked to assist. There was hearty response from the schools and the chapters . . . and most of the districts feel that their committees will be interested in doing some- thing definite towards recruiting each year. A novel idea was developed in Sanilac County, Michigan, by Elba L. ^lorse, Hed Cross supervising nurse for Michigan. Three '^mother and daughter banquets" were held with a total attendance of eight hundred and fifty mothers and daughters, and on these occasions the traditions and advantages of nursing were presented. Miss Morse described the type of program : The county nurse outlined the program and twenty-six high- school girls took part. The teachers assisted in choosing the girls and in rehearsing them, so it took very little time. The play was called The Scope of Nursing and was given by twenty girls dressed in white, each girl representing a phase of nursing such as hospital superintendent. Army nurse, Kavy nurse, Hed Cross nurse. As each appeared, she told the pleasant duties of the branch she represented. When the twenty lined up, each with their cards telling what phase they represented, so the mothers saw plainly the wide scope of the profession. Next came lumian pictures, "the greatest mother in the world," the pul)lic health nurse as '"the foster-mother of the race"; "the Lady with the Lamp." . . . Otiier phases of the banquets were music and addresses by prominent nurse leaders. In one town the banquet was free; the committee solicited funds mostly from the wartime worker and invited every niothor and daugliter in the town. Four hundred and fifty atteiulod and the ]\Iethodist Church was crowded as it liad not been since the war. One other town sold tickets at fifty cents and the third at seventy-five cents. Both towns had to restrict the number of tickets to two hun- dred, but could have sold many more. In one place it was voted that a similar banquet be held as an annual affair each year to different nurses from that locality who had died over- seas, the extra proceeds of the banquet to be used as a scholar- ship for a local high school girl entering training. . . . Twenty girls entered schools of nursing in the fall of 1021 as a result of the "mother and daughter banquets." The indirect results of such educational effort, however, went on, for the ideal of altruistic nursing service had been planted in the impressionable minds of young girls and was not to be wliolly forgotten. 1064 HISTORY OF AMERICAN RED CROSS NURSING The movement to recruit student nurses was not confined to definite time limits but was intended to be a steady con- structive upbuilding of public interest and judgment of nursing education. At the present writing, it is too early to estimate the efi^ect of the movement upon the profession. Throughout the period of demobilization, an acute shortage of nurses in all phases of service was experienced. Schools of nursing reported to the Red Cross Bureau of Information and later to National Nursing Headquarters special difficulty in securing adequately-trained nurse instructors. The dearth of this type of personnel was particularly serious because such a condition, if not remedied, would check the supply of properly- trained nurses at the very source, the school ; so at Miss Noyes' request, National Headquarters appropriated funds to be used as scholarships for nurses desiring to take post-graduate courses to fit themselves to teach in schools of nursing. Twelve such scholarships and four loans were granted in 1921 to enable nurses to take courses at the department of nursing and health at Teachers' Colleges. Perhaps the outstanding accomplishment of the nursing pro- fession during the period of demobilization was the winning of assimilated rank of Army nurses. This accomplishment was brought about by the persistent efforts of nurses and friends of nurses in the face of strong opposition from the War De- partment. While the American Red Cross officially took no part in this legislative struggle, individual leaders of the Red Cross Nursing Service were staunch sponsors of the movement. For this reason and also because the new law materially affected the Red Cross in that its nurses are the reserve of the Army Nurse Corps, a brief account of this movement belongs in a history of the American Red Cross Nursing Service. An early request which the nursing profession made to the War J)epartment for definite status and authority for Army nurses was as follows: The American Nurses' Association, in convention assembled in riiiladelphia on tliis first day of May, 1917, would offer the following resohiiion : Whereas, it is true that nurses wlio are responsihle for the actual nursing of the yjatieiits in the military liospitals have no autliority to regulate hygienic conditions therein; and DEMOBILIZATION 1065 Whereas, this situation tends to discourage nurses from undertaking the work ; and Whereas, this is a danger to the hospitals' population ; and Whereas, it has been found essential in representative civil hospitals to place upon the nurses the responsibility for the care of the patients, the wards and operating room and the cleanliness and order pertaining thereto : Therefore, be it resolved : that it is the sense of this meeting that the proper military authorities should be requested to specifically define the status of the nurse and confer upon her the authority necessary to control the situation, to the end that the general welfare of the sick may be promoted and a very grave danger to the well averted. Early in the summer of 1917, the War Department issued the following regulation defining the status of Army nurses: As regards medical and sanitary matters in connection with the sick, members of the Army Nurse Corps and Army Nurse Corps Reserve are to be regarded as having authority in mat- ters pertaining to their professional duties (the care of the sick and wounded) in and about military hospitals next after the officers of the Medical Department and are at all times to be obeyed accordingly and to receive the respect due their position. The phrase "in matters pertaining to their professional duties (the care of the sick and wounded)" permitted individ- ual interpretation on the part of commanding officers of mili- tary hospitals as to whether the nurse's authority did or did not extend beyond the person of the patient. Thus the authority over ward matters such as ventilation, light, temperature, sani- tary conditions, supplies and other questions was not definitely granted Army nurses and the regulation, nurses felt, did not meet their demands for definite authoritative status. Their struggle, therefore, continued. One of tlie first organized moves to secure rank for Army nurses came in the summer of 1917 from a group of prominent New York woukmi who formed a committee later known as the New York Committee^ to Secure Kank for Army jSTurses. ^Mrs. Harriot Stanton IMatch was chairman and ^Irs. H. (). Ilave- meyer an enthusiastic member. This committee had the active support of leading nurs(>s in New York (Mty, among whom Miss ^Maxwell was perhaps the most ardent. Helen Iloy 1066 HISTORY OF AMERICAN RED CROSS NURSING Greeley, a graduate of Vassar College and a member of the New York Bar, first volunteered her services as counsel and later, when nation-wide organization was secured, was retained by the nursing profession to represent them. Early in 1918, bills were introduced into both houses of Con- gress, in the Senate by Mr. Chamberlain and in the House of Representatives by Mr. Dent, which purposed the general re- organization of the Army Nurse Corps. These bills called for an increase in the number of executive officers in the Nurse Corps, the raising of compensation of Army nurses and the collecting in one place of all regulations regarding Army nurses. The discussion in Congress regarding the reorganization of the Army Nurse Corps offered opportunity for the advocates of rank for nurses to press their claims. Two bills proposing absolute rank for Army nurses were introduced into the House of Representatives ; the first one was introduced by Congressman Lufkin on March 27 and proposed commissioned rank with the rates of pay proposed by the War Department reorganization bill ; the second bill was introduced by Congressman Raker on April 5 and proposed the pay incident to the rank. On April 16, the House Committee on Military Affairs, of which Representative S. Hubert Dent, of Alabama, was chair- man, held the first meeting on the question of rank for Army nurses. Mrs. Greeley stated that the object of the committee was to secure rank ... in order to promote the efficiency of the nursing service of our boys by conferring upon the nurses some out- ward, visible sign of the authority which is supposed to be in them, a sign by virtue of which their instructions may be promptly carried out in the wards. For at present their authority to give orders is continually disputed by the enlisted men who serve as orderlies and friction and dangerous delays in the execution of orders result. We believe that the insignia of rank will give conclusive notice to all that nurses are officers and are to be obeyed. Mrs. Greeley then summarized the action following the introduction of the Lufkin and Raker bills ; she stated that after conference with each other and with General Gorgas, the ad- vocates of the two bills had agreed to abandon their bills and support a proposition for relative rank in the form of an amendment to the War Department's reorganization bill. This amendment read : DEMOBILIZATION 1067 Section 3. (a) That the members of said corps shall have relative rank as follows: The superintendent shall have the relative rank of major; the assistant superintendents, director and assistant directors the relative rank of captain; chief nurses the relative rank of first lieutenant; and nurses the relative rank of second lieutenant; and as regards medical and sanitary matters and all other work within the line of their professional duties siiall have and shall be regarded as having authority in and about military hospitals next after the medi- cal oHicers of the Army and shall wear the insignia of the rank in the army to which their rank corresponds. The meaning of the term "relative rank" was next defined by Mrs. Greeley: You will notice that this amendment differs from the Luf- kin and Ixaker bills in asking for relative rank instead of absolute rank. The term "relative rank" has two meanings. It may mean simply relative position, or it may mean a kind of rank which lacks one or more of the essential elements of absolute rank and so is quasi instead of actual, relative instead of absolute. We are using the term in this second sense. The relative rank here conferred is only quasi rank. It lacks several of the essential elements of absolute rank it does not call for a commission; it does not carry the pay, the allow- ances or the emoluments of absolute rank ; and it makes no attempt to confer the power of command incident to a line office of similar grade. The only incidents of absolute rank which the relative rank contemplated in this amendment will confer are : 1. The dignity incident to the name of the rank. 2. The right to wear the insignia thereof. 3. The eligibility to exccise authority within the limits set forth in the law, which are as follows : As regards medical and sanitary matters and all work in the line of their duties, they shall have and shall be regarded as having authority in and about military hospitals next after the medical othcers of the Army. . . . Among the nnrses present at the hearing was ^fiss Delano, and !A[rs. Greeley called npon her to testify. !Miss Delano said: !Mr. Chairman, for a number of years T was superintendent of the Army Xnrse Corps when Surg. Gen. Torney was Sur- geon General of the Army. As the superinterdeut of tlie Army Xurse Corps 1 inspected all of the military hosjiitals in 1068 HISTORY OF AMERICAN RED CROSS NURSING this country, Honolulu and the Philippines, and had ample opportunity to watch the working out of this plan in times of peace. Now, I believe that what was true under conditions which obtained then would hold true to a greatly increased degree now in time of war. I had a basis of comparison, because before I came into the Army Nurse Corps I was for a number of years superintendent of what was at that time the largest training school in the United States, that at Bellevue Hospital. When 1 went into the military hospitals I found an absolute lack of coordination of the activities in the wards. I found division of responsibilities and more or less friction; a tre- mendous amount of adjustment necessary on the part of the nurse; a tremendous amount of yielding of things they con- sidered important for the sake of peace. I found this adjust- ment constantly necessary, and, even in time of peace, great difficulties. . . , I will cite one instance. . . . We had notice from the tuberculosis hospital at Fort Bayard that a number of the nurses were reported as having incipient tuberculosis. I was sent to Fort Bayard to look into the matter. ... I found the head nurses of the wards absolutely without responsibility for the cleanliness of the wards. I had again a basis of compari- son, because we had a large tuberculosis service at Bellevue, and I was entirely familiar with the methods necessary to prevent the spread of tuberculosis or the reinfection of pa- tients. I found, so far as I could determine, no systematic plan for preventing the spread of contagion in the hospital at Fort Bayard because the cleanliness of the ward rested abso- lutely in the hands of the corps men. !N[iss Delano next discussed the regulation given above which defined the status of the Army nurse : Efficient organization in any hospital, civilian or military, is in my opinion to be secured only by placing definite responsi- bility upon one person in the ward. In the matter before us I do not believe that any regulation will eireet the purpose we desire. First, because we have back of us the traditions of years. We have the corpsmen, we have even the officers themselves and perhaps the nurses, with these traditions of divided responsibility, and we have this tradition of the Hospital Corps man, who in the past has not been placed definitely under the nurse. Now, a new regu- lation is made, but, as Mrs. Greeley said, the interpretation of that regulation depends entirely upon the temperament of the DEMOBILIZATION 10G9 commanding oflicer or of the person to whom he delegates the duties regarding it. . . . Mrs, Greeley then called Julia Lathrop, chief of the Chil- dren's Bureau, who spoke in favor of the proposcid amendment. Mrs. Highbee was the next speaker. She brought forth the comparative powerlessness of the nurse to deal with an insub- ordinate orderly. !Miss Goodrich was the next speaker. She pointed out among other things, that in the view of the fact that personnel of the Hospital Corps was constantly changing, it was highly important that the authority of the head nurse should be so clear to all with whom she came in contact that no loss of time should result in teaching the new men her real status. Rank would immediately establish this authority with- out words or written regiilations. Mrs. Greeley then read letters supporting rank from nurses in foreign service, and called upon additional speakers. Among these were Colonel Victor C. Vaughan, Medical Corps, National Army; ]\Iajor ^Fartin, then a member of the Advisory Commission of the Council of National Defense ; Miss Thompson of the Army Nurse Corps; Major W. J. Mayo; Dr. William M. Geer, Vicar of St. Paul's Chapel, New York City; Mrs. Harriot S. Blatch, representative the New York Committee to Secure Rank for Nurses; and ]\Irs. Harriot Blaine Beale, of the District of Columbia. The hearing was then adjourned. On April 20, the Military Affairs Committee heard General Gorgas' opinion regarding the proposed amendment to the medical reorganization bill; the Surgeon General stated that he "'did not see the necessity or the advisability for commissioning the great number of nurses, it would be over .^0,000 as second lieutenants. I do not see," he said, "that it is necessary for their functioning. We can give them all the authority they want in the war now. . . ." The reorganization of the Army Nurse Corps, which was finally contained and passed in the Army appropriation bill for 1!>1!, became law on July 9, 1018, but rank for nurses was not includc^l therein. The failure of the proposed amend- ment providing for rank to be included in the Army Reorganiza- tion bill, was largely due to the opposition of th(> War De- partment. Th(> nursing profession was resolute in their claims for rank and continued to agitate the (juc^stion. On .luly <>, 111S. Rcprc^- 1070 HISTORY OF AMERICAN RED CROSS NURSING sentative Raker introduced a bill into the House, H. R. 12698, which read as follows: Be it enacted by the Senate and House of Representatives of the Ignited States of America assembled, that the members of the Army Nurse Corps shall have relative rank as follows : The superintendent have the relative rank of major; the assistant superintendent, director and assistant directors the relative rank of captain; chief nurses the relative rank of second lieutenant; and nurses the relative rank of second lieutenants; and as regards medical and sanitary matters and all other work within the line of their professional duties shall have and shall be regarded as having authority in and about military liospitals next after the medical officers of the Army and shall wear the insignia of the rank in the Army to which their rank corresponds. This bill was referred to the House Committee on Military Affairs. In the pressure of the times, the bill was lost sight of until late in 1918 when the subject of rank for Army nurses again began to claim interest. With the return of nurses from foreign service early in 1919, rank for Army nurses became the foremost nursing issue of the demobilization period. A National Committee to Secure Rank for Army Nurses was formed by the addition of new members to the old ISlew York City Committee of which Mrs. Blatcli had been chairman. Among these new members were the presidents of the national organizations of nursing, the membiirs of the former Committee on Nursing of the Council of National Defense and influential lay men and women, Mr. Taft was the honorary chairman. Miss Noyes vice-chairman and ]\Irs. Greeley was secretary and counsel. At its midyear conference in New York in 1919, the Board of Directors of the American Nurses' Association voted to sup- port the movement to secure rank, drew up with the aid of the National (Taft) Committee a plan for state organization and instructed their secretary, Katharine DeWitt, to write to all State Nurses' Associations asking their cooperation. On Janu- ary 28, li)19, ]\[iss DeWitt wrote in part as follows to the officers of all State associations, asking their active support to the following plan : 1. That the State-wide committees to be formed should be the State Branches of the National (Taft) Committee to Secure l^ank for Nurses. DEMOBILIZATION 1071 2. That these state communities should be composed about twenty of lay persons and nurses, the chairman i)referably a lay person, either a man or a woman. 3, That the State Committee raise enough money through voluntary subscription to finance its own work and to con- tribute a quota of $250 for the 1919 campaign, to the National Headquarters in Washington, payable as soon after ^larch 4, 1919, as possible. By April, 1919, only twelve state committees had been or- ganized. In the April issue of the Journal, Miss Noyes, as president of the American Nurses' Association and vice-chair- man of the National Committee to secure rank, addressed the presidents, other officers and members of state associations, outlined again the plan of organization and closed her letter with a strong plea for cooperation. In the same issue, the Journal spoke in the editorial columns for rank and from then until the passage of the Lewis-Raker bill, was a persistent and eloquent advocate. On June G, 1919, a bill similar in wording to that of the second Raker bill, was introduced in the Senate by Senator Jones, was referred to the Senate Committee on Military Affairs and was published as Senate bill No. 17-37. From then until the end of the legislative struggle, the bills proposing rank were referred to as the Jones-Raker bills. Throughout the summer and fall of 1919, the nurses or- ganized their forces in the field. At Washington, ]\[rs. Greeley organized extensive office headquarters and from there di- rected the work in the field and "on the Hill" with persistent cheerfulness and vigor. Sara E. Parsons, veteran nurse edu- cator and war loader, volunteered her services at Mrs. Greeley's office and during the fall and winter of 1919 and 1920 spent much time in bringing to the attention of Congressmen the vexations, experiences and privations to which nurses had been needlessly subjected overseas on account of lack of rank. Expert publicity advice was secured and a news service established at Mrs. Greeley's office which issued bulletins periodically to the press and to State Committees to secure Rank for Army Nurses. Hundreds of nurses who had had foreign service sent in affi- davits recounting the difficulties which they had experienced in the performance of their duties, in traveling, in questions of quarters and even in recreational matters, due to their lack of dignified and authoritative status in the Army. These letters 1072 HISTORY OF AMERICAN RED CROSS NURSING and affidavits were published in the Journal throughout the campaign and copies of them were sent to Congressmen with urgent letters asking for rank. ''Ever since April," stated the editorial columns of the (November, 1919) Journal, "a stream of letters, resolutions and petitions has been trickling into Congressmen's offices from nurses, lay persons and organiza- tions, recently from doctors, too. . . . Not only has a pleasing proportion of the whole Congress promised to vote for rank when it reaches the floor, but a goodly number of influential men on both Committees [on Military Affairs] are pledged to its support in committee. Both chairmen. Senator Wads- worth, of New York, and Representative Kahn, of California, have become avowedly sympathetic." Early in the fall of 1919, Congress undertook a general re- organization of the Army. The Senate Committee on Military Affairs took up for consideration the Jones bill proposing rank and submitted it at the War Department. The following letter was written on August 28, 1919, by the Secretary of War to the chairman of the Committee : In reply to your memorandum of August 20, 1919, in which vou request to be furnished with the views of the War Depart- ment relative to the bill (S. 1737) "To grant rank to the Army Nurse Corps and for other purposes,"' I beg to inform you that the War Department is opposed to the provisions of the proposed bill. The bestowal of the relative rank upon Army nurses as provided for in the bill, while not actually providing them witli commissions, would in effect result in placing a consid- eraljle number of Army nurses alcove a large number of x\rmy officers, including medical officers under whom they are serv- ing in hospitals. Tender regulations issued by the War De- partment, members of the Army Nurse Corps have been given rank above all enlisted men in the Army and as regards medical and sanitary matters and work in connection with the sick have authority in and about hospitals next after the officers of the Medical Department and are at all times to be obeyed accordingly, and to receive the respect due to their })ositio]i. The enactment of tlie proposed legislation would not, in my opinion, serve any useful purpose. On September 4, General Ireland appeared before the Senate Committee on ^Military Affairs to discuss the reorganization of the Medical Department and expressed himself as opposed DEMOBILIZATION 1073 to rank. Hitherto, General Ireland had been a staunch advocate of all projects which seemed to better the condition of nurses in the Army ; in fact he was perhaps the first advocate of the Army Nurse Corps, for he had gone down to the beach at Siboney during the Spanish-American War and had asked the nurses on the Ked Cross ship Texas to come ashore and help in the care of the sick. This request of his had been a very radical de- parture from Army precedence and the services of the nurses from the Texas had formed one of the entering wedges of pro- fessional nursing service in the Military Establishment. But at the hearing on September 4, 1919, General Ireland stated that he felt the nurses' "idea in securing rank to better their position would be altogether wrong." Even if General Ireland had him- self believed in rank for Army nurses, it would have been highly embarrassing for him to have advocated it, because he could not well have opposed the Chief of Staff and the Secretary of War, both of whom were vigorously opposed to granting rank to Army nurses. On October 31, the Senate and the House Committees on ^Military Affairs met jointly to hear General Pershing express his views on Army reorganization. General Pershing stated that he favored the bestowal of rank upon nurses "up to and including the rank of second lieutenant." His indorsement and that of the American Legion, gave much encouragement to advocates of rank and the campaign went on spiritedly. Officially, the American Ked Cross took no part in the strug- gle. At the first meeting of the Xational Committee on Ked Cross Xursing Service after the signing of the Armistice Miss Palmer read the following resolution : ^Vhercas From hundreds of nurses and doctors of all grades of rank and ability returning from Army service to civil life we have heard of the distressing handicaps put upon the Army nurses in the late war by her lack of suitable officer's rank ; and Mlicreas That handicap not only appreciably lowered the efficiency of the nursing service rendered but also permitted discomfort, discourtesy and disrespect to result to the nurse in all her relations, ])r()fessional, recreational and social ; and Mlirrcns X(>t tlio Army alone took advantage of her lack of rank hut puhlic institutions unacquainted with her position and function and even Ked ('ross agencies themselves at times discriminated a'^ainst her for the avowed reason that she was 1074 HISTORY OF AMERICAN RED CROSS NURSING not an officer, Red Cross hotels having some of them denied her shelter and comfort on that ground ; and Whereas The lack of standard treatment by the Army, which she so valiantly served in no conscript capacity, and the failure on the part of the great organization, the American Red Cross, to support her in her great need for rank and a clearly defined position, have altogether bred in far too many of our Army Xurse Reserve a deep-seated discontent ; and ^Yhereas The hardships and humiliations complained of seem upon analysis to have resulted in no wise from the exi- gencies of war, but from purely avoidable causes; now there- fore be it liesolved: That we, the Xational Committee on Red Cross Xursing Service in annual conference assembled this 9th day of December, 1919, do hereby deeply deplore not only the unfortunate conditions that have existed and the feelings they have aroused, but also the hitherto omission of the American Eed Cross to lead or participate in any effort to correct these difficulties, or a recurrence of them by the elimination of their causes and the establishment of rank for nurses; and further Resolved: That we express to the Central Committee of the American Eed Cross our deep concern that in the absence of cooperation by the American Eed Cross in the nurses' present struggle to establish a suitable and dignified officers' status for themselves in the American Army comparable with that of other English-speaking nurses, there may be little heart in the nurses of America for continued enrollment in the Eed Cross for service in Lhe Army Eeserve ; and finally be it Besolved: That "we therefore invite and urge the Central Committee to a most serious and earnest consideration of the obligations of the American Eed Cross to American nurses in these premises. This resolution had been drawn up and signed by Miss Max- well, Miss ^Tutting, ]\riss Palmer and Miss Crandall. After Miss Palmer had tinishod reading it ]\Iiss Xoycs stated that the Red Cross had never taken any active part in legislative work, but she believed that it was sympathetic with the movement. Miss ]\rinnigerodo moved that the resolution be adopted and presented to the Central Committee of the Red Cross for con- sideration. 'J'his motion was carried. On JJeccmber 22, ]\Iiss Xoyes transmitted a copy of these resolutions to Dr. Farrand, eliairman of the Executive Com- mittee, and on January 2, 1920, he acknowledged receipt of them DEMOBILIZATION 1075 and asked Miss Xoycs to discuss them in detail with him at her convenience. Some days hiter, she and Mrs. Greeley had a conference with Dr. Farrand, at which he stated that the Red Cross was in sympathy with any movement which would better the condition of Army Nurses in that the Red Cross Nursin^i; Service was the reserve of the Army Nurse Corps, but that its policies did not permit it to take part in any legislative struggle. He stated also that while he appreciated that grave consideration was due to formal resolutions passed by a committee as power- ful and representative as the National Committee, yet he did not think it advisable to present these resolutions to the Executive Committee for action, because General Ireland was a member of the Executive Committee and was also one of the chief op- ponents to bestowing rank on Army Nurses. Dr. Farrand said that he felt that if these resolutions were submitted to the Executive Committee, the mc^mbers would naturally seek the advice of General Ireland, the highest medical officer in the Army, and after hearing his views which were known to be dis- tinctly hostile to rank, would in all probability refuse the aid petitioned by the National Committee. This, he felt, would result in embarrassment to the Red Cross and in harm to the cause of rank for nurses. However, he. advised Miss Noycs to continue her individual efforts to secure rank and the con- ference was then closed. No recordof these resolutions appear on the !Minutcs of the Central and Executive Committees. The legislative struggle was, however, nearing an end. The clause proposing rank for Army nurses was included among the provisions of the bill for Array reorganization and was introduced as such in the Senate on January 0, 1920, by Senator Wadsworth. It was also included in the House bill on xVrmy reorganization. After five weeks, during which nurses inter- viewed Congressmen ''on the Hill" while other nurses and friends of nursing brought pressure to bear on the committee men from the field, the conference committee on Army re- organization finally came to agreement on May 27 and reported that ''tlu> provision for the relative rank of nurses was agreed to, it being contained in both bills." The House of Represen- tatives adopted the conference report on ^lay 28, the Senate adopted it on the next day and the bill for Army reorganiza- tion, with its clanse bestowing relative rank on Army nurses, was signed June 4 by PresidcMif Wilson and IxH-anie law. The conference had made the following: chaui^es in the word- 10T6 HISTORY OF AMERICAN RED CROSS NURSING ing of the original Lewis- Jones-Raker bill : Head nurses were added to the class having the rank of second lieutenant; the clause "and shall wear the insignia of the rank of the Army to which their rank corresponds," was omitted and in its place were inserted the words "The Secretary of War shall make the necessary regulations prescribing the rights and privileges con- ferred by such relative rank." On August 10, 1920, the Surgeon General was notified by the Secretary of War regarding these regulations and he imme- diately placed the gold leaves of a major on the shoulders of the Superintendent of the Army Kurse Corps. Other nurses in the corps donned the insignia as soon as orders to that effect could be disseminated through American Army hospitals. Thus was ended the second most important legislative struggle re- garding American military nursing service which had arisen in the United States. In retrospect, it will be seen that at no stage of its develop- ment did the Red Cross Xursing Service take a more important place in nursing activities than during the period of demobili- zation. Miss Xoyes' dual position as president of the Ameri- can iSJ^urses' Association and director of the Red Cross Xursing Service may have been one of the reasons for this ; another and perhaps more vital cause was the fact that the American Red Cross from 1919 to 1922, in its foreign program, its public health nursing and educational activities, was the organization employing the largest numbers of nurses in the world, and therefore, with its previous war responsibilities and its newer peace activities, it was an organization heavily charged with professional adjustment and advance. The dual projects undertaken by the Red Cross Xursing Service and outside organizations were the establishment of the Bureau of Information and its subsequent metamorphosis into Xational Xursing Headquarters ; the creation of the Xurse Corps of the Public Health Service, with the Red Cross Xurs- ing Service as its reserve ; the hospitalization and reeducation of sick and disabled nurses; memorials to nurses; and the stu- dent nurse recruiting movement. The purely Red Cross nursing projects were public health nursing, class instruction, and edu- cational work through the Chautaiupia. The one major project of demobilization in which the Xursing Service had no official part was the struggle for rank. CHAPTER XII THE CLOSE OF THE FOUEIGX EMERGENCY RELIEF PROGRAM The Commission for Europe The Commission for Poland The Commission for the Balkan States Montenegro Albania Greece North and South Serbia Roumania Contraction of War Organization Oi^ November 11, 1918, the American Red Cross had nine commissions conducting medical and general relief activities in Europe and Asia ; these commissions were operating in England, France, Belgium, Italy, Palestine, North Russia, Siberia, Serbia and Greece. Accounts of the nursing service rendered by these commissions have already been given, with the exception of those to Serbia and Greece. The Com- mission for Roumania, it will be remembered, had been with- drawn previous to the cessation of active hostilities. During the post-Armistice period, the immediate task before the American Red Cross was to bring about as swift a re- trenchment of foreign activities as was compatible with the ideals and obligations previously assumed by the society. The nations of western Europe were well able and eager to under- take their own reconstruction and by the beginning of the year 1020 the American Red Cross had recalled its commissions from England, France, Belgium and Italy. The need for medical and general relief in Poland and the Balkan States, however, was only just beginning. The war cloud which had previously shrouded true conditions in these countries was gradually rolling back and the poverty and dis- ease which existed there began to receive cognizance in the minds and press of western Europe and America. In June, 11)1!), the Congress of the United States authorized the Secre- tary of War to transfer to the American Red Cross such medical and surgical supplies and dietary foodstuffs in Europe as should not be needed by the American Army abroad or at home, "to be used by the American Red Cross to relieve the pressing needs of the countries involved in the late war." 1077 1078 HISTORY OF AMERICAN RED CROSS NURSING Thus a two-fold foreign problem confronted the American Red Cross : First, to terminate its activities in the countries where a continuation of such service was no longer needed; second, to develop a constructive program in countries where such service was needed and desired. Under the regime of the War Council, the form of organiza- tion for American Red Cross activities overseas first contem- plated, had been a Commission for Europe, with headquarters at Paris and branches operating in different countries of the European field. Major Murphy's title, it will be remembered, was that of Commissioner for Europe. As the need for Ameri- can Red Cross relief activities developed in 1917 and 1918 in different countries and was presented to the War Council, new commissions with complete quotas of personnel and supplies, were organized at I^ational Headquarters and sent into the field. If the area of their assignment was geographically so situated that the Paris office, the headquarters both for the Commission for Europe and for the Commission for France, was the logical line of communication with National Head- quarters, the War Council linked up their organization with that of the Commission for Europe ; if not, as was the case with North Russia and Siberia, they operated independently of the Commission for Europe and reported only to National Head- quarters, On January 29, 1918, President Wilson notified the War Council of the resignation of ]\lajor Murphy from member- ship on that body. Major Murphy's services were desired by the Array. On February 5, Major Perkins was appointed Commissioner for Europe. The Nursing Service at National Headquarters and that overseas, however, was not accorded di- rect representation on the staff of the Commission for Europe. Miss Delano had thought that Miss Russell would occupy such a position but she had been assigned, instead, to duty in the Department of Military Affairs of the Commission for France and there she had stayed until her resignation and the subse- (juent reorganization of the Nurses' Bureau under the Bureau of Women's Hospital Service. In lieu of other representation, the Chief Nurse of the Commission for France had also served as the medium of communication between the executives of the Nursing Service at National Headquarters and the various chief nurses of commissions in the European field and tlie records of duty of nurses assigned to Belgium, Italy and Palestine were CLOSE OF THE FOREIGN RELIEF PROGRAM 1079 kept in the j^urses' Bureau of the Commission, for France. Miss Delano and i\liss Xoyes knew that this form of organiza- tion was not perfect but it had been uphill work to get even that, as has been stated before. When the War Council went out of office on February 28, 1919, the Executive Committee was confronted with the need for new governing machinery. The post-Armistice reorganiza- tion at Xational Headquarters has already been described. As a form of organization through which to conduct the post- Armistice progi'am overseas, the Executive Committee voted a continuation of the form of organization first adopted by the War Council, a Commission for Europe, with headquarters of the connnission at Paris and the various commissions in differ- ent countries heading up through the European Commissioner to National H(>adquarters, Dr. Farrand, it will be remembered, was the new chairman of the Central Committee. Dr. Fred- erick Paul Keppel, one time Dean of Columbia University and during the participation of the United States in the European War, third assistant Secretary of State, came to National Head- quarters on July 1, 1919, to act as vice-chairman in charge of foreign operations, in which capacity he assumed the direction of all Am(>rican Ked Cross work overseas. The new Commis- sioner for Europe was Lieutenant Colonel Eobcrt E. Olds, a lawyer from St. Paul, Minnesota, who had formerly served as counselor to the American Ixed Cross Commission for France. He took up his new duties early in 1919. In ^fay, 1919, tlu\Executive Committee formally appointed a Comniitte(^ .for the Iveadjustment and Liquidation of Euro- pean Activities. This committee was charged with the respon- sibility of selling all Ked Cross supplies no longer needed in Europe and of reducing all activities to a minimum. The com- mittee was composed of L. J. Hunter, comptroller of the Ameri- can Ked Cross, and A. IL Gregg, director of the former Depart- ment of ForcMgn Atl'airs at National Headquarters. Both of these men liad been in France working on the problems of re- trenchment since early in April and among otlun* duties, they took over \ho atl'airs of the Commission for France. American Ked (h'oss nursing service in France in conn(>cti()n with the close of the military program has already bocii de- scribed. Of the trend of French reconstruction policy, Miss Hall, then chief nurse of the American Ked Cross in France, wrote Miss Noyes on March 14, 1919: 1080 HISTORY OF AMERICAN RED CROSS NURSING It appears that the French Government has not asked the American Bed Cross to assist in reconstruction work in France; furthermore, it welcomes instead small groups work- ing directly under its own direction, rather than the work of a large organization like ours, which wishes to formulate its own policies and to carry on the work according to its own methods. An illustration of this is given in the fact that both the Smith and Vassar College Units have now been severed from the American Ked Cross and are engaged in reconstruc- tion work under the French Government. There is every evidence here that an effort is being made to bring the affairs by the Red Cross in France to a conclusion as rapidly as is consistent with the size of the organization and the varied work it has done. As far as the nurses themselves are concerned, it has seemed the wiser policy to return as many as possible to the United States, owing to the need for nurses at home. We have kept the number needed for other European commissions and also a small reserve for emergencies here in France. On December 1, 1918, there had been approximately six hun- dred American Red Cross nurses on duty with the various com- missions in Europe and all administrative details in connection with their service had been carried on through the Bureau of Nursing of the American Red Cross Commission for France. As the nursing activities of these commissions were brought to a conclusion in the spring and summer of 1919, the majority of the nurses then in Europe reported back to the Nurses' Bu- reau at Paris and were returned to the United States. On March 24, Miss Hall wrote ]\riss Noyes : . . . The work of the Nurses' Bureau is being brought to a close and the major part of it will be finished this month. A few activities, however, will continue to be maintained and it will take perhaps two or three months to wind up these pro- jects. To carry these and the new constructive program, it has been suggested that a Bureau of Nursing be attached to the Commission for Europe which is now under organization and which will have its headquarters at Paris. As long as there are nurses on duty with other commissions in Europe, there will be need for a Nurses' Bureau in Paris. In this letter, ]\riss Hall asked that her resignation as chief nurse of the American Red Cross in France be accepted ; she had been overseas for two vears and desired to return to her CLOSE OF THE FOREIGN RELIEF PROGRAM 1081 former work in the United States. "May I suggest," wrote Miss Hall in the letter of March 24, "that Alice Fitzgerald would make a most admirable candidate for the position of chief nurse of the new Bureau ?" A month later. Miss Hall wrote Miss Xoyes of the further contraction of American Red Cross activities in France : Great pressure is being brought to bear on the Medical and Surgical Department, including the Nurses' Bureau, of the American Eed Cross in France, to bring our affairs to a close and to get our personnel started for the States. May 1 has been named as the date for the nominal closing of the Xurses' Bureau. I have pointed out the demands which may be made upon us for nurses and I have been toid that the Commissioner for France can no longer be responsible for the further assign- ments of nurses to duty; if any nucleus of this bureau is retained, it will have to be attached to the office of the Com- missioner for Europe. Fifty-nine nurses were released and sailed for the United States in April ; fifty-eight others left in May and in June and July one hundred and fifty additional ones returned home, ^liss Hall left Brest late in May, but before her departure from Paris, she made recommendations to the new Commissioner for Europe regarding the organization of the nursing staffs of future Red Cross commissions and these recommendations be- came the basis of future American Red Cross nursing organiza- tion overseas. The release of nurses continued until there remained in Europe and in Paris only such nurses as were needed for the so-called "constructive" program. On May 8, 1019, Colonel Olds transmitted Miss Hall's recom- mendations as follows to all departments and Bureaus of the Commission for Europe : The Bureau of Xursing, formerly reporting to tlie Com- missioner for France, will be transferred to the Cumniissioner for Eurojie about ^lay 10, the time wlien the operating tasks which it has been conducting in France will have been sub- stantially completed. Because of the altered work of the American Hed Cross in Europe, tlie activities of this Bureau will l)e substantially different hereafter than they have been heretofore. Its re- sponsibilities will induce: 1082 HISTORY OF AMERICAN RED CROSS NURSING 1. Aid to each operating commission in securing a chief nurse and in assisting chief nurses in obtaining an ade- quate force of workers. 2. General advisory service to the chief nurse reporting to each commissioner. 3. Direction of any nursing operations remaining under the Commissioner for France. 4. Continuance of the nursing records already established and of the present personal service to all nurses in Europe. In all this work, the Chief Xurse, in direct charge of the Bureau of Cursing, will work in close cooperation with the Department of Nursing at National Headquarters and will apply the general rules laid down by that Department to meet the above responsibilities, she shall maintain such a reserve force of nurses as may be required to meet the policies of the Commission for Europe and this question shall be given con- sideration in arranging the release of nurses now engaged. The Chief Nurse shall report to that member of the Com- missioner's staff who is in charge of medical service, at present Lieutenant Colonel Taylor. Upon Miss x^oyes' recommendation, Colonel Olds on May 10 appointed ]\[iss Fitzgerald chief nurse of the American Red Cross in Europe and, as such, director of the Bureau of Nurs- ing, and suggested that she immediately get in touch with the chief nurses of the various commissions then in Europe. This reorganization of American Red Cross nursing service in Europe marked the successful culmination, on paper, at least, of the struggle begun bv ]\Iiss Delano in 191-i and carried on by her, by Miss Noyes and the majority. of chief nurses in the field during the ensuing years, for a digiiified and profes- sional status of American Red Cross nurses on active duty. On ]\ray 22, one hundred and ninety-seven nurses and twenty- one nurses' aides were on duty in Europe, makiiig a total of two hundred and eighteen. Thirty of tlu^se nurses were still serving in F'rance, some at American Red Cross Hospital No. 10l>, the maintenance of which was continued for the benefit of tlie personnel of American w(dfare organizations still in F^ ranee ; some at various dispensaries; others in the Nurses' E([uipment Shop and the Salvage Department; and still others on duty at the Red (^ross dock infirmaries. Flight nurses had been loaned to the Rockefeller Foundation; eighteen to tlie C( nunission for the Relief of Belgium; thirteen to the Serbian CLOSE OF THE FOREIGN RELIEF PROGRAM 1083 Tuberculosis Hospital ; two to iVIontcncfp'o ; and one to the French Army as a radioj^rapher. The nurses on duty on May 22 with the various foreign com- missions numbered one hundred and thirty-one. Ninety of these were serving in the Balkan States. Late in October, 11)18, Xational IIead(|uarters had organized a Commission for the Balkans, of which Henry W, Anderson was chairman and Helen Scott Hay chief nurse. ^liss Hay arrived in Paris hea(l([uarters in December and recruited from among the nurses being released by tlie Army Nurse Corps in France and tlic Nurses' Bureau of the former C\)mmission for France, a large staff of experienced and able public health and institutional nurses for duty in the Baltic States, An account of these activities will be given later. In ^fay, twelve nurses were still on duty in Italy, under ^liss Foley's direction. Nineteen were in Palestine but had no chief nurse and as the affairs of the Commission for Palestine were then being concluded, no successor to ]\Iiss ]\Iadiera was appointed. Eight other nurses were on duty in Poland and two in Prague, C^zecho-Slovakia. The affairs of the Commission for Great Britain were being brought swiftly to a conclusion and by July 1, all American Red Cross nurses on ^lajor Endi- cott's staff, had sailed for the States or accepted assigmnents under the cinnmissions remaining in Europe. Among the unsettled problems of the former Commission for France was that of nurses' equipment. On August 5, Miss Fitzgerald wrote Miss Noyes: As long as we had supplies here in Paris, it sceracfl proper to continue to equip nurses, but the time is coming very shortly wlien we will not have enough supplies left tu do so. I have discussed the question thoroughly with Miss KIkmIcs and we agree that several or even one depot for equipment would be very expensive and woTild not l)egin to give satis- faction to all : for instance, an Equipment llureau in Paris could barely reach some parts of the Balkans and an equip- ment de])Ot in the Balkans could not reach Poland or Sil)(>ria. Transporiation is highly uncertain and much loss of time and eipiijunent would inevitably ensue. Owing to this. 1 have suggested that a dress allowance he made to each nurse assigned under the l\'ed Cross, with which she is expected to provide the outdoor uniform. All the other articles she will ])rovide at her own expense. An allowance of 1084 HISTORY OF AMERICAN RED CROSS NURSING one hundred dollars would cover the expense of a suit each year, a straw and felt hat, two waists and perhaps an ulster one year and a raincoat the next. What are your wishes in this matter ? This recommendation was approved bv Miss Noyes and the Commissioner for Europe. The Nurses' Equipment Shop was closed and the supplies distributed or returned to the Bureau of Nurses' Equipment of the Atlantic Division. The close of the Nurses' Equipment Shop and the return of nurses from Great Britain, Belgium, Italy, Palestine and Siberia marked the termination of the pre-Armistice nursing program. The true post-Armistice nursing program embraced three distinct types of nursing service : First, emergency nurs- ing to alleviate suffering incident to the war in Poland and the Balkan States ; second, a constructive program which consisted in the establishment of schools of nursing under American standards in foreign countries and the development of nursing service in connection with health units ; and third, indirect stimulation to the development of an international advisory nursing service in the League of Red Cross Societies. These last two phases of the post-Armistice nursing program will be treated in subsequent sections. This section of this chapter will deal only with the emergency nursing relief given in Poland and the Balkan States. On November 9, 1918, the Independence of Poland had been solemnized and on June 28, 1919, the treaty of Versailles had recognized the Republic. When Poland was opened to the Allies in December, 1918, she was found to be without adequate food, machinery and textiles of all kinds. Her lands in the East had been the arena for much of the heaviest fighting between Germany and Russia in the early days of the war, and reconstruction there had not yet been initiated. The political and military situation was a seething one and the entire popu- lation had since 191G been the prey of typhus, cholera, small- pox, trachoma and the skin diseases due to inadequate feeding and unsanitary housing conditions. Some insight into the conditions of poverty and misery which had existed in Poland since the collapse of Russia were known to relief organizations in the United States during 1918, but the bristling Teutonic front did not permit the sending of CLOSE OF THE FOREIGN RELIEF PROGRAM 1085 Allied relief personnel. However, the Polish Reconstruction Committee and the War Work Council of the National Board of the Young Women's Christian Association had organized and given short courses in elementary nursing and social service technique to a group of young Polish- American women then in the L^nited States, with a view toward assigning them to relief work in Poland as soon as that nation would be opened to the Allies. These young women were to be known as Polish Grey Samaritans. Recruiting and training was under the direction of a joint committee; JNladame Laura de Gozdawa Turczy- nowicz, Madame Marya Przybylowska and Misses Elizabeth Packard and Alice Preston represented the Polish Reconstruc- tion Committee; Mrs. John R. Mott, Miss Sarah S. Lyon, Mrs. Henry P. Davison and ^Irs. Harry M. Bremer represented the Young Women's Christian Association ; Mrs. Mott was chair- man. The committee had at its disposal the sum of fifty thou- sand dollars with which to finance the training of the Samari- tans and their assignment overseas. Contact between the com- mittee and the American Red Cross had been established in June, 1918; Madame Turcynowicz had written Miss Delano regarding the placement of Polish Grey Samaritans in hospitals where they might assist in the care of the 200,000 Poles then in the American Army and !Miss Delano had referred her to Miss Goodrich and the Army School of Nursing. The first contingent of Polish Grey Samaritans went to France in September, 1918, under the direction of Madame Paderewski, wife of the distinguished Polish pianist who later became president of the Polish Republic. With them was an American-trained Polish nurse, Josephine Jokaitis, who had done public health nursing under the Chicago Infant Welfare Society. Mrs. Jokaitis was enrolled in the American Red Cross Xursing Service through the Paris Committee early in 1919 and afterwards played an important part in American Red Cross nursing service to Poland. A second group of one hundred Grey Samaritans sailed from New^ York on April 19, 1919, lor service in Poland. The floint Committee of the Polish Grey Samaritans had intended to as- sign a nurse to take charge of the unit and broached the subject to Miss Albaugli, but arrang(>nients were finally made betv.-een the Joint Committee and ^liss Xoyes and ^liss Hall whereby the unit would bo linked up in Poland, if opportunity developed there for their services under the American Red Cross, with the 1086 HISTORY OF AMERICAN RED CROSS NURSING Chief Nurse of the American Red Cross Commission for Poland. In February, 1919, at Paris Headquarters, an American Red Cross Commission for Poland was organized, of which Dr. W. C. Bailey, of Boston, was the director. The nursing per- sonnel was composed of four American Red Cross nurses and thirteen Polish Grey Samaritans of Madame Paderewski's group. Emma Wilson, a Hopkins nurse who had done medical social service work at Bellevue Hospital, public health nursing at Henry Street and had served under the Commission for France in the Service de Sante and at the Bordeaux dock in- firmary, was chief nurse; Mrs. Jokaitis was her assistant. A second Polish nurse, Marie Suchowska, who had also been trained in the United States, accompanied the unit. The two other American Red Cross nurses were Mary Bartley and Martha S. Clarke. A trainload of supplies had already been sent up to Poland in January and the commission took another trainload with it when it left Paris for Warsaw, in two sections, on February 20 and 21. In a report of the Nursing Service in Poland from March to June, 1919, Miss Wilson wrote: On March 3, our band of five nurses and thirteen aides reached Warsaw, and on April 26 three more Red Cross nurses arrived. We immediately began to set up headquarters and a personnel house. . . . Calls for nurses for special duty came early and have since been constant. . . . The uncertainty of our plans, the diffi- culties of transportation and the extent of the territor}' to be covered made it seem undesirable to establish a hospital at Warsaw to care for ill members of the commission. On June 3, we had given twenty-six weeks of private duty nursing to our own personnel. We also furnished nursing care to British officers of the Inter-Allied Commission and to a Captain of the Hoover Food Commission. Since the plans of the Polish Commission were in a forrnu- lative state, we were invited to help at the large military hospital at Warsaw, the Ujazdoivski Spital. On March 10, one half of our nurses and aides went on duty there. A-t first the conditions seemed unbelievable, but we have seen much worse since. The native nurses were, of course, untrained and their hours of duty seemed very short to us, but in view of their insufficient food and uncomfortable quarters, little more could have been expected of them. CLOSE OF THE FOREIGN RELIEF PROGRAM 1087 There was no soap, no bed linen ... no suitable food for patients on liquid or light diet and practically no medicines or nursing appliances. The day's rations of hard black bread was placed each morning on the bedside table of the con- valescent and the dying alike. Xo Red Cross supplies even were available for our nurses or their patients during their three weeks' assignment here, but the American nurses' work won for them many friends. Late in March, the commission decided to undertake general relief work in the Department of the East and the cooperation of the Polish Red Cross was sought. Twenty-two young Polish women were secured to act as interpreters and were attached to Miss Wilson's staff as nurses' aides. Of their assignment to duty, Miss Wilson wrote : We divided our forty nurses into four units, each with American Red Cross nurses in charge of numerous aides, and on April 3 we left Warsaw on the Commissioner's supply train. On April 2G, nine more Polish aides and on IMay 14, thirteen others were sent from Warsaw into the field, so that the nursing staff finally numbered seven American Red Cross nurses, thir- teen Grey Samaritans and forty-four Polish aides. The plan for relief work embraced the assignment of American Red Cross personnel to the Korel district from whence they were to work north through the regions of Brest-Litovsk and Bialy- stok. ^lajor 11. W. Taylor took charge of the work in thc^ Department of the East with ]\rajor A. J. Chesley as his chief of staff'. One of the units went to Maciejow, a village with a popu- lation of 2()()(), of whom the majority were -Jews, and established a small hospital and dispensary in an old building formerly used as a German hospital and bathhouse. Food and supplies and a small amoiint of nursing and dispensary serA'ice were distributed from this base to the surrounding countryside. A second unit went to Dolsk and established a dispensary and canteen in buildings foruu>rly belonging to an old Polish estate. ^Fiss fjarthy was in charge^ of the nursing activities here and Mrs. dokaitis did public lu'alth nursing. Th(^ third unit went to Pruzana. a village located a few hours' travel north of Brest- Litovsk. The nnrs(>s and aides went into an old palace which was half occupied by the military 1088 HISTORY OF AMERICAN RED CROSS NURSING authorities but found conditions such that little medical or nursing service could be rendered. Instead, Mrs. Clarke, the nurse in charge, and her aides did the housekeeping for the American personnel and ran a canteen which daily fed eighteen hundred people. North of Pruzana was located Bereza Kartusa and the unit assigned there established an orphanage for sixty Polish children and a dispensary from which medical service, public health nursing and general relief was extended into the surrounding country. Early in June, 1919, Miss Wilson returned to Paris head- quarters. Conditions in Poland were chaotic. The nurses had had no voice in the determination of nursing policies and the executives of the commission seemed to possess little idea of the possibilities for the broad and varied service Avhich nurses might render. The leaders of the commission felt that a speak- ing knowledge of the Polish language was of paramount im- portance, without which the American nurses could do little, and they appeared to prefer the services of poorly-trained Polish-speaking aides to that of American Red Cross nurses working with interpreters. ]\Iiss Wilson had stood out for the development of dispensaries and public health nursing service under the direction of the well-trained American nurses ; but the Commissioner did not agTce with her in this policy and ordered her to return to Paris Headquarters. She understood that tlie nursing program in Poland was discontinued and ex- pected that the American nurses and Polish aides would follow her within a few days, if not on the next train. The days passed and no nurses made their appearance. Miss Fitzgerald, anxious lest the undire(*t(^d group should come to grief, sent a cable of protest to the Commissioner for Poland regarding the treatment given ]\Iiss Wilson and requested that an acting chief nurse be appointed at once who would communicate with the Nurses' Bureau at Paris IIead(]uarters and send in reports of the nurses' conduct and welfare. In response, Colonel Bailey appointed ^Irs. fFokaitis as acting chief nurse and held the nurses in Poland, where they continued to do civilian relief work. During the summer of 1010, all the affairs of the Commission for Poland were in a somewhat fluid state. On August 11, (V)lonel Cheslev was appointed to succeed Colonel Bailey and he immediately drew up plans for the development of an extensive CLOSE OF THE FOREIGN RELIEF PROGRAM 1089 medical and luirsing; pro-am in Poland. Early in September, he called npon the Chief Nurse of the European Commission to secure ten Polish-speaking American nurses for service in Poland hut several days later had countermanded the order, authorizing instead a social service worker to go to the United States and recruit all personnel, professional and otherwise, for the reorganized Polish Commission. In place of the usual salary of $70 a month for Ked Cross nurses in foreign service, ^Major Chesley authorized the sum of $105 ; he also stated in his letter of instruction to his new representative that "it is not essential for our work that the nurses have the regular nurses' uniforms, as those issued to social workers will be satisfactory." ^fajor Chesley wrote on the same day to Miss Noyes, that he felt that '*it would be better, not only for the workers but for the Ked Cross, to have Miss personally superintend the recruiting of the nurses and to convoy them to Warsaw to us," rather than to have it done through ^liss Fitzgerald's office. The situation which ensued possessed certain elements of humor which !Miss Xoyes and ^liss Fitzgerald would have been better able to appreciate if their patience had not already been overtaxed by the seemingly complete ignorance, on the part of Red Cross foreign commissioners, of the standards and regula- tions of the Xursing Service. To offer nurses a higher salary for service in Poland than that which was being given to those working under other Tied Cross foreign commissions was mani- festly unfair. To delegate to a lay woman the choice and super- vision of Ked Cross nurses and to suggest that when so chosen they wear the uniform of social service workers, was a pro- cedure which iiew in the very face of nursing traditions. ]\lonths were consumed in tlie adjustment of this irr(\iiularity. Finally, the ten Polish-speaking nurses were recruited through the Xurs- ing Service at National Headquarters and in tlu^ various Di- visions, particularly that in Chicago, and set sail from Xew York in December, under the leadership of Kdith ]Merle Benn, one of the former nurse lecturers on the Kadcliffe Chautauquas. ^liss Fitzgerald's last piece of work as chief nurse of the American Ked Cross in Europe consisted of a tour of inspection which she mad(^ in Poland ])(^tween Octolx'r 2 to October 17. Of the activities of the connnission in Bialystok, she wrote: We visited two vorv large warehouses, one of which was particularly well stocked with clothing, medical supplies and 1090 HISTORY OF AMERICAN RED CROSS NURSING general equipment. We visited a refugee camp to which the returning natives are brought for cleansing, are kept on aji average of three days and supplied with some clothing by the American Eed Cross. Some of the soldiers stationed nearby have also received clothing from the organization. We also visited a typhus hospital of five hundred beds Avhich has been vastly improved through the guidance and advice of our physicians and to which some equipment has been given. Xo American Eed Cross personnel, however, is assigned there. Next we went to an Army hospital of one thousand beds to which the commission had given equipment, and also the laboratory, of which Dr. Placida Gardner is in charge. . . . Apart from the equipment given to the hospitals, no American Eed Cross medical work of any sort is being done in Bialy- stok. . . . On their way east, Miss Fitzgerald's party visited the village of Slonim to which the commission had previously given equip- ment. Miss Fitzgerald wrote : The hospital was in a very bad condition and the only person who seemed to be at all responsible was one native woman wlio took us around. The patients were not cared for, the building was dirty and nothing seemed to be in place. I have never seen a more striking example of the uselessness of giving equipment to a hospital without providing at least a temporary loan of personnel to teach the natives how to use that equipment. ... A very elaborate bathing arrangement which has been put up was naturally out of order and all the water which should have been in the boiler or in the tub was on the floor. I remarked on the fact that a nurse or nursing aide could do a great deal even in a short time in such a hospital, but it seems that that kind of work has not entered into the scheme outlined in Poland in the past. From Slonim, Miss Fitzgerald went to Baranovicci and found there a hospital attached to a military camp and a large dis- tributing center. Miss Fitzgerald wrote : The hospital is in better shape than any I had previously seen. ... A Polish aide was on duty there and others were busily distributing clothing and food, going in carts from one village to another. . . . This distribution represents a great deal of work and requires a consideral)le number of people. In tlic montli of September alone the unit stationed CLOSE OF THE FOREIGN RELIEF PROGRAM 1091 at Baranovicci reached 148 villao;es and distributed clothing to about 4(),()()0 people. . . . When si(k people are found in the homes no attempt is made to ^ive them medical attention at that time, but if very ill the family is advised to take the patient to the nearest hospital, which in many cases is a long distance away. From Baranovicci, Miss Fitzgerald went to Kobryn and found similar work being carried on. From there she proceeded to Brest-Litovsk and thence back to Warsaw. She then made the following recommendations: There is practically no medical work being done by the American Ked CVoss in Poland and I feel that we are missing a great opportunity by not placing nurses and nurses' aides in the Polish hospitals. There is no reason to think that when this method has succeeded so well in other countries it would not be equally successful in Poland. . . . Hitherto, the policy of the American Red Cross in Poland lias placed the question of language before any other factor. This is plainly shown by the very large Polish personnel composing the commission. In units like those at Baranovicci and Kobryn, the only American people are the doctor and one stenographer ; the rest of the fifteen or twenty women are Poles, some of whom were enrolled in America but many of whom do not even speak English. I have been told on excellent authority, and I can readily believe it, that the Polish people themselves would prefer American workers and undoubtedly these would carry with them a ])restige which no native can obtain. It is not always easy to determine the spirit in which the native distributes assistance and there is always the danger of crippling one's gift through a patronizing attitude. The military situation in Poland early in 1020 was fayor- {ible to the deyelopmcnt of an American Ivcd Cross program. In April, 1020, the Republic had an army of 700,000 men in the field. An active spring offensive was ex])ected on the part of both the Poland Army and the Red Guard and the Aiucri- can Red Cross commission in Poland made extensive plans to furnish medical, nursing and general relief to Poland during the (Misuing months. In addition to the unit of ten Polish-sjK'aking nurses. Xa- tidual ll('ad(|uarters s(Mit other units during the early spring 1092 HISTORY OF AMERICAN RED CROSS NURSING of 1920, so that by June, 1920, the nursing staff of the Polish Commission nnmbered eighty-one nurses and twelve nurses' aides. On iMay 19, Miss Hay left Paris to make an inspection trip in Poland and during the following weeks she visited the chief centers of xVmerican Red Cross nursing activities and found that the Commission for Poland had developed a broad program of medical relief in the regions dominated by Warsaw in central Poland ; by Vilna and Minsk in northeast Poland ; by Bialystok and Brest-Litovsk in central-eastern Poland and by Lemberg and Cracow in southern Poland. The resume of nursing activities which follows is based largely on Miss Hay's report of her tour of inspection made in May and June, a report submitted to Miss l^oyes on July 15, 1920. In Warsaw, American Red Cross medical and nursing relief included the maintenance of a typhus research hospital and a small hospital for the care of American Red Cross personnel in Poland. The Typhus Research Hospital had been established in March under the direction of the League of Red Cross Socie- ties.^ The patients consisted of especially typical and critical cases of typhus, which were chosen from among patients of hospitals in the field, particularly that at Stanislau, and sent to Warsaw for observation and treatment. The capacity of the hospital was twenty-eight beds. The nursing staff was maintained at an average strength of about twelve nurses of the Commission for Poland. The commanding officer was Dr. r. E. Palfrey and the head nurse, Stella Mathews. Miss Mathews was a ]\Iilwaukce nurse who had organized the nurs- ing personnel and served as chief nurse of Base Hospital No. 22 and Evacuation Hospital No. 20 at Beau Desert Center, A. E. F., France. The hospital established for the care of American Red Cross personnel in Poland was located in Praga, a suburb of War- saw, and was called the Praga Hospital. Lenna H. Denny was head nurse. Northeast of Warsaw was situated the Russian-Polish city of Vilna, where the Polish Army opened on .^^arch 19, 1920, a military surgical hospital. The American Red Cross Com- mission for Poland furnished ecjuipment for this hospital and ^ For a complete account of tlio caiii})aiirn aiiaiiist tv])lms in Poland, see the Bulletins of tlie Lca-'uc of Tvcd Cross Societies, 'l!)l!)-1920. Vol. 1. A ward of the Vilna ^rilitary Surgical Hospital, Vilna, Poland. The American Red Cross Orphanage at Liskow, Poland. CLOSE OF THE FOREIGN RELIEF PROGRAM 1093 assigned twenty-seven nurses to duty there with Edith Clen- denning as head nurse. The hospital was housed in tents, barracks and a hirgo and attractive buihling which had for- merly been occupied by the Russian Military School. The capacity was three hundred and fifty patients, with an emer- gency expansion to six hundred. On the outskirts of Vilna in a large pine forest the Vilna Railroad had maintained (prior to the outbreak of the Euro- pean War) a hospital for the benefit of its employees. The large main building had been subsequently wrecked and was not usable, but the hospital establishment included detached cottages wherein infectious cases had been treated. The com- mission took over and repaired seven of these, assigned an American Red Cross surgeon and seven nurses to duty there and assisted the Vilna Railroad in the maintenance in these cottages of a hospital of fifty beds. Like the Vilna Military Surgical Hospital, this institution was run under dual man- agement, with Dr. ^rachcvsky, the head physician of the Rail- road of the Vilna District, cooperating with the American Red Cross officer, Captain J. J. Donovan. Louise M. Water was the head nurse. Southeast of Vilna was the former Russian province of ^linsk and in it was located the city, Minsk. Here during the spring and summer of 1920 Field Unit J^o. Ill operated; Marie Suchowska was the nurse in charge of several Polish aides and under her direction they carried on a certain amount of district nursing and distributed food and clothing in the Minsk district. Southwest of ^liiisk was Bialystok, headquarters of the American Red Cross in the Department of tlie East. Here the commission had established early in January, 1920, an orphaiuige in the main barracks of a former post of the Rus- sian Army and by July 1 had collected 7S.3 children there. The childrcMfs food was largely supplied by the Polish Govern- ment and the American Relief Association, with supplemen- tary rations from tlie warehouses of the commission. Classes in car]K'ntrv, j)luinl)ing, cobbling and sewing for boys and girls were organized and school gardening was encouraged undin- the aus])ices of the American Junior Red Cross. In connection with the Rialystok ()r])hanage, a hospital of one hundred Ix'ds was maintained for th(> care of the children, "who are always below standard upon admission," wrote Miss 1094 HISTORY OF AMERICAN RED CROSS NURSING Hay, "and suffer from tuberculosis, pink-eye, measles, mumps, whooping cough and malaria." On June 25, 361 children had been cared for in the hospital, while at the dispensary 2224 treatments had been given. The nursing staff consisted of fifteen American Red Cross nurses and the head nurse. May L. White. In addition thirty-five Polish aides were on duty in the orphanage. Twenty-seven of them were employed by the commission and nine by the Refugee Bureau of the Polish Government, which cooperated with the American Red Cross in the maintenance of the orphanage. At the Orphanage Hospital, instruction was given to Polish aides in elementary nursing. The textbook in Home Hygiene and Care of the Sick was translated into the Polish language and was used as a basis for theoretical teaching. Dr. Laleski, assistant medical chief, supplemented this text by lectures and one of the Polish-speaking American Red Cross nurses, Doris Wartosky, conducted practical work for the aides in the wards of the Orphanage Hospital. South of Bialystok on the Bug River was located the city of Brest-Litovsk. American Red Cross Field Unit Xo. II were assigned to duty there early in 1020 and made it the headquarters for medical and general relief without the dis- trict. Eleanor ^lettel, an American Red Cross public health nurse, was in charge of several Polish aides. The work, like that of Unit Xo. Ill, consisted largely in the distribution of relief supplies, but Miss !^[cttel made a constructive step for- ward by interesting and training her staff of Polish aides and the local midwives in more adequate care of mother and child. American Red Cross Field Unit No. IV was assigned to the town of Tarnopol, situated southeast of Brest-Litovsk in Galicia among the foothills of the Carpathian Mountains. Tar- nopol was in 1U20 a city of some ten thousand inhabitants and had suffered considerable destruction and consequent demorali- zation during the war. Field Unit Xo, IV was engaged in distributing relief supplies there. Alice A. Tanguay, an American Red Cross nurse, was on duty and had in charge the three Polish aides. Two hospitals were maintained at Tarnopol, l)i!t not by the American R(>(1 Cross. One was the Infectious Hospital, wliich "in cleanliness and care of the ])atieiits," wrote ^liss Hay, ''is above the average." The other was the Muiiici])al Hospital, which was under the direction of Sisters of St. Vincent de Paul. CLOSE OF THE FOREIGN RELIEF PROGRAM 1095 Southwest of Tarnopol and situated among the Carpathian ranges was Stanislaii, to which Field Unit No. VI was assigned. A large typhus hospital was maintained here by the local government and sent cases northwest to the Typhus Research Hospital at Warsaw. The services of the American Red Cross nurse and Polish aides of Unit No. VI were utilized, however, for civilian relief work. The Galacian city of Leml)erg (Lwow), which was northwest of Stanislau, was the headquarters for the American Red Cross in southern Poland and the warehouse base for activities in Stanislau and Tarnopol. Here Pauline H. Wilkouski, an American Red Cross Polish-speaking nurse, was on duty but her work was chiefly in the field of civilian rather than medical relief. West of Lemberg was located Zakopane, near which the Countess Zamoyska had established some twenty-five years be- fore the war, a School of ])(miestic Science for Polish Girls. In her report of a tour of inspection made in Poland in May, 1920, Miss Hay wrote: This school is located about four kilometers from Zako- pane, among the beautiful foothills of the Carpathian Moun- tiiins. The main building is a three-story one and there are also detached cottages. The housekeeping is that of the thriftiest housewife, scrupulous cleanliness, tlioroughness and thrift are apparent everywhere. Dairying, poultry rais- ing, gardening and agriculture are included in the three years' course of training. "One must eat and cooking is necessary," the Countess Zamoyska used to say, "therefore every woman should know how to cook. One must have clean surroundings, therefore one must be taught how to make the home clean and orderly and to keep it so. One must have clean clothes, so one must learn to wash and iron." With practical ideals such as these, the Countess and her daughter bave established a course of training of great benefit to bundreds of young Polisb women, and as tbe scbool has always been Irnhj Polish in sju'rit. it has become a fostering center for ardent jiatriotism and love for Poland. On ^Tay 1, 1020, h'mily Skorupa. one of the \en nurses of ^fiss B(Min's unit and an American-trained ])ublic health nurse of broad experience and much ability, was assigned to Countess 1096 HISTORY OF AMERICAN RED CROSS NURSING Zanioyska's School to organize and conduct classes in Home Hygiene and Care of the Sick. Miss Skorupa had herself been graduated from the school before she had come to the United States, so her assignment there was a particularly happy one. Miss Skorupa translated the Delano textbook on Home Hygiene and Care of the Sick into Polish and used it as the basis for her instruction at the school. The course was eagerly received by teachers and pupils alike. Two of the teachers received special instruction^ with the view of preparing them- selves to give the course in the event that the American Red Cross nurses might be withdrawn from Poland. West of Zakopane was located Cracow, a Galacian city which boasted a municipal hospital of fifteen hundred beds. In connection with this institution, a group of Polish women, among them Miss Epstein, had endeavored years before the war to establish a school for nurses, but the plan had met with scant success, if judged by Anglo-American standards of nurse education. Early in the spring of 1020, Stella Tylski, another Polish American-trained public health nurse of Miss Bonn's unit, had been loaned to the Municipal Hospital ; she had gone on duty in the School for Xurses and tried to do what she could. Of the conditions of poverty and misery which existed there in May, 1920, Miss Hay wrote: We visited the medical, gynecological, obstetrical, chil- dren's and eye and ear departments. The medical and surgi- cal wards are large and light, but in them exist frightful conditions of overcrowding. two adults to every bed even in the most unclean cases. There is space for more beds, but there is no money with which to purchase them, or, for that matter, any other supjilios. One likes to picture the heavenly transformation tliat could be brouglit about here with a mini- mum of su])])lies and an adequate nursing personnel. The gynecological department is located in one of the oldest parts of the building, directly under the dormer roof. Crowded as it is witli patients in intense suffering, dirty, with no nursing care, one wonders how any benefit could ever be found here or how any surgeon could daily face such des- perate conditions. The obstetrical department is in a bigger aiul lighter room, but is so crowded and so destitute of sup])lies as to be truly tragic. "Clean" ol)stetrics woidd seem an impossibility. One shuddered with sympathy when they weiglied the naked little babies, one after another, in the cold metal scale pan! The CLOSE OF THE FOREIGN RELIEF PROGRAM 1097 nursing service is under the Sisters of St. Vincent de Paul, good and patient women but powerless to cope with the many difliculties. The nursing care, except for that coming from the Nursing School, is given by domestics of the most slat- ternly and indifferent type. Miss Tylski states that the patients and beds throughout swarm with vermin, that when bandages are removed unspeakably bad conditions are re- vealed. ... In these departments and under such conditions, the stu- dent nurses browse about in search of whatever scraps of nursing knowledge they may chance to find. Miss Tylski has done what she could to help them, but any good influence or careful lessons from her are likely to be lost in the objection- able conditions abounding everywhere. On June 15, 1920, Miss Benn resigned as chief nurse of the American Red Cross Commission for Poland and was suc- ceeded by ]\Iiss Mathews, formerly head nurse of the Typhus Research Hospital. Such were the nursing activities of the American Red Cross in Poland during the spring and summer of 1919. National Headquarters and the Commission for Europe were turning their attention from the widespread distribiition of emergency relief to the devc^lopment of a more permanent and constructive program. One of the major phases of this constructive program included plans leading toward a better appreciation in foreign countries of the value of the professionally-trained nurse, and a pioneer attempt along these lines was launched in July, 1920, at Warsaw. Tlie Polish Red Cross Society maintained there a hospital wherein it gave, after the custom of other continental Red Cross societies, a three months' course in the theory of military nursing to young women who were called Polish Red Cross "war aides" and who were subsequently assigned to ser- vice with the Polish Army. In July the class under instruc- tion at the Polish RcmI Cross Hospital in Warsaw numbered lOf'3 students. ^Fadame Tdjukovska, the director of Xurses of the Polish R(>d Cross Hospital, calk'd on the Chief Xurse of the Commission to assist her in giving more thorough prepara- tion to these aides, ^frs. Jokaitis and Praxeda Franczak, a Polish-s])eaking American Red Cross nurse who had gone over- seas in ^liss Renn's unit, were assigned to duty there and tried to develop an elemeiitarv course similar to that in Home Hy- giene and Care of the Sick. The attempt was not an unquali- 1098 HISTORY OF AMERICAN RED CROSS NURSING fied success. The American nurses went into the wards of the Polish Red Cross Hospital, cleaned them and gave bedside care to the patients, but this service resulted in loss of prestige for the Americans in the eyes of Polish aides and patients alike. While the actual care of the sick was regarded by the Ameri- can nurses as dignified and altruistic the Poles regarded it as degrading menial labor fit only for domestics. Thus the American nurses could maintain little discipline and their en- deavors to provide instruction through theory and actual dem- onstrations of nursing technique were received with scant enthusiasm. Early in August, 1920, the Polish Armies met with military reverses. The Soviet Army of Russia invaded Poland from the north. On August G, Colonel Olds cabled Xational Head- quarters that "owing to the critical situation in Poland, thirty- seven nurses were immediately released. . . . Thirty-five others are being held in Poland for any emergency. Future nursing service in Poland," concluded the cablegram, ''is sta- tionary." On August 11, the Red Guard cut the Danzig- Warsaw Railroad and three days later began to close in about Warsaw. The military crisis wiped out American Red Cross medical and nursing relief in northeastern and central-eastern Poland and caused the evacuation of personnel and supplies from W^ar- saw to Cracow. One of the picturesque incidents of this with- drawal was the removal of the orphans from Bialystok. The order for immediate evacuation allowed Miss Mathews scant time for preparation. She applied at once to the military authorities for transportation and in spite of the traffic conges- tion and the great need for rolling stock, they allotted her fifty-one freight cars. Into these all equipment which could be moved, clothes, food, cots and medical supplies, were placed and lastly the thousand children. Two nurses were assigned to oaoli car full of children. During the four days' trip south- ward through the panic-stricken country-side food was served from an American Red Cross canteen car attached to the long evacuation train. Their destination was the village of Liskow, near the south- western border. When the youngsters arrived, there were not houses enough in Liskow to shelter them all. It was a warm midsummer night, so Miss INIathews had the cots set up in the fields, and the young Poles rolled up in their American CLOSE OF THE FORl'JGN RELIEF PROGRAM 1099 blankets and slept in the open. The next day temporary billets for them were found in Liskow and in as of American Red Cross sup- plies in the Warsaw and Rialystok districts had been moved to Cracow. Five railroad tr;iins were secured by the commission then in Cracow and were loaded with food and clothing. Can- teen and dispensary cars to which doctors, nurses and other personnel had been assigned, w^ere attached to the trains and each train was started back from Cracow at different tangents into Poland. The trains stopped at towns and villages and fed and clothed the refugees and native population and gave first aid to many who had been wounded in the Soviet advance. "The reports of these railroad units," stated the Annual Re- port for the year 19:^1, "show that they cared for more than 1000 surgical cases weekly and fed a maximum of 750,000 persons in a single month.'' The evacuation of hospitals and the subsequent withdrawal of American Red Cross personnel from Poland to Cracow marked the closc^ of the plan for nation-wide medical relief for Poland which had been contemplated by the commission. The nurses and representatives of other types of personnel were not returned, however, to Paris, but were k(^})t in Cracow and lat(>r Warsaw. "Tii Octol^er, 1920," wrote :\liss Hay, "the nurses' activities in Poland were largely restricte(l,to clash-work in home nursing in Cracow, Posen, Kornik and Warsaw. In addition, tluM-e was at C^racow a day nursery av(M'agiiig seven- teen babies; a tuberculosis and general disptMisaries : and visit- 1100 HISTORY OF AMERICAN RED CROSS NURSING ing nursing among the families of dispensary patients." The development of the child health program which later took place in Poland will be described in a subsequent section. The second verdant field for American Red Cross emergency relief during the post-Armistice period was, it will be remem- bered, to be found in the Balkan States. In October, 1918, Miss Hay had been released from her work as director of the Bureau of Instruction at National Headquarters and with two nurses, Marietta Wilsey and Caroline E. Robinson, had sailed early in December for France. In London, Rachel Torrance had joined the group as Miss Hay's assistant and the four had proceeded to Paris. Miss Hay there organized a unit of some fifty-three nurses who were then being released from duty with the Army and the Commission for France and with them had gone to Rome. Colonel Anderson, the commissioner for the Balkan States, had succeeded in recruiting personnel for his staff and in bringing into the Balkan States approximately 25,000,000 pounds of supplies which consisted largely of food, hospital supplies, clothing and agricultural implements. In January, February and March, Headquarters for the Commission for the Balkans was located at Rome ; in April, they were transferred temporarily to Salonika, Greece, and later to Belgrade. Previous to the arrival of Colonel Anderson and his staff at Rome, two American Red Cross commissions were already operating in the Balkans but were engaged chiefly in civilian rather than medical relief. The first of these, the Commission for Serbia, of which Dr. Edward W. Ryan was in command, had been engaged in distributing supplies tliere since the spring of 1917. The second, the Commission for Greece, of which Lieutenant Colonel Edward Capps was in command, had ar- rived in Athens on October 23, 1918, with large supplies of food and clothing. Xo American Red Cross nurses, however, were on professional duty with either of these commissions; Miss Gladwin had assisted Dr. Ryan in the distribution of material relief in Serbia but returned to the United States early in 1919. The organization of the Commission for the Balkans followed in miniature that of the Commission for Europe : Colonel An- derson and the heads of various departments who formed his staff had charge of the ''enrollment of personnel, the acquisition CLOSE OF THE FOREIGN RELIEF PROGRAM 1101 and movement of supplies to the various ports and similar service outside the several countries . . . but on arrival of per- sonnel and supplies at the ports, they came under the control of the commissioner or unit for that territory, which had direct charge of the work in its given state." ^ The line of communi- cation between the various commissioners to the Pavis (3ttice and National Ileadiiuarters was through Colonel Anderson and for the Nursing Service, through Miss Hay. ]\Iiss Hay and her nurses arrived in Home in January and immediately the fifty-three nurses were divided into units, each with its head nurse, and were sent into the Balkan field. Additional nurses were assigned to service in the I^alkans early in 1019 by Miss II all and Miss Fitzgerald and on June .'iO, 1919, the nursing staff numbered ninety-eight nurses who were working under six units assigned to ^Montenegro, Albania, Greece, North and South Serbia and Roumania. These units were attached each to the staff of the commissioner of the country to which they were assigned and the head nurse worked in as close cooperation with the commissioner as could be established. Such, in January, 1919, were the organization, the personnel and the facilities for development of an extensive American Red Cross relief program, both medical and general, in the Balkan States. Of the standards of nursing care which existed there, ]\riss Hay wrote her report of the Nursing Service of the Balkan Commission, November 1, 1918, to September 30, 1919: The trained nurse and good nursing have scarcely been known in the Balkans until the recent wars and the influx of foreign nurt^ing missions so splendidly demonstrated their value.^ Conditions in Balkan hospitals have been mo.^t inadequate and the care of patients deploral)le. . . . The nursing service, always trifling and incidental, has degenerated still further from the increased amount of work and the scarcity of helpers. Where with fifty patients one never jdanr.ed to give a ])ed bath or do ought to prevent a bedsore, how could any such 'See Annual Report, 1919, p. 124. ' For an account of the foreign units gent between 1914 and 1918 to Serbia, British, Scotch. Russian, French. Bolieniian, Danish, (ireek and American, see "l\epori of tiie Nursing Service, iJalkaii Coinmission. Ameri- can Red Cross, November 1. 191S to September .'50. 1919," by Helen Seott Hay. i)p. 2-8, Red Cross Archives. 1102 HISTORY OF AMERICAN RED CROSS NURSING extraordinary activity be expected with five hundred patients? Medical students, both men and women, feldchers (men with a limited amount of medical and hospital training) and mid- wives were able to assist with operations and dressings, to prescribe simple remedies and to tal-ce temperatures, but none of these had any mind for nursing tasks themselves. Neither did they know or desire good nursing from the helpers in the wards, who were men and women of the lower classes and who clattered about their hospital duties without training or super- vision of any kind. . . . For the ills of the neighborhood, the boils and malaria and rheumatism, there are the old hahas, or grandmothers who incline to squash poultices. No one in the average Balkan village ever bothers himself or his neighbors with questions of prevention or any public health propaganda. The big task, therefore, in our medical relief work is far less one of dressing so many wounds and washing so many babies, and caring for so many tuberculosis patients, as it is to create among the people a real appreciation and desire for an improved order of living : for the sanitary hospital, for the skillecl care of the typhoid sufferer, for the right care of well babies and the like. Neighborly assistance and foreign skilled supervision may be desirable for some time to come. But when the people themselves have been educated, through the example of doctors and nurses, to the point of wanting this improved order of living, on that day they will be able them- selves to carry on admirably the desired activities. In all health projects, the trained nurse or trained woman worker is essential. . . . This account of American Red Cross nursing service in the Balkans during the period previous to the adoption of the policy of child health units, a period lasting from January to November, 1920, will begin, for geographical reasons, with a brief account of the nursing service in Monteiu^gro and will continue with accounts of that developed in Albania, Greece, North and South Serbia and Roumania. The Commission for ^Montenegro arrived late in January in Podgoritza, the largest city in jMontenegro and one which had a population of about fourteen thousand, and established its headquarters there. The first American Red Cross commis- .sioner for Montenegro was ^fajor Elliot G. Dexter; he resigned on April 28, 10 ID, and was siu'ceeded by a Californian, ]\Iajor Uenrv R. Fairclouiih. The first head nurse of the unit of four- CLOSE OF THE J^OREIGN RELIEF PROGRAM 1103 teen nurses in ^fontcnef^ro was Georgia B, Greene. She was succeeded on April 15 by Lena Margaret Johnson. In working in a country as isolated as Montenegro, where supplies had to be brought in ])y camion or on the backs of mules or porters when the roads grew impassable, the American Red Cross personnel naturally met with primitive living con- ditions. The plan adopted by the commissioner of such a group was to establish upon arrival in the field of future ac- tivities an American Red Cross personnel house, equip it with ]{ed Cross supplies and charge one of the personnel with the duty of maintaining the household in cleanliness and providing adequate meals. Sometimes this housekeeper was a nurse, sometimes a social service worker, but the fate which had overtaken the Gevgeli L'^nits in 1915 in Serbia had made Xa- tional Headquarters especially charge each commissioner with the responsibility of safeguarding the health and welfare of his personnel. Another plan used in the Balkans was the establishment of Red Cross central mess and recreation rooms. The different members of the personnel were then furnished, usually througli arrangements by the Government of the coun- try to which they were sent, lodgings close at hand. They then lived in those lodgings and went to the Red Cross head- quarters for meals and diversion. Such a plan was established at Podgoritza and \\as more or less satisfactory. "Two of the nurses,'' wrote ]\liss Hay, '"were quartered in houses where a pig was also a denizen. The others were very comfortable." The American Red Cross established in Podgoritza a hos- pital of sixty-bed capacity. This was first located in an old military barracks, but was moved in April to the former resi- dence of Prince ^lirko, just outside the city. The lower floor was used for ])ers()nnel, the second one for operative and sick medical cases requiring nursing care and the third for conva- lescents, "salvarsans" and (piarters for nurses' aides, tli(^ native housekeeper and orderlies. The house was lighted by kerosene lamps and was heated by wood stoves but had no running water. Of the native aides, ^liss Johnson, the chief nurse in Montenegro, wrote: We si'cured throe young intelligent-looking girls of a])Out eighteen and took tluMU into the hospital. They learned some of th(> first ])riii(iples of nursing easily, but after a year's training: neither of tliem could read a thermometer, nor eould IIOJ; HISTORY OF AMERICAN RED CROSS NURSING we trust them to carry out orders unless we were there to see that they did it. One reason for this is that the word of a man is a command, so when a man patient insists on getting up immediately following a laparotomy, the aides in fear and tremhling let him, and when an hour previous to an operation he madly calls for food, they dutifully get it. Xow both they and the patients, however, are gradually beginning to learn that an American Avoraan"s word, if she is head of the ward in which he happens to be, is as good as that of a man. In connection with the hospital the commission maintained a lively dispensary where from fifty to ninety patients were daily treated. A dental department was an active phase of this service. One nurse was on duty at the dispensary and tw^o others, Mabel Is^elson and Sara McCarron, did visiting nursing among the families of dispensary patients. The city of Podgoritza was bisected by a small river into the ^"old" and the ''new" towns. The '*old" town included a large Turkish settlement aiid there the nurses found conditions which seemed unbelievably wretched to the Occidental relief worker. Miss McCarron wrote: When we arrived in Podgoritza on January 26, 1919, it was very cold. There was no coal and little wood. . . . Six days later I started out to do district work and my first patient Avas a bad nephritis case. I found her almost on top of the stove; they do this to keep warm. The family was in fairly affluent circumstances and could provide the nourishment she needed. We visited from twenty to thirty families each day. My district was in the "old town," tlie Turkish section, or "Turkey-town," as we called it. It was five hundred years old. A\ hen we first arrived, the spirit of the people was at low ebb and they were slow to grasp the idea that we were there to help, but when they did, every door was open to us, Christian and Turkish alike. The poverty was stark and terril)lo, no fires in some of the homes, the people scantily clad; dirty; no soap; hungry. ]\Iany had no beds and those who bad mattresses to lay on the dirt floors were considered Avell off. Otliers, desperately poor, had only a slip of burlap to lie on. Oh, it was heart-rending ! One case, a widow with an eight-year-old girl, was suffering from an infected foot, and I got there at twilight. After I had closed the door, which was the only means of light they bad, I could not see the patient huddled in a corner on a CLOSE OF THE FOREIGN RELIEF PROGRAM 1105 bundle of filthy rags, reeking with pus from the infected foot. The wound had been discharging for two years, the patient told me. We sent her to our hospital for two months. When she came home, she found that the walls had been white- washed, a small hole opened in the ceiling above the fireplace for tlie smoke to escape, an army cot, sheets, blankets and food daily until she could get work. Early in March, the two public health nurses in Podgoritza started school nursing. Miss McCarron wrote : The five hundred children in tlie primary school were bare- footed, illy clad and lonely. The school was not heated in any way and they sat there and shivered, too cold to study. I inspected them every month and on my first inspection found over two hundred cases of pediculosis; numerous ones of scabies; some impetigo and nephritis; no trachoma; one case of acute conjunctivitis and on a later inspection two of farus. I succeeded in having thirty-one bad head cases shaved at once, more than 1 could ever accomplish at home in ten months. The principal and teacher were splendid in their co- operation. Spine and eye cases went to the dispensary for treatment, also pediculosis victims for petrol and lard. Talks on care of the teeth and mouth were given by Dr. Wolf, our dentist, and tooth brushes, handkerchiefs, covers for drinking glasses and soup were distributed. All tuberculosis, malnutrition, scurvy, convalescent pneu- monia, ])ronchitis and influenza cases in the district were referred to the dispensary every morning at nine o'clock and received evaporated milk, jam, eggs and any other article of diet the doctor ordered. A large soup kitchen was maintained at Podgoritza and "feeds nearly one thousand people daily," wrote Miss Hay, "with a very palatable thick soup prepared with vegetables and flavored with bacon. For ^rohanimedans a similar soup is furnished which contains vegetable oil instead of bacon. The daily food ration is a liberal half pint of soup and one-sixth of a kilo of bread and many of the recipients sit down on the sidewalk and eat it immediately. One day Mr. Tnekerman, the Ked Cross man in charge of the soup kitchen, called my attention to two cliildren who, while waiting for their soup, had ])icked uj) a bone from the gutter and were voraciously gnawing at it." 1106 HISTORY OF AMERICAN RED CROSS NURSING North of Podgoritza was located Niksic, a city of some five thousand population. There the commission established a hos- pital of thirty beds and maintained a dispensary and visiting nurse service ; Emily Chancy, Emma Robbins and Edith Bur- gess were on duty. Two of these nurses also assisted in con- ducting the soup kitchen 'Svhere we saw the same ragged and underfed people," wrote Miss Hay, "and many children shiver- ing in the cold wind which comes down from the snowy mountains." The Podgoritza unit endeavored to extend its work to Ko- lashin, a mountain town northeast of Podgoritza, and nurses and other Red Cross personnel were sent up during the spring of 1919. Throughout Montenegro, the American Red Cross hospitals and dispensaries treated many peasant farmers and in Kolaskin the nurses tried to do rural visiting nursing. Local bandits made such work unsafe, however, and finally the unit was recalled to Podgoritza. South of Podgoritza was Cetinje, capital city of ]\Iontenegro. It also had a population of five thousand. The iVmerican Red Cross Hospital which was established there was located in a building known as the Prince's Palace. Elizabeth ^litchell, the nurse in charge, finally transformed the Palace from a dirty and inadequately equipped hospital into one which was attractive and at least sanitary. In connection with the hos- pital, a day nursery for children of working mothers and another for tuberculous children was developed. At Cetinje a ]Montenegrin women's club had organized the only orphanage which existed early in 1919 in the small principality. ^liss Alitchcll became interested in it and tlie commission furnished food, clothing, bedding and tooth brushes (and considerables advice in the use of these articles) to the ragged yet happy youngsters. One of the American Red Cross nurses at Cetinje was Ber- nice Brady, a public health nurse. She wrote: Cetinje docs not look as if it had five thousand inhabit- ants, but practically every room housed an entire family. Naturally, sanitary conditions were inipossil)le. We often ejaculated, "What a hardy race!" but wc only saw those able to survive the crowded housing, the scarcity of fuel, the lack of clothing and food in winter snows and cold spring rains and hot dry months when water is of necessity rationed. The An American Red Cross nurse, Jeannie Frasier. instriictinpr two pupils of a Little Mothers' class in elementary nursing procedure, Podgoritza, Montenefirro. wm w p > An American I'ed Cross nurse and her interpreter pivinp a lesson in Home Hygiene and Care of tlie Sick to a grouj) of refuurces in Tirana. Albania. CLOSE OF THE FOREIGN RELIEF PROGRAM 1107 country is mountainoiis and unproductive, ricli in only one thin<^, history and tradition. (Tlie Albanians say that St. Peter was horn in a wayside hovel Ix'tween Cetinje and Podgorit/.a, l)ut do not ex])lain his subsequent change of resi- dence.) The story of Montenegro is one of constant fighting to retain their freedom and they boast that they have never been conquered. The men are used for the Army and the women do prac- tically all the manual labor. 'J'he birthrate is low and the infant mortality high, to judge from observations. Practi- cally no records are kept and birth registration has yet to be introduced. Aside from a fe^v of the up])er class, women have little or no education. Widows predominate and, as there are no industries and they usually have several small children to care for, they earn a meager living by buying and selling in a peddler fashion, journeying over the mountains on foot and returning with supplies on their backs. They are often absent for four days and in that time the children at home fend for themselves. Many of the poorer people live in stone hovels. When they have wood, they build their fire on the dirt floor and huddle about it in rags such as one cannot imagine in one's wildest dreams rf poverty. Even with all the patches, many are scarcely covered. Wliorovor ]\riss Tlay and her nurses went, they carried with tliem the i(l(>as of sanitation and orderly living, which are the Inundation stones of sound nurse education, and they strove to }>ass these princi]>les on to the natives with whom they worked, ^rontcnegro in 1010, lunvever, was not a fertile field for such ideas to take root. At Xiksic, Miss Chancy and Miss Rohbins were able to instruct their native aides with considerable suc- cess, but the brave plans for introducing the class-work in Home IFygiene and ("an^ of the Sick which were initiated by ^Fiss Hay and th(> "Kolo Society," a women's organization at Pod- goritza, did not develop. The American Red Cross Commission for Albania, of which ^Tajor lutbcrt C. Dcniiisoii was tli(> first commissioner and Caroline K. Robinson sii])crvisor of the fourteen nurses, ar- rived in Albania bite in T'ebruary, 1010, and (levelo])ed in six Albanian cities the hos])ital, dispensary, visiting nurse and. civilian relief service which formed the chief phases of Ameri- can lied Cross relief ihrouirh the ]>alkans. 1108 HISTORY OF AMERICAN RED CROSS NURSING To Scutari, the most northerly and the largest city in Al- bania, one of which had a population of about thirty-two thou- sand, the commission sent a unit of eleven American Red Cross workers. Four of these were nurses, with Ella McGovern as head nurse. Tlie city boasted of the only hospital in Al- bania and to it the commission gave supplies and raised its capacity to one hundred and thirty-five beds, instead of de- veloping a separate institution. Xeed existed, however, for a dispensary, so the commission established one which by July 1 had treated 2606 cases. The visiting nursing at Scutari which was first developed by Viola Nohr and Leslie Wentzel was comparatively successful. By July 1, the nurses had made 1349 calls. Scutari main- tained an orplianage for thirty girls and to it the commission gave food and clothing. Miss McGovern lectured there on simple questions of hygiene. Similar health talks were given by her in the city schools and in the American Red Cross sewing rooms, established to give training and employment to women. South of Scutari the Mati River flowed to the Adriatic Sea and the early spring rains swelled it into a torrent. During the Austrian invasion in 1915, the only bridge spanning it had been destroyed and in 1919 had not been rebuilt. Travel was possible only by motor, carts or on foot and the roads were poor. AVhen travelers came to rivers such as the Mati, they had to cajole the native ferrymen to convey them across at cost of many words and numerous coins. Nevertheless, the commission strove to establish dispensaries in small and iso- lated Albanian towns and with true zeal, the nurses and other workers started out over the rough but always picturesque and often beautiful mountain rjads. Such a town was Kroya, where Marion Echtcrnach and Sarah Buchannan did 'S'isiting nursing and were on duty in the American Red Cross dis- pensary, ^liss Bnchannan's report contained an interesting description of the quaint life: On April 8. 1919. after three hours of mountain climbing, we found ourselves on tlie side of one. in the little village of Kroya. the home of the Alhanian hero, Skender Bey. The streets were too narrow and rocky to allow our camion to come into the tc)wn. so we walked. . . . Our house was a typical rural Alhanian one; although it was now, it was made of old material. When we arrived, men CLOSE OF THE FOREIGN RELIEF PROGRAM 1109 were layin<^ a concrete floor in a large room on the ground floor, but it never dried. We had two small rooms above for tiie four of us, the doctor, the interpreter and the two nurses, ^liss Kchternach and J shared the same room and used it also for kitchen and dining room. We cooked with charcoal on a three-legged affair called a mongal. We followed the Albanian custom of sending our meat and pudding out to be baked. One day I attem))ted a pie ; in lieu of a board, I used a large sheet of paper and my rolling pin was a milk bottle. Marvelous to say, the pie was voted a success. In a fair-sized room in the next house, we establislicd our dispensary, and during six weeks treated tliirtcen hundred. !Many skin diseases, tuberculosis of the bone and gastric con- ditions were prevalent. The stomach troul)le we attributed to the almost exclusive diet of poorly baked corn bread and sour milk. Unfortunately our supply of drugs was limited, but we had quinine, phenacetine and epsom salts. We made cough sirup, using as a basis sugar and lemon juice. The people in the village were absolutely drug famished; tlie Austrians had taken everything and nothing had been imported. Some came and said they were not sick but wanted medicine for the time when they woidd be. Others reported having been ill five or ten years ago as a pretext for begging medicine now. In another town where there was a pharmacy, the doctor gave a written prescription to a man and explained that in return for the paper, if presented at the pharmacy, he would receive six pills and that he must take one of these every day. On the sixth day, the doctor was much surprised when the patient presented liimself with a small scrap of the prescrip- tion, and the request that he might receive another. On questioning him, the doctor found that he had taken one-sixth of the pai)er each day. ^lost of our drugs were in powdered form and we found that the patients invariably took })aj)er container as well as the powder. Taken as a whole, the people of Kroya wore appreciative and solf-rospocting. "We have no beggars," wrote ^liss Bu- channan. South of Kroya was Tirana, an inaccessihlo liill-town of twelve hundred inliahitants. ''The only mode of travel to this town," wr()t( ^liss l>ucliannan, "is hy horseback. The road was in many places the merest trail, st(Mp and rocky, with a 1110 HISTORY OF AMERICAN RED CROSS NURSING precipice on either side, so that one false step of your horse would be fatal." Six American Red Cross nurses, including Miss Robinson, the head nurse in Albania, were on duty at Tirana, some of them in an American Red Cross hospital of thirty beds. Miss Buchannan at one time was among these and she wrote: We had four native women of the gipsy class for assistants and we were able to teach them quite a bit. The women of the upper classes cannot be induced to come out of their seclusion. The majority of our patients were men, many of them gun- shot cases. These mountaineers are constantly fighting over some ancient family feud. At Tirana, the American Red Cross maintained an active dispensary service. Two of the nurses did district work. An interesting development of the Tirana dispensary was a mobile unit which operated in the hill-towns in the vicinity. At Singerc, this unit treated 374 patients in four days. Lucy Joaquim was the public health nurse who accompanied the mobile dispensary on its journeying. The unit at Tirana also furnished supplies and medical and nursing service to a local orphanage. Westward from Tirana and located on the Adriatic shore, was the capital city of Albania, Durazzo. Two nurses. Barbara Sandmaier and Emily Chancy, did some temporary nursing- there but were transferred in ]\Iay to Tirana. Sarah Buchan- nan assisted there in distributing supplies in March to sixty children who attended a school which was located on a hill above the bomb-wrecked town. ''W^e redressed all the small children," wrote ]\liss Buchannan, "but had nothing for the larger ones. The children were very modest in being re- clothed; some of them showed extreme embarrassment. This modesty in children T have found everywhere in Albania and it is charming to see." Southwest from Durazzo and Tirana was the hill-village of Elbasan and there two nurses, Annie Slack and ^Margaret Gar- retson, did disp(Misary duty and visited anu)ng the needy and appreciative Albanian peasants. From Elbasan, Miss Buchannan went out with a mobile dis- pensary to Kavaja and during the four days the unit was on duty there, they treated about three hundred pati(>nts. '"JMany, 1l ^^ (Above) Tlie open sewers of Tirana, Albania. (Center) An Amcriian Ivcd Cros-; dispensary in Albania. (Lower) A mosque of Tirana. CLOSE OF THE FOREIGN RELIEF PROGRAM 1111 we felt," wrote Miss Buchannan, "came out of curiosity. We saw the usual amount of tuberculosis and the syphilitic condi- tions which existed in other towns." Koritza was the farthest south city in Albania wherein the commission developed a hospital dispensary and visiting nurse service. Among its eight thousand residents were many Chris- tians and numerous Americans and Albanians who had been in the United States. Accordingly, the American Red Cross work met with success. American Red Cross nursing service in Greece was marred by organization difficulties which rendered the work of the nurses ineffective and after some nine months' endeavor, all emergency nursing service was discontinued. The Commis- sion for Greece, of which ]\Iajor Capps was in command, had arrived in Athens in October, 1918. The nursing staff of the commission, as organized in the United States, numbered seven nurses. Three of them were American Red Cross nurses: Lena Margaret Johnson, chief nurse, ^larie Clare Glauber and Mary Margaret T\^non ; the other four were Greek nurses who had been trained in America : Marie Zacca, Elene Inglisaki, Marie Kouroven and ^Fargaret Chrvsakis. These Greek women had been sent to America by the Greek Government and were under contract to render five years of service to the G]-cek Red Cross on completion of their training. In the sum- mer of 1!>18, arrangements were effected between ]\riss Delano, Commissioner Capps and the Greek ^Finister whereby the American Red Cross agreed to enroll these four women as members of the Xursing S(>rvice and send them to Greece with the commission. Upon their arrival there, thev were to remain in service with the conmiission as long as they were needed and wvYO finally to be transferred to the Greek Government for the fulfillment of their contract. The nurses arrived in Athens in Xovember, 1018. On De- cember 17 ^liss Chrvsakis was transferred from the commis- sion to the Greek IumI (^ross in accordance with the terms of her contract. T]w remaining six nurses were assigned to tem- porary duty, half of tliein in a Greek military hospital in Athens and the otJiers in a Greek military hospital at Salonika. In flanuarv, l'.Ul, tli(> nursing staff of the Commission for Greece was augmented by the arrival of two additional units of the American Red Cross nurses. The first unit, which 1112 HISTORY OF AMERICAN RED CROSS NURSING consisted of six of the nurses of the original Balkan unit, with Miss Phelan as head nurse, had been sent to Athens by Miss Hay in Rome. The second unit arrived in Greece ten days after Miss Phelan's group; it consisted of three nurses with Sarah Addison as head. Thus the total nursing strength of the Greek Commission numbered eighteen enrolled nurses. By the middle of November, 1918, the executives of the commission had outlined a program of general and medical relief work throughout Greece, so the nurses were recalled and assigned to different posts of duty under various members of the Commissioner's staff. The work which tliey accom- plished falls into three principal groups; first, civilian relief among the Greek refugees in Bulgaria and on the Aegean Isles of Samos, Mitylene and Chios ; second, medical relief in Mace- donia, Athens and Crete ; and third, health and social surveys made on Samos and Mitylene. The civilian relief rendered by American Red Cross nurses will first be described, begin- ning with that given to Greek refugees in Bulgaria. During the last two years of hostilities, the Central Powers had deported many Greeks and held them in Bulgaria. These unfortunates were beginning to come home late in 1918, so the commission established relief stations along the railroad leading from eastern Macedonia into Bulgaria. At these relief sta- tions, dispensary service, food and clothing were furnished to the rapatries. Miss Johnson was assigned to the station at Tirnovo-Sienieu and held the position of chief nurse of the eastern Macedonian district. Miss Zacea went to the station at Dedeagatch and Miss Kouroyen to that at Xanthi. The three nurses left Athens on December 5 bound for Drama, where the British forces gave them rations for two days. Miss Hay ^\'Tote: From Drama, they went on their way in a freight car, quite empty. Through the ingenuity of one of the American men, a modicum of comfort was acquired; beds were made from boxes, blankets were tacked up to give some privacy. In this car, ^liss Johnson and two men lived for six weeks and hsre they entertained eri pnsmnt the Bulgarian ^Minister of War, the commander of the French armies in Greece, the faculty of Robert College, Constantinople, and French, G^-eek, English and Bulgarian officers galore. At each of the three railroad centers, Tirnova-Siemen, Dedeagatch and Xauthe, quarters were arranged in a house or CLOSE OF THE FOREIGN RELIEF PROGRAM 1113 freight car for a cook-house, a dispensary and living places for the American Ked Cross personnel. Needed supplies for the daily distributions were arranged for in cars alongside. Hot soup and bread, or rice and bread were ready when the trains of rapatries arrived. The task was to get to every person in that sorry crowd that needed food, clothing and medical care. To make sure that no one would be overlooked meant quick and systematic work. All were in a sad state, emaciated, ragged and dirty. With no food for two or three days, sick, weak and cold, they had been huddled together sixty to severity-five m a car. In this miserable and destitute company, births and deaths were frequent occurrences, and one given duty of the Ameri- can Red Cross at each station was the burial of the dead. To tlie new mother were given extra food and such wonderful baby clothes as were not to be hoped for in those days of bitter want. From Tirnova, ]Miss Johnson sent a list of patients who had received special treatment or needed further care to Miss Zacca at the next American Eed Cross station, Dedeagatch. After good food and kindly treatment there, the rapatries went on to Xanthe, where Miss Kouroyen and her helpers gave them needed final assistance before their arrival in Greece, just over the border By January 11, 1910, all Greek refugees were reported to be out of Bulgaria and the American Red Cross relief stations were closed, with a record of having cared for 48,000 refugees. The storied isles of the Aegean Sea, Samos, Chios and ^Hty- lene were the other scenes where American Bed (^ross nurses did notable civilian relief work. To Samos on February 1, 1019, a subnuirine chaser of the American Xavy brought the two nurses, Laura Bunting and ^lary Frances Mingane, and two social service workers. The nurses assisted in the direction of a large workroom and in the distribution of supplies. When the American Bed Cross workroom was closed on May 16, 1010, 5425 refugees and poor on the isles of Samos and Nicaria had been aided and 11,704 garments distributed. Xorth of Samos lay the Isle of Chios. Miss Johnson, the chief inirse of the commission, was assigned to duty there by Commissioner C^ipps on February 17 and with Dr. Harriet Chirk, established a dispensary which daily treated sixty cases. It was closed, however, in two weeks on account of a lack of medical supplies, so Miss Johnson assisted in the distribution 1114 HISTORY OF AMERICAN RED CROSS NURSING of food and clothing until March 21, a date on which all sup- plies were exhausted. "A total of 3120 families (11,000 per- sons)," reported ]\Iiss Johnson, '^received both food and cloth- ing. One thousand and fifty families (7000 persons) received only food." i^orth of Chios was situated the Isle of Mitylene and there two American nurses, Blanche Gilbert and Mary Fleming, conducted a work room in which 30,347 garments were made in six weeks and later distributed with food, to refugees and the poor of Mitylene, Tenedos, Embros, Samothrace, Lemnos and Nudros. ''There was nothing done in this group of islands," wrote Miss Gilbert, "of a medical or nursing nature. The con- dition of the refugees is fairly good. There is little sickness. The housing is impossible but the homes for the most part are clean, but with very poor sanitary facilities. The unfortunate people have received so much aid that many of them seem to have lost their self-respect and will willingly beg." The program of American Red Cross medical relief, as was previously stated, contemplated the establishment of dispensary and visiting inirse service in Macedonia, Greece and the large isles in the Aegean Sea. Four nurses, with Miss Addison as head nurse, were ordered to Macedonia late in January. Miss Addison established headquarters in Kavala and with her nurses, cleaned and equipped a small civil hospital there and assisted the American Red Cross doctor in establishing and maintaining a dispensary there which in four months treated 3598 patients. The public health nurses made 270 visits dur- ing the same periods to homes of dispensary patients. To Rodolivas, a village near Kavala, were assigned two nurses, Emily Porter and Mary Frances JNfingane. In addition to "specialing" one of the American Red Cross personnel who had typhoid fever, the two nurses assist(>d in the treatment of 1150 pati(!nts at the American Ived Cross dispensary, made 25 home visits and gave instruction and distributed clothing to 530 school children, all in a period of tliree months. In addition, ]\Iiss Porter organized and directed a small workroom which employed eight women. At Prava, in the Kavala district. Miss Zacca developed a dispensary service which treated b(>tweeu February 10 and May 3, 3805 pati(>nts. She also gave nursing care to thirty patients in their homes and supervised the nursing of the children of a local ()r])lianage. CLOSE OF THE FOREIGN RELIEF PROGRAM 1115. North of Kavala, was the village of Drama. Four American Red Cross iiiirsos were assigned to duty there ; they gave nursing care to sixteen hundred patients in a Greek hospital, in the Ameriean Red Cross dispensary and in their homes. The work at Drama had been interrupted by the assignment of two of the nurses to ''special" an American Red Cross social worker who had a severe case of typhus. They had no sooner returned to Drama than they were recalled again to Kavala to nurse an American Red Cross physician, also stricken with typhus. Serres was a small mountain town northwest of Kavala and to dispensary and nursing service there, three nurses were assigned at various times. Even though the nursing service in the Kavala district was interrupted by the nursing care given to the American Red Cross personnel, its accomplishment was commendable and, wrote ^liss Hay, "was the only piece of general medical relief work attempted in Greece. Nurses should not, however, be left alone in such work in any stations as were Miss Zacca and Miss Porter, although the attitude of the nurses them- selves, in such lonely assignments as in the care of the typhus cases, was soldierly." The nursing service in the Greek Peninsula centered at Athens and consisted in baby welfare work and in the establish- ment of a school of nursing, to be treated later by ]Miss Noyes in Athens. The infant welfare program iiicludt^d a bi-weekly baby clinic and instruction to mothers at the clinic and in their homes. IMargaret T_>Tnon, the nurse in charge, al.o conducted classes, the first of ten and the second of fifteen, to train young Greek women to assist in infant-welfare work. When the time approached for ]\liss Tymon to return to the Ignited States, the American Red Cross physician advised the Patriotic League, the Greek organization which was to take over the management of the clinics, that an untrained woman would meet the American R(m1 Cross requirements as Miss Tymon's successor. This Gre(^k woman had had no training either as a nurse or an infant welfare^ workc^r. ]\Iiss Hay finally prevailed on the commission and the Patriotic Leaiiiie to refer the matter to ^liss Xoyes at Xational Headquarters. Opposite Athens, on the western shore of the Peninsula of Greece, was the ancient s(\i-town of Patras and tlierc^ the com- mission on ^larch 7 S(Mit Ijlanclic Kaccna t(^ open an infant welfare clinic. On April 2;>, Miss Gilbert, an cxpericMiced 1116 HISTORY OF AMERICAN RED CROSS NURSING infant welfare nurse, arrived and subsequently developed an active center. The prospect for a permanent station at Patras was, however, not bright "because," wrote Miss Torrance to Miss Hay, ''the poor have little means and desire on account of the more spectacular demands, resulting from the war, to im- prove their own living conditions and the more educated and responsible class have yet to feel that such living conditions among the poor ought not to be tolerated." The only other infant welfare station which was developed by the commission was located at the Isle of Crete. Miss Phelan and Miss Fleming arrived on April 7 at Canea, the second largest city on the island, and developed baby clinics there in cooperation with the local branch of the Patriotic League. Miss Phelan left Canea early in June to return to the United States ; Miss Fleming took over the direction of the station and another nurse. Alma Hartz, was assigned to duty there. The station was turned over on July 1 to the Patriotic League and the American Red Cross nurses withdrawn. The two health surveys conducted by the commission were made by Miss Phelan on the Isle of Mitylene and by Miss Bunting and Miss ]Mingane on the Isle of Samos. Such were the activities and accomplishments of the nursing service of the Commission for Greece. The efficiency of the nurses, as it was said before, was marred by administrative difficulties. Miss Hay wrote : The nurses of the Greek Commission were a fine body of women, representing a high order of ability, experience and devotion. They have good reason to resent the treatment accorded them and l"o deplore the fact that their accomplish- ment in actual nursing service was so pitiably small. Xo one resents the fact that they were used so largely for civilian relief work ; that may have been necessary. What seemed deplorable was that the advice and special services that they as nurses were so well qualified to render were never asked and rarely accepted. . . . In the summer of 1919, Miss Hay recommended that the American Red Cross nurses assigned to duty with the Greek Commission, be withdrawn at the end of their six months' term of service and that they be returned to the United States. The recommendation was accepted, but a subsequent change of plans later permitted the development of a child-welfare pro- gram. CLOSE OF THE FOREIGN RELIEF PROGRAM 1117 In Serbia, the nursiiif^ service was more extensive than that rendered bv the commission in any of the Balkan States. The headquarters of the American lied Cross Commission for Serbia were located in Belgrade. Rachel Torrance, Miss Hay's assist- ant, was chief nurse. In northern Serbia, twenty-two nurses were assigned to duty and they used as bases for activities ex- tendinu: into numerous villages, the two cities of Kragujevatz and J'ozarevatz, and four towns, Cuprija, Kraljevo, Palanka and Petrovatz. Kragujcvatz was located south of Belgrade, a city of some eighteen thousand population. To it the commission assigned Dr. Harriet Gervais, a physician. Dr. Marion Stevens, a dentist, and ^lary B. Boss, a nurse who had had much experience in social service work in New York City. The three women estab- lished sewing-rooms where Serbian women were given employ- ment in making garments to be distributed among the needy when completed. They gave professional care and many supplies to about one hundred and thirty orphaned children who were being cared for by a local Serbian welfare organization. The orphans were housed in one of the former royal residences. Southeast of Kragujevatz was the village of Cuprya and here two American physicians, Captains John Voor and Thomas Lowe, and three nurses, Kathryn Williams, Inez Gilliland and ]\Iarv Snow, established a hospital and a dispensary. "The unit is, to mv mind," wrote Miss Ilav, "one of the strongest in Serbia." In Kraljevo, a village southwest of Kragujevatz, the com- mission established a dispensary and a chain of sewing rooms. 1'he clinics were small enough to require the attention of only the American Bed Cross physician, IJr, ^larv Elliott, so the two nurses, ^larietta Wilsey and Sybella Haviland, gave their entire time to supervising the manufacture of garments in sew- ing rooms at Kraljevo, !Milanovatz, Chachak, Terznik and Kruslicvatz and distributing food supplies and the finished garments to the destitute in these and neighboring villages. Generous supplies of linen and hospital garments were made and given to the local Serbian Hospital. Xorth of Kragujevatz was situated th(> village of Palanka and there the American Bed Cross inirses renovated a hospital where conditions existed similar to those encountered by the nurses of the Gcn-geli Fnits of l!tl4 and in d(\u're(' if not in extent, bv ]\Iiss Xiu'htinii-ale herself at Scutari. Harriet L(H'te 1118 HISTORY OF AMERICAN RED CROSS NURSING and Lieutenant McNabb of the Balkan Commission inspected the Palanka Hospital on March 11, through the courtesy of the one over-worked Serbian physician who alone was trying to meet the medical needs of the hospital and a district of some hundred thousand residents. Miss Leete wrote: In front of the Palanka Hospital, the yard was filled with mud and filth. In the rear were trenches which were used as toilets. Sanitary ! Yes, there were toilets, but they were in an impossible condition. All refuse and excreta from the hospital was thrown into a ditch which emptied near the open well. The condition of the surrounding fields was even more dangerous. . . . The hospital was a military one and was filled with Serbs and prisoners. When we arrived, there were 297 patients and thirty beds. The main corridors were fairly clean, but lead- ing from each wing were outside entrances and one of these halFways was used as a toilet-room, no conveniences, just tlie floor, part of which was tiling, with the doorway of earth. From the hallway the stench penetrated throughout the long corridors. In the hallway adjoining the other wing, Lieutenant JMcjSTabb and I discovered, apparently thrown in and piled one upon another, at least twenty bodies of patients who had died in the hospital. The daily death rate at that time was from ten to twenty and frequently the bodies were allowed to remain there for several days. It was a ghastly sight. In the wards where the thirty beds were, the patients were lying on the few mattresses or on the boards. The cots had no springs. In the other wards they lay close together on the floor, sometimes with dirty straw for bedding. Tuberculosis, dysentery and pneumonia cases all in the same ward. White faces! White as the ones in the morgue. ^Many coughing, many more too weak to move and apparently, from the odors in the ward, they were going without any care. The doctor said that there were orderlies. It took some time to discover them, as they were soldiers who spent most of their time in the office or in the kitchen. . . . On ^Farch 14, ]\riss Leete returned to Belgrade and asked that she be reassigned to Palanka with supplies and a sufficient number of nurses to clean up the hospital and train the orderlies. Four days later, she and another nurse, Faith Denison^ reported to Lieutenant AlcXabb, wlio had remained at Palanka, and they began the renovation of the hospital. Two more American CLOSE OF THE FOREIGN RELIEF PROGRAM 1119 nurses, Ek^anor Blackstone and !Marie McDowell, arrived on ]\Iarch 2() and the Serbians sent ten soldier-orderlies and sorno Serbian nurses from Bel^ade. By April .'5, M iss Leete and her nurses had changed conditions to such an extent that the death rate had ceased, ^fiss Denison came down with typhus on April 11 and some twelve days later, j\Jiss Ix^'te. The two other American nurses cared for them and they returned in the summer of 1919 to the United States. All American Red Cross activities in Palanka were discontinued late in May. To Betrovatz, a village east of Palanka, the Commission for the Balkans sent two physicians. Alberta Greene and Marjorie Buriduim, and two nurses, Anne O'Hara and Laura Lowe Kreigh, They developed a large dispensary service at Petro- vatz which treated about one hundred cases a day, and once a week held clinics in the neighboring villages of Scotonje, ]\Ie- lenica, Pashanatz and Ilunovitch. A small hospital was opened during the summer in an old building outside the village. Xorth of Petrovatz was situated Pozarevatz, a city of thirteen thousand inhabitants, and here the commission developed a gen- eral hospital, and dispensary, a tuberculosis hospital and a bouncing orphanage. Two physicians, Egbert Borgeson and David Kadesky and three nurses, Jennie Hoagland, head nurse, Efiie Swayze and ]Mary Bicketts, were on duty there. The hos- pital was of thirty-four-bed capacity and in it an active operative service was maintained. At the dispensary connected with it, clinics averaging forty patients daily were held. Miss Hay described the typo of cases treated : An Albanian woman with inoperable carcinoma, who en- treated the doctors to operate if there was a single chance, stating tliat she would gladly take all responsibility; a mini- ber of women with female disorders; eczema of the breast; much bont' tuberculosis; an accident case, a young man who had fallen from a hay wagon on to a bay fork, dying soon afterwards from a ruptured spleen; a badly emaciated child with tender abdomen who wailingly refused hospital treat- ment. . . . On t]\o outskirts of the town, set among a grove of trees on a slight rise of land was the attractive and well-equipped Tuber- culosis Hospital. There were accommodations for thirty odd patients but when Miss Hay inspected it in -lune, there were only fourteen. **'rbe discouragenuMit in the work thus far,"' wrote 1120 HISTORY OF AMERICAN RED CROSS NURSING Miss Hay, "has been the unwillingness of the patients to stay long enough to get benefit from the treatment." To a local orphanage where thirty young Serbs were being cared for, the unit at Pozarevatz gave food, clothing, linen and medical attention. South Serbia was honey-combed with relief activities of the American Red Cross. In nine towns and their outlying vil- lages, the commission conducted general and medical relief. Thirty American Red Cross nurses were assigned to duty there. Southwest of the city of Nish in central-eastern Serbia was Pirot, an inaccessible town of eleven thousand inhabitants lo- cated near the Bulgarian frontier. Five Americans were on duty there, the physician, Captain Herman Hundling, two nurses, Eva Ferris and Mrs. Maud Metcalf, the nurse who liad served in Belgrade in 1915, and two civilian relief workers, Alida Bigelow and Frangoise de Bacourt. Pirot had a clean and well-run civil hospital and to it the commission gave many supplies. Captain Hundling maintained a dispensary which treated a daily average of fifty patients and the nurses aided him there and did district-visiting. The nurses also assisted in the distribution of food and clothing throughout the Pirot district. Leskovac was a town of fourteen thousand population and was located southwest of Pirot. On duty at Leskovac were two nurses of the commission, Sara Crosley and Esther Rose, and an enrolled American Red Cross nurse, Phebie Whedon, who had gone to Serbia in 1!)11: as a member of the Franco-Serbian Relief Association and had later worked under Dr. Ryan after he had taken over the activities of the Franco-Serbian Relief Association. Miss Whcdon had charge of the distribution of supplies and Miss Crosley and ^liss Rose were on duty in a military hospital where two hundred and fifty Bulgarian prisoners had been receiving the medical and nursing care typical of Serbian hospitals. Although the advent of the Ameri- can nurses was not hailed with enthusiasm, they did good work in clearing up the building, requisitioning American Red Cross supplies and instructing the orderlies in the use of them and giving the patients the needed surgical nursing care. The ma- jority of the Bulgars were invalided home in May and the two nurses were transferred to Vranja. This town of eleven th(uisand souls was situated south of T-eskovac, on the single railroad which bisected Serbia loii^-i- CLOSE OF THE FOREIGN RELIEF PROGRAM 1121 tudinally from Gcvgeli, on the Greek border, to Belgrade, on the Anstro-llnngarian frontier. Medical relief work at Vranja centered abont the Scottish Women's Hospital and ^liss Crosley and ^liss Rose conducted an extensive dispensary service in connection with it. The Scottish Women's Hospital Unit on duty at Vranja in 1919 had come to Serbia in Sept^'mber, 1910, had been assigiied to duty at Ostrovo and after an active service there had been transferred in October, 1918, to Vranja to care for typhus patients. There were many orphans in Vranja and the commission maintained there soup kitchens, an orphanage, and sewing rooms for girls. Helen King, a graduate of the Massachusetts Gen- eral Hospital School but not an enrolled American Red Cross nurse, was in charge of this work and was assisted by a young Scotch woman, Vida Matheson. Southwest of Vranja and near the Albanian frontier was Prizren, the fifth largest city in Serbia. Here the commission assigned two surgeons and a physician and four nurses, includ- ing ]\Iildred Williamson, the supervising nurse, and they de- veloped a hospital of seventy-seven beds, an orphanage where eighty-four young Serbs were cared for, and a soup kitchen which daily fed five hundred people. Captain M. R. Bradner was in charge of these activities. The hospital was picturesquely located on the banks of a swift mountain stream. It maintained an active operating room, surgical wards and two isolation tents for the treatment of tuberculosis patients, and across the turbuknit water-course and reached by a small foot bridge, a two-story building which housed the medical wards. "The entire hospital at Prizren,"' concluded Miss Hay, "in the care given the patients both by doctors and nurses and the cleanliness and thrifty management apparent on every side, is pleasingly American." In all the Balkan States, the American nurses and surgeons did the work closest at hand and most deserving of immediate attention. In some towns, this means the establishment of s()Uj> kitchens and dispensaries for the civilian population. In other towns were native' military hospitals where, like festering sores of war, the wounded were still, even as late as the midsummer of 1919, being cared for in the haphazard methods which char- acterized the treatment of the sick and wounded throughout eastern Kurope. Such a town was Skoplje, wliicli was located southeast of Prizi-cn and to it in February, 1919, went a unit 1122 HISTORY OF AMERICAN RED CROSS NURSING of six American Red Cross nurses, with Eleanor Wilson as supervisor. They were first on duty in the Vardar Hospital but in April, all the patients there were transferred to the big Half Moon Serbian Military Hospital in the western section of the town. Miss Hay wrote : In such a report, it is not possible to portray the sweeping changes that were made in the departments given over to our nurses in both the Vardar and Half Moon Hospitals. But they worked such seeming miracles in order, cleanliness and efficient care that even the most indifferent of the officials took notice and begged for the continuance of their services. The infinitely greater comfort and the more kindly treatment which their services meant for the patients themselves is also a thing which cannot be told. Gostivar was a town located south of Prizren and southwest of Skoplje. A unit of six American Red Cross workers were assigned to duty there; Lieutenant Theodore Reed was the physician, Eugenia Bogart was supervisor of the three other nurses and Geneva Bateman was in charge of civilian relief work. They established a hospital of twenty-five beds, a dis- pensary with a daily average attendance of one hundred and twenty-five patients and conducted visiting nursing and general relief in the adjoining mountain villages. The hospital was a trim and thoroughly model little Ameri- can institution set down among the Serbian foothills. Even the American Red Cross personnel house reflected ingenuity and high standards of cleanliness. ''Althongh there is no kitchen," wrote ]\Iiss Hay, "and the meals are prepared on the porch, regardless of wind and weather, they are good. Miss Bogart acts as housekeeper. One chief distinction of this unit is the possession of a big, tin-lined serviceable bath-tub, impro- vised from a tin-lined tobacco case and large enough to accom- modate (with careful adjustment) even a full grown man. This tub, like other conveniences at Gostivar, is due to Dr. Reed's inventive gifts." Monastir, second largest city in Serbia, was situated south of Gostivar in the southwestern corner of the small principality. Two groups of American Red Ch-oss personnel were on duty there. The first group consisted of four nurses, with Elsie Jessnp as head, and they served in the American Women's Hospital ; the second group consisted of one nurse as supervisor, H !i II 1 i n g the wouiided in carts to \'ranja, Serbia. An American Rod Cross nurse hrinpin})s, had wrung the country drv. When the sec(Uid Auicrican Red Cross conmiissinn ar- 1126 HISTORY OF AMERICAN RED CROSS NURSING rived in Bucharest on February 25, with Lieutenant Colonel H. Gideon Wells, of Chicago, in command, they found horses dead from starvation on the streets, children and adults alike in rags and gaunt with hunger, going barefoot in the snow, and typhus, pellagra, war dropsy, eye troubles and tuberculosis pandemic. Only the iron constitution of the Roumanian peas- ant prevented a much further decimation of the Roumanian population than has been described in a previous section. When an entire nation is hungry, the people want food, not toothbrush drills or other devices of health education. Thus the American Red Cross program in Roumania was a feeding and clothing program on a national scale and a subsidy, on equally large proportions, of drugs, linen and food to Rou- manian hospitals. In any emergency relief program, a public health nurse is an able instrument, because a good public health nurse is trained to estimate both the social and medical needs of those whom she is endeavoring to aid. Several of the fifteen Ameri- can Red Cross nurses of the second Commission for Roumania were women highly skilled in public health nursing and medi- cal social service, such as Florence Patterson, the chief nurse, Katharine Holmes and Evelyn Obear. The others were in- stitutional nurses who were well fitted to go into a Roumanian hospital and prepare the requisition lists of drugs, blankets, linen and food which were necessary to put that hospital again into operation. Thus while the American nurses in Roumania established no American Red Cross hospitals per se, and oper- ated few dispensaries on a scale comparable to that which pre- vailed in the other Balkan States and did practically no visiting nursing, their services certainly may be said to have been util- ized in a professional capacity. They were not tucked away in isolated sewing-rooms and civilian relief stations in Rou- mania ''to keep them out of mischief" as in Greece, but were given authority and a field to cover which was almost unbe- lievably broad. Miss Patterson, in addition to her duties as chief nurse, was the assistant director of civilian relief of the commission. The method in which the second Roumanian Commission attacked its tasks is well illustrated by a brief description of the work of several units. In Bucharest, ]\riss Patterson and Dr. Bayne worked out a civilian relief program which supplied food, clothing, drugs, and equipment during the spring and Roumanian refiifreoa living in mud dug-outs in the devastated war zones. An American l\ed Cross nurse serving soup to Roumanian refugees. CLOSE OF THE FOREIGN RELIEF PROGRAM 1127 early summer of 1919 to eleven Roumanian hospitals; sixteen, schools and children's aid societies; twenty-four orphanages; and fourteen asylums and sanatoria. Three special canteens were established aiul by the end of July, 191!), had served 168,118 portions of thick soup and bread, and had been aided, either with this food or by gifts of clothing, 53,140 persons who were not included in the ;ibove list of institutions aided. To develop the program in rural sections of Roumania, units were organized and sent out into the field each with its ([uota of villages to cover. Such a unit was the Focsani Unit which established its headquarters at Focsani, a city of some twenty- five thousand population which was located in south-central ^foldavia near the boundary line of Wallachia. Captain Ar- thur 1). Fulton, Katharine Holmes and Josephine Ellett com- posed the personnel of the unit and their territory consisted of eighty-five villages, fifty-seven of which had been bombed. The two nurses and Captain Fulton established canteens in each one of these fifty-seven villages. From these canteens a daily ration of thick soup and white bread was served to an average of one hundred people. An example of the effect which resulted from the distribu- tion of sanitary supplies and a judicious amount of advice by the American Red Cross representatives, was found in the village of Odobesti. During their occupancy there the Germans had built a good bathhouse but in the absence of soap and towels the Roumanians in 1919 were not using it, though typhus was epidemic in the community. Captain Fulton urged the local authorities to put the baths into operation and ]\fiss Holmes and ^liss Ellett distributed soap and told the recipients to go and use it at the public baths. Within due season the effects of an adequate diet, as partially sup])Iie(l by the canteens, and the use of the soap began to bear fruit in a diminution of ty])hus cases. The distribution of supplies and drugs to already establisluHl but im])overish(Hl Roumanian hospitals was described in a re- port covering the activities of the Tlfov Unit: Ruth Weir, a graduate of the Roosevelt Hospital and a nurse who had served at American Red Cross Hospital Xo. 1, was a member of this group. The official report was in part as follows: We found at T^udesti (a village in the Rudiarest district) a Eoumauian liosjjital witli eiglity-twu cases of tyitlius. The 1128 HISTORY OF AMERICAN RED CROSS NURSING hospital had nothing in the way of equipment but some iron bed frames, with boards laid across them. In many cases, we saw as many as five people trying to lie on one bed ; they were wrapped in bits of carpet and in rags. Men, women and children were all crowded together. One old woman lay dying while her three bedfellows shrank as far from her as possible to remain on the bed. The doctor in charge, a capable appearing young man, showed us the linen which had been turned over to him ; it consisted of shapeless bundles of rags. He had no medicines, no means of transportation to visit outside cases and prac- tically no food for his hospital patients. They were trying to make sugar from some old beets to add to the diet. We left him pajamas, convalescent robes, blankets, soap, food supplies, a little medicine and some advice. The general relief administered by the Ilfov Unit consisted, by the first week in July, of forty-one canteens which were serving food to 418,030 people in 114 villages. "Our clothing distributions," stated the writer of the Ilfov report, ''ran neck to neck witli the aid given through canteens and hos- pitals and we finally covered the people before they died of sunburn. Xo matter how well conducted our distributions were at the beginning they always ended in a riot wlien our most numerous clients, the Tiganes, began to think there would be nothing left for them. When the last shirt was gone, we dashed for the car, guarded by gendarmes and special con- stables who love the opportunity of wielding the big stick." In this respect, ]\riss Holmes was much horrified during her early weeks of service to see the local authorities trying to keep the Roumanian peasant women from stampeding the piles of layettes, by lashing tliem with ox-wliips, treatment which had little effect upon the somewhat over-eager mothers. Early in June, 1019, Colonel Wells resigiicd as commis- sioner for lioumania and returned to the United States. Colonel Anderson then moved the headquarters of the Balkan Commission from Belgrade to Bucharest to be able to keep general oversight of the work in Boumania. The summer of 1019 saw the com])lete reorganization, in policy at least, of the Commission for the Balkans. By that date the paralysis of trade with the Balkan States, due to the enemy's submarine activities in the ^lediterranean, was ended and after an interval of four years, ships were again bringing CLOSE OF THE FOREIGN RELIEF PROGRAM 1129 supplies into the Balkan ports. ^loreover, the crops of 1919 were being harvested by the women and a time of compara- tive plenty was again at hand. The national temperament of the various Balkan principalities was one of great physical stamina. Accustomed as they were to almost constant war- fare and quick to feel its ravages, the peoples of the different countries and especially Roumania were equally swift in re- sponding to the piping times of peace and with their heredi- tary enemy crushed, they attacked reconstruction with hope. The autumn of 1919 seemed an auspicious time for the close of the emergency relief as undertaken by the American Red Cross in the Balkans and throughout Europe and for the initia- tion of a constructive program limited to the field of health. ^lany of the nurses and surgeons of the Balkan Commission had been overseas since 1917 and desired to return to the United States. Even more important was the fact that the large quantities of the Red Cross general and American Army medical supplies which Colonel Anderson had brought to the Balkan States in January had been distributed and the finances of the society, in the estimation of the executives at National Headquarters, did not permit the purchase of new supplies with which to continue emergency relief of an international scale. Thus the personnel was slowly withdrawn, leaving only a nucleus in various dispensaries and welfare stations around which was soon to be built the constructive program in the field of child health. During the summer of 1919, the development of the League of Red Cross Societies progressed rapidly and on ^Xovember 17, 1919, ^liss Fitzgerald resigned her duties as chief nurse of the American Red Cross in Europe to assume those of the Director of Xursing of the League. Florence ^I. Waters served for some months as acting chief nurse of the European Commission, but in January, 1920, came to the LTnited States for a short vacation preparatory to returning to Europe as ^riss Fitzgerald's assistant in Geneva. A happy sequence of events followed. The ]\rinutos of a meeting held December 23, 1919, of the Commission for Europe recorded statements that . . . Colonel ()](]> announeorl that Colonel Kniorson is about to go to Sprl)ia with autliority to make arraiiLrcnioiUs with Miss Jlay to establish her headquarters in Paris, as chief 1130 HISTORY OF AMERICAN RED CROSS NURSING nurse of the commission. So far as the work in the Balkans is concerned, it has seemed that she could handle these details fully as well from Paris as from Belgrade. Miss Hay's experience in the Balkans subsequently proved to be of invaluable assistance in working out the details of American Red Cross nursing service in connection with the child health units and the establishment of schools of nursing in foreign countries. Her powers of administration, always considerable, had increased with her years of Red Cross ser- vice ; in fact, a Red Cross colonel had once said: ^'JMiss Hay is the biggest man in the Balkans." Her detailed knowledge of local conditions often seemed truly amazing to those with whom she worked, but the reasons for this were simple: She had assisted her nurses in dispensaries and hospitals in iso- lated Balkan villages, she had gone with them into dark and poverty-stricken homes, she had struggled alike with arrogant commissioner and insubordinate nurse, with avaricious native politicians and easy-going public officials, and she actually knew whether the initiation of a permanent welfare program would not be practicable. Thus she was able to render, in her new office, service of a broad and high order. Of the six American nurses who received the Florence Xight- ingale Medal of the International Red Cross, four of them had had service at some time during the European War in the Balkan States. At a meeting held December 10, 1919, the Xational Committee had passed a motion that the chairman appoint a sub-committee to consider candidates for this medal and submit its recommendations to the Xational Committee. This sub-committee nominated Helen Scott Hay, Martha Rus- sell, Florence Johnson, Alma Foerster and Linda K. Meirs, and renominated Mary E, Gladwin, whose name had been pre- viously brought forward by the Xational Committee. Dr. Farrand forwarded these nominations on March 2G, 1920, to the International Committee at Geneva and the medals were subsequently conferred on these nurses. The last months of 1919 saw the close of the American Red Cross cmorgcncy relief program in the T^alkan States, Palestine and Si])eria. Conditions in the l^alkan States had reached the stage favorable to the initiation of a constructive health pro- gram. In Palestine and Syria the American Committee for CLOSE OF THE FOREIGN RELIEF PROGRAM 1131 Relief in the Near East assumed major responsibility for the alleviation of suffering. Political conditions in Xorth Russia had already made necessary the withdrawal from Archangel early in 1*.)1U of the American Red Cross repr(!sentatives. In Siberia, Bolshevik victories also caused the withdrawal of al- lied forces and the American Red Cross late in 11)1!) and early in 1920. The only commissions remaining overseas and operating on the old pre-Armistice policies of nation-wide general and medical relief was that in Poland and the close of this phase of service has already been described. The Euro- pean Commission, with its headquarters at Paris, was serving chiefly as the clearing house through which w^ere being admin- istered the details coincident to the close of the emergency relief and the initiation of the new child health program. With the termination of the emergency relief program and the withdrawal of the commissions per se from Great Britain, France, Belgium, Italy, Montenegro, Albania, Greece, Serbia, Roumania, Palestine, North Russia and Siberia, the overseas service of the American Red Cross immediately incident to the European War may be said to have been ended. On June 30, 1920, only one hundred and sixteen American Red Cross nurses were on duty overseas. In the sixteen months which had passed after the resigna- tion of the War Council on February 28, 1919, an appreciable contraction in American Rod Cross war organization had taken place. On February 28, 1919, the number of persons in Red Cross em])loy in the United States and overseas totalled 14,- 625, 1921 of whom w^re volunteers (un])aid workers). On June 30, 1920, the number of persons totalled 5517, of wliom thirty were volunteers. The American Red Cross administra- tive, clerical and field staff had thus l)eon rcMluced by the r(^sig- nations of 9108 individuals, 1891 of whom liad been volunteers. As to the Chapter and membership strength of tlu^ society, on February 28, 1919, the American Red Cross had had 3,724: active Chapters and an adult membership of 20, OOO, ()()() per- sons; on .Jiuie 30, 1919, the society had 3.<)72 active Cha])ters and an adult membership of 8,988,140 persons. Tlie decrease shown by tli(>s(> figures was of 52 Cha])ters and 11,()11,S(U) adult niemb(n*s. In tliis figure which gives ihv loss of eleven million nuMiibcrs. there was a ])at(Mit reason for the tenninatioii of tlic t'orcliiu relief })rogram. In the minds of the Anieriean public, the war 1132 HISTORY OF AMERICAN RED CROSS NURSING was over and the need for American Red Cross activity ac- cordingly ended. To the average American, the Red Cross was primarily a war organization, so defined by the main clauses of its Congressional Charter, so understood by the man on the street. Some eight millions in 1919 had caught the idea of the need for continued support of an American Red Cross for- eign and domestic program, but eleven millions had not. Unquestioning and universal public support from the Ameri- can people is perhaps the most powerful genie in the world and with it the American Red Cross had, indeed, accomplished wonders. The society in some respects may be compared to the lamp of Aladdin. Xear the close of the nineteenth century, Clara Barton had found the lamp in Switzerland and had brought it to the United States. From 1905 to 1914, it had been held tenderly in the hands of Miss Boardman and a few influential friends and had then possessed but comparatively meager financial resources with which to perform its services, chiefly in domestic disaster relief. Then the European War had burst upon a startled civilization and Miss Boardman had prevailed upon the still comparatively feeble genii of the lamp to organize and finance the Mercy Ship Expedition. A brief period of comparative rest followed. In 1917, however, the national emergency brought about a changed aspect of the American Red Cross and it became an organization deserving the unqualified and universal support of the American public. President Wilson appointed the War Council. Mr. Davison as chainnan vigorously rubbed the lamp and lo, the American pub- lic responded in twenty months with a total contribution of four hundred million dollars. The society was reorganized on the basis of a Rockefeller corporation and expended in foreign and domestic relief two hundred and seventy-three of those millions. Then in turn the emergency subsided, the fickle genie of American public support turned its attention to other matters and the lamp was handed back to the Executive Com- mittee, still possessed of many lesser genii who could be com- manded to do useful things, to be sure, but with the all-powerful genie of universal, unquestioning public support gone until anoth(>r national emergency would again automatically com- mand its service. CHAPTER XIII PARTICIPATION IX INTERNATIOXAL XTRSIXO EDI'CATION" Tranxit'ion League of Red Cross Societies Schools of Nurs- ing Miss Noycs' Trip Overseas Child llealih Coders Nursing Activities in Insular and Foreign Possessions of the United States FOLLOWING the Armistice the general impression that the American Ked Cross had fulfilled its mission in Europe seemed to have prevailed. The commissions which had hecii estahlished in practically all the conntries of the Allies were gradually withdrawn until early in 1920, with the exception of the Commission for Poland, there were none left. These commissions had been largely occupied with questions of general relief and medical nursing care of both the civilian and military sick. General relief activities predominated and included the distribution of supplies of all kinds, clothing, food, hospital furnishings, linen, surgical instruments, drugs, etc. ; also raw materials of all kinds, sewing machines, sewing materials needles, thread, thimbles, buttons, tape in order that employment might be given to the women of the country. Hospitals and dispensaries were opened, child welfare work established, also visiting nursing; mother clubs were started and Red Cross classes in Home Hygiene and Care of the Sick were conducted (juitc widely. Into all this work the Red Cross nurse was introduced. With the uncertainty attendant upon the (hn'elopment of a clear-cut program, nurses fre(juently found themselves assigned to work in which tlunr professional training seemed partially wasted, such as supervising workrooms and soup kitchens, the distribu- tion of supplies and tlu^ housekeeping in personnel houses. Xot infrequently did the nurse do her day's work in a nursery or clinic and at the same time, cook three meals a day for the entire personnel, attend to all the buying and look after the cleanliness 1133 1134< HISTORY OF AMERICAN RED CROSS NURSING of the house, for unless the doctors, nurses and other personnel had comfortable living quarters, with well-cooked food, they ran serious dangers from infection; and native cooks unless trained by some one were ignorant of the American method of preparing and cooking food. When members of the personnel fell ill, the nurse assumed, in addition to her regular duties, their nursing care. Instances of hours of night work, added to an already overcrowded day, were so common as to excite no comment. Good sports as they were, the nurses assumed these extra responsibilities without faultfinding and with a cheerfulness truly commendable. It was part of the service, they were the ones prepared and, because of their special preparation, they accepted the responsibilities without question or complaint. That advantage was taken of them goes without saying. Instances where guests in large numbers were brought in with- out warning by the members of the unit were, alas, only too frequent. Under these circumstances, the nurses did not shine as social lights at such simple festivities as occurred in the evening. They were, moreover, painfully conscious of the fact that they suffered in this respect, by comparison with the other women members of the unit, social and clerical workers and teachers. In spite of their philosophy as a group, there were some heartbreaks on this account and individuals here and there found it difficult to maintain their equanimity and poise. Following the withdrawal of the commissions, a stream of workers, nurses, doctors and others poured back from Europe to America, leaving here and there a worker or two, to supervise specific pieces of work, to guard warehouses filled with Red Cross supplies, including those turned over by the Medical Department of the Army, and to develop Junior Red Cross activities. Red Cross officials at headquarters both in Paris and in Washing-ton were deeply conscious of the fact that the war-torn countries of central and eastern Europe were still in dire need. They were practically without the necessities essential to sup- port and maintain life. ^Icdical and nursing assistance were needed fully as much, if not more, during the reconstruction period than during the period of active hostilities. The dis- courag(>ment of the people facing this situation almost without supplies of every kind and with so depreciated a currency that it was practically impossible to go outside of Europe to INTERNATIONAL NURSING EDUCATION 1135 buy them, was quite understood by the American Red Cross. This condition was greatly complicated by the overwhelming problem of the refugees; each country had its own and the enormous numbers from Russia iiicreased their difficulties. Further than that, the problem of war orphans in large num- bers in each country seemed almost unanswerable. With full and intimate understanding of the situation, execu- tives at National Ileadipiarters were, nevertheless, obliged to listen to questions raised by members of the American Red Cross throughout the country, who had been working at con- siderable tension even before the United States became one of the combatant nations and at high speed from then on. "The war is over," they said, ''so why should we continue? We want to go back to our own affairs." Although- there were still large quantities of supplies in European warehouses of the American Red Cross and money left from the war budget for European work, a strong feeling existed on the part of many individuals in the United States, even though they were sympa- thetic, that the countries of Europe should assume the question of rehabilitation for themselves. To Red Cross officials, the question was a perplexing one. An operation of such proportions as that being conducted by the American Red Cross in Europe could not be stopped imme- diately. The warehouses which w^ere filled with Red Cross supplies in various parts of Europe and to w^iich the War Department in 1919 turned over large consignments of supplies and dietary foodstuffs as authorized by Congress,^ had to be guarded and plans developed for a systematic and efficient method of distribution, while particular activities such as the Junior Red Cross work, child welfare activities in Greece, and the varied phases of service in Poland could not be immediately discontinued without destructive results to the countries con- cerned. However, the executives at Xational Headquarters knew that they must take cognizance of the trend of American public, opinion. Governed largely by the factor of the sup- plies in European warehouses, they tinally decided on a re- stricted and clearly defined program of a constructive character. The nursing service of this program embraced four distinct phases: Indirect stimulus to the nursing service of the League of Red Cross Societies ; schools of nursing ; nursing service in ^ Bulletin No. 23, War Department, July 19, 1919. Army Appropriation, Act of Con;iri'ss. 1136 HISTORY OF AMERICAN RED CROSS NURSING connection with child health centers; and nursing activities in the insular and foreign possessions of the United States. Sentiment at National Headquarters " after the Armistice was pointing toward the participation by the American Red Cross in a broad and general program in which all the Red Cross societies of the world might become participants. On December 3, 1918, President Wilson wrote as follows to Mr. Davison : Pursuant to our conference of yesterday, I am writing to ask you if you will not be kind enough to make arrangements, if possible, to come to France at an early date for the purpose of conferring with me and others there as to the international relations and cooperations of the Eed Cross. I sincerely hope that you will give the most serious consideration to this and that you will arrange to come, if it is at all possible. When ]\rr. Davison arrived in France in December, 1918, he endeavored to develop a league which included in its member- ship the Red Cross societies of the world and had as its aim the betterment of humanity. He was appointed by the American Red Cross as chairman of an American Red Cross International Commission and resigned on March 1, 1919, as chairman of the War Council. A large siim of money was appropriated by the American Red Cross for this International Commission. Mr. Davison endeavored to get the Peace Conference at Ver- sailles definitely to endorse the plan for a League of Red Cross Societies. They declined to do so, but with the assistance of President Wilson, it was possible to secure the insertion of Article XXV in the Covenant of the League of Nations. It is to be noticed that this article does not refer at all to the League of the Red Cross Societies but to National Red Cross societies throughout the world : The members of the League agree to encourage and pro- mote the estal)lishment and cooperation of duly authorized voluntary national lied (Voss organizations having as pur- poses improvement of health, the prevention of disease and the mitigation of suffering throughout the world. ^On Xovcmber 27, 11)18, a confidential personal letter was addressed to President Wilson by a bifrh ofTieial at National Headquarters wbicli struck a prophetic note. T'nfortunately the carbon of tliis letter is nnsifrned and varions men tlien in hif^h antliority at National Headquarters have since disclaimed autliorship of it. Hence it is not quoted. INTERNATIONAL NURSING EDUCATION 1137 Shortly after Mr. Davison's appointment representatives for the Red Cross societies of Great Britain, France, Italy, Japan, and the United States formed a committee, which established headquarters at Cannes for the purpose of studying the situa- tion. The committee finally decided to call for conference, experts in health, medicine, economics, and nursing from all parts of the world, in order to prepare an extended program of Red Cross activities, in the interest of humanity, to be pre- sented at a meeting of the International Red Cross Committee at Geneva to be held thirty days after Peace was declared. This conference finally took place from April 1-11, 1019 at Cannes. Miss Delano had fallen ill some weeks before this, but it was expected that she would make an early recovery and be able to represent the American Red Cross Xursing Service when the meeting was called. In fact she did attend one pre- liminary conference held at Mr. Davison's house at Cannes for the purpose of advising on nursing questions to be presented at the conference, and also on nursing representation from other countries. As the time for the conference approached, however, the possibility of ^liss Delano's attendance was dissi- pated and it became necessary to provide for a suitable substi- tute. The American Red Cross had been requested by ]\Ir. Davison's committee to send IMiss Lillian Wald to represent the Federal Children's Bureau, Department of Labor, L^. S. A. As ^liss Wald had been a member of the liational Committee on Red Cross Nursing Service since its early days, it was deter- mined that she should represent as well the American Red Cross Xursing Service. While arrangements to this effect were being made at I^a- tional Headquarters, Mr, Davison, appreciating ^liss Delano's condition and not waiting for advice from Washington, asked ^liss Stimson, then director of the Army Xurse Corps in France and formerly chief nurse of the American Red Cross in France, to attend, ^liss Plall, who had followed Miss Stimson as chief of the Nurses' Bureau at Paris headquarters, was present, ^fiss Fitzgerald was also in attendance, not, how- ever, as a nursing delegate, but because of her linguistic ability as an interpreter and translator. Great Britain was represented by ]\Iiss A. ^l. Gill, then sup(n-intendent of nurses. Royal Infirmary, Fdinburgh, and president of the Scottish ]\latrons, and by ^liss Alicia Lloyd- Still, the head Matron of St. Thomas' Hospital, London. 1138 HISTORY OF AMERICAN RED CROSS NURSING Countess de Roussy de Sales, of the French Red Cross, was the representative of France. Italy was represented by Professor Emilia Malatesta Anselmi and the Countess Nerina Giglincci, both of whom were volunteer nurses of the Italian Red Cross. Miss Stimson acted as chairman of the nursing representatives. The Report prepared on lines suggested by the Executive Committee of the Cannes Conference is in the main as follows : A. More important existing nursing organizations: In regard to international and national organizations, both offi- cial and voluntary, the field is so vast and available informa- tion so inadequate that it is thought best that the preparation of such a survey of the position be postponed, subject to the consideration of a larger and more representative gathering. B. Indications for international Ked Cross action: The proposed Central International l?ed Cross Bureau should include a Nursing Department. The chief objects of this Department should be : 1. To act as an intelligence center, to collect, analyze and distribute information regarding all matters pertaining to nursing, and to women's work in public health, such as infant welfare, housing, social service, etc. 2. To undertake propaganda in countries where trained sick nursing and public health work are not at present fully develo])ed. 3. To seek out in these countries (Par. 2) suitable per- sonnel for training both in sick nursing and in public health work, to advise and assist thom to o])tain the necessary training, and to return them to their own countries as pioneers. 4. To arrange for conferences of representative nurses and health workers from all countries for the interchange of ideas. C. L^tilization of existing Ped Cross assets: It is recog- nized that the Ped Cross at the ])resent time is in possession of a very valuable asset in existing personnel. This personnel includes : 1. Fully trained professional nurses. 2. In Franc'C and Italy, volunteer trained nurses. 3. I'ntrained and partially trained workers, known in .America as nurses' aids (under the lied Cross), and social workers; and in England as V. A. D.'s (under the Ped Cross), Special ^Military Probationers, and health visitors: and in France and Italy, auxiliary nurses. D. Permanent Ped Cross nursinfj or(l. That ju-opagaiida bo undertaken as soon as practicable in thos(> couiitrii^s wlicre trained sick inirsing and ])ublic health nursing are not as yet dovcHoped. to encourage the establishment of traininir schools for jiurscs. 1140 HISTORY OF AMERICAN RED CROSS NURSING 3. Eesolved. That suitable personnel for instruction, both in the care of the sick and public health nursing, be sought and trained so that such personnel may return subsequently to their own countries, qualified to inaugurate and direct move- ments for the establishment of training schools and for the training of nurses. 4. Resolved. That a system of scholarship be established to make it possible for trained nurses to receive the necessary supplementary education to qualify them as public health nurses and as teachers. 5. Eesolved. That information in regard to the importance of public health nurses and the lack of adequate facilities for their training be widely disseminated; that there be wide- spread information so that the courses of training in existing schools may be adjusted to meet the requirements of public health nursing; and that special schools may be established to qualify women for the great opportunity for service open to them in this field. It was significant that while the importance of public health nursing was stressed, the emphasis was placed on the establish- ment of schools of nursing. Out of the Cannes Conference grew the League of Red Cross Societies. The relation of the League to the International Red Cross Committee at Geneva, with special reference to duplica- tion, was explained by Mr. Davison at the first meeting of the General Council of the League, which was held in March, 1920. The two fundamental principles of the Constitution of the International Committee were neutrality and universality and these principles made it impossible for the International Com- mittee to assume in 1919 the program proposed for the League. The spring of 1919 was a busy one for the newborn League. Its first venture in the nursing field took place in June, 1919. Ten nurses, with Emma Wilson as head nurse, were released from service under the Xurscs' Bureau of the Commission for Europe at the request of the medical director of the League and were assigned under the Bureau of Hygiene and Public Health of the Polish Government, to work in typhus hospitals in Poland. In a letter written June 30 to ]\riss Xoyes, ^ Miss Fitzgerald, then chief nurse of the American Red Cross in Europe, de^^eribed the plan : 'Diplikiiifx the use of tho personal pronoun 7 and finding the term "Na- tional Director of the Red Cross Nursing Service" awkward because of its lengtli. the writer of this chapter has decided to use the phraseology "Miss Koycs." INTERNATIONAL NURSING EDUCATION 1141 The nurses' salaries are to be ])aid by the League and transportation from Paris to Poland and back again will bo the responsibility of the Polish Government. The length of contract is for four months and the plan of work involves the assignment of one American Ked Cross nurse and an English- speaking Polish aide to a Polish hospital, where our nurse will act as chief and will train native nurses to do the work there. Of the eleven nurses who are going, eight of them have already seen service with foreign commissions and two others in the Service de Sante. The ten nurses were assigned to various Polish typhus hos- pitals and did the best they could for the four months' term of their contract. Late in November, 1919, they returned to Paris headquarters, and of the work accomplished by them, .Miss Fitzgerald wrote in her report of a tour made by her in Poland, October, 1919: The Polish hospital which I visited showed the effect of the good work done here by two of our American Red Cross nurses assigned to the Polish Government. Neither of them spoke Polish and no interpreter had been secured for them, but they had been able to clean up the hospital ; to obtain equipment for it from Colonel Gilchrist; to train native women and put them in a neat uniform; and, above all, to secure the full confidence and cooperation of the Polish doctor in charge. The same can be said of all the units where these nurses have been placed. . . . The Polish Government cited the nurses' work as "devoted and fruitful." The League had not yet appointed, as recommended in the nursing resolution adopted at the Cannes Conference, a director of nursing. Much concern because of this delay was felt by l)oth Miss Xoyes and ^liss Fitzgerald, as will be seen by read- ing the correspondence that passed between them at this time. A letter of July 22 from Miss Fitzgerald emphasized this point : I assure you that T have not been idle about trying to have a nursing representative attached to the League of Uvd Cross Societies. 1 think that the Commission for Europe as a liody is keenly anxious to have this done and the departure of the unit for Polaiul was used as a special argument in favor of having this new development announced l)y tlie League. A 1142 HISTORY OF AMERICAN RED CROSS NURSING nursing unit, such as the one to Poland, which does not actually come under our jurisdiction, must necessarily be cast quite adrift, unless the League of Ked Cross Societies assumes the responsibility of supervising this unit and other units which we may have in the field. This crossed a letter from !Miss I^oyes which indicated that she too was anxious 'and was even then preparing a communication to the League upon this question. Because of this lack of proper preliminary investigation and centralized direction, the unit sent to Poland was not able to render service of as far- reaching a type as had been hoped. The recall of the unit ended further joint enterprises of this nature in Poland. In the appointment of a Director of Nursing of the League, the N^ational Committee on American Red Cross ISTursing Serv- ice took an indirect part. As the plans for an extensive nursing program were developed by the League, Miss Noyes became anxious lest a person of inadequate preparation be selected as director. This, she felt, would not only create very definite difficulties, should the American Red Cross withdraw, which then seemed possible, leaving certain undertakings under the supervision of the League, but would tend to break down the standards already established. As the American Red Cross had standardized its ISIursing Service and had supplied approxi- mately 20,000 graduates for actual service during the war, it seemed quite proper that it should take the initiative in advis- ing the LeagiTO upon as important a matter as the selection of a Director of Nursing of the League. A mooting of the Advisory Committee of the National Committee was called and a special letter was prepared and sent through the chairman. Dr. Farrand, offering the facilities of the National Committee to the League. This letter was sent by him, with a letter of transmittal, to Mr. Davison, the chair- man of the League. The offer was quickly accepted and a cable soon followed from the League asking the National Committee to submit names of nurses suitable for appointment as Nursing Director. It is interesting to note that practically every one of the National Committee gave in recommendation the name of ]\Iiss Fitzgerald. Thus, Miss Fitzgerald's name in recom- mendation was transmitted to the League by cable. In a letter of October 27, 191!), Dr. Richard P. Strong, then medical director of the League, expressed his appreciation of the ser- vice of the National Committee. It is of interest to note how INTERNATIONAL NURSING EDUCATION 1143 far the influence of the National Committee had been ex- tended since its creation in 1909 and the appointment of a Director of Nursing of the League of Red Cross Societies ten years hiter. On November 17, 1919, ^liss Fitzgerald resigned as chief nurse of the American Red Cross Commission for Europe to become Director of the Division of Nursing of the League. Of the early organization of the League, Miss Fitzgerald wrote : ... In the sunnner of 1919, the League of Red Cross Societies had olHeially established itself in an historical old house in Geneva, Switzerland, under the protective wing of the Cathedral. By this time, Sir David Henderson had been appointed as Director General and Dr. Richard Strong as (ieneral ^ledical Director. The dill'erent sections of the ]\Iedi- cal Department were the divisions of Tuberculosis, Medical Information, Library of Public Health, Sanitary Engineering and Nursing, Child Welfare, Vital Statistics and ^lalaria. On November 17, I reported for service with the Lea;^ue and I doubt if any one ever accepted a position with so slight a knowledge of what it entailed, with lesser oj)portunities for following any established precedents and with less data on whicli to build a program. ]\Iost of us felt very new and unequal to the task which had been set before us by the Resolutions passed by the Cannes Conference, but we made up in enthusiasm, ciiprit de corps and loyalty to our ideals our lack of experience in international service and the absence of any helpful guidance or precedent. In ])lanning for the work of the Division of Nursing, my first step was to try and secure as much information on nursing as I could gather from the different countries. One dominant fact impressed itself on my mind through those months of ])reliminary work in antici})ation of our lirst assem- bly was the ditlieulty of understanding and being understood, internationally s])eaking. Words were used by many nations with entirely different meaning in each case, comparative studies of re]iorts were therefore of no value and 1 felt that I was not trctting on the right road to '"internationalize nurs- uvX' according to the needs and resources of different coun- tries. 1 therefore prejiared a report for the Assembly which embodied the ]irogram of my department along general lines and otferinsi the choice of several nu_>tliods in carryinu- out my idea of oll'ering a training in nursing and preparing (iualilic(l young wouKMi in the countries where such traininir was not alreadv a\ailable. 1144 HISTORY OF AMERICAN RED CROSS NURSING Early in March, 1920, the League held at Geneva its first General Assembly, and representatives of twenty-seven national Red Cross societies were present. At a meeting of the medical section, Miss Fitzgerald's Report on Nursing was read and the following resolution was voted: Resolved : That the League of Red Cross Societies urge the establishment in Europe of one or more model training schools for public health nurses, but that until this can be realized there be founded under the supervision of the League nursing scholarships for the national Red Cross Societies of those countries where no such facilities exist, in a city chosen as being most appropriate. Of the development of this scholarship project, Miss Fitz- gerald wrote: ... I went to London and arranged for a course in prac- tical and theoretical public health nursing which was given at King's College for Women with affiliations with the dif- ferent child welfare centers, tuberculosis dispensaries, school nursing and other associations for rural nursing, district nursing, etc. The League of Red Cross Societies offered ten scholarships and asked National Red Cross soci- eties to offer others to enable nurses to go to London and study public health nursing as a post-graduate course. Twenty nurses representing the following eighteen countries answered the first call: The United States of America (two nurses), Canada, A^enezuela, Peru. England. France, Italy, Portugal, Belgium, Denmark, Sweden, Switzerland, Poland, Czecho-Slovakia, Serbia. Roumania, Greece, Russia. These nurses were most carefull}' selected by the different Red Cross societies according to directions issued from Geneva: Age: Twenty-three to forty years of age. Education : Evidence must be produced showing continuous education up to the age of eighteen years. Training: The student must possess a diploma or certificate as regulated by the highest nursing standards of the country which she represents. Health : A medical certificate of general good health must be produced. Reference : Should l)e given in evidence of good character and efficiency. Tn selecting students particular attention must be paid to the necessity for unusual intelligence to enable them to profit by a course which is necessarily intensive. INTERNATIONAL NURSING EDUCATION 1U5 Language: The students must be sufficiently familiar with the Knglish language to follow lectures and take notes. Form of Application : Must he filled in and returned to the Director of the Department of Nursing of the League of Red Cross Societies. It was felt that this method of training in public health was, for the present at least, our best way for keeping to standardized nursing in its branches and the course in Lon- don is being repeated with thirteen nurses present from the following countries: England, Canada, ^Mexico, Japan, Xew Zealand, Austria, Hungary, Bulgaria, Latvia, Lithuania, Ice- land and Czeclio-Slovakia. This course, like the first one, is under the direction of Miss F. M. Waters. The general progTani of the Department of Nursing of the League included as one of the duties of its director careful ''follow-up" supervision of nursing activities developed bv na- tional branches of the League. IMiss Fitzgerald also supervised some child welfare activities which had been developed and financed by local agencies in Roumania and Czecho-Slovakia but the medical direction of which had been placed under the ^fedical Department of the League. Of the development of schools of nursing, ^fiss Fitzgerald wrote: A training school for nurses in Belgrade, Serbia, was organized under a special committee comprised of representa- tives of the Serbian Ked Cross, the Serbian Cliild Welfare Committee of America, the Serbian Minister of War, Minister of Health, military hospital and civil hospital. I was privi- leged in meeting several times with this committee and I assigned Miss l"]nid Newton, a British trained nurse of ex- tended e\j)erience, to be director of the new school in answer to the request that the League of Red Cross Societies take an active part in its administration. The development of this international advisory nursing ser- vice was fraught with many difhculties and considerable dis- couragement. Miss Fitzgerald wrote: . . . PtThajis the greatest obstacle to quick action and rapid results will contimie to l)e tlie distances wliich separate our lieudciuarters from many of our member societies. Let- 1146 HISTORY OF AMERICAN RED CROSS NURSING ters travel slowly, wires are expensive and unsatisfactory, and personal visits prohibitive in many cases.* The Department of Nursing of the League of Red Cross Societies finds some encouragement in the fact that it has established a personal contact with nurses from thirty dif- ferent countries, many of whom will act as pioneers in nursing under the flag of their own Red Cross society and with what help we of the League of Eed Cross Societies can give them. The League of Red Cross Societies lost the services of Miss Fitzgerald in the autumn of 1921. After an absence of six years from the United States, she had returned for a much- needed rest, and also with the hope of arousing some interest on the part of philanthropic individuals and "foundations" in the nursing service of the League. While she was in the coun- try some changes in League policies influenced Miss Fitz- gerald's resignation. She was succeeded by her assistant, Miss Katherine M. Olmsted, an American Red Cross nurse who had shortly before been appointed to advise in public health nursing matters of the League program. At the second meeting of the General Council, held in Geneva, starch 28-31, 1922, the nursing program of the League was discussed. In this discussion emphasis appeared to be laid on public health nursing at the expense of nurse education, which is necessary as a sound fundamental basis to any nursing service. This caused some anxiety to those who were inter- ested in the development of the nursing program of the League. The change of name of the Bureau from that of "Department of Nursing" to "Department of Public Health Nursing" seemed a clear evidence of misplaced emphasis, and appeared to suggest a drawing away from the resolution adopted at the Cannes Conference. By the date of the second meeting of the General Council of the League, the "experimental period" ^ of its existence may be said to have been ended. In the light of past experience, it became possible in 1922 to define "with relative confidence" ^ * The fact that each Red Cross society was permitted to interpret tlie qualifications of the students led to lack of uniformity. The Canadian or American nurse found herself a member of a class which contained women with Red Cross certificates it is true, but who could hardly be retiaided as ^'raduate nurses. Recent reports show that an effort has been made to adopt a mininuim standard, but so far without success. '^ See "Second -Meetinjf of the General Council, League of Red Cross Societies,"' Vol. TI. p. 18. "Ibid., p. 19. INTERNATIONAL NURSING EDUCATION 1147 the type of service which tlie League could most eifectively render. This service was thought to be chiefly in an advisory capacity rather than in the development, as first contemplated by the Cannes Conference, of the League as an international health organization or of an extensive program in the field of medical research. This change of policy involved a substantial reduction in the entire program of the League, and in this re- duction the Division of Nursing shared. Miss Hay attended the Council meeting as a representative of the American lied Cross Nursing Service, and in a speech made at that time emphasized the necessity of nurse schools as the only safe basis for a general or special public health service : It seems to me wc should lose an unusual opportunity, even ne that the American Tied Cross develo]) a school. A brief survey of local hospitals was nuule that infornuition might be fully in hand should tho Cracow authorities urge this des'ic of theirs. 1156 HISTORY OF AMERICAN RED CROSS NURSING Miss Hay and Miss Noyes left, after two days, for Warsaw, where in addition to making a fairly comprehensive study of the general conditions, specific consideration was given to the question of the development of the school of nursing, toward which Miss Fitzgerald and j\liss Hay had been working in oi*- operation with the Polish Red Cross. Conferences were held with representatives from the Min- istry of Health, the University of Warsaw, the Municipal Government, with Miss Zlenkier, a nurse who had built in Warsaw a complete and modern hospital for children and who had taken a partial course of training at St. Thomas Hospital, London. Various hospitals were visited ; among them a chil- dren's clinic, where an unusual opportunity seemed to be pre- sented for the development of a central school; the Infant Jesus Hospital, a large institution which had been under the direction of Russian authorities and from which, upon their evacuation, they had removed all the furnishings. This hos- pital, unlike others which had been visited, was quite modern in its equipment, with lavatories and diet kitchen well fur- nished. The hospital was under the direction of Sisters who were good housekeepers and possessed comparatively modern ideas of nursing, as the cleanliness of the wards, beds and bed linen clearly indicated. The local authorities interested in the development of the school presented a plan which had been prepared by the special committee, which included the individuals already mentioned as well as others. This plan was formulated from suggestions apparently made by Miss Fitzgerald and Miss Hay, combined with local ideas. Included was the Prussian system of keeping a hand upon the graduates after the com- pletion of their course ; for a given space of ten years they were to be under the control of the institution. The plan also carried with it insurance for invalidism and old age ; it in- cluded a Congregation of Sisters, every nurse to be a member of this Congregation, etc. The merits of the plan were dis- cussed at a conference and a counter one was prepared, which with modifications was used as the basis of understanding and contract with all the schools sponsored by the American Red Cross. The six main points of the plan were as follows: 1. A corps of instructors of broad experience and unques- tioned ability. At least four trained nurses are necessary for the class and practical instruction and supervision. A fifth INTERNATIONAL NURSING EDUCATION 1157 nurse is also desired to organize and carry on some public- health activity, so that preparation for this important field of usefulness may he made a part of the school's program. 2. A nurses' home adequately furnished and maintained. Such a home must be large enough to take care comfortaljiy of the total pupils decided on . . . besides rooms for the facidty. for classes, ftudy, recreation, household menage, etc. It should be attractive, comfortable, sanitary, well heated and lighted, and with sufficient service to keep it immaculate. Because pupil nurses have large demands made of them, physical and mental, the food should be ample and of the best quality. Amj)le laundry and bathing arrangements are also necessary. 3. Uniforms, textbooks and translation of same, equip- ment for class work, as charts, models, etc. It is possible tiiat in order to attract a sufficient number of pupils, a small monthly allowance also be provided. 4. Ilospital atliliation. Such hospital affiliations should be secured as will ensure the thorough practical training of the pupils in tiie various classes of disorders, a.s medical, surgical, transmissible, gynecological, pediatric, etc. It is important that the directress of the school, with her assistants, be given the nursing control of such hospital divisions as are secured for this practical training. It is understood that rules and regulations governing the admission of pu])ils, their supervision and general direction, may safely be left to the director of the training school to develoj) after her arrival. Also rules governing the activities of graduate nurses should primarily be left with the graduates themselves. In this connection, it is important to state that any rules binding the graduates of such a school to extended service or control after graduation are contrary to American methods and principles and are, we believe, certain to react unfavor- ably on the school itself and to reduce materially the number of desirable candidates available for the training. It is ex- pected that the director of the school and an interested school committee will lend every assistance in securing proper recognition and adequate salaries for the members of this new-l)orii profession, either through suitable Xurse Practice Acts, registration bv the Government, or in such ways as would jirotect the people and the nurse graduate. 5. C'o(")[)orati()n of the medical fraternitv. or leading mem- bers of it. wlio would assist in securing the desired h()S]utal affiliations, as also in various le which began by urging lower educational entrance reciuirenients, Letter bv Drs. Adaniski and :\Iiklasinski, Aimust IS. 1921. 1160 HISTORY OF AMERICAN RED CROSS NURSING Miss Ita MacDonnell, a Red Cross nurse who had been sent as director of the school, and who had been accustomed to working with Sisters in America, gradually effected an arrange- ment whereby the Sisters were given the housekeeping, pur- chasing of supplies, supervision of help, and laundry. This meant, however, that the small group of American nurses with the assistance of ten probationers were obliged to assume, both day and night, the actual nursing work in the wards. The difficulties, met and overcome, would have discouraged a less enthusiastic group. Such handicaps as bedbugs, lack of water, shortage of linen and utensils, low beds, poor mattresses, laun- dry only every two weeks, were met and conquered ; gradually order and cleanliness were secured. The type of student admit- ted was excellent, and a two-year course was arranged to the best advantage. The school was formally opened on Novem- ber 10, 1921. A request for an appropriation of $11,500 was approved by the Executive Committee of the American Red Cross in 1921, with the expectation that it would take care of the teaching faculty for two years and six months. It was further expected that graduates from the school or from among the Polish students brought to this country on Rockefeller Foundation Scholarships and placed in the Massachusetts General School of Nursing would at the end of that time be available for this work. In April, 1922, Dr. Hill, then vice-chairman in charge of foreign operations at National Headquarters was able to increase the fund to $15,000 in order that an additional in- structor, increasing the faculty to four, might be provided, and Lena Johnson was added to the staff. In April, 1921, plans for the development of the Warsaw School had reached such a stage that Helen Bridge, whose work with the Siberian Commission has already been described, sailed from New York as director. The project was financed by Miss Dorothea Hughes. On ]\riss Bridge's arrival in Po- land, she began organization of the committee, selection of buildings, repairs and equipment, preparation and printing of circulars and application blanks, publicity, interviewing candi- dates, selection of staff and the countless details incident to a project of this nature, difficult in a well-organized country like America, but doubly so in a country wasted by war and ham- pered by a thousand economic and tradifional obstacles. A less optimistic person than ^liss Bridge might have lost heart, but INTERNATIONAL NURSING EDUCATION 1161 she believed in the enterprise and so did her conmiittee, and she forged ahead. In a letter to Miss Noyes under date of August 2, 1921, Miss Bridge wrote : You will be delighted to know that up to the present we have had sixty-four inquiries concerning the school. I have accej)te(l four candidates and have forty-five applications pending. We are quite pleased to have a quality of applicant superior to that which I anticipated. The first applicant was the daughter of a Polish Countess^ a splendid girl, but too young. She has withdrawn until next year. The first appli- cation to be completed was that of Mary Pawlowiczowna. She is a splendid young woman who has had one year at the University of Warsaw. Is it not significant that our first acce))tcd candidate should come to us so well prepared? . . . Of the four accepted there is another who has had two years at the university, one who is quite ready for the university, and the fourth falls short of having a certificate from the eighth class (the equivalent or more than our high school) because she failed in French. Almost every candidate I have interviewed speaks French and a number of them also speak English. . . . The attitude of the physicians on the Council and others in Warsaw toward the school seems very good. Each succeeding report recorded the growth of interest and the betterment of conditions. Finally' October 19, 1921, was de- cided upon as a suitable date for the formal opening, which in- cluded the ancient Polish custom, the Blessing of the House by the Cardinal. ^'American nurses," stated an address of wel- come written bv ^liss Xoyes, "extend their hands across the sea and welcome this new school as they would a new relation." The address by Dr. W. ]\Ieczkowski, a friend of the school, showed the attitude of the best element in the medical profes- sion toward this project: Poland is now like a bad housekeeper who, having an abundance of everything, wastes; many children are born, but the nation does not exert itself to keep them alive. Death takes tbem away as in no other country in the world, and the general mortality is much greater in Poland than anywliere else. There must come a time for us to open our eyes and see M"here we are going. We must begin a wise and planned war 1162 HISTORY OF AMERICAN RED CROSS NURSING against illness. We must visit our ill people and examine the conditions of life of the healthy ; we must enter the homes of the peasants and the town dwellers, we must render popular the idea of real nursing, we must increase the means of pre- venting disease, we must take care of women during preg- nancy and after childbirth, and we must provide the proper care for sick people in their homes and in the Hospitals. This task can be carried out only by an intelligent and devoted nurse, such a nurse as graduates from the schools of North America and England, Our school has as its object the production of such nurses who must be pioneers. Its task is to produce the first nurse instructors for the medical in- stitutions, and that is why, in accepting our iirst candidates, we have been so exacting in regard to their moral and edu- cational qualifications. After thanking the Polish Committee members, the Ameri- cans and others who had made the school possible, he con- tinued : Before I finish I wish to speak to the pupils of the School of Nursing, to those pioneers who on graduation from this school will go the first into Polish society, taking to the villages and towns the rules of hygiene, cleanliness and order, and who will give to the patients in the hospital and in the home honest and wise care. Nursing as stated in our regulations is not an ordinary profession. For us it is like an Order which demands a special vocation. Here hard work does not suffice, there must be sacrifice, a vow to give oneself with one's whole heart. Tliis high task of giving help to the poor and suffering, of preventing disease, will be your reward, and the common service to this high idea will create among you links, sincere sisterly relations. This school will aid you in educating your heart and brain and in developing your love of mankind. The report for January, 1922, announced the sad death of Dr. ]\re('zk()\vski, whose last office for the school had been to secure the balance of 4,000,000 marks due on the 1921 appro- priation to be given by the Polish participants. The report as well indicated the completion of the plan for hospital affilia- tions. The economic situation, affected as it was by the rapid depreciation of the currency, brought financial anxieties and complications that greatly increased the problem for ]\riss Bridge, yet so well h;ul tluy acconiplished their work that the First class of tlie Scliool of Nursing. Warsaw, Poland, established by the American Red Cross. J-lMerior of the School ol >siu>iii;^. Warsaw, roland. INTERNATIONAL NURSING EDUCATION 1163 Administrative Council at a meeting in December asked the school to assume responsibility for the hous(!keeping, kitchen, and dietary for patients and the laundry. A Hospital Com- mittee was also suggested, 'i'hat iMiss iiridge, supported by Miss JMathevvs, appreciated the practicnl ditHculties as well as the advantages of taking charge of the housekeeping was shown in a letter to Miss Hay under date of December 20, 1921 : I talked the whole thing over with !Miss ^Fathews and she agrees with me tliat, while it is a large order, tliat we will probably be able to bring up the standard of the nursing much more quickly if the housekeeping is under our control. This same letter recommended a dietitian, qualified to as- sume the instruction to student nurses not only in invalid cookery and nutrition, but in household administration, includ- ing the laundry ; to arrange the dietaries and to take charge of the buying of food. Furthermore, she should be able to speak either Polish, French or German. The Paris office approved this request, and a cable to this effect was sent to National Headquarters. On ^lay G Bertha Holman, an enrolled Ked Cross dietitian, left the United States for Warsaw. That she was needed and was facing heavy res2:)onsibilities was plainly evident, as shown in a letter from ]\Iiss Bridge of April 17: Tlie hospital is in a perfectly wretched condition, very dirty and wthout signs of anything you could call real organi- zation. . . . It is the same old story of preceding slowly until you have won local confidence. We went into the hospital with eiglity-five jiatients to care for, but this number was quickly increased to one hundred and twenty. . . . After the ))reliminory course, our twenty-two student nurses went into the wards. I shall never forget the picture they made on that first morning in their cris]> new uniforms and tlieir fates bright with antici))ation. Two of the students who had never heen in a hos])ital l)efore were so frightened that we had to stay with them in the wards for a time until the first sharp vd^^e of their fear had worn off. 1 still remem- ber the fluslu'd frightened face of one of them. After the first day, the patients begged the students to stay with them all night, for, they said, "we have heen taken care of to-dav hut to-night it will l)e the same old thiuir. We will rini: and vlw^ and no one will answer."' 1164 HISTORY OF AMERICAN RED CROSS NURSING Fortunately for the school, three of Miss Bridge's assistants were Polish as well as Roman Catholics, this being the pre- vailing religion. Consequently, when questions arose concern- ing attendance at mass at eleven o'clock in the morning by all the students, they were able to satisfactorily explain why this was not possible. The night nursing m the nospital was still left to the Polish Red Cross nurses. There was little or no system and no dis- cipline. Such nursing attention as the patients required was largely left to the sanitars (orderlies), who waited on men and women alike, even performing such delicate attention as giving bedpans to women patients. This condition troubled the American nurses, as they were accustomed to seeing patients receive the same careful nursing at night as was given during the day. Miss Bridge expected to place the student nurses upon night duty as soon as they were sufficiently experienced, but in order to do so many internal changes were necessary. However, at the time of the completion of this history these changes had not yet been made. The conditions that prevailed in the operating room made it impossible to give student nurses training in surgical technique and operating room procedure. Here the felcher (operating room orderly) had reigned supreme regardless of sex and nature of operation. It became evident that student nurses could not be assigned to service in that department until a qualified American nurse had been secured to reorganize the work, direct the nursing and instruct the students in surgical technique. A request was sent to America for a nurse qualified for this work, which would in- crease the teaching personnel in the school to six. This, how- ever, was to be regarded as temporary. In no way, however, were the American nurses discouraged. In the period of slightly over a year during which tlicv had been at work they accomplished marvelous things. Their staff included four graduate nurses, one dietitian and thirty student nurses. They had an attractive residence, well furnished, with suitable class rooms and good teaching equip- ment. Several well equipped wards offered a satisfactory field for practical instruction. Control of the housekeeping, laundry and dietary department rounded out the facilities as a teaching field. They had a representative school committee called "The Administrative Council," a well arranged curriculum with a preliminary course, a lecture course given mainly by university INTERNATIONAL NURSING EDUCATION 1165 teachers, and a group of students exceptionally intelligent, well educated and refined. This acconiplishnicnt demonstrated good and efficient management, and a receptive and cooperative school committee. When the time shall arrive for the with- drawal of the American nurses the futr.re of the school would seem to be assured. History repeats itself, for as it has been the nurse in America who has been the instrument through which nurse education and institutions for the care of the sick have boon brought to their present state of excellence, so it will probably be in Poland, if educated and cultured young women enter the schools. The school at Posen differed in some respects from that at Warsaw, the latter being organized on a basis that would com- pare favorably with the most modern school in America ; the former, excellent in character, and run on sound principles, was unable because of certain inherent conditions, such as liv- ing quarters, to develop on as progressive a basis. The July, 1922, Keport of the Posen School showed a faculty of four American Pod Cross nurses, two of them of Polish nationality; fifteen students; a two years' regular course and a three months' preliminary course; arrangements per- fected for practical experience in medicine, surgery, gynecol- ogy, children; affiliations in obstetrics and communicable diseases ; a corps of instructors, doctors and nurses. In both schools a tuition fee was required ; an eight-houi working day prevailed in each ; the character and educational qualifications of the students were excellent. A school of nursing had been discussed by the American Red Cross Commission for Greece, and a plan had been pre- pared by ]\[ajor Carl E. Black in July, 1910, and presented by him to Colonel Capps. This plan was based upon Major Black's survey of Greek hospitals and a study of Greek methods of preparing nurses. Afajor Black discussed his plan with the Greek Pod Cross, Colonel Capps, physicians, hospital authorities and others, but although Miss Ilolon Scott Hay, a recognized nurse educator, was directing all Pod Cross nursing activities in the l^alkan States, including Greece, she was not called into any of tlioso conferences or shown the plan until after it had been suljuiittod to American and Greek Pod Cross authorities. She had ])re])ared, at Colonel Anderson's re(]uost, a suggestive outline for a scliool of nursing, it is true, soh^ly as a basis for disciission and with little opportunity for study 1166 HISTORY OF AMERICAN RED CROSS NURSING of local conditions, and with the understanding that it would not be regarded as a complete plan. Fortunately Major Black's soundness of views on the ques- tion of educational entrance requirements, as well as on the social and professional status of the graduate nurse, enabled him to present recommendations of a sound and dignified character. His plan, which was an ambitious one, called for an operation covering five years at an estimated cost of about $12,000 per year, or about $60,000. Matters had proceeded even so far as to discussion of a hospital upon which to graft the school, a point of great moment to such American nurses as might be sent to carry the plan through, and a matter upon which the advice of Miss Hay would have been of great value. The concluding paragraph of Major Black's report stated: At the time of leaving Athens for America, we have re- ceived no answer from the Hospital Board, and do not know their final decision when confronted by the terms in detail. The matter is left in the hands of Major Dewing for final consummation with either the Evangelismos Hospital or some other hospital in Greece. Little was heard of the project of the Greek school of nursing during the early months of 1920. During the summer of that year President Venizelos had a conference with Com- missioner Olds in Paris, at which the Commissioner again offered on behalf of the American Red Cross to assist in devel- oping a school of nursing in Athens. One of the conditions of the offer was that the Greek Red Cross should provide suit- able buildings. The finances of the Greek Red Cross did not permit them to assume this item in the summer of 1920. In October, however. President Venizelos wrote Commissioner Olds that a member of the Greek Red Cross had presented a million drachmas to the Society for such purposes; that in his estimation the Greek Red Cross was prepared to accept the offer of the American Red Cross; and that he had placed the matter in the hands of Mr. J. Athanasakis, then president of the Greek Red Cross. In November, 1920, ]\fr. Athanasakis wrote Commissioner Olds that the Greek Red Cross had de- cided, however, to place the direction of the school in tlie liands of two of its volunteer Red Cross nurses. This action amounted practically to a rejection of the American Red Cross oifer, as INTERNATIONAL NURSING EDUCATION 1167 in its training school contracts the American Red Cross had reserved the privilege of appointing American nurses trained under the Nightingale System to direct the schools, and this clause was clearly understood by the officers of the Greek Red Cross. Such was the state of affairs when Miss Hay and Miss Noyes arrived in Athens late in November. Great excitement then prevailed throughout Greece. Political changes had deposed the "Commoner" and brought back King Constantine. Miss Hay and Miss Noyes tried to see the president of the Greek Red Cross but did not succeed. Thus a final settlement other than that described above regarding American Red Cross co(")peration in the establishment of the Athens School was not effected. Bulgaria was again in 1920 urging the reorganization of the school started in 11)15 under the direction of ]\Iiss Hay at the Alexandra Hospital in Sofia, which was described in Chapter IV. As the plan presented was incomplete and somewhat un- satisfactory, it was felt that a conference with the Bulgarian authorities would be of great value. When Miss Hay and Miss Noyes reached Bulgaria they found that the situation had changed since overtures had been made a few weeks previous. The Bulgarian Red Cross, which had for some years conducted a so-called school of nursing, had requested the Government to lay aside the plans for the Alexandra Hospital School, and to pay to it any moneys available for this latter project. The bill covering this change in plan had already had two readings in Parliament, although the nurses from the Alexandra Hospi- tal School, who had been under Miss Hay, and many physicians and other prominent people had done all they could to delay a decision. The situation was critical. Through the American Charge d'Affaires a conference was secured for Miss Hay and ]\liss Xoyos with the Acting Prime Minister Dimitroff. Prior to this, however, they had been invited to visit King Boris and had laid the reorganization plan before him. He manifested the greatest interest, and gave assurances of his support. The attitude of the Prime ^linister was wholly non-committal, but an early decision was promised. However, such other re- assurances were given to the effect that the reorganization of the school would go througii with the passing of the budget that it seemed a foregone conclusion, ^liss Noyes waited several days at Sofia with the hope that a definite decision 1168 HISTORY OF AMERICAN RED CROSS NURSING would be reached. She was finally obliged to leave, but before doing so submitted the following recommendation: That we assist the Bulgarian government as far as possible in the resumption of a school of nurses, providing the Bul- garian government itself is ready to do its full part, finan- cially and otherwise, by stating that it would seem but fair under the circumstances that we should select and provide salaries for not less than two American nurses, and at least partial maintenance for not less than two years. In the event of failure to establish the school, that at least one scholarship might be given to the best qualified nurse of the Queen's School, so that she might complete her course in America and be better prepared to assist her country in developing nurse education. It seemed highly desirable that there be a modern school in Sofia, not only to perpetuate the plans so dear to the heart of Queen Eleanora, but because it was greatly desired by a large number of Bulgaria's most thoughtful people. The Bul- garian Red Cross, however, produced one argument which apparently was most convincing to the Bulgarian government, and that was economy. The cost of maintaining a school of the first order necessarily represented more outlay than people of many foreign countries were accustomed to think necessary. At that time the lev was selling ninety to a dollar, and failure to secure an enthusiastic acceptance of the assistance which the Bulgarians had voluntarily sought might be ascribed to this cause. From time to time, however, the question of the school was again raised by those most interested. In the early summer of 1922 a final cooperative plan based on the preceding recom- mendation seemed a foregone conclusion, and an appropriation to cover it w^as established at Xational Headquarters. The Bulgarian authorities were notified and asked to submit their reassurances. At the time this history goes to press these have not been received. A leading citizen of Bulgaria when discussing with ]\riss Noyes the project and the tendency to procrastinate said, '*It is the East." This may explain the present delay. At Constantinople a school of nursing was established with which the American Red Cross was affiliated. ]\[rs. Anna Rothrock, who had boon assigned as chief nurse to the unit of fifty-four nurses wliicli had been organized by the American INTERNATIONAL NURSING EDUCATION 1169 Red Cross for service with the Near East Relief, was detached from that organization in the spring of 1J)20, and asked to undertake the development of a school of nursing and a hos- pital in Constantinople, under the auspices of a local com- mittee. This committee included representatives from the American Red Cross, American (^ollege for Women, Roberts College and American interests such as the Standard Oil and the Near East Relief. Substantial assistance was given them by the Xear East Relief in gifts of equipment; also by the American Red Cross Commission and the American Red Cross Chapter at Constantinople, of which Admiral Mark L. Bristol, United States Navy, high commissioner to Constantinople, was the chairman. The institution was developed in "Old Stamboul," in a building formerly the home of a rich pasha, a large three-story house with two distinct divisions, the Haremlik and the Saremlik. The building was in very poor repair with deep rooms with windows only upon one side. Rough wooden floors and total absence of heating facilities and plumbing made the question of proper organization of the hospital a difficult one. Nevertheless, with the supplies which had been given, the building was put in good shape. Hundreds of feet of stove pipe were used in setting up stoves, the only means of heating the w^ards and the living quarters of the nurses. While marvels were accomplished in making the place habitable, nevertheless it was far from being an ideal building for either a hospital or a school. The dangers of fire, with no means of control should one occur, the long steep stairs and the general unsuitability as far as arrangement was concerned, made the building far from satisfactory for the purpose. The hospital proper consisted of wards with from six to twelve beds, and five private rooms of one or two beds, a total of eighty beds ; two large halls for convalescents, an operating room, a pharmacy supply room and dispensary. There was one kitchen for the hospital and the staffs, with a single Greek cook. An American Red (^ross dietitian, Nellie Halliday, was in charge and was accomplishing astonishingly good results with the facilities at her disposition. The water supply was un- certain ; there was no laundry except an outside room which had originally acconunodated th(^ laundry work for a private family. The toilets were of the Tui'kish variety, marble and in good repair. Jn tlu> equipnuMit was a Turkish bath, wliile inodcru bathtubs with a uuiiiue stove arrangement t'(r luxating 1170 HISTORY OF AMERICAN RED CROSS NURSING the water were installed in some of the smaller rooms. The Dispensary was on the ground floor under the part of the build- ing used for the graduate nurse staff. Linen and dressing rooms and sewing rooms adjoined. The home for the student nurses was arranged in what was formerly the servants' quarters. The rooms were clean and sufficiently large for two or three students. A combination sitting room and study was provided, the pupils taking their meals in the personnel house. The faculty consisted at that time of six American nurses, all of whom had been recently engaged in the care of refugees on the Island of Proti. They had been temporarily loaned to the American Hospital upon the closing of work on Proti. In November, 1920, five of them were permanently engaged on the regular hospital staff. The school course was finally arranged to require a period of twenty-eight months. The minimum educational require- ment for admission was that the applicant should have com- pleted a full high school course or its equivalent. Anatomy, physiology, bacteriology and chemistry were taught by an instructor of the Constantinople Women's College. Practical and theoretical nursing were taught by members of the nursing staff. While this school was not strictly speaking a Red Cross enterprise, American Red Cross nurses, some of whom were partially or entirely paid by the American Red Cross, had effected the organization, and had brought this school into line with other schools in Europe wliich the American Red Cross had subsidized. In the course of time the staff was decreased and a gradual change in personnel resulted. Upon the resignation of Mrs. Rothrock in the fall of 1921, Miss Lvda Anderson, who was acting as assistant to ,\riss Hay in the Paris office, was appointed to replace her. Under !Miss Anderson's administration some changes gradually took place, the course of instruction was reduced from three to two years, and a definite affiliation was being sought with the i\.merican College, similar to university affiliations which exist in America. The type of student admitted to the school gradu- ally improved and included representatives from many coun- tries. The question of langiuige was a serious one, and as interpreters were out of the question classes in English were given in order that the students might not only avail tliera- selves of the best textbooks written in English, but ])rafit by the instruction given by the American nurses. INTERNATIONAL NURSING EDUCATION 1171 Tliere were in 1022 no other modern schools of nursing in that part of tlie worUl. The future usefuhiess and importance of this school not only to Constantinople but to a large sur- rounding area is self evident. A new hospital and school building of good type of construction was imperative, while many improvements had been made to facilitate the work the inherent defects of construction were of such a nature that it would have been useless to try to overcome them by temporary repairs. From the beautiful tropical island, called indiscriminately Haiti or San Domingo, depending entirely upon whether one refers to the western one-third, Haiti, or to the eastern two- thirds, Santo Domingo, there came early in 1020 from the (overnment a requ(>st for four Red (!^ross nurses. In 1018 a school of nursing had been organized under the direction of Commander N. T. ^McLean of the ^^ledical Corps of the United States Xavy in connection with the City General Hos- l)ital in Port-au-Prince. The protecting arm of the United States Government had been extended under the treaty of 1015 to the "Black Kepublic" and representatives of the Medical Department of the United States Xavy had been assigned to direct the sanitary development of the island. Lucia D. dordan, assisted by -losephine T. Ray, members of the Xavy X'^urse Corps, under difficult conditions, had laid a substantial foundation for the first modern school of nursing on the island, but in 1020 were withdrawn. Hence the request of the island government. j\Iiss Butler, then director of the Xursing Service of the Insular and Foreign Division, secured as director of the School of Xursing at Port-au-Prince Vashti R. Bartlett, whose name and record has appeared in previous chapters, and two others, Anna M. Ilansberry and ^Nlary Griffith. These nurses were paid, transported and maintained by the Haitian Govern- ment. ]\liss Bartlett, with her training school experience, energy and enthusiasm and ability to speak fluent French, was especially well (pialitied for the task. The little grouj) of three sailed in July, 1021. Olive M. Simons followed later. They found Sisters in charge of the wards. Later, however, the Sisters withdrew from this work and devotcvl themselves exclusively to the housekee])ing. Xotes in Miss l>artletr\s iirst report to the sanitary enginiM-r, Com- mander McLean, indicated some diseourai'Mnu- features: 1172 HISTORY OF AMERICAN RED CROSS NURSING There are at present 31 student nurses and about 400 patients. . . . The school having started with a two years' course, the seniors shouhl have graduated in October, but the date ... is still unsettled pending the result of all examina- tions and a policy to aid nurses in starting their outside work. Special duty was considered for the unemployed graduates and at first a salary of $10.00 a week was offered. Oppor- tunities for practical experience in the wards were limited, but facilities for additional experience was secured in a special ward where Sisters had been in control. Suitable class rooms and better sleeping accommodations were secured and lesson plans, the translation of textbooks and the preparation of lectures in French occupied the attention of all the nurses. The future of the graduates continued to trouble ]Miss Bartlett, as the poverty of the people seemed to preclude any extensive use of qualified nurses. Not the least of the difficulties was a distressing epidemic of smallpox described by Miss Bartlett in a letter, January 28, 1921: I am discouraged about the school. The smallpox has almost disrupted the hospital. From 60 to 70 patients are admitted each day and so many nurses are needed for this work that the other branches of nursing are neglected. We do no operating except emergency cases because the patient may break out with smallpox the next day. Some of the cases are awful ; those that we do not find for several days come in in l)ad shape. This morning, for example, three nurses worked for several hours picking worms out of the sores of one patient, and this happens every day. Many times we have to take them out of their eyes. In one ward two days ago, where our illest patients are, we had 14 deaths in 24 hours. I think we have about 600 smallpox patients and, with 14 nurses leaving, it is a question liow to give them the {are they need, and T fear new nurses will not come with conditions as they are. A few minutes ago they telephoned and asked for two special nurses and I hardly know hov^ to spare tliem. Yet !Miss Bartlett with characteristic reserve said nothing of the heroic work done by the American Red Cross nurses who worked day and niglit to relieve the suffering of the poor unfortunates. After a vear of eanie~r work, ]\Iiss Bartlett and Miss INTERNATIONAL NURSING EDUCATION 1173 Griffith resigned. Miss Hansberry was appointed director. Olive Simons with Grace White and Sara S. Smith, who had been assigned in November, 1921, completed the Red Cross nnrsing family. Early in 1920 the American Red Cross appropriated through the Insular and Foreign Division $10,000 for the purpose of erecting a suitable building as a house and school for nurses in accordance with the suggestion of the ^ledieal Department of the Navy. Plans were submitted to National IIead(iuarter.s and, with certain minor changes suggested by ]\liss Noyes, were approved. As a Red (Jross Chapter existed in Haiti, a committee from this Chapter was appointed to supervise the construction of the building and the expenditures. This com- mittee included Commander J. M. ^linter, ]\I. C, U. S. Navy; Commander A. L. Parson, M. C, U. S. Navy, as well as repre- sentatives from the Chapter. The money was made available in the autumn of 1921 and work was immediately begun. The school building grew rapidly and soon the old and tottering building was torn down. In order to ap])reciate the discouragements encountered in attempting a project of this nature one must understand the character of the people and the country as well as the historical background. Here Columbus first landed, finding Indians and gold, which the Spaniards coveted and gained. Contact with the white man exterminated the Indian. The negro from Africa was introduced, the beginnings of slavery in the new world. The French occupied the island with reforms and general improvement. In time they disappeared, leaving only their language, until to-day the people are mainly negroes, with some mixed blood. Revolution followed revolution, debt, poverty, misery, banditry and disease existed, accompanied by inevitably low standards of morality. The invited and accepted intervention by the United States in 1915 brought many im- ])rovements, among others the School of Nursing, the first of its kind in the island. In 1922 it was but four years old, a mere infant, but growing stronger as indicated by the reports. From the records of the school, as well as from photograjjhs of the student nurses in their trim uniforms, all negroe.-;, a conclusion may be drawn that in spite of many (litficnlties and discouragenuMits, tli(> work of the American nurses, i'our of whom aic still (l'.>22) there, has not been in vain. They are slowly (l<'velo})ing an educational systrin that will ultinuitely 1174 HISTORY OF AMERICAN RED CROSS NURSING give to the island what they greatly need, a well-trained native nursing personnel. These were steps in an educational program of the American Red Cross. They indicated that the peoples of European and other countries, perhaps through observation of the work done by graduate nurses from other countries during the war, or be- cause of the work of American Red Cross nurses with children and refugees following the war, were intelligently seeking assistance for the purpose of developing their own supply of nurses. And the American Red Cross was becoming painfully conscious of the fact that it could not continue to provide nurses and supplies indefinitely to the stricken countries of Europe. Furthermore, the Red Cross appreciated that its health work, especially for the children, would not be con- structive if native nurses were not ready to ^'carry on" when the American Red Cross nurses had to be withdrawn. The League of Red Cross Societies was also stimulating interest in schools of nursing wherever its Director of Nursing saw and felt that it w^as practicable. For these reasons the x\mer- ican Red Cross was deeply interested in the organization in these countries of modern schools of nursing. But throe years of study through direct participation it realized that educa- tional work of another type must go on. Quite generally in the countries of Europe and in Haiti, where American Red Cross nurses had conducted classes in Home Hygiene and Care of the Sick, or had established schools, the feeling quite generally existed that routine bedside nursing procedures, the performance of such housekeeping details as scrubbing and scouring, sweeping and dusting should be dele- gated to servants. The war and the example of graduate nurses did a great deal, however, to change this attitude of mind. In Poland particularly the students caught the idea, and began setting an example that will inevitably break down many age- old traditions. Quite generally the feeling prevailed that the work of the nurse ended with the application of a few surgical dressings ; the bathing of the patient, and the making of his bed belong to a servant. Even in Haiti it was noticed that an orderly sent on an errand wliere a basket or bundle must be carried would press into service for a few pennies a man or woman tottering with age, or a half-starved child, to relieve him of this burden. American nurses 'Svho rolled up their sl(>evcs" and with soap and water and plenty of energy cleaned INTERNATIONAL NURSING EDUCATION 1175 up a particularly bad situation not infrequently lost prestige thereby. Until the principle that actnal work with one's hands is dignified and honorable and uplifting can be implanted in the minds of the peoples of countries where autocratic forms of government prevailing for centuries have developed sharp class lines, modern schools of nursing or other democratic sj'S- tems of education \vi]\ make but slow progress. In line with other educational work special scholarships were given by the American lied Cross to three members of the committees organized in Italy under the guidance and direction of ^liss Gardner. One of these was given to Contessa Balzani of the Rome Committee, one to Signorina Bosio of the Florence Committee, and one to Marchesa Firmaturi of the Palermo Committee. This group reached America in the late summer of 11)21. After visiting schools of nursing, public health nursing organizations in Boston, New York, Chi- cago, Pittsburgh, Washington and Baltimore, they returned to Italy. Scholarships of this nature were developed not only to strengthen the work started under the direction of the Red Cross in Italy, but with the hopes that special efforts would bo made toward the establishment of schools of nursing to supply a qualified group of nurses in Italy to supervise, direct and extend the work so well started in that country. Italy, as was the case with many other countries where the Red Cross had operated, was in great need of a qualified nursing personnel in order to continue public health and other nursing activities. Scholarships had also been given in the year 1020 to two French nurses from the city of Lille, France, to ^Ille. Matter and Durrleman, both graduates of the Xightingale School at Bordeaux, for the purpose of studying school administration at Teachers College, Xcw York City. It was their expecta- tion to return to Lille to assist wnth the organization of a school in that city. Three additional American Red Cross scholarships had been granted to enable two Italian nurses and one French nurse to attend the course at King's College, London, which was de- veloped by the League of Red Cross Societies. Although the American Red Cross had be(>u conducting ex- tensive nursing activities overseas since li)14, no representative of the Xursing Service^ who possessed a knowledge of the entire lield had by 1!)20 r(>viewed the work Aliss Delano had gone 1176 HISTORY OF AMERICAN RED CROSS NURSING overseas for this purpose but her illness and death interrupted the plan before it had been begun. In 1920, requests asking that Miss Noyes come overseas were reaching National Head- quarters and it was finally decided that she leave in September. Three particular reasons existed for this tour of inspection; first, to inspect existing American Red Cross nursing activi- ties; second, to confer on the nursing aspects of the proposed child health work ; third, to advise on the foreign schools of nursing subsidized by the American Red Cross. As president of the American Nurses' Association, Miss Noyes took with her to deliver to the Trustees of the Florence Nightingale School of Nursing the terms of the deed of gift money for the American Nurses' Memorial. Miss Ida F. Butler, then as- sistant to the director of the Nursing Service, was left in charge of nursing activities at National Headquarters and Miss Noyes sailed on the Aquitania on September 21, landing in Cherbourg, France. After a few days spent in Paris in conference with ofiicials of the European Commission, Miss Noyes and Miss Hay left Paris October 4 for Prague, having arranged an itinerary which included in Poland the cities of Cracow, Warsaw, Bia- lystok and Posen ; in Austria, Vienna ; in Serbia, Belgrade ; in Bulgaria, Sofia ; in Turkey, Constantinople ; in Greece, Sa- loniki and Athens ; in Albania, Valona, Durazzo, Tirana and Scutari ; in Montenegro, Podgoritza, Danilograd, Ragusa and Zelenika, and in Italy, Florence. The League of Red Cross Societies had, through Miss Fitzgerald, invited Miss Noyes to visit Geneva, to confer on the International League of Red Cross nursing affairs. She wished as well to visit King's Col- lege, London, but these visits were later found to be impossible. During the summer of 1919 the policies which were to gov- ern the future program overseas of the American Red Cross were, as it has been said before, being formulated. Several of the commissioners for foreign service favored the continuation of general and medical relief on national proportions; some few officials desired to narrow the progam to one which cm- braced only preventive health measures and which utilized the dispensary as the principal operating unit in the field rather than the large surgical hospital. On June 10, 1919, Miss Hay prepared and submitted to Colonel Olds the following memorandum of nursing activities in Poland which clearly sliows that an extension of both an emergency medical program, INTERNATIONAL NURSING EDUCATION 1177 as evinced in the reference to two thousand beds for Poland alone, and of constructive work of a remedial and educational nature, as evinced by the reference to the establishment of dis- pensaries and the organization of classes for women, was still being considered by American Red Cross officials overseas : Ilosintal \Vorh: With the contemplated establishment of approximately 2000 hospital beds throughout Poland by the American Ped Cross, American nurses would of necessity be used only in a supervisory capacity, one nurse to every fifty patients or more and Polish aides to assist in the actual care of the patients. Dispensary and Public Health \\'ork: These to be estab- lished in outlying Polish towns and to consist of one or more physicians and two or three nurses whose duties would be to assist in tlie dispensary and develop various public health activities as visiting nursing, baby welfare, school visiting and courses in Home Hygiene and Care of the Sick. In such centers, the emphasis would be placed on (a) the thorough grounding of Polish aides in their duties so that they can carry on under Polish physicians; (b) such awakening of local interest in health problems as is possible through various local organizations and through popular instruction of women in Home Hygiene and Care of the Sick. Health Education: The organization of short courses in nursing seems to appear as an important and immediate duty. This educational work falls into three classes: (1) an inten- sive course for Polish War aides; (2) a course for Polish aides now working under the American Red Cross; (3) a popular course for educated Polish women in Home Hygiene and Care of the Sick; (4) the establishment of schools of nursing along American lines in Poland, to be treated in a later chapter. ... At the present time, there are in Poland seventy-eight nurses. It is estimated that a total of one hundred nurses could be well engaged in carrying out satisfactorily the pro- gram recommended above. The necessity for the shifting of the emphasis from a pro- gram of general medical and material relief in Europe to a more constructive one of preventive health measures with special emphasis upon the w(>lfare of children, began to be felt and publicly discussed by the Anunncan Red Cross officials at National Headquarters in the autumn of 1919. Commissioner Olds in a letter dated .lulv 1:2 submitted t(^ th(> chairman of 1178 HISTORY OF AMERICAN RED CROSS NURSING the Central Committee certain general considerations relating to the future work of the organization in Europe. In this communication he emphasized the gravity of the problem of the children in Europe. In a cable of August 23 to Commis- sioner Olds, Dr. Farrand recommended a definite plan for the establishment at available points in Europe of ''child saving centers," with necessary dispensaries and medical and nursing personnel. The recommendation recognized that the American Red Cross should cooperate with other organizations operating in the field ; it further set forth that it would concentrate upon the field of undernourished and neglected children and the prevention of epidemic and disease. In a masterly brief pre- sented October 30, Colonel Olds made the following statement : We rest under no illusions concerning our capacity to handle such a situation. It is plain that the American Eed Cross cannot possibly assume to take up more than a small part of the burden. In the first place we have never accepted any responsibility for feeding any large groups, even children, and do not propose to do so now. That operation, Ijasic as it is, must continue to be an obligation of governments and of other organizations. On the other hand, we believe the Ameri- can Eed Cross may well undertake a health service for chil- dren at various critical points on a scale commensurate with the resources at its disposal. We do not foresee any difficulty in confining our responsibility within any reasonable limits which may be imposed. If permission to proceed is given we are ready to go ahead with a definite plan. It involved the setting up of field units, organized on the simplest and most effective lines, to furnish health service for children. While some delays must be expected when there is a shift from one program to another, the child health program seemed slow in getting under way. There were doctors, nurses, execu- tives and other workers still in the various countries of Europe, especially in Poland, who wore more or less inactive. ^ledical men, including children's specialists, were being sent to Europe and requests for additional nurses were being received at National Headquarters. Conference followed conference at the Paris office, cables came and went, but still the ''curtain did not go up," although the program was there and the actors waiting. A clear-cut plan of detailed organization and opera- tion seemed to be lacking, and what was more significant, the INTERNATIONAL NURSING EDUCATION 1179 motive power and force to swing a plan into action in the field was either not there or if there was without authority. Miss Noyes**^ was greatly concerned by the inaction, especially when she found a group of twenty nurses waiting in Paris for assignment. Having drawn heavily upon the nursing resources of America, where nurses at that time were greatly needed, it was disappointing to her to find so many in Europe still unas- signed. This was still more distressing when it could be ap- preciated that a great opportunity for their services existed ; indeed instances were later noted where initiative was actually discouraged on the part of public health nurses because of the lack of knowledge and experience on the part of the individual medical directors and other officials. In Poland Miss Hay and Miss Noyes found many sore spots. Here again were unassigned nurses; in Cracow but sixteen out of twenty-eight were at work. An effort was being made to use nurses in Warsaw, but here again the announced program was not moving. The need for a well-trained public health nursing supervisor was apparent and a recommendation made to that effect. Miss Mathews had been appointed chief nurse in Poland, but because of a lack of understanding and experience in nursing affairs on the part of the commissioner her position as chief nurse was not only uncertain, but at times unrecognized. It was necessary, therefore, to prepare and present to the commissioner a definite statement defining her relationship to the commissioner, nurses, physicians and other personnel. The idleness of the nurses in Poland was in a measure due to the Bolsheviki Advance in the summer of 1920, which retarded the subsequent development of the child welfare program. The disturbing factor was that in spite of this situation additional nurses were still being requested for Poland. In Belgrade but one Red Cross nurse was found. Miss Rhobie Wliedon, who was then in charge of the Belgrade Or- phanage, which was being run under the auspices of the Gov- ernment. Conferences with Dr. Reeder inspired a recommen- dation to Colonel Olds that the American Red Cross assist the American Child Welfare Association as far as possible in '"Neither Miss Noyes nor Miss Hay regarded themselves as experts in public health nursinarly approaching that of the niissionarit's who 1194 HISTORY OF AMERICAN RED CROSS NURSING neither seek nor expect immediate results, but who measure success by decades, and who expect to give years of continuous service. Between these two extremes were two others: A. After the retirement of the American commissions a limited subsidy could be left to be administered by native groups under certain stipulated conditions. B. In addition to such subsidy or without it, a tiny Ameri- can personnel could be left, not more than two or three people, one of whom should be a well equipped public health nurse who would act in an advisory capacity either to the subsidized bodies or to those desiring such assistance. The last plan, though possessing many advantages, should not, I believe, be unreservedly recommended for all countries. I think the time will soon have come when a cessation of outside stimulation is to be desired. If at the end of another eight, ten or twelve months such an American advisory service is not very generally and sincerely wanted and asked for, it should not, in my opinion, be offered, certainly not for the mere object of tying a string to a subsidy. The task which confronted the Red Cross administrative workers in Paris, medical directors, nurses and social workers in the field, was monumental. It meant not only the organiza- tion of local committees and the building up of local interest, but the physical task of organizing and opening up child health centers. Then there was the work of selecting and training local nurses and health visitors. This entailed special courses for the latter at Cracow, Prague and elsewhere, for the former a preparation by special courses in connection with the new schools of nursing at universities, of which, for example, the school at Dorpat, Esthonia, under the direction of Mrs. Vaughan, was one. While the child health work had been discussed since early 1920, and its development authorized, a final plan of organi- zation had not been formulated until 1921. Tlow^ever, with the simplification of central administration and with the knowl- edge that to the American Red Cross, as a member of the European Relief Council and because of surveys made by Red Cross doctors and nurses, had been allocated the medical and social care of the children, gradually the activities seemed to group themselves into two classes: INTERNATIONAL NURSING EDUCATION 1195 First. Child Health Centers. Which mi<^ht be anibulatoria, children's hospitals or chil- dren's wards, milk stations, clinics for the examination, weighing and measuring of children, also special areas for intensive pre-natal work, as a community demonstration were included. Second. Educuiional M'orl-. Pre-natal and post-natal instruction for mothers, instruction in Home Hygiene and Care of the Sick, care of children, child health })ropaganda for the general public, and instruc- tion in public healtii nursing to graduate nurses as in Aus- tria, Baltic States and ('zecho-Slovakia, as well as on health visitors at Cracow, in order that personnel should be devel- oped to "carry on" after the withdrawal of the American Ked Cross. Modifications of the general plan were used in each country where the American Red Cross operated. In the main, the field supervision included one or two American doctors, a su- pervising nurse and a social worker ; to the centers were as- signed local doctors, an American nurse, also a local nurse where one existed and from two to four student health visitors. From the central office medical, nursing and social direction was given by American personnel, which included well-known specialists such as Dr. J. II. ^lason Knox and Dr. Phillip Jeans and also Dr. Hugh Manning for general medical supervi- sion. General nursing direction was given by qualified public health nurses, ^Irs. Elsbeth Vaughan for Czecho-Slovakia, Poland and the Baltic States; Miss Sophie C. Xelsou for the Balkan States, Austria. Hungary and Serbia. Both of these nurses had been assigned as assistants to ^liss Hay in 1921. With tliis organization a clearer understanding of the work was gradually acquired. In Austria one hundred and one centers were established. Here, as well as in Hungary, the nurses, with the exception of the supervisors, were natives. In the Baltic Stat(>s there were by July of V^'2\ sixty-six centers, in September one hundred and forty, tliis rapid expansion occurring before tlie arrival of tiie AnieiMcan Ived Cross nurses. These centers were reduced on January, 1!)22. to fifty-six, by ^[ay of 1!>22 all the centers were statFed by native personnel. In Czecho- slovakia twenty-one centers were established. In Hungary there were fiftv. In Montenc^irro eleven were maintained. In 1196 HISTORY OF AMERICAN RED CROSS NURSING Poland one hundred and fifty-six ambiilatoria and sixty-nine centers were organized and when the Red Cross withdrew over twenty thousand children were registered and under supervision and two thousand expectant mothers were receiving practical instruction. In Roumania the American Red Cross work passed through various stages: First, the American Red Cross commission had developed general and medical relief until ld'20. Then, upon the withdrawal of the commission, six American Red Cross nurses had been left with Lady Paget's Mission, but were finally withdrawn. Later one Amer- ican Red Cross nurse. Miss Agnes Von Kurowsky, was as- signed to Roumania and worked with the Junior Red Cross until November, 1921. Later the Government assumed the responsibility for the baby clinic at Breaza, which she had supervised. In Serbia the American Child Welfare Associa- tion, subsidized by the American Red Cross and supplied with American Red Cross nurses, developed ten stations and con- ducted a health workers' course. In connection with the work local committees weie formed, contracts were made with local agencies and local personnel were trained. In some instances clothing was supplied and layettes in large numbers were dis- tributed. Food was usually distributed, however, through the local or State representatives of the American Relief Associa- tion, such as the P. S. K. P. D. of Poland or other agencies. That Dr. Hill had his mind fixed upon a given date as an objective toward which to w^ork is best told in his own words: In organizing the child health centers of the American Eed Cross in Europe, it was my notion in July, 1921, that in some countries at least a period of two years would be neces- sary for effective operation. But by October, after I had traveled over the field and visited the centers already in opera- tion, I reached the conclusion that, while it would probably take more than two years for the American lied Cross to carry the program to a thoroughly satisfactory demonstration, yet in one year it would probably be possible to convince local agencies of the possibility and desirability of their taking responsibility for the continuation of the work. This opinion was confirmed by a conference with ^liss Gardner just before her return from Europe. Accordingly, throughout the year an effort was made to encourage local participation in the program and to develop local agencies and local personnel. From correspondence with the Conmiissioner for I^urope and irom the reports of INTERNATIONAL NURSING EDUCATION 1197 the directors of field operations, it became clear that the transfer to local agencies by July 1, V,)'^2, was not only feasible but wise, even if that involved the granting of sub- sidies in some instances to these local agencies for the first year of their operation. Accordingly, the Central Committee at a meeting held February 17, VJ22, took the following action : That it is the sense of the Central Committee that the Red Cross sliould conclude its work in Kurope, with the exception of certain activities of the Junior Red Cross, on June 30, 19"2"^, this resolution being subject to the following conditions : I. It is recognized in order to secure the transfer of Red Cross activities to other agencies with the least possible loss of value that the Red Cross may continue a certain amount of supervision and in special cases render temporary assistance of an incidental nature to the agencies taking over these activities, etc. Of course the action referred to had reference to the child health program only, and did not mean the discontinuance of the work of training nurses, nor of the relief to Russian refugees in Constantinople, nor of the furnishing of medical and hospital supplies to Soviet Russia. That the personnel worked as a team is demonstrated by the fact that by July 1, 1922, nearly all the field workers were released. The exceptions were certain nurses whose services were in connection with the schools and ^Mrs. Ileilman in Greece. The American Red Cross made provision for Mrs. Ileilman's salary until July 1, 1922, a date on which it was assumed locally. The services of Miss Elizabeth Marshall were retained until October, 1922, in Constantinople, where she had been assigned to develop public health nursing for the school of nursing there. Also here and there in Eastern Europe was left a nurse advisor Mrs. Vauglian for the l]altic States and Poland ; Miss Nelson for general supervision of the Balkans, Austria and Hungary; ^fiss Schaub in Hungary, and ^riss Torrance in Czecho-Slovakia. Thus the nurses who had been first in the field were the last to leave. Miss Hay, in spite of her desire ''to see it through,'' had been obliged to return to America June 4. 1922. because of the illness of a member of her family. Mrs. Vaughan was left in general charge. She, however, was also obliged for similar reasons to leave in September, 1922. Miss Xelson thus rcnnained as 1198 HISTORY OF AMERICAN RED CROSS NURSING the representative of the Nursing Service until such time as it was deemed wise to leave the committees without special advice, and until the last of the field nurses were withdrawn. The organization of the child health work under the Amer- ican Red Cross appeared to be slow in getting under way, but the rapidity which characterized its later development and the final withdrawal of the majority of the American workers by July 1, 1922, may well lead to speculation as to its real value and permanency. As a demonstration, even though there may be some criticism of the American Red Cross for trying to develop in a short time under most difficult conditions a type of work that usually required a longer period even in America, we believe it was valuable. The minds of the people were directed towards positive health as an objective. The instruc- tion of thousands of women and girls in personal hygiene, in the care and feeding and proper clothing of children and the emphasis placed by the American nurses by precept and example upon the importance of good nursing service to the sick as well as health nursing cannot have been entirely lost. The island possessions of the United States also profited by the skill and devotion of American Red Cross nurses. Their services were first called for in 1919 and at the closing date of this history, June 30. 1922, numerous types of nursing activities were in process of active development. Adminis- trative details in connection with this insular nursing service were conducted through the Department of Nursing of the Insular and Foreign Division of the American Red Cross, of which Miss Ida F. Butler was director. The islands in the Atlantic Ocean to which American Red Cross nurses were assigned were Santo Domingo and Porto Rico of the West Indian Group and the Virgin Islands, which were located east of the West Indies ; those in the Pacific were the Hawaiian and the Philippine Islands. When the United States Marines were sent in 1919 to police the Island of Santo Domingo, the ]\Iedical Corps of the United States Navy sent a complement of Navy surgeons, sanitary officers and enlisted men with them, and these medical men of the Navy served as sanitary officers of the island. Through them the Dominican Republic called upon the American Red Cross to assign nurses to service there, the Republic to provide salaries, transportation and maintenance, the Nursing Service INTERNATIONAL NURSING EDUCATION 1199 to select the nurses, to act as the intermediary for the Govern- ment and to advise and direct the nnrses' work. From 1919, and up to June, 1922, ten American Red Cross nurses, Mary Muriel Cameron, Marie F. Falconer, Mabel Dershem, Eliza- beth Wrif^ht, Henrietta Wiltzius, Clara J. Farnsworth, Eliza- beth Hunt, ^lary E. Shaneman, Agnes Meyer and Elizabeth Miller, were on duty on the island. The type of service which these nurses met included the reorganization and direction of hospitals, the establishment of dispensaries and the organization of classes of instruction. In addition there was the actual routine of nursing work, in which, under conditions next to impossible, they performed almost superhuman nursing tasks. Some attempt was made to train young women in the principles and practice of nursing, but the chief accomplishment in this field lay in the practical phases and little was done toward the organization of schools or the standardization of nursing education. In the majority of Dominican hospitals the nursing service was under the management of religious Sisterhoods. The experiences of the nurses were more or less the same, and an extract from a letter written by Miss Wiltzius to Miss Xoycs on August 5, 1022, will serve as an illustration of the difficulties under which they all w^orked. Miss Wiltzius was on duty at the hospital at Santiago. She wrote : When T tell you that it is the dirtiest, most neglected place I have ever been in, you can guess that it is terrible, for I have seen and helped ''clean up" a few unsightly so-called hospitals before tliis. Not one room is in any kind of order. The bedside tables serve as individual medicine cases, clothes lockers and food containers. . . . The sanitary arrangements are unspeakable. . . . Soiled linen, garbage and used gauze are thrown out of the windows or in some corner. When a new bed is needed, it is set up. There is no such thing as spacing the beds at regular intervals in the wards. . , . The buildings themselves are very nice and when they are painted and connected by covered corridors I tliink this can be made the prettiest hospital on the island. Located as it is on the outskirts of the town, with the mountains behind it, the situation is ideal. ^liss Wiltzius' advent had not been greeted with enthusiasm by the native doctor in charge of the hospital at Santiago, but 1200 HISTORY OF AMERICAN RED CROSS NURSING after some weeks ''he seems to have ceased," wrote Miss Wiltziiis, "to regard the American nurse as a necessary evil and the air is not as frigid as on the first day." Miss Wiltzius' living quarters were almost as primitive as were conditions in the hospital. She wrote: I am living with a very nice native family downtown be- cause the hospital is in an undesirable neighborhood. This family, however, lives at some distance from the hospital but I have a "sea-going hack" which takes me back and forth. The arrangement is satisfactory when it comes, but it is dis- couraging to have to wait and then walk. The two rooms I occupy are on the street with only one door for ventilation and light. I did feel very "shut in" after Seybo but now that I have a cot and sleep on a balcony, it seems wonderful. Down here on the street I had no air and the dust just pours in. The Marines were very good about getting me "fixed." Commander I. S. K. Reeves, Marine Corps, United States Xavy, whose effort to improve health and sanitary conditions had borne such fine fruit, spoke appreciatively in a letter of June 27, 1922, of the nurses and their work: You have sent me nurses of the most superior type. They are a credit to your organization and a pride and Joy to mine. I cannot say too much in praise of your choice and take this opportunity to thank you again. Under the direction of the United States iSTavy doctors, who acted as sanitary officers, and because of the energetic and devoted work of the Red Cross nurses the hospitals were gradually developed into first-class institutions. Great im- provement took place in the nursing care of the sick, and through dispensaries a better knowledge of personal hygiene and health conditions was disseminated. This last phase of the sanitary program in Santo Domingo was greatly assisted by classes in Home Hygiene and Care of the Sick, which was given by Isabel Hall Basken. Mrs. Basken was a native of the Dominican Republic and a graduate of Lincoln Hospital Scliool of Nursing in New York. In April, lt20, she was appointed as an instructor of this course and was energetic in organizing classes among the women and voung girls of that country. In a period of two years fifty were INTERNATIONAL NURSING EDUCATION 1201 instnictedj fortj-one received certificates, ^frs. Basken also translated sections of the textbook on Home Hygiene and Care of the Sick into Spanish. Another island possession, Porto Ilico, asked in the early months of 1J)21 for a public health nurse. Here there was a well organized Chapter which had been exceedingly active during the war, with J\Ir. Knowlton ^lixer as executive secre- tary. Kathleen D'Olier, whose fine work in developing the child welfare work in Greece has already been described and who had resigned from that field in December, 1020, was secured. She sailed April 23, 1021, and in her first report wrote ; The Xursing Center of the Porto Eico Chapter, American Bed Cross, opened its otlice ]\[ay '31. The staff consisted of the supervising nurse [Miss D'Olier], two staff nurses and two part time doctors. . . . The aim of our work is the reduc- tion of the infant death rate. . . . The death rate among infants under one year in Porto Rico is 146 per 1000 births. . . . The need for the pre-natal clinic is demonstrated by the death of a large num])cr of children before reaching the age of one month, or even one week. . . . While we are chiefly interested in the mother and baby, once we enter a home we make the family the unit of our work. Miss D'Olier found a virgin field with but few nurses, graduates from the local schools, that might be secured to assist her. The standards of nursing were low. While a registration law existed, its provisions were not maintained or enforced. !Miss D'Olier urged Red Cross participation in the organization of a school of nursing at San Juan similar to those sponsored by the Red Cross in Europe. A plan and recommendations were prepared and presented, but these were, at the time of writing, still awaiting confirnuitorv assurances from the local authorities upon certain points regarded as essential to a cor)})erative enterprise. After a year's service, ]\Iiss D'Olier returned to the United States for conference and a vacation. The climatic conditions and tlic (lifficulti(^s iiuM- dent to a field where 8000 active cases of tuberculosis alone needed attention, the charg(> of a sanatorium acconnnodating 87, with a waiting list of 400, made a change and rest advis- able. After a month in this counti-v she return(^(l to San Juan. Two Porto Rican nurses, graduates of St. Luke's Memorial 1202 HISTORY OF AMERICAN RED CROSS NURSING Hospital School at Ponce, were brought to the United States on Red Cross scholarships. They returned in June, 1922, and were assigned to duty as assistants to Miss D'Olier. This increase of staff relieved in a measure the strain. Miss D'Olier and her staff helped to develop clinics of various types, home visiting and courses of instruction, three phases of the Red Cross program which will unquestionably help to develop a higher sense of community responsibility and a better under- standing of good health requirements. Located some forty miles east of Porto Rico were the Virgin Islands, which the United States had purchased from Den- mark on ]\Iarch 31, 1917, with a United States Treasury war- rant for $25,000,000.^- This transaction closed a question which had been an open one for fifty years. Wireless messages were sent on that day to the Danish and American authorities to lower the Danish flags and raise the Stars and Stripes. A representative of the !Na\'y Department was assigned by Secre- tary Daniels to assume governmental responsibilities until the permanent government had been determined upon by Cruze. The total area of the islands amounted to one hundred and thirty-eight square miles and the total population, according to a census taken in 1911, was 27,086 persons, of whom a large number were negroes. The chief islands of the group were St. Thomas, St. Croix and St. John. Less than a month after Secretary Lansing had consummated the purchase of the Virgin Islands, the United States declared war upon Germany. Through its Insular and Foreign Divi- sion, the American Red Cross subsequently organized Chapters for war work in the newly-acquired territory. When Mr. Frederick A. ^loran, a field representative of the Insular and Foreign Division, made a visit in June, 1920, to the Virgin Islands, he found that the Chapters at St. Thomas and St. Croix were still active and were interested in the peace pro- gram of the Red Cross. Ilis first report to ]^ational Head- quarters urged the assignment of two nurses, one to St. Thomas and St. Jolm, the other to St. Croix. When the sanitary officers of the United States Navy had first come to the Virgin Islands, they luul authorized the estab- lishment of schools of nursing. The work incident thereto had not, however, progressed very far and but two native ""The European War," New York Times Current History, Vol. XI, Ifll". INTERNATIONAL NURSING EDUCATION 1203 nurses had boon graduated. With the support of the other physicians, Dr. ^link, Chief Medical Aid, Navy Department, urged the assigiinuMit of American Rod Cross public health nurses to inaugurate health work in the public schools. Thus the services of the two nurses requested by Mr. Moran were to be utilized in school nursing, which was to serve as an entering wedge until the training school project could be taken up again. ]\Iiss Butler secured Florence C. Freeman and Ruth C. Watorbury to develop the nursing program in the Virgin Islands. ^liss Watorbury was a graduate of the Hopkins School and was a highly qualified public health nurse. She was, moreover, familiar with the American Red Cross Nursing Service, because she had served as a nurse member of the Com- mission for Poland. The two nurses arrived at St. Thomas on November 4, 1920. IVIiss Waterbury had been instructed to act as supervisor of all the nursing work in the islands, so she set up headquarters at St. Thomas. ]\riss Freeman proceeded to St. Croix. Both nurses began immediately the development of the school nursing program. Their work met with appreciation and success. The *S'/. Thomas Mail Notes for June 5, 1921, contained the following statements I would further call your attention to the splendid work in the line of school nursing aeeoniplished in the past year. Of the 199"2 children enrolled in all the schools, public, pri- vate and parochial, 1701 have been carefully examined and in the cases found defective appropriate action was taken to correct such defects. For til is noble work we are indebted to the Red Cross and most especially to ^liss Waterbury of that service, backed most cordially l)y the Government and medical officers and all school officials. Inevitably there were many discouragements. encountered in a new venture of tliis type in a recently acquired possession where many of the ''left-over" officials from the previous regime wore certainly not enthusiastic, if not openly hostile to now methods and the introduction of new systems. Hap- hazard, easv-going administrations do not constitute the 1204 HISTORY OF AMERICAN RED CROSS NURSING happiest foundation npon which to build a more rigid, thorough and progressive system. In the late summer of 1921 Miss Waterbury began to feel the strain and went back to the United States for a rest and conference with National Headquarters. Miss Freeman had resigned the previous May. Miss Waterbury returned to St. Thomas on September 15 and took with her an assistant nurse, Elizabeth S. Robinson, who was assigned to school nursing at St. Croix and Frederiksted. The work at Frederiksted de- veloped so rapidly that another American lied Cross nurse, Alice F. Stenholm, was assigned on January 4, 1022, solely for duty there. As the months passed health centers were established both at Frederiksted and Christiansted in addition to school nursing. Classes were held and native nurse assistants were secured and trained. That the work had local govern- mental support is shown by the special order issued by the governor, which, under date of September 25, 1921, supported the public health nursing program, announced the appoint- ment of Miss Waterbury as the supervising lied Cross school nurse of all school nursing in the islands and indicated the centers of development as St. Thomas, Christiansted and St. Croix. Some months later Miss Waterbury was asked to serve, in addition to her work as supervisory nurse, as the general field representative of the American Rod Cross in the Virgin Islands, an arduous program for one person to carry, but one for which her training and enthusiasm made her well fitted. From time to time the nurses of her staif returned to the United States, for any nursing service in the tropics is a severe one, and new nurses were sent to fill their places. From the date of IMiss Waterbury's return to the Virgin Islands in September, 1921, the nursing activities there de- veloped steadily and by June of the year 1922 the improved condition of the school children well rewarded the nurses for their hard work. Th(^ two groups of islands in the Pacific Ocean in which the American Red Cross developed various nursing activities were the Hawaiian and Philippine Islands. In Hawaii a local Committee on Red Cross Xursing Service had been organ izcnl prior to the war and an active Red Cross Chapter had tilso rendered conspicuous service during the period of hostilities. When the post-war program in public health nursing was announced the Ililo Pranch of the Hawaii INTERNATIONAL NURSING EDUCATION 1205 Chapter voted to support it and secured a California public health nurse, (Catherine S. Eastin, to develop a community nursing service. Miss Bastin had seen service overseas at Dr. Blake's hospital in Paris and later in the Army Nurse Corps in France. In a letter written December 20, 1921, Miss Bastin gave an interesting account of her work : The work here is of a peculiar nature. Think of twelve nationalities and add to them all the possible mixtures, and what a motley crowd it becomes! Japanese are the predomi' nating j)eople. They are an industrious, quiet, law-abiding race. Tbey have their own customs of long standing and, although very polite to the white nurse, they seldom let me do anything. I am always ushered in and made welcome, but when I suggest a batli or some other treatment for the patient, they only smile and bow and say, "I too much thank you" but I am not allowed to give the bath. The Chinese and Koreans I find most amenable. The Portuguese are dirty and indilTerent, as a rule. The Hawaiians do not like to put forth an effort. They have lived very contentedly with their fishing, sweet potato and tarrow patches, and a few fruit trees. Life has always been very simple to them, so why make it complicated by a lot of "newfangled" ideas about food, clothes, and sanitation? j\Iuch of my work has been in the schools as there is no school nurse and that is where the greatest need lies. . . . The infant death rate is very high in these islands, and so I have started a well baby conference, which I hope in time w^ill help to reduce it. This is too large a field for one nurse, but I can see no immediate prospect for another one coming. , . . In a communication a few days later, IMiss Bastin wrote that she cx])octcd to start within a month two classes in Home Hygiene and Care of the Sick. One course was to be given to Hawaiian women and the other, a modified course, was to be conducted in the high school. Aliss Bastin was also much interested in the student nurse recruiting movement and distributed the recruiting literature and posters throughout her territory. By ^lay. 1!)22, she had devclo])('d a well organized and varied program of com- munity service. In tiu^ Philij)])ine Islands prior to the Eur()]~oan War, the American Bed Cross Xursinii' Service had oi-iiani/cd a Local 1206 HISTORY OF AMERICAN RED CROSS NURSING Committee for enrollment. The large numbers of American nurses then resident on the islands and the several schools for training native nurses, which had as their superintendents well-trained American nurses, constituted a supply from which the Nursing Service hoped to draw members. An active Chapter has also been organized and previous to 1917 had rendered good service in the field of disaster relief. During the European War both the Local Committee on Red Cross Xursing Service and the Chapter were active participants in the various types of nursing activities and chapter production and when the post-war program was launched the Chapter took up the development of public health nursing and of class instruction to women in Home Hygiene and Care of the Sick. In December, 1920, Emmet W. White, who as manager of the Insular and Foreign Division, was then on a tour of in- spection in the Philippines, cabled National Headquarters, requesting the appointment of a Director of Nursing for the Philippine Chapter. This cable was followed by others from him which suggested various individuals, some of whom were not nurses, others not enrolled nurses. Before Miss Butler and Miss Noyes had succeeded in securing a suitable appointee, Mr. White on February 28, 1921, cabled that he had selected a director. It was found that she had been in the Philippines many years, but was not enrolled in the Red Cross Nursing Service ; neither did she meet all the present requirements, and furthermore she was without public health experience or training. Her preliminary training, received many years ago, was good, her knowledge of the Philippines and the people was a decided asset and her spirit and interest were unusual. On the other hand, she lacked a background of Red Cross nursing experience and knowledge of Red Cross organization. The issue at hand between Mr. White and the Philippine Chapter and Miss Butler and the Nursing Service at National Headquarters then became the old issue of "maintaining standards." Possession in 1922 of the coveted badge and appointment card of the American Red Cross Nursing Service was a definite guarantee to whomsoever it might concern that tlio owner thereof had successfully met requirements of train- ing, experience and character which placed her among the representative women of her profession. In justice to the many nurses whose applications for enrollment had been re- jected, the Nursing Service could not, on the whim of im- INTERNATIONAL NURSING EDUCATION 1207 pctuoiis Chapter and Division officials, set aside these definite requirements and enroll any nurse the latter might choose to select. An ironclad regulation of the Nursing Service, a regu- lation of the greatest protection both to the Chapter and the Nursing Service itself, was that every nurse engaged in Amer- ican lied Cross nursing service should be an enrolled nurse. Thus the Local Committee at Manila could not recommend nor could the National Committee at National Headquarters ratify the enrollment of Mr. White's appointee as Director of Nursing of the ^fanila Chapter and the nurse herself was faced with the embarrassing task of trying to develop a nursing service without the aid or supervision of National Headquarters. The situation which resulted was chaotic. Graduates of schools of nursing in the Philippines which did not meet the requirements for enrollment were employed by the Chapter and called American Red Cross nurses. Courses of instruction for Red Cross aides were given which were not authorized Red Cross courses. These irregularities were not only con- trary to all instructions, but in some instances constituted an actual infringement of the law established to safeguard the use of the Red Cross emblem. The nursing situation in the Manila Chapter was, indeed, little more than the old struggle which had seemingly to be fought over and over again between the leaders of the Nursing Service at National Headquarters and each new commissioner or Chapter official in the field, struggles as wearisome to Miss Delano and ]\riss Noyes as the repeated accounts of them must be to readers of this history. Commissioners and officials of remote chapters, who had been in Red Cross service compara- tively overnight and who did not choose to acquaint them- selves with the long-established methods of organization and procedure which had prevailed for many years at National Headquarters, took up their duties with understandable en- thusiasm and as a first gesture of their new authority reorgan- ized or initiated anew nursing activities in line witli their own and local ideas ; as a result they set awry the well-oiled machinery of a long-established professional service. Because nurses wore wcmien. each new commissioner or official seemed to think that he could do with them anything he wished. It is seriously to be questioned if the medical phases of American Red Cross service, a fair professional comparison, were so dragged about by the ears as was the Nursing Service. The 1208 HISTORY OF AMERICAN RED CROSS NURSING executives of the ^Nursing Service at National Headquarters were answerable to the American Nurses' Association, which had accepted affiliation with the American Red Cross on cer- tain definitely defined "professional prerogatives," and Miss Delano and Miss Noyes strove to defend these prerogatives at cost of much labor and weariness of spirit. Certes, they grew as tired of "fighting for standards" as their opponents must have grown of having them fight ! The most discouraging aspect of the whole situation was that it seemed as if every step of the struggle for professional status had, like the em- bryonic steps in the evolution of the race, to be lived through before a new nursing service could be brought into being. To return to the Manila Chapter: As the irregularities increased, it finally became evident even to Chapter officials that the services of a well qualified and enrolled nurse should be sent to supervise their nursing activities with as little delay as possible. Accordingly, Virginia Mason Gibbes, a graduate of the Roper Hospital School of Nursing, Charleston, South Carolina, sailed on March 26, 1922, to assume the responsi- bilities of Director of Nursing for the Manila Chapter. As a member of an enrollment committee, as an instructor in Home Hygiene and Care of the Sick, as a Town and Country public health nurse and as a member of the Southern Division nursing staff, ]\Iiss Gibbes had gained a rich and varied back- ground of Red Cross nursing experience. The affairs of the Chapter were also put into more satisfactory alignment with the organization at National Headquarters by the appointment of Mr. Knowlton Mixer some months previously as manager of the ]\ranila Chapter. Like Miss Gibbes, he was experienced in Red Cross organization and policies, and together they began to study the situation and bring the Red Cross activities into line. Miss Gibbes began a study of local affairs, nursing schools, resources and organization as a necessary basis for all Cliapter nursing activities. One of the outstanding difficulties in the Philippines was that the Chapter, by utilizing the services of poorly trained nurses' aides, was depriving the professionally trained nurses on the islands of employment. ]\riss Gibbes soon reported an apparent over-supply of graduate nurses. She wrote: "Of one hundred and two recent graduates of the School, twenty have no prospect of immediate employment. As far as I can learn, there is no registry for nurses." This lack INTERNATIONAL NURSING EDUCATION 1209 of employment was one of the chief in]iil)itions to tlie develop- ment of professional nursing in the Philippines, and profes- sional nursing service was one of the vital needs there. Miss Gibbes immediately "advised the development of nurses and not nurses' aides," as stated in the ^finutes of a meeting held ^fay 12, 1022, of the Executive Committee of the Manila Chapter. In a letter addressed on June 8 to Miss Noyes at National Headquarters, Mr. Mixer announced an important change of policy : . . . The Chapter has abandoned its plan of training Red Cross aides. . . . We are using only graduate nurses. ... I believe our present program is quite in line with your ideas and I am fully convinced that we will obtain better results and cover a wider field of usefulness. It is true that a few aides were still used in the provinces, but their activities were to be supervised by graduate nurses. In connection with the development of public health nursing in the Philippines, several native nurses came to the United States in 1921 and 1922 for post-graduate courses in public health nursing. Two of them were given Red Cross scholarships and entered the courses at the University of California in San Francisco. Two entered Teachers' College and were prepared to return to ^lanila to engage in Red Cross work. While Miss Gibbes and ^fr. ]\rixer were laboring to bring al)out these changes, an appointment of international interest to nurses had been made in the Philippines. It will be re- membered that late in 1921 Miss Fitzgerald had resigned as Director of Nursing of the League of Red Cross Societies. In ^larch, 1922, she was appointed through the Rockefeller Foun- dation to membership on the staff of General Leonard Wood, then governor general of the Philippine Islands, for the pur- pose of making a study of nursing resources, schools of nursing and public health nursing in the Philippines and also to act as geiun-al adviser to General Wood on all nursing questions. That a nurse should have been appointed as an adviser on nursing affairs to the governor of a state or province was a progressive step forward in the cause of professional nursing and one which may be regarded as a good oiufMi. indeed, in the development of sound nurse education and the betterment of nursing care of the sick. 1210 HISTORY OF AMERICAN RED CROSS NURSING With the close of the emergency relief and child health programs, the American Red Cross Nursing Service, as it has been said before, withdrew its nurses from the foreign field and left, with the exceptions already mentioned, only the nurses who were conducting schools of nursing in Europe and the Island Possessions of the United States. During the four transitional years in which this close of foreign activities and withdrawal of personnel had taken place, contraction of the organization created to meet the military needs had taken place in the United States. The number of Red Cross Divisions had been reduced from fourteen to five. This contraction was one of administrative machinery alone and was not, in any sense, a lessening of American Red Cross nursing activities in the United States, for the "peace-time" nursing program of public health nursing and class instruction to women was being developed to unprecedented proportions, as may be seen in subsequent chapters. Death alone had broken the ranks. Jane Delano and Henry P. Davison, outstanding war leaders, had died during this period, both of them from practically the same malady and both of them in their prime. Ida M. Tice, a charter member of the National Committee on Red Cross Nursing Service, and Sophie F. Palmer, a woman whose keen mind had piloted the nursing profession through the stormy waters of registration, one of the first nurses to sponsor affiliation with the American Red Cross and the first advocate, and for fifteen years the guiding spirit of the' Journal, had died and from among the rank and file, as a direct result of service in the European War, two hundred and eighty American Red Cross nurses. But the vanguard of the Nursing Service remained and was on July 1, 1922, serenely and powerfully moving on to the ful- fillment of its destiny, with an enrollment of thirty-nine thousand nurses and a National, State and Local Committee system of over fifteen hundred nurse volunteers. "It seems," wrote one of these forty thousand nurses pledged to respond upon call for altruistic service, "that when we have once heard and answered the call of the Red Cross, we ever wait and listen, readv to come when needed." CHAPTER XIV FKOM RURAL NURSING TO THE PUBLIC HEALTH NURSING SERVICE Outline of Early Growth Requirements for Applicants Affiliation Principles Adopted Growth of Central and Branch Units Early Affiliations The Interruption of Wa r Scholarships. RURAL nursing, so called, or the extension of the visit- ing nurse's service to the people of isolated districts, has long been carried on in many countries in Great Britain and Ireland bv the staff of the Queen Victoria Jubilee Institute ; in Norway and Sweden by Red Cross nurses ; in Australia ("bush nursing") by a nationally organized associa- tion ; in Canada by the nurses of the Victorian Order, and to some extent by various groups in other foreign lands. In this country a pioneer rural nursing association was founded in 180G by Ellen ]\[. Wood, a Johns Hopkins nurse, in Westchester County, Xew York, where she volunteered nursing aid to the country people in her home community. Successful from the beginning, it grew until (by 1920) it had extended over some twenty villages. Miss Wood died abroad (1900) of typhoid fever, contracted on board ship while nursing a sailor smitten with the disease. After her death her name was given to the association. Another pioneer was Lydia Holman, a Philadelphia nurse, who, having visited the Kentucky mountains, made her home there for some years and carried on an individual service to the Southern Highlanders, living in a little cabin and l)eing supported mainly by the voluntary gifts of food materials brought by her patients. She was later able to develop the Lydia ^l. Holman Association (1911), her chief assistants being medical members of the Johns Hopkins L^niversity and Medical School. This association was, however, not pen-manent and had been dissolved before Red Cross plans for Rural Xursing had been made public.^ -Reports of tlio Holman Association. 1211 1212 HISTORY OF AMERICAN RED CROSS NURSING In 1905, when the Peace Conference following the Russo- Japanese War was held in Portsmouth, New Hampshire, the envoys of those countries made a gift of $20,000 to the State to be used for charitable purposes. Several persons then tried to have this gift used in establishing a State-wide system of rural nursing, but their efforts failed.^ The service carried on under the American Red Cross, first called The Rural Nursing Service, afterwards renamed "Town and Country Nursing Service," and still later the "Bureau of Public Health Nursing," had its inception in the mind of a woman especially distinguished for a combination of nursing talents with social gifts and creative energy. This was Lillian D. Wald, founder and leader of the well-known Henry Street Settlement in New York City, first called the Nurses' Settle- ment. A New York State woman, graduated from the New York Hospital Training School under Irene Sutliffe, Miss Wald's venture into a mode of life which combined visiting nursing with all the other interests of an ardent lover of humankind and a progressive citizen, has been made widely familiar through her book, "The House on Henry Street." In her long and remarkable service she has done more, perhaps, than any other one American woman to change the conven- tional form of visiting nursing into those varied civic and community efforts which she was the first to call "Public Health Nursing," thus enlarging Miss Nightingale's phrase "Health Nursing." Miss Wald has already been mentioned as one of the Red Cross members in New York State before the reorganization of 1904-11)05. It has heen shown that she gave assistance to the New York Auxiliary during the Spanish-American War, and afterwards remained faithful to the work of enrollment, yet she felt, and expressed, strong dissatisfaction at seeing so popular and potent an organization as the Red Cross limited to the uncertain and irregular service of relief in war or calamity. She reflected that both must in their nature be sporadic, and that if, in time of peace, there were no absorb- ing interests to hold the enthusiasm of members, they would fall away, and each emergency would need fresh reorganiza- tion. ^Moreover, it seemed to her wasteful to have a national, well-organized society periodically inactive. For(!ign Red ^"Flistory of Rural Nursing": Fannie F. Clement, American Journal of Cursing, April, 1913". Gray dross, cnpv and s(ra\v hai wdrii li>- AmcricaTi lu'd Crdss nurses. This unifdnn is also worn hy Aiiicrican lu-d Cross pulilic licallh nurses. FROM RURAL TO PUBLIC HEALTH NURSING 1213 Cross societies had to train and maintain their own nurses in time of peace, but in this country it was different. She con- ceived the idea that the Red Cross wouhl be the logical associa- tion to promote visiting nursing in rural districts and small scattered towns on a national scale, and early in 1908 she had an opportunity to bring her idea forward. There was in that year a meeting at Mayor George McClellan's house in New York City to promote tuberculosis camp work, which, follow- ing the International Red Cross resolution at the Convention held in England in 1907, was being taken up by the Red Cross societies of the different countries and states. Miss Wald spoke at that meeting and though she kept no copy of what she said, her plea was along the lines here indicated. It linked well with the anti-tuberculosis campaign in which the Red Cross societies were then ready to take a part, and though no immedi- ate result followed from her address that day, she, herself, waited only for another opportunity to press her point. An influential and generous member of the Board of Incorpo- rators of the American Red Cross was Jacob H. Schiff, one of Miss Wald's family's friends, and through him the following letter from her reached the annual Red Cross meeting in Wash- ington in December, 1910: My dear Mr. Sciiiff : ... It seems to mo particularly appropriate for the Red Cross society to undertake ultimately in America, an exten- sive and systematically organized service of nursing for the scattered dwellers in rural regions, such as we now find well developed in Great Britain and in Canada. In the older countries armies of trained nurses arc sent into remote coun- try regions to nurse, to educate, to bring scientific, advanced humanitarian and sanitary messages to the public. In America in a few sporadic instances only, are nursing care and protection against infection possible to the sick country person. After developing the day camp, why should not the liod Cross society undertake the organization of a vast, far- reaching sclieme of country nursing, getting such support and cooperation as may be possible from the dwellers in mountain, farming or lonely desert regions, coordinating and guiding all, and bringing tlie help of the nurse to scattered, isolated families. . . . There could be no larger or nobler work ])ossible to the Eed Cross soci(>ty of a country deilicatiMl to peace, nor could there be a more [)ractical way of enrolling under the IJeil Cross a 1214 HISTORY OF AMERICAN RED CROSS NURSING band of faithful and devoted workers held together between disasters for a universal need, an army ready to be enlisted for an extraordinary disaster. I very ardently hope that the National Ked Cross society will take up in serious manner the organization of a rural nursing system, that it be national in its scope. ... I believe that it would not be difficult to administer a service of this kind even on so large a scale. Headquarters might well be maintained in Washington and a traveling supervisor, a trained nurse [be employed], In addition to this traveling supervisor, there should be local supervisors and possibly county local chapters to supple- ment and keep in touch with the nurse or nurses. Support of the nursing organizations should come from the central organizations but money would be obtained from the bodies to be sent into the general treasury. . . . [There should be] affiliation . . . perhaps federation with all existing societies. This I think would not be difficult to accomplish as the country nursing associations now in exist- ence feel isolated and need the fellowship of similar bodies. At first it would seem a most difficult matter to obtain suitable women for this work. I believe this is not insur- mountable. The very existence of the association on so great a scale would stimulate the nurses in the training school. . . . It would probably develop that scholarships could be given to send specially fitted young women to the post-graduate course at Teachers (^ollege.^ This course was established largely for the purpose of equipping women to do work of this kind. . . . In my opinion, it would be much more desirable for the Eed Cross society to take up this work than it would be to organ- ize another national society, for reasons that are so obvious. I do not think the United States would need much stimidus, for I believe that the cause carries its own appeal. (Signed) Lillian D. Wald. The members present when this letter was read naturally could not decide so large a plan off-hand. The majority opinion was that enrollment and organization should be the chief object of concentration for some time longer, hut a sub- committee was appointed to talk the matter ov'cr with ^liss Wald. ISTo records were kept of its informal and intimate 'The post-firadiiate work at Teachers Colletie here mentioned had de- veloped broa(ily from its first plan "Institutional Manatrenient," but it had not yet undertaken preparation for "Rural Xursing." ED, FROM RURAL TO PUBLIC HEALTH NURSING 1215 conferences, but the results are evident in later papers. At the annual meeting in December (11)11) letters were read in- dicating that Mr. Jacob Schiff and Mrs. Whitelaw Ileid offered generous gifts to establish a fund for a rural health nursing service. Mr. Schiff ultimately promised that if rural nursing was practicable he would give the Red Cross an endowment in securities amounting to $100,000, the income to be used for the service. Until permanently established, he would give $5000 yearly. ^Irs. Keid promised an annuity of $1000 and later increased this sum to $2000. At the Executive Com- mittee meeting on December 14, Miss Boardman proposed a special committee with Miss Delano as chairman to make a study of the subject and report. On February 6, ^liss Delano made her report and the project for rural nursing was approved in principle and referred to the National Relief Board. A trial year was agreed upon. On November 1, 1912, Miss Fannie F. Clement was appointed superintendent. The year's work was successful. At 'its end a meeting was held in New York at Mrs. Whitelaw Reid's house, where the continuation of the Service was advised. The endowment was finally ac- cepted, and the Rural Nursing Service renamed and made permanent.^ ^[iss Delano made public mention of the new field at the American Nurses' Association meeting in Chicago, June, 1012. She then said : There is one pliai^c of the Red Cross work which scarcely conies in here, but ! would ask especially to present to you the possibility or the fact of our rural nursing service, which is soon to be organized and the possibility of the need of many nurses for positions in this service. ^lay 1 urge upon those of you who may contemplate taking up this work that at the earliest moment you jilace yourselves in line for some form of exj)erience in nursing of this kind. If this movement is estab- lished, we sliall need hundreds of nurses throughout the country. I cannot impress upon you too much the importance of carrying this work into the neglected communities; it is work tliat I am sure will be near the liearts of all of us. I'hose of you who may consider taking this up. please make arrangements as soon as possible to communicate with tlie * Red Cross Report, 191.3. See letter from the Secretary of War. traiismitt iii^r tliis Report to Congress. Document No. 1028, House of Rejjre^entat ives. 1216 HISTORY OF AMERICAN RED CROSS NURSING Eed Cross and place yourselves in line for experience and instruction.^ The Committee on Rural Nursing for the trial year, stood thus : Mabel T. Boardman, chairman ; Jane A. Delano, vice chairman ; Lillian D. Wald, ]\rrs. Whitelaw Reid, Mrs. Wil- liam K. Draper, Annie \V. Goodrich, John M. Glenn, Wick- liffe Rose, Dr. Winford Smith, Surgeon J. W. Schereschewsky, Public Health Service. Miss Clement, the chosen superintend- ent of Rural Nursing, was, of course, always present as an ex- officio member of the committee, and acted as its secretary, at first informally, then after a year or more by official appointment. The first meeting of the committee was held November 14, 1912, in Mr. Glenn's office in the Russell Sage Foundation Building, New York City, Miss Boardman in the chair. There were present: Mr. Rose, Miss Wald, Miss Delano, Miss Good- rich, Miss Clement, to w4iom the direction of the work was confided, and Mr. Glenn. The four nurses present were ap- pointed a sub-committee, of which Miss Delano was chairman, to draw up recommendations, and the next day they^ proposed as suitable qualifications for applicant nurses : 1. The existing requirements of the Red Cross for enrollment, omitting reference to age. 2. A course of four months (one-half an academic year) under supervision of a recognized Visiting Xurse Association. 3. Recommendation by such association. Tlie sub-committee also considered the financial basis, and for this they advised the development of scholarships and loan funds, suggesting that loans be made siifficient to cover the expenses of the special training, to be repaid on favorable terms and that a limited number of scholarships be ofi^ered. Their suggestions were adopted and the details, as will be set forth later, were agreed upon. At the annual Red Cross meeting (1012) ^[iss Delano said: Following a resolution passed at the last annual meeting, measures have Ijcen taken for the establishment of a Rural Nursing Service. The organization of this work has been placed under a special sub-committee of the National Relief ' Proc('('(lin;rs American Nurses' Assoeiation, 1912. FROM RURAL TO PUBLIC HEALTH NURSING 1217 Board, but it is hoped that the Nursing Service committees already in existence will render valuable assistance in secur- ing a personnel for Rural Nursing. A more extended report of this work will be given by Miss Fannie F. Clement, who has recently been appointed Superintendent of Rural Nursing.^ With such brevity of words and simple, direct action, a service was begun which led the way to a revolution in health conditions in our neglected country areas. In her iirst report ^liss Clement outlined the activities to be looked for as a result of the initial year's work, and empha- sized tiie stimulant effect upon educational standards that might be expected. She said in part: The Red Cross Rural Nursing Service is to be concerned with nursing the sick in rural communities, carrying instruc- tion along sanitary and humanitarian lines into the homes, and dealing with environment in a way to improve living conditions. It hopes to cooperate with all agencies dealing with questions of individual and public health and the many organizations that in the final analysis have a common object in view. The unlimited opportunities for humanitarian and educa- tional work to 1)6 found in rural communities will appeal to nurses who understand and enjoy country life and people, and who are interested in public health movements and social work. It is reasonable to expect that the result of such a standard of qualifications will not only assure the best prepared women for rural nursing, but will also influence the establishment of courses in public health work and social service in hospital training scliools wlierc such courses properly belong. Women who anticipate rural nursing will eventually look for their training to schools qualified to prepare tlicm to meet the re- quirements of the Red Cross for this work. The superintendent began at once to make a survey of all the nursing associations and (>ducational institutions of the country to ascertain where suitable supplementary training and experience in visiting nursing and related work might be obtained. This survey showed that, of all visiting nurse associations in the United States employing ihroo or more nurses (there were 'The Jird Cms!? Bulletin. January. 1913. 1218 HISTORY OF AMERICAN RED CROSS NURSING then about forty associations of that size), training centers where nurses could obtain preparation in public health nursing as deemed necessary by the Red Cross for rural work were few and far between. Only about six visiting nurse associa- tions offered a so-called course, and in most of those there was little class instruction. Circulars of information were prepared and widely dis- tributed, giving the scope and aims of the venture, and the organized nursing profession was directly appealed to. Miss Clement wrote : The Red Cross is dependent largely upon hospital training school superintendents to induce the right kind of women to enter the rural nursing field. Presidents of alumnse asso- ciations, officers of state, county and local nursing associa- tions, nurses' clubs and registries, and the members of Eed Cross committees are in a position to lend their influence to aid the Red Cross in its endeavor to build up its Rural Xurs- ing Service. It is important also that they do so if it is to succeed in fulfilling the purpose for which it has been organized. The call for public health workers must be sounded in every hospital training school, among nursing organizations, and educational institutions, and much remains to be accom- plished in providing special training for these workers, oppor- tunities for which are far too inadequate. . . . The Red Cross will meet the expense of organization and general supervision. In order to maintain a imiform stand- ard of nursing, all Red Cross rural nurses will be under the general direction and supervision of the superintendent. . . . For rural communities already alive to the advantages of visiting nursing which are looking for a nurse, for those which realize these advantages but need advice as to ways and means of support of a nurse, and for those regions where it will doubtless appear necessary to demonstrate more fully the need of one. the Red Cross Rural Xursing Service stands ready to furnish all possible assistance.^ At the end of the trial year (1913) the name "Rural Nursing Service" was changed to "The Town and Country Nursing Service" for reasons to be specified presently. The sub- committee on nursing then became the Town and Country Nursing Committee, and was enlarged to allow representation ''Red Cross Magazine, July, 1913. FROM RURAL TO PUBLIC HEALTH NURSING 1219 tipon it to the three national nursing associations, whose scope and titles have been mentioned in a former chapter. To the sub-committee as originally formed there were now added Miss Krueger (American Nurses' Association), Miss Nutting (National League of Nursing Education), and Miss Crandall (National Organization for Public Health Nursing). Thus complete coordination of these societies was brought about, as was essential for the solution of such pressing ques- tions as the establishment of new training centers and the ad- justment of relations with public health organizations and related bodies. Finally several valued members were added to the committee from the laity. The complete list follows: Town and Country Nursing Committee : Mrs. Whitelaw Reid, chairman Prof. Thomas N. Carver Jane A. Delano, vice-chairman Matliild Krueger Mabel T. Boardman Edna Foley Lillian D. Wald Mrs. Larz Anderson Mrs. William K. Draper Mrs, Willard Straight Annie W. Goodrich John !M. Glenn M. Adelaide Nutting Wickliffe Rose Ella P. Crandall Dr. Winford Smith Dr. J. W. Schereschewsky, P.H.S, To consider the conditions of affiliation with local organiza- tions, with power to act, there was a committee consisting of: Miss Boardman, chairman Miss Delano Miss Wald Miss Goodrich Finally, there was the Committee on Education : Miss Goodrich, chairman Miss Clement Mrs. Draper Miss Wald Miss Crandall The cooperation thus arrived at was of great significance, for the steady and unbroken growth of nursing organization had made American nurses a real power. Tt will be recalled that at the convention of 11)11, the Associated Ahnnua^ had broadened into the American Nurses' Association, in 1!)12 the SnjK'rintondent's Society had reorganizf^d on ampler lines to become the National League of Nursing Education, and within its membership and that of the American Nurs(M' Association 1220 HISTORY OF AMERICAN RED CROSS NURSING there had been formed the new and potential National Organi- zation for Public Health Nursing, with Miss Wald and Miss Crandall as its first president and secretary. This new body necessarily included many members of the laity, and because of its own vital energy and the demands of the times, promised to have a future of wide scope, while the League of Nursing Education now took" the key position of being the one united force responsible for guiding the adequate training of the nurse in manifold new lines. The delicate questions of coordi- nation opening before them were dealt with by Miss Wald in a letter to Mrs. Whitelaw Reid : December 2, 1913. We are in the position of which we have dreamed for years, of promoting and actually establishing nursing for the people throughout the country. I presume all of us are too experi- enced in the organization of great movements not to expect to make some mistakes, but I have the hope that this great movement for hitherto neglected people will be phenomenally free in this respect. I am tremendously interested in the two organizations recently established, this one and the National Organization for Public Health Nursing. Each has, in my judgment, a distinctive place and should interlock without overlapping. But there seems to have arisen some question of the latter and since the same people are interested in both organizations, that would appear to be avoidable. May I suggest that at the meeting in Washington, so far as possible, the scope of each may be definitely outlined. In my judgment, the National Organization for Public Health Nursing should maintain the purposes of its consti- tution. It is in some measure a mutual benefit society, wherein nurses and individuals and organizations that pro- mote the work of nurses may meet together for combined effort. The methods whereby their efforts may lead to mutual benefit are written into the constitution. . . . It is my hope that the supervision and the central control of the l^ed Cross society will be so obviously advantageous that gradually every rural and small community nurse will be enrolled under its organization,. I believe that it would be practical and statesmanlike for our committee of the Ped Cross to limit its work during its constructive period to the first object that it has set out to accomplish, namely, the promotion of interest in country nursing, and the establishment and supervision of nurses iu FROM RURAL TO PUBLIC HEALTH NURSING 1221 country communities and small towns. The difference be- tween the two societies, as 1 see it, is that the one is for edu- cation and mutual benefit, a union of workers and those inter- ested in their work, and the other administrative and super- visory. In my judgment it would seem that our Ked Cross Committee ought not to establish educational centers, but that it should send nurses who are to be' enrolled in Ked Cross work to the educational centers provided by other organiza- tions. It ought to be the business of Teachers College and the National Organization for Public Health Nursing to pro- mote these educational centers in the interest of public health nursing throughout the country. Should these agencies fail to provide proper educational facilities for the Eed Cross nurses, our society may eventually be obliged to organize such, but it seems to me that we are dissipating some of our strength by assuming functions which as yet we are not in a position to carry out efficiently. (Signed) Lillian D. Wald. The relationship between the National Organization for Public Health Xursing and the Town and Covuitry Service was defined at a committee meeting in March, 1914, in the following statement : The National Organization for Public Health Nursing is a general body, including in its membership persons engaged in all forms of public health nursing. It is concerned with de- veloping standards of ethics and technique, maintaining a central bureau of information and issuing regular and occa- sional publications. ... On the other hand the Red Cross has undertaken a specialized piece of work, namely, the or- ganization and administration of visiting nursing in towns and country districts, its efforts being directed toward the establishment of a personnel of visiting nurses especially qualified for this work. To this end it assists in the organiza- tion of local nursing associations and on the basis of affilia- tion assigns l^ed Cross visiting nurses to local organizations wishing to employ a Ped Cross visiting nurse. The Ped Cross Town and Country Nursing Service represents an effort to standardize visiting nursing in tlie towns and rural dis- tricts and to correlate the work of isolated nurses and nursing organizations under a central body as a means of strengthen- ing to the fullest possible degree their powers to meet most adequately the health needs of their communities. Bv mutual agreement, the promotion of interest and advice on all visit- ing nursing questions in small towns and rural comnninities 1222 HISTORY OF AMERICAN RED CROSS NURSING is deflected as far as possible by the National Organization for Public Health Nursing to the Red Cross. . . . The Na- tional Organization for Public Health Nursing does not maintain a nursing personnel as does the Red Cross, nor does it assume responsibility in the supervision of the work of visiting nurses. ... By reciprocal representation, it is made possible for either organization to hold intimate knowledge of the other's activities, and for the two to work together consistently to develop and maintain standards of visiting nursing technique to the ultimate benefit of both the nursing profession and the public at large. The energy with which Miss Clement and her small staff worked in those first months may be judged by lines taken from the brief records of May, 1913 : Nearly seven hundred letters enclosing bulletins on rural nursing have been sent to superintendents of all hospitals in the United States of fifty beds and over, asking them to inter- est pupils in rural nursing. A request has been sent to one hospital in every large city asking for addresses of local registries, and by this means one hundred and thirty-six nurses' clubs and registries have been informed upon the work. Circulars have been sent to over four hundred Red Cross nurses enrolled since 1912, to one hundred and sixty-seven members of state committees, and to the chairman of local committees, with the request to interest nurses. About four thousand, five hundred circulars all told have been distributed. Several articles on rural nursing have been published in the nursing journals and in one a course of instruction in visiting nursing has been advertised.^ The records of January 1, 1914, show the following- figures and give the action of committees on points coming before them: No. of associations affiliated 14 Applications from nurses received 120 No. of nur.^es appointed IG Applications rejected 2G Preparatory courses arranged for nurses 15 " Minutes of To\'n and Corintrv Xursing Sprvicp Conimittop, Mav 5, 1013. FROM RURAL TO PUBLIC HEALTH NURSING 1223 Courses completed 8 Courses discontinued before completion 2 Nurses still in training, Jan. 1, 1914 5 Applications pending 10 Eligible for appointment (not including those ap- pointed ) 19 Eligible for preparatory courses 27 Scholarships granted 3 Amount of money expended in scholarships. .$350.00 Loans made to nurses 4 Amount of money loaned 199.00 Supervisory visits 5 By that time the question of affiliation with State boards of health had come up twice. It was talked over at the January meeting of the Town and Country N^ursing Com- mittee (1914) and it was agreed that the demands which would inevitably come through such extensive affiliation could not yet be met. The Committee on Education then framed the following resolution : This committee recommends that the Town and Country Xursing Service concentrate its effort for the present within a comparatively small area, ratlicr than to undertake work in widely scattered districts, where proper supervision and de- velopment are practically impossible. On ^farch 2, 1014, increased scope was given to the Com- mittee on Education by enlarging its functions to include questions of (1) Organization, (2) Administration, (3) Affiliation. The committee thereupon handed in on ^^larch 9, 1914, these recommendations: 1. That for the present, women of high school education be given ])refercnce, and that two years of high school be re- quired. 2. That as soon as possible, full high school education be made a prerequisite. 3. That for the present every candidate be obliged to take at least four months' training, except in cases of exceptional women, who might be required to take only theory, allow- ing their former experience to serve as equivalent for field work included in such course. 1224 HISTORY OF AMERICAN RED CROSS NURSING The end of 1914 showed figures and statistics of a work as yet only in its incipiency. Alone, these figures express little, but are striking in comparison with later statistics and are valuable as showing the very beginnings, always the records most easily lost in historical files: December 8, 1914 Loans No. Amoujit Loans granted previous to December 1, 1913 3 $ 199.00 Loans granted Dec. 1, 1913, to Dec. 1, 1914 13 1,900.00 Total $2,099.00 Scholarsliips Scholarships granted previous to Dec. 1, 1913 3 $ 350.00 Scholarships granted Dec. 1, 1913, to Dec. 1, 1914 1 200.00 Total $ 550.00 Exhibit Eequests for exhibit 10 Granted 6 Nurses Total number of nurses appointed Dec. 1, 1913 13 Js'urses appointed Dec. 1, 1913, to Dec. 1, 1914 33 Total appointments since organizations of service 46 Appointed nurses receiving preparation under direction of Eed Cross 7 The exliibit referred to in this report was the first one pre- pared for use by the Town and Country Xursing Service, and after being shown at the International Dry-Farming Congress in Tulsa, Oklahoma, it was taken to the nurses' convention at St. Louis. It was intended for use at conventions and in small communities that were considering public health nursing, as it portrayed in a simple way, by cliarts and photographs, the daily work of the lied Cross visiting inirse. A special exhibit on Town and Country Xursing Service was next prepared for the World's Fair in San Francisco (1915). For til is a certificate and bronze medal were awarded. Another form of educational work of that year was the travel- ing library put into circulation on August 3, 1914. Four months after its foundation it had fiftv-five books with an aver- FROM RURAL TO PUBLIC HEALTH NURSING 1225 age daily circulation of fourteen. It grew in usefulness and in dimensions until early in April, 1020, when it was discon- tinued by reason of the very extensive and thorough plans of the National Organization for Public Health Nursing for pro- viding special sources of reference in at least one public library in every state. The committee work of 1914 was full of planning and preparation ; the results of much of this will be met in detail in subsequent pages. The pressing need for more centers which would offer courses in preparation for the Town and Country Nursing Service was continually dealt with, and a great part of the labor of those early months consisted in correspondence with schools and training leaders all over the country. Several visiting nurse associations were opening their fields of work for practical use, but it was essential that theory, properly presented, should be combined with the practical work. How this problem was met will be told presently. For the help and interest of affiliated groups as well as for communication between the nurses, the first leaflet, called ''The Red Cross Visiting Nurse," was issued on April 12, 1915. "In order" [it said editorially] "that members of the Town and Country Nursing Service as well as affiliated organizations may become acquainted ... to keep the nurse and affiliated organizations informed . . . every member . . . and every affiliated organization is invited to become a contributing Editor . . ." It was issued several times in multigraphed form, and in September, 1915, it expanded into a printed leaflet, published at the discretion of the superintendent, not at fixed periods. This little bulletin was presently named "The Town and Country Nursing Service" and appeared at intervals until December, 1918, when it was discontinued. The National Rod Cross and the various Divisions had mean- while adopted a similar form for their Bulletins. In January, 1920, the service began publishing a department in "The Public Healtli Nurse!" organ of the N. O. P. 11. N., under the title "Red Cross Public Health Nursing." By 1914 tlie organizations affiliating with Red Cross Rural Nursing were of a varied nature Red Cross Chapters, wom- en's clubs, health and w(>lfare societies. Associated Charities, visiting nurse associations and corp(u-ations, while their locations brouaht the Red Cross Town and Countrv nurse into 1226 HISTORY OF AMERICAN RED CROSS NURSING Alabama, Arizona, Connecticut, Illinois, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New York, Ohio, Penn- sylvania, South Carolina, Virginia, West Virginia and Wis- consin, thirty-eight in all, the first nurse having received her appointment in July, 1913, to an Ohio village, Cuyahoga Falls. The second one went to Warrenton, Virginia. The human side, which, after organization has been per- fected is ever the all-important side of the work, may be best shown in the graphic reports, narratives and appeals of the nurses engaged in the service. For a comprehensive impres- sion of the chief events as they occurred in the early years the following material has been selected from the reports made by Miss Clement to her committee: . , . The effort to begin rural nursing in Laurel, Mary- land, first brought up the question of Eed Cross cooperation with the Metropolitan Life Insurance Company. This cor- poration had on the suggestion of Miss Wald already devel- oped an extensive visiting nurse service for its industrial policy holders. An agreement was finally concluded with it by the Eed Cross in May, 1913, of which the most essential provision was this : "The Eed Cross is prepared to make an arrangement with the Metropolitan Life Insurance Company in providing nursing care for its industrial policy holders through the Eed Cross Eural Nursing Service, this arrangement to include the official endorsement by the Metropolitan Life Insurance Com- pany of regulations for rural nurses authorized by the Eed Cross." The Eussell Sage Foundation, through its Southern Higli- lands Department, was instrumental in bringing about co- operation with the Eed Cross in the southern mountains, and early in 1913 before any affiliations with the new Service were made, the superintendent of nurses under the auspices of that department visited five counties in the Kentucky moun- tains, stopping at the various denominational schools and learning of opportunities for introducing Eed Cross nursing. The Eural Organization Service of the Department of Agriculture cooperated with the Eed Cross in 1914. It was among the early organizations to appreciate the part public health nursing was to play in the development of rural life, and in its local demonstration work a group was organized in Chilton County, Alabama, to have charge of a county nursing FROM RURAL TO PUBLIC HEALTH NURSING 1227 system, the first in the state. The committee, constituting as it did one of the very earliest examples of cooperation be- tween public and private interests, is worthy of special note. The lied Cross nurse appointed in March, 1914, was respon- sible to a county health committee on which served the county health otlicer, the county superintendent of schools, the county agent of the Farmers' Union and a representative of a leading woman's club. Expenses were met by an appro- priation of $500 from the county board, $500 from the school board, and $500 from private sources. ... In Alabama there are "beats," territorial divisions which include several school districts. A county improvement association with branches in each beat, under a "beat man- ager," has been organized, each beat subdivided into school districts where a superintendent is head of a small group. . . . Industrial nursing early came within the scope of the Town and Country Nursing Service. While a number of the nurses worked in manufacturing towns or villages they were not invariably emi)loyed by an industrial concern. The Xew Jersey Zinc Company as early as April, 1914, sought Red Cross affiliation. This company for many years has carried on welfare work successfully and when its work extended, a Red Cross nurse was assigned to Palmerton, Pennsylvania. Franklin, Xew Jersey, where the smelter of this com])any was located, employed a Red Cross nurse in June of tlie same year and a nurse was sent to its mining section in (Jilman, Colorado, in 1917. In 1913, through the generosity of a member of the Com- mittee of the Rural Xursing Service, a nurse was appointed to organize a nursing association in Hazard, a rapidly growing railroad town in the Kentucky mountains. This first effort did not stimulate local support as was anticipated, but when the work was started again in May, 1914, the town contributed toward the nurse's salary and the work continued for a year, during which time a valuable demonstration was made as to what put)li(' health nursing may mean to this and otiier moun- tain sections. Tn six months' time the nurse examined all the school children, and found in one small village that seven per cent of the children had trachoma. . . . Tiirough her efforts the state law excluding such cases from the schools became for the first time effective in that part of the state. The Bureau of Rural Sanitation of the Virginia State Board of Ilealtli, administering funds of the Rockefeller 1228 HISTORY OF AMERICAN RED CROSS NURSING Foundation, employed a Red Cross nurse to work in the Eagged Mountain section of the Virginia mountains. The physicians who had made the initial survey and administered treatment for hookworm disease had left, and it was the plan to put nurses in the field for follow-up work, teaching prac- tical sanitation from home to home and working under the county health officer in giving further treatment for hook- worm. This was a new departure in public health nursing and a promising one, but the funds were withdrawn by the Rockefeller Commission for other purposes, and after several successful months this work was discontinued. In a South Carolina community a unique phase of the work of one of the Red Cross visiting nurses has resulted from her appointment, amongst various other duties, as sanitary in- spector of washerwomen. Since last March, such workers have been required by law to hold permits. Over seven hundred have applied for permits, and the living and working condi- tions of over half of them have already been investigated, and permits granted by the nurse. The first appointment west of the Mississippi was made in October, 191-i, to a typical mining community in Arizona. This represents a pioneer work, for the nurse was the first in the state who had had special training in public health nurs- ing. To the credit of the group responsible for this work in Jerome, it may be said that in order to obtain a nurse thus qualified they volunteered to pay her traveling expenses across the continent. Success in developing her school nursing and general community service played an important part in the extension of public health nursing in Arizona as was fre- quently attested by the State board of health and State medical authorities. The Red Cross visiting nurse in Wisconsin is developing school work particularly, inspecting children in public and parochial schools. After examining several hundred children she found that many had spinal curvature. This condition was reported to the school authorities, who will remedy the faulty seating and desk arrangements. The defective eyesiglit and hearing, throat troubles, skin and teeth conditions brought to light give convincing evidence of the need of close supervision of the physical well-being of children. Wherever school nurses are employed communities are pretty generally aroused to this fact. Teachers, and parents appreciative of results, are usuallv m.ost grateful for the attention given the FROM RURAL TO PUBLIC HEALTH NURSING 1229 children by the nurse. She has also been asked to give talks on hy alxAc cpialifications may be made with the approval of the committee in charge. 1236 HISTORY OF AMERICAN RED CROSS NURSING A four months' course with selected visiting nursing asso- ciations is arranged by the Red Cross for nurses who have not had this preliminary training. Where possible, one month of this period will be spent with a visiting nursing association in the country. These requirements had been agreed upon at a meeting of the Committee on Rural Nursing Service, held on December 10, 1912. One year later (December 9, 1913) they were reissued with the added proviso, moved by !Miss Delano and voted affir- matively by the committee, that enrollment with the Red Cross Xursing Service should be made one of the requirements for appointment to the Rural, by that time renamed the Town and Country, Xursing Service. A number of exceptions to the regulations for general enroll- ment were then found to be necessary for the admission of nurses to the Town and Country Nursing Service. Such were allowed as to the age limit, uniform, and other details In 1914 some stiffening of the requirements was agreed upon. To the general hospital regulation it was now stipulated, as already specified in t^he regulations for enrollment, that such training must have included the care of men. The applicants' school record was taken up for discussion, and the subcommittee on education recommended (October 18, 1914) that two years of high school or its equivalent be required for appointment to the Town and Country Nursing Service until October, 1916, after which a high school diploma or an equivalent to a full high school course, be required. ^^ The standard thus set seemed feasible in view of the aca- demic ratings of the thirty-five nurses in active service, namely : Common school 8 High school, one year 3 High school, two years 2 High school, graduate 7 (generally 3 yr. course) High school, equivalent 3 In "doubt 8 College, two years 2 College, graduate 1 Having these figures and the unanimous recommendation in favor of high school i-e(|U!re]iiciit of the supervising nurses of "Minutes T. & C. X. S.: Dec. 8. 1914. FROM RURAL TO PUBLIC HEALTH NURSING 1237 the Metropolitan Life Insurance Company, with which the service was cooperating, the Committee on Education voted unanimously to establish this standard as recommended, and at a meeting of the whole committee (March 18, 1915) the step was endorsed, one vote only being cast in the negative. At the same meeting the committee discussed the possibility that the special training might come to be included in the training school period, and with this in mind it was moved by !Mrs. Draper and seconded by ^liss Wald that the following resolu- tion be sent to the Committee on Education of the League of Nursing Education : Inasmuch as tlie Town and Country Xursing Service can- not meet the increasing demands of comnmnities for nurses, the committee calls to tlie attention of the National League of Xursing Education the advisability of including in the training school curriculum a s])ecial course fitting the nurses for this public health service, the Ked Cross recognizing that even to require a minimum of four months postgraduate work is asking a great deal of the nurse after a regular three years' course.^- In the meantime, while waiting and hoping for the training schools for nurses to act on the resolution, though the regulation for four months special postgraduate training still obtained, the committee I'ccomnieuded that student nurses be encouraged to take the more thorough preparation offered in the several eight months courses then developing. This policy was fol- lowed, even though its adoption by reducing the number of training centers to which applicants for the service could be referred, made more difficult the work at H(>adquarters in try- ing to meet the demands upon it. In lOlH, with the pressure of war problems then arising, the decision regarding high school was reconsidered, and temporarily discontinued as shown in the following rcccu-d : Of the sixty-nine nurses m the sorvieo. twelve have had a grammar S(h()(d education only, twcnfy-three one year hiirh school or less tluin two. twenty-one have had fwo or three years of high school in advance of grammar sclinol. and thir- teen liave had four vears' high school or more. It was move(l by ^liss Crandall and seconded hy Airs. Draper that the high "Ariiuitcs T. c^ C. \. S.: ^farch IS. 1015. 1238 HISTORY OF AMERICAN RED CROSS NURSING school requirement be suspended, but that the question come up for action a year hence. This was voted.^' The leaflet of information for applicants, published March 21, 1917, announced the final action on the high school requirement : A minimum of two years' high school education or its equivalent is required. Study and experience subsequent to schooling will be taken into consideration when determining an equivalent.^* In the same leaflet, candidates for the Town and Country Xursing Service were required to have "attended schools of nursing which included in their courses both theory and prac- tice in obstetrics and the care of children." This, as all nurses know, meant post-graduate training for many, as it was then by no means universal, even in general hospitals, to find these two branches provided. This new requirement of the Red Cross undoubtedly stimulated greatly that process of "affilia- tion" between hospital nursing schools which was designed to afford every pupil training in these and other important spe- cialties. Another requirement of a different kind met with in 1917 was this: A knowledge of driving or riding horses, and more fre- quently the use of an automobile is necessary. In 1918 attention was drawn to the personal equation: The fact that a nurse meets the educational qualifica- tions and the professional requirements as well, is not suffi- cient to secure lier acceptance and assignment by the Bureau of Public Health Xursing. Personality and the ability to manage difficult situations and to carry responsibilities will also be considered. Regulations of 1917 and 1918 said: Certain visiting nurse associations and educational institu- tions accept as students for a four or eight months' course nurses who wish to prepare for the Town and Country Nurs- ing Service, and who, though otherwise eligible have not had "Minutes T. & C. N. S.: December 12, 1916. "A. R. C. 150, March, 1917. FROM RURAL TO PUBLIC HEALTH NURSING 1239 training or experience in public health nursing. It is ex- pected that their preparation will include several weeks with a rural nurse in order that they may come in direct contact with rural social problems before assuming responsibility in work of their own. The requirements of 1920 for general enrollment were these: Nursing Education. The applicant must be a graduate of a school for nurses giving at least a two-years' course of training in a general hospital which includes the care of men and has a daily aver- age of at least fifty patients during the applicant's training period. Graduates of hospitals for the insane are not eligible for enrollment unless their experience includes at least nine months' training in a general hospital, either during their course of training or subsequent thereto. Subsequent post- graduate training or hospital experience which supplements deficiencies of training may be accepted as an equivalent by the National Committee upon recommendation of a Local Committee on Red Cross Nursing Service. Registration. In states where registration is provided for by law, the nurse applying for enrollment in the Red Cross must be registered. Age Limit. Applicants must be at least twenty-one and not over forty- five years of age. Exceptions to this requirement may be made by the Red Cross for those enrolling for public health nurs- ing and other special Red Cross service. Physical Examination. A physical examination certificate must be filed with the enrollment application. Immunization against typhoid, para- typhoid and smallpox is also required when an applicant is enrolling for services of a nature which renders such pre- cautionary measures desirable. Blank forms will be supplied for this purpose and the jihysical examination and immuniza- tion treatment will be given without expense to nurses by a physician designated or provided by tlie Nursing Service. Enrollment for public health nursing carried these require- ments (1020) : 1240 HISTORY OF AMERICAN RED CROSS NURSING Applicants must have had at least two years' high school education or its equivalent and must have attended schools of nursing which include in their courses both theory and prac- tice in obstetrics and the care of children. Special training or experience in public health nursing may be accepted by the Red Cross to supplement deficiencies in hospital training. In addition, applicants must have had not less than eight months' experience on the staff of a recognized public health nursing association under a supervising nurse, or not less than a four months' course in public health nursing in a school acceptable to the Red Cross Bureau of Public Health Nursing. Exceptions to these requirements should be taken up with the Division Director of Public Health Nursing and such applications will be considered on their merits. The fact that a nurse meets the educational qualifications and the pro- fessional requirements as Avell is not sufficient to secure her acceptance and assignment by the Bureau of Public Health Nursing. Personality and the ability to manage difficult situations and to carry responsibilities will also be considered. While the minimum requirement of the Red Cross for pre- paratory training is a four months' course, including both theoretical and practical work, experience in the past few years has demonstrated the advantages of nurses having even longer preparation for public health nursing in the smaller communities, where the responsibilities devolving upon the nurse working alone are considerable. There is, in addition, a great demand for nurses who have had a more thorough preparation. The four months' course may be supplemented by theoretical work, such as given in the six weeks' summer course at Teachers College, Columbia University, New York City, and by other special courses offered by this and other educational institutions. In addition to academic training, eight months' courses, including experience in school nursing, pre-natal and infant welfare work, tul)erculosis and industrial nursing, and other branches of pu1)lic Iiealth nursing may be obtained in Bos- ton, New York, Cleveland, and other sections of the country. There are a number of universities or schools offering post- graduate courses in public health nursing which are accept- able to the Red Cross. ^^ A later and briefer statement shows that the hope of having public health training included in the regular hospital had not been realized. Tt is, in fact, often not practicable, and still oftcncr even impossible. "A. R. C. 703, Revised, Jiilv 15, 1920. FROM RURAL TO PUBLIC HEALTH NURSING 1241 Public health nursing is a highly developed form of nurs- ing, preparation for which is not included ordinarily in the training school curriculum. It is necessary, therefore, for the nurse who wishes to be successful in this iield to undertake a postgraduate course or to secure her training through super- vised experience under the direction of a public health nurse instructor.^^ During the winter of 1912 and 1913 letters of inquiry were tent bv Miss Clement to forty Visiting Nurse Associations to learn what course of post-graduate instruction might be oifered by them, and what possibility of cooperation there might be in the special training of rural nurses, lieplics were received from twenty-six, and arrangements were made by the Red Cross with several, next to be mentioned, whereby applicants who had not yet had suitable experience and who in other re- spects were qualified, should receive a short course in public health nursing. None of these associations charged tuition. Three of them gave a salary during the special training. Out- lines of the available courses were typed by the Red Cross for distribution, and their important details are given below. Many minor points covering uniform, expenses, etc., have been omit- ted as unessential. The Instructive District Nursing Association, Boston.^' In response to the increasing demand of the public for nurses qualified for positions in public hoaltli work this asso- ciation oll'ors to nurses of recognized hospitals a post-graduate course of four months in public health nursing. This course is designed to give a basis for any field or social work where nurses are in demand. Tiie variety of field work, lecture? and class discussion, shows the relation of nursing to other social activities. Field work consists in nursing the patients under the care of the Instructive District Xursing Association, in preventive work for babies, in work with the Boston Asso- ciated Charities, and in tiio observation of the work of several Boston charities. Three courses deal with the following sub- jects for which reading is required: I. History, principles and administration of public health nursing. This includes tlie origin of district nursing, its purposes, j)rinciples, and methods, records and record kcc])ing, organiza- "A. R. C. 71.'). Kcvisod. .\iijrnst 1. l!t-20. "This association liad hocii tlie lirst to otfcr puHt-uradiiatc traijiing in I)uiiiic licnlll' luiisin;:. It had taken tliis >.tc|) in llMiti. 1242 HISTORY OF AMERICAN RED CROSS NURSING tion, administration and reports; the development of school nursing, preventive work for babies, tuberculosis nursing, welfare work in shops and factories, hospital social service and rural nursing. Opportunity is given to observe these various branches of nursing. II. Medical and social relations of disease. What can be done towards prevention as well as treatment of infant mortality, tuberculosis, alcoholism, venereal disease, neurasthenia and occupational diseases. Proper nutrition of families is considered. III. Elements of sociology and social progress. a. Introduction to the social field with special reference to the life of the industrial city family, to get a sympathetic un- derstanding of their lives, their health, education, recreation, labor, politics, religion, ethics, and ideals. b. Social progress as to health, education, recreation, etc., considering what other agencies are doing and how nurses can best cooperate with them. Henry Street Settlement, ]^ew York City. The Henry Street Settlement offers a three months' course in public health nursing. . . . Each nurse is assigned to one of the regular Settlement districts, for which she becomes directly responsible. She is expected to assume the nursing of the patients in her district with the same care and enthusiasm that would be shown if she were to remain permanently. In her district or field work, she is under the careful guidance and instruction of her head nurse and supervisor. Class instruction is given once a week. A talk upon a given subject on one week is followed on the next by a visit of in- spection to some institution, this visit being intended to illus- trate the talk. Tlie following outlines represent one of the courses cover- ing three months. Lesson I. Observation. Inspection of Ellis Island. Lesson II. Talk, Public Health Nursing in New York City. Lesson III. Talk. Babies' Welfare Associations. After the lecture, class visits the Settlement l\[ilk Koom. Lesson IV. Talk. Social Service Bureau of Mt. Sinai Hospital. Lesson Y. Stafl' ^Eeeting. (a) Welcome, by I>illian D. Wald. (b) Organization of the Public Health Xursiiuj As- sociation in the United States, Ella P. Crandall, secretary. JHOM RURAL TO PUBLIC HEALTH NURSING 124,3 Lesson VI. The Public School Nurse. Lesson VII. Observation. School nursing in one of the Public Schools. Lesson VIII, Symposium on Settlements by members of the staff living in various Settlements in the city. Lesson IX. Staff Meeting. Talk : New York's Milk Sup- ply. (Lantern Illustrations.) Lesson X. Observation, (a) 79th St. Branch of the Henry Street Settlement; (b) East Side House Settlemeni;. Lesson XI. Talk, (a) Institutions for the care of tuber- culosis patients; (b) Convalescent care. Lesson XII. Observations. The Rest; Grand View on the Hudson (Convalescent Home of the Settlement). Visiting Nurse Association, Chicago, Illinois. The Chicago Visiting Nurse Association gives a three months' course, covering the various branches of public health nursing. Personal attention is given by the super- visor. Weekly meetings are held at the office and daily meet- ings at the sub-stations. Detroit Visiting Nurse Association, Detroit, Michigan. The District Association provides a course of three months, giving the advantage of observation in the several districts with various types of populations, in five dispensaries where Association nurses serve, in the baby welfare field, in tuber- culosis work including an open air school, one county and two city sanatoria and in the summer home for mothers and children at Bay Court. Through the Board of Health nurses get in touch with the work of the school nurses. Practical teaching in the homes will be given chiefly by the senior nurse. Nurses are expected to do general nursing, giving half time to field work. Eichmond Instructive Visiting Nurse Association, Richmond, Virginia. The Richmond Association provides a three months' course or longer with field work under supervision of the Associa- tion. Experience will be given with the staff of nurses doing instructive work in the infant mortality and tuberculosis field, also experience with the medical and sanitary inspec- tors of the citv. 124-4. HISTORY OF AMERICAN RED CROSS NURSING District Nursing Association, Buffalo, New York. A six months' course for graduate nurses is provided by the District Nursing Association of Buffalo, New York, giv- ing the first months' training in office experience, followed b}' practical field work under a supervisor for four months, changing districts and nationalities, A three months' course is also given. Through cooperation with the Board of Health experience with the school nurses and tuberculosis nurses is provided. The baby welfare nurses are under the Nursing Association, and experience in this field will be included in a course. Nurses will be given opportunity to attend weekly conferences by the Associated Charities. Weekly lectures are given on such subjects as the follow- ing: Friendly Visiting; Principles of Organized Charity; County Poor Department; Children's Aid and Care; Health Department; School Nursing and Child Hygiene, Children's Court ; Truant School ; Probation System ; Crippled Chil- dren's Guild; Settlement Work; District Nursing and Social Service Work. Visiting Nurses' Settlement, Orange, New Jersey. This association provides a three months' course to in- clude lectures on social and nursing work, classes in cooking and general instruction in visiting nnrsing. In classes for the baby clinic instruction is given by a physician. District Nursing Association, Concord, New Hampshire. The association provides a three months' course. Experi- ence is provided in connection with courses taken in Chicago, 111.. Concord, New Hampshire, and Eichmond, Virginia. It is the intention of the Ped Cross to provide at least one month's experience in rural nursing for all nurses who have completed a three months' course with a city organization. Experience in rural work will be provided by the District Nursing Association of Northern Westchester County, New York, and the Nursing Association in Ilagerstown, Maryland. As other associations will be utilized by the Ped Cross as training centers for its rural nurses, the foregoing outline is subject to additions at any time. It is hoped that at least one association in every state may become a training center for Ped Cross nurses in city and country. Those schedul(>s have been repeated in detail because as pioneer efforts of great sincerity and altruism they deserve FROM UUllxVL TO PUBLIC HEALTH NURSING 1245 recognition, and also bocauso historically tlioy will sorvc to measure progress. Even a few years after their origin, the broadening and enriching of their teaching work was marked, in the ease of those associations that continued to teach. The Henrv Street Settlement, for example, in afiiliation with Teach- ers College, gi'ew to the stature of an eminent educational center. None would now, at time of writing, use the term "course" in connection with their carefully planned field work and instruction, but however they may expand no finer spirit of service can they show than that of their early and eager service. As other opportunities w-ere opened some of the pioneers felt relieved of responsibility. Soon after these schedules had been published twenty-four nurses had been assigned ; twelve to Henry Street Settlement, New York ; five to the Ilichmond Association, five to Boston, and one to Chicago. This type of preparation through apprenticeships continued for several years (1!)12-1015), gradually giving way to "courses'' of a more genuinely educational character given by universities and colleges. Not content with simply recommending the existing special courses to its applicants, the Committee on Education, at an early moment, had gone thoroughly into the subject of prepar- ing its own minimum standardized schedules of post-graduate work for the help of training centers. As early as 1914 requests had come from several colleges in the South and West for outlines of courses for Rural Nurses, and tentative sugges- tions had been submitted in reply. The demand for schedules for suitable courses grew to be insistent, and this at a time when it was difficult even for the leaders in nursing education to formulate the mininuim requirements of post-graduate study to fit nurses for this new and rapidly developing field of service. The field itself seemed daily to disclose broader horizons, reach- ing far beyond those that the ordinary training of nurses had equipped them to meet. To crowd specialized instruction into a four months' post-gTaduate course soon proved unsatisfactory to the centers trying this method, as well as a severe tax upon the student, and yet while the Town and Country Nursing Service felt early and keenly the need for d(>tinite courses as the only sure foundation for the proper develojuiient of its work, its recoinineiulations were, of course, subject to the de- cision of educators. I'herefore, while tentative outlines wcvo 1246 HISTORY OF AMERICAN RED CROSS NURSING sent out by the Red Cross previous to 1915, it was not until March of that year that it definitely sanctioned an outline, and that was for an eight months' course only. The early outlines, always tentative, were agreed upon by the Committee on Nursing, in two forms : one, the minimum for a four months' course ; the second, for an eight months' course. ^^ They were sent, always with emphasis laid upon the longer one, to the various groups of institutions which subse- quently established training centers. An active correspondence was conducted from Headquarters on the proposed courses, and a general propaganda was carried on, including personal visits to a number of cities. The propaganda was of considerable magnitude, and it may be justly held that the influence of the Red Cross in thus promoting opportunities for advanced train- ing in public health work was very gTcat and constituted the first efforts at standardizing such courses. Miss Clement said of that period: The education of the rural nurse was of such vital impor- tance in the early days of the service, that our struggle to locate opportunities for obtaining it never ceased. Our out- line of the four months' course was prepared at the time when we first began to insist that a "course" must include academic training and not experience alone. The proposal of a training center to be established by the Red Cross itself, came up be- fore the committees on Town and Conntry Nursing Service, but it was generally agreed that teaching was the duty of strictly educational institutions and should be left to them. The outlines of those earliest tentative schedules drawn up by the Committee on Education are here given: The minimum training period in preparation for Red Cross visiting nursing is four months, a])proxi]nately eighteen weeks. It should include class instruction, lectures and visits for observation, together with practical work in connection with well organized public health nursing agencies in city and country. The academic work of a four or eight mouths' course given in counection with a uuiversity or other educatioual institu- tion must be in charge of a teacher nurse well grounded in the principles and technique of public health nursing. This part of the course, consisting of class instruction and lectures, should occupy five or six hours weekly. Additional time should be allowed for visits of observation. " Annual Meeting, Committee on Xursing, December, 1913. FROM RURAL TO PUBLIC HEALTH NURSING 124-7 Four ^Months' Course L Public health nursiiif; (three hours weekly) to he given by nurse. History, development, principles, equipment, technique, nursing care, surgical nursing, medical nursing, nursing of chronics, nursing of children, nursing of infants, maternities, insurance and industrial nursing, emergencies, free medical service, relief and cooperation, fees, gifts and other related subjects, household hygiene and dietaries, clerical work. II. Hygiene and Sanitation. (Two hours weekly.) A general survey of priiuipal health problems of a modern municipality and rural district. The fundamental ]trinciplcs of sanitary science, their ap- plication to water supply and milk supply and to the disposal of sewage and garbage. Air supply, problems of tenement and factory sanitation, functions and methods of boards of health. The use of vital statistics as an index of health conditions. III. Practical Sociology (one hour weekly). This course should be designed to suggest, with such class discussion as the limited time permits, the important and significant phases of the social treatment of families and indi- viduals. It shoidd include the making of an investigation, keeping of records, recognition of the normal standard of living, enforcement of ordinary family and social obligations, utilization of one's experience with individuals and families in distress as a contribution to movements for prevention and social protection, and other common elements in these various kinds of social work. Pcading and special topics for study might be included. Field Instruction. . . . The field nursing in its various branches must be under close supervision of experienced visiting nurses. It is im- perative that general visiting nursing, school nursing, tuber- culosis and infant welfare work should be well organized in the city where the course is offered. During the course stu- dent nurses should be given opportunity to learn of board of health activities, what public institutions exist for relief, and the laws relating to health, education and employment of men. women and children. They -"hould attend Associated Charities conferences, where the relief work is well organized and learn of the office routine, methods of family treatment. record kee])ing and use of the contidential cxcliaiiire. If a well-organ i zed social service department of a hospital is available, the nurses should visit and learn of it< procedure. 1248 HISTORY OF AMERICAN RED CROSS NURSING Visits for observation to various other social agencies might' be inchided. Of the fifteen weeks' work spent in the city, eleven might be given to general visiting nursing of surgical, medical, ma- ternity and infectious cases, special attention being given to asepsis, use of household utensils, disposal of used dressings, ventilation, care of room, diet, medication, provision for care between nurses' visits, disinfection, sick room comforts, baths, provision for care of family during illness of a parent, isola- tion and quarantine precaution, treatment of family problems, cooperation with other agencies, special branches, two weeks in the schools, one week in tuberculosis and contagious nurs- ing, and one in infant welfare work. Record keeping in the various branches of public health nursing should be a subject of special study. If experience in these branches is included in the general work of a visiting nurse association, corre- sponding allowance should be made in the amount of time devoted for special work in each branch. The last three weeks should be spent in a rural community, if possible where school nursing is carried on, and where the nurse has developed classes or clubs for young persons, or- ganized mothers' conferences or has been instrumental in de- veloping other forms of social work. It would be well for the nurse to attend a meeting of the local visiting nurse associa- tion and to have explained to her the form of organization, duties of committee and methods of financing the work, that she might understand the problems from that side. Eight Months' Course I. Public health nursing (see I under four months' course) "^J^hree hours weekly. II. Nutrition Two hours weekly. A non-technical study of the functions and nutritive values of foods, the feeding of families and larger groups with par- ticular reference to nutritive requirements and the cost of food in relation to the family budget. III. Elements of psychology and their application to nurs- ing problems Two liours weekly. IV. Preventive Medicine Two hours weekly. ^Methods of application by nurses of modern scientific medi- cal knowledge in the prevention of disease; the causes of in- fant mortality, tuberculosis and the more prevalent communi- cable diseases; alcoholism, feeble-mindedness, insanity, etc., and available measures for prevention and methods of care. V. Hygiene and Sanitation Two hours weekly. (See n under "Four months' course."') IKOM RURAL TO PUBLIC HEALTH NURSING 1249 VI. Modern Social Problems Two hours weekly. An introduction to the study of modern social problems and their relations. Such topics as the following: Adjustments made necessary by changes affecting the fam- ily, property and freedom of contract ; the demands for better protection of personal rights in contrast to property rights, emphasized by the growth of the democratic movement; the tendency toward direct action in the affairs of government; the control of industrial conditions in the interest of the com- mon welfare; the adjustment of the educational system to modern needs; the public; health movement in its relation to other social ])roblems; the movement through labor organiza- tions and other voluntary associations, or through social legis- lation and social insurance, to raise and maintain the stand- ard of living; finally the emphasis upon cooperation in con- trast to individualism. VIT. Practical Sociolog}' One hour weekly. (See III un- der "Four Months' Course.") VIII. Pural Sociology One hour weekly. In j\rarcli, 1915, the schedule given above was revised in certain details as follows. The new material only is shown : III. A Study of Mental Processes Involved in the Work of a Xurse with Individuals and Communities Two hours weekly. (Compare III. Elements of Psychology.) This course will include definitions and class exercises illus- trating certain connnon mental processes. These will be con- sidered in their connection with tho bedside and educational work of a nurse and application made with reference to her aiiproach to individuals, families, classes and other group meetings, as well as to the entire community. Foreign and native populations in their old and new environments will be studied with reference to customs, superstitions and other racial characteristics. Practice in construction of lesson plans and jiresentation of subject material will be required. Con- crete plans for community service will be developed. VII. Practical Sociolog}' (slightly modified) One hour weekly. This cdurse should be designed to suggest, with such class discussions as the limited time permits, the important and significant ])liases of the so{Mal treatnuMit of families and indi- viduals. It slionld include the making of an investigation, the kee])ing of records, the recognition of the normal standard of living, the enforcement of ordinary family and social obli- 1250 HISTORY OF AMERICAN RED CROSS NURSING gations and other elements of social work. Reading and special topics for study might be included. VITI. Rural Sociology (new) One hour weekly. This course is descriptive and sociological in character with a purpose of directing students into practical forms of ser- vice. It includes lectures, recitations and a limited number of special papers presented by members of the class. The ma- terial used is the Country Life Bibliography on the topics, Church, School, Public Health, Good Roads, Cooperation, etc. A study is made of the history of rural society, its ex- tent, the rural population, size, composition, sources, regional populations; the rural community, types and organization, peculiar communities and peoples, contrasting types, as the individualist and the highly socialized communities, princi- ples of social service, methods and results, specific problems such as poverty, rural health, rural education, the country church, cooperative organization and the method and princi- ple of rural survey for finding the basis of country social service. To this suggested outline, several training centers having by that time been opened, as we shall see later, the Committee on Nursing added: Your committee expects to present for your consideration during the current year a resolution to the effect that only training centers offering eight months' courses shall be ac- cepted as giving satisfactory preparation for Red Cross Town and Country Nursing Service ; that a suggestive outline for an eight months' course as herewith presented be endorsed and your Superintendent be authorized to use it. No sooner had the needs of the Rural Service become evi- dent than Miss Nutting, at the head of the Department of Nursing and Health at Teachers College, Columbia University, took action to meet them. A special four months' course was established there in the winter of 1913-1014. The practical instruction was worked out in cooperation with the Henry Street Settlement and the District Nursing Association of Westchester County, New York. Two months were spent in the Settlement, in visiting nursing in the homes ; one in the Division of Child Hygiene and Con- tagious Diseases of the New York Board of Health ; one with the public school nurses and in the Tuberculosis Service and FROM RURAL TO PUBLIC HEALTH NURSING 1251 Milk Stations, and ono in the rural nursing work. Instruction by means of lectures, conferences and excursions was given twice weekly by Teachers College, as grouped under the three heads: 1, Public Health Nursing; 2, Rural Life Problems; 3, The Application of Preventive Medicine in Nursing. Teachers College, said Miss Clement, was thus the first educational institution in the country to offer a course by whicli graduate nurses coukl receive academic instruction in rural problems in coiniection with a short course in public health nursing. The Boston Visiting Nurse Association (formerly the In- structive District Nursing Association of Boston), followed next to Teachers College in framing a course meeting the spe- cial needs of the Red Cross Town and Country Nursing Ser- vice. It gave its practical teaching in a ''model district" under a competent supervisor. Two months spent in this way were followed by two in preventive work with mothers and babies, and the field work of the Associated Charities, under the guid- ance of the respective secretaries of those associations. Special provision was made for actual service in rural communities, and special classes and reading on rural problems provided. The lectures and class work covered : 1. History, principles, and administration of public health nursing; 2. Medico-social relations of diseases ; 3. Elements of sociology and social progress. Excursions were arranged weekly to institutions and char- itable agencies in l>ost()n. Opportunities were given for obser- vation of industrial welfare work, public school nursing and tuberculosis nursing and prevention. Similar steps were taken in a number of other localities so that the Red Cross Report covering the year ending Novem- ber 30, 11) 1(), said: Four and eight months' courses have been opened this year in Cincinnati. Columbus and Chicago. Tlie estal)lislunent of such courses closely concerns the dcvelopiiicut of the Town and Country Nursing Service. ... St. Louis. Baltimore and Iowa City are anionic centers now organizing general courses in public healtli nursing. ^lilwaukee bas a tbree months' 1252 HISTORY OF AMERICAN RED CROSS NURSING course and several cities, among them Pittsburgh and Detroit, are offering lecture courses for nurses on public health topics. Seventeen nurses have entered upon courses this year. The increased number of nurses desiring to qualify for Red Cross service in the eight months' courses in preference to the shorter periods of training, is a particularly encouraging' fea- ture in the development of rural nursing. Ten nurses now taking eight months' postgraduate courses in Boston, New York, Philadelphia and Chicago, will be available for appoint- ment in June. The results of improved opportunity were shown in the following record : Out of sixty-six nurses in service in 1916, thirty-three had had special courses including academic training, fourteen having had eight months' courses. Of the total number of thirty-three, fourteen were prepared at Teachers College in conjunction with Henry Street Settlement, four months' course ; two were prepared at Teachers College, eight months' course ; eight were prepared at Phipps Institute, eight months' course; three were prepared at Boston Instructive District Association in conjunction with Boston School for Social Work, eight months' course; four were prepared at Boston Instructive District Nursing Association, four months' course; one at New York School for Social Work, eight months' course ; and one at the Chicago A^isiting Nurse Asso- ciation, four months' course. Two of these taking the Summer Course, four and eight months' course, and seventeen the four and six months' course given in conjunction with Henry Street Settlement. Covering about this same period, twenty-two candidates for the Town and Country Nursing Service entered the Bos- ton Instructive District Nursing Association courses given in conjunction with other local agencies. Of these five took the eight months' and seventeen the four months' course. A year later Columbia University took another advanced step by preparing Teachers College to give special public health instruction to undergraduate nurses during their hospital training. While it was true that public health nursing in general was becoming more and more seriously developed, yet the con- crete specialty of rural work was not always thoroughly dealt with. On this point Aliss Clement wrote : FROM RURAL TO PUBLIC HEALTH NURSING 1253 With one or two exceptions the courses in public health nursing do not include study or experience in rural health and sanitation or practical experience in rural nursing. There is need for such a course for while knowledge of city conditions serves as a good foundation for rural work, some knowledge of rural sociology and familiarity with country life will forestall lessons otherwise to he learned hy sad ex- perience. Any one of the present schools of public health nursing, were financial assistance from the IJed Cross forth- coming, might willingly provide for specialization in rural nursing. In 1919, of thirteen educational institutions giving public health nursing courses, two were recorded as giving eight months', four giving four months', and two nine months'. The others gave summer or evening courses. With the development of the Educational Committee of the National Organization for Public Health Nursing (1917-1918) it was no longer neccssarv for the Red Cross to give time and labor toward stimulating the establishment of courses in public health nursing, or advising upon the form and contents of their curricula. For then a new committee of the N. O. P. H. X. took over these responsibilities, and employed an educational secre- tary to carry on its work, ^fuch of the time of this secretary was given to field work, visits to schools already conducting or preparing to open public health nursing courses. The Committee nuide a study of existing centers with the aim of arriving at a satisfactory basis, and presently announced a minimum standard based largely on the previous models set up by the Kcd Cross Town and Country Xursing Service. It then gradually compiled a list of schools which maintained this standard and which it endorsed. In 1918 the Town and Country Xursing Service definitely placed the responsibility of endorsement upon the Xational Organization for Public Health Xursing. i^y July, 1921, tlu^'c were t('n public health nursing courses fully endorsed by the Educational Committee of the Xational Organization for Public Health Xursing and nine tentativ(>ly endorsed, meaning that full (Mulnrsemciit was to be given when certain (jualitications had been met. All of these courses were us(>d by the Red (^ross for the training of public health nurses who had been grant(>d scholarships. The public lu^alth nursing courses wer(> established on a sound educational basis. In most cases they were a j^art of 1251 HISTORY OF AMERICAN RED CROSS NURSING the curriculum of a leading university and in a few they were developed within a school for social service or social economy. Lectures and instruction of a high order in the theory of public health nursing were thus assured. The length of the courses was usually one academic year, with the possibility of further specialized or advanced study. A course of four months was also offered for nurses unable to take the longer one. The work of the courses was divided about evenly into theory, obtained in the university or school, and field work, where the theory was applied. To this end, practice fields were developed or existing facilities utilized to provide supervised experience in the different forms of public health nursing. Thus for four months of study and class room instruction in the principles of public health nursing, medical inspection and school nursing, nutrition, communicable disease control, sani- tary science, educational and industrial hygiene, educational psychology and sociology and principles of modern social work, the student spent the full four months in the field putting into practice what the course had taught her. Perhaps the greater part of the time would be spent on the staff of a good visiting nurse association which offered experience in the care of all kinds of illness in the home and in teaching the principles of healthful living, home hygiene and sanitation. Some time would be spent on the staff" or at least in observing the work of the school nurses ; with the board of health nursing staff, observing methods of communicable disease control and other activities. A definite period of actual family ease work would be aft'orded with a charity organization society so that the nurse might become accustomed to treating the family as a unit and also might gain an insight into social problems and their solu- tion. Experience in methods of infant and child welfare, nu- trition, care of dclin(iucnts, dependents and other special classes was included either through participation or observation. Some courses provided also a rural field where conditions peculiar to country life might be met. This incomplete list serves to show how public health nurs- ing education had progressed since the short time when the pioneer district mirsing associations provided the only means for public health nursing training. The process of eil'ecting a working union with local groups prepared to assist in taking up rural work preceded and gave FROM RURAL TO PUBLIC HEALTH NURSING 1255 rise to the present organization of the Town and Country Nursing Service as perfected in its central and related associa- tions, and therefore logically comes next in our text. As already pointed out, there were few Red Cross Chapters before the World War, nor did these occupy themselves espe- cially with questions of health. It was, therefore, to groups of a different character that the Rural Nursing Committee first turned. To reach and inform such groups a pamphlet was issued (1913) giving a statement of the aims of the Rural Nursing Service and offering suggestions on how to organize a local nursing association. Local groups were asked to w^ite to Head- quarters, and upon request suitable b^'-laws for their needs and an outline of suggested duties would be forwarded to them, A year later (1914) a revised pamphlet called ''American Red Cross Town and Country Nursing Service, General Outline, Form No. 2" contained full information on every point. From those first leaflets only the earliest and later sections historically interesting will be quoted, in order that changes may be traced and the general continuity on main lines made clear. It is the purpose of the Eed Cross, through its To^vn and Country Nursing Service, to further the establishment of local nursing associations in order that the services of the visiting nurse may be brought within reach of small towns and country districts of the United States, and through afTiliation witli local organizations to assist them in promoting the inter- ests of public health nursing. In accordance with this pur- pose the Hed Cross endeavors : 1. To assist local groups iu the organization and adminis- tration of nursing associations within its scope when called upon to do so. 2. To develop a personnel of eflficient visiting nurses well equipped by trainiufj and exjierience for visiting nursing in the smaller connnunities, such nurses to be employed by local organizations atliliated witb the Town and Country Nursing Service. .3. To assist atliliated or of a few regulations on the ]iart of local organizatioiis constitutes afliliation with iho Town and Coun- try Nursing Service. These conditions have been adopted for 1256 HISTORY OF AMERICAN RED CROSS NURSING the purpose of establishing some degree of uniformity in the administration of visiting nursing. They consist of standard regulations deemed essential by the Eed Cross to conserve the best interests of local nursing associations and the community at large. All other regulations or recommendations contained in this "Outline" are suggested, not prescribed. 1. An affiliated organization shall regularly employ such visiting nurses as fulfill the requirements of the Eed Cross and are appointed to its Town and Country Xursing Service. (Although the assignment and dismissal of these visiting nurses is made by the Red Cross, whether they retain their position or not depends upon the recommendation of the affiliated organization by which they are employed, and to which they are directly responsible.) 2. Temporary or substitute visiting nurses employed by an affiliated organization shall be approved by the Red Cross. 3. At least six months' salary shall be assured before a visiting nurse is assigned to duty by the Eed Cross. 4. When on duty Eed Cross visiting nurses shall wear the uniform and pendant of the Town and Country Nursing Service. 5. The constitution, by-laws, rules and regulations that con- cern the visiting nursing of affiliated organizations shall be approved by the Eed Cross (and before adoption any subse- quent alterations or timendments thereto). 6. The designation "in affiliation with the American Eed Cross Town and Country Xursing Service" shall always follow titles of an affiliated organization when appearing on publi- cations, record blanks, etc. 7. For each year's service a Eed Cross visiting nurse shall be entitled to one month's vacation with pay, during which time a substitute nurse sliall be employed. (The Eed Cross will endeavor to supply substitutes.) 8. In order to guarantee maintenance of nursing standards, the work of Eed Cross visiting nurses shall at all times be subject to inspection by the Eed Cross. 9. The nursing of patients by Eed Cross visiting nurses shall always be carried on under the direction of a physician. 10. When two or more visiting nurses are employed in one community by an affiliated organization, one shall be desig- nated by the Eed Cross as liead nurse or superintendent. In such instances it is so advised that provision be made for the nurses to live together, exceptions to which custom shall be approved by the Eed Cross. 11. Eed Cross visiting nurses shall keep careful records of their patients on report cards provided or approved by the FROM RURAL TO PUBLIC HEALTH NURSING 1257 Eed Cross, and an attiliated organization sliall sul)niit to the Red Cross duplicates of the niontlily reports made by the nurse or report sheets for this puipose. 12. Eed Cross visiting nurses shail not attend infectious diseases unless due provision can be made for the care of other patients. (They give instruction in nursing and every possi- ble assistance to families in which such cases occur.) !;>. lied Cross visiting nurses shall not act as midwives when medical attendance is available. 14. A\'herevor an aHiliated organization assumes the re- sponsibility of nursing care of industrial policy-holders for the Metropolitan Life Insurance Company, the montlily re- ports of such visits sent to the office of the company in ac- cordance Mith an arrangement previously effected, shall be acconi])anied by bills for the amount to be paid by the com- pany to the Ked Cross for the ser\ice rendered, the full amount of said bills to be remitted by the Eed Cross to the Affiliatexcept in emergencies the nurse is expected to make visits at night only at the request of a physician. 5. It is advisable that calls for a nurse be accepted from all sources in (-onununitics where tliis ])lan is ])racticable. but it sliould be generally understood tliat the nursing of patients is always conducted under the direction of a medical prac- titioner. (). A nurse is expected to obtain the consent of her com- mittee before answering the call of a ])hysician outside her district and this should only be given when the nurse's other cases ])erniit. 7. Nurses are ex})ected to pay for aprons, uniforms, liats and coats of tlie ])attern prescriljed for Red Cross rural nurses. 1260 HISTORY OF AMERICAN RED CROSS NURSING 8. Xurses are not allowed to attend infectious diseases unless due provision can be made for the care of the other patients. They may give instruction in nursing and every possible assistance to families in which such cases occur. 9. They should not act as midwives when medical aid is available, nor under ordinary circumstances be expected to attend normal deliveries. They may answer calls to patients reported any time after confinement. 10. Where two or more nurses are employed in a com- munity, one will be designated head nurse. 11. Xurses should not accept personal presents of money from patients or friends of patients, 12. They should not attempt to influence the religious or political opinion of patients, to influence patients in the choice of a physician, or prescribe for patients or dispense drugs except under directions of a physician. 13. Nurses are not allowed to solicit in any way for com- mercial interests with which the Ked Cross through local organizations cooperate in the care of the sick. 14. Giving of material relief is outside the sphere of the visiting nurse, and cases requiring such aid should be reported to the committee or directly to an agency in the community whose province it is to provide for such needs. The nurse, however, should be provided with means for relieving emer- gency need until such time as her committee or the relief agencies can act. This "emergency fund" might also be increased to include extraordinary expenses such as a night nurse, or a relief nurse, or the transportation of a patient when necessary. 15. Kural nurses are expected to keep careful records of their patients on report cards provided by the Red Cross for this purpose, 16. To avoid leaving verbal messages with patients or their friends when not able to communicate directly with the physician, the nurse should do so in writing, and in order to protect both patient and the nurse it is hoped that under similar circumstances the physician will observe the same rule. 17. Xurses should be held responsible for property loaned by the local board of patients, and they should take a receipt for the same, seeing that it is returned in good condition. 18. Xurses are expected to share in the responsibility of local committees in every way, to protect their property and practice economy in the use of supplies. 10. Xurses will be under the general supervision of the Eed Cross, which will be maintained by occasional visits of FROM RURAL TO PUBLIC HEALTH NURSING 1201 the superintendent of rural nurses and through tlieir montlily and annual reports submitted by local conimittees. This supervision will in no way interfere with the responsibility or the nurse to the local board under which her work is con- ducted. 20. Enrolled Ked Cross nurses form the nursing reserve of the Army and Xavy. They are called u])on for (hity only in time of war and for emergency work during cahimities or national disasters. Enrolled lied Cross nurses may be ap- pointed as rural nurses, in which case tiiey will not be sul;ject to call for emergency work outside their own community. 21. Kural nurses, although primarily responsible for the efficient care of patients, are expected to take an active interest in families, teaching by instruction and demonstration tiie principles of hygiene as applied to their homes and surround- ings as well as of person. They should know the health laws and what opportunities exist in their community for the improvement of unsanitary and other unfavorable conditions in which the patients live. They should be informed upon social matters and avail themselves of educational advantages within their reach to enable them to meet more adequately the needs of their people. With the support of an al^le and enthusiastic committee, they have unlimited opportunities for constructive work through the homes, interested individuals, private societies, country scliools and other public institutions. The foregoing conditions and regulations are subject to amendment as I^ed Cross rural nursing develops. Affiliation with societies organized on the state-wide plan was a question of frequent recurrence. It had been considered premature in 1914. In 1015 it still seemed so, but a beginning was then made. The BuUetin of Xovember 17, 1915, said: It would l)e impracticable for the Ked Cross to contract atliliation with State organizations in wliich cases it would he im])ossiblc to meet its ol)ligations tlK'rel)y assumed to sup])ly qualified visiting nurses. Tlie Red Cross, however, as far as it can, will appoint nurses for local work at the instigation of State organizations to communities where local Red Cross athliation with the nursing organization or committee is accomplished. An important reservation made in 191("1 was u]ion the rela- tionship with relief-giving societies. It was tinally dccich'd that such affiliation should not be cnten-ed into, as it was lield to be inadvisable to associate the nurses in the public mind 1262 HISTORY OF AMERICAN RED CROSS NURSING with agencies for giving material relief or charitable aid. Up to that time, affiliation with such bodies had not been entirely ruled out, although, as the regulations show, emphasis had been laid on the importance of separating the nurse's work from that of the charity worker. Such separation, however, for practical purposes, was difficult and from the popular point of view impossible, if affiliation actually existed between charitable bodies and Red Cross nurses. The official record on this point was: The attitude among the leading nursing associations today being against material relief giving, the question as to whether or not Eed Cross affiliation Avith Associated Charities should be contracted was discussed at length. Miss Wald moved that the sense of this committee he recorded as against affiliation with organizations of relief, or those known as relief giving agencies. Mr. Bicknell seconded the motion, which waj carried. ^^ On the matter of financing visiting nursing the earliest sug- gestions made to local associations for their guidance were : 1. The chief item of expense in rural nursing is the salary of the nurse. The cost of livery will be an important item in some communities. This may be lessened by suggesting to families requiring the services of the nurse that tliey send a conveyance for her when possible. The use of a bicycle or horseback riding may often be practicable. Where there is no telephone in the house where a nurse resides one should be provided where possible. A fully equip])e(] bag for profes- sional use should be loaned her by tlie local Board. It will be necessary to maintain a supply closet from whith articles may be loaned or rented to patients. Xcodle Work fiuilds ami other societies may be expected to contribute some of the necessary supplies. 2. Various ways of raising money are in a-Mioral use. "Members of the board should improvise digiiilied methods adaptable to local conditions. As many ])erso . in the com- munity as possible should be urged to contribute toward the Avork, either by an annual house-to-iiouse camass or by send- ing out written requests. As all persons without any lines of distinction enjoy the benefits of impro\ed conditions l)rou,ssary, unification was brought about. All Red Cross nursing, of whatever FROM RURAL TO PUBLIC HEALTH NURSING 1265 variety, was then composed into one general service,^*' with ordered subdivisions, as has been described under Mobilization. Hitherto there had been no formal relation between the Town and Country Nursing Service under the National Relief Board, and the Nursing Service operating under the War Relief Board. But now (191 (J) all Red Cross nurses were placed in one "Red Cross Nursing Service," of which the component parts were defined thus* Tlie term "Red Cross Nursmg f^ervice" includes (a) the National Committee: (b) State and Local Committees on Nursing Service and such other committees as it may deem necessary to appoint; (c) all enrolled Red Cross nurses, in- cluding members of the Town and Country Nursing Service ; (d) enrolled dietitians, Sisterhoods and other orders, when assigned to duty under the Red Cross; and (e) women volun- teers selected for liospital service or other duties relating to the care of the sick. All nurses employed by Chapters, other Red Cross organi- zations, or aflliliated societies authorized to use the Red Cross insignia, must be enrolled Red Cross nurses and subject to the regulations of the Nursing Service. All Red Cross courses of instruction, except those in First Aid and Accident Prevention, are under the control of the Red Cross Nursing Service. This National Committee was empowered to create special sub-committees. The Town and Country Nursing Service next (1917) becamo one of the two bureaus operating under the National Committee on Nursing Service, the other being the Bureau of Nursing Service. The title of the superintendent was altered to "Director of the Bureau" and certain changes of policy for the nursing staff were adopted, which will be dealt with in a later paragraph. The position given to organized nurses on the National Committee was unique among interna- tional Red Cross societies, and emphasized both the recognition of and the grave responsibility devolving upon the American nursing profession as a self-controlled body of organized workers. In July, 1017, a third bureau, that of Instruction, had been organized in the Red Cn^ss Nursing Sci-vice, but the *" Tlio Minutes of tlie Central Committee, December 13. 1916, read: 'RESOLVED: First, that the Committee on Town and Country Nursing be hereby discontinued and tliat tlie duties and functions with wliich it was chartred be transferred to tlie National Committee on Xursin<: Service." 1266 HISTORY OF AMERICAN RED CROSS NURSING functioning of the Bureau of Town and Country Nursing was unaltered. In December, 1915, when the three governing boards of the Red Cross were made advisory, the executive powers which they had formerly had were placed in newly created Departments. The Department of Civilian Relief then functioned as had the former ''National Relief Board" and the Town and Coun- try Nursing Service bore the same relation to it as it had borne toward the older body. This arrangement, however, resulting as it did in a division of responsibility between the "Nursing Service" and the '^Department of Civilian Relief," was not permanent, and on December 7, 1917, the Red Cross Nursing Service was made a Department, and thenceforth the Town and Country Nursing Service functioned as one of its bureaus. The general extension of branches and Division headquarters that took place during the war has been outlined (see Mobiliza- tion), and the reorganization after the war will be described in a final chapter. No special form or name was required of local organizations wishing to affiliate, but simply that they should have the purpose of promoting rural visiting nursing by the help of the Red Cross organization and equipment. However, when affiliation was effected with a society not primarily organized for com- munity nursing, an effort was always made to have a special group created to be directly responsible for this branch work : It is expected that in the development of TJed Cross rural nursing, local committees will be created, meeting standards of salary and other regulations which are deemed necessary to insure the best interests of a community. The locality bene- fited by file work of a nurse is expected to meet the expenses connected with it. Fees collected from patients are not sufficient for this, as all sick persons arc not able to pay for the services of the nurse. As a rule, patients are expected to pay for professional visits, according to their means, but those unable to make any payments should not go uncared for. The responsibility for raising the necessary funds rests witli the local committee, which also superintends tlie work of the nurse. How necessary and valuable the influence of the Red Cross was and is locally in maintaining good nursing standards, is well illustrated by the following incident. A local association FROM RURAL TO PUBLIC HEALTH NURSING 1267 affiliated in the early days with the Red Cross formed a secon- dary, informal relation with another local group not connected with the Red Cross. This second group employed untrained women, whom it called "attendant nurses." The Red Cross then, through its affiliated associations, requested the secondary group to use only the term '^attendant" and to discontinue calling untrained women ''attendant nurses." It is precisely by such easy steps as the above that local standards may be lowered in the absence of some strong, central, unifying body. The early work of the I^ed Cross in encouraging local pioneer efforts was tireless and painstaking. No beginning was too small to receive its fostering care. As a result, it created an atmosphere that stimulated and encouraged. An advantage of a strong central body is found in the inspiration of the feeling communicated to its membership, of belonging to something large, something luitional. The personal visits, the national correspondence, the definite standards, convey a sense of sup- port and encouragement. While supervisors soon come to be a necessity in any large organization, they were also definitely useful in the early work as organizers. This was recognized from the first, and in the Report of 191-3 we read: To reach the most neglected communities, it is necessary for an organization to spend much time in the field, and the demand for this work will in future be more adequately met by the appointment of another nurse, whose salary will be paid by tlie l?e(l Cross. With this addition to the staff, it will be possible to make regular and systematic visits of inspection to affiliated organizations, and more opportunity will be available to respond to many calls asking for someone to present the work at various clubs and mass meetings, whicli has been possible thus far only to a limited degree. In 1014 the Iveport said: ]\riss Abbie f?ol)erts. formerly superintendent of the Msit- ing Xurse Association of Cincinnati, and wlio has recently completed a course in the Department of Xursing and Healtli at Teaclicrs Colle(re, Columbia University, has beeen ajipointcd supervisor of Red Cross visiting nurses. Fifty-one supervisory visits to affiliated organizations have be(Mi niad(^ by the superintendent and supervisor during 1!)14, and, with the |)ur])()se of placing before nurses the public 1268 HISTORY OF AMERICAN RED CROSS NURSING health needs of the smaller communities, they have presented the work of the Town and Country Nursing Service in seventy- five hospital training schools. In 1914 the field supervising nurses of the Metropolitan Insurance Company, four in number, who were appointed to the Town and Country Nursing Service, were requested by the Red Cross to make a special study of the demands made upon rural nurses and the preparation needed by members of the Town and Country Nursing Service. At an informal meeting in St. Louis, held later that year (1914), these field nurses, whose work took them from coast to coast, met with the Com- mittee of the Town and Country Nursing Service of the Red Cross to discuss their findings. An arrangement had lasted for a year (1913-1914) by which these supervisors, paid by the Company, made reports to the Red Cross of organizations aifiliated with the Rural Nursing Service. In the matter of a uniform standard the Red Cross visiting nurses were under the general supervision of the superintendent or her supervisors. But in matters relating to their local work their responsibility to the local group was complete. In 1915 the supervisory visits numbered sixty-seven with eighteen more for organizing work. In 1916, sixty-nine, with many additional meetings with committees and public officials, and to address organizations and mass meetings. The Annual Report of the service for 1917 said: A second supervising nurse was employed for several months early in the year. This has made more visits to communities possible than during 1916. One hundred and eight supervisory visits and fifteen visits of organization were made. To do justice to a most important function of the Town and Country Nursing Service, additional supervisors are needed. ^Many affiliated organizations are seeking more frequent supervisory visits than the present limited number permits. To help the local applicants it was agreed that members of the Town and Country Nursing Service Committee should, whenever possi])le, act as advisors and organizers in their own environments, and the superintendent recommended that annual conferences for Red Cross visiting nurses and affili- ated local groups be arranged for yearly at the time of the annual Ked Cross meetin^r in Washinciton, FROM RURAL TO PUBLIC HEALTH NURSING 1269 To assist ill tlio formation of local units the Red Cross Nursing Service prepared and distributed leaflets of advice on how to organize. The earliest form of this advice was included in the first pamphlet issued by the Service in 1013. In any work the initial efforts have a special interest, and are, moreover, too easily lost sight of, and so it is befitting to record the affiliations of 1913 and 1914 that they may not be forgotten. Location Name of Organization Date of Affiliation Cuyahoga Falls, Ohio Warrenton, Va. Hot Springs, Va. Bloomfield, N. J. Winchoater, Va. East Islip, N. Y. Clarksburg, W. Va. Laurel, Md. Spartanburg, S. C. Dorset, Vermont Gloucester, Mass. Greenwood, Va. Purchase, N. Y. Manchester, Mass. Greenville, S. C. Cohaaset, Mass. Chilton County, Ala. Pahnerton, Pa. \'isiting Nurse Association July 1, 191,3 District Nurse Association " " Hot Springs Valley Nursing As- " " sociation League for Friendly Service Aug. 1, (Community Nursing Service taken over by R. C. Chapter) District Nurses' Association " " (Community Nursing Service) Visiting Nurse Committee of R. " " C. Cliapter (Community Nurs- ing Service) Women's Civic Club (Community Sept. 1, Nursing Service) Visiting Nursing Committee " 15, (Temporary Community Nurs- ing) Spartanburg Health League " . 30, (Community nursing service cotton mills) Dorset Nursing Association Nov. 1, Gloucester District Nursing As- " 8, sociation. Inc. Greenwood Visiting Nurse Asso- " 21, ciation Purchase Nursing Association Dec. 1.3, Manchester Visiting Nurse Com- " 23, mittee of the \V(mien's Club (Community Nursing Service) Children's Charity Circle, later Feb. 1, 1914 known as Public Health Nurs- ing Association District Nursing Committee of " 6, . " the Social Service League Cliilton County Health Commit- Mar. 24, " tee (Primarily health educa- tional work with 3 county schools) Visiting Nurse Committee of Apr. 16, " New .Tersev Zinc Co. 1270 HISTORY OF AMERICAN RED CROSS NURSING Location Name of Organization Date of Affiliation Hazard, Ky. Albemarle County, Va. Franklin, N. J. Canaan, Conn. Chippewa Falls, Wis. Cambridge, Md. Grosse Pointe, Mich. Alorgantown, W. Va. ilt. Carmel, 111. Bridgeton, N. J. Jerome, Arizona Litchfield, Conn. Fulton, Ky. Perry County Nursing Associa- May 4, " tion (Mining section of moun- tain and general work) Community Work of Bureau of June 1, " Rural Sanitation, Va. State Board of Health (Educational Health Service) Visiting Nurse Committee of " 13, " New Jersey Zinc Co. (Indus- trial Nursing on Community basis) North Canaan Visiting Nurse Aug. 1, " Association Associated Charities (Community " 5, " Nursing Service) Cambridge Visiting Nurse Asso- Sept. 12, " ciation Mutual Aid Society and Neigh- Oct. 1, " borhood Club (Community Nursing Service) Child Welfare Committee of As- " " " sociated Charities (taken over by Morgantown Chapter, A. R. C, Nov. 1, 1919) Women's Club (Community " 7, " Nursing Service) City Nurse Committee of Bridge- " 8 " ton Civic Club (taken over by Cumberland County Chapter Community Nursing Service) Visiting Nurse Association (Re- " 21, " opened under Board of Health) Litchfield District Nursing Asso- Nov. 20, " ciation R. C. Public Health Nursing Dec. 3, " Service ( formerly known as City Health and Welfare League until Nov. 18, 1918) If space permitted, credit should be given in the case of ever}' association listed above to some one or more specially devoted women to whose ability and influence success was largely due. It would be a fitting tribute to them to mention special phases of their work, but one which would require anotlier volume. So wroto the first superintendent of the service, and she added : Then, too, if anyone connected with the Town and Country Xursing Service deserves sjiecial mention, it is that grouj) of niirses who labored with such faithfulness and courage in countrv districts from the beginning. FROM RURAL TO PUBLIC HEALTH NURSING 1271 They were superior women, the heart and soul of the public health nursing, and after all k said the greatest benefit of affiliation resulted from their attraction to the Ked Cross and the appointment of women of their type. Before the outbreak of the World War the organization of the Red Cross by Chapters was but slightly developed. Those that were strongest were in large cities where the rural nursing idea was not felt, and as a rule the Chapters did not then take up activities along lines of health conservation. It was only after the entrance of the L^nited States into the war that rural sec- tions generally organized into Chapters, and not until after the armistice did these Chapters turn to the activity of the public health service. The influence of the war on both general organization and the Town and Country Nursing Service was profound. As to the nursing service, a completely new policy was formulated, and in organization generally new forms developed. The nurs- ing staff will be considered first. It is to be remembered, at this point, that while any regularly enrolled Red Cross nurse with additional requirements for public health nursing might enter the Town and Country Nursing Service, and many did, not all Town and Country nurses were necessarily "enrolled." For them enrollment for war service had not at first been required, and in place of the Red Cross badge of the enrolled nurse the To^\^l and Country Nursing Service staff wore a pendant, but under the excitement of the war menace a new situation arose, partly brought about by the inclination of nurses to volunteer for the war; partly from the desire on the part of the leaders in Public Health Nursing to keep their forces intact in this country. The situa- tion offered these alternatives: Either the Public Health Nurse was to be put in a separate group, of which the members should be given credit for military service, or all nurses should be allowed to decide freely whether to take active service under the War Department, or home service in their own country. A combination of these alternatives eventually brought about a kind of classification enrollment for the Red Cross, In 1U17 Miss Clement wrote : When the two Services were brought together under the one administration, definite provision was made liy the Na- tional Coniniittee on Hed Cross Xursincr Service regularly to 1272 HISTORY OF AMERICAN RED CROSS NURSING enroll nurses who were available for the Town and Country Nursing Service solely. Thus all nurses assigned to duty under this Service are now enrolled Red Cross nurses. They are enrolled as any other Red Cross nurse by the National Committee on Nursing Service, but with the understanding that response to a call for war service is not compulsory, or any other Red Cross duty outside the community to which they already are assigned under the Town and Country Nursing Service. The Bulletin of April 15, 1917, said: While one of the most important duties of the Red Cross is to maintain at all times an adequate enrollment of nurses for service in the event of war, the rapid development of various peace activities under the Nursing Service has made it desirable to enroll nurses with special qualifications who might be available for war duty. Certain exceptions to the usual requirements for enroll- ment will therefore be made, as in the case of nurses selected for committee work, those willing to act as Instructors of Red Cross classes, and candidates for public health nursing under the Town and Country Nursing Service. Many inquiries regarding the calling out of enrolled Red Cross nurses in the Town and Country Nursing Service for war relief work have been received of late, both from nurses and their nursing organization. There being over eight thousand enrolled Red Cross nurses, those assigned to duty under the Town and Country Nursing Service will not be called out by the Red Cross for war service. Although the latter would not be debarred from volunteering for war ser- vice, the Red Cross considers the public health work in which they are at present engaged as most important, and only if urgent needs of this country require it would the Red Cross consider calling them for other duty. The following letter from Miss Delano to the nurses belongs to this period : April 2 G, 1918. In these days of unprecedented demand upon the nursing profession, decision as to tlie relative usefulness of individual efFort is often a matter of great difficulty. The call for nurses for military service both here and abroad must rightly and of necessity draw heavily upon the nursing resources of tlie country, but we feel that the public health nurse is also an FROM RURAL TO PUBLIC HEALTH NURSING 1273 important factor in the preservation of national health. It is therefore the policy of the Hed Cross to leave undisturbed as long as possible the nurses of its Town and Country Xursing Service. Should a change of this policy (which now seems unlikely) ever become necessary you will be personally notified. Mean- while, I hope you will continue at your present work with the assurance that the Red Cross fully appreciates its importance and value to the country. We are planning to supply an insignia to be worn on the arm by all Ked Cross nurses who at our request are remaining at their present post of duty. Very sincerely yours, (signed) Jane A. Delano, Director, Department of Nursing. This attitude of tho Red Cross, strongly supported by public health bodies generally, was quickly justified by events, for while on the one hand war demands broke through the routine of peace, on the other, the calls for nurses for health conserva- tion were immensely increased, and the nurses who stood at their posts in this field were classified as the Special Service Group. This group has already been described with sufficient detail. In the Bulletin of October, 1918, Mary S. Gardner wrote : Soon after the declaration of war the National Committee on Ked Cross Nursing Service provided for an enrollment of pui)lic health nurses to be held available for public health work under the lied Cross either in this country or abroad. Later it seemed necessary to safeguard the training of our ])upil nurses and the maintenance of our national health by creating a special group for all nurses holding important positions in training schools or in public health nursing. This group was called the Special Service Group. As soon as this ])lan was completed ^liss Delano sent you a letter to tell you that the Ked Cross recognizes the important part you are ))laying in the protection of the health of the nation and asks all of you to remain at your posts as members of this Special Service Group. To many public health nurses the decision to stand by an important piece of home work has been a (lilUcult one. It is not easy in such times as these to pursue a safe and ingloriou> way, even though the sign-posts be very })lainly marked "patli of dutv." 1274 HISTORY OF AMERICAN RED CROSS NURSING The public health group, however, is not a large one, if all the nursing resources in the country are taken into account. It would seem, therefore, wise that though all nurses should enroll in the Eed Cross, those trained or experienced in public health work should for the present at least use that training and experience where it will be most effective, namely, in doing the work for which they alone are prepared and which so sadly needs them. A further extension of the service resulted from the need of special health protection in the military cantonments at home. Miss Gardner wrote: We had been at wslt but a short time, when the Red Cross added a new activity to its countless forms of helpfulness and one involving public health nurses. Zones were formed by the United States Public Health Service around the big canton- ments and in these zones public health nurses were placed working under the medical director. For this service experi- enced nurses are needed. At first, part of the nurses were Eed Cross nurses, and on the Red Cross payroll, part were engaged and paid by the United States Public Health Service. It has been decided that all the zone nurses should be enrolled Red Cross nurses, thus setting a single standard for all, and that on the recommendation of the Red Cross all chief nurses should enter the United States Public Health Service. When this zone work carried on by the Red Cross in co- operation with United States Public Health Service eventually found its way into the Town and Country Xursing Service it seemed only out of place because the name of the bureau was not sufficiently inclusive to be descriptive of such an activity. It was therefore decided to change the Bureau's name to the Bureau of Public Health Nursing.^^ The change in name and scope of the service went into effect on May 18, 1918. Miss Gardner had then succeeded Miss Clement for a temporary period only, with Miss Fox as asso- ciate director. Both were exceptionally well fitted to direct the enlarging service. Mary Sewcll Gardner was a Connecticut woman, of a repre- sentative Xew England family. One of her ancestors on the maternal side had been president of the first Provincial Con- gress of Xew Hampshire and later a signer of the Declaration of Independence. On the paternal side her family had in- -' Bulletin No. 3, Vol. 4, October, 1918. FROM RURAL TO PUBLIC HEALTH NURSING 1275 eluded many lawyers and judges and her father served on the Supreme Bench of Massachusetts. jMiss Gardner's early edu- cation had been entrusted to tutors and later she attended a girls' school in Farmington, Connecticut, then traveled exten- sively abroad. She was given the position of superintendent of the Providence (Rhode Island) District Nursing Association immediately after her graduation from the Newport Hospital. To enable her to help in the development of the Red Cross Town and Country Nursing Service the trustees of the Provi- dence Association generously gave her leave of absence for that purpose. ^liss Gardner was recognized throughout the country as an authority on all phases of public health work, and she had had unusual experience in rural nursing while extending visiting nursing throughout Rhode Island. She was the second president of the National Organization for Public Health Nursing and a permanent member of its board. She wrote ''Public Health Nursing," the first book on that subject and a standard one. In 1918 Brown University gave her its M. A. as a "pioneer in making the care of the sick an honored profession ... a gentlewoman whose writings and example have brought us healing of the body and inspiration of the spirit." Very charming, feminine and attractive with a rich sense of humor and a balanced mind, so upright that she commanded general confidence, Miss Gardner threw all her gifts into the Red Cross work, but in the midst of her administration she was dispatched on a special mission to Italy to organize public health nursing there, and then after the war she returned to her position in Rhode Island. Elizabeth Gordon Fox then became the director of the Bureau. Born in ^Milwaukee, she took honors at the University of Wisconsin (Phi Beta Kappa) and graduated with distinction from the Johns Hopkins Hospital. She served on the staff of the Chicago Visiting Nurse Association for four years, then became superintendent of the Visiting Nurse Association of Dayton, Ohio, and from there went to a similar position in the city of Washington, where she also served as president of the Board of Nurse Examiners. She had been enrolled in the Red Cross Nursing Service since 1913. In 1921 she was chosen as vice-president of the National Organization for Public Health Nursing, and upon the resignation of Edna Foley, then presi- dent,, succeeded liej* and was elected as president to a second 1276 HISTORY OF AMERICAN RED CROSS NURSING term of office in 1922. Her largest achievement after becoming director of the Red Cross work was in knitting np the relations between the Red Cross national organization and its branches and State health boards. This important stage of progress will be described in the next chapter. Forceful, direct and unaffected, a keen and analytical thinker and a remarkable organizer. Miss Fox held her bureau in strong hands. At first the war worked injuriously upon the service. Miss Fox wrote : The Town and Country Nursing Service experienced a check in its growth during the war brought about by the transfer of national and local attention from peace activities to war work, and by the serious shortage both in qualified public health nurses and in candidates for post-graduate prep- aration occasioned by the withdrawal of many thousands of nurses for military service. The secondary effect of the war and its accompanying calam- ity, the epidemic of influenza, was to heighten the interest of Red Cross Chapters and the general public in health and nursing matters. The first financing of a Rural Nursing Service was made possible, as has been told, by the gifts of j\Ir. Jacob Schiff and Mrs. Whitelaw Reid. But not all could be used for loans and scholarships, as the general administration of the Service had to be covered as well. In 1912 $1000 was set aside for loans, a maximum of $250 being agreed upon for one loan, and seven scholarships were announced, three of $200 each and four of $100 each. Previous to December 1, 1913, three scholarships were granted and three loans made. Between that date and December 1, 1914, one scholarship and thirteen loans were granted. In 1915 ^Ir. and ^Irs. Schiff gave $5,000 more to be used expressly for the Loan Fund and the Scholarship Fund was thereafter abolished for a time. Between December 1, 1914, and December 1, 1915, eleven loans were granted. By Decem- ber 1, 191G, eight more had been made. At the annual meeting of that year it was agreed that, as nurses were taking the eight months' course in larger numbers, the maximum loan should be increased from $250 to $.'300 and, in special cases, to $400. It was never contemplated that the Red Cross would entirely FROM RURAL TO PUBLIC HEALTH NURSING 1277 support the cost of a local rural nursing service. Its policy was against this practice? from the very start even though appeals for financial aid were numerous and although lack of local funds became a frequent cause for the discontinuance of affilia- tions one after another. It was not long, however, before the financial helplessness of certain communities became appeal- ingly clear: Before the end of the first year of the service, and before any outside effort to meet particular financial appeals was contemplated, a member of the Committee on the Town and Country Nursing Service had volunteered to meet the ex- penses of placing a nurse in the Kentucky mountains. Con- tributions from private sources for particular communities were later administered by the Red Cross in a number of instances, primarily to encourage the introduction of visiting nurses in the Southern Higlilands. These donations were used to pay the salaries of nurses temporarily in whole or in part with the idea always in mind that the work would eventually be supported locally. In 1914 the possibility of creating a sustaining fund was discussed. The records say (December 8, 1914) : The desirability of the Red Cross establishing a fund whereby the salary of nurses might be supplemented who were to be employed in sections of the country that could not at present provide the salary of a Red Cross visiting nurse in full, was favorably considered. ]Miss Delano offered to supple- ment tbe salary of a nurse to be sent to the mountains of North Carolina under the Presbyterian Board for one year. The report of December, 1915, returned to this theme, dwell- ing especially on the needs of the mountain regions: In many mountain communities local financial resources are sucli that the salary of the nurse cannot be raised either by private subscription or public appropriation. The church mission boards and educational organizations which have been active in the mountain country for years have included visit- ing nursing in their activities in twelve or thirteen instances, but there are three million persons living in tlie Southern Highlands. The Town and Country Nursing Service was organized to help just sucli coninninities as this section represents, and yet they cannot procure Red Cross vi.'-iting nurses unless some 1278 HISTORY OF AMERICAN RED CROSS NURSING provision can be made to aid them financially. Three Red Cross visiting nurses have been appointed to mountain com- munities, one in each of the States of Virginia, Kentucky and North Carolina. One was employed by a visiting nurse asso- ciation supported by private subscription from the mountain people and summer visitors, one by a denominational mission board, and one by local funds supplemented by outside indi- viduals. Within the past few months inquiries have been received from several mountain schools asking if the Red Cross could aid in financing the work of a visiting nurse. A broad field for rural nursing lies open in this section and study of its resources reveals the fact that unless some provision is made by the Eed Cross or other organization whereby such com- munities may be aided financially, there is little prospect of nurses who have met the standards of hospital training and post-graduate preparation in public health nursing required by the Red Cross being employed in this part of the country. The meeting of the committee (March 18, 1915) had taken steps to meet this need. The Department of Agriculture under the Smith-Lever Act had aided numerous rural locali- ties throughout the country by contributing toward the sup- port of county agents. There was a close connection between the work of these agents and health work being done by the county nurse. One middle western state had even written to the Red Cross to ask if nurses could be supplied to fill county .agents' positions with the aid of State and Federal support. Other instances were .kjiown too where Federal money was being used for local educational health work by nurses. Thus the idea of direct financial aid from the Federal Department of Agriculture in tiie extension of rural nursing was not entirely novel wlien the committee appointed its chairman, Mrs. Beale, and Miss Lathrop, head of the Children's Bureau, a committee to interview Secretary Houston upon this subject. The interview took place, however, with negative results. Within a short time, however, public support by contribu- tions to local funds had grown rapidly along lines indicated as the original plan of the Red Cross. ^^ A committee report (November 30, 1916) said: In twenty-seven communities public funds are now paid toward the support of the work. There is little uniformity in the amounts of appropriations, ranging as thej do all the way "Pvcport by ^Fiss Cloment. Dpc, J9J5.. FROM RURAL TO PUBLIC HEALTH NURSING 1279 from $200 to $300 annually, the amount received by six com- munities, to $1200 and over received by six other communities. The entire salary is paid in six communities from public funds. By 1917 gifts from individuals and from Rod Cross Chapters had bo from among the thousands of nurses returning from war service seemed good, providing some means were available to help them pay the cost of preparation. Just before sailing for Europe (January 1, 1010) !Mis3 Delano presented a recpiest to the general manager that the War (\)un('il of the Red Cross appropriate $50,000 for a schol- arship and loan fund for nurses needing instnu'tion in public health nursing before being available for assignment to duty under the Red Cross: In the development of our Rod Cross public health pro- gram. 1 do not feel that it will be necessary to ask for any large expenditure of funds for administrative progress. The organization which we now have ought to be sulVicieiit. It will, however, be necessary, in my opinion, to have funds 1280 HISTORY OF AMERICAN RED CROSS NURSING available for other phases of the work, the most important of which are as follows : 1. A loan or scholarship for nurses who need instruction in public health nursing before being available for assignment to duty under the Eed Cross. May I recommend that $50,000 or so much of this fund as may be necessary be set aside as a loan or scholarship fund for the coming year. 2. A fund available for the maintenance of a public health nurse during a period of demonstration in rural or mountain districts which are unfamiliar with the value of such a service. The communities most in need of public health work are often absolutely ignorant of the advantages to be gained, and, while perhaps entirely able to support a nurse, can be convinced of their needs only by an actual demonstration of at least a few months. Time and again we have found in the development of our Town and Country Xursing Service that communities were entirely able and willing to support a public health nurse after such actual proof. In contrast to communities of this character, remote and scattered settlements may never be able to provide the entire salary of a public health nurse. For such communities the Eed Cross might be justified in supplementing the salary which such a community might l)e able to pay by an amount sufficient to secure the services of a graduate nurse. I have no doubt that the Eed Cross Chapters can be inter- ested in assuming the responsibility for the salary of nurses during this period of demonstration, and I believe that every effort should be made to secure the funds locally, if possible, but there should also. I believe, be a fund at Headquarters which could be used in an emergency until other arrange- ments could be made. 3. A fund for the establishment of a teaching center where nurses can receive definite instruction and experience in the management of a rural community. For several years I have hoped for the establishment of such a center in a typical rural community preferably a county with a small city or village as headquarters. Such an organization could no doubt be established in cooperation with the community, but it would scarcely seem fair to ask a county to meet the entire expense, as this project would be conducted as a trying-out place and instruction center for nurses who would be employed in other communities. 4. A fund for the extension of Eed Cross courses of instruction to include all the women of the country, especially those who are living in remote and rural districts. Our plan FROM RURAL TO PUBLIC HEALTH NURSING 1281 of instruction in Home Hygiene and Care of the Sick and in Home Dietetics has so far been avaihible only for women living in large cities or where graduate nurses and dietitians are easily available to give the instruction. It has not been possible to extend the work to isolated conimunities where the need is far greater than in the cities and larger towns. These courses of instruction especially in rural communities might often give us the opportunity to conviiu-e the com- munity of the necessity of establishing a public health nurs- ing service, and wouid be our easiest and most natural point of approach. These courses would secure for the nurse serving such a community the intelligent cooperation of the women and would greatly facilitate and increase the usefulness of her work. I believe that some plan should be worked out to provide instruction for all classes of women, regardless of their ability to pay for such instruction. Funds for this purpose should, I believe, be secured through the Chapters, but may 1 recommend that a letter be sent to the Chapters, authorizing them to use Chapter funds for the extension of our educational program. I submit in connection with this a recommendation adopted at a recent meeting of the Division Directors of Xursing.^^ On December 81, 1918, the War Council authorized an appropriation of $80,000 as a Scholarship and Loan Fund for nurses needing instruction in public health nursing. Later it was decided to allot $25,000 for scholarships and $5,000 for loans. ^^ This fund was appropriated for the exclusive use of nurses preparing to do public health nursing under the Ked Cross, since its purpose was to make possible the plan for the expan- sion of such work. In February, 1919, a group of representatives of the iSTational Organization for Public llealth Xursing, headed by Miss Wald, conferred with Ur. Farrand, the chairman of the Central Committee, for the purpose of asking the American Red CVoss to make an additional appropriation f, as follows: "^ Letter from Miss Delano to Mr. Scott, Docoinbor 14. 1018. "Xotter Ironi ^Jiss Noycs to Mr. Scott, January S, 1!)19. 1282 HISTORY OF AMERICAN RED CROSS NURSING Just prior to the entrance of the United States into the war there were estimated to he about six thousand public health nurses, and the demand was already greatly in excess of the supply. While the war increased this demand and created an enormously increased need for such nurses, the supply became even less, and with the coming of peace this momentum, already great, has become overwhelming. Municipal, county and state departments of health, public schools, child saving agencies, industrial establishments, visit- ing nurse associations and other public and private agencies are unable to develop their public health plans because of inability to secure a sufficient nursing personnel, and are making demands for nurses, which cannot be filled except in very small measure. The introduction of two federal bills, one by the Children's Bureau of the Department of Labor and the other by the United States Public Health Service, both projecting plans which will demand many hundreds of public health nurses, also emphasize the need. The Bureau of Public Health Nursing of the Red Cross proposes to develop rural and small town public health nurs- ing and will need several hundred nurses for this purpose. The appropriation of $30,000 made by the Red Cross for the preparation of public health nurses for the service of this bureau will provide from seventy-five to one hundred nurses. The Chapters, through Chapter scholarships, it is expected, will provide possibly one or two hundred more. The rest of the nurses needed by the bureau must be secured through other means. While the work the Bureau of Public Health Nursing expects to do will meet a great need, it can care for only a small part of the whole field. Therefore, there is a great need for an added appropriation of $150,000 to prepare several hundred nurses for public health work outside of the Red Cross. With a fund of $150,000, $300 scholarships could be given to five hundred nurses for a four months' course in public health nursing. However, as there is a special and immediate need for executives and teachers, it is the feeling of those primarily interested in public health nursiiig education that a more desirable distribution would be to offer scholarships of $000 for an eight months' course to 125 nurses especially adapted by preparation, experience and temperament for the larger executive and ediicational positions. The remaining fund of $75,000 would then be available as $300 scholarships for 250 nurses for a four months' course. There are at present thirteen centers scattered throughout FROM RURAL TO PUBLIC HEALTH NURSING 1283 the country already organized and conducting such courses, which couhl admit and most satisfactorily train these nurses for public health work. Such a group of l??5 women especially equipped for rural, town and city work requiring executive and teaching ability, combined with social knowledge and vision, while not com- pletely meeting the constantly increasing need, would serve as a tremendous impetus to public health nursing throughout the whole country. The Ked Cross nurse appeals strongly to the heart of the American public, and the ])ublic woukl unquestionably ap- prove the expenditure of Eed Cross money in any plan to bring help to Ked Cross nurses in the difficult period of readjustment, especially when such help might be given her as a recognition of her tine service and as an expression of the conviction of the American Ked Cross that the country still needs her in a valuable public service here. Public health nursing cannot continue to meet the greatly stimulated demand without a scholarship fund sufficiently large to show appreciable results. It is more fitting and less confusing to have such a fund come from one source, not several sources. Such a Eed Cross scholarship fund might well be admin- istered by the special committee of the Eed Cross, now in existence, which has in its membership representatives of the three national nursing associations, and which is now acting in an advisory cajiacity to the Ked Cross Bureau of Informa- tion for returning nurses. (signed) Lillian T). Wald, Honorary President of the National Organization for Public Health Xursing for the Otlicers and Members of the Advisory Council. On February 27, 11)10, the War Council acting upon this petition, authorized the appropriation of seventy-five thousand dollars ($75, 000) as an additional Scholarship Fund for nurses needing instruction in public health nursing but not lUH'cssarily promising to serve in the Red Cross Public Health Xursing Service. This made a total of $100,000 for scliolarships and $:).0()0 for loans authorized on December .'U, 1!1S, and February 27, 1!)1!>. The general terms under which this fund was to bo administered were stated in a letter to ]\Iiss Wald from the general manager as follows: 1284 HISTORY OF AMERICAN RED CROSS NURSING 1. These scholarships are open to TJed Cross nurses or those eligible for enrollment on the recommendation of the Division Directors of Public Health Nursing and the Joint Committee representing the tliree national organizations of nursing through their representation at the Red Cross Bureau of Information, These recommendations are subject to the approval of the director of Public Health Nursing Bureau and the director of the Department of Nursing at National Headquarters. 2. While the appropriation is mainly intended for those who are being released from military service, other nurses who meet the general requirements are also eligible. 3. While the War Council stipulated the purpose for which this fund should be used, they did not wish to establish hard and fast regulations, but preferred to leave the matter of spending it subject to alterations within the discretion of the general manager and the director of the Department of Nursing. 4. In addition to the scholarship fund of $110,000 ($25,000 of which was appropriated for preparation of nurses for service under the Bureau of Public Health Nursing of the Eed Cross) there is a loan fund available of $5,000. The maximum loan shall be $350. Recommendations for loans from this fund are received through the same channels as indicated above for scholarships. It is definitely understood that loans should be awarded by the Department of Nursing for the purpose of educating nurses for Public Health Nursing under the Red Cross Bureau of Public Health Nursing.^^ The specific conditions governing the distribution of scholar- ships and loans were set forth in a memorandum of instruc- tions, July 15, 1919, as follows: There are now two scholarship funds available for Red Cross nurses who contemplate preparing themselves for public health nursing by taking post-graduate courses. Scholar- ships from the first of these funds are known as "restricted scholarships," meaning that they are restricted to nurses who are pledged to serve in the Red Cross Public Health Nursing Service for one year. There are three types of scholarships awarded from this fund. ''J'hese scholarships are awarded for post-graduate courses of eight months', four months' and six weeks' dura- tion. The maximum scholarship for the eight months' course ''Letter from Mr. :\f()nr()o to ^fiss Wiild, February 20, 191fl. See Di- visions of File Records, Natioiiiil Headquarters American Red Cross. FROM RURAL TO PUBLIC HEALTH NURSING 1285 is $()00; for the four months' course $300; and for the six weeks' course $75. The scholarship carrying tlie maximum of $75 is designed only for nurses who have had a considerable amount of {)ublic health nursing experience under super- vision and who feel the need of additional theoretical prepa- ration before undertaking independent work. This scholar- ship is to enable them to take the six weeks' summer course in theory. There are two or three such courses which are approved by the Department of Nursing. Xurses who have had very little experience or experience of doubtful value should take one of the longer courses. Scholarships may be awarded to nurses who have had no experience in public health nursing, who have had a limited or considerable amount of public health nursing experience without supervision or who have had considerable experience under supervision and give promise of further development. It is not thought wise to grant scholarships to nurses who have had considerable experience in public health nursing under supervision, but who have shown no e\idence of ability to work witliout supervision. Candidates should meet the train- ing school requirements necessary for enrollment in the Red Cross. Preference should be given to high school graduates or those who can show a substantial equivalent. Registration should be required in accordance with the ruling of the Red Cross. In states where registration is provided for by law the nurse applying for enrollment in the lied Cross must be registered : Preference should be given to nurses who are enrolled or who are eligible for enrollment and will become enrolled, although exceptions may be made where deemed necessary. In general, scholarships will be awarded to nurses between the ages of twenty-three and forty years. Exceptions may be made where candidates possess unusual ability. The candi- date shall present a doctor's certificate of her physical con- dition. ]\Iuch more than good education and good physique is required to make a good public health nurse. The candidate must possess good judgment, self-reliance, the ability to work in harmony with all kinds of people, good nature and common sense. In order to be certain of this a request for information should l)e sent to the superintendent of her training school, two or more recent employers, and possibly a school teacher who had known her for some years. Where the candidate has been engaged in private duty this request should be sent to at 1286 HISTORY OF AMERICAN RED CROSS NURSING least two people who have known her intimately, in addition to the superintendent of her training school. If the candidate has been engaged in war service. National Headquarters will secure her efficiency record. In February, 1919, the director of the Department of Nursing received the following letter from Dr. Taliaferro Clark, of the United States Public Health Service, chief of the Bureau of Sanitary Service of the Red Cross: I am in receipt of communication from the Surgeon General of the U. S. Public Health Service under date of January 25, 1919, in which he states that the service desires to inaugurate a system of social service and follow-up work as a part of its program for the prevention and control of venereal diseases so that infected persons may be kept under observation with strict supervision of their homes and places of employment until they have been cured. The services of qualified public health nurses who have had additional training in social service work are required to do this important public health work effectively. After a canvass of the field the Surgeon General advises that no registered public health nurses having special qualifications for follow-up work in connection with venereal disease control work are available at the present time, although the Public Health Service is prepared to give immediate employment to ten nurses qualified for this particular form of public health work and to continue the employment of such nurses in increasing number for an indefinite period of time provided the appropriations asked of Congress for this purpose are granted. Furthermore, it is the plan of the Service to transfer this special form of activity to State and Local Boards of Health as rapidly as this can be arranged, thereby creating an increased demand for nurses with the special qualifications mentioned. The Surgeon General states that so far as it is known to him no funds are available for this purpose from any source and recommends that, if such request be consistent with the Eed Cross program for public nursing and not at variance with the Rq(\ Cross program for post-war work, tbe sum of $6,000 be appropriated to l)e expended in the training of not less than ten public health nurses for a period of four months each at tlie .Tohns Hopkins Hospital. Baltimore, ^Maryland. In view of the wide prevalence of venereal infections in the general population niu^ tbo potential danger of tbese infections to national efficiency, the desirability of adopting all fruitful FROM RURAL TO PUBLIC HEALTH NURSING 1287 measures for their control and the lack of public health nurses with the special training desired by the Public Health Service available for duty in connection with its program for the control of these diseases, I wish to recommend that the War Council be requested to appropriate the sum of $G,000 to be expended by the director of the Bureau of Public Health Nursing for the training of not less than ten public health nurses in accordance with the plan proposed by the United States Public Health Service. In response to this letter the Department of iNTursing made recommendations to Mr. Munroe which were approved by him, and certain funds were appropriated for the cooperation seught by the United States Public Health Service. With the exhaustion of the first large scholarship and loan fund the need for another such fund stood out sharply as stated in a memorandum sent by the director of the Depart- ment of Nursing to the Central Committee in December, 1919, as follows: After careful consideration and conference with the Division directors of the Departments of Nursing and the director of Public Health Nursing at National Headquarters, it seemed highly desirable to present a request for an additional appro- priation for scholarships and loan funds to the Executive Committee. At the meeting of the National Committee on Red Cross Nursing Service on December 9, 1919, the matter was pre- sented for their consideration and it was a unanimous vote that the request be prepared. The recommendations for this appropriation are based upon the following arguments : 1. The Division directors of Public Health Nursing have estimated that they can readily use sixteen hundred public health nurses and will acutely need at least one thousand public health nurses during the coming six months. From present resources there is very little possibility of meeting even a small part of this personnel. 2. It will be necessary, therefore, to look to the graduates of courses in public health nursing to fill this need. The courses can admit during the next six months somewhere between 450 and oOO students. There are undoubtedly as many more nurses who are ready for post-graduate course^;, but the large majority will be unable to do so unless they are given lil)eral financial assistance. The high cost of living continues to make it practically impossible f -r them to forego 1288 HISTORY OF AMERICAN RED CROSS NURSING a salary and in addition meet the cost of a course from their own resources. 3. Chapter scholarships will undoubtedly be available in considerable number, but they can by no means be relied upon to meet the whole need and they are limited to a comparatively small group of nurses who are in a position to return to the Chapter which grants the scholarship. There will be many occasions when the Division directors would like to grant scholarships to nurses but will not find the Chapter scholar- ships suitable. There are also Divisions where Chapter schol- arships will be scarce. 4. The original scholarship fund of $100,000 is exhausted. The results achieved from it would seem to justify us in seeking another such fund. It helped materially in meeting the need; by this means, 247 nurses have already been pre- pared for this branch of work ; it greatly increased the popular appreciation of the need of adequate preparation for public health nursing ; and it undoubtedly stimulated the opening of several new courses. Following the granting of this appropriation new instruc- tions were issued governing its disbursements indicating certain changes in policy from that governing the distribution of the first fund : A second national fund of $100,000 is now available for Eed Cross nurses who contemplate preparing themselves for public health nursing by taking a post-graduate course. This fund is divided into two sums, $00,000 being for scholarships and $40,000 for loans. Xo part of this fund is "restricted" and no recipients will be required to serve in the IJed Cross Public Health Nursing Service although all recipients must promise to engage in public health nursing for one year. In addition a special loan fund of $10,000 has been appro- priated to be distributed among the Divisions for the purpose of defraying traveling and other incidental expenses incurred by nurses taking the post-graduate courses in public health nursing. Where such loans are considered necessary in addi- tion to a National or Chapter scholarship or loan, they may be made from this fund by the Division Department of Nursing direct to the nurse. It is desired that oidy those candidates shall be recom- mended for scholarships who are well educated, academically and professionally, and whose records show more than ordi- nary ability and personality. FROM RURAL TO PUBLIC HEALTH NURSING 1289 Furthermore, it has been deemed unwise to set any stated amount either for the scholarships or the loans. In making announcement of this second fund no amounts will be speci- fied and no maximum and minimum stated. Funds are avail- able for partial scholarships supplemented by loans to be added to the nurses' own resources, the amounts to be deter- mined individually for each candidate. It is desired that in the future the majority of candidates shall receive smaller scholarships than in the past and that deficiencies shall be met by loans. Scholarships covering the entire cost of the course, no part being in the form of a loan, shall be granted hereafter only under exceptional circumstances. Scholarships and loans from the national fund may be awarded for one or both semesters of a post-graduate course of eight months; for a post-graduate course of four months or for one of six weeks. The scholarship or loan for the six weeks' summer course should be granted only to nurses who have had a considerable amount of public health experience under supervision and who feel the need of additional theo- retical preparation before undertaking independent work. Nurses who have had experience of less than six months, or without supervision, or of doubtful value, should take one of the longer courses. It should be explained to applicants that scholarships and loans are not awarded to nurses who are able to meet the expenses of a course themselves. Candidates should apply for the minimum amount whicli will enable them to meet the cost of the course. Nurses who can take the course with the assistance of a loan shall be granted a loan rather than a scholarship and where possible partial scholarships, supple- mented by loans, should be encouraged. ^"^ With the decentralization of the Bureau of Public Health Nursing earlier methods of administration became obsolete and a different system was set up. New instructions were issued to the Chapters, whose great increase in numbers has been mentioned. Sections relating to finance are quoted below: 15. Wliere no Puljlic Health Nursing Service exists or none is immediately projected it is very desirable that a Chapter establish such a service and Chapter funds may be used for this purpos*^. However, it will be preferable in many cases not to use Chapter funds wholly, ])ut to enlist the sup- port of the community i)y seeking the money needed from "Instructions for Divisions, March 15, 1920, from general manager. 1290 HISTORY OF AMERICAN RED CROSS NURSING sources such as municipal or county funds, private contribu- tiouB, or special campaigns. 18. Where a nursing service is being conducted by a mu- nicipality or county at public expense, but is affiliated with the Eed Cross Bureau of Public Health Nursing, the Chapter should be permitted to contribute money from Chapter funds to cover certain necessary expenditures not provided by law to be paid from public funds. The Chapter, however, should not take over the entire financial responsibility for a nursing service which is now being conducted by the city or county and supported by public funds. 20. The desirability of establishing a Chapter public health nursing service having been decided upon, the Chapter should adopt in advance some plan for financing it. The financing of the public health nursing service shall be done by the Chapter Committee on Xursing Activities, subject to and with the advice of the Chapter Executive Committee. 21. It will be well to have available at the time of starting the service an amount sufficient to finance it for a period of at least three months. 22. The various items of expense which may be expected are: The salary of the public health nurse or nurses. The salary of a possible substitute for either the period of a nurse's vacation or illness. The rent of an office for the nursing service, where neces- sary. The purchase or rental of a conveyance. Street car or train fare. The cost of a telephone in the nurse's home. The cost of loan closet supplies.^" The cost of the nurse's bag with equipment. With the promulgation of the above reorganization plans the final policy of the Red Cross was thus stated : The Red Cross would prefer to have communities organize and finance their own public health nursing service, when possible, under the supervision of tlie state autliorities. Where the community is unable or not ready to bear the entire burden of financing a public health nursing service, the "In cflFect March 1, 1919. FROM RURAL TO PUBLIC HEALTH NURSING 1291 Red Cross will undertake to organize the service, and finance it, with the aid of tlie community, or from its own funds, until such time as the State or Municipality will take over the direction and supervision of the service. It was well known that when the Red Cross launched its Rural Xursing Service large sections of the country had no visiting nurses. In loot), in seventeen states of the Union, only seven visiting nurses were reported, or one to every 230,000 square miles. Throughout Great Britain and Ireland in 1900 there was one Queen's Xurse to every seventy-two square miles. On the basis of population there was (1000) an average of one nurse to 614,03-1 persons in the seventeen states under consideration, while in Great Britain and Ireland there was one nurse to every 27,246 persons. The sixteen Red Cross nurses appointed in 1013 were a veritable grain of mustard seed. Nearly twelve months later the variety of groups employing Red Cross visiting nurses included : Health Committees and Social Welfare 9 Health Committees 3 Social Welfare Organizations 4 Associated Charities 2 Visiting Xurse Associations 11 Women's Civic Clubs 3 Red Cross Chapters 2 Corporations 2 Miscellaneous 1 One year more, and the demand far outran the supply. In that year 21 new affiliations were accomplished, but 8 old ones were discontinued for lack of funds. By 1017, 85 affiliated associations were employing 07 nurses in small towns and rural communities. In that year it was estimated that all the nurses save one were at work in communities numbering from 5U0 to 10,000 people, the early limit of 5000 inhabitants per town having gradually risen to 25,000. Nineteen fields of work had populations running from 1000 to 5000: thirteen other fields varied between" 5000 to 10,000. The visit- ing areas ranged fro;n two square miles in the smallest field of 500 persons to from two to eight S(|uar(> miles in those having 1292 HISTORY OF AMERICAN RED CROSS NURSING 1000 to 5000 persons, and from one to seven square miles in those having populations between 5000 to 10,000. By February 1, 1917, there were sixty-one communities where Red Cross visiting nurses were stationed. Twenty-two states entered into this list, New Jersey and Michigan each having eight, Massachusetts seven, Kentucky and Pennsylvania each five, California, Arizona, North Dakota, Missouri, Ohio and Iowa each one. During the previous year (1916) the cases having received nursing care numbered 10,286 ; the total num- ber of visits made were 112,836. These visits fell, approxi- mately, into classes as follows: Public school visits, eight per cent; infant welfare, seven per cent ; prenatal care, two per cent ; tuberculosis cases, three per cent; visits of sanitary inspection, four per cent; nursing care, forty-seven per cent ; while business and unclassified calls completed the list. In other words, bedside nursing came first with 47 per cent of visits made. Instructive visits came next, with 17 per cent, business calls, with 13 per cent ; social service calls, with 11 per cent, and unclassified, 10 to 12 per cent. Inquiries from com- munities eager to learn of visiting nursing or to establish it now increased by nearly 100 per cent, while applications from nurses also increased. The status of public health nursing generally after the Armistice is described in the next chapter, and the statistical chart there shown gives a complete picture of the statistical side of oux" material. CHAPTER XV RED CROSS PUBLIC HEALTH XIRSIXG AFTER THE "WAJl A MONTH after the Armistice the general manager (Frederick ^Iiinroe) wrote to the Division managers the following: ''With the declaration of peace the further development of our public health nursing and of our courses in Home Hygiene and Care of the Sick and Home Dietetics, which have been temporarily interrupted hy the more insistent needs of the war, will now be among the foremost activities of the Red Cross." '"It is planned," he wrote, ''that each chapter will have a Committee on Xursing Activities through which all matters relating to this work may function," and stated that one of the activities to be assumed by this committee would be "to develop and aid the organization of public health nursing over the entire territory of the Chapter." Thus the first official step was taken toward the initiation of the expanded public health nursing program of the Red Cross after the war. The reasons given by the Bureau of Public Health Xursing in recommending this expansion were set forth as follows: Public health nursing, like many social developments of recent years, had its origin in the large city, spreading slowly from one city to another and from city to town, but not ex- panding to any extent at first to small towns, villages and the open country. Only in the years immediately preceding the war had there begun to be an active appreciation of the need of extending the advantages of public health nursing heyond the larger centers. The attention of many students and leaders of American affairs shifted its focus to the study of the development of country life. They were quick to dis- cover that among other elements of neglect one of the most serious was tiie lack of provision for the preservation of health and care of the sick. At the same time national and state agencies, both public and private, concerned witli health prob- lems, were also discovering these gaps in tlieir system for maintaining high standards of health and were giving much thought to ways and means of lilling them. State tuhercu- 1293 1294 HISTORY OF AMERICAN RED CROSS NURSING losis associations in many states, and state departments of health in a few, began to extend public health nursing to the people in the smaller towns and the country, and were making fair headway. And then the war came and a large part of the trained personnel necessary for the execution of these plans was drawn into war work, thereby seriously crippling their fulfillment for the time being. At the same time the need for extending health machinery and increasing the number of health workers all over the country was greatly accentuated by Avar conditions, and so soon as possible emergency plans to fill these needs were set going. For five years before the war the Eed Cross also was en- gaged in promoting rural nursing through its Town and Country Nursing Service. Having for the most part a quite uncultivated field in which to labor, this service progressed but slowly. Though the number of services under its direc- tion never exceeded one hundred at any one time and the work consequently never reached impressive proportions, its influ- ence was much in excess of its size and it played a valuable part in the early days of rural nursing. During the war a number of new activities came under its direction. Since the old title, the Town and Country Nursing Service, did not fit these new phases of work, it was changed to the more appro- priate one of the Bureau of Public Health Nursing. Out of the experience of the war and of the country during the war grew certain great primary lessons of more universal and convincing value than could perhaps have been taught by all the educational work of all the health agencies together before the war. Jt is unnecessary here to recite these lessons, since they are known to all. As the result of them at the close of the war there existed throughout the country a lively awareness of the present inadequate distribution of public health nursing, an acute consciousness of the universal need for it and a widespread demand for public health nurses. A year after the armistice, we found in taking stock of the situation that there were two states, Ohio and Wisconsin, in which there Avas a mandatory law compelling every county to have a public health nurse (in Wisconsin the law provides the alternative of a public health instructor) ; that in sixteen states there were permissive laws enabling the counties to use county funds for public health nursing, if tbey choose so to do; that in fifteen states there were state supervising nurses employed by the state department of healtli as directors of bureaus, divisions or sid)-divisions of public health nursing, whose functions were to promote ])ui)li(' health nursing in the counties and to get county officials, county funds and county PUBLIC HEALTH NURSING AFTER THE WAR 1295 interest back of a public program for public liealth nursing. According to Miss Yssabella Waters' figures there were four states, Massachusetts, Connecticut, Khode Island and New York, in which there was one public health nurse to every four or five thousand people. Dr. C. E. A. Winslow says the ideal is one to every two thousand. From the high standard of these states the ratio decreased rapidly, the lowest being one public health nurse to one hundred and eighty thousand people in IMississippi. Wyoming had only two public health nurses; Nevada, three; Utah, outside of Salt Lake City, none. So rapidly in the last few months, however, has rural nursing progressed that no doubt these figures are already out of date. At the same time the country was covered with "ready- made" groups of workers in Red Cross chapters. These work- ers were disciplined by continuous and exacting war duties; they had learned to get together for a common purpose ; they had shared in the responsibilities of the nurse and had felt the exhilaration of serving others in a big cause. Their war duties were drawing to a close, but for many of them the spirit of service remained and could be put to use in com- munity activities. With this machinery and this spirit ready at hand and a great need existing throughout the rural parts of our country for public health nursing, the Red Cross was in a position to make a great contribution to the welfare of the people of the nation by setting the chapters to work to promote this activity in territories which otherwise might not be able to introduce it for some time to come. In so doing the Red Cross would simply bo extending its traditional duties of saving life, miti- gating suffering, preventing unnecessary disease and fortify- ing physical stamina.^ The Red Cross was convinced that the Chapters in niral and semi-rural comnmnities would find an excellent opportunity to perform a service of great value through the establishment of public health niirsing since there were many counties, towns and villages having no such service, where the need was great and where the installation of such a service bv the chapter would be warmly welcomed. It was planned, therefore, to en- courage Chapters in such localities to develop a public health nursing service. The scope of the Town and Country 8ervice had been limited to towns having a population less than 25,000 and to rural ^ Fehniary, 1920. issue of tlio Puhlic Health Xursc: "The development of the Ked Cross Public lleulth Niirsiiifr Service." 1296 HISTORY OF AMERICAN RED CROSS NURSING communities. In the spring of 1918 the National Committee on Red Cross Nursing Service removed this limitation and set no restriction in its place on the basis of population. It was henceforth permissible to establish a nursing service in com- munities of any size when so desired. The Red Cross did not propose, however, to enter communities where the work was well established and the people well informed in public health nursing principles and procedures. Such communities were already meeting the situation in this field and were not in need of assistance and supervision. The concern of the Red Cross was for those communities in which public health nursing was just being established, where the people had yet to learn how to develop and manage this new undertaking, where advice and trained supervision were needed, or where the backing secured by being a part of the Red Cross service was a source of moral support and strength. It was recognized that public health nursing was a public function which depended for its success on its understanding and willing acceptance by the people of the community. For this reason, it was agreed that it would be much more sound and permanent in character and wider in scope if it were built slowly and if the general public had a share in the local re- sponsibility for and management of this fundamentally public enterprise. As public health nursing was considered to be a community service, it was to be developed in harmony and cooperation with other community activities. Furthermore, as any local accomplishment formed an organic part of the work of the state, it was agreed fliat the Chapter should plan its service in line with the state program for public health nursing and should always be responsive to suggestions from the state. The Red Cross was to be considered an educational agency, not necessarily the permanent directing agency, and assumption of financial responsibility by the municipal or state authorities was to be welcomed. Moreover, as reported later: "In working out the plans for the conduct of this work, consideration was immediately given to the fact that the Red Cross was not alone in the field ; that many other agencies, national, state and local, public and pri- vate, were engaged in promoting some one or mcu'c branches of public health nursing; and that much good work was already under way. These agencies were attacking the need from vari- ous angles, none of tlicni with complete programs or with any PUBLIC HEALTH NURSING AFTER THE WAR 1297 immediate expectation of meeting the whole need. There seemed to be no probability that all of them working together would be able to meet more than part of the great need of rural communities for some time to come. The Red Cross merely proposed to supplement the work of these agencies by bringing assistance to rural people until governmental agencies could more nearly take care of them." ^ When this general plan had been accepted by the Central Committee of the Red Cross, instructions were issued which set forth the following policy : Chapter nursing activities shall always be conducted with the thought that in so far as they alfect the public health they constitute one phase of a very broad public problem. With this thought in mind the chapter nursing activities shall be carried on in a manner that will assure cooperation with medical or social welfare work existing or to be introduced in the community. It is equally important that the spirit in which the work is conducted shall be one that will enlist the interest and aid of the entire community. With that end in view the activities shall be developed as a public service and not as a charity and the personnel conducting such activities shall make an especial effort to popularize them. It is not proposed to initiate public health nursing activities in com- munities where agencies exist for this purpose, unless to co- operate with or aid the estaldished agencies. The American Red Cross seeks only to develop the public interest in public health nursing activities. It does not seek to retain permanent supervision of these activities and will welcome state or municipal assumption of supervision and control of all public health nursing services. Tlie Red Cross proposes to initiate public health nursing services only in localities where there are no existing agencies for that purpose and where none is immediately projected by any other state or national organi- zation. The b'ed Cross also desires to cooperate with other organizations already in the field and to render the fullest measure of such cooperative service. It does not seek to supplant or compete with any existing service or organization, or to initiate any ])rograni which will conflict with the plans of other organizations. The l?ed Cross rather seeks to aid other agencies with the ultimate purpose of securing the wisest })ossible development of the public health nursing serv- ice through the properly constituted State and local organiza- '"The Red Cross I'uhlic TIcalth Xursitifx Service. A History and Fore- cast." Jicd Cruiss Hullitin, January 20, 1920. 1298 HISTORY OF AMERICAN RED CROSS NURSING tions. Because of its extensive Chapter organization, the Eed Cross feels that it is able to promote the establishment of these activities in territories which otherwise might not be able to introduce such a service for some time to come. By this development the Red Cross may make a distinct contribution to the progress of public health nursing throughout the country.^ Participation in and the organization of public health nurs- ing by the American Red Cross was described as follows : The American Eed Cross is anxious to promote this work in small towns and in the country, but would prefer to have communities [public authority] organize and finance their own public health nursing service, where possible, under the supervision of the State authorities. Where the community [public authority] is unal)le, or not ready to bear the entire burden of financing a public health nursing service, the Eed Cross may undertake to organize tlie service and finance it, with the aid of the community or from its own funds, until such time as the state or municipality will take over the direction and support of the service. The ways in which the Red Cross may proceed in develop- ing public health nursing may roughly be classified under four headings : (a) It has authorized its Chapters to develop public health nursing services and to use Chapter funds for tliis purpose. The work may therefore be started by the Eed Cross Chapter. (b) Where one or more other local agencies, public or pri- vate, are desirous of combining in a joint nursing service and are ready to sliare in its cost, the Chapter may participate and contribute its share of the funds if it is proportionately represented on the committee in charge of the service and if its standards of personnel and work are maintained. (c) Occasionally an organization which is conducting a local public health nursing service desires the assistance of the Eed Cross in securing a nurse and its advice and help in regard to and supervision of the nursing service. It may secure this continuous and systematic assistance by affiliating with the Eed Cross Public Health Nurs- ing Service. In so doing it must agree to maintain ' "The Organization and Administration of a Public Health Nursing Service. Instruction for Chapters," March 1, 1919. PUBLIC HEALTH NURSING AFTER THE WAR 1299 certain standards of sorvico set forth in the . . . statement caUcd the "Aftiliation Af(reement" and must sign this statement as an evidence of its intention to ohserve these conditions, (d) Where there is an existing organization conducting a puhli(! liealth nursing service which might greatly ex- tend the development of its work through the financial assistance of a Chapter, the Chapter may contrihute a sum suilicient to aid in this development. No dona- tions from Chapter funds in excess of one-tenth of the yearly expense of conducting the puhlic health nursing service may he made, however, excejit under special circumstances and with special permission from the Division.* The old Town and Country Xursing Service had consisted largely, as set forth in the preceding section, of a series of aliiliations with local organizations, quite independent of the Jvcd Ooss Chapter, such as women's clubs, Visiting Xurse Associations, Civic Leagues, town and school boards and similar groups. While the plan was now changed to extend the service hereafter throngh the chapters, the old method of creating athliations with local organizations outside of the chapter was not abandoned, althongh limited by the new- policy that such affiliations should not be made in states having a well developed system of State supervision of nursing nnder the State department of health. It was felt that the State super- vising nnrse was prepared to give the necessary direction, as- sistance and supervision to independent public health nursing organizations and that conse(piently any affiliations which the Red Cross might form with them would only result in needless duplication. As stated in the first paragraph of this chapter, all nursing activities conducted by the (^hapter including public health nursing werc^ to be administered by a Committee on Nursing Activities. I'lie method of appointing this committee and sug- gestions concerning its membership were set forth in the in- structions to chapters as follows : The mem])ers of this committee shall he appointed by. and continue in office during the ])lcasurc of. tlie Chapter I-accu- tivc Coiumittce. Th(^ ai)i)()iiitnioiits to the Cha]itcr Cdininittoe * Tnforniiit ion for Communities Conccniinjr tlio TumI Cross Public Health Xursin" Service, 1300 HISTORY OF AMERICAN RED CROSS NURSING on Xursing Activities shall be approved by the Division Director of Nursing before they are confirmed. The commit- tee should consist of as many workers as, in the judgment of the Chapter, may be necessary to carry on the work effectively and should include both men and women. It will usually be found desirable to limit the committee to fifteen members and there should not be less than five members. The chairman of the committee shall be appointed by the chapter p]xecutive Committee and should be a person having a positive interest in all the activities under the jurisdiction of the committee. A vice-chairman should also be appointed to carry on the work of the committee in the absence of the chairman. The chapter Committee on Nursing Activities should in- clude among its members one or more representatives of each of the following : (a) The Board of Health. (b) The Board of Education (or representative teacher). (c) The ]\Iedical Association. (d) The Chamber of Commerce or Board of Trade. (e) The Clergy. (f ) Such other active local organizations as the Civic Club, Woman's Club, etc. (g) The Chapter Home Service Section. It may be of advantage also to have a representative of the Com- mittee on Nursing Activities on the Home Service Committee, and it is suggested that this be arranged for when practical)le. (h) The Local Committee of the Bed Cross Nursing Ser- vice, where convenient ; or, if not, then a representative Eed Cross nurse qualified as a general representative of the Bed Cross Nursing Service should be appointed with the approval of the Division Director of Nursing. (i) Other local public health iiursing agencies, if any. (j) Chapter School Committee. (k) United States Department of Agriculture (usually a Home Demonstration agent)."' Certain regulations were made concerning the nurse's ser- vice to the Chapter. Tlie first three months were to be consid- ered probationary and a month's vacation with pay allowed an- nually. It was recommended that after six months' service one half the trav(ding oxpc^nsos incurred by a nurse in reporting '^ "Tlio Dovplopmcnt and Administration of Chapter Nursing Activities; Instruction for Chapters/' March 1, 1919. PUBLIC HEALTH NURSING AFTER THE WAR 1301 for duty be refunded. One half day a week, exclusive of Sun- days and holidays, was assigned for rest and recreation and sick leave with pay arranged for. if night duty were necessary in emergencies, the nurse was to have sutHcient rest the follow- ing day. Private practice by the nurse was absolutely for- bidden. In addition, definite instructions were issued concerning certain aspects of the work, such as the professional relation- ship of the nurse to the medical profession, the inadvisability of material relief given by the nurse and the placing of the work on a business rather than on a charity basis, allowance being made, however, for those unable to pay the full cost of the nurse's visit and for the maintenance of a free service for Army and Xavy men and their families and for disabled ex- service men. In regard to appointments the instructions read : The public health nurses must be appointed to the Chapter by the Bureau of Public Health Nursing at Ked Cross Division headquarters. . . . Xurses desiring to serve as Tied Cross public health nurses must meet all the requirements of the Ped Cross Bureau of Public Health Xursiug and must be enrolled Ked Cross nurses or must make application for enrollment. . . . Requirements for appointment in the Red Cross Public Health Xursing Service were defined as follows : A graduate nurse who has had no experience or training in public health nursing cannot conduct a public health nursing service satisfactorily. The varied responsibilities demand a person who is an organizer, teacher aiul demonstrator as well as a nurse and one who is familiar with public health problems and procedures. These qualifications and this knowledge are only secured by experience under direction or by special training. Public health nursing is a highly developed form of nurs- ing, ])re])aration for winch is not iiuhided ordinarily in the training school curriculum. It is necessary, therefore, for the nurse who wishes to be successful in this lield to undertake a post-graduate course or to secure lier 1 raining thi'ougli super- vised exiierience mufer the direction of a puMie health nurse instructor. Professional requirements for tlie Bed Cross i)uhlic health nurst^ ;u'(> eliuihilitv for enrollment in 1 he I'cd Ci'oss Xur'^inctors of Bureaus of Public Health Nursing in four of the Divisions. Having had several years' experience of public health nursing in the east, west and south and a post- graduate course at 1'eachers College, Anna A. Ewing was appointed to the Atlantic Division and filled the position with painstaking zeal until the Atlantic Division was merged in the Washington Division in June, 1922. ^Madeline Oldfield, who had had ten years' experience in public health nursing largely in or around New York City, was appointed to the Potomac Division and was later succeeded by Nellie F. Oxley. ^Irs. Grace Engblad, an English woman, trained and with years of experience in this country, undertook the work in the Gulf Division, wli(>re she served until her health made a change necessary. Sli(> was succeeded by Mary ]v. Nelson. ]\Irs. Ethel S. Parsons, a graduate of the public health nurs- ing course at ^(^acliers College and with several years of execu- tive public health nursing experience in Texas, became Director of Public Health Nursinii' in the S(^utlnvestern Division. After 1304 HISTORY OF AMERICAN RED CROSS NURSING a year of service she resigned to become Director of Public Health Nursing in the Texas State Board of Health and was succeeded by Anna L. Stanley. One of the leading school nurses in the country, Miss Stanley could not long be satisfied in a general executive position and in July of 1920 gave up the Division directorship to become special supervisor of school nursing for the Red Cross, in which position she did much to work out a standard school nursing technique for Red Cross nurses. She was succeeded by Ethel Pinder. Two years' experience in industrial nursing gave Mrs. Florence Downing, who was appointed director in the Penn- sylvania-Delaware Division, an added advantage in handling the public health nursing problems in Pennsylvania, a state of many industries. Coming from the East originally but with ten years of public health nursing experience on the Pacific Coast, Emma Grit- tinger, as director of the Bureau of Public Health Nursing in the Northwestern Division, was no "outsider." Leaving for the East in February, 1920, to take up public health nursing work at Teachers College, she was succeeded by Grace Har- rington. Also with an eastern training, but a western exxperience, Mary L. Cole was taken over from the super intendency of the Visiting Nurse Association of Santa Barbara, California, to become Director of Public Health Nursing in the Pacific Division and later director of the Nursing Service as well. Each Division Bureau was a part of the Division Depart- ment of Nursing. It remained the function of the National Bureau to determine general policies and plans, set uniform standards, outline uniform administrative procedures, make contact and work out agreements with other national agencies and to guide and help the Division Bureaus. It became the function of the Division Bureaus as projections of the National Bureau to interest the Chapters in and to help them to organize and administer public health nursing services, to secure for them trained public health nurses and to guide and assist them by visits of the Division staft' to the Chapters and of Chapter officials and workers to the Division office, by regional and state meetinas, through correspondence and a system of monthly reports and by other nietliods. The Division ]^ui'eau was re- sponsible for the niaintenanee in the Chapters of standards of PUBLIC HEALTH NURSING AFTER THE WAR 1305 nursing work and personnel set by the American Red Cross as previously described. The operating unit was the Chapter, which was usually coun- trywide, or the affiliated organization. The planning, direction and execution of the work was left entirely to these local units with national standards for their guidance and with the super- vision described alwve, which always had as its primary con- sideration the peculiar needs and possibilities of the individual Chapter. The line of communication was from Chapter to Division and from Division to National Headquarters. The latter did not negotiate directly with the Chapters. In ^larch, 1!)1J), soon after the work was decentralized, the general manager issued two sets of instructions to be dis- tributed by the Division managers to the Chapters. These were called **The Development and Administration of Chapter Nursing Activities" and "The Organization and Administra- tion of a Public Health Nursing Service" and were designated as "A-700" and ''A-TOl." ]\Iany extracts from these Instruc- tions have been given in the preceding pages. Two pamphlets called "Information for Communities Concerning the Ked Cross Public Health Nursing Service" and "Information for Nurses Concerning the Red Cross Public Health Nursing Service" were issued by the bureau, as was also a popular pam- phlet for propaganda purposes called "Have you a Community Nurse V The typical methods used by the Divisions to introduce pub- lic health nursing to the Chapters were described by one of the Division directors of Public Health Nursing as follows: The progress of the work in the chapters may be indicated through the followiii;^ methods which have been ])ursued. The work had its first introduction tlirough the medium of a cir- cuhir letter from the Division Manager to all Chapters, an- nouncing the ])lan and sending a copy of ATOO and ATOl. Tlie next step was to make the general field rejirescntatives thoroughly familiar with the {)lans and ])urposes of the Bu- reau. In their general development (if Chapter activities they included the giving of information concerning public health nursing as a possible activity of the Chapter. The tliird step was to acquaint all hosjutals and training sciiools for nurses with the phin for jirovidiii','- IJed Cross sch(ilar>hi|)s whicli made training in public health nursiiiL;- available. This infor- mation was also sent to all Local Coinniittees on lie(l Cross 1306 HISTORY OF AMERICAN RED CROSS NURSING Xursiiig Service and to all Home Service secretaries. In addi- tion, the Department of Publicity pjave full information re- garding the Red Cross plans for public health nursing to the publicity chairmen of the different Chapters and also to press officials. The Division publication, "IJed Cross Briefs," also carried regular articles on the subject and in order to make this information available to nurses about to be graduated, every hospital in the accredited class was asked to furnish a list of the senior nurses in their training schools and these nurses were put on the regular mailing list for "Briefs," thus giving them each week current information regarding the progress of the work of the bureau and other information w^hich might be of value to these prospective nurses in plan- ning their work after graduation. Efforts were made by the Division Directors to visit in person or to send a nurse assistant to visit as many of the Chapters as possible both to introduce the work and to help the Chapters which were interested to take the right stops toward its organi- zation. Some of them commented as follows : Only those Chapters were visited by us who requested us to do so, saying they were interested or could Ije interested. Every Chapter and most of the larger branches in the Divi- sion have been visited by tlie Division Director of Nursing and the health ])rogram presented. The Division Director made personal visits to Chapters, hchl coiiforeuces, spoke to groups of nurses, Chapter execu- tives, liigh school ])u])ils, physicians, boards of health, and to various other groups of people. While this w^as going on in the Divisions, miich publicity was being given the public health nursing program by the Red Cross in n(;wspapers, popular magazines, nursing journals, tho Bed Cross Magazine and from the platform. The response from the Chapters to th(! suggestion that they might engage in public health nursing was so immediate that the Division directors were soon overwhelmed by its volume. As an immediate corollary, it was reported, they had to find public health nurses to fill the positions which immcdiatelv began to spring up, or to interest other nurses in securing the necessary preparation to fill these pr)sitions. PUBLIC HEALTH NURSING AFTER THE WAR 1307 The second proposition was much harder than the first. Hun- dreds of Chapters received with great interest and zest the information that under certain conditions they might engage in puhlic health nursing and were eager to get under way at once. Their demands speedily outran the supply, and the Division directors had to turn from stimulation to restraint. They described the methods used to reach and interest nurses as follows: Interviews and correspondence with nurses in Division offices; addresses to nurses at State and local organization meetings and to pupils in training schools; circularization of nurses and superinteiulents of training schools; distribution of the booklet "Information for Xurses" and Division bulle- tins to senior classes of training schools; personal talks to nurses who were to take state registration examinations ; in- fluencing Cbapters to interest senior nurses in training schools by inviting them to social functions at which public health nursing was ])resented ; advertisements and write-ups in news- papers, magazines and The Puhlic Health Nurse and the American Journal of Nurying.^ They ascribed their inability to keep up with the demand to a variety of causes, the most common being : the lack of properly qualified public health nurses ; the lack of convenient post-grad- uate schools and their overcrowded condition ; the inability of numy nurses to take post-graduate training because of insuffi- cient (education or lack of funds; the difficulty in getting nurses to undertake rural work, and the scarcity of accredited training schools in several states. In June, 1020, the national director of Public Health Xursing reported : During the year nearly SOO nurses have been added to our field staff and 20 per cent of tlie cha])ters have been enabled to launcli a public health luirsing service, a truly remarkable achievenieiit. The securing of so large an additional per- sonnel in so short a time was due ]irincipally to three things: 1. The return of tliousands of nurses from overseas, many of them witli a new interest in ])ublic health nursing. While bundre(ls of these came into our service, huiulreds also went into ]iuhlic JK^alth iiursinLT und(M' other ausjuces. thus greatly incrcasinLT the total nuniher of work(>rs in this field. 'i'lic I'fd Cross I'lililic llcnllli Nursing Service. A History and Fore- cast," h'xl Crn.K.K HuUrlii). .lanuarv -iC., 1920. 1308 HISTORY OF AMERICAN RED CROSS NURSING 2. The active campaign carried on by the Divisions in all nursing centers, such as training schools and state and local nursing associations, and the broadcast advertising given rural nursing. The Eed Cross has made rural nursing popular among nurses. Formerly interest was largely directed toward city work, and only a few nurses had caught the vision of the great opportunities awaiting them outside the large centers. To-day rural nursing occupies the limelight, and nurses by the hundreds are flocking into it. They have had their imagi- nation fired by the infinite possibilities for original, effective and very human service in the smaller towns and the country. 3. During the past year 278 scholarships and 69 loans have been awarded from the National Fund of the Red Cross to graduate nurses to enable them to secure public health nursing training at one of the accredited schools or universities giving a public health nursing course. The Chapters also have shown great interest in assisting nurses to become fully prepared for their public health nursing work, and have given approxi- mately 2G-\: scholarships for this purpose. The Metropolitan Chapter of Boston alone has furnished 60 scholarships to graduate nurses, leaving them free to take up their public health work in whatever part of the country they desire. [This was also true for other Chapters.] Both the National IJed Cro* and the large city Chapters have been most generous too in aiding schools and universities giving a public health nursing course to perfect either their theoretical or practical work. Peabody College has been helped to carry on its course through a large subsidy from the Eed Cross and at the University of Louisville, Kentucky, the salary of a director for the course is contributed by the Red Cross. ... A practice field is being provided for the course at the University of California, and the Richmond School of Social Service and Simmons College, Boston, have been aided with appropriations. The ]\Iinncapolis Chapter is financing the practice field in Hennepin County for the course in pul)lic healtli nursing given by the University of IMinnesota. The St. Louis Chapter is contributing not only the entire cost of the practice field for the public health nursing course given by the ^lissouri School of Social Economy, but the salary of the director of the course and three supervisors as well. The New York County Chapter has made a large appropriation toward the preparation of public health nurses at the Henry Street Settlement, Xew York City.' ^'' Tho University (if Micliipan and the Sclinol for Sdcial Service at Philadelphia were given financial assistance later bv the National Red Crosis. PUBLIC HEALTH NURSING AFTER THE WAR 1309 Because of tlie tremendous demand for nurses trained espe- cially for public health nursin<,% because of the popularizing of rural nursing which demands special preparation, and because of the much needed assistance rendered hundreds of nurses through Ked Cross scholarships, there has been a remarkable boom in all the schools giving courses in public health nursing. Formal training in public health nursing through definite educational channels has been given tremen- dous impetus, and nurses generally are becoming convinced of the need for such training before undertaking public health nursing. Attendance at the various schools for public health nursing iiu-reased during the school year 1919-20 from 100 to 1000 per cent. Three new courses were opened and there are definite prospects of three more being opened in the fall of 1920. At the conference of the staff of the Department of Xiirsing at National Headquarters in the fall of 1910, it was estimated that the Divisions would need over 1000 public health nurses in the uext year. The great question was how to secure them. The number of nurses returning from overseas service who had had training in public health nursing and whom it was hoped to recruit for chapter service was far too few. The scholarship fund of $100,000.00 was a great help toward ob- taining a trained personnel, but meant delay while the nurses were receiving their public health nursing training. In the meantime the Chapters were clamoring for public health nurses. In the discussion at the conference, the directors spoke again and again of the eagerness of the Chapters to help their communities through establishing a public health nursing ser- vice and the pitv of losing the opportunity. Various methods of adding to the supply of public health nurses without seri- ously lowering the standard established by the Red Cross were discussed: the sending of nurses to a good visiting luirse asso- ciation for a few months' experience and then placing them in a Chapter service with the understanding that tluMr theoretical training should bo gotten at the first ()p])ortunity ; or the placing id" carefully sch^cted nurses who had had teaching expcricmce but no public health nursing experience in positions under con- tinuous supervision for a few weeks with freipicnt follow up visits so that they might learn while gaining experience in the tield and delay the taking of the course until the opportunity arose. 1310 HISTORY OF AMERICAN RED CROSS NURSING It was the growing sentiment of the conference, however, that a four months' public health nursing course was little enough training to require and Miss Gardner crystallized this feeling in words which met with overwhelming agreement : Before we put in inexperienced nurses why couldn't we frankly say that we haven't the goods to deliver? This is not a proposition that we can go at by leaps and bounds. It is slow moving. We are going to lose a certain amount of enthusiasm, but we can afford to. We should educate the Chapters more and stimulate them less. Let us frankly say Ave cannot meet the demands with trained people all at once and must wait until we can, rather than resort to all sorts of makeshifts. In view of the stand taken by the directors that the Red Cross should not attempt to meet the needs of the Chapters with unprepared nurses, another way of securing a few experienced public health nurses was brought up for discussion. It was suggested that Visiting Xursc Associations should be looked upon as recruiting and training centers for public health nurses, giving them, through actual experience on the staff under super- vision, sufficient preparation for independent work in the coun- try. Ways of accomplishing this without making it difficult for the already overburdened Visiting Nurse Associations were discussed. The conclusion seemed to be that two methods might be followed. The first, suggested by Miss Gardner, was to send nurses from a given locality to a Visiting Nurse Associa- tion to become a member of its staff for a sufficient period to gain necessary experience, probably not less than eight months, and then to return to the community from which she came, to take an independent position. The Visiting Nurse Association would probably be able to take such a nurse on the usual salary basis. The second, that already in vogue, was for the Division directors to make personal or written re(piests to specific Visit- ing Nurse Associations for candidates to fill specific vacancies, since the nurses with the Visiting Nurse Associations were more likely to be interested in a concrete offering of a definite posi- tion than in a general appeal for interest. Directors in Divi- sions far removed from the larger Visiting Nurse Associations might, by this nu'thod, interest soni(^ of the nurses on such staffs to come to their Divisions to definite positions. The Division directors concluded by unanimously recom- mending the continuance of a national fund for scholarships PUBLIC HEALTH NURSING AFTER THE WAR 1311 and loans to prepare nurses for public health nursing in the regular post-graduate courses. Several months later the problem of meeting the needs of the Chapters for public health nurses having continued acute, the subject of some temporary measure to meet the need was again considered. A plan was laid before the Divisions for the employment of nurses not fully (pialified because of a lack of sufficient training or experience in public health mirsing. It was proposed that these nurses should be appointed as substi- tutes, be given two months' preliminary preparation on the staif of a recognized public health nursing organization under supervision and then be placed in Chapters under much closer sup(n'vision than that given the regular staff. Jt was further proposed that these substitutes should carry on a })r()cess of self-education through prescribed reading and be encouraged to complete their preparation as soon as possible through taking a full standard course, or at least a summer course of six weeks. This plan was decided upon with much reluctance and appre- hension, because it was feared that nurses with so inadequate a preparation would not be able to meet the many responsi- bilities of a public health nurse, since those with far better j)reparation were finding that their knowledge was scarcely equal to their tasks and that they had to draw on every resource to handle the problems daily confronting them. It was a pleasant surprise therefore to discover that the chapters on the whole had so far progressed in understanding the range and importance of public health nursing that they were not willing to accept this opportunity to launch a service without further delay, but preferred to wait for a fully quali- fied ])ublic health luirse. In the words of one state supervisor's report : Here 1 found the Committee on Xursing Activities composed of seven men and two women, and the most wide-awake com- mittee we have. They were well organized, seeking informa- tion, studying the ])roiM)sition from all and in this substitute plan than were Chapters, and it was not possible to iiml many willing to undertake it. In an Annual Report the national dirt'ctor of Tublic Health .Xursinu' stated: 1312 HISTORY OF AMERICAN RED CROSS NURSING The plan for the use of substitutes has not met with much enthusiasm so far. The five Divisions which are able to fill their positions have no need of it. In many states the State standard has now been elevated and a return to a more ele- mentary form of training would not be acceptable to the state, as in California, for instance. A very practical obstacle has been that the Chapters themselves, and even many public officials, are not willing to start their nursing service with a nurse who is not sufficiently trained to do a big constructive piece of work. They demur when it is suggested that they accept a substitute and frequently say they would rather wait until a fully equipped public health nurse can be had. Every division reports this same response. Substitutes are not going to be popular. Furthermore, the nurses themselves have passed the stage of makeshifts and are daily becoming more impressed with the need for further preparation. Few nurses of the right sort are willing to accept the status and prepara- tion of substitutes. Nevertheless, the plan will be tried in perhaps a half dozen states where the need is pressing and the supply small. ^^ As a result the plan soon fell into disuse and was abandoned. Not more than thirty substitute nurses were employed. It must not be construed, however, that all the Chapters were so enlightened that they recognized the value of employing only a qualified public health nurse. Every now and then the Divi- sion directors found that some Chapter had employed a local nurse with no training or experience in public health nursing without consultation with the Division. In the course of time, however, it frequently turned out that the Chapter regretted its action and later came to the Division seeking a nurse w'ith adequate preparation. It also happened even more frequently that the nurse engaged by a Chapter without any public health nursing experience or training soon discovered that she was beyond her depth and voluntarily decided to seek further train- ing. This tendency was mentioned in several of the monthly reports : One of the healthy signs of growth is that the nurses who have gone on duty without sufficient training have in every instance recognized their need and have api)lied for assistance in planning fur post-graduate courses. In the Lake Division no less than four nurses insufficiently prepared and placed by Cliapters without due consultation "Annual Report, July 1, 1!)1!) to June 30, 1920. PUBLIC HEALTH NURSING AFTER THE WAR 1313 with Division headquarters have themselves now felt the in- adequacy of their own training and are seeking to supplement it by a course in public health nursing. On the whole, the effect of Red Cross public health nursing has been to elevate the standard. Some of the State depart- ment of healtli men still say quite openly that they think the Red Cross is demanding too high a standard, but many of tliem are coming to feel that we have been wise in maintaining a high standard and a good many people in the Chapters are beginning to realize the necessity of demanding nurses with better preparation. There is much more definite recognition of the need for special training for public health nurses among all groups employing such nurses. Appreciation of the necessity of special training is constantly increasing among the nurses themselves with the sudden prominence given to public health nursing. We feel that our program has had a stimulating effect and aroused tiie interest not only of the nurses but of county boards of supervisors. In a recent conference with a member of a board of supervisors we were told that the board realized the need for qualified women and was especially anxious to have the supervision of the Red Cross. Chapters who have put on unqualified nurses without the knowledge of the Division ofiico have almost invariably come to realize that the nurse is not able to carry the program and have asked us to assist them to secure proper preparation for the nurse. When sucli nurses liavc resigned and the Chapters have asked for another nurse they have stated they would prefer to wait indefinitely in order to have a qualified public health nurse. It must be confessed that now and then one of those iinqnali- fiod nurses did surprisingly well, coml)ining valuable experi- ence in other nursing fields with personality and good sense. One State director reported the work of a nurse with no public health nursing training: "Miss deserves special mention. Tlie toclmique of her work seems ideal, and h(^r acconiplislinients have been niar\cl<)us. In no district has been found better coiipcrat idU from doctors and nursins,^ conimittecs. Tliis is due almost 1314 HISTORY OF AMERICAN RED CROSS NURSING entirely to the personality of the nurse. Her marked success and the failure of some of the young graduates of the four months' public health courses gives rise to the question as to whether an older nurse with experience as a hospital execu- tive, even without public health training, is not preferable. As the State is now districted, the district supervisor is able to give close supervision to all nurses, and certainly in this one instance the experiment has been successful. In almost every instance do we find that the older women are doing better work than younger nurses. With the rapid growth in the number of public health nursing services the necessity arose for securing assistance by building up a field staff, each department in the Red Cross having its own specialists in the field. Before decentralization eight Division Directors of Public Health Nursing had been appointed who in turn had appointed fifteen assistants and field supervisors. As even this expansion was inadequate the national director in the summer of 1919 sent this memorandum to the general manager recommending that the staff be doubled : The American Red Cross in undertaking the promotion of rural public health nursing throughout the country has taken upon itself the responsibility for a very far-reaching and im- portant public activity. This undertaking will be either a widespread, superficial, comparatively unproductive and poor piece of work, or else it will be an intelligent, thorough- going, permanently productive enterprise. With almost no exceptions the Chapter people know very little about public health administration in general and in particular of the activities carried on under the name of public health nursing or community nursing. The suggestion that they should undertake to develop public healtli activities within their jurisdiction usually is a new idea to them. Tliere is very definite and immediate need for the enlarge- ment of the Division staffs. In response to our stimulation many of them are conceiving original ])lans for carrying on public health nursing, which very frequently are not sound nor well adajited to local needs. Inasmuch as they have little knowledge of the scope, functions, principles and management of public health nursing, it is quite natural that their plans frequently should be unwise and imperfect. PUBLIC HEALTH NURSING AFTER THE WAR 1315 Tlie overwlu'lming (lemand for public; health nurses has made it iiecest;ary for us to appoint to independent and re- sponsible positions many nurses who are young in years, lack- ing both in general experience in the world and special experi- ence in public health nursing. We are requiring only a minimum of preparation. For all of these reasons it is absolutely essential to the success of our work that there should be very close contact between the Chapters and the Divisions; that there should be personal visitation at frequent intervals; and that guidance and assistance should be at ail times available to the Chapters without undue delay. This necessitates adequate and well- trained staffs at Division headquarters permitting constant field supervision. It seems essential that there sliould be pro- vision on the staffs of the Division Bureaus of Public llealtii Nursing for at least one public health nurse for each state to act as field organizer and supervisor. By fall, that is six months after decentralization was com- pleted, the Division and field staff numbered 42. In this same time the number of local nurses had grown from 99 on ]\[arch 1, 1919, to .310 October 1 of the same year. A paragraph in the Annual Report for the fiscal year ending June 30, 1921, reads as follows : In addition to the Division Director of Xursing local Red Cross nurses are receiving lielp and supervision from fifty-five supervising nurses, whicli is an average of twenty-four local nurses to one sui)ervisor. Of these fifty-five supervising nurses, thirty-seven are employed wholly by the Ked Cross and eighteen are shared with the State department of health or the State Tuberculosis Association or both. It is our hope that our supervisory staff can be increased sufficiently to give more assistance to tlie young nurses who are taking up their first ])iece of executive work. All of us need help and advice and inspiration, but especially when we are starting out alone into a new field, and it is a serious obligation on the part of the Red Cross to give full measure of support and assistance to these young pioneers in our service. At the nuM'ting of the Xational and Division staffs of the De- partment (if Xursing at Xational lleadcpiarters in the fall of 1911>, referred to previously, a discussion of the need of the chapter nurse for assistance hrought out many interesting points of view and suggestions. Several felt that the nurses 1316 HISTORY OF AMERICAN RED CROSS NURSING needed much help in the first few months of their service and should be visited frequently. Others thought that a super- vising or organizing nurse should go with the newly appointed nurse to her new territory and assist and guide her in making her contacts. Still others felt that organizing nurses should go into a county, before the coming of the Chapter nurse to prepare the ground for her reception and insure the right work- ing relations between the nurse, the committee and the com- munity. The concensus of opinion in regard to supervision was that it should be primarily for the purpose of consultation and encouragement ; frequency and length of visits depended largely upon the nurse ; the nurse should if possible be given a chance to spend a few days at the Division office before taking up her work with the Chapter in order that she might learn something of her Chapter and of general Eed Cross organization and procedures. It was felt that if a nurse was well prepared for her work she should be given the chance to make her own contacts and to develop her own initiative. It was also suggested that the nurses would learn much from each other and from the Division staff if they could come together occasionally in state meetings or in smaller meetings of those in a group of counties. This plan was followed with good results in a number of Divisions. ]\[eetings were arranged of Chapter nurses from perhaps eight or ten adjacent counties at the most central point. Often the nurses drove to these meet- ings on a Saturday. They were usually the guests of the Chap- ter of the county in which they were entertained. The Division director or a field supervisor usually met with them and many practical problems were discussed. Another way of comparing experiences and passing on ideas, of forwarding helpful sug- gestions and of keeping the nurses in touch with what was going on in the Red Cross was thnuigh the issuing of periodical Division bulletins to the nurses. The bulletin^ were informal, newsy, personal documents, not pretending to be dignified lit- erary achievements but partaking more of the character of a family letter. This method proved so popular, stinuilating and helpful that it became the regular practice in nearly all of the Divisions. A large volume of correspondence passed between the nurses or menilx'rs of their committee and the Division office. Through ;li;' receipt of tlie nnrs(\s' monthly statistical and narrative; PUBLIC HEALTH NURSING AFTER THE WAR 1317 reports the Division directors were able to keep in pretty close touch with the work of the nurses and with their problems and to offer many suggestions. In many Chapters where a public health nurse was employed there was already a Home Service secretary in charge of the social work of the Chapter. It happened occasionally that a difficulty arose in determining what should be the division of work between these two. As a guide to a solution of this diffi- culty, Miss ]\fargaret Byington of the National Department of Civilian Relief and later director of Field Service prepared in collalx)ration with ^liss Fox a statement which defined the re- spective functions of both nurse and social worker so that there should be no duplication but rather a dovetailing of each other's activities to insure a unified piece of family health and social work. Matters of health were thus the responsibility of the nurse, and social and economic problems that of the social worker, both being alike responsible to the Chapter Executive Committee and neither undertaking to direct the work of the other. A better understanding also grew out of State and Division conferences attended by Home Service secretaries and public health nurses. A report of one such conference stated : Tennessee was well represented at the conference held the lat^t week in August at Division headquarters for Home Service secretaries and nurses. This conference was particularly nec- essary and proved to be most valuable in making it clear to secretary and nurse just what their respective duties were and how they were related very closely to each other. It also gave a vision of what cordial team work could accomplish, as the reports from communities where Home Service secretary and nurse were working together were a real inspiration. I am quite sure that each Home Service secretary and nurse who was working alone went away with a desire to so organize their connnunity that a co-worker would he einjiloyed. The tendency on the part of the Chapt(n*s to use the Homo Service secretary as executive scn-retary led occasionally to dis- cord which required a visit from the supervising nurse or field representative to adjust. Since expcricMice had proven the wisdom of keeping the line of responsibility from the nurse to Nursing Activities Comiiiittce and from the Nursing Activities Committee to the Kxecutive ('onnnittee it was not necessary 1318 HISTORY OF AMERICAN RED CROSS NURSING for the executive secretary to assume any responsibility for the nursing service other than that of helping to coordinate its undertakings with other activities of the Chapter. The instruction that public health nurses should not engage in relief giving was found to be too rigid to be followed at all times in Chapters having no Home Service worker and com- munities having no social worker. In svich localities, in order to accomplish her primary purpose of alleviating and pre- venting disease, the nurse was confronted in many homes with the necessity of first removing the social or economic difficulty which was causing the ill health. The safest and wisest pro- cedure seemed to be for the nurse to report her problem to her Executive Committee and to place the responsibility for action with it. In such situations as these the Division was prepared to give attention to each individual family problem and to advise the Chapter Executive Committee. A matter of important concern to the Red Cross was its initiation into State departments of health and other State agencies, such as the State Tuberculosis Association, from a standpoint of cooperation and the maintaining and upholding of the authority of the State department and the good work of all while developing public health nursing in the Chapters as a part of the Chapter organization and program. The Red Cross believed that the State departments of health should have the moral if not the legal authority and responsibility for outlining a State-wide, general program for the development of public health nursing throughout the State, and for establishing and maintaining at least a minimum standard of personnel and service. It believed that the programs of public and private local organizations should fit in as far as possible to the general program for the State as a whole and should be under the gen- eral oversight of the State in regard to standards of personnel and practice. The Red Cross also believed that the State would have no reason nor desire to interfere with the internal organi- zation and administration of local private agencies or their rela- tion to their central bodies, as long as the State standard was maintained as a minimum and as long as the activities of the private agencies did not conflict with the general plan outlined by the State. There was at first in several states an attitude on the part of some of the State departments of health of doubt and even disapproval of the Red (^ross purposes in expanding public PUBLIC HEALTH NURSING AFTER THE WAR 1319 health nursing through its Chapters. This was due largely to the fact that it was a slow and difficult task to bring about working agreements, owing to the rapidity with which the work expanded, the diversity of conditions in each State, and the differences in program and development of the various State departments of health. Thus in order that there might be some generally accepted principles of cooperation, representatives of the Executive Committee of the Conference of State and Provincial Health Authorities, the l^ational Tuberculosis As- sociation and the American Red Cross carried on a series of consultations. These resulted in December, 1919, in a mutually accepted statement of principles as follows : I. In undertaking to develop public health nursing the Red Cross does not seek to supplant or compete with State and local departments of health or other organizations, national, state or local, public or private, engaged in the same work. Jt seeks rather to supplement their activities by assisting legitimate public healtli nursing agencies and by establishing itself or working with other agencies to establish community nursing services. It plans to interest its Chapters throughout the country in public health nursing with this purpose and policy in view. II. The Red Cross believes that in time public health nurs- ing should and will become a public service conducted by the State, county or municipality, through their official health agencies. Red Cross Division officers will seek consultation with the State health authorities in each state where this has not already been done, for the pur- pose of learning what plans the State Department of Health may have for developing public health nursing, and of determining in what way the Red Cross may co- operate and make Red Cross plans for the development of this work by its Chapters throughout the state conform to the plans of the State department of health. In tliis undertaking the Red Cross will have as its ohjeet the ultimate assumption by the State, counties and luiuiic- ipalities of public liealth services initiated by its C]ia]>ters. III. Following this principle the Red Cross will encourage the creation of a Bureau, Division or Sub-Division of Public Health Nursing within the State department of health, wliich should assume such supervision of public health nursing as may be assigned to it by the (.liief health executive otbccr of the Slate. 1320 HISTORY OF AMERICAN RED CROSS NURSING IV. (a) Looking towards the establishment of a bureau, division or sub-division, a State supervising nurse might be appointed to serve the State department of health, who would study the public health nursing needs of the State, would work out a plan to cover them, assume super- vision of local services, as indicated in paragraph III, and correlate so far as possible the nursing activities of other agencies within the state such as the Red Cross and the State Tuberculosis Association. (b) In states where these two agencies are working ex- tensively it is suggested that the State supervising nurse should have assistant supervising nurses, one in charge of the nursing activities of the Red Cross and one in charge of these activities for the State Tuberculosis Association. These two agencies would provide the sal- aries for the assistants in charge of their respective activities. The assistants would be responsible both to their respective agencies and to the State supervising nurse and would submit their plans to her for adjustment and endorsement. V. In each State a Committee on Coordination of Public Health Nursing Services might be created representing the State Department of Health, the Red Cross, the State Tuberculosis Association and other appropriate agencies to advise with the State Department of Health at fre- quent intervals concerning the best alignment and co- operation of the various nursing activities. VI. Where State supervising nurses, assistant supervising nurses and other public health nurses attached to the State health organization and supported by funds con- tributed jointly by the State health organization and other agencies or are contributed wholly by such agencies, appointment should be made by the State health execu- tive with the approval of the participating agencies. Such appointment should not be in conflict with existing laws of the state. Public health nurses supported wholly by funds contributed by the American Red Cross or other extra-governmental agencies should be free from Civil Service restrictions. VII. Where the State Department of Health is unable to pro- vide the salary for a state nurse and where some mutually satisfactory plan of cooperation (such as that outlined above) has been agreed upon by the State Department of Health, the Red Cross and State Tuberculosis Associa- tion, the salary might be paid in part or in whole t)y any PUBLIC HEALTH NURSING AFTER THE WAR 1321 or all of these and other agencies. This should he a tem- porary measure, the State to assume the salary as soon as possible and the nurse regardless of the source of her. salary should be state supervising nurse for the State Department of Health. Vin. Where the Eed Cross pays in whole or in part for any nursing service, I?ed Cross standards of appointment of nurse and service should be observed. IX. Public health nursing as carried on by the Red Cross may cover any of the following activities: Prenatal or infant welfare work, Maternity service. School nursing, Control of communicable diseases, including tubercu losis and venereal diseases, Industrial nursing, IVfental Hygiene nursing, Care of the sick on the visit basis. Which one or ones of these branches is to be undertaken by the Pcd Cross Chapter in any given community would be determined by tlie need, by the adequacy of any existing services, by the practical factors of territory to be covered and population to be served and by the plan adopted by the Red Cross after consultation with the State Department of Health for the development of public health nursing by the Eed Cross in that state. While this statement was in process of preparation there ose a need for a supplementary statement to cover tlie prin- ciples to be followed in states where there was no State bureau of public health nursing and no State nurse, but where both the Red Cross and the State Tuberculosis Association were engaged in promoting public health nursing. The gist of the plan which was suggested to meet this situation was contained in the iirst two paragraphs of a supplementary statement drawn up by the Red Cross and Xational TubcrcTilosis Association : I. It is higlily desirable tliat a public health nurse should be appointed by the State health ollicer upon joint recom- mendation of the Red Cross and the State Tuberculosis Association to liave charge of ])ublic JKnilth nursing witliin the state. Tier (wpenses might be sban'(l by tbe State De- partment of Healtli, the K'ed Cross ami the Tul)crculo.-is 1322 HISTORY OF AMERICAN RED CROSS NURSING Association, or by the latter two, until such time as the State Department of Health is able to assume part or all of her salary. II. This State Director of Public Health Xursing shall be made the official representative of the Division Bureau of Public Health Nursing of the Ped Cross, and of the State Tuberculosis Association, and shall be charged with the responsibility for the development of their public health nursing activities in conformity with the plan of organiza- tion, methods of procedure and standards of each. Through the State health officer she shall be responsible to the State Tuberculosis Association for its part of her work and shall be responsible to the Division Director of Public Health Xursing for nursing activities in which the Ped Cross Chapters participate. The principles set forth in those two statements were fol- lowed in the working plans that were subsequently agreed upon in a number of states. The efforts made to work out co<)per- ative plans in the various states were described in these words : The formulation of working arrangements in the states, however, on the basis of these principles has been a slow and difficult task. Xo two State agreements have been just alike. In 22 states a definite written agreement has been made with the State Department of Health. In 7 more, an agreement W'ill soon be in written form. In 6 states, there is a definite understanding but no formal agreement, and in 13, the final plan of cooperation has not yet been determined, in a few of which we have been unal)le to reach any common ground. In these few, however, we are slowly overcoming antagonism and approaching the day when peaceful cooperation will be possible. The majority of these efforts at cooperation are working out very well. There are at present 11 states in which the State wholly finances its State program of public health nurs- ing. In these states the Ped Cross has done one of three things: 1. It has made tlie State nurse, already appointed ])y the State Department of Health, the official representative of the Ped Cross Department of Nursing as well. 2. It has su)~>plied an assistant State nurse in charge of Ped Cross luirsing. 3. It has maintained its own State nurse, who works in PUBLIC HEALTH NURSING AFTER THE WAR 1323 close consultation and cooperation with the State Department of Health, though independent of it. In 7 more states the State pays the larger part of the State nursing budget, the l?ed Cross contributing the remainder under a cooperative arrangement similar to one or the other of the first two plans given above. In 7 states in which there has been no State nursing service, the Red Cross is developing such a service unTIer the auspices of the State health officer but at Ked Cross expense. In 7 states the State nursing budget is fmanced jointly by the State, the Tuberculosis Association and the Red Cross. In the remaining states the Red Cross is working independently in anticipation of joining hands with the State within tlie next few months. Our efforts have been directed primarily toward finding a method of cooperation with the State departments of health, and secondarily, wherever possible, of including coo})eratioii with the State Tuberculosis Association at the same time. In 15 states this joint agreement has been effected. In several states we are working amicably by the side of the State Tuberculosis Association, although there is no formal agree- ment. In some states its program does not include the organi- zation of local public health nursing service. At present the Red Cross is responsible for the salaries of approximately oU State and assistant State supervising nurses. The activity of the Red Cross in organizing town and county public health nursing services, in developing supervision on a State basis, and in providing or contributing toward the pro- vision of the personnel for State bureaus of pul)lic health nursing has done much toward advancing State public health nursing programs. State bureaus wholly or partially main- tained by State funds have been created in more than a dozen states during the past year. Legislation will be pushed in a number of states to provide public fuiuls for State bureaus of nursing now financed by private contribution, or to increase the State budget already provided for this purpose. The character and standards of State work have also ])een notice- ably improved and elevated. The superior quality and bt'ttcr results of work done according to higli standards has been so convincing that many public officials, who at first thouglit our standards were too higli. are now saying publicly that a nurs,' without special training or experience in public health nursing rarely accomplishes any constructive work.^^ In the course of time, as the Chapters continued to undertake public health nursing services and as these services became '-Annual Report. .Inly 1. 1019. to -Juno ;?0, 1920. 1324 HISTORY OF AMERICAN RED CROSS NURSING more closely integrated with the other activities of the Chapter, the need became clearer for maintaining a close connection between Chapter pnblic health nursing and the whole Red Cross organization as directed and supervised from the Division. It did not seem appropriate or desirable to require the State or assistant State supervising nurse of the State Department of Health to give as much of her time, energy and thought to Red Cross matters as was necessary to maintain the necessary in- ternal relationship between the Chapter public health nursing services and other Chapter work, and to take part in the general administrative obligations of the Red Cross under the direction of the Division Staff Council (the need for which will be explained later in this chapter). In order to accomplish these Red Cross objects and at the same time to adhere to the principles agreed upon with the Executive Committee of the Conference of State Health Authorities, it was necessary merely for the Division to arrange to assign a member of the Division nursing staff to act as an assistant supervising nurse in states in which the State De- partment of Health had a State nurse, with the understanding that this nurse in her capacity as assistant would have complete charge in all matters of internal organization of the Red Cross public health nursing services in the state under the guidance of the Division. To the end that this procedure might have the understanding and approval of the State health authorities the Executive Committee of the Conference of State Health Authorities was invited to meet with the Red Cross national officials and Divi- sion managers at Washington on April 20, 1921. The report of this meeting was as follows: In response to the request of ^Ir. Persons (vice chairman), Miss Fox put before the meeting the problems with reference to the public health nursing services now being carried on by the Chapters of the American lied Cross in accordance with agreements made by the Eed Cross witli the various State healtli authorities. These problems are: 1. The intense demand for puljlic liealth nurses has forced the placement in Cha])ters of nurses wlio are inexperienced and inadequately trained in community organization, in the use of volunteer assistants and in the stimulation of general Chapter PUBLIC HEALTH NURSING AFTER THE WAR 1325 (levelopniont. Tt is not so much a question of addinf^ work to the well recognized forms of pui)li(! iiealth nursing as it is the adaptation and correlation of the nurses' service to other as- pects of the Chapter's program in the local community. Chap- ters find it impossible to have their nursing service divorced from their Junior Hed Cross work, their Home Service and several of the other recognized Red Cross activities. 2. Under the present form of agreement with the health authorities in several states, in accordance with which the nurse who supervises the Red Cross nurses is the State super- vising nurse, it has been found that she cannot give sutficient time and attention to the peculiar phases of Red Cross public health nursing to meet the needs of the nurses employed hy Chapters, to detect weaknesses in Chapter machinery, to de- velop other kinds of Chapter service and to organize com- munity interest. ^Miss Fox pointed out how the newer forms of agreement and understanding which have been worked out in the State of ^lichigan, where there are more than (55 Wed Cross nurses, are proving satisfactory and effective in solving the problems of the Red Cross. Dr. Olin (Commissioner of Health for ^liclii- gan) and ]\riss Ahrens (Director of Nursing in the Central Division) explained in detail the present arrangements. Both the State supervising nurse and the Eed Cross super- vising nurse were appointed npon the joint approval of the State health commissioner and of the Division office of the Red Cross. Each time before the Red Cross supervisor goes into the field she consults with the State supervisor of nursing about the local situation of each place which she plans to visit. In this way the local Red Cross nurse receives a direct message as to State jdans and is kej)t closely in touch with the State bureau of nursing. The State report forms arc used by tlie Red Cross nurses and duplicate reports arc filed with the State hureaus. The Red Cross nurses wnto directly to tlie State Dej)artmcnt of Health on all ollicial lu^alth matters. They write to tlie Division ollice on toclmical nursing questions and on matters relating to Ciia])ter l)usiness. It was the general ojiinion, expressed hy Dr. Crumbine (State health otlicer of Kansas) and other State health offi- cers, that tlie public health ]irogram of the American Red Cross has been well articulated with the State nursing pro- grams and that, with the exception of an occasional mis- understanding due to the blunder of soint> individual, there was less troulle in corr(>lating those activiti(s than there was in keeping alive the interest of the conimunity and in jiro- 1326 HISTORY OF AMERICAN RED CROSS NURSING moting the idea of rural public health nursing. Dr. Crumbine was convinced that the necessity for keeping Ked Cross Chap- ter activities entirely under the Red Cross, if Chapter interest is to be maintained, had been taken too lightly. ]t was also generally agreed that it is to the interest of the State to have Red Cross Chapters attain permanency, stability and con- tinuity. These, better than the official agencies, can educate communities to want public health nursing and to appreciate standards in nursing. Eventually all the Red Cross nurses should be taken over by public local health authorities, but it is anticipated that it will require a long time to bring this about in some communities. The Red Cross must, therefore, pursue a policy that will both raise its nursing standards and insure Chapter understanding and support. In reply to a question from Dr. Williams (State health officer of Virginia) Mr. Persons assured the health officers that new forms of cooperation in the various states would be effected only as both the Red Cross and the State health authorities had reached a full and complete agreement. The Red Cross is not approaching this situation with preconceived ideas to be rigidly applied in all situations. . . . There was general agreement that better mutual under- standing would be achieved if the Division managers and the State health officers met more frequently in friendly, informal visits, when things are running smoothly, and not, as now, when, usually, contacts are limited to the occasions on which there is some question at issue. Because of the partial identity of goals and problems, even though there was distinct divergence of method and approach, the need arose for an understanding between the Red Cross Public Health Nursing, the National Tuberculosis Association and the National Organization for Public Health Nursing. The successful accomplishment of this understanding was re- ported as follows : Last December the National Organization for Public Health Xursing, tlie National Tuberculosis Association and the Red (Voss came together to discuss their respective nursing programs for tlie pur])ose of deciding upon a division of labor, methods of cooperation and chainiels of consultation. As a result, the functions of each in the fiebl of nursing were defined, measures for the use of each other's facilities were adopted, the undertaking of certain projects jointly was de- termined upon and a permanent conference committee ap- PUBLIC HEALTH NURSING AFTER THE WAR 1327 pointed. This action shiit the door on the possibility of misunderstanding, wasteful duplication and divided interest among public health nurses and opened up great opportunities for joint effort, intelligent team work and united support. The agreement follows: Foreword : The Red Cross and the Xational Tuberculosis Association, through their Division and State organizations, being the organizations probably administering tlie largest numl>er of public liealth nursing services, and the Xational Organization for Public Health Nursing, as the voluntary body representing all types of public health nursing, necessarily have many interests and problems in common. Therefore, they seek to supplement each other by utilizing the facilities of each in common as far as possible and by joining forces in under- takings in which it is advantageous to do so. To accomplish this it is necessary that the functions of each organization and the lines of cooperation be clearly defined and future lines of cooperation be, so far as possible, anticipated. These three organizations, through their accredited representatives in con- ference assembled in Washington, D. C, December 5th, 1919, hereby define wliat each organization considers to be its func- tions in the field of public health nursing, and enter into an agreement as to methods of performing its functions by means of coordination and cooperation. . . . Ways and Means of Cooperation. I. Educational 1. Courses The Red Cross and the Xational Tuberculosis Association look to tiie Xational Organization for I'ublic Health Xursing to take the lead in matters pertaining to the education of pul)lic health nurses. Before granting either financial subsidy or scholar- ships to a post-graduate course for public health nurses the ]?ed Cross will require that the course be endorsed by the Xational Organizaticui for Pulilic Health XuTsing. The Xational Tuberculosis Asso- ciation will make tlie same requirement, l)ut will insistently urge through its representative on the I'Mucational Committee of the Xational Organization for Public Health Xursing that such courses male jirovision for a suitable proportion of teaching of 1328 HISTORY OF AMERICAN RED CROSS NURSING tuberculosis and is ready to cooperate in establishing standards of teaching for tuberculosis nursing based upon the judgment of the leaders in this field, medi- cal nursing and sociological. It further urges simi- lar consideration for the advice of other specialized health organizations. 2. Forum The Educational Committee of the National Or- ganization for Public Health Xursing will act as a forum for the discussion of all questions pertaining to the education of public health nurses. The direc- tor of the Red Cross Bureau of Public Health Xurs- ing and the National Tuberculosis Association Sec- retary for Xursing, and possibly later representatives of other national organizations interested in public health nursing, will sit on this committee as mem- bers. These organizations will undertake jointly or separately, but under the general direction of the Educational Committee, to prepare series of mono- graphs on practical methods of conducting various public health nursing activities, and also pamphlets on other special subjects as needed. 3. Institutes Believing strongly in the need for annual and widely distributed institutes for public health nurses of considerable experience or training, the Ped Cross and the Xational Tuberculosis Association will join with the Xational Organization for Public Health Xursing in recommending that such institutes (to cover two M'eeks or more) be organized and con- ducted by suital)le estal)lished agencies within the states with the assistance of the Xational Organiza- tion for Public Health Xursing, in consultation with these other national bodies. The latter will offer the assistance of their Division and State staffs in con- ducting the institutes and will encourage their local staffs to attend. These three organizations agree that these institutes should be general in character; including tuberculosis, child hygiene, venereal dis- eases and other special sul)jects. The Ped Cross staiids ready to suggest subjects and teachers in the rural nursing field and the Xational Tuberculosis Association to furnish outlines of lectures and teach- ers in tuberculosis subjects. PUBLIC HEALTH NURSING AFTER THE WAR 13^9 4. Library In view of the fact that the Xational Organization for Public Health Nursing has a library department "with an appropriation for adequate expansion, and has a circulating package library operating through 44 state library centers, which has been endorsed by the American Library Association, the Ked Cross and the National Tuberculosis Association will not endeavor to develop duplicate library facilities but will recommend that their field staffs make the fullest possible use of the facilities offered by the National Organization for Public Health Nursing. The latter organization will undertake to develop its library resources to meet the special needs of these staffs, particularly as their work affects the rural nurses. 5. Magazines The Public Health Nurse has granted a section to the Eed Cross Bureau of Public Health Nursing under the editorship of the director of the bureau, to be devoted to the activities and developments of that bureau. The National Tuberculosis Association does not at this time suggest a department in the magazine de- voted exclusively to tuberculosis, but suggests that a reasonable amount of space be given to tlie considera- tion of tuberculosis nursing and other phases of the tuberculosis movement. II. Recruiting The Eed Cross hopes to join with the three na- tional nursing organizations in a program for re- cruiting student nurses. The National Tuberculosis Association recognizes that this is distinctly a function of the nursing organizations. III. Employment Believing that there are many advantages to be secured through a luitional clearing house of emjiloy- ment whicli would also serve as a directory of infor- mation, the National Organization for Public Health Nursing will endeavor to accomplisb this for ])ublic health nurses as a i)art of the activities of the pro- posed joint nursing headquarters. It is understood that while nil credentials would l)e obtained by such a clearing house, ])lacements would continue to be 1330 HISTORY OF AMERICAN RED CROSS NURSINC made through the various existing agencies. The Eed Cross, because of its great demand on the supply, will appoint its own representative to the executive staff of the clearing house. IV. All three organizations are free to conduct analytical studies of various typical and atypical pieces of machinery for the purpose of determining standard methods of organization, practice and technique, but will consult each other in planning these studies in order to avoid duplication and to take advantage to the fullest extent of the facilities and fields each can offer for this purpose. V. Legislation The National Organization for Public Health Nursing and the National Tuberculosis Association will seek to create public opinion in favor of, and assist in, the enactment of suitable public health nursing legislation, such as the appropriation of public funds for public health nursing and the crea- tion of divisions of public health nursing within State departments of health. The Red Cross en- dorses this broad endeavor but prefers not to take part in efforts involving legislation. VI. Machinery for Coordination 1. Joint Consultation Committee The executive secretary of the National Organi- zation for Public Health Nursing, the director of the Bureau of Public Health Nursing of the Red Cross and the secretary for nursing of the National Tuberculosis Association will form a joint consulta- tion committee. This committee will meet fre- quently for conferences relative to problems and projects confronting or contemplated by any one of the three. 2. Exchanges of memoranda regarding new pro- grams or clianges in policy before putting the same into action. 3. State Committees on Public IlealtJi Nursing The Eed Cross, the National Organization for Public Health Nursing and National Tuberculosis Association favor and will endeavor to create State committees on public health nursing representing generally the three organizations and the State De- PUBLIC HEALTH NURSING AFTER THE WAR 1331 partment of Health and may include other State nursing organizations and State agencies engaged in, or responsible for, promoting public health nursing activities. Such a committee will have no admin- istrative responsibility for, but will concern itself with, the advancement of public health nursing in the State through the stimulation of public opinion, through interpretation and advice and through the promotion of coordination. It is mutually understood that no changes will be made in the procedure outlined in this agreement without the full con- sideration of the three participating agencies. "While the joint consultation committee described in the paragraph on Machinery for Coordination was not made use of, the methods of working together described under Ways and Means of Cooperation were carried out with regularity and mutual satisfaction and the reciprocal relations of the three organizations were uninterrupted and cordial. EEOKGANIZATION The Red Cross during the war and for two years after the Armistice was organized in departments, each one of which had its own field staff for the purpose of promoting and supervising its special work in the Chapters. There soon developed a ten- dency, however, to concentrate much of the immediate guidance of Chapter work in the hands of a general field staff who were responsible for the organization and administration of Chapter affairs, but not for the professional activities of the Chapters. In July, 1!>20, a ''Joint Memorandum on the Relation of State Supervising Nurses to Field Representatives" was prepared by the directors of the Bureau of Public Health Nursing and Field Service. This read in part: We think it is pretty generally understood that the new plan of Division organization places upon the general fieid representatives tiie responsibility for advising the Chapter concerning its organization, administration, general program and apportionment of funds. It is their task under tlie guidance of department heads to develop in the Chapter a coherent, balanced and unified plan of work, apj)ropriate to the nc^(ls of the connnunity and m response to the genuine interest and wishes of the people. It is their task to see that the Chapter ollicials and the connnittecs are representative, 1332 HISTORY OF AMERICAN RED CROSS NURSING well selected and on the job; that various committees work together and that their activities dovetail; and, in general, representing department heads, to assist Chapters to carry on these activities successfully. The directors of various depart- ments are responsible for seeing that the activities which the Chapter undertakes are carried on according to Red Cross standards. In the case of the Public Health Nursing Service, the State nurse has a special responsibility for the supervision of the nursing service in the Chapter, including the selection and appointment of the nurse, advice as to the type of nursing work to be carried on and its relationship to other nursing service in the county and the supen'ision of the professional aspects of the nurses' work. From this it is evident that the field representatives and the department representatives must have a genuine understand- ing of each other's work based on constant consultation and interchange of information and opinions. Such team work is only possible where the two groups of workers meet for regular and frequent conferences. Much of the work of preparing the Chapters to undertake public health nursing was delegated to these field representa- tives by the Division Bureaus of Public Health ^Nursing. The reorganization of the Red Cross in the spring of 1921 brought about a much closer relation between the general field staff and the nursing field staff. The change in administration was described in The Public Health Nurse, May, 1921, in an article entitled "Remodeling the Red Cross," from which the following extract is taken : In order to meet the needs of the Chapters in their local expression of Red Cross service the war organization of the Red Cross has been revised. An organization designed to do a national war task obviously was not suited to the present community work of the Red Cross. . . . The result of this change in the needs of the Chapters has been the doing away with departments in the national and Divisional organization and the erection in their place of staff councils of specialists, meeting in consTiltation with the managers, concerning the problems of the Chapters, with the resulting harmonizing of tlie professional recommendations of each specialist into a single unified scheme for the guidance of the Chapters. This change in organization wliich has just come about in the Division and in the national organization does not in any PUBLIC HEALTH NURSING AFTER THE WAR 1333 way mean that the professional and technical phases of the work carried on l)y the Chapters will be severed from profes- sional and technical standards of work or from the advice and guidance of professional leaders in the division and na- tional or<^anization. Professional stiindards will be observed just as jealously in the future as in the past and the means of ujdioldinjf them will be maintained and carefully guarded. In all professional matters Chapter nurses will be supervised as heretofore by nurses. The field staff will include public health nurse suj)ervisors as formerly in order that the local public health nurses may continue to follow and uphold the best professional standards and technical practice under the guidance of supervisors thoroughly familiar by training and experience with such standards and practice. The reorganization also changed somewhat the status of the Bureau of Public Health Nursing: "When the elimination of departmental organization in the Ped Cross took place on April 1st," the Annual Report of 1920-21 states, ''the Bureau of Public Health Nursing became the Public Health Nursing Service, with its director a mem- ber of the National Staff Council. Its administrative charac- ter was converted into an advisory character and its inter- relationship to other Ped Cross activities became more firmly established. While the Public Health Nursing Service has equal standing and representation on the National Staff Coun- cil with other services, there is a closer relation to the Nursing Service than to any other because of the almost in- separable connection between public health nursing and nurs- ing as a whole. It, therefore, continues to be a ])art of the Nursing Service, although it has direct representation on the National Staff Council and its director is responsible directly to the vice-chairman." The inquiry preceding the reorganization brought out the fact that ir \vas necessary for the public health nnrs(\ in those (haptcrs in wliicli she was the only trained worker, to take a larger measure of responsibility for the atlairs of tlie Chapter in genei'al, and in all Chapt(>rs to relate \\ov work closely to the other Cliaptcr activities. This meant she must have a more intiuiare knowledge of all phases of Red Cross work and in addition to her technical duties must become something of an oruanizer and leader. 1334 HISTORY OF AMERICAN RED CROSS NURSING "In looking over the work of our nurses during the past year or two,'' the director commented in her Annual Report, "we find that though usually skilled technicians they are not always good organizers. When one stops to consider that many of them have just completed their preparation for public health nursing and iiave had no executive experience, and moreover that many of them are city bred and city trained, it is not surprising that they do not at first show qualities of leadership and organizing ability. The task which they con- front is a complicated one and difficult even for older and wiser heads. We wish that there were enough public health nurses so that we need not place responsibility for the organi- zation of new work on the shoulders of inexperienced young public health nurses. Their courage and enthusiasm are abundant and admirable, but their ability as creators, execu- tives and leaders is not yet developed. Often a public health nurse is the first and only trained worker with whom the Red Cross Chapter officials and the community have ever had dealings. She may be the only person in the whole county trained in public health work and thinking in terms of broad social endeavor. Upon her shoulders falls the responsibility for making her work a part of the life of the county, for drawing the people throughout the county into it as individ- uals or organized groups, for developing ways of multiplying her service through the help of untrained volunteers, for making public health nursing understood, belie^ed in and used and its responsibilities shared by people throughout the county. She also has the responsibility of developing public health nursing in harmony with the other activities of the Red Cross Chapter and of making it serve the purposes of the Chapter to the fullest possible extent. Her task is a big one and a most interesting one but requires very definite qualities of leadership which usually come only with experience. The majority of our Red Cross public health nurses are recent graduates of public health nursing courses or have not been in public health nursing work very long. Many of them are young and unused to taking their part in public work. That they need a great deal of help from their State and Division supervisors is natural and justifiable. That many of them develop into real leaders in their counties where given enough help at the beginning is being proven by our experience. The process undertaken late in the year of knitting tlic field staff together and making it more general and therefore more useful in character will help to strengthen the Chajjter public healtli nursing services. Not only will the Public Health PUBLIC HEALTH NURSING AFTER THE WAR 1335 Nurses have behind them the supervisoiy nurses but the general representatives of the field staff as well.^^ Rural and small town nursing were of such recent develop- ment that no standard methods of procedure had been formu- lated and no plan for a complete rural community nursing service was announced. Because of the widely varied condi- tions existing in different parts of the country, no stereotyped plan could ever be universally applicable. A number of ex- periments, it was felt, would have to be conducted and their results analyzed and measured before any working models could be endorsed as thoroughly tested and satisfactory. In the summer of 1921 Virginia Gibbes, who had had sev- eral years' experience in the Red Cross, both in community and Division positions, made a study of the Chapter services which had been successful in meeting certain organization problems. Several hundred of the Chapter nurses also wrote an account of the methods used to develop their work in their Chapters. A pamphlet based on this material, which repre- sented the results of widespread and varied experience, was nearing completion as this book went to press. As approximately 80 per cent of the Red Cross public health nurses in rural districts were giving all or part of their time to school nursing, for which no recognized standard technique and practice had been evolved, ]Miss Anna S. Stanley, formerly director of Public Health Xursing in the Southwestern Divi- sion and an expert in school nursing by reason of years spent first as school nurse, then as supervisor of scliool nurses and later as teacher of school nursing in one of the accredited public health nursing courses, was asked to conduct a series of conferences on school nursing in six of the Divisions of the Red Cross. As a result of these conferences a standard prac- tice of technique for school nursing was agreed upon and em- bodied in a mimeographed outline of school nursing procedure. This proved to be of the greatest help to nurses and met with an increasing demand. The effort to bring alxjut a closer articulation of tlie various activities of tlie Chapter was strengtliened by tlie ten(l(>ncy to do away with the multiplication of Chaptor committees, tlins concentrating the general management of all its affairs in tlie hands of the Executive Committee. There was frecjuent difli- ^' Annual Koport, July 1, 1920 to June 30, 1921. 1336 HISTORY OF AMERICAN RED CROSS NURSING culty in securing suitable personnel for the Executive Com- mittee, the Home Service Section, the Committee on Nursing Activities and the Chapter School Committee, without using the same people for all of them. The great need for closest cooperation between the various committees was apparent. In many Chapters it was felt that the various activities could be developed more intelligently and harmoniously if the Chapter program was conducted by the Executive Committee, with sub- committees to deal with the details of different undertakings. The comment of one director represented the experience of them all. We are finding it somewhat difficult to secure sufficient number of people willing to serve on a Nursing Committee as outlined in A-700 and A-701, In several Chapters we have found it advisable to use the Executive Committee, adding to it the several people who would be helpful and necessary to carry on the work. We believe this latter method will be generally used in the smaller Chapters. In the light of this general tendency to unify the hitherto independent activities of the Chapter, a review of the various methods of engaging in public health nursing by the Chapters was made. The Red Cross had previously agreed that no one activity of the Chapter should bo operated independently of the others and that Chapter funds should only be used for work in the opera- tion of which the Chapter shared directly and for which it possessed an administrative responsibility commensurate with its financial responsibility. As a result it became clear that Chapters thereafter should engage in public health nursing only when they could share in its operation and when they could have a connection with other Chapter work, such as the service for ex-service men and the activities of the Junior Ived Cross. It was also felt that since the field staff was more than ocm- pied with the supervision of Chapter public health nursing services, affiliations with independent organizations should be discouraged except when the public authorities, having taken over a (^hapter service, desired the continuance of the assistance and supervision of the Itcd Cross, PUBLIC HEALTH NURSING AFTER THE WAR 1337 TYPES OF RED CROSS PUBLIC HEALTH NURSING Red Cross public health nursing had as its object the saving of life, the upbuilding of family health, and the promotion of community sanitation and hygiene. It dealt with individuals and families in its efforts to restore the sick to health; to find and correct ])hysical imperfections; and to teach the practice of healthful living and establish hygienic habits. It dealt with the community in its efforts to assist in checking and eliminat- ing communicable and preventable diseases ; in discovering and correcting unsanitary conditions ; and in educating the public in physical hygiene and public sanitation, ^o phase of public health nursing was omitted, the nurses engaging in bedside nursing, prenatal and maternity nursing, infant and child wel- fare and school nursing, tuberculosis nursing, communicable disease control and health education of many kinds. Seldom was a public health nurse able to carry on all of them. Usually, when working alone in a large territory, she confined herself to one or two activities, the choice being determined by the need, the desires of those she served and the possibility of accomplishment. The great majority of the Red Cross Chapter public health nurses worked in rural districts and most of them had as their territory an entire county. In the more highly organized sec- tions there were sometimes several health nurses working in the same county, each nurse having a certain community within the county for her special field, but in general the nurses were called u])on to cover a large area. Some of the western counties in particular were no less than enormous, covering as larg(> a territory as c(M'tain of the small eastern states. Idaho County, Idaho, was one of these vast counties, being larger thiui the conibincMl states ot" Massachusetts and liliode Island. The Chapter public health nurse for this county wrote: ^Fy baggage lias to be designed to pack on the saddle. A year ago 1 left London the ])roud ])ossossor of three jxM't'ect traveling hags, something for (>\'erv occasion as 1 thmm'lit. and now 1 am ci'ossing tlie mountains with all mv immediate wants tieil to the saddle, in tho last two weeks 1 have ridden ten dill'ereiit horses and have cov(>red one hundred and iifteen miles, lifty of that Ity stage. When yon rein(Mnher that this county is twelve thousand s(|uare mihs in area, you can inuiiiine that one needs to he something of a traveler. 1338 HISTORY OF AMERICAN RED CROSS NURSING The Red Cross public health nurse in Alaska, whose work of health instruction took her from place to place often widely separated, used whatever means of transportation were at hand. At the end of an Arctic winter, she wrote : I had quite a trip. One place I went by dog team over a hundred miles, then to another place by train. There is only one, which runs to suit the company. I was four days coming one hundred and thirty miles, but the scenery was sublime. This same nurse was not deterred when trains and other methods of transportation failed. Of her trip over the broad pass from Anchorage to the interior, she wrote: We (the nurse and two teachers) left Anchorage July 5th and got to Dead Horse that night. Stayed all night and left next morning for Hurricane Gulch, arriving there at two P.M. That is the end of the railway on that side. From there we had to walk seventy-two miles to Healy, the begin- ning of the railway into the interior. We took it slowly the first day so as to get used to walking. The walking was very bad in some places, the ground being wet and swampy and the heat and mosquitoes were dreadful ! The third day out one of the teachers met with an accident, so they had to turn back and I continued my journey alone, but every one along the way was so kind and I got horseback and ''way-on" rides for about twenty miles, so I just walked fifty miles in all. In another of the big counties of Idaho, Lemhi County, the nurse reached her most isolated schools by means of a typical coach of pioneer days. She said : We got in a covered stage drawn by four and six horses. If you ever saw Buffalo Bill's show, the "Deadwood" coach, you see my picture. We hold our breath as we go up nine thou- sand feet straight up like a ladder and then over the moun- tain ; the road is spiral but we go up all the time ; ninety miles and four days' trip. There are only seven children in the school, but they are four hundred miles from a hospital and our visit is worth while. Another pioneer nursing service of the Red Cross was that which was established among the lumber camps along the Pemigawasott River in the Xew Hampshire wilderness. The nurse had her headquarters in the little town of Lincoln, the center of the lumbering operations, where she taught the PUBLIC HEALTH NURSING AFTER THE WAR 1339 mothers Home Hygiene and Care of the Sick. Her "district" was the whole Pemigawasett wilderness. She assisted the doctor, accompanying him to the distant lumber camps often into the very heart of the mountains. Here she found great need of preventive work as well as actual nursing. Tiie men were huddled together in large numbers in almost unventi- lated bunk houses. Many of the men were unvaccinated and no care was taken in regard to communicable and other diseases. In their work of felling trees and getting them to the stations in the dead of winter, accident and frostbite were common.^* A great majority of our nurses being employed by Eed Cross Chapters whose jurisdiction covers a whole county, are engaged in county-wide work. A few are employed by Rod Cross branches and their service is limited to the town in which the branch is located. The nurses engaged in town work have found it possible to develop a fairly well rounded public health nursing program. Those who are attempting to cover a whole couiity without assistance have found it mani- festly impossible to develop more than one or two of the several phases of public health nursing. Usually the nurse and the Chapter together have decided that the best way to open a new service is offered by undertaking school nursing. It is obvious that if there are from 00 to 90 rural schools scattered over a large county, in all of which the nurse wishes to render some service, she will not have much time to develop other phases of public health nursing. There is a danger, however, that the people of the county may come to think that school nursing represents the whole of the public health nurs- ing program when the nurse makes this her primary work. In order to avoid this misunderstanding we present tlie pro- gram of public health nursing in terms of family health work rather than in terms of a number of independent s])e(ialties. We say that we want to help to secure and maintain good health among all the families in our county and that our first step towards attaining this object will be taken through tlie avenue of the schools. It is, of course, our object to build eventually a complete and adequate county nursing service providing all the different forms of public health nursing, including the care of the sick.^^ Especially in the great counties of the West, school nnrsing seemed to he the most practical and result producing prouram. ^* Public llenlth \ursr, Fchniary, 1921. '' Animal Rfport, June, 1920, tu'july. 11)21. 1340 HISTORY OF AMERICAN RED CROSS NURSING A typical winter day's work of a school nurse was described by Miss F. B. Palmer, public health nurse for Martin County, Minnesota, and published in the October, 1920, issue of the Public Health Nurse. I had come to the county for a few weeks as a public health nurse with the hope of impressing upon the people the need of and the benefits to be derived from a continuous county nursing service. It was in December, when the snow was many inches deep and the thermometer below zero. The superintendent of schools, an active and intelligent woman of fifty-five years, had mapped out the schools and districts that were most isolated and in need of a nurse. We took the 4:10 a.m. train to a little town twenty-five miles away. Here we searched for something that looked like a hotel. Finding it at last, we walked in and, seeing no one around, we took possession of the stove and chairs and curled up and slept until 7 a.m., when the "proprietor" came thumping down stairs. He was as surprised to see us as we were glad to see him. In a short time we had breakfast coffee, bread without butter, and some boiled meat. Breakfast being over, we started forth in an auto for a school ten miles north, but half way there we ran up against so much snow that we had to dig our way out. The school wasn't reached until about 10 :30, but as there were only four pupils in this school we had plenty of time. All the children were from one family and were born in a foreign land. They had had nearly all of the contagious diseases and were left with some of their complications and were still abiding by a few old customs. An annual bath and clothes sewed on for the winter was their one law. One child had eye trouble and was deaf, due to poor care during the measles. Another had enlarged tonsils and adenoids. All four had defective teeth and pediculosis. We decided to take the children home and explain their condition to their parents. The father was not home and the mother was in bed with a new bai)y. While the nurse was caring for the mother and baby, the county superintendent started on the children and it wasn't long before a great change had taken place. The superintendent informed the mother that she would keep in close touch with her and help her to make healthy citizens oTit of her children and that in the spring slie would call and take the children to the doctor, and when spring came she did bring the children in to tlie doctor, but she had to do it only once, for the pareiits have been doing it ever since. ii J An Aniorican Kcd Cross public health nurse on her ro\inds PUBLIC HEALTH NURSING AFTER THE WAR 1341 From this home we drove our car six miles, got out, hired a team of horses and buggy and slowly wound our way for four miles through the tall evergreen trees. Only a rabbit or deer jumping through the trees helped to break the silence of the woods. It indeed seemed like the "forest primeval." At the end of the narrow passage we reached a lake which we crossed with a little more speed. As we drove up tth busy. The rsu HISTORY OF AMERICAN RED CROSS NURSING Red Cross had employed one nurse full time for the week and the various public health nurses from the schools, Metropoli- tan Life Insurance Company and Ked Cross, besides several married nurses volunteered their services on the various days. It was somewhat hurried and crowded but with all a real success, I think. Four hundred and thirty-six pre-school chil- dren were examined during the week and Mrs. Price wrote me that since they did not finish with all who had registered, they had continued the clinic for two days the following week. Their public health nurse will do the follow-up work. De- veloping from the campaign is their plan for a demonstration in modifying milk in the near future and for baby clinics twice a week tliis summer. The films "Birth Eegistration" and "Infant Clinics" were shown at the various movie houses during the week and pic- tures were taken of a great many of the babies. Slides will be made of these pictures and they will he shown later on. That the nurses did much bedside nursing was shown in many of their reports as follows : One day during the influenza epidemic I visited one large town in my territory and, as I always do on arriving in a town, I called on the three doctors and obtained from them a list of people they wanted me to visit. The people whom I saw and their circumstances vary so widely that I am going to enumerate them. The first was not an influenza but a maternity case. The baby three days old was wrapped in a Ijlanket and placed at the foot of the mother's bed. When I entered the door I stepped on several pieces of coal which had rolled down from the pile of coal against the wall on the floor on one side. One table, two cliairs, one cupboard, a bed, an ironing board and small stove completed the furnisbings of the two rooms in whicli tliis young married couple lived and brought tlieir first child into tbe world. \\'itli little to do with outside of the equi])ment in my nurse's bag, I bathed the baby, demonstrat- ing to tbe motlier and fatbcr who were watching the different steps and impressing upon tlicm tlie importance of beginning right with their first baby and feeding lier at reguhir intervals and Jiot just when the baby cried. After bathing and dressing the baby I ga\e tlie reguhir routine care to the mother, and then left with fliud brief repetition of important points in the care of her baby. ]\Iy next call was on a ])reniature baby two months old ana when I saw the lean-to which was used for kitchen, dining PUBLIC HEALTH NURSING AFTER THE WAR 1345 room and sitting room for a family of five, including the baby which was bundled up in old quilts behind a red-hot stove, I didn't wonder the doctor had sent me. When 1 looked at the baby I thought it must have been shoveling coal along with the dirty-faced uncle who came in. The baby was almost the color of a pickaninny from soft coal soot, and his little shirt I'm conii(lent had not been changed for a Aveek at least, but he was gaining even with such treatment although still very thin. 1 asked for materials for a bath and before the indilfercnt unmarried mother and interested young aunt, and skeptical grandmother demonstrated a bath and urged that the baby have one every day. On seeing the baby's bottle I de- cided to suggest how it should be cared for, which I did. The mother grew more interested in time and promised to bathe the baby regularly, but she will need frequent instruction and encouragement for to all appearances she has the mentality of a child of about ten years. My last call late in the afternoon was in a home with four small children three of whom were coming down with the measles, and one boy had had measles and now had pneumonia. He was irrational and had a high temperature so the mother quickly assembled the materials for a warm sponge ordered by the doctor and while I was giving the bath she frantically finished making him a new nightgown to be put on after the bath. I had been there the day before and had advised that the children be put to bed so of the three prospective cases one was in a crib and the other two crossways on a divan-bed, making the living room resemble a hospital. The sick pneu- monia boy was in a room by himself as directed with a window open and was receiving care just as I had demonstrated the day before. The mother watched every movement I made and although she said she knew nothing a])Out caring for the sick, she appeared to have learned more in two hours from the looks of her patient and bedroom than most people would learn in many days. I'll explain my long silence by telling you of my experi- ence during an epidemic of typhoid which broke out at Oil- more, 17 miles from Salmon and 10,000 feet in the air. One would naturally think that altitude would jnirify most any- tliing. but we had 18 cases. We lost only one. l)ut as we had her in our care not more than eighteen liours you can inuigine she was a pretty sick woman when we got her. Fortunately this mining camp had a little hos])ital of eight beds which was very well equipped. Wo coininaiuUMTod it and .started movins: in the worst cases. 1 took with me from 1346 HISTORY OF AMERICAN RED CROSS NURSING Salmon a young girl, an undergraduate who had had four months' training in a hospital in St, Louis and who was most helpful. As soon as their temperatures were normal the patients were sent home. Three were kept all of the time. It was necessary to melt snow for water, split wood and shovel trails. I made regular visits to the homes, instructing the people how to take care of themselves and of those dependent upon them, so as to prevent further cases developing. The snow was between four and five feet deep and I was seventy miles from a physician. This last week I was asked to investigate a T. B. case, a man living with his four children all in one room living, cooking, eating and sleeping in the same tiny space. One son 17 had a very suspicious cough. A girl of fourteen did the washing and cooking for the family besides going to school. She washed the father's handkerchiefs, advised the girl about disinfecting and the general care of her father. The Eed Cross has furnished a tent, and the neighbors have put up the frame. The happy man is now in it, away from the cooking, and he feels so much better in the fresh air. The house has been scrubbed and cleaned generally and the children are to be examined next week. An average day's work of a nurse in one of the larger coun- ties was given by one of the Red Cross public health nurses in a Minnesota county: A ride of thirty-five miles in a tin Lizzie brought me to my destination a schoolhouse of one room, poorly lighted and dirty, to teach the first lesson of a series of twelve two-hour lessons in Home Hygiene and Care of the Sick. Twenty mothers of different races Polish, French, Irish and Ameri- can were assembled. A bed had been installed with a straw tick, sheets, pillow cases and blankets borrowed from the pupils. Each mother was taught how to make a bed, turn a helpless patient, change draw-sheets, lift and make comfortable paralyzed patients. The position and quantity of furniture and the temperature and ventilation of a sick room were also explained. There were discussions on this lesson and preparations were made for a second meeting the following M^eek. Good-bys were said and I left for another thirty-five mile ride over a sandy, rough road when I was hailed by a farmer, "Be you that county nurse?" "Yes." "Well, come and see my colt, it's got hurt." Another drive of three miles to find PUBLIC HEALTH NURSING AFTER THE WAR 1347 a beautiful animal six weeks old torn by wire on the left shoulder straight across the chest to the right leg. The depth of the wound was fully two inches, the length over sixteen. The farmer had done some veterinary work two days before, but his hands, needle and cotton were dirty. Infection and high fever had set in and a bad condition was the result. A large sheet was spread on the ground, the patient laid out on it, hind and forefeet tied together and flexed, the master of the house sat on its head, while the young son did likewise on its flank. I sterilized my hands thorouglily and proceeded to business and for one hour steadily cleaned and removed in- fected tissue, cut away the old stitches, washing with hot water and lysol, tied two arteries and poured tincture of iodine into the wound the patient resting peaceably and quietly as if it knew the county nurse was doing her best to help it. A few days later I found the animal doing well and the wound healing. Another start was made towards home when a woman emerged from the woods. "Please come and see my twins, one is dying." I found two baby boys, aged three and one- half months, weighing seven and one-half pounds each, in a very serious condition, being fed every half hour on con- densed milk, wrapped up in blankets, lying on a feather bed behind an immense stove. There was no fresh air in the room and this was August ! There was a history of tuberculosis in the family and the mother wondered why the children didn't grow ! She couldn't see any reason for it. With the proper care and with the instruction eagerly followed by the mother, within a week a marked improvement in babies and mother, house and surroundings, could be seen, and all lived happily ever after. We have an average enrollment of two hundred pupils in the Home Hygiene and Care of Sick classes. Five hours' daily teaching, and in addition, the weighing of various babies, the changing of formulae, the removal of incipient tuberculosis cases to sanitaria, and to make a life a little more interesting the taking of a mental case to a State institution finishes an average day's work.^*^ The class work in Homo Hvgiene and Care of the Sick stimu- lated the demand for permanent public health nursing services. One Division director said : From actual work in the field we have come to the conclu- sion that all county public healtli work should be prefaced by ^"American .Journal of 'Surging, Juno, 1920. 1348 HISTORY OF AMERICAN RED CROSS NURSING classes in Home Hygiene and Care of the Sick. As one of the Red Cross chairmen has written in, "You will see that the nursing classes act as trumps in this game of demonstrating to the people the necessity of county-wide public health work." In this particular community the instruction work has brought about the demand for two public health nurses. One of the most constructive activities of the public health nurse which was always attended with encouraging results was nutrition and growth work, one aspect of which was health and growth classes and another hot lunch and milk in the schools. One Division director wrote : Many of our nurses have started hot lunches in the rural schools, and have been able to interest the mothers in devoting some of their time to preparing the lunches : thereby relieving the nurse of this extra responsibility. Also, in some of the high schools, the older girls are assuming this responsibility, one group preparing and serving the lunches, and anotlier putting the kitchen in order, under the supervision either of one of the teachers or some member of the Eed Cross Xursing Activities Committee. Another Division director said : A splendid cooperative work is being done by Miss Mayer, public health nurse for Miscogee County, and ]\Iiss Jessie Fortson, county demonstration agent. ]\Iiss Fortson at- tended Dr. Emerson's lectures at the Division office and has returned to her county, and is putting her knowledge into practice. She goes with ^Miss ]\Iayer into the schools and weiglis and measures the pupils. While ^liss ]Mayer is doing physical inspection of the pupils ^liss Fortson keeps a list of each pupil's name, weight, etc., and checks up those of normal weight. Then she classifies the underweight children and gives them special advice about the selection of food and how to increase their weight. In this way contact is made with the pupils, and much interest is shown by them in trying to bring their weight up to normal. The pupils also have ex- hibited much interest in the physical inspections. Miss Mayer sends a report sli]) to the parents of normal children as well as to the parents of those needing correction of defects, as parents not getting a slip have been sending tlieir child Ijack for his or her report of inspection. These workers are really making their efforts count for somethinnf. PUBLIC HEALTH NURSING AFTER THE WAR 1349 That the Red Cross public health nurses were called upon to do much teaching and organizing was evident from a narrative report from the supervising nurse for Tennessee : On a recent trip through Tennessee, we found the most extraordinary enthusiasm for the public health nurse mani- fested by tlie chapters which have nurses employed. The nurses have done excellent work, inspecting school children, giving nursing care, instructing mothers in the hygiene of pregnancy, organizing little Mothers' Leagues, conducting health classes, opening health centers, infant welfare stations and rest rooms for farmers' wives. They are conducting classes in Home Hygiene and Home Care of the Sick, and giving other health instruction to pupils in grammar, high and Xormal schools and colleges. They are giving nursing care and instruction in hygiene to patiejits ill with tuberculosis and instructing families how to prevent the spread of tuberculosis and other dangerous com- municable diseases. In fact, their activities are so many and their work so well received that at the Farmers' Convention a great deal of time was given by the Home Makers' Section to the telling of the activities of the nurses in the various chapters. The work of the nurses knew no color line, l^ot only was much bedside nursing undertaken among the colored population, but school inspection, special dental clinics, baby conferences and health centers were established in colored sections. Mary Quinn, Red Cross public health nurse for Wichita County, Texas, wrote: On Friday, we had a health conference for the colored. The basement of the Baptist Church was fixed up, and Doctor Welcli and Doctor ]\reans, prominent church workers over in the district, lined up tlie mothers and babies. There were twenty-two babies weighed and measured and examined. Talks were given after the examination and a committee appointed to continut- witli the health conference every month. The last Thursday of the month has been decided on. I nnist say the colored folks are very enthusiastic over the public health cen- ter work. There are three cases who, I know, have had ton- sillectomies since the conference in September. Scores of colored midwiv(>s in the vSonth, S(une of them living on islands which could onlv be reached bv rowboats on a certain 1350 HISTORY OF AMERICAN RED CROSS NURSING set of the tide, were instructed and advised by public health nurses of their own race. The nurses found excellent opportunity for health publicity in connection with the State and county fairs, particularly in the South and West. Interest aroused in this way was made the basis for future intensive work. An example of this activity was found in a report from San Joaquin County Chapter, Cali- fornia : The Public Health Xursing Service of San Joaquin County Chapter lield a very successful Children's Health Conference, in connection with the County Fair, the week of September 13th-18th. As the fair committee had very few permanent buildings, the conference was housed in a tent. The space allotted us was 30 x 50 feet or one-half of the tent. At first glance it looked hopeless, but after a carpenter had erected beams for dividing into smaller booths, we felt more hopeful. By the use of sheets and mosquito netting, we were able to arrange a dressing room, weighing and measuring room, ex- amination room, booth for the dental hygiene department and a large space for demonstration and exhibit material. One hundred and sixty children, ranging in age from six weeks to six years, were examined during the week. The ex- aminations were made by physicians of Stockton and San Joaquin Ceunty, volunteering for three hours each. The den- tal exhibit from the University of California proved of great interest to both mothers and children. A Stockton dentist was in attendance each afternoon. Demonstrations on the care of the infant were given each afternoon, by pupil nurses from the local hospitals. In the evening Bed Cross films were shown. "American Junior," "Winning her Way," "In Flor- ence Xightingale's Footsteps," "An Fqual Chance," the Xa- tional Organization for Public Health Xursing film and the Federal Children's Bureau film, "Our Children," were also shown. A separate tent with a cot and First-Aid appliances was provided and a number of minor cases were cared for. Although the Health Conference meant a week of toil for the public health nurses, we feel that it has been very much worth while, due to the interest shown by mothers of children of all ages and also by a great number of prenatal ca>;cs. We also feel that it gave the people throughout the county a better understanding of the work undertaken by the American Ped Cross. An iutorcstin*r feature of the exhibit was a booth main- PUBLIC HEALTH NURSING AFTER THE WAR 1351 tained by the public library, featurinf^ l)ooks on child care, and emphasizing the excellent cooperation they give the pub- lic health nurses in our work throughout the county. The County Farm Bureau gave valuable help throughout the conference, and displayed in their booth was an excellent poster stating the cooperation of the Bed Cross with the Farm Bureau in giving the classes in Home Hygiene and Care of the Sick. The foregoing examples written for the most part in the nurses' own words gave some idea of the scope of Red Cross public health nursing. It was by no means the whole story, however, but rather a glimpse here and there of undertakings and accomplishments. Underlying every activity and an in- separable part of every public health nurse's program w^as the constant, persistent teaching of hygiene and health habits, better care of the sick and better living through practice and precept, through demonstration, illustration and personal advice. The following paragraph which plosed the annual report for the fiscal year^ 1920-21, epitomized the service rendered by the Ked Cross public health nurses : All over the country in the most out-of-the-way places, as well as in the thriving agricultural centers, our nurses are at work. In the tiny settlements in the high Sierras, among Indian tepees, in the heart of the Appalachians, on the lonely islands off the New England coast, on tlie wind-swept plains of Montana, in the villages along the ^Mexican border, in the heart of the forest of northern Michigan and in the mining camps of Kentucky and West Virginia, the chance to live, the message of health and the good will of the Bed Cross are being carried by those brave, and often lonely workers, in the uniform of the nurse and of the Bed Cross. CHAPTER XVI CLASS IXSTRUCTIOX FOR WOMEN THE system of class instruction for women under the Red Cross Kursing Service, now so extensive and so carefully worked out, took its rise in a suggestion made by Miss Boardman to the District of Columbia Branch in 1908. The January Bulletin for that year said : The District of Columbia Branch at its annual meeting took up the subject of special Eed Cross courses in First Aid (for men) and Home Nursing (for women). Committees were appointed to arrange for such courses. In the April following the Bulletin reported: Lectures on First Aid for men and Home l^ursing for women, instituted by the District Red Cross Branch, have proved most successful. Especially the latter were largely at- tended. Inquiries have been received as to arrangements being made anotlier year for nursing courses to be provided at small expense for women's clubs, etc. These first classes in home nursing were given in St. John's Parish Hall, Washington, 1). C. the First Aid lectures, to men, were held in the Y. ^1. C. A. auditorium. Both halls were given without charge for their use, but the District Chapter paid the lecturers ten dollars for (>acli class. The nurses who conducted the classes for women were, Lily Kancly (Connecti- cut Training School) ; (ieorgia Nevins (Johns Hopkins) ; and Mrs. Charles Voung (Kochester Homeopathic). They taught largely by demonstrations of practical nursing procedures. 'I'he j)reanible and schedule of this early home nursing course follow, l^nfortunately the precise authorship cannot be stated ; very probably the tliree nurses mentioned collaborated in ar- ranging the printed material. 1352 CLASS INSTRUCTION FOR WOMEN 1353 HOME NURSING COURSE FOR WOMEN There are thousands of families in which sickness occurs yearly, when the services of a trained nurse, either because of the question of expense or for some other reason, cannot be obtained. To provide a simple course in Home Nursing for those who will have the care in such cases of illness, the Ked Cross has arranged for the following lectures to be given and demonstrated by trained nurses. It is suggested tliat those taking this course bring })aper and pencil or blank book for the j)urpose of retaining notes of these valuable instructions. I. Hygiene of t Home Nursing classes wore then for a time uppermost in Miss Delano's tluuiglits. ^larv A. Clarke, a Bellcvue class- inato who assisted her during that [x-riod wrote: 1358 HISTORY OF AMERICAN RED CROSS NURSING During all the busy days of 1911 Miss Delano did not for- get a little pigeon-liole compartment of the big steel filing cabinet, said drawer being marked "Home Care of the Sick."' Into this from time to time she tossed some little scrap from her pen, or gleaned from the nursing magazine, or any other source. She explained to me that she was collecting these for a book on Home Xursing, that she did not know when she would ever have time to write such a book, but it was in her mind to do so, for she candidly thought it was urgently needed, trained nurses being then, as they always would be, beyond the purse of the great majority; and moreover, any intelligent woman was capable of putting into practice the principles of nursing. . . . Some months after this when I was asked to take charge of the first Home Xursing class formed in Philadelphia, com- posed of the Girls' Friendly Society of the Parish of St. John, Kensington, ]\Iiss Delano furnished me with chapter headings of the book to be as arranged by herself and Miss Mclsaac, the famous little book not having yet reached the stage of proof sheets. For two classes I gleaned my subject material whence I could, but for the third I was supplied with proof sheets which w^ere my pride until the book was published. Miss Mclsaac had then come to Washington as superintend- ent of the Army Xurse Corps. She was already a well-known author of nursing text-books and her collaboration made pos- sible the speedy conclusion of the book Miss Delano had begun. The Red Cross Magazine announced the publication of this text-book by saying in the issue of October, 1913 : So valuable and successful have the Red Cross Textbooks on First Aid proved that tlie Committee on Xursing Service decided to provide an equally valuable text-book on Elemen- tary Hygiene and Home Care of the Sick. This new textbook has been prepared by two of the best known nurses in this country. Miss Jane A. Delano, K.X., was superintendent of nurses at the University of Pennsyl- vania Hospital, of the great Bellevue Training School in Xew York, and of the United States Army Xurse Corps. Her collaborator in the textbook is one of our equally prominent and able nurses ]\Iiss Isabel ]\lclsaac, P.X., for- merly superintendent of the Illinois Training School for Xurses and at present superintendent of the Army Xurse Corps. CLASS INSTRUCTION FOR WOMEN 1359 The title page of the textbook read : AMKRICAN' HED CROSS TEXT BOOK ON ELEMENTARY HYGIENE AND HOME CARE OF THE SICK by Jane A. Delano, R. N. and Isabel ^Iclsaac, K. N. Prepared for and indorsed hy the American Red Cross. It was published by P. Blakiston's Sons and Company, Phila- delphia, and had a preface written by Miss Boardman, in which she said : One of the most significant facts in the march of human progress during the last decade is the great awakening of public interest to the questions of health. Work as hard as they might, neither the medical nor nursing profession could alone accomplish much along sanitary lines until the people in general became aroused to the importance of such mat- ters. Knowledge that personal health depends largely upon the liealth conditions of the community brings home to each individual _a serious personal interest and sense of responsi- bility. But in spite of the strongest barriers yet devised, dis- ease cannot always be kept out. To the gentle hands of women belongs the care of the sick and every woman should realize that the time may come when such a care will be hers. It was hardly to be expected that courses in elementary nursing procedures could be launched by the Red Cross with- out considerable discussion and some opposition. Especially was this true of graduate nurses, who brought forward the criticism that individuals completing the course would prac- tice nursing as nurses. So deep was this feeling on the part of individuals here and there, that they refused to act as in- structors, ^riss Delano and ^fiss ]\rcTsaac were so determined to safeguard nursing standards, and yet to give the people at large some instruction in nursing technique, that they decided not even to use the word ''nursing" in the title of the book, sub- stituting the term ''Care of the vSick'' in place of "Home Xurs- ing." These words convc^ycd at once the intent of the course and its use in the home for hygienic betterment and for the care of the sick. 1360 HISTORY OF AMERICAN RED CROSS NURSING Before the textbook was printed much of it was submitted to superintendents of training schools for suggestions and criticism. The National Committee on Red Cross Nursing Service was also called upon to review the manuscript before it was finally published. ''The Home Nursing classes," stated the Minutes of a meeting of the National Committee held on December 10, 1912, "were then considered and the National Committee approved of this undertaking." Every effort was then made to place the emphasis upon the course as one, not to prepare women for nursing as a livelihood, but as a means of preparing them to look after their own health and that of the family with more intelligence. Instructors were urged to make this most clear to each class. The first year's work in Home Nursing classes, summed up at the end of 1912, seems quaintly simple as compared with the statistics shown in another part of this chapter. Miss Delano wrote : The object of this instruction for women is not to fit them for professional service, but to make it possible for them to render such service to the sick in their own homes as may safely be intrusted to tbem. The following classes have completed a course in Elemen- tary Hygiene and Home Care of the Sick under the direction of the Eed Cross; South Manchester, Conn., two classes; Washington, D. C, two classes; Philadelphia, one class. Several classes are now receiving instruction in Philadel- phia, Cincinnati, El Paso and Paterson, X. J., and other classes are being organized. In a class largely made up of factory girls, recently ex- amined in Elementary Hygiene and Home Care of the Sick, by one of our Local Committees on Eed Cross Nursing Ser- vice, the general average for the class of ten, for both written and practical examinations, was over 85 per cent; the highest average being 90 per cent, with only one member of the class below 80, her standing being 79.5 per cent, on a scale of 100. In the same report Miss Delano spoke of the possibility of beginning courses in dietetics and household economy. This was the first mention made of the desirability of instituting class instruction in these subjects, now so largely developed under Ked Cross auspices in its teaching centers. The encon rag- ing popular response to the classwork decided the Red Cross CLASS INSTRUCTION FOR WOMEN 1361 to augment its efforts by enlarging the list of subjects taught. Early in 1913 the following circular was issued: The American Eed Cross has decided to organize classes of instruction for women in First Aid, home imrsing, hygiene and allied subjects^ to be given under tlie supervision of the National Committee on Red Cross Xursinjj Service. 1. To afford women the opportunity to learn first aid to the injured and to provide simple instruction in the home care of the sick. 2. To afford woinen the opportunity to learn how to pre- pare food for the sick and well. 3. To afford women the opportunity to learn how to pre- pare rooms and other places for the reception of the ill and injured. 4. To afford women the opportunity to learn how to pro- tect their own health and that of their families. It must be distinctly understood that this course of in- struction for women is only intended to prepare them to ren- der emergency assistance in case of accident, to give more intelligeJit care to their own families under competent direc- tion and in exceptional cases, to assist in relief work under the supervision of the Xursing Service of the American Red Cross. Much needless suffering is now caused the ill and injured on account of the ignorance of unskilled persons. It has been said that the fate of the injured is dependent on the care which their injuries first receive. It is therefore necessary for everybody to learn what to do first in an emergency, and what not to do. This is easy to learn, but the subject must be learned. Xobody can be ex])ected to know this without instruction. The number of people injured in the United States is rapidly mounting and is now in the hundreds of thousands annually. Knowledge of first aid to the injured cannot, it is true, prevent the consequent suffering entirely, but it can be made an important factor in this result. The health of the family depends largely upon the liome maker, and it is most essential that she have a definite knowl- edge of ])ersonal and housebold hygiene and the ])roper ])repa- ratioii of food. Spei'ial diet for the sick is no less essential. Scarecdy a woman is unacquainted with the sick room in her own family and some sim])le instruction in the care of the sick should he a ])art of every woman's education. It is the purpos(> of th(> Red Cross to provide tliis instruction. This work is just heing started in this country, so that great results cannot yet he reportetl. It has already been 1362 HISTORY OF AMERICAN RED CROSS NURSING demonstrated here, however, that instruction in first aid will reduce deaths and serious results from injuries about one-half. On railroads and everywhere else that the Ameri- can Ked Cross has carried first aid instruction, all interested are enthusiastic in praise of the benefits derived. The list of classes conducted during the year 1914 is his- torically interesting, as that fateful year made a dividing line in all fields of work. 1914. Fifth Report, i^ational Committee Nursing Service; Completed Classes : Washington, D. C, nine classes ; South Manchester, Connecticut, two classes ; Manchester, Massachus- etts, one class ; Danville, Illinois, one class ; Paterson, N. J., two classes ; Providence, 11. L, one class ; Philadelphia, Pa., six classes; Elyria, Ohio, one class; Cincinnati, Ohio, seven classes; total number of classes, thirty ; total number of pupils, five hundred seven ; total number of certificates issued, two hundred seventy-five. Current and Incomplete Classes : Clinton, N. Y., one class ; Basking Ridge, N. J., one class ; Gladstone and Pea- cock, one class ; Bernardsville, 'N. J., one class ; Amesbury, Massachusetts, one class ; El Paso, Texas, one class ; Cincinnati, Ohio, nine classes ; Paterson, N. J., two classes ; Utica, N. Y,, one class; Cleveland, Ohio, one class; Norfolk, Va., one class; Troy, N. Y., two classes; total number of classes, twenty-two; total number of pupils, three hundred forty-four. Grand total, fifty-two classes ; grand total, eight hundred fifty-one pupils. The war stimulated the nursing activities of women to an intense degree, and this stimulus was heightened in 1916 by the threat of trouble on the Mexican border. Miss Delano w^rote (December, 191G) :2 The interest in preparedness excited in this country by the European War, intensified in the early summer by the pos- sibility of war between the United States and Mexico re- sulted in an extraordinary increase in the interest in the courses of instruction given under the auspices of the Ked Cross. The demand by women anxious and eager to be of service to their country, for some form of instruction that would in a measure be preparatory, resulted in the recommendation by the National Committee on Xursing Service at the last annual meeting, that a combined course of ten lessons in 'Seventli Annual Report, 1916. CLASS INSTRUCTION FOR WOMEN 1363 Elementary Ilygioiic aixl Homo Care of the Sick and five in First Aid be arranged and put into j)ractical operation. This was done, but as the demand for wliich this course was espe- cially ])rovided was no longer urgent, the special course was finally withdrawn September 1, 11)1(5, after which the course of fifteen lessons in Elementary Hygiene and Home Care of the Sick was adopted as the basis of preparation and selec- tion of women for service as nurses' aides. The lessened urgency to which ]\Iiss Delano here refers did not last long, for although the menace of war with ^lexico re- ceded in the latter part of 1910, the next spring brought its own catastrophe, and the teaching of nurses' aides was resumed. This has already been described under its own heading. We return now to ^fiss Delano's interrupted report, (1916) in which she describes the ''teaching center." Eed Cross classes for instruction have developed so rapidly that Chapters have been urged to form educational commit- tees for the pur])ose uf supervising some of the details of class organization and teaching. A closer cooperation has been urged between the Chapters and the Local Connnittees on Eed Cross Nursing Service. This is being accomplished by membership upon the educational connnittees of the Chapter by one, or in some cases, two or more nurses from the Local Connnittees on Eed Cross Xnrsing Service. One of tlie ])i-actical outgrowths of this interest by the Chapters in the educational work of the Red Cross has been the development of the ''Teaching Center" with a nurse director. Class organization and in many cases, instruction may be conchicted by the director. Houses have been loaned or rented, adecpiate teaching equipment secured and by this centralization more \iniform and ellicient teaching has been the result. In some instances^ all the Chapter activities cutting and sewing, ])reparation ot" surgical supplies, packing and distribution as well as the instruction have 1)een cen- tralized under a K'ed Cross inirse director. Xew York. Brooklyn. Philadelphia, Washington. Cincinnati. Cleveland, Chicago. San Francisco, Pasadena and Los Angeles have established such. The classes iu Khnnentary Hygiene and Home Care of the Sick lia\e nnt oidy increased in number but liav(> extended over a wider area. They ha\e been given in Hawaii and in 1364 HISTORY OF AMERICAN RED CROSS NURSING nearly all the states in the country, while larger cities and small towns display equal interest. The classes are given under the auspices of Chapters, clubs, churches, schools public and private individuals, stores, and industrial con- cerns. In many instances, where pupils cannot pay the class fees, these have been provided by persons interested in extend- ing this instruction. The widespread interest in the courses of instruction given under the Eed Cross has been revealed by an unprecedented demand for qualified Instructors. Every effort is being made by the Bureau of Xursing to secure, through Local Commit- tees and the National and Local Leagues of Xursing Educa- tion, the names of nurses qualified and available for this work. Classes in Home Dietetics were systematically launched with the publication of a textbook in 1917. The first were organized in February of that year. They rapidly became very popular. With the great expansion of interest in these courses due to the war, they were placed under the Bureau of Instruction. The many groups acting as sponsors for class instruction gave decided color to the whole field of work, so varied were their forms and characters. They included Young Women's Chris- tian Associations and Girls' Friendly Societies, Red Cross Chapters, women's clubs, church circles, public and private schools, shops, factories and individuals. The war period added semi-military groups, such as the encampment schools of the Women's Section of the ^avy League. Early in 1918, still under the pressure of a vastly augmented bulk of administrative work of all kinds, the decentralizing sys- tem of organization already described was effected by the Red Cross and the work of class instruction became more and more clearly defined as a growing, special branch of activity. In the earliest work of founding classes, either for First Aid or Home Hygiene the Red Cross published simple suggestions on the following lines to guide its members : Organizers of class- work were to be certain of a suitable number of pupils who would agi'cc to be regular in attendance, and who were then to select some one from the number to act as president of the class. The president so selected was to communicate with the De- partment of Instruction for Women at National Headquarters. A roll was then to be supplied to the class president, on which names of class members were to be inscribed and answers given, CLASS INSTRUCTION FOR WOMEN 1365 in respect to certain essentials. Pupils under sixteen years of age were not to be accepted. The proper size of a class was between ten and twenty. The class president was expected to find a local physician or nurse to teach the respective classes. The name and address of each physician or nurse was to accom- pany the roll of pupils' names. Before the classwork was actually begun all instructors were to be approved by the Ked Cross and a card of authorization issued from National Head- quarters. Thus simply organized, the class teaching ran along easily for several years until the increasing stimulus of war efforts made itself felt. By 191G classes for instruction had developed so rapidly that the Ked Cross Chapters were urged by Headquarters to form Educational Committees to supervise the details of class organization teaching. The Chapters were also encouraged to cooperate closely with the Local Committees on Red Cross Nursing Service, which have been spoken of in a previous chapter, by placing one or more of the nurses from such committees on the educational committees of the Chapters. The Chapters responded so well and so intelligently to these sug- gestions that, from their coordinated educational efforts there developed the Teaching Center with a nurse director described by !Miss Delano on a previous page. To facilitate the organization of classes as thoroughly as possible either under the auspices of Chapters or other agencies, it was necessary to develop careful plans and procedures. These were worked out by the Nursing Service at National Head- (}uarters. The instructions were very simple at first, and as the earliest classes were infrequent, each one was practically supervised from National Headquarters. Finally, however, many pamphlets and separate forms were required to explain the procedure, comprising as it did the qualifications and ap- pointment of instructors; financing the classes; fees; equipment for teaching; the methods of sending in reports; conduct of examinations; marking papers; certificates; subject matter of the various types of instruction ; guides for instructors and bibliograpiiies for students and instructors. So complete was all this material that it forms a valuable part of the records in the archives of the American Ked Cross at Washington. 1). (\ The early phases incident to the organization of any project are often marked by difficulties and interruptions. Soon after the courses of instruction were set in motion, Marion Oliver, whose entliusiasiii and interest had banished everv thouirht of 1366 HISTORY OF AMERICAN RED CROSS NURSING difficiilty, was obliged to leave Washington and sever her con- nection with these courses. The effect of the war, however, was to stimulate greatly the public interest in all Red Cross work, and the organization of the Nursing Service in all its branches went swiftly on. Miss Delano, as chairman of the National Committee on Nursing Service had assumed, from 1914 to 1916, the entire responsibility of these classes. Upon the appointment of Clara D. Noyes as director of the Bureau of Nursing Service in 1916, the classes were transferred to her general direction until they were placed under the Bureau of Instruction in April, 1917, with Helen Scott Hay in charge. The decision of the Red Cross at the request of the War Department, early in 1916, to prepare twenty-five nurses' aides to form an auxiliary gToup to the nurses of each base hospital then under process of organization by the Red Cross for the War Department, gave a great impetus to the course of Ele- mentary Hygiene and Home Care of the Sick. The course in itself was not considered as adequate preparation for this group, but hospitals acting as the parent institution to a base hospital were asked to give each individual selected for this group a month's course in the institution. Nevertheless hundreds of women who had finished the course felt that it might qualify them for service in military hospitals should the United States become engaged in war. The idea became more widespread and the demand for classes increased. Particularly was this true immediately after the declaration of war in April, 1917, and during the months that followed. The demand for instruc- tion increased beyond the ability of the Nursing Service to provide facilities for it. The textbook on Home Dietetics which had been issued during the early winter of 191G, also attracted much interest. The demand for dietitians for service in military hospitals, as well as to act as instructors, became almost as great as that for nurse teachers. Until June, 1917, ]\riss Noyes worked alone with these activities. She was at the ofiice early and late, Sundays and holidays. The pressure was so enormous that work increased beyond the space capacity to care for it. The third floor of the Headquarters building, in- cluding tlie gallery, was crowdc^d with desks, and from approxi- mately ten workers, including ^liss Delano and ^liss Noyes, the nnmber grew until there were eighty, and still the work was bevond control. The details of the classes formed a con- CLASS INSTRUCTION FOR WOMEN 136T sifloral^lo part of th(^ work with wliich this office force was busy. During the sinmner of 1917, the pressure for instructors was very great. There were as yet no Division officers to whom the selection of these nurses might be r(>ferred. Therefore, tlic Local Red (^ross Nursing Committees, of which each state had one or more, were asked to recoumiend instructors. ^hmy times during the crowded summer of 1917 several baskets of papers of enrolled nurses would require examination in order to determine the (qualifications for teaching the course before the instructors' appointment card could l)e issued. Be- fore the card was sent out the approval of the Local Committee was secured. With the offices so crowded, and the click of typewriters and constant interruption making sustained, delib- erative thought almost impossible. Miss Noyes frequently used the attic in which to scrutinize these credentials. Even the gravest occasions may have their humorous aspect and evidently this impressed one well-known writer Gelett Burgess who, in Colliers Weekly, August 1, 1917, wrote: "But liere is the director of the Bureau of Nursing Ser- vice, come for a necessary conference. Crowded into a narrow space between tables, with women pushing, 'excuse me I excuse me !' past them every minute the conversation goes on until ']\Iiss Xoyes, jMiss Xoyes' the head of the Bureau of Nursing Service is called to the long distance phone, where a lady in another city, who had taken the examination in Home Care of the Sick, wildly wants to know: 'Where is my certifi- cate?' ^Fiss Noyes ])romises to send it l)y special delivery, does send it immediately. Her tormentor, however, witliont waiting the necessary time, continues to write, phone and felc- gra])h, as if she expected the certificate to arrive instantane- ously by wireless. Poor ^liss Xoyes I In order to do a little writing she lias to forsake her comfortable oiliee and flee for refuge to the attic." This pressure continued until relieved by the appointment of ^liss ITay in July, li)l7. So rapidly had tlu^ woi'k expanded that ^liss Hay found a corps of 1.") steiiograjihcrs, six clerks, six typists and on(^ messenger, who w(u-e attending to the details of this oiu^ activity. Aft(U' decentralization was completed, the details of tlii^ conduct of classes wer(^ gradually transferred to the ])ivisi(Ui offices. The number oi' \lv(] Cross Cha]it('rs had ai'owii to :)700 and a vastlv increased interest in the courses 1368 HISTORY OF AMERICAN RED CROSS NURSING was spread throughout their jurisdiction. As interest in the classes of Elementary Hygiene widened some dissatisfaction with the textbook was expressed, and revision seemed neces- sary. Miss Delano appointed a committee during the summer of 1917 to work out a suggested plan, of which Anna C. Jamme, of California, was the chairman. Two other nurses formed the committee of three; one of these was a Washington (D. C.) nurse whose name cannot be secured and the other was Amy Hilliard, who for the moment put aside her duties as general superintendent of Bellevue and Allied Schools of Nursing to come to National Headquarters and work out this plan. Anne Hei'vey Strong, graduate of Bryn Mawr College, of the Albany Training School for Nurses and also of Teachers College, at that time professor of Public Health Nursing, Sim- mons College, Boston, was asked to undertake the revision, using the plan developed by the smaller committee and later approved by the National Committee. This she consented to do. After some delays, the book was ready for circulation early in 1918; the name was changed to ''Home Hygiene and Care of the Sick" ; the text revised and brought up to date with several other changes, such as a rearrangement of contents and the addition of a bibliography. At this time an interest in the book held by Miss Mclsaac's sister was bought by Miss Delano. By the terms of Miss Delano's will the textbook with all author's royalties became the sole property of the American Red Cross. Within the Division Departments of Nursing, the work in connection with the two courses of instruction, Elementary Hygiene and Home Care of the Sick and Home Dietetics, was systematized on the following plan: a. Advice to and supervision of, Chapters on matters of general policy and practice prescribed by National Head- quarters. b. Supervision of instruction personnel; appointment of Chapter supervisors of the courses in Elementary Hygiene and Home Care of the Sick, and in Home Dietetics ; appointment of instructors for Elementary Hygiejie and Home Care of the Sick; cooperation with National Headquarters in the enrollment of r?ed Cross Dietitians and the appointment of instructors for Home Dietetics. c. Advice to Chapters on matters concerning compensation of instructors and class fees. CLASS INSTRUCTION FOR WOMEN 1369 d. Maintenance of records of instruction personnel, and forwarding of this information to Chapters. e. Study and recommendations as to methods of promoting enrollment of students. f. Advice to and cooperation with, Chapters on matters re- lating to classrooms and classroom equipment. g. Sunnnarization for the Division manager of reports of class instruction work received monthly from Cha])ters and preparation of Division summaries for transmittal by the Division manager to National Headquarters. With the newly decentralized system, the work of the Bu- reau of Class Instruction at National Headquarters was divided and placed under the supervision of two bureaus known respec- tively as (1) Bureau of Elementary Hygiene and Home Care of the Sick, with Miss Hay as director, and (2) the Bureau of Dietitian Service, with Miss George as director. As the volume of work increased, it became necessary to appoint Di- vision directors of the Bureau of Elementary Hygiene and Home Care of the Sick, In January, 1918, the Surgeon General of the Army re- quested that Miss Hay be released from the Bed Cross to do some special work in his office in connection with the Army School of Xursing. Following !Miss Hay's resignation, Har- riette Sheldon Douglas, whose name and interesting background have already been given in a previous chapter, became director of the Bureau of Nurses' Aides and Instruction. She continued in that office until December 31, 1921, when she resigned be- cause of pressing personal claims upon her time. ^Irs. Isahelle Wilbur Baker succeeded ^liss Douglas, coming to Xatiomil Headquarters on January 1, 1922, from the Xew England Division, where she had served successively as an instructor, director of a Chapter teaching center and l)ivisi(m Director of Instruction in Home Hygiene and Care of the Sick. This practical training and experience was a valuable contri- bution to the development of the work at National Headtpuir- ters. Mrs. IJaker was a graduate of tlu> Bhod(> Island School of Xursiug and ])revi()us to her marriage, had been su})erinten(lent of the Johnson ^lemorial Hospital, Stattord Springs, C\)n- necticut. During th(> period which elapsed between the year 1917 and the ycai' 1922. class instruction for women increased to an almost incredible magnitude. Its character, too. altered per- 1370 HISTORY OF AMERICAN RED CROSS NURSING ceptibly and a marked difference in the class of students, during wartime and after, became evident. The war brought out many women who had visions of war nursing, but afterwards the ex- tent of class teaching among factory workers, the young women of humble homes and, most strikingly, among rural families, mountain and farm dwellers, and little country villages, gave gratifying proof that a solid and enduring work of education had been built up. The number of certificates issued from 1914 to 1921 follow: 1914, 273 certificates; 1915, 250 certifi- cates; 1916, 3927 certificates; 1917, 31,188 certificates; 1918, 27,942 certificates; 1919, 49,072 certificates; 1920, 89,748 certificates; 1921, 61,304 certificates. These figures do not include thousands of women and girls who took the instruction but who for various reasons did not complete the course and receive the certificate. The peak of enrollment was reached in 1920 when 117,908 pupils took the course. That the enthusiasm in this phase of health education should have reached its height at this par- ticular period was a natural result of the alarm created by the influenza epidemics of the two preceding years. Never had the necessity for preparedness by every woman against the on- slaughts of disease been more gTaphically and tragically em- phasized. When this instruction was first given there was but one au- tlmrized form the Standard course. This consisted of lessons totaling twenty-two and one-half hours as a minimum; it was conducted by an authorized Red Cross nurse instructor. Exam- inations, both practical and theoretical, were given at the end of the lessons, and certificates were granted to those whose markings wore satisfactory. In 1920 an adaptation and modi- fication of the Standard course were authorized. The Adapta- tion of the course consisted of the same number of hours, fol- lowed by examinations and certificates as in the Standard course, but teachers of physiology, biology, physical training, and home economics and others specially qualified were allowed to give the theoretical instruction. It was designed for use in schools and remote communities. Autliorized Red Cross luirse in- structors in every instance were made responsible for the course and for giving the practical lessons. A plan was worked out by National Headquarters indicating thos(^ chapters in the Hod Cross textbook that might be taught by the lay teacher and those that should be taught by the nurse instructor. By this CLASS INSTRUCTION FOR WOMEN 1371 arrangement the nurse instructor's time was conserved, thus making it possible for a greater number of students to have the advantages of the instruction. The ^lodification was authorized for the benefit of those women who would find it difficidt to take a written test, for women lacking a knowledge of English and for girls too im- niatur(> to take either Standard course. It covered the same number as the other two of the lessons to be given en- tirely by a lit'd Cross nurse instructor. No written examina- tion was to be re(iuired, but practical tests were to be given, and at the completion of the lessons a certificate granted to those eligible. In order to secure a standardized, efficient method of instruc- tion and to give some special training in teaching to instruc- tors, institutes were held in every Division under the super- vision of the Division Directors of Home Hygiene and Care of the Sick, whose experience in teaching and administration had been demonstrated. The educational benefits of these insti- tutes were invaluable, they not only enabled the Division Di- rectors to come into personal contact with the instructors in their Divisions, but served to improve the methods and techni(|ue of the instructors themselves. A still further step leading to the better preparation of nurses as instructors in Home Hygiene and Care of the Sick was the inauguration in several universities and colleges of a short course in methods of teaching. The ''Guide for Instructors" was revised in the spring of 1021, with the expectation that it would help to secure great(>r uniformity of method in presenting the information contained in the textbook. It was compiled to assist especijilly the in- structors who lacked experience in teaching or who had not h'arned to apply teaching methods to the carc^ of tli(> sick in the home. This Guide as revised contained outlines of the course, an exc(>]lent explanatory text, illustrations of nursing teclmiipu} iiiteii(l(Ml to standardize demonstrations, sugg(>sted lists of (Mpiip- nieiit for teaching centers and traveling (^luipnient, and lists of substitute appliances which might be improvised from materials available in the simplest home. The substitute appliances were not ;'lunisy devices, but ship-shape and trig. The pamphlet was amply illustrated. Miss Douglas lavished her eneruies in en- couraging and devi'loping resourcefulness among the instrnctoi's and in this she met with response and enthusiasm from the Division direct(U's. 1372 HISTORY OF AMERICAN RED CROSS NURSING Because of the increased demand in rural communities for these classes, itinerant or field instructors were appointed in many of the Divisions. These instructors were supplied with traveling equipment which could be transported very easily no matter into what remote districts they traveled, or by what methods they were carried. Thus was simplified in a great measure the problem of carrying the message of Home Hygiene to isolated regions where it was impossible to set up teaching centers. The instructors in the insular possessions of the United States and in the foreign field were objects of special interest at Headquarters and their work was aided in every way by Miss ^oyes and Miss Douglas. A complete miniature equipment for demonstrations in class was made up and sent to Alaska for the use of the instructor who conducted classes there. Miss Douglas wrote (1921) : I cannot praise too highly the splendid work many of our nurse instructors have done. They have been missionaries in the true sense of the word, overcoming many seemingly in- surmountable obstacles and never sparing themselves in order to give various groups this necessary instruction. Classes have been held in all types of schools: grade, high, parochial and private schools ; vocational, Americanization and Continuation schools; universities, colleges and normal schools. They have been held in industrial plants, church and commercial organizations ; for groups of Camp Fire Girls and Girl Scouts and for groups in Red Cross Teaching Centers. The work has been carried on in Alaska, the Dominican Republic, Hawaii, the Canal Zone, Porto Rico, Siberia, Poland, Czecho-Slovakia, China and the Philippine Islands. The classes have included missionaries, Indians, foreigners, deaf mutes and the blind ; classes have been conducted for the Chinese women of China- town, N. Y. C, for the girls in the Crittenden Homes and other correctional institutions, for women and girls in practi- cally all occupations, and as well those of the leisure class. The instruction has been related more and more closely with the daily life and acts of service of those who have completed it. The desire to put the knowledge gained in these courses to practical use in the community has been evident. In several places where this work has been going on "Health Clubs" have been organized which participate in community projects, espe- cially those which aid in public health. CLASS INSTRUCTION FOR WOMEN 1373 The public health nurses recognize the value of this in- struction as an introduction to their work in rural communities and as a means of developing civic pride. In one community a new school house and in another a hospital was established. The vocational value of this course has been incalculable. Many a young girl, hesitating as to the choice of a vocation, has caught a glimpse, through the course in Home Hygiene and Care of the Sick, not only of the opportunities for service and success that lie in the nursing field but of the realization of any innate capacity she might possess for this career. Schools of nursing have already seen the truth of this statement and many of their applicants have been recruited as the direct result of the interest aroused by this instruction. From every Red Cross Division instances have been reported where young women, having developed an interest in nursing from these classes, were encouraged to enter a school of nursing. 'From one Division alone it was reported that 125 young women had entered schools of nursing in one year. Many were from isolated homes in remote country or mountain regions where their opportunities were few and their future most limited, and who from their Home Hygiene classwork were led into wider lives of action and interest. A certain Division Director of Home Hygiene was inter- viewing a candidate instructor: "Are you familiar with our course?" she asked. "Yes," was the reply. "Probablv my desire to become a nurse would never have been stimulated but for this Red Cross covirse." "This is most interesting!" exclaimed the Division di- rector, ''and goes to show the importance of presenting the instruction to young girls as well as to older women." "All through my training," went on the candidate, "niy ardent desire was to instruct classes in Home Hygiene under the Eed Cross." Xecdless to say she received the appointment as an instructor. All over the country during the intluenza epidemics of 1918 and 1910 the groups who had completed this course and many who had taken the course in pr(^])aration for the national emer- gency, gave volnntarily of their strength, time and service. Un- der the sup('rvisi(ni of nurses and physicians they took care of children, the aged and the chronically diseased, thereby releas- 1374. HISTORY OF AMERICAN RED CROSS NURSING ing the graduate nurses for the care of the influenza patients. The majority of these women could not have rendered this service had it not been for the Red Cross instruction in Home Hygiene and Care of the Sick. Motion pictures have been utilized for class instruction. "Every Woman's Problem," produced in 1920, was of such simple universal appeal and genuine educational value that it met with a never-failing popular welcome. It told the story of Mrs. Helpless and how she learned, through her course in Home Hygiene and Care of the Sick, efficient methods of caring for invalid Aunt Mary. For the schools and rural sections where the motion picture could not be used lantern slides were prepared. The slides with captions, depicted the practical work of the course. The wide extent and popularity of the classes in foreign fields as well as at home created a demand for the translation of the text-book on Home Hygiene and Care of the Sick in whole or in part into Czecho-Slovakian, Korean, Russian, Polish and Spanish. Perhaps no other book of its kind has been so widely translated. Among the interesting exhibits placed in the museum at National Headquarters was a miniature reproduction designed to show how a class may be successfully conducted in an ordinary bedroom in an average home, using home equipment. The room contained two windows and a fireplace, providing almost perfect ventilation. The painted fioor was bare except for a few rag rugs. Extra chairs were added for the accommodation of the class members, but otherwise the bedroom furnishings consisted only of two single beds, a dresser, washstand, a bedside table and a comfortable chair. A blackboard stood at one side of the room, and models and charts were suitably arranged. A hot water bag w^as in evidence. In one of the beds a member of the class acted as a patient and reclined against pillows sup- ported by a suitcase which was utilized as a head rest. The instructor in full Red Cross uniform instructed the members of the class, one of whom made the empty bed, another carried a tray to the patient, while the ''model" infant was seen in the foregi'ound safely confined within his "kiddie coop" improvised from an inverted table. CHAPTER XVII THE DIETITIAN SERVICE THE history of Red Cross work in "Home Dietetics," the "Bureau of Dietitians' Service" or the "Nutrition Service" as it has been variously called, falls easily into three periods. The first of these covers the time from the inception by the Red Cross Nursing Service of work in dietetics to the time when the nation began to make definite moves towards casting in its lot with the Allies in the World War. The second period extends, practically, from the time of the planning and organization of the first base hospital units to the sigiiing of the armistice. The third period is the period of transition from the acute situations of war to the more normal problems of peace, and closes, in so far as this history is concerned, with the date on which the bureau was made into an independent Red Cross service. Th(> Ivcd Cross Nutrition Service, as it has come to be called, had its beginning in a course of instruction in "dietetics and household econi my" which was ofi'erod by the National Com- mittee on Red Cross Nursing Service along with courses in "First Aid" and "Hygiene and Home Nursing." The follow- ing statement of the purposes of these courses and the plans for them appeared in the annual report for the year l!tl2 : It lias been demonstratod that the instruction of men in first aid will reduce deaths and serious results from injuries about one-half. Similar instruction, including liygieno and home nursing, is no less im])ortant tor women, hut has never be(Mi un(k'rtak('n on a national scale. The American Hed Crcjss has decided to orj^anize such cdasst's aiul has ])hu-e(l them umU'r the u'cneral direction of the National Conunittee on lu'd Cross Nursing Service. We hope foi- the codijcration of state and hu-al committees and all enroded I'cd Cross nurses. The i-ourse of instnution will include 1^ lessons on first i:i75 1376 HISTORY OF AMERICAN RED CROSS NURSING aid, 15 lessons in hygiene and home nursing and 15 lessons in dietetics and household economy. . . . The first aid courses must be given by a physician, and other instructions by a lied Cross nurse unless otherwise authorized by the committee in charge. Miss Marion L. Oliver, of Washington, was placed in charge of the organization of these classes. The reports for 1013 and 1914 showed that no regular work in home dietetics was under- taken during these two years : lOlS The instruction includes first aid, elementary hy- giene and home care of the sick, with possibly later courses in dietetics and household economy. 191Jf Soon after the adoption of the general plan for the instruction of women, Miss Marion Oliver who was placed in charge of the organization of these classes, was obliged to leave Washington and give up temporarily the work in which she was so much interested. The unusual demands made upon the chairman of the National Committee during the past year have made it difficult to d(j much constructive work in connection with these classes for women, but we have been gratified at the evidences of interest and often surprised at requests for information from unexpected sources. A little instruction in 'Vlietetics" was sometimes included in the courses in home care of the sick given hv nurses to classes organized during the year 1!)15 and in the earlier months of the year following. In a letter written to ]Miss C. E. ^lason of The Castle School, I'arrvtown-on-thc-IIudson, under date of May 4, lOlG, ^liss ]:Joardrnan stated tliat ''200 women in the Xavai Service School arc taking courses in First Aid, Home Care of the; Sick and iJietclics and Surgical Dressings. Tlies<,' courses," wrote ^liss Boardnum, "are all given under trained nurses." While such limited instruction in diet may have been all that was thought necessary under the original plan, Miss Delano was (|uick to recognize that the country was approaching a crisis in which the best possible work in each line of service would be needed. In a letter to Pratt Institute dated July 2, 1115, she stated that "one of the instnietors in dietetics in the public! scIkjoIs of Washington, Miss Kiitli 'rill'any, was good enougli THE DIETITIAN SERVICE 1377 last year to ^ive a course of lessons in Dietetics which was organized under the auspices of the American lied Cross." This was the beginning. of a correspondence with a number of home economics people in regard to the preparation of a text- book on the subject of ''Food Vahies and Home Dietetics" for use in similar classes. As a result, such a book was prepared by Miss Ada Z. Fish, head of the department of art and home economics of the William Penn High School for Girls, Phila- delphia. The aim and scope of this first text-book was given in the author's introduction : This book is designed for general use in classes to be taught under the supervision of the American Ked Cross Nursing Service. Tiie aim of the course is to give in a simple way the underlying principles of cookery. These are presented in fif- teen lessons. There are also directions for fourteen lessons in practical cookery." The book was not ready for circulation until in February, 1917 ; meanwhile little classwork was attempted. The Annual Report for 1910 said: During tlie year four experimental classes in dietetics were held, with a total enrollment of 43 pupils, and 36 certificates in this course were issued. These classes were organized under the direction of ^liss Noyes and were taught by dietitians. The new aspects of the work were voiced in the same report : A great interest in tliis course in home dietetics has been evinced and the necessity for qualified instructors as well as for dietitians for base hospitals has resulted in the organiza- tion of a national conmiittee on dietitians, of which Miss Enmui A. (iunther of Teachers' College, is the chairman. It is hoped ultinuitely to organize local connnittees to assist with the work of enrolling dietitians for this purpose. At a meeting of the National (^ommittee on Red Cross Xurs- ing Servic(> ludd in Washington, December 1:2, 10 Ki, ^liss Gun- ther's appointment was aj)pr(n-ed. The other nunnbers of the committee as chosen by Miss Guntlier, Anne W. Goodrich, F-lva A, George and Isalxd Kly Lord, were also approved. At 1378 HISTORY OF AMERICAN RED CROSS NURSING an adjourned meeting on the same date the chairman of the Committee on Dietitians was made an ex-officio member of the National Committee on Red Cross Nursing Service. At this meeting Miss Guuther outlined very briefly the work that had been done and such plans for organization as had been formulated. She spoke of the opportunities for dietitians in connection with the Red Cross, not only as instructors in the course in Home Dietetics, but as dietitians for base hospitals and for such other opportunities as might eventually present themselves. Even while this committee was being approved in the routine of business of the December meeting, Miss Delano was antici- pating the need for a larger and more representative committee in order to compensate for the lack of State and Local Com- mittees on Dietitians' Service. In a letter to Miss Fish under date of August 30, 1916, she wrote: We are planning to increase the Committee on Dietitians securing a representative woman in each of the large cities who will help us in securing instructors for the classes. Miss Gunther of Teachers College is chairman of this committee and you will no doubt hear from her soon in regard to mem- bership on her committee, and I do hope that you will feel that you can accept the position. I am quite sure that we shall have difficulty in securing suitable instructors and shall rely upon your interest and cooperation. The committee, as enlarged during the early months of 1917, was composed of the following members: COMMITTEE ON RED CROSS DIETITIAN SERVICE P]x-officio Member Miss Jane A. Delano, Chairman, National Committee on Eed Cross Nursing Service. Miss Edna White, Cliairman, Ohio State University, Colum- bus. Oliio. Miss Emma Gunther, Teachers College, Columbia University, New York City. Miss Isabel Ely Lord, Pratt Institute, Brooklyn, N. Y. Dr. Euth Wheeler, Goucher College, Baltimore, ]\[d. Miss Lenna Cooper, Battle Creek Sanitarium, Battle Creek, Mich. Miss Catherine J. MacKay, Iowa State College, Ames, Iowa., THE DIETITIAN SERVICE 1379 Dr. Agnes F. AEorgan, University of California, Berkeley, Cal. Miss (rraee K. McCullough, Peter Bent Brigham Hospital, Boston, Mass. Miss Ada Z. Fish, William Penn High School, Philadelphia, Pa. Miss Ettie Paitt, University of Washington, Seattle, Wash. Miss Annie W. Coodrieh, Army School of Nursing, Surgeon OeneraFs Office, Washington, D. C. Miss Elva A. George, Ked Cross Headquarters, Washington, D. C. Miss Emma Smedley, Philadelphia, Pa. Miss Helen M. Pope, Carnegie Institute, Pittshurg, Pa. Miss Lulu Craves, care ^fodern Hospital, Chicago, 111. Miss Flora Rose, Cornell T'ni versify, Ithaca, New York. Miss Violet Hyley, Invalid Soldiers Commission, Toronto, Canada. Miss Alice Loomis, University of Xehraska, Lincoln, Xebr. Miss Clara Colburn, University of Chicago, Chicago, HI. Later, at the suggestion of the chairman, ^liss White, Miss Emma Conley, who was in Washington temporarily, acted as chairman of the committee during her stay in order to facili- tate the work. In May, 1917, Miss George, a member of the committee, a graduate of Pratt Institute, Brooklyn, and long associated with ]\rt. Sinai Hospital, New York City, was brought to Red Cross Headquarters to take charge of the enrollment of dietitians and the organization of classes in Home Dietetics. In the face of the prospect of w^ar which overshadowed the country, no better statement of the organization aims and obligations of the new Dietitian Service of the Red Cross could have been formulated than that contained in ^liss iSToyes' circu- lar letter to dietitians, issued in January, 1917: The development of the educational work and the organi- zation of base lu)S])ital units under the aus])ices of the American Ped Cross has created a demand for qualified and experienced dietitians. The opportunities for dietitians in this service may be grouped for the ])resent under two main divisions. A. Instructors in Home Dietetics. B. Dietitians for base hospitals. Tin' course in Home Dietetics given under the auspices of the American Ked Cross sbouhl he iiivcn hv a dietitian who 1380 HISTORY OF AMERICAN RED CROSS NURSING meets the requirements as established by the Central Com- mittee on Dietitians of the American Red Cross. This com- mittee passes iipon the credentials of applicants and recom- mends to the Bureau of Nursing Service such dietitians as appear to meet all the requirements for instructors. Classes in Home Dietetics are now being organized in all parts of the United States, and it is the desire of the Red Cross to keep on file at the National Headquarters as com- plete a list as possible of qualified dietitians who are ready to serve as instructors. A textbook has been prepared by Miss A. Z. Fish, William Penn High School, Philadelphia, and may be secured from the Eed Cross at a cost of one dollar ($1.00). The course in Home Dietetics consists of fifteen lessons of three hours each. Full particulars explaining the manage- ment of the classes will be forwarded upon request. Dietitians are also needed to take care of the special diets in connection with the base hospitals now being organized by the Red Cross. Base hospitals are organized around civil institutions in time of peace in order that we may be prepared in event of war to send out groups of nurses, doctors and other personnel who are accustomed to working together. The dietitians are enrolled with the nursing staif and at the same salary, $50 per month. It is also desired to keep lists of dietitians who will be available for dietetic work in convalescent hospitals, refresh- ment rooms, etc. If it is your desire to enroll for any one of these services, kindly fill out the inclosed application blanks and return to the Bureau of Nursing Service, Washington, D. C. The year 1917 showed a rapid development of this service. Professional home economics workers, although already busy with tests, experiments and the preparation of literature for the solving of some of the problems which the country would be called upon to face in the conservation of food and other ma- terials and in the safeguarding of health, were stirred by this added opportunity for service under the standard of the Ked Cross. The first dietitian was enrolled February 3, 1917; by the end of the year six hundred and forty-five dietitians had been enrolled as instructors and an additional two hundred and eleven for Tied Cross service in military hospitals. The first classes in Home Dietetics were organized in F\'bruarv and by the end of ()cti)ber, 1917, '509 classes liad completed the course of instruction, and 2891 certificates had been issued. At the THE DIETITIAN SERVICE 1381 time of making the annual report classes in Home Dietetics were being hold in one hundred and forty-nine teaching centers. How successful this bureau was in enrolling and assigning dietitians for war service was summarized in Miss Delano's statement before the Twentj-first Annual Convention of the American Xurses' Association in 1918 in which she stated that 85 livd Cross dietitians were then in service in cantonment and naval hospitals while 48 others had been assigned to base hos- pital units and 3 to French military hospitals under Red Cross supervision, making a total of 183. "We were fortunate," concluded ^fiss Delano, "in developing this service just before the needs of war came upon us, and so we have been able to meet the demands of the Army, the Navy, and special divisions of our own work." Although the record of the total enrollment of dietitians by the Red Cross during the year 1917 was gratifying, on April 6 but twenty had been listed as qualified for service with base hospital units. By the end of June the enrollment had reached sixty-nine. Of these, nine had been assigned to units which sailed for France during May and June. Later in the year Miss Delano reported that seventeen were on active duty with base hospitals in France and that eighteen had been assigned to cantonment hospitals in this country. As is stated in another chapter the first six base hospital units to be sent to France from this country, ^lay and June, 1917, were loaned to the British Government and assigned to work with the British Expeditionary Forces. These were followed almost immediately by assignments to the American Expedi- tionary Forces, to camps and cantonments in this country, and to the Xavy. The distinction of being the first dietitian to enter active service overseas may be claimed by Florence Bettman ^ of Base Hospital Unit Xo. 10, Pennsylvania Hospital, Philadelphia, or by Anne T. Uphani,^ Base Hospital Unit Xo. 4, Lakeside ' Floipiico T?('ttnian was horn in Jersey City, N. J., attended school at Plainfield Seminary, and received lier technical training in Boston and as pupil dietitian in Jefferson Hospital, riiiladelphia. Later she lieid posi- tions as (lietitiun in tlie N'acation House of the Pennsylvania Hospital for the Insane, and in tl:e i'reshyterian Hospital. Pliiladel])hia. *Anne T. I'phain was horn at Keene, New llain])siiire. She attended scliool at \\ heaton Seminary and completed the full course in homo econdinics at Simmons C'(dle<:e. Pxiston. After teacliinr for the one hundred and twenty in money which gives me what is called mess nionev. With it 1 buy fresh vegetables, fruit and other things not jirocurable in the Mrarjorie Hulsizer was l)orii in Ficiniii^^dn, New Jersey, attended (^lierlin C()ilc;,'e and later jfraduated fnmi SiinuKins C'ellc.^e. Slic was a pupil dii'titiau in the Peter lieiit liri^iiani llespital Ijcfore takini,'' up her wurk at Wincliester. 1384 HISTORY OF AMERICAN RED CROSS NURSING rations or from the canteens near camp. The old market women shake hands with me, tell me that hefore the war is over I shall speak excellent French, and they complete the occasion by handing me a bunch of flowers, a "souvenir." Some days we get enough flowers to make 'the mess hall a regular bower. For marketing I am allowed a Red Cross ambulance. One of my P. B. men goes with me to carry the baskets and the officers' mess cook goes in at the same time to do his buying. These ambulances are driven by girls from England. I get a different one detailed to me each time and I so enjoy talking to them. Their regular work consists in carrying the wounded from the trains to the hospitals. The other part of my work is to keep the Sisters' quarters, seven huts, nine tents and seven alwyns, or portables, and the bathhouses clean. For that I had three P. B. men, but they have recently gone and all I have now is one patient detailed to my \\ork full time and two patients two hours a day who can do no scrubbing or hard work, but we rub along somehow. That things did turn out well at last for this particular dieti- tian, was chronicled in a letter which !Miss Hulsizer wrote to the Director of Red Cross Xutrition Service at Washington after her return from France : After I left the 'B. E. F. in December, 1918, } went to an American Hospital. Base 57. in Paris, for as soon as I learned that my unit, the Peter Bent Brigham. was to 'be sent home, I asked Miss Hall, chief nurse of the Red Cross in Paris, to find out if I could be transferred to the A. E. F. I felt that I couldn't go home without having the experience of feeding the patients themselves. She immediately arranged it for me with Miss Stimson. The hospital in Paris, Xo. 5T, had been a large one. There were nearly a thousand patients when 1 arrived. In my diet kitchen we prepared food for four hundred and on down to fifty, and for one on the day 1 left. The work was interesting and I enjoyed working with the American soldiers. They are the most considerate, thouglitful, intelligent and easily taught boys I have ever seen. With the B. E. F. J had been running things absolutely on my own. A certain sum of money was given me eacli week by the chief nurse and 1 did the buying and kept the accounts. At Xo. 7u I fcnind a mess officer to whom I appeared to be responsible. Xutbing was explained THE DIETITIAN SERVICE 1385 to me. I was left to "fall into things," and I fell. The mess orticer was a most dillicult one to get along with, but he was really very efficient and I respected his ability if not his personality. Finally, one day, 1 had a little talk with him "man to man" and after that we got along splendidly. He allowed me to buy, or to have bought, nearly everything that I needed. Occasionally 1 had to do a little explaining, but usually my orders were unquestioned. On the whole, my experience in France was free from friction. I wanted to tell you this, as I have heard so many dietitians say that they have had most uncomfortable times. I never have had to do any of the cooking myself. I was always given plenty of cooks and K. P.'s. But I liked to have the boys feel that 1 actually could do things myself, so I often spent a good deal of time in the diet kitchen preparing food. On June 10 Base Hospital Unit Xo. 2 from the Prcsbvtprian Hospital of ]^ew York C^itv assumed charge of British ^lilitarv Hospital No. 1 at Le Treport, France. ]\[ary Radford Harold, a graduate of the j\retropolitan Hospital School of Xursing, of Xew York City, and special student at Columbia University, acted as a dietitian with this unit, although she was enrolled as a reserve nurse. Miss Harold did not sail with the unit but took up her work later in the summer. The fifth unit in the assignment to the British, Base Hos- pital Xo. I'l, from the Xortli western University ]\Iedical School and Cook County Hospital, sailed May 19, on the S. S. Mon- golia. On account of the tragic accident happening a few days out, which is described in another chapter, the Mongolia re- turned to Xew York, but on ^May 22 again sailed for France. With this unit were two dietitians, Mary Lindsley,^ house director and business manager of the Illinois Training School for Xursing, and Margaret Knight,^ head resident of Willard Hall, Xorthwestern l^niversity. Although ]Miss Knight's ap- * ^fary Lindsloy was l)orn in Green Villafje, Xew Jersey. She attended soliool at Eastern Seminary and later ffrailuated from Pratt Institute, I^rooklyn. Slie was dietitian for tlie Ilarrisl)iirp (leneraf Hospital for two years, was with the Woman's Hospital of Xorthwestern I'niversity Medical School for two years and a half, and had lieen with the Illinois Training School for Xursiiiir for four }"cars at the time of receivinjx -her appointment t<) military service. " Marj^aret Kni^dit was horn in Ann Arbor, Miciiijjran. She graduated from \'assar College and later received the degree of Master of Arts from Ohio State rniversily, specializing in l'"rench. Her trainiiig in Food and Xutrition was received in the Department of Home P>conomics of the latter institution. 1386 PIISTORY OF AMERICAN RED CROSS NURSING pointment was primarily as an interpreter, she was later as- signed to duty on the hospital staff. All through the report submitted by Miss Lindsley there radiated an optimism seemingly untouched either by the hard- ships which were beyond any one's control, or by entrenched British custom, (including tea for breakfast, which was beyond "Act of Parliament"). Her description of the bath accommoda- tions gave evidence of her disposition to see the best side of things : The bathhouses were in reality long huts with a fire in the middle for heating the water. Xo other heat was available. Finding one's bath day posted meant, at the appointed time, putting on a trench coat and rubber boots and tramping through rain and slush to find icicles on the edge of the bath- tub. And yet I know of no one who took cold, or who was otherwise made ill, by the tramps through the wet, or from taking a bath in the cold place. Perhaps the most trying thing in the whole situation was the "long arm" method which she was called upon to use in doing her w^ork. The British military mess system was well organ- ized and no woman, dietitian or otherwise, was allowed access to the mess kitchen. In spite of the fact that Colonel Collins, commanding officer of the unit, made an earnest plea to the Division Director of Military Service that Miss Lindsley be allowed a diet kitchen, the thing simply could not be done. Her suggestions and orders were all formulated in consultation on the outside and reached the kitchen through the top ser- geants. Nevertheless, she reported as among the things which made the work pleasant and interesting, the "working with the sergeants to secure greater variety in their messes, making substitutions for the regular army ration aiid formulating new recipes for using the limited materials to be had." The value of such a service as this following the not infrequent occasions when the German submarines had "beaten them to" the food transports, can well be imagined. Auotlier paragraph of ^liss Lindsley's report showed that war has its playtime as well as its more serious business : Perliap? one of the most interesting experiences we had was our Field Day. July 4, 1918. As the British had entertained us at different times with their field sports, the officers and THE DIETITIAN SERVICE 1387 men of our unit decided it was up to us to entertain them with some real American sports. The Fourth of July was the day set, aiul invitations were sent out to all thesurroundin<^' camps. Back of our camp was a plain between two slopin only three wr.rds not under canvas and our hospital had ISoi) beds, later eidarged to '22~)0. 'Hie women's quarters were one- story huts with rooms for two: the l)atlihouse in a separate metal buihling. and llie kiteluMi, iness and sitting room in a larg(>r hut soinewliat more eai'efully built. Tlie niglit of our arrival we slept on boards with straw mattresses, hut within a 1388 HISTORY OF AMERICAN RED CROSS NURSING few days our army cots had arrived, and with the addition of some essentials, such as a basin and pitcher, a table, an improvised chiffonier and curtains, a room became fairly comfortable for the warm months of the year. But in the winter the cold Avas almost unendurable; four pounds of coal per person per day is a pretty small ration and we always saved it until we could both be in the room, when our little stove did its best for us. When, during the war, Miss Knight's parents received a letter from her in which she gave an account of the fuel al- lowance, they proceeded to weigh out four pounds of coal in order to visualize more clearly just what the possibilities of such an amount of fuel might be, and as Mrs. Knight reported, **We looked at that little heap of coal and then looked at each other." Miss Knight's report continued : The work given the dietitians was different in each hospi- tal. Sometimes they cared for the nurses' home, with perhaps occasional assistance given to the officers' mess. In other places the dietitian prepared food for especially sick patients ; still elsewhere she would have charge of the general hospital diet kitchen or the general walking patients' dining hall. This last was my special assignment. The dining tent seated 320, eight at a table. Our serving was done cafeteria style and all the food carried across an open lot from the cook house. We had an improvised dish warmer, a huge box lined with pieces of tin that were cracker boxes flattened out. The shelves were of woven wire fencing and the heat was furnished by a little oil stove on the bottom slielf. When the meal was finished, the soldiers took their dishes to the exit and deposited them in boxes from which they were taken by tlie dish-washers, washed and sterilized. The washing was done out of doors; only a canvas stretched over tent poles protected the dish-washers. We had six army stoves each holding a huge pot which was kept constantly filled witli water. It took nearly all of one man's time to keep these six fires going and the containers filled with water. Sometimes we fed 1450 each meal; that meant dishes were washed and returned to the serving table constantly. Tlie best we could do was to serve 725 per hour and the sight of that long line of wounded and sick men standing patiently in the mud and rain waiting for their meals will always stay in my memory. We had a waiting tent for them, where tliey THE DIETITIAN SERVICE 1389 could sit till a chance came to get into the dining tent, but nothing would induce them to use it no matter what the weather. The herding instinct was too great or else the army habit of a cue was too strong to overcome. In the afternoons and evenings the dining tent was used as a club room. We always managed to ir or the mess otticer would ])('rmit. Surely a third reason for whatever stu'cess the dietitians mav have to 1392 HISTORY OF AMERICAN RED CROSS NURSING their credit is due to the fact that, given the opportunity, they were able, in most instances, to demonstrate the value of their service ; recognition was sometimes slow in coming but it usually came. Following the Circular of October 2, 1917, already quoted, no formal action in regard to dietitians was taken during the remainder of the year, but a few excerpts from the report of a dietitian, Mrs. MacPhadyen ^ who was with one of the first base hospital units of the American Expeditionary Forces illustrated well some of the points which have just been made. In her report she said: We sailed from New York August 7th, 1917, arriving in St. Nazaire August 20th, 1917. On arrival we found that all Eed Cross nurses and dietitians were transferred to the Army. We did not feel very happy about this, but of course there was nothing to do but make the best of it. HoAvever, the Eed Cross did not forsake us. After we arrived at our destination we received many things which added to our comfort, blankets, sweaters and warm clothes, which were greatly needed, as our first winter was very cold. I found that no provision had been made by the Army for special diets or diet kitchens. It was a case of using my own initiative and doing what I thought best in my own depart- ment. I was allowed to have several chests of cooking uten- sils and equipment sent by the Red Cross, and I began my work by taking a corner of the main kitchen and making special diets for the sick, which after two weeks numbered about fifty. ^ly first patients fared well, I assure you. . . . Finally, our commanding officer, seeing I was determined to have a diet kitchen, came to my rescue and provided suitable quarters, also furnishing all extra equipment needed, such as a gas range and cooking utensils. The Red Cross ranges were put into the main kitchen for cooking light diets, of which I also had supervision. Everything moved alojig smoothly. I soon had a well- *Mrs. Margaret ^racPhadycn was born in Ivernie, Aberdeenshire, Scot- land. Slie was graduated from ]MacDonald Ontario Agricultural College in 1913. and the following year was instructor in domestic science and food value for the Agricultural Department of Toronto. Her hospital work previous to her entering military service was done in Harlem Hos- pital, in Bellevue and in the Ontario Ladies Hospital. On October 10, 1918, Mrs. MacPhadyen resigned from tlie ^Medical Department of the United States Army and accepted a position as dietitian with tlie Bureau of Hospital Administration, American Eed Cross Headquarters. Hotel Regina, Paris. ^Irs. MacPhadyen was assigned to U. S. Base Hospital Unit No. 9, New York Hospital Unit. THE DIETITIAN SERVICE 1393 equipped and up-to-date diet kitchen, one that would compare favorably with those of many New York hospitals. Our patients increased rapidly. I rarely had less than three hundred light and special diets, and during the drive five or six hundred. I did my best to represent the lied Cross and to do the work I knew they would wish me to do. In a letter to Miss George, under date of January 31, 1918, Mrs. MaePhadyen stated: There are some things in regard to the work here which I would like to tell you about. To begin with, there seems to be a vague idea of wliat we are really here for. 1 have had to do all my own planning. Fortunately, I have a splendid commanding oflicer, who has done everj'thing in his power to aid the work. The chief nurse, I am sorry to say, has not been of much assistance, thinking at first, appar- ently, that I did not "belong" because I was a "civilian." This going as a "civilian" is a strange arrangement and very disagreeable. ... I was able to take my place and to hold my own after I came here, but a younger and less experienced person would have been completely discouraged. . . . There is another matter I wish to know about, they are asking officers, enlisted men and nurses to take out insurance. I wished to do so but was told that I could not, as I was a "civilian." In ^lay, 1917, Congress authorized the establishment of thirty-two camps and cantonments in this country, and in September the Red Cross was called upon to furnish dietitians for this sen-ice. Here they served as administrative dietitians, as diet supervisors or as instructors in dietetics in the Army School of Xursing. As might be expected, conditions under which the dietitian worked varied as widely in the diti'erent cantonments as in the base hospitals overseas. Thus, from one dietitian: The three months 1 spent at Camp Wadswortli were not as ])]t'asaiit as tlicv nii'iht hav(> been because tlic status vi' Aw dietitian was so very uncertain. Pai't of the time 1 was under the chief nurse, and part of the time umh-r the mess ullicer. There were no ruh's or regulations (oiicerning me. And this from a dietitian at Camp Shelby: 1394 HISTORY OF AMERICAN RED CROSS NURSING I am directly responsible to the mess officer and the com- manding officers, and am rated with the officers. Judging from the following report from a dietitian at Camp Greene, Korth Carolina, things were not so bad merely a trifle confused : The mess officer under whom I work is very progressive and is getting things into fine shape, improving all the time. . . . Are there any special rules for the dietitians, especially as to hours, or do they keep the same hours as the nurses, and, if so, what hours are the nurses supposed to have ? IsTotwithstanding the fact that work in 'the cantonment hos- pitals did not afford the inspiration which accompanied service overseas, something of the spirit of the "trenches" was usually evident whenever things got a bit thick. To quote a report from Camp Travis : I have been here two weeks as dietitian, and I find my position a peculiar one. ... I supposed that when we were sworn in that, for the period of the war, we were members of the Army ^urse Corps. . . . Xow 1 find that we are listed as civilian employees and have no military standing . . . but, whatever my standing, it will make no difference with my work which 1 am trying to do as well as I can. "Carrying on" in the face of more serious difficulties was indicated in this report from a dietitian at Letterman Hospital: I have been assigned to the diet kitchen in the officers' ward, and have been disappointed in finding much manual work to be done by dietitian. . . . Heretofore, as you know, nurses have had charge, the last one having been in this diet kitchen for more than two years. She was a hard-working German woman, willing to stay on duty all hours, and who did much of the actual (ooking herself. ... 1 took the matter up with Miss Keener, the chief nurse, who sees the situation as 1 do. and slie in turn took it to the commanding officer. He was very kind biit said he could give me no extra hel]). He said to simplify the menus and to cut out all special diets, giving the semi-solid, light and full diets practically the same. . . . This very morning, after the order had been given to retrench on specials, the wrath of the ward medical chief came down upon my head, for he wished to test a four- THE DIETITIAN SERVICE 1395 day diabetic diet. Wlien I explained the situation he saw- things my way and returned to his duties but, / did the diets for him, as 1 know I always will do if it is at all possible. The work of giving instruction in the Army School of Nurs- ing was attractive to most of the dietitians assigned to this duty. The extracts quoted below from the report of Irma Latzer (now Mrs. Gamble), a graduate of the University of Illinois, give a picture of this phase of the work of dietitians, and, at the same time, throw a side light upon the confusion wrought everywhere by the never-to-be-forgotten epidemic of influenza. She stated : I was at the Base Hospital at Camp Grant from theimiddle of September, 1!)18, to the middle of the following April. Because of my previous experience [ was assigned the duty of giving instruction in dietetics to the students in the Army School of Xursing. Three days after 1 arrived at camp the "flu"' epidemic reached us and classes could not be started until the epidemic had passed. During that time every one served where most needed in caring for the sick as they were brought to the hospital by tlie hundreds. 1 was given charge of the nurses' mess. The meals were not hard to plan or prepare, for the allowance per person was liberal and the detail help was ])lentiful. Of course the "flu" did not pass up cooks and waitresses, but with volunteer help from Kockford we all managed to be fed. When the time came for classes to begin it was not a dilTi- cult problem to equi]i tlie diet kitchen. Lieutenant Colonel D. C. Micbie, conunandiiig officer of the Base Hospital, was dee])ly interested in the welfare of the student nurses and through liim and Miss Anna Williamson, chief nurse, the purchasing of good and adequate equipment was ('omj)ara- tively easy. ... A complete set of kitchen utensils for every desk and one large electric range made it as easy to teach dietetics in the army as in any modern university classroom. The students were an interesting grou]) to work witli. Although they varied as to age and previous school training all were there for a definite purpose and eager to make the best use of th(M'r time and opportunities. The course outlined for tlie Army Scliools of Xvirsing was followed as clostdy as practicable. l)ut this course was preceded by four deinoiistration lessons to aid the students in their practical work on the wards. The student group had to be 1396 HISTORY OF AMERICAN RED CROSS NURSING divided into four sections because of the large number md their different times of arrival at camp. Every section upon the completion of its course gave a dinner to which were invited the various commanding officers of Camp Grant and members of the faculty of the Army School of Nursing. The course in dietetics was followed by a lecture course in diet in disease, in which the students were also keenly inter- ested. Of course, overseas service was the hoped-for goal of many of the dietitians who entered service here, and it can be believed that the following note which reached Miss George was intended to carry a hint : I have been on duty at Camp in the dietitian service since January 10th, and I find that the experience in an army diet kitchen here . . . would certainly be very valuable by way of introduction to hospital work abroad. In no calling or profession does each individual measure up to standard in matters of training, experience, executive ability, personality or tact. Dietitians were no exception to the rule, and in view of the responsibility which came to the individual dietitian, the wisdom of the requirement made by the War Department that, before being assigned to duty overseas, the dietitian must serve in a cantonment hospital in this country may be appreciated. The following letter from Dr. Ruth Wheeler to Aliss George of the date of May 2, 1918, gave an indication of the sifting-out process. When you can, will you have some one look into conditions in our side of the work at Camp ? Eeports have come to me that there are lour dietitians there, no one of whom has sufficient training herself to enable her to train the others or to direct the whole scheme really well. One of our alumnae wlio is there says she is doing nothing that any maid servant could not do. ... I have written her that her job just now is to be thankful that slie is in such a fortunate position for get- ting the knowledge and ex])erience she needs. . . . She is probably doing as important work as she is capable of right now. Two dietitians died while in the service in cantonment hos- pitals in this conutry. Olive Ward Xorcross, of Worcester, ^fassacliusctts, a liTaduafo of the State Xormal School at Tram- THE DIETITIAN SERVICE 1397 ingham, Massacliiisotts, died September 26, 1918, at Camp Dix, New Jersey. ^leda !Morse, of Foxboro, ^lassacluisctts, also a graduate of Framiiigbam Normal School, died December 24, 1918, at Camp Taylor, Kentucky. By the end of June, 1918, eighty-two dietitians were on duty in the cantonment hospitals in this country. This number was greatly augmented during the following months and at the close of the fiscal year June 130, 1919, one hundred and forty-three were on duty in the United States and Hawaii. As dietitians were not named in the enumeration of positions open to enlistment in the Navy, the one dietitian, Henrietta L, French,'^ who saw Naval service abroad, enlisted as a yeoman (f) and later functioned as a dietitian. Miss French entered the service in October, 1917, and was assigned to Naval Base Hospital No. 2 at Strathpeffer, Scotland. Fifteen dietitians served in Naval hospitals in this country, five being assigned to the Great Lakes Naval Training Station Base Hospital with Mildred G. Stiles ^ as head dietitian. Miss Stiles was assigned to duty February 8, 1918, and resigned from the service in June, 1920, on account of ill-health. During this time she served in the hospital at the Norfolk Naval Base, with the Naval Hospital at Annapolis and New York Naval Hospital. Taken in cross-section, the Navy seems to have regarded the innovation of the dietitian strictly from the point of view of the ''special interest" involved. This statement from a Naval officer : With all this difficulty of getting food, I want a dietitian who can tell nie what to use if I haven't the particular article of food which 1 should have. And this from "before the mast:" "We got auotlier one o' them." "One o' what ?" "One o' them as wants to take our l)eans." Mloiirietta L. Frcncli j^'raduatcd in Ilmiie Ecdiiomics at Lewis Institute, Chicafjo, and subsoquciitly lield tiie position of dietitian at Miidlavia Sani- tarium at Kramer. Indiana, in tiie I'liiversity of California Hospital and in tl:c Xaval Base Hospital at Stanford. California. * Mildred O. Stiles was nearly cNcrywhei-e great waste of food, with conseciuent underfeed in. Jt will be noted that Miss Hungate did not sail for ovcn'seas until Angiist, 1918, some time after the ^Military Department had issued the order referred to above, ^liss Ilungate's report read in part as follows: After a session of several months at Camp Wheeler, Georgia. 1 became the one hundred and oneth feminine mem- " ^Fary Taylor Tltinjrate. (now 'Sirs. W. F. Bennett of Qiiantico, Vir- rinia i was liorn in Ndiraska. She was turn from overseas siie was apj)oint('d to Walter Heed Hospital and later to the I'niteil States Army Department Hospital al Hcjnolulu. 1406 HISTORY OF AMERICAN RED CROSS NURSING ber of Base Hospital Xo. 51, an organization which originated in Boston, but which contained about thirty others who, like myself, Avell remember tbeir first trip east to Chicago. The doctors and hospital corpsmen of the unit were sent overseas first, while the nurses were retained in New York, being out- fitted with uniforms and schooled in military drill. The hundred nurses all wore street uniforms of blue serge, blue velour hats and tan shoes; while I, the dietitian, the one hundred and oneth, was duly fitted out in a similar suit of gray, a black hat and black shoes. Tbere was no question about it, I was the odd member of the family ; my clothes served only to indicate that I was with, but not of the unit. Furthermore, no one seemed to know just what I was there for, or just what to do with me after I arrived. But during those long hours of drill in tlie hot Armory, I was in my glory, because the officer in charge divided us into squads according to our heights, and my gray uniform was permitted to blend inconspicuously with the blue ones. At last our flag was dedicated, our trunks and suitcases locked, our days of drill were over and we were to embark for ''overseas,'* We had spent hours in that sweltering Armory practicing the process of embarking, with military precision, on an imaginary boat, and when the great day arrived we were all ready to swing into formation and march up the gangplank like a group of vet- erans. But how different was the reality! We stood for hours down at the pier at Hoboken. (I remember that I perspired entirelv through the back of my only gray silk blouse, which turned it a brilliant henna, but nevertheless I dressed up in said blouse for the ensuing six months). Finally, they admitted us to the boat. Oh, the tragedy of it all! Those hours of rehearsal were forever wasted, because, instead of forming into squads and marching double-file up the gang-plank, we scurried in through a coal-hole doA\n in the bowels of the ship, and T, with my gray suit and black hat, trailed in the rear as pleased as Punch over being allowed to go along, even thougli no one, myself included, had any definite ideas about just what T was going to do. Miss Hnngate's storv jfs it proceeded showed that once mor3 the "one hundred and oneth" was found mingling inconspicu- ously with the "hundred." My chronicle must inchifle a sketch of the welcome we received when we arri\ed at Brest, in August, 1918. At that time Brest was not considered the most attractive place in France, and T am positive tluit it was never slandered. We THE DIETITIAN SERVICE 1407 left the Ship La France in "lighters" and soon had parked our suitcases on the pier, used same lor convenient seats and set- tled down in the drizzle awaiting the appearance of Army trucks to carry us up to Pontanezan Barracks, where we were to be quartered. Our numbers were now 303, as units Xo. 55 and No. 50 were in our convoy. Finally a train of huge trucks put in an appearance and I think that most of us received a real thrill as we bumped along over the cobble- stones to our destination. From every liouse and shop were excited groups of French waving the Tricolor or the Stars and Stripes and shouting a welcome to the American women. We waved our flags and shouted ourselves hoarse in return. By the time we reached Pontanezan Barracks we were all su- premely pleased with ourselves and camped on our suitcases in front of Xapoleon's old headquarters, indifferent to the drizzle overhead and unconscious of the consternation we were causing within the historic old building. But when three hours had elapsed without any disposition being made of us we began to notice that our "dress up" uniforms were becom- ing slightly damp and that mess call would not be unwelcome. Finally a second lieutenant stepped out from headquarters and looked us over: three hundred and three women deject- edly sitting on suitcases awaiting their fate. He did not seem pleased with our appearance, for after an audible "My God ! Three hundred women I" he turned his back and went inside. It seemed tliat we were not expected ; in fact, previous to this time but one group of women had landed at Brest, the other detachments having gone by wa}- of Southampton and Le Havre. ^Moreover, at that particular instant one hundred thousand American troops were wallowing in the Brittany mud and under such circumstances, tlie problem of finding shelter for three hundred women extra was a serious one indeed. But the impossible was accomplished and we were quartered in some partly constructed hospital wards which furnished us with bods and slielter even though they did not provide so necessary a convenience as a water supply for the first twelve hours. Base ITospital Xo. 51 was one of the eight hospitals which coni])rise(l the Justice Hospital group just outside the city of Toiil. . . . Our unit arrived here at three o'clock in the morning of Sept. 11, 1918. The memorable San ^riliiel drive began on the Iv'th and before we had time to get our bearings we were fairly inundated by the stream of patients which poured in almost incessantly for four days and nights. ... I had no time to draw up a jilan. to perfect an organization, or to do anything except the work that crowded me at the 1408 HISTORY OF AMERICAN RED CROSS NURSING moment. I was given a range in one corner of the main kitchen. At first my only helper was a walking patient, a lad who had been gassed and who was notoriously slow both in thought and in action. Later he was reinforced by two French women who gave very good assistance though they were not cooks nor could they understand English. There was one thing that we did accomplish all through this busy time and that was to always have a boiler of hot cocoa or soup available in the receiving ward. The condition of the patients as tliey were admitted was most pitiable, all were hungry and had been without hot food for days. The physicians decreed that tlie hot drink was advisable even for those that went direct to the operating room and for those cases which did not demand immediate surgical attention we supplied bread and jam in addition. Miss Hungate's report also indicated a rather free interp; tation of the prerogatives of a "civilian" employee in the Arm ^- ^re- lian" employee in the Army : On October the sixth I was given two very small rooms on the first floor of the main hospital building for a diet kitchen and with my gassed cook and two French women I moved in. This moving was a verj' simple process, as I was given no utensils lo work with, and it was with difficulty that we borrowed (?) a few necessary articles from the already inade- quate supply of the main kitchen. ... To add to the diffi- culties was the omnipresent lack of water. The French always retained the control of the water supply and the only hours that it could be drawn were from seven to ten in the morning and from three to five in the afternoon. Often the water would be shut off before we had even filled the G. I. cans, which never seemed to hold enough even when full. I added to my meager store of kitchen utensils by making a personal trip to the group supply warehouse and persuading the officer in charge to give me what he had. I had no au- thority for drawing these precious articles, so did not trust them to our own supply sergeant for delivery (lie had too many equally insist'^nt demands for them and would have assuredly divided them among the three other kitchens), so I had them borne to my kitchen on a litter and settled with the Quartermaster later. ^fiss Hungate's story of the Thanksgiving dinner of Base Hospital No. 51 is full of human interest: Tlianksgiving day, 1018. will always be a "red-letter" dav in mv memorv. The war was at last over ; Thanksgiving had THE DIETITIAN SERVICE 1409 attained a new significance. Base Hospital 51 planned to celebrate with food, and every delicacy that would add to our dinner was purchased, regardless of cost. The kitchen forces worked overtime, cooks labored all night in order to insure a quarter-section of pumpkin pie to every patient that could eat same with even a semblance of impunity. The wards took on a most festive appearance as the "up patients" decorated them lavishly with greens, ornaments made from Ilershey wrappers or other bright materials, and the frames that sup- ported those poor wrecks of crippled bodies were festooned like carnival bootiis. But on Thanksgiving eve, we girls received a shock that almost brought tears. A hospital train was due in the early morning and three hundred of our patients were to leave for a port of embarkation. It seemed hard to send those lads away without their feast. Some of them had been in the hospital for weeks and had not grumbled even when the fare was both meager and monotonous. The goody box which the nurses had packed in New York had been set aside for Thanksgiving, and, on hasty consultation, we decided to devote its contents m preparing a treat for those patients. Some of the girls made fudge and the Red Cross provided cigarettes and matches, so when those men lined up for evacuation the next morning the nurses were there with cornucopias of goodies and each patient was sent away with the "bon voyage" of his floor nurse ringing in his ears. The hand of fate seemed mysteriously to evacuate those patients on that particular morning, for by the time that dinner was to be served their number was almost replaced by the raggedest, most forlorn bunch of stragglers I have ever seen. They were for the most part British soldiers, filthy, hungry and footsore. Some had spent four years of hard labor in the salt mines of Metz, and when the Germans gave them their freedom they set forth without rations, proper shoes or transporta- tion. Our hospital sheltered over two hundred of tlicse ex- prisoners, gave them baths, clean clothing and beds, and, l)est of all. was able to share the turkey and goose and pumpkin pic. Had it not been for the timely evacuation of the morning we would have been forced to feed tliem the "corned willie," the hardtack and coffee of an emergency moal. I have never seen a more cosmopolitan gathering seated around a single board than the one which graced the table after the "chow" had been sent out and the kitchen force sat down to its feast. Beside the student from Colgate, who had enlisted in the hos- pital corps in order to drive an ambulance, sat an ex-acrobat from Ringling's. The cooks, ono handsome Italian, one F.ast Side Jew. a \'iri!;inia neiiro and an An<:li)-Sax(in who liad for- 1410 HISTORY OF AMERICAN RED CROSS NURSING merly labored in a Kentucky brewery, occupied the seats of honor. The three "Hinies," prisoners of war, whom we all liked and respected in spite of race prejudice; one Russian, a lad whom we had adopted after his daily pilfer of our garbage cans and who never did learn to savvy the strange tongues which surrounded him; and three volatile, chattering French women. Miss Hiingate quoted a stock query from mess sergeants, with her equally stock responses; also a few other amusing notes are included: "Now, Lady, would you mind explaining to me, just what is a 'dietitian ?' You see, you are the first one of your kind I have ever met, and I would really like to know what you do ?" "Certainly. A dietitian is a 'lady mess sergeant.' The female of the species is more deadly than the male that's why they invited us to come to war."' A mess officer, evidently not speaking under instructions from the chief nurse, said to a dietitian who reported to him for duty : "We have enough 'diet cooks.' Hadn't you rather do nursing on the wards ?" But it is to be assumed that here, again, the function, if not the status, of the dietitian was pre- sented convincingly, in view of the fact that the hearty co- operation of the mess officer was soon accorded to this dietitian in her work. ]\Irs. Thurman, of Base Hospital No. 41, reported : Many funny things happened, but one thing stays in my mind most. I was relieving a nurse in one of the wards, taking care of a patient, a dear boy, just eighteen, who was coming out from under ether. He was making a lot of noise, and I said, "Oh, Earl, do be quiet; just remember the boy next to you, whose back is almost blown away, and he is not scream- ing." He replied, "Yes ! but that's him, and this is me." . . , This from Ruth Shott, of Evacuation Hospital Xo. 19 : One mess officer insisted on serving tripe to all patients because it was cheap and he had purchased an oversupply. And this from ]\Iiss Palmer: There was Aimce, our gay, cheery little French helper, wlio had lost cvervtliing in the war. The bovs all studied French THE DIETITIAN SERVICE 1411 in order to talk with her and wrote out little notes from their French books for her. She promised to go back to America with mo, but she married the mess sergeant and came home with him instead. In passing, a brief quotation from Bertha Baldwin, whose report follows, is respectfully referred to whom it may concern : Just as I was leaving one hospital, the commanding oflicer, in obedience to a general order just gone out from ]Iead- quarters, asked me to assist with the general mess. The mess officer was a doctor, a specialist in nose and throat, but knew nothing about foods and kitchens. The acting mess sergeant was an ex-butcher, and he it was who made out the menus. An account of the work of the dietitians who served directly under the Red Cross overseas would constitute an entire chapter in itself. A formal report of the Diet Kitchen Service was sub- mitted to the Red Cross by Bertha Baldwin,^^ Red Cross dieti- tian; also Miss Baldwin furnished the Bureau at Xational Headquarters with a more personal account of her sixteen months of service. In the interest of brevity excerpts are made in order from these reports : The Diet Kitchen Section was organized in September, 1917, as a part of the Medical and Surgical Division of the Department of ^lilitary Affairs, with ^Iiss Ruth Morgan as chief. The personnel, American Red Cross registered dieti- tians sent from the United States and auxiliary dietitians recruited in France, were attached directly to the section registering with the main Bureau of Personnel. When the Women's Bureau of Hospital Service was established in July. 1918, the Diet Kitchen Section still remained a part of tlie ^Medical and Surgical Division. On August 24th, 1918, in the reorganization of the Ameri- can Rod Cross the Service of Diet Kitchens remained under " Bertlia X. I'aldwin was born in Cloverdale. Cowley County, Kansas. Slic was ench hospitals. The needs of the American hospitals when our Army would be needing their services were arranged for. In December, 1917, trained registered dietitians were cabled for. ... I was the first to be sent over for American Red Cross work, arriving February 19, 1918. I was loaned to the Bien-etre du Blesse to look after the American Red Cross interests, under ^liss Ruth ^lorgan, chief of the diet kitchen section, under Dr. Burlingame. The Bien-etre du Blesse made me chief dietitian to install and organize and supervise all their diet kitchens, to standardize the equipment, the diets, the menus and the reci])es. ... 1 was transferred temporarily to American service American Red Cross Hospital Xo. 101. The men who had volunteered for the trench fever experiment had just been sent out. about 70 in number, and I assisted in the food part of tlie work. . . . The greater part of June and July. I was at American Red Cross ^lilitary Hospital Xo. 3 (Officers), Paris. 1 went over to install and organize a diet kitchen. i)ut took cliargt' of the main kitchen with soldier cooks when the Fr.Mich t'hef and his assistants left, and later was asked by the C. O. to assist the mess ofhcer for tlie general mess in tlic main kitclien. Although the hospital was not a large one. it was overcrowded 1416 HISTORY OF AMERICAN RED CROSS NURSING for the cooking facilities. I was acting chef for a couple of weeks until permanent arrangements could be made. In September, Dr. Burlingame, chief of the Bureau of Hospital Administration of the Medical and Surgical Depart- ment, asked for my assignment as dietitian for the bureau to aid in the food situation in all American Red Cross hospitals. I continued the work I had begun on rations and menus. As this work was entirely organized, it was stopped by the Armistice. Since all work in the military line was practically finished, in February I was assigned to the Social Center of the chil- dren's work in the 19th Arrondissement. The food clinic for the three dispensaries was held there, with food consultations for mothers, and a feeding class for undernourished children, and conferences with mothers and teachers were to be devel- oped. The middle of April the organization of the work was entirely changed and my work finished. At this time a Frenchman, executive secretary of a large society interested in nutrition and hygiene, asked for my services to give lec- tures at the Academy of Medicine on the work of the die- titians at home. The American Red Cross did not feel that this could be arranged, as the bureaus were closing so soon. Miss Baldwin's concluding paragraph is of interest as it expressed the opinion of a woman of broad general training as well as special training in her profession : Dietitians were needed very badly in every American Red Cross department and bureau which had to do with food, as well as in the hospitals. Food was too scarce to waste, and those untrained in food lines cannot appreciate the value and possibilities of foods. If there could liave l)een a Food Bureau which handled and supervised food stuffs for all departments buying, standardizing of recipes, menus, rations, etc., with people trained scientifically and practically, it would have been quite worth while. In the hospitals dietitians are indis- pensable, bec-ause neither soldier cooks nor French chefs (no matter liow good their cooking) can appreciate what sick men need or want. Even in the staff mess for doctors, nurses and men, the dietitian has proved herself invaluable. There were continuous demands from the Army for dietitians. If the American Red Cross could have developed the Dietitian Service, a most vital part of war work would have been reached. THE DIETITIAN SERVICE 1417 Personally 1 have enjoyed immensely my service in France. All my work has been professional, which only a dietitian could have done. Because of that 1 felt as if I were really of use. Sprightly echoes of Miss Baldwin's report may be traced in the following extracts from a letter written by Laura J. Haw- ley ^' to Miss George, under date of September 9, 1918, Paris: I told you of the joyful welcome I received at Red Cross headquarters when 1 arrived because I was to work with the French and how in the twinkling of an eye they mysteriously changed their attitude and asked me to go into a base hos- pital. I was very much disappointed. For that reason, I investi- gated the situation as thoroughly as I could. I spent some time with Miss Baldwin and found out just what she had done. ... to go back a long way the original cable for six dietitians came about in this way : ^Ime. d'Andigne found her work growing rapidly and was unable to get suitable assist- ants. She therefore came to an agreement with the Red Cross by which they supplied the dietitians and a certain amount of equipment, I believe and she supplied the food for the diet kitchens and paid the dietitians. Sliortly afterward she de- cided to use volunteers and a second cable was sent asking for volunteers. There was more or less friction and a good deal of feeling on the part of the Red Cross that ^Ime. d'Andigne's work was too slow in being organized. ^liss Baldwin in the meantime fitted in very liappily. pleasing both factions, though ^liss INIorgan felt things went pretty slowly through no fault of Miss B.'s of course. Then I appeared. ]\liss ^Morgan and Mmc. d'Andigne got together. (Both of these women are exceedingly erratic and altogether chnrming.) The outcome of the interview was that for the time the Red Cross decided to open no more kitchens imdcr tlie Bien-rire du BJes.'^e. ^Ime. d'A. offered to pay me a salary and put me at once at the front in a diet kitclien if I would leave tlie Red Cross, rather if 1 could leave. She was not asking me to leave. She told me she was anxious to have graduate dietitians and could pay them li(>rsolf. "Laura .Tay llawley was l)orn in Salt Lake City. Slio studied at Rockford (Illinois) C'ollopo and at Stout Institute. Menomonie. Wis. She acted as dietitian for the Oirton School at Winnetka. 111. and also for the Conprepational Trainin;:r Scliool. Cliicajio. Her military order states, "Vou will sail April 10, 1918. for service in French military hospitals.'" 14.18 HISTORY OF AMERICAN RED CROSS NURSING Through her wide social acquaintance she has the entree into many French hospitals where the American Red Cross cannot go at all that is why the American Red Cross has co- operated with her. All this sounds very mixed up and is mixed up but so is the whole situation. I was sent to St. Xazaire, where the Army has a regular Army hospital not a Red Cross one. The C. 0. had asked frantically for a Red Cross dietitian and I was loaned. Dr. Burlingame said I could make the job as big as I wanted to, for the proposition was probably the worst in France. All I can say is that / hope it was the worst. Quite unoflficially I'll tell you the sewer was backed up 4 inches in the basement kitchen, where the cooking was done in garbage cans. The food was frightfully prepared. The officers' trays were impossible. Everything is wretchedly slow over here but this is what I have done. I am afraid you will not think it is very much. 1. Built new kitchen for enlisted men's mess (conva- lescent), introducing cafeteria system of service, 2. Had new diet slips printed. 3. Built and equipped diet kitchen and serving rooms. 4. Standardized liquid and soft diets. 5. Invented system for serving soft diets directly from diet kitchen to patients in outlying shacks. (Official report has been made on this to A. E. F. Headquarters as suggestive to other hospitals.) In the meantime I have run the original diet kitchen. I have gone all around France, more or less, seeking sundry necessaries breaking all the rules in the army, but getting away with it. This week T am in Paris seeking a lot of new equipment for our main kitchen. The mess sergeant has been up and found nothing so I am particularly delighted to have located the impossible myself. A British dietitian and a volunteer worker have been offered to me as understudies but I would rather wait a little longer and have an honest to goodness dietitian. This is a stupid letter, sticking to facts. Some day I'll try to write you an interesting one. My address is care American Red Cross, Paris. I don't know of any two dietitians over here doing the same thing. But each problem is unique. 1 have been very thankful to have no rank. I do not like having our uniforms like the nurses' aides absolutely un- professional women. THE DIETITIAN SERVICE 1410 Space permits of no more than a passin^^ notice of the work done bv the dietitians in the Red Cross Imts. Miss Hazen's ^'^ report (juoted below contained tliree interesting^ tonchis: A tribnte to the splendid work of the many practically nntrained ''hut" workers; an evidently innocent contrasting of the atti- ludes of mind of two commanding officers, and an entirely naive statement that the real interest of a dietitian is the feed- ing of the sick: ^[y work in France was rather unique because, while \ had had more theoretical diet work, having taught the three years, and as much practical work as many of the girls, I did less actual diet work than most of the dietitians. The few weeks 1 spent at American Ked Cross Xo. 5 at Auteuil, Paris, was as dietitian. When the hosjjital was closed there I was sent to Vichy to take charge of the kitchen of the IJed Cross recreation hut. . . . The girls in charge were doing splendid work, but they were not accustomed to working with the huge quantities of material necessarily handled, which were almost beyond them, and they welcomed my arrival. At that time we were serving cocoa in the afternoon between one-thirty aiul three; the time had to be limited because there were such swarms of boys that the line often reached clear through the ball aiul down the street for a block. Xot only did we serve the I'ocoa in the but, but at the sug- gestion of Colonel \Vel)b. the connnanding officer of the center, cocoa and sandwiches were served to every boy after be came from his bath. This was done because so nuiny of them seemed weak and hungry following the bath. At that time we were serving from !M) to I'iO gallons of cocoa a day and from 1"200 to ISOO enormous sandwiches. I did none of the serving but simply had charge of the kitchen. After Christmas as tlu^ work grew easier, we started the making of special delicacies to >r\\i] into tlu' lios]utals. In working in the hospital I bad found ibc hoys craving the little sjiecial tilings such as they bad liad at Iionic With the consent of the colonel a system was workcil out wlicrchv wc t-ould dis- " Gertnuk' Ilazcn was tiorii in Chctopa. Kansas. Slic stu(]ic<] at IJaker I'niversity. lialdwiii. Kansas, and at tlic ('arn('j.'i(' Institute of 'rcciinoloj^y at I'ittshiirfih. T.atiT slic ri'Ci'ivfd the dcLTt'c df Master of Arts at tiie I'niversity of Kansas. She was an instnictnr in lidiiie ecdndniics in the Abilene. Kansas. Ilij,'h School, also in the Howard I'ayiie .liiiiior ('ol!ee liotli for our own few cases, and in fact my line dl actixity is neral, Base and Port of Embarkation Hospitals, Department Surgeons and Camp Surgeons, Certain Post Hospitals, Surgeons, Independent Posts, Air Service: THE DIETITIAN SERVICE 1423 1. A consideration of the duties and status of dietitians in a number of military hospitals indicates the necessity for a general statement defining rather exactly the dietitian's place and duties. It is realized that any such general statement will be subject to modification when applied to individual hospitals. 2. RELATIOy OF DIETITIAN TO HOSPITAL STAFF. The dietitian is responsible as far as her professional work is concerned to the commanding oflicer of the hospital. As assistant to the mess officer, she cooperates with him and the chief nurse. The chief nurse of the hospital will send in a separate efficiency report of dietitians, monthly, basing this report not only on her own observations, but on those of the mess officer as well. Socially, the status of the dietitian should be that of nurses, and in matters of conduct she is under the authority of the chief nurse. 3. STATUS. The dietitian is a civil employee of the ^ledical Depart- ment, but to place a competent dietitian on the same basis with cooks and maids is an injustice to her and a disadvan- tage to the hospital in which she is working. Dietitians designated as head dietitians receive an additional $5.00 per month. Dietitians performing the duties of head dietitians but not so designated should be recommended for such appointment. 4. DUTIES. (a) Of the head dietitian. Reports to the chief nurse, or ward surgeon, deficiencies of service found in wards in order that these may be corrected through ])roper channels. Reports deficiencies of preparation and service found in tlie mess hall and kitchens, to the mess officer. Inspects serving of food in all the wards and has the responsibility of seeing that it is properly prepared. Super- vises and assigns the work of her assistants. Is responsible for the planning of all patients' menus but confers with moss officer concerning market conditions before approving menus. (b) Of the dietitian. Have immediate supervision of the preparation of food in the general patients' mess, sick officers' mess and nurses' mess (if desired by commanding officer). They also have charge of the filling of the food carts. Have immediate supervision of general diet kitchen. Plan menus (these to be approvtMJ. however, before use by the head dietitian). Have direct re- 1424 HISTORY OF AMERICAN RED CROSS NURSING sponsibility for the preparation of diets and should be sup- plied with sufficient help to relieve them of the details of this preparation. Visit wards to confer with ward surgeons, nurses and in suitable cases with patients regarding special diets. 5. EQUIPMENT. The head dietitian should have an office provided with a desk, the office to be located in a quiet place near the mess department or diet kitchen. G. The value of the dietitian to the hospital is largely de- termined by the degree to which cooperative relations are es- tablished. Conferences at regular intervals, in which the commanding officer meets with the head dietitian, chief nurse and mess officer, are recommended. By direction of the Surgeon General : C. K. Darnall, Colonel Medical Corps, U. S. A. Executive Officer. In June, 1919, the United States Public Health Service issued Bureau Circular Letter No. 173 to the "Medical Officer in Charge, United States Marine and Public Health Service Hos- pitals," in regard to dietitians' service. The instructions and specifications contained in this circular are practically identical with those issued by the office of the Surgeon General, but a few rather interesting variations are noted under their special head- ings (the italics are the author's) : BeJation of Dietitian to Hospital Staff. . . . She is expected to work in coordination vrith sucli other officials including the chief nurse as may be designated by the officer in charge. The effi'ciency of the dietitian's ser- vices will be determined from reports of ward surgeons who are directly responsible for the prescribing of diets. The chief nurse will also render a monthly statement of the efficiency of the service of foods. The dietitian has social status equal to that of the chief nurse, but subject at all times to such regulations and restrictions as may be in force governing all nurses in the service of the hospital. 2. Status. Tlie dietitia]) is a civil scientific employee of the bureau, and is not to he placed on the same basis with cooks and maids. To do so is an injustice to her and a disadvantage to tlie hospital. . . . THE DIETITIAN SERVICE 1425 While perhaps few persons could have been found sordid enough to have desired the prolongation of the war, the fact re- mains that the sudden termination of actual hostilities came as a distinct shock to numbers of persons engaged in absorbing war activities, and cherishing ecpiallj absorbing plans for future accomplishment. The vicissitudes of the dietitians offer a case in point. Since the earlier months of the war. Miss Thompson had felt the need for a supervising dietitian to care for the business of the service in the office of the Surgeon General. No funds being available for the salary, she at last hit upon the plan of placing such a person upon the pay-roll as a clerk in the Army Nurse Corps. Miss Cooper, who had volunteered for the service, was appointed by Miss Thompson, but only in time to take the oath of office on the day of the signing of the Armistice, a little late to bring much in the way of aid and encouragement to the dietitians in the overseas service. The method of the appointment was a makeshift, but it indi- cated a willingness on the part of ^liss Thompson to see the affairs of the Dietitian Service directed by a person of that pro- fession. The duties assigned to ^liss Cooper included the gen- eral supervision of the work of all dietitians, responsibility for the recruiting, assigimient, transfer and discipline. In the course of her work ^liss Cooper inspected the dietary depart- ments of thirty Army hospitals. The portion of Miss Cooper's report which was published in the Report of the Surgeon Gen- eral, U. S. Army, to the Secretary of War, 1919, Vol. 11, Page 1127 is given below: The Dietitian Service although a comparatively new branch of the Medical Department has grown considerably in size and importance since the beginning of the war, at wliich time there were no dietitians- attacbefl to army hospitals. At the close of the fiscal year, June 30, 1918, there were KJl die- titians in the service. At the time of the siirning of the Armistice. November 11, 1918, there were ^o*') dietitians. Of this number 84 served overseas; the remaining 272 were dis- tributed among 97 base, general and ])()st hospitals of the United States. Since the signing of tlie Armistice the num- bers have been gradually decreased, lltl having been dis- charged or are under orders to proceed to their homes for dis- charge from the service. Tliere arc still "iS overseas or en route t(j this country. There are 1 13 still in this country and Hawaii, distril)uted among i')'2 liospitals. Nine (9) new ap- ])ointments have been made to fill vacancies. 1426 HISTORY OF AMERICAN RED CROSS NURSING Early in Xovember, 1918, a supervising dietitian was ap- pointed and assigned to duty in the Surgeon General's office. The increasing demand on the part of hospitals for addi- tional dietitians and complimentary verbal reports from com- manding officers are evidences of the popularity of this branch of the service. Some of the larger hospitals have had as many as ten dietitians. During the epidemic of influenza the die- titians proved themselves of inestimable value in organizing forces for the feeding of the sick and well. Three dietitians lost their lives during the epidemic and several others were seriously ill from it. It seems unfortunate that these profes- sional women, who worked side by side with nurses, doctors and enlisted men, should not have the privilege of War Risk Insurance. The value of food and nutrition for both sick and well has come to be recognized as such an important factor in army life that it is believed that the dietitians have come to be a permanent factor in all well regulated Army hospitals as well as civilian hospitals. Unfortunately for the development of the office, Miss Cooper's leave of absence from her work in the Battle Creek School of Home Economics could not be extended and she relinquished her position in the Surgeon General's office in July, 1919. To suc- ceed Miss Cooper it was not easy to find a dietitian possessed of the degree of training, discrimination and executive ability which the situation demanded, and who would be willing to accept the position, or who could be spared from whatever position she might be filling. However, previous to her de- parture, Miss Cooper had written to Josephine Happer, a grad- uate of the University of Illinois, who was then dietitian at Jefferson Barracks, asking her to undertake the work. This Miss Happer consented to do, but was transferred to Walter Bced Hospital, presumably for the reason that the budgets of all the departments were being reduced to such an extent that the Army Xurse Corps no longer had sufficient funds to allow for the salary of a supervising dietitian. She remained on the pay-roll at Walter Reed Hospital but was sent to the Surgeon General's office on temporary duty. From this time on the office became an empty title. In reporting her experience Miss Happer wrote : 'S\\ duties while at the Surgeon General's office were chiefly the transferring of dietitians from one hospital to another. THE DIETITIAN SERVICE 1427 keppinfj records, answoririfj letters from dietitians, in fact all letters concerning dietitians. Dnrinj; the time 1 worked in the Snr^eon General's ofhce I worked at Walter Heed for two weeks when a numher of the dietitians were sick. Most of the work was done under the supervision of Major Stimson, or of some of her assistants. With the passing out of tho rule permitting fiold cmployeos to occupy a bureau or office position, ]Miss llapper was transferred to Camp Dix in the early part of February, 1020, and ^fajor Stimson took over the work of the office. The following letter from Major Stimson to ^liss Cooper, under date of February 10, 1920, is self-explanatory as to subject matter, but in passing it might be said that possibly any dietitian with sufficient train- ing and experience to make her acceptable to the profession would have hesitated to accept as predetermined a position as the one here suggested. ^lajor Stimson wrote : It is not at all my desire to take over tho Dietitian Ser- vice, but for the time being it is necessary for me to do so. I have been searching diligently for some accredited, graduate dietitian who is also a graduate nurse, into whose hands I can put the Dietitian Service. Such a person could be appointed into the Army Xurse Corps, and there would be no dilficulty about the payment of her salary. Such in brief is the story of the supervising dietitian under the Army Xurse (^orps. To say that it was here an empty name is not to criticize the Xurse Corps as s\u*h. A similar maladjust- ment would have persisted had the dietitians l)een placed under any alien service. The problem of suitable food for the army extended beyond the hospital and the dietitians should have been included in and answerable to the general Food and X'utrition Division of the military organization. Detinite recognition of the work of the dietitians came to them in various ways. I'he bestowing of decorations by the 1 British (loveniment upon five of tliose who served with the British Kxjx'ditionary Forces has already been nuMitioned. That the American Kxpeditionary Forces had approval, if not "decorations,'" to offer was related by Miss llungate in the concluding paragrajth of her report: In July, inin, 1 found nivsolf fiiir of all the remaining iliotitiaiis nf tlic A. K. V., on Ijoard tiie I niprnilor and bound 1428 HISTORY OF AMERICAN RED CROSS NURSING for home. Of course we exchanged experiences and found no two had faced parallel conditions. We had all gotten so far from our training, from our ideal of a dietitian and her work, that most of im were inclined to be disappointed in our results. A brigadier general who was a fellow passenger did much to hearten us and reestablish our morale. He wanted to per- sonally meet and thank some dietitians for their good work. He said that his only experience in an Army hospital, some years before the war, had branded them in his consciousness as places of badly selected food, poorly prepared, and utterly unfit for the sick. To his surprise, when he became a patient in an A. E. F. hospital he was served- trays of palatable, well chosen food, and upon inquiry, learned that a college trained dietitian was responsible. He was so enthusiastic over our work that he thought it should not be confined to hospitals alone, but should be extended to the feeding of the entire Army, where cooks and mess sergeants could be given train- ing and supervision in the preparation of food and the bal- ancing of menus. And Major Hoskins, who visited nearly every camp and cantonment hospital in this country, had this to say: . When the dietitians first came into the Army, they encoun- tered many difficulties incident to the introduction of women into what had previously been in the military experience a strictly masculine pursuit. I have much admiration for the skill with which they met these tactical difficulties, and the valuable service they rendered to the army. !More to be appreciated than any of the foregoing was the approval voiced by Surgeon General Ireland when he stated ^' that the dietitians had proved themselves of such value to the Army that the organization of an Army general hospital staff which did not include them could scarcely be contemplated any more than one which did not include nurses. Tlio home work of the Xnrsing Service and with it the Dietitian Service paralleled tlie work abroad throughout the war period. In March, liHS. the Bureau of Instruction was divided into a Bureau of Instruction and Nurses' Aides and a "Testimonial ofTcrrd by tlie Surfroon Ooneral at a special meeting of the Xatioiiai Committee on Red Cross Nursing Service called at Red Cross Headquarters. January fl, ir_2. to consider a proposal to eliminate the Nutrition Service oi tiie Red Cross. THE DIETITIAN SERVICE 1429 Bureau of Dietitian Service. Miss George assumed responsi- bility for the latter under the guidance of the Committee on Dietitian Service. At this time the United States faced the possibility of several years of war. The course in Home Dietetics was sup- plemented in June, 1918, by the publication of a manual on "Kmeriicncy Cooking for Large Groups of People," a pamphlet intended ''as a guide for instruction in cooking for large groups of people in emergencies, such as fires, floods, the movement of troops, etc., which Ked Cross Chapters are frequently called upon to meet." Several months later material for a course in "War Diet in the Home" was issued. Instruction in Home Dietetics, as in Home Hygiene and Care of the Sick, was first carried on entirely by National Headquarters dealing directly with the local organizations giving the courses. But following the decentralization in March, 1918, Division Directors of Xursing were made responsible for all details pertaining to these classes. The plan was, however, to appoint special direc- tors of this service under the nursing service in each Division, and during the year following directors were appointed in the Atlantic Division and in the Central Division. The appoint- ment of instructors continued to be made from Xational Head- quarters. As has been shown earlier in this chapter, the original course in Home Dietetics was planned to ''give in a simple way the underlying principles of cookery," but this was soon found to be inadequate to the needs of the time. The limitations and restrictions of the food supply were putting upon the people the task of making substitutions for this or that food material which chanced to be at the time either unol)tainablc or needed for the fighting forces. The hardships consecineiit to the use of unaccustomed foods was found to be more than a (piostion of f(u-egoing one's preferences. As a matter of fact, certain ''sub- stitutes," so called, were in many cases not snl)stitutes, no matter in wliat form they were served. It IxH-anic evident that a knowledge of what f ability to prepare^ food well. The home economics workers of the country had been modifying their teaching to make it consistent with results of observations being made in the nutrition laboratories of the country, and the ni'cd for a revision of the lied Cross course in Hume Die- 14,30 HISTORY OF AMERICAN RED CROSS NURSING tetics became apparent. Accordingly, in the spring of 1918, Mabel Wellman, Head of the Department of Home Economics of the University of Indiana, was asked by the bureau to prepare a course which should be based upon the principles underlying the selection of adequate food and emphasize the importance of these as compared with mere skill in food preparation. While Miss Wellman prepared the bulk of the course, Dr. Dorothy Reed Mendenhall, of the University of Wisconsin, furnished the material for the lessons on infant feeding and food for the child, and Caroline Hunt, of the U. S. Department of Agriculture, States Relations Service, wrote the chapter on "Calculation of the Dietary." As rapidly as this material could be gotten in shape it was sent out to the classes by the bureau in typewritten form pending the time when the lessons could be unified and printed as a textbook. Unfortunately for the class work in Home Dietetics the work of preparing the new course of lessons was retarded through pressure of other obligations which seemed of more importance at the time. In January, 1919, Miss George wrote Miss Delano, who was then in Paris: We have gone very slowly with the Home Dietetics plans. ... So many of our very good committees on dietitians are elusive these days; they all seem to have an enormous lot to do under any number of different organizations. The workers in the field were not slow in seeing that a new impetus had been given to the whole subject of food and nutri- tion and that the Red Cross was faced by an added responsi- bility concerning it. In a letter to ]\Iiss George, ^liss Sells, director of Dietitian Service of the Atlantic Division, said : Home Dietetics has no popularity because the available instructors have tried to teach according to the textbook. A little later ]Mrs. Mehlig, director of the service for the Central Division, wrote: In one case the texture of the custard interested the teacher more than its use in the diet, its digestibility or its composi- tion. There has been so much criticism of our text that 1 feel the need for holding our instructors up to a very higli standard. THE DIETITIAN SERVICE 1431 She added: Miss Marlett, of Wisconsin, writes me that the Red Cross course will have to he sufficiently worth while, before the Ex- tension teachers will be warranted in teaching it. In August, Lettie G. Welch, director of the Nursing Service of the Mountain Division, wrote to National Headquarters: It is very gratifying to know that a complete change of plan for Home Dietetics instruction has been made. I trust that the revised plan proves more feasible than the previous one. . . . It is my desire to assist in this activity to the fullest extent possible. The widening scope of the Dietitian Service was suggested by Miss George, in a letter to Miss Noycs, requesting authoriza- tion to represent the Red Cross at the meeting of the American Home Economics Association to be held in Blue Ridge, North Carolina, in June, 1919: It is desirable to present to the American Home Economics Association the revised Red Cross course in Home Dietetics. Several members of the Committee on Dietitians will be pres- ent, and will present the matter and lead in discussions that may arise. A rough draft of the outlines is being prepared by the Department of Agriculture in cooperation with the Red Cross which will be ready by June 2Gth. Another object in having a Red Cross representative at the meeting is to arrange for cooperation with tlie Home Demonstration agents through the States Relations repre- sentatives who will bo present, in organizing Red Cross classes. It will also be pertinent to the establishment of tliis edu- cational work in the Soutli to confer witli the large representa- tion of household economics people from the Southern states who will be present. In granting the authorization requested Miss Noves said: r shall be very glad, indeed, to have you attend the conven- tion which meets at Blue Ridge, X. C.. and U\A sure that it will be greatly to the advantage of the Dietitian Service of the Red Cross. On July ir>, 1919, ]\[iss George resigned her position as director of the Bureau of Dietitian Service; ^larszarct 1432 HISTORY OF AMERICAN RED CROSS NURSING Sawyer, a graduate of the University of Illinois, succeeded her at National Headquarters. The year following her graduation Miss Sawyer studied at Cornell Medical School and llussell Sage Institute of Pathology in New York City. Following this she was made instructor of applied nutrition in the State University of Iowa, where she remained for three years. Because of the service she was able to render when the medical staff of the University was depleted by war time demands, Miss Sawyer was not called into active war service until it was decided to make some test observations upon the diet of aviators. In October, 1918, she was ordered to report for duty at Ellington Field, Houston, Texas, but she was shortly transferred to Rockwell Field, San Diego, Cali- fornia. Later she was assigned to Walter Reed Hospital on detached duty, remaining there until July, 1919, when she was made director of the Bureau of Dietitian Service. Because of Miss Sawyer's special training and interest in the subject of applied nutrition the date which saw her assumption of the position would seem to constitute a natural dividing point between the work which the bureau found at hand during the war and which ]\riss George had so faithfully directed, and the new field which was opening up before it. With the prospect of being able to place a director of the service in each of the Divisions, the need for the very large Committee on Dietitian Service was no longer apparent. At a meeting held in Cincinnati on September 11, 1019, the Com- mittee on Red Cross Dietitian Service made the following recommendations to the National Committee on Red Cross Nursing Service : I. That the present committee of nineteen members be re- duced to five members. II. That the national director of the Bureau of Dietitian Service act as the secretary of the National Committee on Red Cross Dietitian Service. III. That a director of the Bureau of Dietitian Service be placed in each of the Division offices. IV. That the memhers of the committee be Dr. l?uth Wheeler, head of Department of Home Economics, Goucher Colle<:e, Baltimore, ^Id. ; ]\Iiss Kdna N. White, head of De- partment of Home Economics, Ohio State University, Colum- hus, Ohio; ]\Iiss Lena F. Cooper, director, School of Home f]conomics, Battle Creek Sanitarium. Battle Crock, Michifran; ]\Iiss Elva A. George, former director of tlie Bed Cross THE DIETITIAN SERVICE 1433 Bureau of Dietitian Service, and Miss Margaret Sawyer, present director, Bureau of Dietitian Service. By unanimous vote, Dr. Wheeler was elected chairman of the National Connnittce on Kcd Cross Dietitian Service. At a meeting of the Xational Committee on Red Cross Xursing Service at Washington, D. C, December 9, 1919, these recommendations were approved. At this same meeting the chairman announced that the text- book on dietetics would be discontinued and a new course, of a lesson plan type, which was then under preparation, would be used. Also, it was moved by Miss Palmer that the director of tlie Department of Xursing further investigate the privileges to which nurses were entitled in the War Risk Insurance and report back to the Advisory Committee. ^Irs. Higbee moved to amend by inserting "and dietitians" after luirscs. The motion as amended was carried. The secretary of the Committee on Dietitian Service ex- pressed a wish that the name of the bureau be changed. It was decided that this be referred back to the director of the Depart- ment of Nursing and the secretary of the Committee on Dieti- tian Service for adjustment. (The change of name to Bureau of Nutrition Service was noted in the Annual lieport, June 30, 1920.) Although the impetus which the war had given this bureau had been very considerable, each month of the transitional period of 1919-1920 marked a further demand for development in the field of nutrition. At a later meeting of the National (V)nnnittee on Red (^'ross Nursing Service held April 14, 112(>, in Athinta, Georgia, a very interesting and extensive program was reconnnended by the Committee on Dietitians and was in nart as follows : Tlie qualifications for enrollment in the Dietitian Service of tlu' American Ked Cross sliall he graduation from an ac- credited school of home economics. . . , All courses shall he given hy enrolled IJed Cross dietitian instructors. State Connnittoes on Ked Cross Dietitian Service shall he fonneil in each state. . . . Tlie organization of the National and State ( 'dinniitlt'es on IJeil Cross Dietitian Service shall he woi'ked uut hv the 1434 HISTORY OF AMERICAN RED CROSS NURSING director, Department of Nursing and the director, Bureau of Dietitian Service, and shall include the following points: A. The National Committee on Eed Cross Dietitian Service, 1. The National Committee on Red Cross Dietitian Ser- vice shall he composed of five members, three of whom shall be nominated by the American Home Economics Association and two by the American Dietetic Association. 2. The members of the National Committee on Eed Cross Dietitian Service shall be members of the National Commit- tee on Eed Cross Nursing Service. 3. All members shall be enrolled Eed Cross dietitians. 4. A quorum of this committee shall consist of three mem- bers. The method of appointment of members of the State Com- mittee on Red Cross Dietitian Service, their qualifications and the functions of these committees were also outlined. It was also recommended that the program of the Dietitian Service showing activities already undertaken and the sug- gested extension be worked out by the Department of Nursing. ''Any one nutrition center," the report continued, "may include all or part of the following adaptations." I. A center where nutrition clinics for children who are suffering from malnutrition may be held. These children are followed into their homes where the mothers are given instruc- tion and help. II. A center to which any individual or agency may refer its nutrition problems. III. A center where food for the sick may be prepared and distributed upon request from any agency, physician, dispen- sary, hospital, or public liealth nurse, and wliere individuals may be sent for instruction in the preparation of food for special diseases. ]\riss Sawyer presented the report to the National Committee. It was moved by jMiss Gladwin that the recommendations made ill the report as read be incorporated in the material to be pre- pared by the chairman and later referred to the members of the National (Jominitteo on Ked Cross Nursing Service. This was carried. The chairman explained that it would be neces- sarv to include the five members of the Committee on lied Cross THE DIETITIAN SERVICE 1435 Dietitian Service in the National Committee on Red Cross Nursing Service. The report of the Bureau of Dietitian Service for the year ending June 30, 1920, told its own story: The fiscal year may be considered the transitional year in the development of the Bureau of Dietitian Service. The responsibilities assumed during the war necessarily had to be continued and at the same time a definite, constructive, work- able program had to be developed in harmony with the gen- eral peace program. As the Army had no supervising dietitian since January 1, 19*^0, this bureau has acted as a recruiting agency for the Army as well as for the Navy and United States Public Health Service. It has also acted in an advisory capacity to the dietitians being discharged from the service and has been the means of putting many of them in touch with openings, as well as aiding many liospitals in securing dietitians. The Bureau of Dietitian Service has 2,387 enrolled dieti- tians. These women are all trained in home economics. Forty-four members were enrolled during the fiscal year, 14 as hospital dietitians and 30 as instructors in Food Selection, making a total enrollment of 509 hospital dietitians and 1.8T8 instructors. The supplying of dietitians to the Army, Xavy and United States Public Health Service hospitals and the extension of its course in Home Dietetics were the main activities of this bureau on July 1, 1919. In developing the health program of the American Ked Cross it soon became apparent that the activities in the field of nutrition would have to t)e exteiuled to meet the health needs of the communities. This concej)- tion necessitated the complete reorganization of the bureau and its activities. A definite policy of cooperation was worked out with the States Kelations Service of the Department of Agriculture and in each of the four Divisions in which a director of the bureau has been placed, a definite plan of cooperation has been efTected with each State Extension Service. It was decided that the most elfective contribution this bureau could make to the health program was tlie develoj)- ment of nutrition classes for undernourished children, the establishment of hot school lunclics. and t!ie extension of its course in Food Selection. Special nutrition classes for undernourished children \ven> carried on in Red Cross Chapters under the li^adersliip of nutrition experts. The nutrition worker organized and cuii- 1436 HISTORY OF AMERICAN RED CROSS NURSING ducted these classes, followed the children into their homes, where she assisted the mother in solving the food problems relative to the diet of the entire family, and also cooperated with the social worker and the public health nurse in special cases wherein they needed advice and assistance. Three nu- trition centers were established during the fiscal year, while 138 nutrition clinics were conducted in the Atlantic and Southern Divisions. Because the development of nutrition classes for under- nourished children promises to be the most important activity of the bureau and because there is great need of standardizing the conduct of them, a plan whereby there will be at least one center in each Division for the training of nutrition workers has been begun. An effort is being made to establish these centers in cooperation with a Department of Home Economics. Such a cooperative plan is being worked out between Teach- ers College and the Xew York County Chapter, and Peabody College and the Nashville Chapter. The course in Food Selection, replacing the former course in Home Dietetics, comprises a study of foods and the factors which determine the selection of an adequate diet for the family. During the fiscal year, 162 classes were held and 1,497 students certified in this course. The Bureau of Dietitian Service stimulated an interest in hot school lunches and assisted in their establishment through Chapter Committees on Xursing Activities, or the Chapter School Committee of the Junior Eed Cross in coun- ties not served by a Home Demonstration agent, and in locali- ties where the request came from the Extension Service. The administrative work of the bureau had demanded almost the entire attention of the director and the need for assistance became apparent. In jS^ovember, 1920, Anna R. Van ^Meter, a graduate of the University of Illinois, and for several years a member of its faculty, also later professor of Home Eco- nomics at Ohio State University, was made assistant director of the bureau, ^fiss Van dieter's first work after coming to National Headquarters was the making of necessary revisions in the lessons in Food Selection. Within a few months the long-promised textbook was published and ready for distri- bution. During the months following the sudden contraction in war activities the Red Cross passed through many transitional and teiitiitive phases in matters of organization and administration, THE DIETITIAN SERVICE 1437 and the Nutrition Service had its full share of these experi- ences. A special meeting of the nutrition members of the National Committee was called for August 17, 1920. Miss Noyes, chair- man, Miss Edna White, Miss Kuth Wheeler, ^Miss Elva A. George and ^liss [Margaret Sawyer were present. The chairman explained that the meeting had been called to discuss the transfer of the Nutrition Service from the Nursing to the Health Service, according to a proposal made to Dr. Farrand by Mr. Munroe and Dr. Peterson, director of Health Service. She stated that inasmuch as the program of the service had changed with the development of the health program of the Red Cross she felt willing to see the service developed on an independent basis, particularly as a profession other than the nursing profession was involved ; but she saw no reason for it to be changed from its present position and placed under medical direction in Health Service, and she felt that no good argument had been offered to convince her of the advantages of such a change. She stated further, however, that if the Nutri- tional Committee agreed that such a change seemed desirable, she would offer no further objection. The members of the committee expressed themselves as in harmony in general with ^liss Noyes' point of view. Miss Sawyer stated that she thought that a service which recruited its personnel from a distinct professional group should not be administered under any different group, and for that reason recommended that the Nntritiou Service be made an independent service. However, if the Health Service were made to include all of the health activities of the Ived Cross, nutrition, as one of the activities, would necessarily have to be included. The meeting then adjourned to ]Mr. Munroe's office. ^Ir. Munroe stated that he felt that it was an administrative matter and that for such reasons he wished to sec the transfer of Uie Nutrition Service to the Health Service. The Nutrition Committee expressed their desin^ to see an independent service but finally agreed to accept the decision of the general manacer that nutritional work should b(> transferred to the Health Service, Notwithstanding the apparent finality of ^Ir. ^Munroe's ruling, no formal steps were taken to effect thi^ transfer and the matter was lost sight of following the appointment by Dr. 1438 HISTORY OF AMERICAN RED CROSS NURSING Farrand of a committee (later known as "The Chairman's Committee of Inquiry") to conduct a study of the entire Red Cross organization. The results of the findings of this com- mittee in so far as they affected the Nutrition Service were shown by the following excerpts from the committee's report submitted January 12, 1921 : Nutrition Service: Nutrition Service should have distinc- tive recognition as a part of the program and should include : A. Development at National Headquarters of general poli- cies and national contacts and, in each division,- of state con- tacts, with assistance to the chapters in developing their local contacts. B. Information and advice for the benefit of personnel in each division and of executive secretaries and paid workers as well as officers and volunteers in the chapters, concerning nu- trition service and ways of enlisting and using trained local volunteer personnel in this service. C. Development of a suitable text for classes in Food Se- lection and of a procedure for organizing and conducting such classes. D. Arrangements for enrollment and training of .workers in nutrition service who will be available for employment by Army and Navy and other government hospitals and by chap- ter committees and civilian hospitals. The Minutes of the meeting of the Central Committee, Jan- uary 29, 1921 (page 1821), included the following: VOTED : That the Central Committee approves in general the report of tlie Chairman's Special Committee of Inquiry, more particularly the fundamental change from a depart- mental organization to a line and staff organization, etc. . . . and that it is the hope of the Central Committee that the transformation can be completed by July 1, 1921. The Aimual Ivoport of the Rod Cross Nutrition Service for the year ended -Juno 30, 1921, told the remainder of the story, in so far as it is connected with this history, and was in itself both a recapitulation and a forecast of the Red Cross Nutrition Service. Nutrition Service operated as the Bureau of Nutrition Service in the Department of Nursing until the general re- THE DIETITIAN SERVICE 1439 organization plan of the American Red Cross went into effect, April 1, 1!)21. Since then it has operated as a separate ser- vice. It lias continued the work of enrolling women trained in home economics to act as dietitians in hospitals of the Army, Navy and United States Public Health Service, or as in- structors in the course in Food Selection. The standards for enrollment are being raised through a more critical considera- tion of the qualiilcations of each candidate than was possible under the pressure of war conditions. Twenty-two hospital dietitians and 101 instructors were enrolled during the year. The total enrollment at the end of thefiscal year was 2,514. The line of activities of the service determined upon last year in conformity with the general plan of permanent opera- tions of the American Ked Cross has been continued. Co- operation with the States Eelations Service of the United States Department of Agriculture has been strengthened, and in those divisions in which the service has a director the work in cooperating with ihe State Extension Service is progress- ing satisfactorily. The prevalence of malnutrition among children of the na- tion, rich and poor alike, as shown by inspections made by physicians, is a menace to the health of the nation and as such constitutes an emergency which calls for help from the Red Cross. Such aid is being given by the Xutrition Service as rapidly as its resources will allow, along the following lines: 1. Nutrition classes for undernourished children. In schools in cooj}eration witli the school physician and the school nurse. In community centers allied with social organizations. In cooperation with Home Demonstration agents. In cooperation with the Public Health Service. Reports for the year show 1,114 nutrition classes conducted with an enrollment of 2"^,0i)() children. Four thousand, i^eyen hundred and thirty-two visits were made to the homes of these children. A training center, to give tlie nutrition specialist the tech- nique for the conduct of nutrition classes, is now in operation in New York City through the coo])eration of Teachers' Col- lege, Columbia University, and the New York County Chapter. A similar training course of six weeks was begun in June at the State University of Iowa, the Department of Home Eco- nomics and the University College of Me(licine co()))erating with the special instructor in nutrition from the Red Cross. Several other universities have shown great interest in this j)lan and have asked that they be allowed to establish similar relations with the Red Cross. 1440 HISTORY OF AMERICAN RED CROSS NURSING 2. Classes in Food Selection. Organized among the mothers of children in nu- trition classes. Organized among other groups as an independent Chapter activity. Organized in cooperation with Home Demonstration agents. These classes are conducted by instructors selected from the list of enrolled dietitians. The textbook, "The Red Cross Course in Food Selection," has been revised and published recently. During the year reports were received from 163 classes in Food Selection and 1,587 certificates were issued. 3. Hot lunches for school. Nutrition Service has worked in cooperation with the Junior Red Cross Service and with the Home Demonstration agents and teachers in stimulating an interest in providing hot lunches in schools. Two hundred and twenty-seven such activities were reported. 4. Nutrition training courses for Red Cross personnel. In the special training courses for Chapter executive secre- taries, which are being developed by a number of educational institutions in cooperation with the Red Cross, ' varying amounts and phases of home economics are included, depend- ing entirely upon the point of view and experience of tlie in- structors. In some cases the material included has been ade- quate, in others not. To meet this situation the Nutrition Service is preparing a suggestive outline of material to be included in the training course for Red Cross secretaries and field representatives. Inasmuch as most of the Cliapter Executive Secretaries and Puldic Health Nurses receive their field training in urban communities, rather than in rural, it is the desire of the Xu- trition Service to plan a course which will deal witli the prob- lems of the rural liome in distinction from those of the city home. In concluding this chapter it may be said that history defines its own limits both as to suljject matter and emphasis, and it has in this case claimed the greater space for the war work of the dietitians. But with tills part of the story ended, the major interest of the Nutrition Service is seen to hark back to the original idea of education. Not a spectacular service to be sure this slow and painstaking work of lielping established agencies in tlicir THE DIETITIAN SERVICE 1441 none too easy task of readjusting their programs to meet the demonstrated need for more rational and consistent education in regard to adequate food. Nevertheless, it has been a service which has embodied to a high degree the spirit of the Red Cross, which impels to the lending of aid wherever needed. APPENDIX ^^ so B tj o to .iiH5 m; aj O;- S EC d I" IS o i e CS o 5J " ^" 5K c 2 0) W oj^>- OS '-3 * is s a ^J3 O I/} W < <^ i< 1^. .2 J t |[?-2 CD 3 J- OSS'" Q <-. ^, r-, J W K I ;2 S t> ^ CO CO 1^ ?? S ^ H ^" : o fc <; 1-5 05 1 o '-' I d r^ LT? H O s: ~ S ^>> O O o CO s ^'*> o o O o . "3 >* ^ ^ y ^ T? "x -ij C 1; U o a > W X ;^ >* y^'A > Ji o 25 ^ "-^ "* s o "" u "3 CS 'r! y-. *^ - ^ ."ti x 'J ^ X ^ _^ O i; '^ ii ^ ^ 2-? -5^ i 5 i5 ;s ^ X o '^ X ^ O i- ^' _- t. ^ _ - . M ec 'J' L-; :c 1^ X OS o ' !M c: rt 1443 1444 APPENDIX bo 0)0 c ? as O ;a2 ^ MfS fe- es 5 3 DQ S b -*^ -tJ ^ K-; S fi< fe S ti^ 3 ^ -It; .si "00 "a! pC3 .5 OC 03 Clara IV No chie Elizabet Carolyn Alice F Ruth I. Grace P Elizabet Helene -a ll ID CO C -^ 3 3 ,^S^^ O 3 W O) c 5 ^ 3 3 ?^ S = a> 3 -^ 3 K -g ^ i-! APPENDIX 1445 P2 5 < Kate Liddle Rachel Ben ham Alice Claude Mabel Peters Josephine Gillies Augusta Morse Mrs. Annie Humphrey Lora Roser Elizabeth Swingle Sara Mansell Jane Powers Mrs. Anna Allen Myrtle Archer Mrs. Susan F. Apted Amy Beers Catherine Sinnott Anna Sangey Frances J. Burch Amanda Metzger 5 5 John H. Jopson S. E. Getty S. E. Landjert I. Lindenberger Lewis K. Xetf E. S. \'an Duyn Alexander Xicoll J. B. Fattic Donald ^IcCrae, Jr. S. V. King Ralph A. Stewart Addison G. Brenizer, Jr. W. ]?attle :Malone R. R. Smith J. Fred Clarke Richard A. IJarr \V. S. Snodgrass M. E. Lott D. M. Ottis - I'reshyterian Hospital, Pliiladelphia Wcstciiester County Associated Hospitals, Yoiikers, X'. Y. Spokane, W'asli. (no parent institution) (ity Hospital, Louisville, Ky. Harlem Hospital, Xew ^'ork City I'niversity Medical College Hospital, Syracuse, N. Y. i'"or(iham Hospital, Xew York City St. Jolin's Hospital, Anderson, Ind. Council BlufFs, Iowa (no parent institution) Allegheny (general Hospital, Pittsburgh, Pa. i'lowi'r Hospital, Xew York City ('luulotte, X. C. (no parent institution) (M'lieral Hospital, Memphis, Tenn. I'.utterworth-Hlodgett University, Grand Rapids, Mich. .Icllcrson County Hospital, Fairfield, Iowa \ aiidcrbilt University, Xashville, U'enn. I Iiivcrsity of Arkansas, Little Rock, Ark. l'.aylor University, Dallas, Texas St. .lolin's Hospital. Springfield, 111. <:^-^^-^-Z^--4.-^y.O'^Z'-'i--^>-^ 1446 APPENDIX c no -*J 3 .n-S O c:^- ^ tcEM-S OS 00 -5 tcrr in IZI OS "^ O :5^ Ofe<: r i, t- ^i; cl O ^ U:* S ^ c8 .a> O > -^ <" t- 3 2 53^^^ . S^ ::;3 S ^ -; '^ S S 3 tii^ ^ cc t^ <-. <^ a: ^'cc fc. ;s K P^ 3 O Oi O cs -::2-:j f- - -^ P7 a o a o >. [u cS >S S"^ 3 . q-Cj ^ '^ p: I- i k-i u ~ C; -X 3 I. '3 ^ ? 5 ?^ -^ -r ^ ^ 3^; ~ ^^-^oa^.y O < '"' tn -t^ 3 . * fcf.3 ^> .5 M P '^ i- cc 3 ^ .^ S * 'Bh 3 -3" .5^ . ^ .!>^ ^^ . r -^ cS "3 3 v^ K-< ^ cT 2 j:-^ ^ 1^ tr d c cs ^ '^ ^ p^ v 5 ,^ 3 c< 3 " _-*^ ;r: CS ^ ^ C^ r^ ,_'' 3 &- X '^ :: *^ ^ZJ p J -:; ^ S 3^^ C =^ ~ >2 ^ -C^ -, f= -3 ^|^o^ I' 3 Bf r^ a! X i 3 "5 ^-3* re 3 a; ^ "3. 2" "'/: ^~ ^ 'it- r; 3. J ai ^ 3^ 1 3 -1^ 3 ti^ ~ 5- 5^ ^ ^ ^11 C3 t~-'XC:0^^'M?t-t'._. ir: O in IC i~ iH L-^ U-t L- LI L- " " iM f^ -f -c t^ c C] C-l (M (M 'M OJ 10 l.t L- i- L.- 1.-^ APPENDIX 1447 eS eiO "S ^- ^ ^ ^ >: o ^-^ -H --H tn C ^ ip 5= ^ ^ "S f: S I; _ H^- -^ , ^!^ r- ->-J rr. f--"i C^-' t)*"' 5!ic>7H cS K |?r-i ." _-:; '/: "t:^ ^ X ^ -'< _ o J: '5^"" S d X ~ O ^ ;*>> j2 S 11 2 i^ :^ - 71 ^ u ':i * S ^ p: " ii ^ ^- -^ ' - 5 - ~'^ i ~ ':::, S -^ S -= X t ^ J- -^ ^ Q "t: ^ .;: :i. /', 'XXX X H:i::::^:5x-N r^ i^ S tn?^::; ^S xx h "x, i-?^ .^ 1- in 1.-5 1- 1- 1.-; i~ 1.- L- lt; o 1.1 1- ir: ir. 1- 1- 1- 1- 1- 1-; 1- 1448 APPENDIX s cS k ^.t u J^ iroc Sull ppe ton tule *< ^ .-s s-M.s s e nna E. R( lizabeth E dith Benn atilda Gu essie E. C ranees Kr -..2 1-3 OK we; "^ i_J ^ 1^ C- i- hZ ^ ^ J 2 '"" = -'" o c o --r; - p o o ^ c '-^ ^ g .^ j^ ^ w ? fi. .2 s. o -^ r- - s = '^^ > -r ?kS = n "si tn '^j "? O K a; 3 .5; o :-H^/^x ^ K a ;: c; C; 5 r c C U H r-H O P^ W ' *; - C 5S o x ~ ;; O '6 M ^^ ' ^ c ^> '^^ . o '^ cs "^ :^ S: f^ 5 E._'E.'p. ^ ^ o O ^ X C !K c< C op: X <^ c S lo cc I- cc c". o -^ "M r^ '* 'f; tt 1^ cc c; o ^^ (M fo ^ o cc :s cs -tc 1^ 1^ I- I- 1^ (^ 1^ t^ 1^ 1^ cc GC cc cc 00 o m u^ ic '.'; ic ic 's >f5 ic m ic o if; ic 'C '^ ic '^ ic AITEiNDIX 1449 == -2 "E = -r; = i- 3 c ;= = >r; ^ r^ c/: c". c: I 01 M <+ Iff i~- go c. ~ ' 'M re -f i" xt r^ cc c: c 'M ?t -t i~ CO ccocccvrc. C5c:c~. sr.r-. C-. cr. ci cr. cocccccroo o ,-^^ L'; I- u- m ir: i.t Lt i.- L'^ L~ 1^ i.~ LI o ^ ^ '^ ^ ~ -~c -^ -^ zc ':s ^ cc ;c -^ -^ 1450 APPENDIX teg Ph ^ aj Ah ^- O 0) ~ j3 " tc ^ ce o es >j P 2 =s S ^2 O ,J5 >H aJ 5 pq e.i: a o G ^H cS ^ .2 1-1 1" u ^ G S ^. -p 4) oo (U S'5 cji (h -(-> -(J cS 00 cS c c::3 >3^ o^ o Q 03 c3 1 3 O O 0) f^^ s C C' ti Op-' _ro o -^ . CO Ph ,-r "^ o o g o f-i V =^ O) -J 0} _"~ _ i-H -g t 3 W S o <^' ' = ^ ^ Q ^ 5, ,5 CO re _!j' < , Tr-^ nS &. H s o K^ --: O - -' Oh > --, ^ P-i Oh .^ ^ o aa w w 5 o^i d c - 03 o i,y -- CO .ti ffi ^ O <^ O 3- ffi o S 3 eS C w ctf t- -= O S 5 ^ r, ^ o o C o ^ ;> CC W K H r-, GC O) u ei ' '^ cS 5 a2 P^ I-! c/3 O O -< Ph to --iSS^HtonJtas ^ v5 15 * '^E cc D-. CC .- -M C O tK " -- fH - ^ hH c C O.t; ^- O ^C^-m^th C ^ QJ r* <* !( "- I < S ^^ O 03 t p- rn t ._ 1^ t^ p,^^ ^, '"' Cjj .S a^ HH !-, P'^ . . 02 ^ 2 2; * 'S S V ^. S .5 "^ ^ ^' ^ ^ rt*- w ?0 t- OO CJ O rH C-1 ,-1 , I ,_l r-l (M OI IM O CO CS CO " cs o >C CO CO Oi o --< (M (M (M Ol (M TO 00 CO CO CO CO CO o ^ CO-^lOCOt-OOC-.Oi-l COOCOCCCOCOC^'*Tt< ^gCOCOCOCOCOCOCOCO APPENDIX 1451 ^ T) ITl o TO ce o ^_i o T3 .fi 3 ^ 4; ej I/; 05 4; "3 "5 73 0/ k> O "a; tf) w a ?: i_i ^ ?^ jl; X c a. a S3 I- E 13 cs O h-i O' t ca c ^ c o .s e ^ I" I- t> C5 .S 5 O 0/ It i; Jt' 2 CB CC CB IB c^K <; cc CA cc X 0/ ::: :-=:a S; 61 5 C ?, C ^O :;;; ^ ^^ _0 O =B >ij "ti * = c ;< - i-r - =s "9 5 IB T. - r; ^ ^ ^ "^ " O 5i o ,.f^< , c ^' ^ ^ E t = = . /. X c; s ^ < s: ^ <-, x 71 ' "^ D^ o cu rt 0) a ^ a ^6 "A "i^ - oT .1"^ o "o a: O -3 o '<;=:. K 03 aj -- 3 ^ o o p^ ! C C a. l-l -l-j o q5.= _'^ .!-! ^ 4> f- !^ CS CL, fc *~^ ?^5 X >,.'' CB . '" " " "to B t fi 'i- ^ % -^ B I I " X C "' -^ a: " -- i- hii 5- o: I I -H -:= 5= ^ :=. 5v: ^ ~ -5 c/5 =: 5^^ ? .t: r^ C CS "?-< y, i^ ;l. y,-j,- x'^H XXXP^H^ O ^^XTlX^XjiX i?t ^2 r^ cc 1452 APPENDIX wo-"- bo > * C*-^ O 01 > Si g c , a 42 s O ^c: 7J 773 0) s cS K OJ "n K as cd cd 00 .S e -2 3o-2'c 02 rt so g c rei .~ o tr 3J S ffi T3 M K< Q u o t/j J cS cS ^ ^ ^ o > S s Ci^ ^ o) *-i b T3 "^ "t:^ f^ *^ ao j;,_ao ,2 C ^ p Oj OJ IB C5 C5 hH r7 rTI *3 "^ (-1 -*-S j_j '^ o 5 , 1 ,-; TO tc" H o ~ * W S r " > -S Ir - Oh p I- - - ^ " 2 o 5 "= O C crt rc 1^ " ^ rr^ --^ ^5 O c8 o 2 Ci r^ r IS 9 -5 .Z^ -r rt ^ ^ ^ :; c ^ tc.5 o <*< '^ X O O o C CS c l^.-^ Si 03 - o fcp rS o > tci^ !r. - JS "?i o c^ OJ 02 C "3 "^ rn r 'o, n ^" 03 '"" C S S < -r 0-:= C C Oj ^ rf ^ 03 n^* i r^ "o J ci5 .= t: ^ ? iT o .2 o c -i-j^H-' ti* ' 2 ^ " -^ 'Z -- 5 ' C o .ti is o. s Oce---; Oo;-'0_^ E c E * ."^ o K O l_l . CS ^1. 130 tc S-^>^ h-IOi : s a. ::: Q <; W i Oi offi K^^ >^ ^ C 'S ^ APPENDIX 1453 I I ^ . 1 I "2 J ^ > -7 -^ i P :5 ^- "H-'i^ J ^ 2_rj ^!^ S I 2 .^S^B ; - S r--- "^ . i = X :_- X ''. X X ^ '', X r^ >^ X' r-. X :^ > IT! X ^. X X '-Z z >^ ^ "M ?7 -f >- '-r r~ X ~. O ^ "M c: -f i.T :i t-- cc . c "m ^ -" >~ t- x r; O Cr ~ ~ C: C ~ ~ 3 1 I -H , 1 ^H f-^ .-( ' ^ -M 'M -M 'M M -M 01 fM "M "M " I- I- I- I- I- I- I- I- I- I'i t'i t^ t- t^ I- t- 1-. I- 1- I- I^ I- t- I- t- t- t- t- I- t- 1454! APPENDIX a* 2 a) 33 S "^ M f" ^ eS 5 o "*1 '- CO QQ Ctf .ti S S o g-S c^ >- J CO CO cConta Alice Garret 6. Seattle, Wash. Dr. Milton G. Sturgis I?lanche Fairweather 7. Houston, Texas Dr. Judson L. Taylor -Maggie E. House 8. Ricliniond, Va. Dr. A. M. Willis Bernice Hall Naval Station Hospital Units Organized by the American Red Cross I'OR THE Uniteh) States Navy Location of Parent Institution Director Chief Xurse L Pittsburgh, Pa. Dr. Nelson H. Clark (Jrace Anthony 2. ( St. Margaret's Hospital ) Philadelphia, Pa. Dr. John A. McGlinn Catherine Moran 3. (St. Agnes' Hospital) Montclair, N. J. Dr. James Hanan Blanche Kennedy 4. (Mountainside Hospital) Brooklyn, N. Y. Dr. John A. I^ess Helen Grady 5. (St. Mary's Hospital) Columbus. Ohio Dr. V. A. Dodd Carrie E. Churchill 6. (Grant Hospital) -Austin, Texas Dr. Z. T. Scott Nell Freund 7. (Seton Infirmary) Toledo, Ohio Dr. Charles W. Moots Daisy Mapcs 9. l'>oston, Mass. Dr. L. R. G. Crandon Emily I'ine (organizing nurse) 10. Minneapolis, Minn. Dr. Clifford Henry Crecentia Dicdcricks 11. San Francisco, Calif. Dr. Carl P. Jones Myrtle G. Chandler 13. Minneapolis, Minn. Dr. William E. Roberts Sadie Murphy 14. St. Louis. Mo. Dr. L. C. McAmis Grace Lieurance 15. Dubuque. Iowa Dr. John C. Hancock Frances Pedcrsen 1(5. Philadelphia, Pa. Dr. M. B. Miller Winifred Brown 17. Seattle, Wash. Dr. John S. MoBride Edna L. Robinson 18. Duluth, Minn. Dr. Arthur Collins M. Oliye Graliam 19. St. Louis, Mo. Dr. R. B. H. (Jradwohl Gcnevieye Thorpe 20. St. Paul, Minn. Dr. 0. W. llolcomb Mabel Larson 1456 APPENDIX Navy Detachmbh^ts Organized by the American Red Cross for thb United States Navy Training School Organizing Nurse Newton Hospital, Newton Lower Falls, Mass Mary M. Riddle St. Luke's Hospital. New Bedford, Mass Susan E. Emmott Union Hospital, Fall River, Mass Anna E. Rothrock St. Luke's Hospital, New York City Carrie E. Bath Orange Memorial Hospital, Orange, N. J Bessie Millman Protestant Episcopal Hospital, Piiiladelphia Katherine Brown Allegheny General Hospital, Pittsburgh, Pa Lettie Draling Columbia Hospital. Washington, D. C Lucy Minnigerode Providence Hospital, Washington, D. C Sister Flavia University Hospital, Charlottesville, Va Margaret B. Cowling Pasadena' Hospital, Pasadena, Cal Lila Pickhardt St. Luke's Hospital. San Francisco, Cal Esther A. Brown Seattle General Hospital, Seattle, Wash Ethelyn Hall St. Luke's Hospital, Seattle, Wash Johanna Burns San Francisco Hospital, San Francisco, Cal Katherine Flynn Anna Jaques Hospital, Newburyport, Mass Jessie Grant Butler Hospital, Providence, R. I Evelyn C. Jehan Children's Hospital, Boston, Mass Elizabeth E. Sullivan Children's Hospital, Portland. Maine Editli L. Soule Garfield Memorial Hospital, Washington, D. C... Agnes G. Hayes Eastern Maine General Hospital, Bangor, Maine. .Ida Washburne Georgetown Hospital, Washington, D. C Barbara Sandmaier German Hospital, New York City Charlotte Grim Hartford Hospital, Hartford, Conn Lauder Sutherland House of Mercy Hospital, Pittsfield, Mass Mary Marcy John Sealy Hospital, Galveston, Texas C. L. Shackford ^Slaine General Hospital, Portland, Maine Margaret M. Dearness Maiden Hospital, Maiden. Mass Charlotte M. Perry Boston, Mass., Local Committee on Red Cross Nursing Service Julia E. Reed, Sec'y Epworth Hospital, South Bend, Ind Margaret R. Parker Fargo. N. Dak Ethel Stanford State University Hospital, Oklahoma City, Okla..Edna Holland Local Committee on Red Cross Nursing Service, Salt Lake City, Utah Daraaris A. Bceman, Sec'y City and County Hospital, St. Paul, Minn Frances U. Campbell St. Vincent's Hospital Aiumnie Association Bertha A. Thompson St. Joseph's Hospital, St. Paul, Minn Sister Mary Charles American Red Cross Military Hospitals in Great Britain American Red Cross Military Hospital No. 4 Mossley Hill, Liverpool American Red Cross Military Hospital No. 21 Paignton, South Devon American Red Cross -Military Hospital No. 22 Lancaster Gate, London American Red Cross Militarv Hospital No. 23 St. Katharine's Lodge, London American Red Cross Military Hospital No. 24 Baroda House, London An American Red Cross Military Hospital of wenty-cight beds was opened near Dublin, Ireland, October' 15, l!fl8, to s- 'e American mechanics from four aerodromes. APPENDIX 1457 AMHaiicAN Red Cross Convalescent Hospitals American Red Cross Convalescent Hospital No. 101 T^ingfield, London American Red Cross Convalescent Hospital No. 102 Wimbledon, London American Red Cross Convalescent Home for Nurses Putney, London American Army Hospitals i.\ Great Britain United States Army Rase Hospital No. 204 Hursley Park United States Army Base Hospital No. .i.i Portsmouth United States Army Base Hospital No. 37 Dartford United States Army* Base Hospital No. 2!) Tottenham United States Army Base Hospital No. 40 Sarisbury Court United States Army Camp Hospital No. 35 Winchester United States Army Camp Hospital No. 40 Knotty Ash, Liverpool United States Army Camp Hospital No. 34- Romsey United States Army Camp Hospital No. 30 Soutliampton American Red Cross Military Hospitals in France No. 1 Neiiilly-sur-Seine No. 2 ."j Rue Puccini, I'aris No. 3 4 Rue de Chevreuse, Paris No. 5 Auteuil. Paris No. 6 Bellevue, Paris No. 7 Jouillv-Seine-et-Marne No. 8 Malabry No. 9 32 Boulevard des Batignolles (for skin diseases) Amehican Red Cross Hospitals in France No. 101 2 Boulevard de Chateau, Neuilly (for personnel of Red Cross and other welfare orf^anizations) No. 102 Neufchateau (for contagious diseases) No. 103 44 Rue Chauveau, Neuilly ( overtiow hospital for A.R.C. Military Hospital No. 1 ) " No. 104 Beauvais, L'Kcole Professionelle No. 105 Jouilly, maintained for French wounded after the witlidrawal of Americans No. 107 Jouy-sur-Morin No. 10i Kvreux, Dr. Fitcli's Hospital No. 110 Coincy, Aisne No. Ill Chateau-Thierry, Aisne No. 112 Auteuil, Paris (under construction) No. 113 Cognac, for the Czechoslovak Army No. 114 Toul L'Hopital dcs Allies, at the Chateau d'Aiuiel. near Campeigne; Ambu- lance Chirurgical St. Paul: the temporary formation at Chantilly ; the Daly Unit and l/f:colr a1li Station, Ekaterinburg. Anti-tyjilius Hospital, Petropavlosk American Hcd Crdss Ibispit;'!. N()\ino Oziskov IJiuicjovico Pardubice Dviir Kralove rizcn llodoiiin Prague Jihlava Pribram (with 2 rural branches) K OS ire Susicc (witli 2 rural branches) Libcrec 1466 APPENDIX 1467 Greece Athens (6 stations) Salonika (in and about Salonika, 7 stations) HUNGABY Baja Balassagyarmat Bekescsaba Budapest (21 stations) Debrecze Eger Esztfrgom Gyula Gyor Hodmezovasarhely Jaszbereny Kaposvar Kecskemet Kiskunfelegyhaza Mako Mlskolcz Napykanizsa Xyirecyliaza Papa Pecs Satoraljaujheli Szepcd Szpglfd Szcklsfclicrvar Szokszar Szolnok Szomtiillicly Ujpcs Veszprem Zalaegerszec Montenegro Cetinje (since January 1, 1022, maintained l)y local doctors) Kolashin (since March 1, 1022, maintained by a local doctor) Niksic Podgoritza (one local health station formed in March, 1022, being a com- bination of American Red Cross and two local organizations. On March 31, transferred entirely to local authorities) Vir-Pazar (since January 1, 1922, running imder local doctors) Poland Alexandrow (near Torun), 1 ambulatorium. Alexandrow ( near Rciers) , 1 ambulatorium. Augustow, 1 ambulatorium and a hospital aided. Baranowicze. 2 ambulatoria. a milk station and a hospital aided. Bedzin, 1 ambulatorium and a milk station. Biala (near Warsaw), 1 ambulatorimu. Biala (near Krakow), 1 ambulatorium and milk station. Bielsk. 2 ambulatoria. Blaszki, 1 ambulatorium. Bobkrii, 1 and)uIatorium and a hospital aided. Borszozow, 1 ambulatorium and a hospital aided. Brodnica, 1 ambulatorium and a milk station. Brody, 1 ambulatoriimi and a milk station. Brzesc-Litewiski, 1 ambulatorium and a milk station. 1468 APPENDIX Brzezany (near Lwow), 1 ambulatoriiim. Brzeziny (near Warsaw), 1 ambulatorium, a milk station and a hospital aided. Bydgoszcz, 2 ambulatoria, a milk station and a hospital aided. Chajny, 1 ambulatorium, a milk station and a hospital aided. Chelm, 1 ambulatorium, a milk station and a hospital aided. Chelmno, 1 ambulatorium and a milk station. Chodziez, a hospital aided. Chrzanow, 1 ambulatorium and a milk station. Ciochanow, 1 ambulatorium and a hospital aided. Cieszyn, 1 ambulatorium. Crodno, 1 ambulatorium and a hospital aided. Czeladz, 1 ambulatorium and a milk station. CzestrochoMa, 1 ambulatorium, a milk station and a hospital aided. Czortkow, 1 ambulatorium. Dabrowa, 1 ambulatorium. Dawidgrodek, 2 ambulatoria. Domaczewo, 1 ambulatorium. Elogzow, 1 ambulatorium and a milk station. Garwolin, 1 ambulatorium. Gostynin, 1 ambulatorium and a milk station. Grajewo, 1 ambulatorium. Grodekjac, 1 ambulatorium and a hospital aided. Grudziadz, 1 ambulatorium and a milk station. Halicz, 1 ambulatorium. Jaroslaw, 1 ambulatorium, a milk station and a hospital aided. Jaworow, 1 ambulatorium and 2 hospitals aided. Kalisz, 1 ambulatorium and a milk station. Kalusz, 1 ambulatorium and a milk station. Kielce, 1 ambulatorium, a milk station and a hospital aided. Kolo, 1 ambulatorium. Kolomyja, 1 ambulatorium and a milk station. Konstanty, 1 ambulatorium. Kovel, 1 ambulatorium and a milk station. Korzec, 1 ambulatorium. Krakow, 4 ambulatoria, a milk station and a hospital aided. Krasnostaw, 1 ambulatorium. Krokovviec, a hospital aided. Krzemieniec, 1 ambulatorium and a hospital aided. Kutno, 1 ambulatorium and a milk station. Lenino, 1 ambulatorium and a hospital aided. Leczyca, 1 ambulatorium, a milk station and a hospital aided. Lida, 2 ambulatoria. Lodz, .3 ambulatoria and 6 milk stations. Lomza, 2 ambulatoria, a milk station, and a hospital aided. Lublin. 2 aml)u!atoria, a milk station and 2 hospitals aided. Lubonil, 1 aml)ulatorium. Luck, 1 ambulatorium and a milk station. Luniniec, 1 ani])ulat()rium. Lwow, 2 ambulatoria, a milk station and 2 hospitals aided. Micdzyrzcc, 1 ambulatorium. Mikdlajow, 1 ambulatorium. Minsk-Mazowiec'ki, 1 ambuhitorium and a milk station. Mlawa, 1 ainbiiiatoriiini and a hospital aided. Xicswioz. 1 ainhulatoriuin and a li()s|)ital aided. Xovoprodck. 1 ainhuhitoriimi, a milk station and a hospital aided. Xowy Sac'z, 1 amlailatoriiim anu>s. French r^ ,, 1, , , r^i f Croix do Guerre, lironze star Lonnellv, l5cttv Clara < i> -j- i ti i ti i r^ n i i \Bri1isli Royal Red Cross, 2nd class Cormier. Bernadette Medaille d'Honneur des Epidemies (silver) Corning, Alice Medaille d'Honneur des Epidemies (Croix de Guerre Medaille de la Reconnaissance (French Army) Cox, Katlierine Order of Elizabeth, Belgian 11 Ti T f Medaille de la Reine (with cross), Belgian Cromwell. R. Lee | (,^,,^^ ^^ ^^ ^^^^^^^ j^^,^^j^^ Croslev. Sara W Cross of Mprcy, Serbian Cuppaidge. Constance Royal Red Cross, 2nd class, British APPENDIX 1473 Donnison, Faith. Delano, Jane A. DeLozier, Mary M. . . . Diamond, Mary Anna. Dingrlev, Nellie Driver, A. Madjje Dunlop, Margaret A Dyer, Genevieve E Ebbs, Helen Jane Eisenliard. Nettie ElU'tt. Josephine S Elliott, Mrs. Helen Brij:s. Elwood, Bessie Lydia Emerson, Martha F Einslcv, Lvdia Evanfreline. . Enjrel." Mrs. Austa White.. Evans, l8al)el Wakeman... Evers, Emma Elise Ferj^uson, Edna Allison.. . . Ferj^uson. Ida M. . . Ferries. Eva Finnell, I'ranoes G. Fit/.trerald, Alice. . . Foerster, Alma I'olckemer. Elizabeth M. I'nincis, .Marv L f Red Cross, Serbian \()rder of St. Sava (Class V), Serbian Distinguished Service Medal, United States, posthumously awarded Distinguished Service Medal (gold) American Red Cross, posthumously awarded Medal awardetl by the Austrian Government for aid rendered in time of war .American Red Cross Medal of Merit Medal awarded bv Pan-American Exposi- tion, to'oi .Medal awarded by American National Red Cross in grateful memory of her devoted and distinguished service, lOOS-lOlO Medal awarded by the National Institute of Social Sciences for service of high and inestimable value to her country Order of the Japanese Red Cross Panama-Pacific Exposition Medal conferred upon Miss Delano as collaborator in the t^ i. \ Jnsigne en Bronze, trench James, Agnes F Medaille d'Honneur des Epidemies (silver) Jeffrey, Lucy W Medaille d'Honneur des Epidemies Jeffery, Jane Distinguished Service Cross, American Jessup, Elsie Cross of Mercy, Montenegrin Jolinson, Florence M Florence Nightingale Medal, International Red Cross APPENDIX 1475 Johnson, Helen Union des Femmes de France (silver) Johnson, Lena Margaret. .. . Cross of Mercy, Montenegrin Johnson, Lillian Croix de Guerre with bronze star T , , ,, . w / Hed Cross (silver), Serbian Johnston, Margaret W |<^.^^^^ ^^ ^j^^^^^ g^^^^i^^ Jordan, Pauline Kegina Maria, Roumanian Jorgensen, Sigrid Croix de Guerre with gold star Kacena, Blanche Medal of Military Merit, Greek Kehoe, Frances M Medaille d'llonneur des Epidemies (silver) Kennedy, Mary Royal Red Cross, 2nd class, British Kerrigan, Helen Palmes Academiques, French ( St. Anne's Silver Medal, Russian Kiel, Sophia V j St. Anne's Gold Medal, Russian I Queen Elizabeth Medal, Red Cross, Belgian ,,. T J Red Cross (silver), Serbian Kipp, Lorrame < , , ,, o u- '^^' { Cross of Mercy, Serbian Kirk, Mrs. ICmily Holland.. Medaille d'Honneur des Epidemies (silver) Knapp, Grace M Medaille d'Honneur des Epidemies (silver) T^ , i. 11' T ,.: / Silver Medal of Honor, with War Decoration, Kochert, \V. Louise < a t. t> i r^ ' \ Austrian Red Cross Krans, Ella M Medaille d'Honneur des Epidemics (silver) Kreigli, Laura L Cross of Mercy, Serbian Lauridsen, Karen Medaille d'Honneur des Epidemies (silver) Leete, Harriet L Red Cross, Serbian / Lester, Minnie A Royal Red Cross, 2nd class, British Lewis, Lydia Royal Red Cross, 2nd class, British'. ^ Lewis, Mary Elizabeth Royal Red Cross, 2nd class, British ' Lister, Hannali Croix de Guerre, bronze star ' Ixjmbard, Arabella A Medaille d'Honneur des Epidemies (silver") Loughran. Nellie ^ledaille d'Honneur des Epidemies (silver) Lyon, Elizabeth C Royal Red Cross, 2nd class, British ,, ^ o u f Red Cross, Serbian ;McC arron, Sarah < ^ , Vr o i ' 1 t TOSS of Mercv, Serbian [Distinguished Service Cross, American McClelland, Helen Grace... . I Royal Red Cross, 1st class, British [citation, by Sir Douglas Haig. McCloskey, Louise Helenne. . Royal Red Cross, British IDistinguislied Service Cross, American Croix de Guerre, bronze star Roval Red Cross, 2nd class, British British Military Medal MacUonald, Irene Cross of Mercy, Serbian Af.i^^... 11 Af^-: T /Red Cro.ss, Serbian JNlcDowell, Mane L (r\ i * oj. o i r^i tt\ e i ' 1 Order of St. Sava (Class V), Serbian Af.^f.ii XT 4. /Hed Cross ^ledal, Serbian -Maciadden, Kate < ^^ i i r >r o i \ .Medal of Mercy, Serbian McGee, Mary Gertrude Medaille d'Honneur des Epidemies (silver) MacCiiilivray, Editli Royal Red Cross, 2nd class, Briti.sli Mao(Jieg()r, Flora Medaille d'Honneur des Epidemies (silver) McCiuire. .Margaret C Red Cross Medal, 2nd class, Hungarian McKernan. Inza G ^ledaille d'Honneur des Epidemies (silver) McKnight. Lillian S Royal Red Cross. British McKee, Inez Royal Red Cross. 2nd class, British McLannan. \'era Royal Red Cross, 2n(l class, British McLaiigliliii. Kinily Royal Red Cross. 1st class, Britisli McMaiiigill, Kila J Croix de Guerre, bronze star. French MacNeal, .laiie (" Roval Red Cross, 2iid class, British 14T6 APPENDIX MacXulty, Carolyn Croix de Guerre, bronze star, French Martin, Florence J Medaille d'Honneur des Epidemies (silver) Martin, Isabelle ., Military Degree, 4th class, Greek Mauffray, Helena Medaille d'Honneur des Epidemies TFlorence Nightingale Medal Meirs, Linda K ] International Red Cross I Croix de Guerre, bronze star ( Cross of St. Anne, Russian Metcalf , Mrs. Maud H I Cross of Mercy, Serbian [ Cross of St. Sava, Serbian Miller, Elsie L Royal Red Cross, 2nd class, British Miller, Mrs. Lena B Royal Red Cross, 2nd class, British Minnigerode, Lucy Gold Cross of St. Anne, Russian Mitchell, Elizabeth Cross of Mercy, Montenegrin Monroe, Edith Medaille d'Honneur des Epidemies Morrison, Edna M ^ledaille d'Honneur des Epidemies (silver) ,, . T, ,, f Roval Red Cross, 2nd class, British Morton, Ruth ' ^^^j^ ^^ ^^^^^^^ ^^^^^^ ^^^^ X' 1 -\f u 1 -V7- I Red Cross, Serbian kelson, Mabel V < ^ ^ Vr Af ^ ' \ Cross of Mercy, Montenegrin Nelson, Mary K Palmes Academiques Nicholson, Ann Estella Royal Red Cross, 2nd class, British Norwich, Margaret Cross of Mercy, Serbian X- rit -r, i.4. f Medal awarded by the National Institute of Noyes, Clara Dutton < ^ -lo- ' ' \ Social Sciences Nye, Sylvene A Croix de Guerre, gilt star Obear, Evelyn E Regina Maria (Class Ila), Roumanian O'Brien, Agnes V Royal Red Cross, 2nd class, British O'Hara, Anne M Cross of Mercy. Serbian O'l^ary, Margaret Regina Maria (Class Ila) , Roumanian Olsen, Lydia Josephine Medaille d'Honneur des Epidemies (silver) O'Neill, Mrs. Mary Agnes. . . Cross of Mercy, Serbian r> 1 T7I T ( Roval Red Cross, 2nd class, British Parmelee, Eva Jean < ^,\.. at i i ^ vt- i ' \ Military Medal, Britisii Parrish, Minnie Cross of ^lercy, Montenegrin Parsons, Marion G Royal Red Cross, 1st class, British Patmore, Amy F Medaille d'Honneur des Epidemies 'Regina Maria Cross, Roumanian Medaille d'Honneur des Epidemies (silver) Dec()rate Ar.,^:-,^ T /Cross of Mercv, Serbian Ross, Alanon J < ,, , ^ / i ^ t- i ' \ Red Cross (silver), Serbian Ross, Mary B Cross of Mercy, Serbian T, A t;. f Cross of Mercv, Serbian Rowe, Anna E < -., , ^ / i \ o t ' 1 Red Cross (silver), Serbian Russell, Martha M j ^^^'^'^ ^'*^^';!"f p '^''"^'^ ' \ international Red Cross Ryan, Lulu B Medaille d'Honneur des Epideinies (silver) T> IT- -e 1 Af /Red Cross (silver), Serbian Ryan, \A inifred M < ^, ^ , / c- i ^ ' \ Cross of Mercy, Serbian Sahol, Elina P. Croix de Guerre, bronze star oi T 1 Af T T)- 1 / Croix de Guerre, bronze star St. John, Mrs. Jane Kignol.. < i r. i r- o i i t> a- i. ' *= \ Royal Red Cross, 2nd class, British Sands. Tyldesley L Royal Red Cross, 2iid class. British Schmitt, Dolly Belle Royal Red Cross, 2nd class, British Schortield, Minnie Roval Red Cross, 2nd class. British Scott. Eleanor M Royal Red Cross, 1st class, British Seratini, Olive E Royal Red Cross, 2nd class. British Sharpe. Anna M Croix de Guerre, bronze star Siegel, Louisa E German Medal Smith, Alice O Croix de Guerre, bronze star c- -ii Af 11 Tj /Red Cross (silver), Serbian Smith, Mollv Bawn < .^ ^ , / c i ' - \ Cross or Mercy, Scrliian Spencer, Ruth Helen Royal Red Cross. 1st class, British Snow, ^lary L Cross of Mercy, Serbian c,, , 1 T T 1 1 [ Distinguished Service Cross, American Stambaugh, .1. Isabel < ,, i*^,, , ,, .-> i i i, . i '^ ' \ Koyal Red Cross, 2iul class, Hntisli Steplienson, Mary E Koyal Red Cross, 2iid class. British f Distinguished Service Medal, American Royal Red Cross. 1st class. British Stimson, Julia C ] Medaille de la Reconnaissance ( French Armv) [citation,* by Sir Douglas Haig Strub, Ann Medaille (I'llonneur des Ej)ideiiiies (silver) Swayse, Ktlie M Cross of Mercy, Serbian Taft. Nora Medaille (riioniieiir des Epideinies Tarr, Kebecea Josephine. .. . Medaille d'lloinieiir des Epideinies (bronze) Taylor. Man.e Royal Red Cross, 1st class. Hritisli Taylor, I'lmebe F ('r / Distinguished Service Medal, American Ihompson, Dora E | Companion of British Empire Thompeon, Sarah R Croix de Guerre Tibbells, Ursula Cross of Mercy, Serbian Tittman, Anna L Gold Medal on the Ribbon of St. Anne, Rus- sian Todd, Louise M Croix de Guerre, bronze star Torrance, Rachel C Regina Maria (Class Ila), Roumanian Turner, Lila B Croix de Guerre, gilt star Tymon, Margaret Medal of Military Merit, Greek Urch, Daisy D Royal Red Cross, 1st class, British Vuagniaux, Emily Croix de Guerre, bronze star Walkinshaw, Arvilla Royal Red Cross, 2nd class, British Wallace, Olive S Royal Red Cross, 2nd class, British Warwick, Bessie Mae Medaille d'Honneur des Epidemics Watkins, Jeannette Medaille d'Honneur des Epidemics Watson, Helen R Cross of Mercy, Montenegrin Watson, Isabel Medaille d'Honneur des Epidemics Weir, Ruth Regina Maria (Class Ila) , Roumanian Whedon, Rhobie Cross of Mercy, Serbian Wilcox, Mabel Order of Elizabeth, Belgium Wilday, Grace German Red Cross Medal, 3rd class Wilkins, Maud Medaille d'Honneur des Epidemics Williams, Kathryn Cross of Mercy, Serbian Williamson, Mildred Red Cross (silver), Serbian Wilsey, Marrietta Order of St. Sava (Class V), Serbian Wilson, Eleanor Cross of Mercy, Serbian Wiltzius, Henrietta / g'""^^. ^ ^^7;, Montenegrin \ Red Cross, Ist Order, Serbian Wood, Edith L Cross of Mercy, Serbian Worley, Pearl M Medaille d'Honneur des Epidemies APPENDIX 1479 American Red Cross Nurses Wuo Died in War Skrvice or as a Result OF Disability Contracted Therein War Service April 6, I'Jll, io November J I, lUt9 Awrsc Date of Death I 'lace of Death Allen, Phoebe . . . . , Aniundson, Esther Anderson, Nora Emelie. Athay, Florence Aubert, Lillian Ayres, Mrs. Edith Babcock, Hazel E Bailey, Margaret S Baird, Laura A. . . Baldwin, Jessie P. Bartlett, Frances , Becker, Edith G.. Bellman, Jeanette Berry, May Bishop, Aniv L Bradiield, Edith Bradley. Laura Belle. Brandon, Hazel Breen, Anne M. C . . . . Brock, Monica Buck, Lydia Muriel. Buell, (Jrace (t Buman, Rose E. . . . Burk. Ethel Marion. ButU'r, Einnui M. . . . Bvrne, Louise E . . . Byron. Patricia Irene. Cairns. Mary Kav... Campbell. Florence W, Oct. Oct. Jan. Nov. Oct. May March Oct. Oct. Feb. 2.S, litis 20, 1918 16,1919 12,1918 0,1918 20. 1917 12,1919 16,1918 16. 1918 6, 1919 Oct. 27, 1918 Dec. Nov. 21,1918 12,1918 Dec. 30, 1917 Oct. May Oct. Oct. Nov. 15, 1918 5, 1918 24,1918 .30, 1918 17,1918 Nov. 29, 1918 Dec. Oct. Oct. Oct. April Oct. March Sept. L'), 1918 8, 1918 1.3, 1918 18. 1918 8, 1918 14, 1918 28. 1918 20, 191 S Nov. 18. 1918 Cardwell, Marv B. Oct. 4, litis Ft. Slocuni, N. V. Base Hospital No. 3.), A. E. F. Base Hospital No. 68, A. E. F. Base Hospital No. 67, A. E. F. Walter Reed Gen. Hospital. Washington, I). C. On board S.S. Monf/olia, Base Hospital, No. 12 Camp Hospital No. 33, A. E. F. Hospital Train No. 58, A. E. F. Camp Merritt, N. J. Evacuation Hospital No. 4, A. E. F., Coblenz, Germany Base Hospital No. 11"). A. E. F., Vichy, France Ft. Benjamin, Harrison, Ind. Base Hospital No. 18, A. E. F. Base Hospital No. 32, A. E. F., France Ft. Rilev, Kans. Ft. Sill.'Okla. Camp Dodge, Iowa Camp Kearney, Cal. Base Hospital No. 48, A. E. F. St. Elizabetli's Hospital, Washington. 1). C. Ft. Logan Roots, Ark. Base Hospital No. ilS. A. E. F. Camp Pike. Ark. Camp Fremont. Cal. Camj) Dodge. Iowa (ien. Hospital No. 1. New York City. Camp McArtlnir. Texas Base Hospital No. .')4, A. v.. v.. Brest. France While on h'avc in Nice. At- faclied liasi' Hospital No. 9. A. K. v., France San Antonio, i'exas 1480 APPENDIX Americax Red Cross Xxrses Who Died in War Service or as a Result OF Disability CoxxfiACTED Therein Xurse Casstevens, Geneva Date of Death Oct. 14, 1918 Casterline, Drusilla Marie Dec. 31, 1918 Catties. Edith June.... Cecil, ^Irs. Katherine W Chandler. Florence Christenson. Mabel C. . . Christman, Caroline H. . Clements, Anna Gertrude. . . . Cochran, Cecil J Collins, Tlieresa V Connelly, Katlierine R. Coover, Etta Cosgrove, Anna M Courtney, Helena J. Cox, Charlotte A. . . Cunimin City Hospital, l'rovi(h'nce. R. 1. Hase Hospital No. (i. A. E. F. Base Hospital No. (iO, A. i:. F. (ami) -'^''l'^- Ta I.. N. Y. Camp Cody. N. Mex. Camp Slielby. Miss. Base Hospital No. (J2. A. !:. F. ('ani[) Jackson, S. C. Evacuation Hosy)ital No. 2. A. E. F.. Col)ienz.(Jermany Waller Reed Hospital, Washington. 1). C. Naval Hospital. N. V. Cam]) Travis. Texas Ft. SaTii Houston. Texas Camp Gordon, (^a. Camp Hospital No. 4. A. E. F.. France U. S. Naval llos])ital. Great Lakes. 111. Base Hospital No. 8. A. E. F. Camj) Lee. Va. (Jrou]) "C"'. (Icneral Hos- pital No. 0. A. E. F. Camp llos])ital No. 4, A. E. F.. Cliateau-Tiiierry, France Camp Custer. ^lich. (icneral llos]iilal No. 1, N(>\v ^(l^k Citv (;rnui) "E". A. E'. F. ( 'aiiiji Cptdii. N. ^'. Hase Hospital Nd. 105. A. E. F. Cain]) McClrllan. Ala. Naval Ibi^jiilal. I'hiladcl- pliia. I'a. l.ci irniiaii llii-pital. San l"i-aiiciscn. ( al. r.a. 1018 Oct. 2o 1018 Oct. 24, 1018 Place of Death Camp McClellan, Anniston, Ala. Camp Custer, Mich, iiase Hospital No. 17, A. E. F. Pase Hospital No. 29, A. E. F., London, England Ft. Riley, Kans. filockner Sanatorium, Colo- rado Springs, Colo. Evacuation Hospital No. 4, A. E. F. Pase Hospital No. 2, A. E. F., France Base Hospital No. G8, A. E. F., France Gardiner Ceneral Hospital, (iardiner, Maine Naval Hospital, Clielsea, Mass. March Field, Riverside, Cal. Pase Hospital No. 08, A. E. F., England Pase Hospital No. 46, A. E. F. Camp Fremont. Cal. Camp Tavlor, Kv. Fort Sloc'um, N.'Y. Camp Dodge. Iowa Kllis Island. N. V. Mobile Hospital No. 3, A. K. F.. France Paso Hospital No. 49, A. E. F. Camp Meade, Md. Cani]) Taylor, Ky. National Militarv Home, Ind. Camp Dodge, Iowa A. K. C. Hospital No. 2, France Ft. Hayard. N. Mex. I't. Ivilcy. Kans. l''t. .'^ncUing, Minn. Drowncii in Lake Michigan (;roii|. "D". A. E. F. Camp Siicrmaii. Ohio Ft. Slicridaii. 111. Camp Cody. X. Mcx. Naval liasc Uosiiital, Scot- land 1486 APPENDIX American Red Cboss Nurses Who Died in War Service or as a Result OF Disability Contracted Therein Nuise Date of Death Place of Death Tliorsen, Emma J Nov. 24, 1918 Camp Dodge, Iowa C S. A. General Hospital No. 28, Ft. Sheridan, 111. Tompkins, Agnes Jan. 6, 1920 Trank, Florence M. Oct. 8,1918 Base Hospital No. 58, A. E. F. Travis, Goldie X. . Oct. 6,1918 Fort Snelling, Minn. Naval Hospital, Charleston, S. C. Treichler, Amy Feb. 14, 1918 Trimble Marie E.. Sept. 13, 1918 21, 1918 Chelsea ^lass. Turner, Marion Pearl Oct. Naval Hospital, Mare Island, Cal. Turner, Phyllis M . . Sept. 28, 1918 U. S. General Hospital No. 1, New York Viberg, Judith S. . . Oct. 14, 1918 Camp Lee, Va. Camp Hospital No. 71, Vietmeier, Ida Henr ietta Jan. 8,1919 A. E. F., France Volland, Magdelena M Sept. 22, 1918 Base Hospital No. 23, A. E. F., France Walch, Caroline Rose Oct. 18,1918 Camp Travis, Ft. Sara Houston, Texas Walker, Anna A. . . June 15,1919 Base Hospital No. 55, A. E. F. Ward, Lillian Oct. July 22,1918 12, 1918 Camp Greene, N. C. Base Hospital No. 15, A. E. F. Ward, Nellie J. . . . Watkins, Gladys . . Oct. 16,1918 Base Hospital No. 56, A. E. F., France Weigiier, Alberta 1. Jan. Nov. 20, 1919 6,1918 Ft. Riley, Kans. Weiniann, Elizabeth II.'.'.'.!'.'. Base Hospital No. 62, A. E. F. Weise, Rose :\Iay 20, 1922 Fitzsimmons General Hos- pital, Denver, Colo. Wellman, ^Maybelle Oct. 15,1918 General Hospital No. 1, New York Wells, :\Iatilda F. . Oct. Jan. 15. 1918 29. 1919 Camp Eustis, Va. Vancouver Barracks, Wash. Welsh, Georgiana M ary Wessel, Dorothy 11. June 4, 1919 St. John's Hospital, Spring- field, 111. West, Anna Belle F Oct. 21,1919 Walter Reed Hospital, Washington. I). C. Whalley, En a M.. .. Oct. 15, 1920 Fitzsinuiioiis General Hos- pital, Denver, Colo. Wheeler, Luella Matilda Jan. 14,1919 Camp Hospital No. 12, A. E. F., France \Miiteside, Lydia V. Oct. 21, 1918 Base Hospital No. 26, A. E. F. Wiggins, Daisy E. . . Oct. 22. 1918 Camp Codv, N. .Mex. \VilIiams, Annie M. . Oct. 15, 1!)1S Base Hospital No. 19, A. E. F. Winchester. Edith M ay May 17, ]!)19 Armenia appp:xdix 1487 American Red Cross Nurses Who Died in War Service or as a Resllt of dlsaklmty contracted therein \urse Wood, Helen Burnett Wortli, Margaret W Wright, Mayme L Young, Alice M ^'oung, Florence M Young, Hose A Young, Mrs. Rose Kirkwood. Dale of Death May 20, 1D17 Oct. 2.3, 1918 Oct. 5, 1918 Oct. 4 1018 Oct. 23, mis Nov. 28, 1917 June 23 1!1!) /'lure of Death On board S.S. Monffolia en route to France Mase Hospital No. 48, A. E. F.. France Camp (Jrant, 111. Camp Sevier, S. C. Camp Devens, Mass. Camp Shelhy. Miss. St. Luke's Hospital, New York Appendix to List of American Red Choss Nihsks Who Dikd in War Service or as a Result of Disaisii.itv Contuac tkd Tiikkkin After ccmsideration and by a special autliori/.ation from Miss Noyes, the folbnving nurses were posthumously awarded Ked Cross medals and cita- tions, along with the other nurses on tliis list wlio died in war service, or as the result of disability contracted therein. In almost every case tlie nurse died of influenza, or pneumonia following influenza, during tlie 1918 epidemic, just after travcd orders for military service had been issued to her, but before slu^ luid oj)port unity to execute the oath. With but probably two or three excejitions, all these nurses had been assisting the Red Cross in caring for intluenza patients while waiting for tlieir travel orders for militarv service. Xtirsr Date of Death Place of Death lireen, Marli Ia. i-'orcc^. France 1488 APPENDIX American Red Cross Dietitians Who Died in War Service or as a Result of Disability Contracted Therein Dietitian Jury, Irene I Keech, Cara Mea Morse, Meda Norcross, Olive Peck, Marian Helen Wind, Hortense Elizabeth Date of Death Dec. 9, 1918 Oct. 18, 1918 Dec. 24, 1918 Sept. 26, 1918 Feb. 17, 1919 Dec. 10, 1918 Place of Death Naval Hospital, Pelham Bay Park, New York Base Hospital No. 68, France Camp Taylor, Louisville, Ky. Camp Dix, N. J. France Norfolk, Va. INDEX Abramson, Mrs. Jennie A., on con- ditions at Vittel, France, 501 Palestine Commission, 8i)2 Accueil Franco- A mericain, 830 Acevcdo, Eufrenia L., Children's Bureau at Toul, 7G6 Acre, Palestine, Red Cross hospital at, !)03 Adams, Mabel K., assistant on Nurse Corps of the Public Health Service, 1028 chief nurse, Base Hospital No. 13, 508 Addison, Sara R., at National Head- quarters, 240 relief work in fireoce, 1112 relief work in Macedonia, 1114 with Service de Hante, 58G Agramonti, Dr. Aristide, yellow fe- ver work by, 14 Ahrens, ^linnio 11., Committee of Transfer, 1021 director Central Division of Amer- ican Red Cross, 247 on mobilization of nurses, Chica- go, 404 pul)lic liealtli nursing, 1303 Aides, Red Cross, 955 Alaska, public health nursing in, 1:538 Albania, relief work in, 1107-1110, 1182 Albaugh, Rachael Independence, 1023 assignment of nurses, 1019 campaign for nurses, 1000 chief of Division of Institutional and StudeTit Assignment, 1017 Delano Memorial Committee, 1051 in iiitluen/.;i ejjidemic, !t75 Albriglit, Josephine, in cliarge of public healtli nursing at Vladi- vostok. 933 Aldford House, used as hospital, 721 Alexander, Amy, Delano Memorial Committee, 1051 Ale.xander, Mrs. Charles B., Com- mittee on Nurses for the Philip- pines, 62 Allan, Ida J., chief nurse of U. S. Army Camp Hospital 35, 428 Allen, Ethan. Committee, Memorial Fund to American Nurses, 1048 Allen, Mary Sherman, president, Texas Red Cross State Nursing Committee, 130 Allen, Dr. May, medical director at Dinard, France, 769 Allenby, General, 893 Alliance Hospital, Yvetot, France, 195 personnel of, 196 work of, 196 Allison, Grace, cliief nurse of U. S. Base Hospital No. 4, 339, 443 on embarkation of unit of Base Hospital No. 4, 414 superintendent of luirses of Lake- side Hospital, Cleveland, Ohio, 328 Altman, Henrietta, visit to devas- tated France, 989 Alunuue Societies of Graduate Nurses, organization of, 20 "Amberiiiu" treatment for burns. Oil Ambrose, Editli, as Chautauqua nurse, 1055 at emergencv liospital at Jouy-sur- Morin, 0(i8 American ambulance, at Neuilly, France, 535 American Committee for Armenian and Syrian Kelief. SS9 American Expeditionary Forces in France, 4S5. 032 nursing service of. (i34. ti05 shortage of nurses for. 515 Amerii'uii I'eih'rat ion of Nurses, af- liliation witli National Red Cross Society. 71, 74, 94 organization of, 71 14S9 1490 INDEX Americati Journal of Nursing, on civic obligations of nurses for Red Cross enrollment, 82 on Retl Cross reorganization and hope of alliliation with nurses, 74 publicizing. Red Cross events, 77 report from, on Red Cross afHlia- ti(m, 71 reprint of Red Cross Central Committee circular on recruit- ing nurses, 75 special military number, May, 1018, on extra-cantonment serv- ice, 394, 395, 399, 400, 402, 415 American ^Medical Association, co- operation with American Red Cross. 12G American Mission hospitals, volun- teer work in Siberia, 914 American National Red Cross, neu- tral character of, 22 non-sectarian character of, 22 organization of, 25 Relief Committee, 26 reorganized, aim and purpose, 75 American Nurses' Association, 1022, 1219 afliliation of American Red Cross nurses with, 71, 74, 123 Twentieth Annual Convention, 387-388 American Nurses' Club, London, 425 American Red Cross, cooperation of, with U. S. Medical Corps, 031 foreign program of, closed, 1914- 1915. >S'ce ]Mercy Ship Expedi- tion. general reorganization of, 1909, 101 in France, establishment of, 532 plan of nurses' enrollment for, 105 proclamation relating to, issued by President Taft, 1911, 120 American Red Cross Commission for Europe, 484, (512 American Red Cross Commission to France, 379 American Red Cross hospital serv- ice, 030, 031 American Red Cross hospitals: Ccmvalescent Hospital No. 101, Lingfleld, England, 434 Convalescent Hospital No. 102, \\'imblc(h)n, England. 438 Hospital No. 5, Paris, 747 American Red Cross hospitals: Hospital No. 100, 731 Hospital No. 101, Neuilly, France, (511 Hospital No. 103, Neuilly, France, on Hospital No. 104, at Beauvais, 590 Hospital No. 105, 604 Hospital No. 109, at Evreux, France, 609-610 Hospital No. 110, at Coincy, France, 616 moved to Villers-Dancourt, 617 Hospital No. Ill, at Chateau- Thierry, 617 Hospital No. 114, Luxembourg, 622, 770 transferred to Fleury-sur-Aire, 623 hospital in North Russia, 680, 684 hospitals in war zone, 612 hospitals, two types of, 532, 533 Military Hospital No. 1, 535 Military Hospital No. 3, 748 Military Hosi^ital No. 4, Liver- pool, 427 Military Hospital No. 5, at Au- teuil, France, 599 recreation hut of, 601 Militarv Hospital No. 6, at St. Chmd, 610 Military Hospital No. 21 ("Old- way House") , 429 Militarv Hospital No. 22, London, 430 Militarv Hospital No. 23, London, 430 Military Hospital No. 24, London, 430 Military Hospital No. 107, at Jouy-sur-M(irin, 0, 605 bombed by enemy aviators, 008 military liospital, at Jouilly, France, 003 militarv hospitals, operation of, 533 American Red Cross Motor Corps, and extra-cantonment zones, 404 American Red Cross Nursing Serv- ice. Kce Nursing Service. Executive Connnittee of National Conunittee on, 259, 260 relaticm of, to Army Nurse Corps, 313 INDEX 1491 American Red Cross ofTicials sub- ject to military jurisdiction of United States, 534 American Red Cross Bureau of Per- sonnel, 1573 American Hed Cross Headquarters, 23.J, 230 American Red Cross Town and Country Xursinj,' Service, name clianf^ed to lUireau of Public Ilealtb Nursing Service, 347 American Relief Clearing House, 531 American troops, brigaded with French and British, 579 sent to Siberia, 911 American Women's War Relief Fimd, Connnittee of, 140 Amiens, air raid on, 405 conditions at evacuation of, March, 1918, 831 work of Children's Bureau at, 774 Anderson, Colonel Henry W., Com- missioner for Balkan States, 1083, 1100 medical director in Roumania, 1128 organization of American Red Cross Commission for Rou- mania, 882 Anderson, P]va, public healtli nurs- ing, 1303 Anderson, Frances, 301. 302 Anderson, Mrs. Larz, Town and Coimtrv Nursing Committee, 1219 Anderson, Lyda. at National Head- quarters. 240 director. Southwestern Division of American Red Cross, 24(), 1038 nursing scliool in Constantinople, 1170 on Austrian suhlicr. 170 on care of wouiuh'd in \'i('nna Red Cross iidspital, ICS on ditlicult it's with individuals (.f units. 171 on (ierinan examination of travtl- lers cro-siiig tlic Ixirdrr. 171 oTi sliortagc of food and supplies in N'icniia. ItiO supervisor of Mercy Ship i'!\pe- ditioM liii K. KIS Angers. I'ranee. l'. S. Xav\- i'lase lln>pital No. 1, at. 72S,"7;55 Anglican order, nursing services of, in Civil War, 8 Angouleme, France, Red Cross dis- pensary at, 838 "Annex," (irst American Red Cross iiospital in North Russia, 080, 084 Anselmi, Kinilia Malatesta, Italian representative at Cannes Con- ference, 11.38 Apted, Mrs. Susan, at American Red Cross Military Hospital No. 5, at Auteuil, 001 A(juit(ini(i, collision with .S'..S'. Shaw, 727 Archer, Frances B., Chateau des Halles iiospital, 781 Archer, Beatrice, Palestine Commis- sion, 892 Arizona, rural nursing in, 1228 Arkwrigiit, Mrs. Preston S., Wo- man's Advisory Committee, 300 Armenia, American Red Cross funds for, 891 Armenia Proper, 888 Armenian and Syrian Relief. Amer- ican Committee of, 889 Armories, Red Cross emergency nurses sui)plie(i to, 02 Armstrong. Dr. Iv K., medical chief, Clifitelet Iiospital, 779 Armstrong, Mrs. W. N., in Army Nurse Corps legislative efforts, 08 Army, relati(m of nursing service to, 310-380. Sec also under Nursing Service. Army and Navy Nurse Corps, in- crease' of salary. 374 domestic service. 374 overseas duty, 374 regulations regarding uniforms, 374 Army Nurse I'ill. defeat of. 09 eir'orts for. 07, OS. 0!) Ariii\' Nurse (,'or]is. appointment to, 43 beiriiinini: of otlicial existence of, 42 bill relatiiii: to rank in. 1070 delit of. 1o Dr. McCee. 40 to Suri:eoii( ii'iieral Sternberi:, 4(; (letinite organization of. 70 lir>t lield service of ( IIUI i . 3 IS in punitive exjieditioii to \rra Cruz ( 191 r . ;!4S 1492 INDEX Army Nurse Corps, made permanent part of Army, 47 legislation for, 67 numbers of, during War service, Spanish-American War, 43 organization of, 42 origin of, 35-38 qualifications for appointment to, 39 regulations, 715 improved, 101 relationship of, to American Red Cross Nursing Service, 313 reorganization of, 106G, 1069 requirements for membership in, 38 salaries of, 697 status of, 356 war services of, Spanish-Ameri- can War period, 43 Army nurses, appointment of first six, 41 assigned to Red Cross, 621 bill to secure rank for, 1069-1072 passage of, by Congress, 1075- 1076 Congressional Committee report on value of, 65 cooperation of Red Cross with, 628 question of rank of, 1064-1066, 1069-1072, 1074-1076 Army rank for Nurses, efforts for, 70, 1064 et scq. *S'ee also Rank for nurses. Armv School of Nursing, 283, 284, 286. 287 Advisory Committee. 285, 286 conception of idea, by Sarah Edson, 11 gifts toward, 286, 287 phm sul)mitted, 284. 285 Arnett, Dr. Lillie A., on dispensary at Angoulemc, France, 838 on work at Le Glandier, 820 Anistein. Leo, director of Military Relief of Now ^'ork Count v Chapter. 363 Arllnir. Major, cfjinnicndation of male nurses on Mis.touri, 00 .Xrtillcry training cciitrc. at Camp ('()i't(|uidan, 738 Ashe. Kliz;il)('tli 11.. cliicf nurse of Chihiren's I'urcau, France, 551. 758 (if Cornniission for Bt'lgiuni, 818 Ashe, Elizabeth H., work in Chil- dren's Bureau, France and Bel- gium, 760 tuberculosis prevention work in France, 846 Asher, Blanche, on trip of Base Hospital No. 102 unit to Genoa, 670 Asile Caserne, Luxembourg, 622. 766 converted into military hospital, 770 Asile Ste. Eugenie, Lyons, France, 853 tuberculosis hospital, 850 Associated Alumnie, as part of The American Federation of Nurses, 71 efi'orts of, towards Red Cross affiliation, 71 misunderstanding between War Department and, 41 oflFer from, for Spanish-American war nursing service, 40 Astor, Mrs. John, Committee of American Women's War Relief Fund, 146 Athanasakis, Mr., president- of Greek Red Cross, 1166 Athens, infant welfare work in, 1116 relief work in, 1111 Atlanta, Ga., call for Red Cross nursing service at, 1917, 136 meeting of Red Cross Nursing Service, 1920, 1433 recommendations of, 1434 Atlantic Division of American Red Cross, 244, 245 Atlantic Highlands, Red Cross nurses at, 61 Auerl)ach, Joseph A., New York home of, used for nurses, 422 Austin Dam, breaking of, 1911, 132 Austrian soldier, 170 Austria, child welfare in, 1191 Autelitz. France, emergency canteen at, 837 Autcuil, France, emergencv hospital at. 59!) Auxiliary No. 3. Spanish-American W'ai'. meinbersiiip composition of. 47 report of, March 1. 1899, 55 Avinigiict. Dr., ciiild welfare work, I'aris, 815 INDEX 1498 Ayers, Colonel I-essie, chief nurse, Base Hos- pital No. 18. 486 on conditions at Bazoilles, France, 490 Baker, (ieorge F., Jr.. director of Commission to Italy. S-")'.) Baker, Newton Diehl. Secretary of War. and Red Cross liospital units, .'!41 on funiishinLT uniforms for Army Nurse Corps, 'M't'.) Baker, N. D., on regulations govern- ing the employment of American Red Cross in time of war (1916), 320 Baker, Mrs. Isabelle Wilbar, direc- tor of Elementary Hygiene and Home Care of Sick, 1369 Balcli, Dr., organization of Base Hospital No. 55 by, 338 Balcom, Helen, State Committee, Iowa, 112 Baldwin, Bertha, dietitian; Report of diet kitclien service overseas, 1411-1417 Baldwin, Dorothea, child welfare exposition at Marseilles, France, 792 Baldwin, Dr. John C, director, Children's Bureau at Nesle, FVance, 772 member of children's Bureau, France, 758 on conditions at Nesle, France, 772 Balfour ^lission, 442 Balkan States, relief work in, 1077, 1083, 1084, 1100. 1102 sanitarv conditions in, at out- break of World War, 187 Balzani, Contessa. scholarship to study nursing, 1175 Bamber, Beatrice, chief nurse. Base Hospital No. 1, 505 Bancroft. Dr. Mabel H., dispensary at Levallois, France. 803 on work for refugees in Paris, 834 Bapaume, France, captured by Ger- mans, 1918. 464 Baranovicci. Poland, condition of hospital at. 1090 Barber, Editli A., director Northern Division of American Red Cross. 247 report on influenza work, 977-978 Barbour, James R., American Relief Ch'urinfr House. 531 Barbussc. on the poilu, 152 Barire of. bv Austro-Germans, October, 191 5. ISO recoverv bv Serbs. Dec. 15, 1914, 179 Bell, Bessie S.. chief nurse of A. E. F., in France, 482, 50:5 director of nursing service, Chateau-Til ierry, 0.'}4 Bell, Surgeon \V. L.. National Com- mittee on Red Cross Nursing Service, 95 Bellevue Hospital. Nurses Training School ostablisiicd at, 1:5 Bellis, Major (J. 1... director of As^ilr Str. Kitgrnic. 850 Bellows, Dr., on women's work in tlie Civil War. 10 president of United States Sani- tary Commission. 8 Belmont, Mrs. August. Board of lncor])orat()rs of American lied Cro.ss, 1007 Delano Memorial Coinniittce, 1051 Woman's Advisorv Coiiiinittcc. .300 Benn, Edith Merle, Chautauiiua nurse, 1055 Renn. Edith Merle, chief nurse of American Red Cross Commis- sion for I'oland, 1089 resignation of, 1097 Bennett, Louise, on cruelty of war, 149 supervisor of Mercy Ship Unit D, 148 Bentinck, Mrs. Cavendish, opened suite for nurses in I^ondon, 425 Bentlev. Grace, public health nurs- ing, 130:} Benton, Dr. Fred G., 107 licreza Kartuzn, Poland, Red Cross relief work in, 1088 Besley, Florence M., Chautauqua nurse, 1053 Chautauqua work for rural nurs- ing, 1231 Besley, Dr. Frederick, director, Base Hospital No. 12, 409 Besom. Pansy, nursing school in Prague, 1152 Besson, Dr., child welfare work, France. 812, 815 Bethel. Mary IL. chief nurse of Vladivostok Refugee Hospital, 933 nursing school in Prague, 1152 Bettman, Florence, first dietitian overseas, i:?Sl Botts. Miss. ai)pointed for Philip- pine service, ()3 Beyea, ^Irs. Daisy Pirie, Chautau- qua nurse. 1055 on conditions at Evacuation Hos- ])ital No. (1. 045 Bialvstok. American Red Cross re- 'lief work at. 1093 Bivrire llnpital. 807 Hicknell, Ernest P., committee on lectur(> course for Red Cross nurses, 122 Coniinitt(>e on Towti and Coimtry Nursing Service, 1204 director-general of Civilian Relief, 231 European Commissioner, 530, 11 ss on typhus in .'Serbia. 180 on uniforms of Army Nurse Corps. :!(.() jilans fnr extension of Red Cross for relief work, 242 liigelow, .Mida, relief work in Ser- bia, 1120 1496 INDEX Bigelow, Glenna F., on preparation for overseas duty, 418 Bigelow, Helen Amy, in charge, Children's Hospital at Evian- les-Baina, 778 Biggs, Dr. Herman M., committee on settling war nursing policy, 254 conference to consider nursing problems, 254 report on tuberculosis conditions in France, 844 Billings, Bernice, public health nurs- ing, 1303 Billings, Dr. Frank, in efforts for Army Nurse Bill, 69 Bingham, Laura Blanche, on work at Children's Hospital for tuberculosis prevention, Paris, 852 Bird, General Charles, Central Com- mittee, 230 Birmingham, Colonel, acting sur- geon-general, U. S. Army, 349 on requirements for enrollment of reserve nurses for Mexican Border service, 352-353 on uniforms of reserve nurses. Army Nurse Corps, 305, 369 Birtles, Agnes C, hospital work at Liverpool, 428 reception of, in London, 425 Black, Major Carl E., plans for nursing school in Greece, 1165- 1166 Black, Miss, delegate to ninth In- ternational Red Cross Confer- ence, 1912, 124 Blackstone, Eleanor, relief work in Serbia, 1119 Blackwell, Surgeon E. M., 126 Blackwell, Dr. Elizabeth, helpful intimacy with Florence Niglit- ingale, 6 share in organizing United States Sanitary Commission, 6 training of nurses in Civil War, 5 Blackwell, Dr. Emily, training of nurses by, in Civil War, 5 Blake, Dr. Joseph A., eslablislied American Ked Cross Military Hospital No. 2, France, 538 Blakelv, Dr. R. M., relief work in Serbia, 1123 Blatch, Mrs. Harriot S., work of, to secure rank for army nurses, 1065, 1069 Bliss, Mr. Robert W., on Executive Committee of American Red Cross, 1007 Bliss, Mr, and Mrs. Robert W., or- ganization of American Dis- tributing Service by, 531 Blodgett, Mrs. John Wood, on nursing course at Vassar, 268 Blois, France, American Red Cross dispensary at, 797 children's hospital at, 798 tuberculosis hospital at, 853 Blue, Admiral, securing of officers for Mercy Ship, 140 Blue, Surgeon General Rupert, 1024 creator of Committee of Public Health Nursing, 266 gives Red Cross responsibilities in influenza epidemic, 973 National Committee on Red Cross Nursing Service, 248 on Red Cross public health nurse, 403 Boardman, Mabel T., Central Com- mittee, 230 committee, lecture course for Red Cross nurses, 122 Committee on Rural Nursing, 1216 Delano Memorial Committee, 1050, 1051 Executive Committee, reorganized Red Cross, 74 National Committee on Red Cross Nursing Service, 95, 127, 249 on appointment of Red Cross nurses, 84 on class instruction for women, 1352 on dietitian classes, 1376 on enrollment in the Nursing Service, 357 on home nursing courses, 1355, 1.356 on importance of Nursing Serv- ice {Red Cros^'i Bulletin), 75 on plan for affiliating organized nurses, 88, 89 on Red Cross nursing standards, 83 on "Tjie Red Cross Nurse," ad- dress before American Society of Superintendents of Training Schools, 75 on Red Cross Nursing Service, 327 INDEX 1497 Boardman, Mabel T., on services of ^rrs. Whitelaw Rcid. 47-48 or^'anizing Rural Nursing service, 12t)4 plan for Red Cross aides, 1052 preface to Red Cross text book, 135!) Town and Country Nursing Com- mittee, 1219 "Under tlie Red Cross Flag," ac- count of sanitary commission of Rockefeller Foundation and American Red Cross in Serbian typhus epidemic, 11)15, 184 Woman's Advisory Committee, 300 Bobigny, France, American Red Cross dispensary at, 810 Bogart, Eugenia, relief work in Serbia, 1122 Bogle, Klizabetb McC, chief nurse, Base Hospital No. 40, 439 Bolignv, !Miss, nursing services at i'once, 33 Bordeaux, France, children's hos- pital at. 795 dock infirmary of American Red Cross at, l(il2 U. S. Base Hospital No. 6 at, 493 Borgcson, Dr. Egbert, relief work in Serbia, 1119 Bosio, Sigiiorina, scholarship to study nursing. 1175 Boston Instructive District Nursing Association, training for public health nursing, 1241 Boston Visiting Nurse Association Training for public iicaltii nurs- ing, 1251 Boulevard Fielleville dispensary, 809 Bouldgnc-sur-Mer, Base Hospital No. 5 at, 453 Bowling. (icrtrude, Chautauqua nurse. 1055 on Argonne victory, (i()4 on conditions at Chateau-Tliicrry, (itiO Bowman, J. Fxatrice. 147 on llaslar Hospital. 14(i on naval iiospital at (ireat Lakes, HI.. 7119 servires at Hat t ieshur--. 190S, 1:50 sui)ervisor of Mercv Sliip liilt !), 14(i on Tommv Atkins, 1 IS Boyle, Sara Jane, child welfare work at Le dandier, 818 on work at Le dandier, 818 Bradbury, Dr. Bial F., director of Mer'cy Ship Unit G, IGO general consulting surgeon of Ger- man military hospital at Kosel, IGO return of. to United States, 167 Bradford, Flora, Chautauqua nurse, 1053 Bradley, Colonel A. S., 484 Bradley, Dr. Frances Sage, on tuber- culosis prevention work in France, 853 Bradner, Capt. M. R., relief work in Serbia, 1121 Brady, Bernice, relief work in Mon- tenegro, 1100. 1107 Braisted, Rear Admiral William C, 080, 092 Central Committee. 230, 1007 Executive Conunittee, 1007 National Conunittee on Red Cross Nursing Service. 248 on committee to secure Red Cross ship for World War, 140 Brandon, Mrs. Gertrude C, work of, at Harbin. 938 Braun, Frederica, on Naval Hos- pital in (luam. 732 P.reaux, Lvdia, Chautauqua nurse, 1055 Bremer, Mrs. Harry ^L. recruiting relief niu'se.s for Poland, 1085 r>rennan, Agnes, superintendent at Bellevue, during Spanish-Amer- ican War period, 4!) Brest, France, doek infirmary of American Red Cross at, 1011 U. S. Armv base hospitals near, 99() U. S. Navv Base Hospital at, 728, 730 Brest-!. itovsk, Red Cross relief work at. 1094 Hrest-Litovsk 'ireaty. 4C.4 ISrcwer. Cliailotte. at National llcad(|uarler<. 240 i'.rewrr. Dr. Ceoige K.. 329. 339 l'>ridi:e. Helen I... dillicuhies in War- ns , on ciliiciit ioiial nursing work in Sjlie; ia. '.>:H M;i(i (i!i scIiomI ill \\ar<:i\\. lltU relief Work in i'dland. 11(10 work of. at Chita. Silieria. 950 1498 INDEX Briglmm, Peter Brent, Unit, U. S. Army Base Hospital No. 5, 452 Brinsmade, Dr. W. C, director of U. S. Navy Base Hospital No. 1, 734, 996 British Nursing Service, 472-482 rules for nurses, 476 status of nurses in, 483 Brogan, Mary A., Children's Bureau at Nesle, France, 772 Brookbanks, Nellie V., chief nurse, American Red Cross Military Hospital No. 4, 435 hospital work in England, 429, 431 Brooke, Meta C, assistant on Nurse Corps of the Public Health Service, 1028 Brown, Eleanor Beatrice, visit to devastated area, France, 989 Brown, Mary Magoun, 361, 362, 371, 373-374, 383-384 Brown, Miss, relief work in Albania, 1422 Brown, Mrs. Edgar, volunteer helper, 241 Brown, Mrs. Leonard, 154 Brownell, Mary, Roumanian Com- mission, 882 Bryan, Dr. Robert C, Roumanian Commission, 882 Bryant, Sallie J., work of, at Bero- soka, Siberia, 947 Buchaloo Hospital, Siberia, 915 Buchannan, Sarah, relief work in Albania, 1108-1110 Buckler, W. H., London Chapter, American Red Cross, 425 Bucklin, George A., Jr., 155 Budapest, establishment of Red Cross hospital at, 172 Budapest, passage of troops tlirough, 175 Budapest liospital, closing of, 175 relief work at, 173-174 wounded at, tlioughtfulness of, 175 Budin, Madame, cliild welfare work, Paris, 815 Buffalo District Nursing Associa- tion, training for ])ublic health nursing. 1244 Bukeh'v, Cajjt. Rud()lj)h, on anti- tvplius work in Siliei-ia, 918, 919 on conditions in Omsk, 925 on conditions in Siberia, 920 Bukeley, Capt. Rudolph, on Siberian prison trains, 921-922 Bulgaria, mobilization of, 221 plans for nursing school in, 1167, 1168 relief work aniong Greeks in, 1192 Bull, Mrs. Lanmau, Committee on Nurses of Auxiliary No. 3, Spanish-American War, 47, 55 nursing services on the Oregon, 32 Bullard, Florence, Chautauqua nurse, 1055 Bunting, Laura, relief work in Samos, 1113 Bureau of Equipment at the At- lantic Division, 371, 384 Bureau of Information for Nurses, 1014-1016 Bureau of Nurses and Medical At- tention, Florida yellow fever epidemic services from, 16 Bureau of Nurses' Equipment, 371 establishment of, 363 Bureau of Sanitary Service under the Department of Military Re- lief, 346 Burgar, Donna G., on Viktoria Theater hospital at Gleiwitz, 162 Burges, Anne, at Orleans, France, 1918, 740 head nurse at Camp Coetquidan, 738 Burgess, Charlotte, supervisor of Mercy Ship Unit C, 156 Burgess, Gelett, on work of Miss Noyes, 1367 Burgess, P^dith, relief work in Montenegro, 1106 Burgess, Elizabeth, 955 conference of medical and army officers and nurses, 284 League of Nursing Education, aides course at Vassar, 268 Burgess, ]Mary A., chief nurse of evacuation hospital in Chan- tillv, 615 Burke, Nirs. E. S., head of Cleveland workroom for hospital supplies, 299 Burlingamc, Dr. C. C, 531, 619 director. Hospital Service, Amer- ican Red Cross in France, 531 on American IJed Cross Military Hospital No. 6, Oil INDEX 1499 Burlingame, Dr. C. C, on American H('(i Cross military liospital at Jouilly, (i()4 on American Red Cross Hospital No. 110 at Coincy, (51(> on emergency hospital at Auteuil, 55>9 on emergency hospital at Jouy- sur-Morin, GO.) report of hospital work, (530 Burnap. Dr. Sidney K., 3.39 lUirner, Ooiah, 491 lUirnliam, Dr. Marjorie, relief work in Serbia. 1110 Unrns. "amberine" treatment for, Gil Bnrns, Sophia M., conference witli Miss Rhodes, oTG Mobile Hospital No. 9, 049 lUurev, Helen T.. on hospital train service, 500, G3G. G39, G42 Burrill, Mrs. Harvey D., State Com- mittee of New York, 110 Bush, Irving. 140 Bushnell. Colonel (Jeorge E., Acting Surgeon (Jeneral, Medical Corps, on expense of equipment of Army Nurse C()r])s, 370 Butler, Edward 1).. conference to consider nursing ])roblems, 2')4 Butler, Dr. Etlian Flagg. director of Serbian Unit No. 2. 180, 187 in charge of surgical pavilions at American Red Cross hospital at Belgrade. 182 Butler. Ida F., Chautauqua nurse, 1055 chief nurse of Hospital Violet, 784 in charge at National Headquar- ters durintj Miss No\es' tour, 117G on results of Chautau(]ua talks, 10.17 Butler. Miiuiette. on care of con- tagious cases. 70.") Bybee, Louise, at f'liatraii- dcs llnlirs- hospital. 7S0 r>yiiigt()Ti, Margaret, on functions of nurse and social worker, 1317 Cabaniss. Sara, nursing instruction for wiiinen. 13.">1 Cabot, Dr. i\i(liarii ('.. director of Paris dispensary. I/Acciiiil Franco. [ nwricaiii, 830 Cabot, Major Richard A., 774 Cadel. Inez, ljoui.se, chief nurse of Trudeau Sanatorium, France, 852 Cadmus, Nancy, record of, 64 Callin, Freda, at Le (Jlandier, 819 Catlin, Freda M., on dispen.sary at Rue Censier, I'aris. 805 on dispensarv at N'alence, France, 842 Caldwell, Mary, on work at Ameri- can Red Cross Military Hos- pital No. 3, 748 California, early work toward re- jdacing Red Cross State Nurs- ing Committee by the State Nurses' Association, SG Nurses' Auxiliary (1909), 135G pui)lic health nursing in, 1342, 1343 exhibits, 1.350 Ciunbrai, school of nursing at, 822 Cameron. Mary Muriel, nursing service in Santo Domingo. 1199 Camouflage Camp, at Dijon, France, 81G Camoullage of ships, 423 Camp I'dack, Red Cross services at, Gl Cam]) Coetquician, artillery training centre. 738 Camp Perry, yellow fever quaran- tine cainj). 15 Campbell, Estidle, and cantonment duty. 390 Canicattini I'agni, Sicily. American Red Cross hospital at, 8(55 Cannes, International Red Cross Conference, A])ril, i91!>. 1137 report of. 1138-1140 Canteens, emergency, at railroad stations in France. 8.37 Capps, Lieutenant -( 'olonel Edward, in conunand of Conuuission for (;reece. 1100 I'clief work in (! recce. 1111 Carditr. Wales, American coaling l)ase. 724 hosi.ital at. 724 Carney. Anne, cliief luirse at Asilc Str. iUnii'nif. S.")l( Carpenter. Mrs. Mary C. on State Cuniniittee of WCst \iri.'inia, 110 (';inel Mi>-ion, in Pnnniania, S7S Carroll. Dr. .lanies. vellnw fever work bv, 14 1500 INDEX Carson, Isabelle F., chief nurse of American Red Cross Military Hospital No. 23, 430 Carter, A. Maury, at National Head- quarters, 240 Carter, Gertrude P., chief nurse of Red Cross unit at Omsk, 925 work of, in Siberia, 914 Carter, J. Ridgely, American Re- lief Clearing House, 531 Carver, Prof. Thomas N., Town and Country Nursing Committee, 1219 Casa dei Convalescent i, 866 Casualty Clearing Station No. 61, 462^ Casualty Clearing Stations, 461 Catholic orders, otfers from, for Spanish-American War nursing service, 40 Catholic Sisters, nursing services of, in Civil War, 7 Cazalet, Colonel Charles, public health work at Bordeaux, France, 796 Census of nurses, 301, 304, 305 need for, 306-308 Central Division of American Red Cross, 247 Cerna, Vilma, training for work in Prague, 1150 Cetinje, ^lontenegro, relief work in, 1106 Chalons-sur-Marne, babies' hospital at, 828 Chamberlain, Senator, bill for re- organization of Army Nurse Corps, 1066 Chambers, Frank R., recommends nursing course at Vassar, 268 Chandler, ^lyrtle Gilmore. on Naval Hospital at Parris Island. 708 Chaney, P^milv, relief work in Al- bania, 1110 in ^lontencgro, 1106 Chanler's Hospital, Miss, Red Cross nurse at, 61 Chanler. Margaret L. (^Irs. Richard Al(iricli), in Army Nurse Corps legishi^ive efforts* 68, 70 investigation by, of Pliilippine nursing conditions. 69 niirsing services at Ponce, 33 services of, 64 Chantiliv, France, evacuation lios- pital at, 614 Chapin, Dr., conference to consider nursing problems, 254 Chapman, Olive, director of public health nursing, Moimtain Divi- sion, 1303 "Chapters," or local branches of American Red Cross adopted, 1909, 102 Charleston, demand from, for nurses, Spanish-American War, 58 Red Cross nurses at, 60 Charlton, Anna, State Committee of New York, 110 Chateau de la Fontaine Bade, 848 Chateau des Halles, hospital for children, 780 Chateau Hospital, at Sermaize-les- Bains, 829 Chateauroux, France, Base Hospital No. 9 at, 499 Chateau-Thierry, American Red Cross Hospital No. Ill at, 617 Chatedguvon, France, Base Hospital No. 20 at, 506, 507 Chaumont, France, Base Hospital No. 15 at, 493 Chautalonette Hospital, opened at St. Eticnne, France, 1919, 789 Chautauqua cooperation for rural nursing, 1231 Cliautauqua nurses, 1053-1059 Cheliabinsk, Siberia, evacuation of, 942 Red Cross hospital at, 940 Chelsea, naval hospital at, 706 Cherry, Elizabeth E., on evacuation hospital at Cliantilly, 615 Cherry Mine disaster, 131 Chesley, Major A. J., chief of staff of relief work in Department of the East, 1087 director of American Red Cross Commission for Poland, 1088, 1089 Chester, Pa., nursing service at, 1917, 136 Chicago Visiting Nurses' Associa- tion, training for I'ublic Health Nursing, 1243 Cliickamanga Park, hospital needs at, 58, 59 Chief nurse (American Red Cross), duties of, 568-570 position after reorganization, 573 C'iiiid, Dr. Dorothy, in cliarge of dis- pensary and lal^oratory, Ciiate- let hospital, 779 INDEX 1501 Child, Dr. Florence, resident physi- cian at CliAtelet hospital, 770 Chihi saving centers, Dr. Farrand'a phin for, 1178 Child welfare, Albania and Monte- negro, recommendation for, 1183 child health work in, 1198 Constantinople, 1180 Dr. Hill's work for child health centers, 1190 expositions, France, 783 at St. Etienne, France, 790 at Toulouse, France, 1918, 795 Europe report of Miss Gardner, 1189-1191 France, 1918, 812 Greece, 1181 Poland, 1179, 1180 program for, 1195 rural nursing, 1231 Children's Bureau in France, activities of, 7G5, 824 at Amiens, 774 at Bloise, 797 at Corbeil, 798 at Dieppe, 779 at Evian-les-Bains, 777 at Lyons, 783 at ^Ia^seiiles, 791 discontinued, 1919, 795 at Nesle. 771 at Paris, 801 discontinued. 1919, 809 feeding of child reTi by, 808 training of visitcuses d'cnfavls l)y. 811 Cliildren's Bureau of Civil Affairs Department, 757 Cliildreirs Bureau, work of, 700 C'liildreirs Hospital, at Evian-les- Bains. 777 Chinese Citv Hospital at Harbin, 937 Cliios, relief work in. 1113 ( liita. Siberia. American Red Cross work at. 950 Clirysakis, Margaret, relief work in (Jreece. 1111 Chubb. Heiidon, National Advisory Committee on Insurance. 1041 Chul)l), Percy, estate of. at Wim- bledon, England, used for con- valescent hosjtital, 43S Cluireli. Mrs. Margaret P.. ehil.l welfare work. France. 1918. Si:! Children's Bureau at Blois, France, 797 Churchill. Lady Randolph, Commit- tee of American Women's War Relief Fluid, 140 Cincinnati meeting of Red Cross Dietitian Service. 1432. 1433 Civil Alfairs Department of Ameri- can lied Cross, 757 Civil War, lack of trained nurses in, 5 nursing services of sisteriioods in, 7 relief work in, by U. S. Sanitary Commission, women of, memorial to, proposed, 123 Civil War nurses, roster of, 12 Civilian Relief, 231 Clark, Alma A., child welfare work, France, 1918, 809 Clark, Dr. Harriet, on Chios, 1113 Clark, Lillian Craig, work of, at Irkutsk, 944 Clark, Dr. Taliaferro, director of Red Cross Bureau of Sanitary Service, report of, 340 on funds for public health nurs- ing, 12S() surgeon. United States Health Service. 340 Clarke, Major William E., Commis- sion for France. 51)2 Clarke, ^lartiia S.. at Asilf f'as(r)u\ Luxembourg. 022 chief nurse of relief work in Pruzana. Pcdaiul. IDSO. lUSS Clarke. Mary A., on Miss Delano's ])lan for home nursing. 13.")7. 1358 on Miss Delano's fitness for Red Cross organization service. 72 on I^ed Cross cnrollnu'iit of nurses, 1 1 t Classification of nurses. 301 Miss Delano's work on. 3()2-:!li;! 30 t Clav. Josephine, at llnjiih:! Aii.r- iUan. Sn. 34. IDO volunteer service at St. \'aleiy, 539 (lay. Cnlniiel and Mrs. Spender. " estate (if. at l.inglirld. Kngland. used for Aniiri;;in Red C'^^-^ eolivali'-eellt liii>]iit :l 1. 4. "4 Clav. Kv.. nursing >crviee at. l'.17 ' Kill' ( lay)M.,,l. May, at. National Head- ' (|iiartn>. 210 1502 INDEX Clayton, S. Lillian, Committee of 'Transfer, 1022 committee to get hospitals to aid in training army nurses, 286 conference of medical and army olHcers and nurses, 284 conference to consider nursing problems, 254 enrollment of nurses, 290 plaji for special enrollment, 258 Joint National Committee, 1047 Joint National Committee of Bureau of Information, 1016 National Committee on Red Cross Nursing Service, 248, 249 Clement, Fannie ., Committee of Rural Nursing, 1216 conferenco to consider |nursing problems, 253 director of Town and Country Nursing Service, 240 head nurse. Red Cross Town and Country Nursing Service, 206 National Committee on Red Cross Nursing Service, 249 on classification of nurses, 1271, 1272 on plan for rural nursing, 1218 on public health nursing, 1253 on Red Crosa 'influence, 1232, 1233 on training for public health nurs- ing, 1246 outline of activities for rural nursing, 1217 report on work in rural nursing, 1226-1231 resignation from rural nursing, 1234, 1235 superintendent for rural nursing, 1215 work for piiblic health nursing, report, 1913. 1222-1224 Clendenning, Edith, head nurse of I'olisli armv hospital at Vilna, 1093 C'lolliing and supplies, purveyed by Florence Nightingale, 3 ('lul)s for nurses, American Nurses Club, London, 425 Coaling base, American. 724 Cobb, David L., counsel American National Red Cross, 1S98, 25 C(/blen/,, occupied by American Red Cross, 994, 995 Coetquidan Camp, artillery training centre, 738 Ooffey, Anna E., assistant chief nurse, A. E. F., in France, 503 nursing service at Chateau- Thierry, 634 Coffin, C. A., Committee for Me- morial Fund to American Nurses, 1048 Cohan, France, conditions at, 753 Coincy, France, American Red Cross Hospital No. 110 at, 616 Colburn, Clara, Committee on Red Cross Dietitian Service, 1379 Cole, Aileen B., on reception of colored nurses at Camp Sher- man (Dec., 1918), 406-407 Cole, Mary L., director of Public Health Nursing, 1304 Collin, Dr., child welfare work, Paris, 815 Collins, Dr. Joseph, tubercvilosis prevention work in Italy, 867 Colon, Annie L., work during influ- enza epidemic in Michigan, 978- 979 Colony Club, mobilization station for nurses, 420 Columbia Universit}', training for public health nursing, 1252 Concord, N. H., District Nursing Association, 1244 Conley, Emma, chairman, Commit- tee on Red Cross Dietitian Service, 1379 Connecticut Training School, ofTer of, for Spanish-American War service, 40 Connellv, Bettv, chief nurse, Mobile Unit No. 5, 451 Connely, Willard, on training of hos- pital corpsmen, 712 Connor, Major C. 11., National Com- mittee on Red Cross Nursing Service, 249 Constantinople, conditions in, 1180 nursing school in, 1168, 1169, 1170 "Contract doctor," 350 "Contract nurse." 350 Contrexeville. France, U. S. Army Base Hospital No. 32, 503 Convalescent Bureau, 614 Convalescent home. La Chaux, at Lyons. France, 785 C(jnvalescent homes, American Red Cross, 732 INDEX 1503 Convalescent homes for nurses, 1033- 1035, 1037, 1040 at Kowayton, Conn., Spanish- American War, Gl Convoy system of transportation, 718 Cooliilge, Mrs. J. Randolph, Jr., Woman's Advisory Committee, 300 Cooper, Edna, hospital train ser- vice, .lOO, 030 Cooper, Ix'na F., Committee on Red Cross Dietitian Service, 1378 letter of Major :\Iurlin, 1400 suj)ervisi(in of dietitians' report, 142"), 1420 vice-president, American Dietet- ics Association, 1398 Cooper, ilrs. Margaret R., Chautau- qua nurse, 1053 Copelin, Bessie A., on trip to Fleury-sur-Aire, 023 Copp, A. W., on Commission for Europe, 530 Corheil, France, plavground at, SOI Red Cross dispensary at, 800 work of Children's Ihircau at, 1918, 798 Corhett, Miss, work for dietitians' enrolhnent for Red Cross hos- pital service, 85 Corbin, Adjutant-General, letter from, aiitliori/ing Red Cross nurses for the Philippines, 02 Corps insignia. Navy Nurse Corps, 095, 097 Corresj)on(U'ncc courses for nurses' training, 20 County Farm Bureau, coiiperation witli pul)lic health nursing, 1351 Cover. Dr. Elh'n, Clu'ilcau ih s lhillr. Hospital, 780 Cowdin, Mrs. Wintiirop, 48 active nicmher Committee on nursing. Auxiliary No. 3. SpuTi- isii-Aiiu ican War. 47, '^'y first cliairinan, Coiniiiittct' to F^c- curc by Att of Congress the Enipioyment of Wdmeii Nurses in Hospital Service of tlie l'. .'^. Army. 07 on special eoiniiiittee for ehiser coiiperat imi lietween lied Cross and goN'eniineiit, 5(1, 57 Cowlcs, Mrs. William L., Commit- tee, on Nurses for tiie Philip- pines, ()2 in .\nnv -Xur.se Corps legislative effort^ 70 pioneer member of Au.xiliary No. 3, Spanish-American War, 47 Cowman, Dr. Isabel Elliot, vice- president. Society of Spanisb- Anierican War Nurses, 40 Cox, Dorotliy, ciiild welfare work at Lyons, France, 780 Cox, Mary 1)., ill with typiuis, 191 Crandall, Flla Phillips, aid in get- ting enrollment of muses, 290 committee to get hospitals to aid in training army luirses, 280 Joint National Conunittee, 1047 Joint National Conunittee of Bu- reau of Information, 1010 National Conunittee on Red Cross Nursing Service, 249 on National Organization for Pub- lic llealtii Nursing, 1220 executive secretary, 347 resolution for rank for army nurses, 1074 Town and Countrv Nursing Com- mittee, 1219 work at Davton, Oliio, Hood, 1913, 134 Crawford. .Maude S., on conditions in an evacuation liosi)ital, 040 Crawford, Sarah Adams, su])ervis- ing nurse of Burt'au of Tuber- culosis, France. 84ti, 852 Creadick, Fli/.aiietli, on American Red Cross Military Hospital No. 5, 002 Crete, infant welfare in, llKi Crightoii, Lily B., chief luu-se in Anierieaii \lvi\ Cross .Military Hospital No. at St. Clouci, Oil Crile. Dr. CcHirire W., director of r. S. Aniiv nM>e Hospital No. 4. l.akeihide. :!:iS. 443 orgatii/at inn of base hospitals f(U' I'liited States Arni\. :!27. .328, 32:t. ;i:;2. 337. 33S pi-oject for oigaiiizat ion and eipiilinicut of (( h{. 25. 1915 i , .!27 Crocker. Mrs. Win. 11.. \\"onian"s AihiMiry ( diiiinil tee. :\n{) C'roisic. l-'raiice. ( iiu\alesci'nt nurses' liniiie at. lit4M 1504 INDEX Cromelien, Maud, visiting agent of Auxiliary No. 3, Spanish-Amer- ican War, 51 tour of field hospitals, 58 Cromwell, R. Lee, 159 Croslev, Sara, relief work in Serbia, 1120 Cross, Miss, volunteer helper, 241 Crowell, Elizabetli, tuberculosis pre- vention work in France, 845 Cuban civil hospitals, American nurses' work at, 64 Cuban Red Cross nursing contin- gent, first, 30 Cudahy, Mrs. Joseph, Board of In- corporators of American Red Cross, 1007 Woman's Advisory Committee, 300 Cullen, Mrs. Thomas S., head of Baltimore workroom for hos- pital supplies, 299 Curley, Teresa, ill with typhus, 191 Curtis, Margaret, child welfare work, 1187 director of Bureau of Refugees and Relief, Paris. 825 Curtis, Mrs. Namah, nursing organi- zation services of, 38-39 Cusliinrr. Dr. Marvey, 329 director, Base Hospital Xo. 5, 452 organization of base hospitals, 332, 333 Cushman, Ruth, on bombing of Cha- lons, 054 Cuthbert, Eugenie J., volunteer helper, 241 Cutler, .J. Otis, manager of Four- teentli Division, 912 Cutting, ]Mrs. Bayard, in Army Nurse Corps legislative efforts, 68 pioneer member of Auxiliary No. 3, 47 Czech naval liospital, 913 Czechoslovak armv, activities of, in Siberia, 910* . Czeclio-Slovakia. cliild welfare in, 1189, 1190 relief nurses in, 10S3 school for nurses at Prague, 1150- 1154 Dalilman. Jane T., Chautauqua nurse. 1055 Dai lev. Anne, Chautauqua nurse, ]'05o Dallas floods, 1908, 130 Dallyn, Capt. F. A., director of Inter-Allied Commission, expe- dition in Siberia, 918 Dalv, R. J., Commission for Europe, "^531 Damar, Annie, instruction for women, 1354 Damer, Miss, Alumnae representa- tive, Committee for affiliating organized nurses with Red Cross, 73, 87 on need that state nursing asso- ciations act directly for Red Cross, 86 on nurses' enrollment with Red Cross, 81 Daniels, Josephus, on hospital ex- pansion at Norfolk, 700 Danna, Dr. Joseph A., director U. S. Base Hospital No. 102, 605 Dannes Camiers, France, air raids at, 453, 472 U. S. Army Base Hospital No. 5 at, 452 U. S. Armv Base Hospital No. 12 at, 469 D. A. R. Hospital Corps, ajid So- ciety for the Maintenance of Trained Nurses, cooperation between, 60 Darche, Louise, early nursing super- intendent, 19 Darrach, Major, at British front, 454 Darst, Lieutenant Gilford, 140 Dartford, England. U. S. Base Hos- pital No. 37 at, 437 Daspit, L. Agnes, director Gulf Di- vision of Red Cross, 246 Dauser, Sue Sophia, ciiief nurse of U. S. Navy Base Hospital No. 3, 722 on L'. S. Navv Base Hospital No. 3, 723 Davis, ^lajor-General George W., chairman. Central Committee, 206 Davis. Rev. Robert, Commission for Europe, 531 Davis, Dr. Robert, worl. with chil- dren in Toul, 765 Davis, John W., Central Committee, 2.30 Davison, Henry P., accepts aid of National Committee to League, 1142 INDEX 1505 Davison, Henry P., and nurses' equipment, 3()4 at International Conference at Cannes, 1919, 1137 chairman on War Council, 253 conference to consider nursing problems, 254 Executive Committee of American Red Cross, 1007 opinion of Miss Delano's services, 967 work of, for Red Cross, 1136 Davison, Mrs. Henry P., cliairraan of Committee for Memorial Fund to American Nurses, 1047, 1048 Delano Memorial Committee, 1051 recruiting relief nurses for Po- land, 1085 Day, William R., action toward fix- ing official status of the Red Cross, 26 Dayton, Ohio, floods, 1913. 132 Dean, ]\Ira., efforts for Red Cross affiliation, 71 superintendent at Mt. Sinai, 49 Deans, Agnes G.. National Commit- tee on Red Cross Nursing Ser- vice, 249 conference to consider nursing problems, 253 Nursing Service Headquarters, 238 De Arizcun, Madame. 154 Deaths of nurses during war, 1032 De Calirole. Madame. 154 Decentralization plan, 242 DeForest, Robert W., Central Com- mittee, 230 Dehellev, Dr., work of, in Rouniania, 878 Delano, Jane Archer, activities of, during Spanish-American War period, 72 address to Convention on Nursing Education. 957-902 American Red Cross parade. New York, 420 appeal to graduating nurses, 343 assignment of reserve nurses to Mexican l^nrder by. 353 at Twentieth Annual Convention. AniericaiK Nurses' Association, 387-388 burial of, temporarv, at Savena\, 1004 Delano, Jane Arelier, cantonment nursing, during epidemic of contagious (iiscascH, 394 ceiiHiis of nurses, 301 chairman of conference to con- sider nursing prol)lems, 253 chairman of National Conunittee, 320 chairman of National Committee f)n Red Cross Nursing Service, 95, 96, 127, 248 Cliristmas boxes to nurses over- seas, 207 conunittee. lecture course for Red Cross nurses, 122 Committee on Red Cross Dietitian Service, 1378 Conunittee on Rural Nursing, 1216 committee on settling war nursing policy, 254 conunittee to get hospitals to aid training army nurses. 286, 287 committees for luirses' enrollment, lOS Conference of ^ledical and Army Officers and Nurses, 284 correspondence witli reserve nurses on Mexican Border, 353- 356 deatii and fmieral of, at Savenav, 1003, 1004. 10.32 delegate to Ninth International Red Cross Conference, 1912, 124 development of American Red Cross under. 3;i0 directions to nurses' aides (let- ter), 274. 275 director of Nursing. 24S early life story of. l(i. 17 editor Red Cros< I)e])artinent of Antrrivan Journal of \itrsiiig, 115 efTorts for Red Cross affiliation. 71 embarkation for trip overscans. 995 ]Mnert:i'iic\' Conunittee on Nurs- ing', -ilU final resting i)]ace of. at Arling- ton ccini'tcry. 1"05. lOOO licad (if I'liitcd States nursing forces. :!11. .'iU. 317. 320 in I'loriiia \cll(i\\ levi-r epidemic, 1(1 last birtlidav ..f. lOdl last illness of. in()i)-10i)2 V 1506 INDEX Delano, Jane Archer, letter of introduction from Walter D. McCan, Cliief Surgeon, A.E.F., Paris, 99!) letter to nurses, at time of war, 1272, 1273 memorial for, 1049, 1050 National Committee on Red Cross Nursing Service, first meeting, 102 National Relief Board, 1912, 125 Nursing Staff, 1916, 235 on affiliation of Red Cross and state societies of nurses, 112 on Army School for Nursing, 963, 965 on assignment of colored nurses, 406 on Base Hospital No. 57, 999 on classification of nurses (re- port), 300 on Committees of Red Cross Nurs- ing Service ( report ) , 252, 253 on Dietitian Service, 1381 on dietitians' classes, 1378 on enrollment in the Nursing Ser- vice. 357, 391, 392 on enrollment of nurses (report), 289, 290 on equipment of Army Nurse Corps, 374-383 on first day at Brest (diary), 996 on home nursing, 1360 on interest in nursing after war, 1362, 1363 on Navy units in Scliools. 693 on Nurses' Drive (report), 291 on nursing census ( letter ) , 308 on nursing groups cooperating ( report ) ', 267 on offer to send Red Cross nurses to Mexican horder. 351 on public health nursing (report), 1215 on routine work (letter), 236, 237 on rumors of treatment of nurses abroad (form letter), 263 on rural nursing, 1216, 1217 on scholarsliip and loan fund for nurses. 1279-1281 on stat)]s of Armv nurse, 1067- 1069 on status of pulilic liealtli nurses and special service group (let- ter), 278 on teacliing centers for home nursing, 1363, 1364> Delano, Jane Archer, on trip across Atlantic (diary), 996 on uniforms for Red Cross Nurs- ing Service, 358-360, 366, 369, 377, 378, 380 on work in first making surgical dressings, 296, 297 on visits to hospitals around Brest (diary), 996-998 on volunteer Nurses' Aides (let- ter), 275, 276 considering advisability (let- ter), 269, 270 status defined, 271, 272 on work in Red Cross (letters to Miss Noyes ) , 232, 233, 234 on work of volunteer helpers (let- ter), 241 organization of base hospitals by, with Colonel J. R. Kean, 333 organization of Red Cross Nurs- ing Service by, 139, 230 plan for Armv School of Nursing, 286 plan for demobilization and aid to nurses, 1015, 1016 plan for home nursing books, 1358 plan of division directors and re- lation to Headquarters, 243, 244 purpose of emergencv detachments defined by, 341 Red Cross enrollment, services in, 76 relationship between Army Nurse Corps and American Red Cross Nursing Service, defined bv, 313 selection of nurses for ]\Iercy Ship Expedition by, 140 superintendent of Army Nurse Corps, 96 resignation of. 98 talk to nurses at Na\-v Base Hos- pital No. 1. 998 text book of, 1368 Town and Countrv Nursing Com- mittee, 1219 tributes to. 1005 twenty-year nursing service period before Red Cross affiliation, 17 will of, 1051 work during infiucnza epidemic, 9S0 work for home nursing courses, 1366 work in census and classification of nurses (letters), 302-304 INDEX 150T Delano, Jane Archer, work in nurses' drive (Miss Noyes' report), 2!2, 293 Delano Memorial Committee, 1050, 1051 Delano Red Cross Nurse, 1051 Delany, Commander E. II., 140 Do Lassence, Mayor Alfred, 154 De Long, Katherine C, work of, in Italy, 803 De Luze, M. Cliarles, public health work at Bordeaux, France, 79G Denio, Oregon, work during influ- enza epidemic, 978 Denison, Dr. Walcott, 1G8 Denison, Faith, at Palanka hospital, Serbia. 1118 ill with typhus, 1119 Dennison, Maj. Robert C, relief work in Albania, 1107 Denny, Lenna II., head nurse of Praga hospital, Poland, 1092 Dent, Congressman S. Hubert, bill for reorganization of Army Nurse Corps, 10(50 Dental clinics, rural nursing, 1230 De Page, Antoine, organizjition of Belgian Red Cross hospitals by, 200 De Page, Madame Marie, death of, on lAtsitania, 201 in United States to raise funds for Belgian Red Cross, 200 Dersliem, Mabel, nurse in Santo Do- mingo, 1199 Desha, Mary, work on Hospital Corps Committee, 36 Detroit Visiting Nurse Association, training for public health nurses. 1243 Devagne. Mrs., child welfare work, Paris. 815 Devine, Dr. Edward T., chief of Refugees and Relief Bureau, France. 820 Dcvouge, Madame, child welfare work. Paris, 815 Dcvraigiie, Dr.. ciiild welfare work, France. 191S. 812 De Witt, Katharine, editor. Red Cross Nuisiiig Dojiartmcnt , .1 mrricau Jinirnal of \ insiny, SO eiindlment of nurses, work for, 290 Sccrt'tary of National ConiinKtee. letter to secure rank for nurse*, 1070, 1071 Dewar, Janet, chief nurse at Vladi- vostok Refugee Iiosiital. 927 on nursing education at N'ladivos- tok Refugee Hospital, 927 Dewey, Elizalx-th, commendation of work of, 751 on work at Field Hospital No. 7, 751 on work at Field Hospital No. 12, 748-750 State Committee of New York, 110, 112 Daxter, Major Elliot C. relief work in Montenegro. 1102 Diemer, Mile., cliild welfare work, France, 191 S. 812, 815 on visHruses d'lufants. 81(5 Dieppe, France, work of Cliildren's Bureau at, 779 Diet Kitclien Service CK'erseas (re- port), 1411-1417 Diet kitchens, organization of by Florence Nightingale, 3 Dietetics, borne. 1304 Dietitian, classification, 1390, 1.391 Dietitian Service, 1375-1398, 1399- 1441 report for year 1919-1920, 14.35, 1430 Dietitians, enrollment of, for hos- pital service, 85 ]\Iiss Noves' circular letter to, 1379, 1380 insignia of, 1401 rank of. 1402 salary of. 1402 uniform of, 1401 Dijon, France. Base Hospital No. 17 at. 494 Hospital I'nit "S"' at. 490 Dinard, France, work with children at. 709 Disability questionnaire for ex-ser- vice 'nurses. 1038. 1039 Disease, percentage of deatlis due to, 980 Dispensaries, established by Ameri- can Red Cross in l-"urope. 54S taken over b\- other organiza- tions, 771 location of. ;it various jioints in France. 7t'i!t at Biois. 191S. 797 at l!oI)i,L:ii\. Seine. SIO at t'orlieil. cart' of American soldiers. Sno at (iri'iiclle, 804 1508 INDEX Dispensaries, location of, at various points in France, at Levallois, 1917, 803 at Lvons, 785 at Marseilles, 702 at Paris, 802, 810 Boulevard Belleville, 1919, 809 at Rue Censier, 805 at Rue de I'Argonne, 808 at Rue de Pre-Saint Gervais, 808 Dispoisaire Marie-Lannelonr gue, 807 Disponsaire des Mignott'es, 807 La- Courn^uve, at Paris, 806 Mutualitr Maternelle, 807 Poteau Dispensary, 808 at Toul, 768 travelinf^, at Jerusalem, 895 District Nursing Association of Troy, N. Y., group affiliation with Red Cross, 85 District of Columbia, first enrolled Red Cross branch, 76 District of Columbia Red Cross Branch, pioneer in home care nursing organization work, 80 Division directors of mirsing, 242 Division of Institutional and Stu- dent Assignment, 1017 Division of I'ublic Health Nursing, 1017, 1020 Dix, Dorotliea L., and accomplish- ment of, 9 head of United States nursing forces, 311 Doane, INIarion, head nurse of St. Luke's Hospital, Tokyo, 917 Dock, Lavinia L., nursing services of, at Johnstown flood, 18 in Florida vellow fever epidemic, 16 Doddridge, CVmimander J. S., 140 Dodge, Mr. and Mrs., loan of estate for convalescing nurses, 1034, 10.35 Doelger, Peter, P.rcwing Company's trucks. 373 D'Olier, Katlilecn, relief work in Creece, 1181-1182 in Porto Rico, 1201 Dollinger, Professor Julius, courtesy of, to American Red Cross Staff, 173 Dominican Republic Red Cross re- lief, 1199 Donald, Jennie, Roumanian Commis- sion, 882 Donnelly, Dr. James F., illness and death of, 191, 193 Donnelly, Katherine, 349 sent to Vera Cruz, 1914, 128 Donet, Dr., child welfare work, Paris, 815 Donovan, Capt. J. J., relief officer at Vilna, Poland, 1093 Doub, Mabel E., work of, at Harbin, 938 Douglas, Arizona, nursing aid given at, 1911, 131 Douglas, Constance, work in Person- nel Houses, Saloniki (report), 1420, 1422 Douglas, Harriette Sheldon, director of elementary liygiene and home care of sick, 1369 Nursing Service Headquarters, 239 on work on instructors, 1372 Downer, Dr. Earl B., assistant sur- geon at Belgrade American Red Cross hospital, 183 on capture of Belgrade in second Austro-German offensive, Octo- ber, 1915, 186 Dowling, Miss, appointed for Philip- pine service, 63 Downing, Mrs. Florence, director of Public Health Nursing, 1304 Doyle, Jennie V., State Committee, Oregon, 112 Drama, Macedonia relief work in, 1115 Draper, Helen F., on committees for nurses' enrollment, 107 Draper, Martha L., work of, at Charleston, S. C, 58 Draper, Mrs. Amos G., member Army Nurse Corps legislation committee, 67, 70 work (m Hospital Corps Commit- tee, 36 Draper, ^Irs. William K., chairman Woman's Advisory Comirittee, 300 Conunittee on Rural Nursing, 1216 conference to consider nursing problems, 253 INDEX 1509 Draper, Mrs. W. K., embarkation of unit, U. S. Army Base Hospital No. 4 (Lakeside), 415 first meeting of National Commit- tee on Red Cross Nursing Ser- vice, 102 National Committee on Red Cross Nursing Service, 95, 127, 249 on enrollment of colored nurses, 405 services for Red Cross enrollment, 76 Town and Country Nursing Com- mittee, 1219 work toward securing superinten- dents' eligibility for Red Cross work, 84 Dreyer, Mary E., vice-president, So- ciety of Spanish-American War Nurses, 46 Drown, Lucy, early nursing superin- tendent, 19 Drunkenness, effo'-ts to combat, by Florence Niglitingale, 4 Duensing, Emma, death of, German Army service, 65 Dunant, Henri, inspired by Flor- ence Niglitingale, 2 organization efforts of, for relief society, 1863, 5 Dunbar, Mrs. L. L., chairman, Nurses' Committee, 129 Dunlop, Margaret A., chief nurse, American Ambulance, at Neuilly, France, 226. 5.36 chief nurse, Base Hospital No. 10, 459 Durand. Dr. J. I., member of Chil- dren's Bureau, France, 758 Durazzo, Albania, relief work at, 1110 Durrleman, ^Hle., scholarship to study nursing, 1175 Dwyer. Elizabeth H., on hospital ships. 700 on Norfolk Naval Hospital, 700 Eakins. Martha St. John, chief nurse. Neuilly hosjiital, 588 East St. Louis, nursing service at, 1917. l:{() Eastern Division, American Red Cross, nursing activities of 939 EafttlatuI disaster, 1915, 135 Echols, Miss, delegate to Ninth In- ternational Red Cross Confer- ence, 1912, 124 Echternach. Marion, relief work in Albania, 1108 f:col (Ic S. M. la Ifrinr, at Le dan- dier, France, 818 iScurv, France, Evacuation Hospital No. 6 at, 645 Eddv, Ruth, Palestine Commission, '892 Eden, Marie, at Le Treport hospitiil, 463 Edith Wharton Sanatorium at Yerres, France, 853 Edson, Mrs. Sarali, Civil War nurs- ing services of, 11 Education, nursing, international, 1145 Red Cross plan of schools in War- saw, 1156-1158 convention for, 955-962 requirements for, 1237 Educational facilities, arranged by Florence Niglitingale, 4 Educational Committee of National Organization for Public Health Nursing, 1253 Edward Trudeau Sanatorium, at Plessis-Robinson, 853 Egbert, Dr. Edward, director of Mercy Sliip Unit C, 150 El Paso. Texas, nursing aid given in, 1911, 131 Elderkins, ^lary, on armistice day in France, 982 member of operating team sent to line, 741 on conditions at Cohan, France, 753 on work at Evacuation Hospital No. 8, 754 on work at .Jouilly, 742 on work with Field Hospital No. 112, 752 Eldon, Miss, cliief nurse. Nursing Bureau, American Red Cross, 618 Eldredge. Adda, chairinan. State Committee of Illinois. 11(1, 112 Eleanora. (^)uecii of liiilLraria. plans of. for cstablisliiiii: training school for nurses in .'^ojiliia. 142 i'lllet, .loscpliitic. Cliiliireirs r>ureau, at roul. 7ti7 relief work in itouiiiaiiia, 1127 Elliott, Dr, Mary, in Serbia. 1117 1610 INDEX Ellis, Maude, ill with typhus, 191 Ellis Island, mobilization centre at, 416 Ells, Marie C, child welfare work, France, 1918, 813 Embarkation of nurses, 423 Emergency Committee, Red Cross, 264 Emergency Hospitals established in France, 595 at Beauvais, 596 at Chantilly, France, 614 at Jouilly, France, 603 at Jouj'-sur-Morin, 605 in war zone, 612 nurses assigned to, 617 Emerson, Dr. Kendall, Committee Memorial Fund to American nurses, 1048 Emerson, Major, acting medical di- rector at Vladivostok Refugee Hospital, 927 Endicott, William, Commission for Europe, 1917, 427, 530 Engblad, Mrs. Grace, director of Bu- reau of Public Health Nursing, 1303 England, American Red Cross Com- mission work in, 441 American Red Cross hospitals in, 431 changes in American hospitaliza- tion policies in, 440 Enright, Miss, Graduate Nurses' Protective Association of New York State, 40 Enrollment of nurses. Miss Delano's report, 289, 290 plan of National Committee on Red Cross Nursing Service, 96, 102 Enrollment of Red Cross nurses, 114 Epstein, Miss, work in Poland, 1090 Equipment of nurses for overseas duty, 575 Equipment Shop, Nurses', Paris, 578 Es Salt, Palestine, conditions at, 905 Escort duty, ocean, 719 Ktretat, France, Base Hospital No. 2 at, 454 European Inquiry Commission, 1188 European system of Red Cross nurs- ing, ideals of. 21 European War, 387-684 building of embarkation camps in, 389 European War: camps in organization of, 389-391 need for nurses, 390-393 cantonment hospitals, establishing in, 389-393 cantonments in, organization of, 389-391 need for nurses, 390-391 entrv of United States, date of, 387 'Red Cross base hospitals in, mo- bilization for, 389 training schools in, establishing of, for artillery, 389 for aviation, 389 for chemical warfare, 389 for engineers, 389 for tank and quartermaster corps, 389 Evacuation Hospital No. 4, Ecury, France, 645 Evacuation Hospital No. 6, Kcury, France, 645 Evacuation Hospital No. 8, Souilly, France, 754 Evacuation Hospital No. 9, 648 Evacuation Hospital No. 114, Fleurv-sur-Aire, takeh over by Medical Corps, 624 Evans, Charles, chief of Bureau of Friends, on American Friends Service Committee, 828 Evans, Madelaine, chief nurse at Asile Ste. Eugenic, 850 Evian-les-Bains, children's hospital at, 777 return of French to, 775 work of Children's Bureau at, 777 Evreux, France, American Red Cross Hospital No. 109 at, 609-610 Ewing, Anna A., director of Bureau of Public Health Nursing, 1303 Ewing, ]Mary C, organization of tu- berculosis sanatorium at Ycrres, 848 Exton, Katharine D., child welfare work, France, 1918, 809 Fairchild, Blair, secretary of Tuhcr- culraux de la Guerre, France, 844 Faircliild, Helen, at British casualty clearing stations, 461 Fairclough, Henry R., relief work in ^lonteneo^ro, 1102 INDEX 1511 Falconer, Marie F., in Santo Do- iiiin<;(), 119!) Fariucr. Florence, \')d at Tuinen Hospital, Siberia, 024 work of, in Siberia, 914 assistant to Dr. Coulter in Siberia, !)r)2 Farnswortli, Clara G., in Santo Do- nuninL' of League. 1144 1512 INDEX Fitzgerald, Alice Louise Florence, on opening Rimini Refugee Hos- pital, Italy, 860 on public liealth nursing in Italy, 872 recommendation on relief work in Poland, 1091 relief in Europe, Polish, 1088- 1091 on visit to Prague, 1148 tour of inspection in Poland, 1089 work in Sicily earthquake, 1908, 131 Flanagan, Kathryn, children's con- valescent home. La Chaux, 785 Fleming, Mary, relief work in Crete, 1116 relief work on Mitylene, 1114 Fletcher, Gertrude, matron of "Old- way House," 147 on expected sickness at beginning of World War, 148 on psychology of war nursing, 147-148 Fletcher, Mabel, Chautauqua nurse, 1055 hostess of Bay Shore Convalescent Home for nurses, 1037 Fletcher, Mary M., chief nurse, Evreux hospital, 539 delegate to Ninth International Red Cross Conference, 1912, 124 on English Tommies, 197 supervisor of Alliance Hospital, at Yvetot, France, 195 resignation, 197 Fletclier, Nora, British Nursing Service, 470 Fleury-sur-Aire, Evacuation Hos- pital No. 114 at, 624 Flexner, Bernard, Roumanian Com- mission, 882 Flexner, Dr. Simon, Chairman Red Cross Medical Advisory Com- mittee, 253 committee (chairman) on settling war nursing policy, 254 conference to consider nursing problems, 254 Flood, Dr. Ma])el F., in Serbia, 1123 Florence II.. S.S.. ('.\])h)sion on, 730 Florence Nightiiigah' Foundation, 124 Florence Nightingale Medal, 1130 Florida yellow fever epidemic, nurs- ing liistory of, 13-18 Red Cross aid in, 13 Floyd, Lulu T., sent to Vera Cruz, 1914, 128 Flynn, B. D,, National Advisory Committee on Insurance, 1042 Foch, Marshal, commander-in-chief of Allied Forces in France, 580 Foerster, Alma E., Commission to North Russia, 677 committee on choosing candidates for medal, 1130 on trip to North Russia, 678 on work in North Russia, 680-683 Roumanian Commission, 882 Foley, Edna, chief nurse of Ameri- can Red Cross Tuberculosis Commission in Italy, 871 Delano Memorial Committee, 1051 Town and Country Nursing Com- mittee, 1219 Folks, Homer, child welfare work, 1187 director of Civil Affairs Depart- ment, American Red Cross, 757 on work for refugees at St. Sul- pice, 837 Food and Nutrition Division of San- itary Corps of Armv, aid to dietitians, 1399 work of dietitians, 1402, 1403 Foodstuffs, to North Russia, 677 Ford, George B., Commission for Europe, 530 Foreign activities, American Red Cross, development of, 536 Foreign relief work of the American Red Cross, 1077 et seq. Fort Hamilton, Red Cross services at, 61 Fort Wadsworth, authorization of Red Cross nurses for, 57 Red Cross nurses at, 60 Fortress Hospital, in Vladivostok, 913 Fortress Monroe, Red Cross service at, Spanish-American War, 61 Fortson, ^lis.;, public health nurs- ing, 1348 Fosl)urgh, Major James B. A., on emergencv hospital at Beauvais, 590 on position of American Red Cross supply units, second battle of Picardy, 579 on sanitarv situation of Second Division.' 603 on work of American Red Cross overseas, 019 INDEX 1513 Foscani Unit, Roumania, 1126 Fotoenoff Hospital, Sofia, Bulgaria, 221 Foundation to Florence Nightingale, 124 Fox, Elizabeth Gordon, director of Bureau of Public Health Nurs- ing, 1275, 1276, 1302 director Town and Country Nurs- ing Service, 240 functions of nurse and social worker, 1317 meeting of Red Cross authorities with state othcials: results and problems, 1324-1326 National Committee on Red Cross Nursing Service, 24!) on Town and Country Nursing Service, 1276 France, division into nine zones by Commissioner Gibson, 612 nurses in, sliortage of, 514 German actfXities in, 464 physicians in, 1017, 758 refugees in, American Red Cross' work for, 826, 843 relief work in, 1080, 1081 U. S. naval hospitals in, 728 Francis, IVfary L., chief nurse, U. S. Army Base Hospital No. 15, 403 Francis. Susan C, director Pennsyl- vania Division of Red Cross, 245, 246 Joint National Committee, 1047 Joint National Committee of Bu- reau of Information, 1016 National Committee on Red Cross Nursing Service, 240 on nursing and public health work. 1050 on Red Cross Aide plan. 1052 Franczak, Praxeda, aide in Poland, 1007 Frankel. L. K.. conference to con- sider nursing problems. 254 Frederiksted. \irgin Islands, nurs- ing work at. 1204 Freeman. Florence C nursing ser- vice in \'irgin Islands, 1203 resignation, 1204 Frencli, Henrietta L., dietitian over- sea*!. 1.307 Freneli, Dr. William J., director of dispensaries, France. lOlS. SO!) French Red Cross, mobilization of. 524 Friends, Societv of, 826 Fuller, Stella, Chautauqua nurse, 10.55 first Delano Red Cross nurse, 1052 Fulton, Cajjt. Arthur D., in Rou- mania. 1127 Furbush, Colonel C. L., Advisory Committee of Army School of Nursing, 285 Furse, Dame Katherine, British Nursing Service in France, 478 GafTney, Clare, Assistant on Nurse Corp of the Public Health Ser- vice, 1028 Gardner, Mary S., chief of Public Healtli Nursing in Italy, 867 on nursing svstem in Italv, 855- 857 on training of Italian nurses, 868 Gardner, Mary Sewell, Committee of Transfer, 1021 director Town and Country Nurs- ing Service. 240 enlarging of Public Health Nurs- ing, 1274. 1275 on attitude of nurses, on Public Health grouping, 1273. 1274 on training of public health nurses, 1.310 report of tour of Europe on child health and nursing school. 1189- 1104 report on work of Miss Clement in town and countrv nursing, 1234. 1235 sent to study ptiblic health nurs- ing in Pairojje. 1187-1188 Gare de I'Est. Paris, emergencv can- teen at, 837 Gare du Nord. Paris. 835 emergency canteen at. 836 (iarretson. Margaret, relief work in All)ania, 1110 Garrett. Alice 'SI., cliief nurse of r. S. Navv Base Hospital No. 5, 72S on r. S. Navv P>ase Hospital No. 5, 72S Garrison. Ciiarlotte. at National Headquarters. 240 (Jeer, Dr. William M.. on rank for ai'iiiy nurses. lOtl!) (ielstoii. Dr. Clair F.. member of Children's Bureau, France, 75S work at Kvian-les-Bains, 777 1511 INDEX General Hospital Xo. 1, B.E.F., U. S. Army Base Hospital Xo. 2 unit General Hospital No. 9, B.E.F., Rouen, France, unit of Base Hospital No. 4 at, 444-452 General Hospital No. 11, B.E.F., Base Hospital No. 5 unit at, 4.52 General Hospital No. 12, B.E.F., Rouen, France, unit of U. S. Army Base Hospital No. 21 at, 467 ' General Hospital No. 12, B.E.F., un- der American Red Cross, service at. 468 General Hospital No. 16, B.E.F., Le Treport, France, 459 General Hospital No. 18, B.E.F., personnel of U. S. Army Base Hospital No. 12 assigned to, 469 General Hospital, Montauk Point, Red Cross services at, 61 General Medical Board, 264 Geneva. General Assembly of League, 1144 Genoa, Italy, American Red Cross Naval hospital at, 865 George, Elva Anne, Bureau of Dieti- tian Service, 1429 resignation from, 1431 charge of dietitians for base hos- pitals, 238, 2.39 Committee on Red Cross Dietitian Service, 1379 desires to widen scope of home dietetics. 1431 director of Dietitian Service, 1369 National Committee on Dietitians, 1377 nutrition member of, 1437 on slowness of home dietetics, 1430 German Government, American Red Cross work in Russia and Ser- V)ia at request of. 225 German military discipline, 163 German women, as early volunteer military nurses. 2. 163, 165 German wounded. 166 condition and care of. 162-163 mental attitude of. 164 Gervais, Dr. Harriet, in Serbia, 1117 Gevgeli. Serbia, 187 accf)mmodations for American nursing units al, 188 American Red Cross liospital at, 187 Gevgeli, Serbia, conditions in, 1125 Serbian Units No. 2 and No. 3 assigned to, 180 typhus among American Red Cross units at, 181 typhus epidemic at, 209 Gibbes, Virginia ^Tason, nursing service in Philippines, 1208 study of chapter. services, 1335 Giberson, Miss, delegate to Ninth International Red Cross Con- ference, 1912, 124 Gibson, Harvey D., chairman, Exec- utive Committee of New York County Chapter, 363 general manager at National Headquarters of the Red Cross, 371 gift for nursing education fund, 1279 Gigliucci, Countess Nerina, Italian representative at Cannes Confer ence, 1138 Gilbert, Blanche, at American Red Cross Military Hospital No. 5, at Auteuil, 601 nursing service in Greece, 1116 nursing service in Mitylene, 1114 Gilbourne, Alice, Roumanian Com- mission, 882 Gilder, Rosamond, on Children's Bureau in France, 824 secretary of Children's Bureau, France, 758 Gill, Miss A. M., Great Britain's representative at Cannes Con- ference, 1137 Gill, Helen Z.. head nurse of surgical ward at Toul hospital, 767 work with Children's Bureau at Toul, 766 Gill, Laura Drake, Auxiliary No. 3 aide, services of, Spanish-Amer- ican War, 50 in Armv Nurse Corps legislative efforts, 68 in cliarge of Cuban nursing party, 32, 55 on Lena Potter Cowdin, 48 services of, 64 Gill, Dr.. director of Russian Island Hospital, 9L3 Gillet-Motte. Madame. 782 Gillihmd. Inez, nursing service in Serbia, 1117 Gilmour, ]\Iary S., efforts for Red Cross affiliation, 71 INDEX 1515 Gilmour, Mary S., suporintondont at New York City School, duriii},' Spunish-American War period, 50 Gilson, Helen Louise, nursing ser- vice of, in Civil War, 10 Givenwilson, Irene M., on European hospitals, 480 on Revigny Hospital, 525 on tour of Freiicli, British and lU'lgian military hospitals, 520 Givson, Harvey I).. American Red Cross Commissioner for France, 612 Gladwin, Mary P]., appointed for Philippine service, 63 career of, 176-177 conunittee, lecture course for Red Cross nurses, 122 committee on choosing candidates for medal, 1130 defense of home nursing teaching, 81 Delano Memorial Committee, 1050, 1051 delegate to Ninth International Red Cross Conference, 1012. 124 dietetic work on the Lampasas expedition, 33 National Committee on Red Cross Nursing Service, 127, 24!) on arrival of medical "reenforce- meuts" diu'ing t\piius siege at Belgrade. 1S1-1S2 on l)(iml)ardmeiit of Belgrade, 177 on condition of wounded at Bel- grade, 17i> on improved conditions at Bel- grade hos])ital after typhus epi- demic. 184 on monotony in Serbia, 181 on Red Cross aide j)lan. 1052 services for Reil Cross enrollment, I I supeivisor of Serbian units, 141, ITii work at Dayton Hoods. 1013. 133 Clasgnw. Artlnir G.. Roumanian Cnininission. SS2 Glauber. Marie Clare, relief work in Civece. nil Gleiwitz. (ierii)an\\ arrival of Mcrev Ship I'liit 1 at. ini care of wdimded ai . I(i3 (lillicnllies at. If..') privat(> KUtiilrrn for otlicers at, 163 Gleiwitz, Germany, shifting move- ments of Russian and German armies about, 163 I'nit I assigned to, 160 Viktoria. Theater hospital at, 162 closing of, 166 Glenn, John M.. Committee on Rural Nursing, 1216 Town and Countrv Nursing Com- mittee, 121!) Glass, Mrs. John, head of Cliicago workroom for liospital supplies, 2!)n Godard, Stella, reserve nurse, Camp Stuart. Newport News, Vir- ginia. 410 Godot, Mile. A. M., child welfare work. France. 1018, 800 Golden, Ruth, chief nurse. Evacua- tion Hospital No. 0, 648 Goldwater, Dr. S. S.. at Convention of League of Nursing Educa- tion. 055. !156 committee to get hospitals to aid in training armv nurses, 286, 287 Golzar. Rachel, reserve nurse, A.N.C., on establishing of can- tonment hospitals, .3!)3 Good Samaritan, as early example of Red Cross characteristics, 1 Goodman. Dr. Alljcrt R.. director of Belgian I'liits Nos. 1 and 2. 2n(l Goodricli, Aiuiie Warburton, 542, 544 committee to secure liospital aid in armv nurses' training, 286, 287 Committee of Transfer. 1022 Committee on Red Cross Dietitian Service. 1370 Conunittee on Rural NursiiiLT, 1216 conference of medical and army ofheers and nurses on plan for armv school of lUirsing, 284, 285 ' conference to considi^r nursing problems. 253. 254 dean of Armv School of Nursing. 286 Joint Xalinnal Committee. 1047 Joint National Committee of Bu- reau of Information. TUti National Coinniittce of American Ibil Cross, !I58 1516 INDEX Goodrich, Annie Warburton, Na- tional Committee on Dietitians, 1377 National Cduimittee on Red Cross Nursinf,' Service, 248 on overseas duty, 553, 554, 555, 559 on plan for special enrollment of nurses, 257 on rank for army nurses, 1069 on Red Cross aide plan, 1052 originator of Armv School of Nursing. 283. 284* plans for Armv School of Nurs- ing, 286. 962 resigns as Dean of Army Nursing School, 289 Surgeon-General's office, 954 Town and Country Nursing Com- mittee, 1219 work for nurses' census, 304, 305 Goodwillie, Mary, vice-chairman \Yc)man's Advisory Committee, 300 Goodwin, Sir John, Balfour Mission, 442 Goodwin, Phillip, Commission for Europe, 531 Gorgas, Surgeon-General William C, 338. 344 appeal by (Aug. 1, 1918), for in- crease of enrollment of nurses, 319 Central Committee, 230 letter to aid drive for nurses, 290, 291 National Committee on Red Cross Nursing Service, 248 on couiiiiittce to secure Red Cross ship for World War, 140 on Armv School for Nursing; sta- tistics, 963. 964 on need of nurses, 954 on need for nurses' census, 306, 307 on organization of base hospital units by Medical Reserve Corps versus American Red Cross, 331 Gosling, Beatrice M.. Commission to North Russia, 677 Roumanian Commission. 882 Gounouilliou. Madame, public healtli work at Bordeaux. I'raiice. 796 Gourlay. Mrs. Roljcrt (Adeline H. Rowland), at National Head- quartersu 2i^0 Government directed routine nurs- ing, as evolved in Civil War, 9 Governor's Island, Red Cross nurses at, 61 Graduate Nurses' Protective Asso- ciation of New York State, olTer of Spanish-American War ser- vices, 40 Graham, Flora A., on recreation on Ellis Island, 419 Grant, Jessie, chief nurse. Base Hos- pital No. 55 (Boston, Mass.), 338 Grant, Robert, Jr., London Chapter, American Red Cross, 425 Graves, Lulu, Committee on Red Cross Dietitian Service, 1379 President American Dietetics As- sociation, 1398 Gray's Ferry Road, Naval hospital at, 701 Great Britain, American Red Cross hospitals in, 431 changes in American hospitaliza- tion policies in, 440 Naval hospitals in, 720 work of American Red Cross Com- mission in, 441 Great Lakes, 111., Naval hospital at, 709 Greece, conditions in, inspected by Miss Noyes and Miss Hay, 1181 Nursing School plans, 1165-1166 relief work of American Red Cross in, 1100, 1111-1116 Gregg. A. IL, Committee on Read- justment and Liquidation of European Activities, 1079 Gregg. Eleanor, Chautauqua nurse, 1055 Greeley, ^Irs. Helen Hay, National Committee to Secure Rank for Army Nur.ses, 1070 plan to secure rank for armv nurses, 1066. 1067, 1071 work of, to secure rank for army nurses. 1066, 1067 Green, Dr. Thomas E., Aid in secur- ing liome defense nurses, 283 director of National Red Cross Speaker's Bureau, 1054 Greene, Dr. All)erta, relief work in Serbia, 1119 Greene, Georgia B., nursing service in ^lontenegro, 1103 Greene, Marion P.. on cliild welfare work at Corbeil, France, 800 INDEX 1517 Oreone, Marion P.. on dispensary at Corht'il, France. 791 on playground at Corheil, France, 801 ' C'vejileaf, Dr. Charles I\., on nurs- ing services of Ijntnpasas nurs- ing group, .34 on services of l.ampasas group, itG on value of Miss Rutty, 34 report of. on conduct of the war with Spain. 31 suggestion, as to land service for Red Cross, 29 Crreenlees, Anna J., State Commit- tee. District of Columbia, 112 Ctreenwood. ^liss. death of, at Stern- berg U. S. Field Hospital. 53 work at Davton floods, 1913, 133 Crenelle, France, dispensary at. 804 Cretter. Mrs. L. E., Delano Memo- rial Committee, 1050, 1051 delegate to Ninth International Red Cross Conference, 1912, 124 State Committee. Michigan, 112 Cretter. Lystra. early nursing super- intendent, 19 OrifTin. :\Iajor R. E.. to Mrs. White- law Reid. on nursing service at Cliickamauga Park. 59 CrifTitli. Marv, nursing, in Haiti, 1171, 1173 C.rittinger, Emma, director of public lu>alth nursing. 1304 C.rouitch. "Mme. Slavko, babv hos- l)ital at Xish. Serbia. 215 Crulee. Dr. Clifford. Children's Bu- reau, France. 1918, 782 Cuest. ^[rs. Frederick, 721 Cwinon, Dr., child wcdfare work. France. 1918. 812. 815 Culf Division of Red Cross. 24(5 Cunn. Dr. Selskar M.. associate di- rector of the Rockefeller Com- mission for the Prevention of Tuberculosis in France. 844- 845 Cunniiiir. Lieutenant Colonel R. C. Ill'; Cunther. Fmmn A., dietetics classes. N;itioiial Commission on Dieti- tians. l;i77 Committee on Red Cross Dietitian Service. 1.'578 Xational Committee on Red Cross Nursing Service, 249 Haas, Miss, volunteer helper, 241 Hagler, Dr., in charge of pavilion at Belgrade American Red Cross hospital, 183 Haifa, I'alestine, hospital at, 901 llaija, I'alestine, out-patient clinic at, 902 Haigitt, Ktlud, reserve nurse, near Junction City, Kansas, on can- tonment nursing, 394 Haiti, conditions in, 1173, 1174 Red Cross nursing in, 1171 smallpo.x in, 1172 llaldora, forerunner of Florence Nightingale, 2 Halifax, munition explosion, 1917, 136 Hall, Carrie M., chief nurse of American Red Cross in France, (513 chief nurse of American Red Cross in Great Britain, 4.34 chief nurse, American Red Cross in C.t. Britain, transferred to Paris, (529 chief nurse, Base Hospital No. 5, 452 National Committee on Red Cross Nursing Service, 249 on Anu'rican Red Cross activities in France, 1079-1081 on foreign relief. lOOS on Miss Delano's health, 1001, 1002 on Miss Delano's illness. 1000, 1001 on nursing situation in England, 4.35 recommendations of, for foreign relief, 1081. 1082 transferred to Paris Headquar- ters. September. 1918. 441 Hall. Eleanor. Army Nurse Corps, Camp Taylor, Eouisville. Ky.. on cantonment nursing, 394-395, :?!H) on ^ledical Corps men. 397 Hall. Maria M. C, and sister. Civil War nursing services of, li llahcrsoii. Leila, at American Red Cross Hospital No. 109. Evreux, tint on wdrk at l''vian-Ies-Baiiis, 779 Ilainiidaii. Persia. Red Cross hospi- tal establisheil at. for Russians, 1(10 1518 INDEX Hamburg, *?..*?., selection of, as Red Cross ship, 140 Hamilton, Dr., opposition from, to first Red Cross nurses' unit, 15 public liealtii work at Bordeaux, France, 71);), 700 Hamilton, Dr. Anna, funds for Scliool for Nurses in France, 1040. 1047 Hamilton. Ellen M., Palestine Com- mission, 802 travelino: dispensary service at Jerusalem, 805 Hammar, ^Mrs. Frank V., Central Committee of American Red Cross, 1007 Delano Memorial Committee, 1051 Woman's Advisory Committee, 300 Hampton, Caroline, early nursing superintendent, 19 Hampton, Isabel, early nursing superintendent, 10 Hankins, Harriet, reserve nurse serving on Mexican border, 355 Hannan, Katherine C, chief nurse at U. S; Armv Evacuation Hos- pital No. 17, 047 Hansberrv, Anna M., nursing serv- ice in Haiti, 1171, 1173 Happer, Miss, supervision of dieti- tians. 1420, 1427 Harbin, Chinese Citv Hospital at, 037 cholera epidemic at, 1010, 930 Harbin Military Hospital, 015 Harcourt, Viscountess, Committee of American Women's War Relief Fund. 140 London Chapter, American Red Cross, 425 Hardv, Nannie R., 340 sent to Vera Cruz. 1014, 128 Harjes, Herman, American Relief Clearing House, 531 Harold, ]\Iary Radford, dietitian overseas, 1385 Hassan, Estlior V., superintendent. Navy Nurse Corps, 537 Harriman, Mrs. E. H., Woman's Ad- visory Committee, 300 Harrington, Grace, acting chief nurse of Siberian Commission, 930 cliief nurso of Western Division, American Red Cross, 039 public heallh nursing, 1303 sail from Vladivostok liome, 952 Harris, Mrs. Betsey Long, chief nurse. Base Hospital No. 36, 501 Harriss, Dr., donator of yacht Surf, 701 Harte, Dr. Richard H., director, v. S. Armv Base Hospital No. 10, 306, 459 Hartridge, Mrs. A. C, State Com- mittee, Georgia, 112 Hartwell, Laura, on attitude of re- turning nurses, 1018 Hartz, Alma, relief work in Crete, 1116 Harvard Unit, first, sailing of, 107 Harvard Unit, second, U. S. Army Base Hospital No. 5, 452 Harvev, ]\Iiss, volunteer helper. 241 Harvey, Alice B., 349 sent to Vera Cruz, 1914, 128 Harvey, I. Malinde, public health nursing, 1303 Haslam, Edith M., Palestine Com- mission, 892 Haslar Roval Naval Hospital, Eng- land, 140, 147 Unit D at. 14G Hassan, Esther Voorhees, first super- intendent of Navy Nurse Corps, 086 services of, 64 Havemeyer, Mrs. H. 0., work of, to secure rank to army nurses, 1005 Haviland, Sybella, in Serbia, 1117 Havre, Red Cross dispensary at, 822 Hawaii, nursing work in, 1204. 1205 Ilawlev, Laura J., dietitian overseas, 1417, 1418 Hawley, Mrs. Joseph R. (Miss Hor- ner), in Army Nurse Corps legislative eflforts. 08, 70 officer. Associated Alumnae, 40 Hay, Helen Scott, 141 aid in Balkans, report, 1102 at Council meeting of League, 1147 at National Headquarters, 230 charge of liomc nursing courses, 1300 Committee for ^Memorial Fund to American Nurses. 1048 Committee on choosing candidates for medals. 1130 Conference to consider nursing ])rol)lcms. 253 Delano Memorial Committee, 1051 INDEX 1519 Hay, Ilclon Scott, Director of Kle- nu'ntarv livj^iene and lioine caii' of ick", i:5(i9 ostablislu'd mirspw' training school in Hulreece. 1183 inspection in Montenegro; recora- nu'ndation, 1 1S3 inspection in Poland, 1179 instruction for women, 1304 memorandum of nursing activi- ties, 1177 nurse, Commission for Balkans, 1083 on American Red Cross activities in Poland, 10!)0, 1100 on conditi(ms at Municipal Hos- pital, Cracow, 109(5, 1097 on conditions in Poland in 1920, 1093-1094 on conditions in Serbia, 1119, 1124. 1125 on Coinitess Zamboya's scliool of Domestic Science in Poland, 1095 on relief work in Greece, 1112, 1116 on work in Serbia, 1122 organixiition of Nurses' Training School at Sofia, Bulgaria, 1915, 219 plan for nursing school in Bul- garia. 1107 })Ian for scliool in Warsaw, 1158 retiring of. from Kief, for Bul- garia. 158 senior supervisor of I'nits C and H. 155 study of Warsaw conditions. 1150 supcrintetideiit of nurses, Meicy Ship expedition. 140. 141 t(Mir of inspection in Poland. 1(M)2 tour of inspection with Miss Xoyes, 117(1 wdik for Nursing Sehool for Poland, 1155 llavs. .Icaiiette. chiM welfare work. France. 191S, S09 Hayton. Ada., (tf 1 lu- Washington. 1). v.. emergencv detachment. 353 Ilayward. Helen, on hospital work in i'aris. 747 Hazard, Miss Blanche E., Committee on Town and Country Nursing Service, 12()4 Hazen, .Miss, report of dietitian work. 1419, 1420 llazlett, Dr. T. Lyle, 159 Healy, Tamar, oflicer Associated Aiunuup, 41 Hearle. Susan, and cantonment duty, 390 Heath, Amarita, at dock infirmary in Bordeaux, 1012 nurse in Serbia, 1 123 Hebberd, Robert W., cooperation with Red Cross in eliminating promiscuous use of emblem, 85 Hickey, Tvfary Agnes, Work with Veterans' Bureau. 1030 Heilnian, Charlotte, scliool nursing, Greece, 1182 work in Greece. 1197 Helferinnin in German hospitals, 1(!3. 105 Henderson, Alice, on inspection of tourists at Pau. France, 152 on Pau, France, 150 on wounded at Pau. France, 151 supervisor of Unit B, 150 Henderson, Benna M., State Com- mittee of Illinois. 110 Henderson. Sir David, director-gen- eral of League. 1143 Henderson. R.. National Advisory Comiiiitlee on Insurance. 1041 Henry. Lady. Committee of Ameri- can Women's War Relief Fund, 140 Henry, Sarah S.. work in Cuba. 04 Henry. Major William H.. at Amer- ican Red Cross hospital in Nortli Russia. 081 Henry Street Settlement. 1212 aid in training public health nurses. 1250. 1251 Army Seliool of Nursing. 2SS traiiiini: for jiuhlie health nursing, 1242^ 12^3 Henshall. Marjorie. apj)ointed for Philip{)iiie service. ().3 apjiointnient to Manila. 58 work at Post Hospital. Fort Wadsworth. 5S Herrick. lion. Pohert. on the poilu. 152 Herring, Mary. Chautauqua nurse, 1055 1520 INDEX Hertzer, Katrina, nursing staff, 235 Navy* Nurse Corps representative at National Headquarters, 689 on condition of patients at Buda- pest Military Reserve Hospital No. 4, 173 on Miss Hassan's work, 686 Hertzog, Dr., military commander of Budapest hospitals, 173 Hewitt, Elizabeth M., services at Hattiesburg, 1908, 130 Hibbard, M. Eugenie, work in Cuba, 64 Hickman, Kv., nursing service at, 1917, 136 Higbee, Mrs., 384 Higbee, Mrs. Lena S., American Red Cross parade, New York, 420 approves plan for special enroll- ment of nurses, 258 Conference to consider nursing problems, 254 National Committee on Nursing Service, 127, 249 on rank for Army nurses, 1069 second superintendent, of Navy Nurse Corps, 687 Hill, Dr., Inspection in Europe, 1188 Hill, Dr. A. Ross, vice-chairman of foreign operations, 1187 Hill, Anne P., on armistice time in France, 981 Hill, Dr. Howard Kennedy, on L'Hospices Civils de Lyon, France, 780 on submarine attack, 718 work for cliild health centers, line Hill, Mary, 159 Hill, Mrs. William H., on hospital train service, 640 work for refugees, in France, 835 Hilliard. Amy, approves plan for special enrollment of nurses, 258 Committee on revision of text book, 1308 conference to consider nursing problems, 254 co-operation witli Dr. Hamilton for funds for nurses' school, 1046. 1047 .Joint National Conimittee, 1047 Joint National Committee of Bu- reau of Informal ion, 1016 National Coinmittcc on Red Cross Nur.sing Service, 249 Hindenberg Line, breaking of, 509, 510 Hinds, Dr. Robert W., director of Mercy Ship Unit D, 146 director of Belgian Units Nos. 1 and 2, 200 Hine, M. Estelle, Spanish-American and World War service, 65 description of Seabright, estate of Mr. and Mrs. SchiflF, loaned to nurses, 1033 Hitchcock, Jane Elizabeth, chief of Division of Public Health Nurs- ing, 1018 work on Division of Public Health Nursing, 1020 Iloag, Elizabeth, on nursing service in naval hospitals, 704 Hoagland, Jennie, in Serbia, 1119 Hobson, Mrs. Joseph, eflforts for Army Nurse Bill, 69, 70 member Army Nurse Corps legis- lation committee, 67, 69, 70 Hodenpyl, A. D., conference to con- sider nursing problems, 254 Hodge, Capt. Edward B., on air raid at Amiens, 465 Hodson, Jane, 65 value of book by, to the trained nurse, 39 Ilofi", Colonel J. V. R., commenda- tion of women for field hospital , work, 59 tribute of, to Miss ^Maxwell, 53 Hoffman. Frederick, on Commission for Europe, 531 Hofker-Lesser, Bettina A., sister- in-chief. Red Cross Hospital. 23 Hogue, E. Elizabeth, chief nurse of L'. S. Naval Base Hospital No. 2, 721 Ilolman, Bertha, dietitian in War- saw, 1103 Ilolman, Lydia, pioneer in rural nursing, 65 rural nursing, 1211 Holmes, Etliei A., chief nurse. Base Hospital No. 24, 504 Holmes, Katharine, relief work in Roumania, 1120, 1127 Holmes. Katheriiu' W., bureau of pul)lic iiealtli nursing. 1303 on work for rofngees, in Paris, S.35. 840 appointed for Philij)pine service, 03 INDEX 1521 Holtzinan, Mrs. Florence L., in cliarge of finances, Chateau (Its II alien, hu8pital, 781 Holt/man, Hospital at Lyons, France, 78."5, 78ti Holy Cross Sisters, nursing services of, in Civil W ar, 8 Home Care Nursing Course, discus- sions concerning, 80, 81 Home Care Nursing Course, origin of, 80 Home defense nurses, 282, 283 Home dietetics, courses, 14;}U Home liygiene, Montenegro, 1107 Santo Domingo, 1200 Home Nursing Committee, work of, 205 Home nursings course circular, l.'Uil Home nursing course for women, outline, work, 130 ."5-1. "5 7 4 report of National Committee on Red Cross Nursing, l.'M7 r'ome nursing courses, organization of, l:U)4, 130.-) Home Nursing Teaching Centers, 1303, 1304 Homesickness, 109 Homrigh, Beatrice von, services on Lampasas expedition of. 33 Hood, Mary, ciiief nurse in \'ladi- vostok Ivefugee llos})ital. 917 Hopital lir)i('vol<\ tuberculosis hos- pital. 84S Hopital Auj^iliarc \o. .V,, 199 Jlnpilal Hen role. !'> his, Paris, 8r)3 Hopital Contplimciitdirr .\o. 2, turned over to Dr. Fitch, 009 Hopital n dietitian's ditli- cnltics. 1403 on work iif dietitians. 142S Hoskin-, Susaniie 15.. child widfare Wdik. I.yiiiis. France. 7S4 C()ii\;ilt'-(rnt lidine, I, a Chaux. 78.') in chai-.L:!' Chihircn's H<)s[iilal at Fviiui-lis-l'ains. 778 on Ildspital Ninh't, 024 Hospital cars. Red Cross service on, Spanish-American War, 01 Hospital conditions in tlie latter 19th century, 18 Hospital Corps Committee, accept- ances of services by Govern- ment, 30 origin of, 30 Hospital economics, class in, at leachers' College, elTorts for Red Cross alliliation, 71 Hospital Holtzman, at Lyons, France, 780 Hospital nurses, for field work, de- sirability of, 84 Hospital sliip Missouri, 60 Hospital ships. Civil War origin of, 12 Hospital staff, relation of dietitians to, 1423, 1424 Hospital standards, in Civil War, 12 Hospital supjdies, 298 Hospital Supplies, country divisions, 299 work started. 290, 297 Hospital training sciiools for nursiv^, establisiimcnt of, 13 Hospital train service, qualifications of nurses for, 043 Hospital trains, ()34. 043 instructions regarding Dur5es, 635 women on duty, 500 Hospital X'iolet, at Lyons, France, 783, 784 Hospitals, American Red Cross, es- tablished in France, 030 two types of, 532, 533 in France, bombed by eiiemv avia- tors. 589-592 in Novendier, lit 18. 511 maintained by L'. S. Navy, 720 maternity, at Toul, France, 708 naval, in Fianie, 728 naval, in (iri'at I'ritain. 72i> of the A. F. F.. location of. 485 Navy station, organization of, 092 L". S. Navy, c()ii\alc>cc:it homes. -Xinerican l!cd Cios^. 732 Hotham, I.ady. on .\incricans. 140 Hough. Mrs. Katlierine C., super- visor of conv;i!('scciil home for nurses at I.c Cn.isic Idto. li)41 supervisor of nurses* training with liic l-'c(h'ral board for \'o- cational i-'.diirat ion. lo29 Howard, (an-ic I... Spanisli-Aineri- can and World War service. 05 1522 INDEX Hower, Martha, child welfare work at Le Glandier, 818 Hughes, Dorothea, finances school in Warsaw, IIGO interest in nursing school for Poland, 1154, 1155 Hughes, Dr. Laura A., vice-presi- dent, Society of Spanish-Amer- ican War Nurses, 4G Hughes, Major, Sixth Division of Marines, 734 Hughes, I'riscilla J., on camouflage of ships, 423 on conditions back of the lines, Lorraine Front, 043 on conditions of German trenches, 987 on conditions of imprisoned Brit- ish soldiers, 'J88 on country about Treves, valley of Moselle, 993 on hospital at Coblenz, 995 on reception of American Red Cross at Guile, 994 Hull, Mrs. John S. '., in Army Xurse Corps legislative efforts, 68, 70 Hulsizer, Marjorie, dietitian over- seas duties, 1303 on dietitian duties overseas, 1384, 1385 Hundling, Capt. Herman, in Serbia, 112U Ilungato, ;Miss, dietitian overseas, 14U5-141U Report on dietitian work, 1427, 1428 Hunt, Caroline, dietary lessons, 143U Hunt, Klizabeth, Chautauqua nurse, 1U55 in Santo Domingo, 1199 Hunt, Rev. Godfrey P., cliaplain of Rase Hospital No. 102, (iG8 Hunt, Harriet, work of, at Irkutsk, 944 Hunter, Arthur, National Advisory Committee on Insurance, 1041 Hunter, L. J., C(jmmittee on Read- justment and Liquidation of Luropean Activities, 1079 Hunter's island. Convalescent Home for 8tli liegiinent in. Red Cross services at, 02 Huntington, Henry S., on work at Haifa. Pah'stinc, 901 Hurst, Alice, work at Field Hospital No. 12, 751 Hutton, Mrs. Henry, 154 Hutton, Colonel Paul C, 606 Idaho, public health nursing in, 1337, 1338 Idjukovska, Madame, director of nurses of Polish Red Cross Hos- pital, 1097 Hfov Unit, Roumania, 1127, 1128 Illinois, nursing service in, 1917, 130 rural nursing in, 1229 Immune nurses, requirements, dur- ing Spanish-American War, 38 Infant welfare, in Crete, 1116 in Greece, 1115 in Patras, 1115, 1116 in Serbia, 1124 Infirmaries, at docks, 1010-1012 for American troops in France, 548 Influenza epidemic, 972, 976 aid of classes in hygiene in, 1373, 1374 need for nurses in, 971-975 Information, Rureau of, 1019 Information Bureau for Nurses, 1014-1010 Information for Nurses Called upon for Active Service (A. R. C. 702, 1917), 372 Inglesaki, Ellen, at school nursing, Greece, 1182 nursing service in Greece, 1111 Inquiry Commission, European, 1188 Insurance, for nurses, 1042-1045 Insurance, National Advisory Com- mittee (jn, 1041 plan of, 1042, 1043 International Nurse Education, 1145 International Red Cross Conference, Cannes, 1919, 1137 International Red Cross Conference, Ninth, 1912. 124 International Red Cross Treaty, ac- cession to, by United States, 6 Ireland, fieneraf Merritte W., 331, 385, 484 ap|)ointmpnt as surgeon general, 571, 081 letter to .Miss Delano telling of fine work of nurses, 984 on Central Conimittee of Ameri- can Ked Cross, 1007 on Kxccutivc Conunittee of Amer- ican lied Cross, 1007 INDEX 1523 Ireland, Gen. Merritte W., on rank for army nurseH, 1()72-1<)7.'{ Irkutsk, SilxTJa. American Red CrosH lioHpilals at, *.H'.i witiidrawal from, of American forces and American Red Cross personnel, !)48 Isabella of Spain, first queen to fur- ther scientific military nursin5 i .JefTery, Jane, at emergency hospital at douy-sur-Morin, 007 wounded in line of duty, 10.31 Jenkins. .Mrs. Helen Harth-y. 415 Jennings, Irene, on work at Le (JIandier. 81! Jerusalem, children's hospital at, H!)0 dispensary service, 8{)5 relief work of American Red Cross in, ilO!) Russian hospital at, 89.3 taken by British, 1917. 891 Turkish municipal hospital at, 894 Jessup, Elsie, service in Serbia, 1122 Joaquim, Lucy, relief work in Al- bania, iiio Johnson, Anna J., on conditions at Evacuation Hospital No. 9, 048 on experiences at A. R. C. Hos- pital No. 104, at Beauvais, 5!)8 on A. R. C. military hospital at Jouilly, 004 Johnson, Elizabeth, State Commit- tee, Indiana, 111, 112 Johnson, Florence Merriam, aid to sick nurses. 10.35. 1030 Committee on choosing candidates for medal, 1130 Delano Memorial Committee. 1051 director Atlantic division of Red Cross. 245, 372-374, 379, 3S3, 384, 1038 Joint National Committee of Bu- reau of Information, 1010. 1017 on Red Cross aide plan, 1052 service in France, 028 Johnson, Josephine, at National Headquarters. 240 luirsitig sfaflT. 235 .biluison. Lena Margaret, nursing service in Chios. 1 113 in (ireece. 1111. 1112 in Montenegro. 1 103 in Roland. 1100 Johnson. Matilda L.. State Commit- tee. Oliio. IIL 112 Idhnsoii. Dr. Philip, eliild welfare wnik at r.oiileaux. I'ranee. 7!>5 .lolmstowu ll(Mi(l. Red Cross relief ninl inir>ing work in, 13. IS Tiiiiit Natiniial Committee of Na- tional Nursing Headquarters. 11147 1524 INDEX Jokaitis, Madame Josephine, acting chief nurse in Poland, 1088, 1097 puhlic service nursing in Poland, 1085-1087 Jones, Major Harold W., 339 Jones. Dr. Louise Taylor, director, Mabel Grouitch Baby Hospital, 216 Jones, Miss, chief nurse of Camp Pontanazen hospital, 997 Jones-Raker Bills, for rank for army nurses, 1071 Jordan, Lucia D., nursing service in Haiti, 1171 Jordan, Pauline, on nursing in Italy, 860 with Carrel Mission in Roumaniaj 878-881 Jordian, J. H., operating manager, American Relief Clearing House, 531 Jorgensen, Mary C. mobilization of nursea in New York, 421 Jorgenson, Sigrid H., 652, 055, 658 Jouilly. France, em.ergency hospital at, 603 Jouillv, navy operating team at, 741, 745 Jouy-sur-Morin, France, emergency hospital at, 605 Junior Red Cross, Greece, 1181 Jury, Irene I., death of, 1.398 Justis, Lulu J., at National Head- quarters, 240 Kacena, Blanche, nursing service in Greece, 1115, 1116 nursing school in Prague, 1149 Kadesky, Dr. David, in Serbia, 1119 Kaisermann, Sara, Palestine Com- mission. 892 Kamerer, Pearl, work of, in recruit- ing nurses, 1062 Kanoly. Lily, at National Committee lioadquartcrs. 206 instruction for women, 1352 Kaplan, Rose, death of, at Jerusa- lem hospital. 65 Kasbin, Pe;-sia. Red Cross hospital establislied at, for Russians, 159 Kavala, relief work in, 1114, 1115 Kean. Colonel Jefferson I!., acting chairman. Central Committee, American Red Cross, 349, 350, 351-352 Kean, Col. JeflFerson R., defines status of volunteer nurses' aides, 271 director general of military relief, 231, 331 director of Ambulance Service of A. E. F., 364, 541 National Committee on Red Cross Nursing Service, 249 on mobilization of base hospitals and American Red Cross, 338, 339 on organization of base hospitals, 332, 333, 337 on Red Cross Nursing Service, 331-333. 339, 340 on requirements for enrollment of reserve nurses, 352 on outline of medical service of zones, 324-325 on uniforms and equipment of Army Nurse Corps, 360, 364 organization of base hospitals, 333, 337, 338, 340 Keech, Cara Mea, dietitian, death of, 1422 Kellerliouse, Grace, at American Red Cross ^Military .Hospital No. 5, at Auteuil, 001 Kellev, Bree S., Chautauqua nurse, 1055 chief nurse of Kerhoun Hospital center, 996 Kelly, Alice A., on conditions during tlie St. Mihiel Drive, in France, 663 Kellv, Mary Irene, visit to devas- tated area, 989 Keenan, Mina, work at Ellis Island, 416 Kemp, Christine, work of, at Ir- kutsk, 943 Kennan, George, Vice-President, American National Red Cross, 1898, 25 Kenny, Tiiomas II., commission for Europe, 531 Kentucky, rural nursing in, 1227 l\eogh. Sir Alfred, ^Icdicnl Depart- ment. British Army, 474 Keppel, i)r. Fre(h>rick Paul, vice- cliairnian of foreign operations of Red Cross, 1079 Kerliouii llosjMtal Center, 996 Kermanshah, Persia, 160 Kerr, Anna K., arrival of. in France for Miss Delano, 1002 INDEX 1525 Kerr, Anna K., Delano Memorial Committee, 1050, lO.ll Nursing Service Headquarters, 238 Kerr, Dr., conference to consider nursing problema, 254 Kerrigan, Ilelen, 183 at llopital Aiuciliare, A'o. S.'i, 1!)!) transferred to Yvetot, France. 184 volunteer service at St. Valery, 539 Kerrigan, Mrs. John, Connecticut Training School, 40 Keyes, Dr. Kegina, in Serbia, 1123 Khoi, Persia, Red Cross liospital established at, for Russians. 159 Kief, Russia,* Polyteclinic Institute Hospital of the American Red Cros.*? at, 155 assignment of Units C and H to, 155 character of Russian patients re- ceived at, 150. 157 Christmas at, 157 closing of. 159 equipment for, 155 record of. 158 routine at, 157 select i(m and preparation of, 156 visitors at, 157 Kiel, Sophia, 3S3 supervisor of Mercv Ship Unit IT, 158 with Russian Red Cross. 159 King, Dr., ill with typhus. 190 King. F. R., Commission for Europe. 531 King, Helen, in charge. Cliildrcii's Hospital at Evian-les-l?ains, 778 in Serbia. 1121 Kinney, Cora, on dispensary at Bo- bigny. Seine, 810 Kinney. Dita II., appointment of. as Dr. McCJee's successor in Army Nurse Corps, 47 head of Government nursing forces, 311 work of. in Army Nurse Corps, 99 Kirby-Smith. Dr. Reynold M.. ar- rival of, witli Pan nurses, at Salonika. ISl on contraction of tyjjlnis by per- sonnel of American Red C'"^^ units. 1S2 director of Unit A. I.'jO Kirkpatrick, Dr. \\ . 1)., director of tlie Rouinaiiian Coininissidn. SS2 Kirkpatrick, Dr, W. D., in charge of ])avilion at American Red Cross lioHpital at Belgrade, 183 Deputy Commissioner for Russia, (578 Kitchen, Dorothy Lewis, on recrea- tion hut at A. R. C. Military Hosi)ital No. 5, (JOl Klee, Kdwin, 159 Kline, (irace, Naval Training Camp at Charleston, 713 Knight, Margaret, dietitian over- .seas. 1385 re])()rt on conditions and duties in France, 1387-1389 Kniglits li()Si)itallera. 2 Knott cliain of liotels, New York, taken over by War Department, for nurses. 421 Knox, Dr. J. H. Mason, 1195 associate chief of Cliildren's Bu- reau at Paris lieadquarters, 817 public liealtli work in France, 702 Kober, Dr. George M.. 126 Kosel, Germanv, assignment of Unit G to. 160' arrival of, 161, 166 changes in units at, 166 military liosjiital at, 166, 167 closing of, 167 public school lazaret at, 166 Kouroven. Marie, nursing service in Greece. 1111 relief work in Gi-eece. 1112 Kraguverats. sanitarv ccmditions at, 187 Kreamer, Laura E.. work witli Chil- dren's Bureau at Toul. 7t)6 Kreigh, I>aura Lowe, nurse in Ser- l)ia, 1119 Kresbs-.Tapy. ^^adame Edouard. on training scliools for nursi's, in Fran((\ 521 Krova, Albania, relief work in. IIOS, 'lino Kriiegcr, M.itliild. at (ievgeli, ill witli typhus. 191 National ('oiumittee on I'eil Cross Nursing Seivic(>, 24M on spirit nf American Units at Ccvgcli. 1S9 on ti-agic cdiiditidns at Gevireli liosjiital, IS!) supcr\i-iir df Scrbinii Units No. 2 and No. :!. ISO. is: Town and (diuitrv NursiiiLr Com- mittee, 1219 1526 INDEX Kulin, Miss, work in rural nursing, 1231 Kurdistan, Red Cross work in, 8S8 Kurowsky, Agnes von, nursing serv- ice in Eumania, 1196 La Bonte, Dr., at Le dandier, 810 La Coumeuve, dispensary at Paris, 806 Ladd, Dr. Maynard, in charge of work with Cliiidren's Bureau in Meurtlie-et-Moselle, 766 Ladies' Relief Committee, work of, in organizing civilian war re- lief, 6 La Garde, Major, request from for Red Cross nurses, 28-.31 Lake Division of Red Cross, 246, 247 Laleski, Dr., assistant medical chief in Poland, public health lec- tures, 1094 Lamlx'rt. Dr. Alexander, 329 Commission for Europe, 531 conference on cliief nurse's posi- tion, 567 director. Red Cross Medical and Surgical Service, 532 Lampasas nursing expedition, 31, 32, 33 services of, 56 Lancer, Dr. John, director of Red Cross liospilal in public school at Kosel, 167 Lanctot. Donalda, child welfare work, France, 1918, 809 Lane, Dr., ill with typhus in Serbia, 190 Lane, Secretary of Interior, Exec- utive Committee of American Red Cross, 1007 Lansing, Robert, Central Connnittee of American Red Cross, 1007 La Panne, Belgium, hospital at, 201 American units assigned to, 149 Lappe, Dr. E. J., medical director of Chatelet Hospital. 778 Lathrop, Mrs. Lsa1)eh work witli cliildren in Toul. H't't Latlirop, Julia, Emergency Commit- tee on Nursing, 264 on rank for army nurses, 1069 Latimer, Frances B., at Neuilly llos- ]iital. .")3S Lat/.er, Irma (Mrs. rianible), on die- titian instruction in Army School of Nursing, J 395, 1396 Laughlin, Mrs. Irwin, London Chap- ter, American Red Cross, 425 Laundry service, organization of, by Florence Nightingale, 3 Lawler, Elsie M., Committee of Transfer, 1021 Laws, Annie, 117 work at Dayton floods, 1913, 133 Lazaret Konzerthaus of the Amer- ican Red Cross, 165-166 Lazear, Dr. Jesse W., yellow fever work by, 14 League of Red Cross Societies, 1140 work of, explained, 1141 Leary, Catherine L., cliief nurse at Camp Sherman, on assignment of colored nurses, 406 Lease, ]M. Agnes, one of first six army nurses, 41 Le Count, Dr. Robert, director of U. S. Navy Base Hospital No. 5, 728 Le Croisic, France, nurses's con- valescent home at, 613 Lecture course for American Red Cross nurses, 122 Leete, Harriet L., chief nurse at Au- teuil American Red Cross Mili- tary Hospital No. 5, 600 inspection of hospital in Serbia, 1117, 1118 National Committee on Red Cross Nursing Service, 249 tuberculosis prevention work in France, 845 typhus epidemic in Serbia, 1119 work in Children's Bureau, Paris, 1917, 761 Le Glandier, France, colony of Bel- gian cliildren at, 818 Lelimann. . ^Margaret, supervisor of :\Iercy Ship Unit A, 150, 183 Lciter Hospital, Red Cross nurses at, 57, 58, 60 Lenilian. Agnes R., child welfare work at Blois, France. 798 Lent. ^Nfarv E., su]iervising nurse, U. S.' Public Health Service, 400 Lentell, "Miss, nursing school in Prague. 1152 Leonard. (Jrace IC. chief nurse of P>ase Section No. 3, France. 434 director of Nursing Service in l''iaiice, 442 Lesage. Dr.. cliild welfare work, France. 812. 815 INDEX 1527 Lesser, Bettina llofkor, association witli Red Cross nos|)ital and Training,' Scliool for Sisters, 22 chief of liospital woriv, American National Red Cross (18'tSl, 2."> on Cuban experiences, .'54, IM Lesser, Dr. A. .Monae, executive sur- geon, American National l^ed Cross (189S), 2o executive sur<,'eon. Red Cross Hos- pital and Traininf^ Sciiool for Sisters. 21, 22 return of. to New York. .SO work with Auxiliary No. .3, 47 Ltterman Hospital, San Francisco, arniv school of nursinfr, 288 dietitians at, L3n4 Levailois, France, dispensary at, 1017, 80:? Leven, ]\I. Emile, child welfare work, France, 1018. 812, 815 Leverman, Katheryn A., on sanitary formations, at Chateau-Thierrv, 0-56 Lewis, Miriam, at children's colony on, Russian Island. <.)^2 T/FTospiecs Civils> dc fji/on, France, 780 Library, Public Health Nursinp, 1224. 122.") Liddle, Katlierine, Hospital Unit "A." 491 Lien. Dr.. joins Dr. Snoddy's croup for Russia. \Cu Lihon. France, captured bv Her- mans. 1918. 404 Lille, school nursinpr at, S22 Limoj^'cs. France. American Red Cross Children's Hos])ital at, S37 Rase Hosi>iia1 No. l."] at. .lOS Rase Hos])ital No. 24 at. r)n4 disi)ensar.v for rcfn^ecs at, 8.'57 Lindslcv, ^farv, dietitian overseas, l;{8.-) report on conditions in France. 138tl. l.n^7 Linixeiifelter. Mrs. M., State Com- mittee of West VirL'inia, lln T>inj:fie]d. F-nudaiid. .AinericMii Red Cross C.invnlesreiit ild-iiital No. inl ;,1. 4;U Liptoii, Sir i'liiimas. on t\))lnis in Serbia. 191 visit iif. t(i CevL^cli b('~pilMl. 19] l.iverim,,!. .\. i;. C, Militar\ [b.-pi- tal Xn. 4 at, 127 Liverpool, U. S. Camp Hospital No. 40 at. 432 i.loyd, i.ulu T., 241, 349 IJoyd-Still. Miss Alicia, representa- tive of (ireat Rritain at Cannes conference. 11.37 Local Committees on Red Cross mirsing service, .390 Local Cnits, formation of, 1209 1270 l.ockerly, Anna, on Oevgtdi condi- tions, 1!I2 on illness of (ievjreli stafT, 190, 191 Rof\in<,', Miss, 183 London, American Red Cross Mili- tary iiosi)ital -No. 22 in, 430 American Ri'd Cross Military Hos- pital No. 23 in. 430 American Red Cross Military Hos- pital No, 24 in, 43!) London Ciiaj)ter, of American Red Cross, 379, 42.1 Long, Dr. John IL, member of oper- ating team sent to i'rance, 741 Longco])e, Col. W. T., .\dvisory Com- mittee (if Army school of nurs- ing, 28."') Long Ishuid City Relief Station, Red Cross ser\ices for, til Loomis, Alice, Commit t(H> on Reil Cross Dietitian Service, 1379 Loomis, May .'~^., director North- we>terii Di\ision of l!ed Cro-^s, 247, 248 "Lord r.tite House," hospital at .terusalem. 8'.K! Lord. Isalud Kly, Committee on r,ed Cross Dietitian Seivicr. 1378 National Cnmmiltee on Dietitian-^. 1377 Lorimer, V, Lota, jmblic health milling, L!(i-'i Loude, Dr.. cliiid welfari' work. France. I'.H^. 812 Louisiana II.mmIs I 1912 >. 132 Loun>lMiry, Mrs. Harriet Camp. Na- t iciiial CiinmiittcM' on l!ed Cross Nursing Sir\iee, 9."), 1 1 1 on Si, rnbrr- C. S. Field lin-pital. Spanish-. \nii'riran War. ."i 4 Stall' Ciinimittei' of West Vir- ginia, im. 112 treasurei". ."-^.iriety nf Snanisli- .V mi rir;! n W a r \ ur~es. U'> l.i.\etl. .Indue K.ilii It <.. 1-1 inference til run^-iiji r lUir-inLT problems, 2:)4 1528 INDEX Lowe, Amy F., child welfare work at CorbcH, France, 799 Lowe, Dr. Thomas, in Serbia, 1117 Lucas, Dr. William P., director of Children's Bureau, France, 758 on cliild welfare legislation in France, 759 on child welfare work, France, 1918, 794 on visit cuscs d'enfants, 811 work at Evian-les-Bains, 777 work at Marseilles, 791 Lucas, Mrs. W. P., member of Chil- dren's Bureau, France, 758 work at Marseilles, 791 Ludd, Palestine, dispensary at, re- organized by Palestine commis- sion, 901 Lufkin, Congressman, bill to secure rank of army nurses, 1066 Lusk, Ida, ill with typhus, 182 Luxembourg, AsHe Caserne at, 622 Lydia M. Holman Association, 12^1 Lynch, Colonel Charles, and First Aid of American Red Cross, 332 committee, lecture course for Red Cross nurses, 122 National Committee on Red Cross Nursing Service, 95 on enrollment in Nursing Service, 357 on making Red Cross members active participants in social re- sponsibility, 81 Lyncli, Mrs. John, Delano Memorial Committee, 1051 Lyon, Alice P., one of first six army nurses, appointment of, 41 Lyon, Sarah S., recruiting relief nurses for Poland, 1085 Lyons, France, dispensaries at, 785 "Hospital Violet at, 624 work of Chihlren's Bureau at, 783 tuberculosis prevention at, 850 ^faas. Clara L., voluntary self-sacri- fice to yellow fever investiga- tion. 05 Mabel Grouitch Baby Hospital at Nisli. Serbia, 215 as (icld ambulance, 1915, 217 :Mcl?ri(]e, Nellie (irace, death of, 920, ] 032 McCainnion, Abl)ie B., developing of Red Cross workrooin. 296 ^IcCaminon, KdiOi M., developing of Red Cross workroom, 296 McCan, Walter D., letter of intro- duction of, for Miss Delano, 999 McCandlish, Mary P., Chateau des Holies hospital, 781 McCarron, Miss, on conditions in Montenegro, 1104, 1105 McCarthy, Dame E. Maud, matron- in-chief, B. E. F., 474 McCarthy, Katherine, member of operating team sent to line, 741 McClellan, George B., on conditions in Italy, 854 McClelland, Helen Grace, at British casualty clearing stations, 456, 461 McClintic, Dr. Brown, 159, 160 McClintic, Eleanor Soukup. See Soukup, Eleanor. McClintock, Mr. James K., Inquiry Commission, 1188 McCloud, Mary J., vice-president. Society of Spanish-American War Nurses, 46 work at Mexico City, 64 McCoy, Lieutenant-Colonel J. C, 619 commanding officer of A. R. C. Hospital No. Ill at Chateau- Thierry, 617 director of American Red Cross Hospital No. 114, 770 McCullough, Ernest, Commission for Europe, 530 McCullough, Grace T., Committee on Red Cross Dietitian Service, 1379 ^McCune, M. Virginia, State Com- mittee of West Virginia, 110 MacDonald, Beatrice Mary, at No. 61 Casualty Clearing Station, 456 wounded in line of duty, 1031 MacDonald, Dr. Charles, director of Mercy Ship Unit E, 173 MacDonnell, Ita, relief work in Po- land, 1159 McDowell, IVIarie, nursing service in Serbia, 1119 McEvoy, Anna Elizabeth, vice-presi- dent. Society of Spanish-Amer- ican War Nurses, 46 Macfadden, Kale, nursing service in Serbia, 1123 McGee, Dr. Anita N., appointment as acting assistant surgeon, U. S. Army, 38, 42 efforts for army rank for nurses, 70 INDEX 1529 McGee, Dr. Anita N., maintenance of liigh standards by, 3!) organization of Hospital Corps Committee by, 3(5 president of Society of Spanish- American War Nurses, 4G report of. on Army Nurse Corps' war service, 43 resignation from Army Nurse Corps, 47 summary of value of services to nursing l)ody, 46 McGovern. Ella, relief work in Al- bania, 1108 McGovern, Nellie E., chief nurse, Romsey Hospital, 434 chief nurse, U. S. Camp Hospital No. 34, 434 work in England, 431 Maclievsky. Dr., liead physician of railroad, of Vilna district, Po- land, 1093 Maciejow, Poland. Rod Cross relief work at. 1087 Mclntire, -Mary, arrival in England with Roumanian units, 1918, 887 Roumanian Commission. 882 Mclntyre, Grace L., chief nurse of U. S. Navv Base Hospital No. 4, 725 on trip to England on '^.>S'. Briton, 725 work at Halifax explosion, 1917, 136 work at Verkhne-Udinsk, 947 Mclsaac. Isabel, in Army Nurse Corps legislative effort, OS book for home care of sick. 1358 death of, September 21. 1914. 101 delegate to Ninth Iiiternatiouiil Red Cross Conference, 1912, 124 head of United States nursing forces. 311 Natinmil Committee of American K.'d Cross. 958 National Committee on Nursing Service. 127 President, Amrricnn .Journal of \iirsin(i Co.. 71 superintendent of Aitiiv Nurse Corps. 101. 359 superintendent of Illinois Train- ing School for Nurses. .'!9 Mack. Annie 1"., chief mirse, I'ase Hospital No. 37, 437 MacKay, Catherine J., Committee on Red Cross Dietitian Service, 1378 McKee, Adelaide, Chairman of Cleveland Local Committee on Red Cross Nursing Service, 328 Mackenzie, Katherine L., child wel- fare work, France. 1918. 809 McKinlev. President, commendatirm of Philippines' Nurse.s' Commit- tee financial statement, 63 reception of special committee for closer cooperation between Red Cross and (Jovernment, 56 McKinnon. .Mrs.. Chateau dcs Ilallea hos])ital. 780 McLaugiilin, Emily A., chief nurse, Base Hospital No. 17, 495 work at Davton, Ohio, floods, 1913. 1.34 ^IcLean, Connnander N. T., at Haiti, 1171, 1172 ^McLcod. Margaret Frances, at Beau- vais hospital, 598 dispensarv at Rue Censier, Paris, 806 on child welfare work at St. Etienne. France, 790 Macklin. Katherine. Palestine Com- mission. 892 Mc:\Iillan. Heh'ua M. State Com- mittee of Illinois, 110 McNabb. Lieuteiumt, work in Serbia, 1118. 1119 ^IcNelis. Mary C. on Naval Hospi- tal. CIray's Ferry Road. 701 on nursing service in the Navv, 702 MacPlunden. Mrs., on conditions for (lict'itians in France. 1392. 1.393 ^IcQuade. Xora M.. on Naval Hospi- tal at Chelsea. 7(16 on Naval Hospital at Parris Island. 709 McQuaide. I'raiiccs. luirsing service in Constant iiioiile. 1 1 SO Palcsliiic Coiiniiission. S92 ^laccddiiia, relict work in. 1114 Madciiii. Edith. Palestine Conimis- sinll. S92 services ,,f. ill I'alcstiiic. 908 Magee. Anita Xewcoiiil), as lieail of I'niied States go\ernnie!it niirs- in- forces, :! 1 1 Magill. Dr. Williaiii S.. senior di- rector of Mercv Sliip Ciiits C ami II. ].")5 1530 INDEX Magill, Dr. William S., resignation as, log ^lagnuler, Dr. Ernest Pendleton, di- rector of INIercv Ship Unit No. 3, ISO, 187 illness and death of, through typhus, 182-183, 103 Mahan, ^Nliss. volunteer helper, 241 Maison d'Evfance, at Marseilles, France, 792 Male nurses, commendations of, by Major Arthur, 60 ]\rallory. Hazel, at Le dandier, 819 Maltbv, Frances, Chautauqua nurse, lOfjo recruiting of nurses, 1062 Manget, Major F. P.. acting commis- sioner and manager of Western Division. American Red Cross, 939 Manget, Felicie, dispensary at Boulevard Eclleville. 800 " Manning. Dr. Hugh, Medical Super- vision. 119.5 Manning, Dr. John P., dispensary work at Paris. 802 at Dispcnsaire Marie-Lanne- lomiuc, 807 at Muiualite MaicrneUe, 800 Mansfield. Perniee D., at Xaval Hos- pital at Great Lakes, 111., 710, 711 Mantoux, Dr. Dora, child Avelfare work. France. 1018, 812 :\rarch, Oenoral Peyton C, Chief of Staff, on regulations regarding equipment of Armv Nurse Corps. 381 -.182 ^farcv. Marw cliief nui-se of Russian Island ilospital. 031 Mare Island. Naval Hospital at. 713 powder magazine explosion. 71-') ]\larie Feodorovna, Dowager Eni- ]>ress of Russia. LI;! Marir-Ilrlrnc Jlopital. partly fi- nanced bv American Red Cross, 800 Mnrii -l.diniflonfiur. Dispoisairr. 807 ^lariiie Ilospital and Relief, Pureau of. 1024 ]\larlb<>r()iigli. Duchess of. Committee of Aiiiericaii \\dnieirs War Re- lief Vun<\. 140 Mars->iir-.\llier. P>ase llcispitals No. 14 and 440 at. .Ill ]\far>eilh's, I'rance, child welfare work at, 701-70.5 Marseilles, France, dispensary at, 792 Marshall, Miss Elizabeth, nursing service in Constantinople, 1197 Marshall, Florence M., director Woman's Bureau, 300 Martha Washington Hospital, Sicily, 805 Martin, Florence J., chief nurse, Base Hospital No. 32, 504 Martin, Dr. Franklin, organizer of General Medical Board, 7 student nurse campaign, 293, 294 Martin, Major, on rank for army nurses, 1069 Marye, Hon. George T., 155 Mason, Adm. M. C, chairman of District of Columbia Red Cross; advocates Red Cross workroom, 296 Massachusetts General Hospital, Nurses' Training School estab- lished at, 13 Massage and pliysio-therapy, 344- 345 Masseuses, demand for, through de- velopment of phvsio-therapv, 344-345 regulations concerning enrollment of, 345 Maternity Ilospital, at Toul, France, 768 Mather, ]\fary E., on child welfare work at Dijon, 817 blather. Samuel, president. Lakeside Hospital, Cleveland, Ohio, 337, 415 Matlieson. Vida. in Serbia, 1121 Mathews. Stella R., 1163 chief nurse, American Red Cross Commission for Poland. 1097 chief nurse. Typhus Research Hos- pital at Warsaw, Poland, 1002 nursing scliool in Poland, 1158, 1150 refugee cliild care, in Poland, 1008 State Conuniltee. Wisconsin, 112 Matter. Mademoiselle, scholarship to study luirsing, 1175 ^lattliew, ^largaret L.. work of, at Cliita. Siberia. 050 ?kfattingly. Dr. George A., director of U. S. Navv Base Hospital No. 4. 725 ^hitzen. Enuna, wounded at sea, 470 Maude, General, at Bagdad, 89^ INDEX 1531 Maxwpll, Miss Anna C, 362 Advisory Committee of Army Scliool of Xursiiifr, 285 aid in nurses' niemoriiil, 1047 Army Nurse Corps, (iS Associated Alumna' Committee to elfeet anUlation of nurses and Red Cross, 7'i at Sternberfj Hospital. Camp Thomas. Cliiekamau<,'a Park, re- port of by. 51-52-53 Committee for afliliatinff or<,Mn- ized nurses with Red Cross, 87, 88 Committee for Memorial Fund to American Nurses, 1048 Delano Memorial Committee, 1050. 1051 delefjjate to Ninth International Red Cross Ccmference, l'.)12, 124 efforts for Red Cross afliliation, 71 National Committee of American Red Cross. 058 National Committee on Red Cross Nursiiifj Service, 05, 111, 127, 240 on Red Cross aide plan, 1052 resolution for rank for Army luirscs. 1074 s('r\ices of, in recruiting nurses, 50 superintendent, Presbyterian IIos- l)ital, 48 tribute to, from Dr. Hoff. 5.3 \isit to Kuropean hospitals. 4S0 work for Red Cross i-nrollment, 77 work to secure rank for Army nurses. 10()5 Slaver. Miss. ])ublic lu'allii luirsinpr, l;?4S Mayo, Maj. W. J., on rank for Army ' luirses. lOC.O ^.leczkowski. Dr. W'., address at schodl for luirses in W'aisaw, 1101. 1102 Medical Division. A. K. F.. hospitals in I-'rancc. 51 1 :\b'dical Service. I'.ureau of. 2?,\ Meijieiiic niul Surtici-y l'>ureau. Naval Hospital Corps sdiools, 712 Xavy Nurse Corps as ]iart of. OSC) MeliliL:. Mrs., on home dieteties, J4;i0, 14.31 Meirs, Linda K., chief nurse, Amer- ican Red Cross Hospital No. 114, 022, 770 ciiief nurse of emergency hospital at douy-sur-.Morin, OOfi Committee on Choosing Candi- dates for Mecbil, 11:50 Roumanian Connnission. SS2 .Meise!i)a(li. Rose, vice-president. So- ciety of Spanish-American War Nurses, 4(5 Melov, Mrs. C S., volunteer lielpcr, 241 Meiuiirial to nurses, Nightingale School. 1047-104!l Memorial to nurses who have died in service. 1(40, 1047 Memorial to women of Civil War l)roposed. 1!)12, 12.3 Mendentiall, Dr. Dorothy Reed, les- sons on infant feeding. 14.30 Mercer, X'ioletta C., on mobile hos- pitals, (i50 Mercy Slii|) F.xpedition, adoption of title '"Sister"' by nurses of, 142 arrival of. in Fngland, 145 cargo of. 141 closing of. 1!)15. 220 daily routine of. on shipboard, 144 distribution of units of, 141 ocean voyage of. 144 personnel assembly of. 143 personmd. |irofi'.-;sior.aI. 141 selection of units for. 142 sentiment of. 142 service unifonn and e(iuipnient of nurses of. 143. 141 stirgeons and luirses recalled, lit 15. 215 I'nit Xo. 1. arrival of. at Salonica, 170 disbanding of. 1S7 military ho-pital at Belgrade taken o\i'i- l)y, 177 personiiel of. 17i) I'nit \o. 2. a,---iL!ne(l to Cevijeli. ISO at Aniei-ii-aii l!ed (ro--, hospital at Cev-ili. is: di.-bamiing nf, ],s7 in typini- e|ii(lrniic. IS). 100 w itlidraw al of. to S.ilcnii i. ]'^1 Tint No. .3. a^^iull^^^nt of. to (;e\- grii. ISO at Aimri.Mii Krr! ( 'ror-s Hospit.il ai (.r\^J,]\. Is: (li-baii.!;ii- of. Is: 1532 INDEX Mercy Ship Expedition, Unit No. 3, in typhus epidemic, 181 withdrawal of, to Salonica, 192 Unit A, assignment to Pau, France, 150 volunteers for Serbian typhus epidemic, 154 Unit B, assigned to Pau, France, 150 volunteers for Serbian typhus epidemic, 154 Unit C, assignment of, to Kief, Russia, 155 changes in, 158 Unit D, assignment of, to Paign- ton, England, 147 at Haslar Hospital, England. See Haslar Royal Naval Hos- pital officers of, 146 withdrawal of, from Paignton, 149 Unit E, establishment of Red Cross hospital at Budapest by, 172 Unit F, officers of, 146 at Paignton, England, 145. See also Paignton. England withdrawal of, from Paignton, 149 Unit G, at Kosel, Germany, 166 Unit H, assignment to Kief, Rus- sia, 155 changes in, 158 Unit I, changes in, 165 members assigned for Russian prison work, 166 Unit K, arrival of, in Vienna, 167 transferred for German prison work in Russia, 171 ^leredith, Mrs. C. K., in Army Nurse Corps legislative efforts. 68 ^Mcrrinian. Mrs. A. X.. Commission to North Russia, 678 M('rv, Dr., cliild welfare work, Paris, '815 Motcalf. :\rrs. Maud, at Mabel fjronitch Babv Hospital, 216 in Serbia. 1120 on conditions at Nish, Serbia, 218 ^Ictropolitan Nurses' Club, offer of services, for Spanish-American War. 40 >rettel, Kloanor, ])ublic health work in Poland, 1094 Metzger, Amanda, chief nurse of U. S. Camp Hospital No. 40, Liverpool, 432 Meuse-Argonne campaign, 633 Mexican border, American Red Cross nurses, first field service of, 348, 349, 351 disturbances on, 1911, 131 nursing service conditions at, 348- 357, 385 U. S. Army base hospital estab- lishment at, 349 U. S. Army camp hospital estab- lishment at, 349 U. S. Army cantonment hospital establishment at, 349 U. S. troops mobilized on, 1911, 117 ^Nleyer, Agnes, in Santo Domingo, 1199 Meyer, Frances H., joins Dr. Snod- dy's group for Red Cross nurs- ing among German prisoners in Russia, 167 supervisor of Mercy Ship Unit G, 167 Michigan, rural nursing in, 1229 Miel, Rev. E. D., Commission for Europe, 531 Miles, Emogene E., on Pau, France, as recruiting station, 151 work at La Panne Hospital, 203 Military probationers, British Nurs- ing Service, 475 Military relief, 231 Mill, Anne P., on hospital train service, 638 Miller, Anastasia, on work at Ref- ugee Hospital at Beauvais, France, 833 Miller, Annie, at Naval Hospital at Mare Island, 713 on types of nurses' service in Eu- ropean War, 714 service at powder magazine ex- plosion on Mare Island. 715 Miller, Elizabeth, in Santo Domingo, 1199 Miller, Chaplain Gilbert 0., funeral service for Miss Delano, 1003 ^liller. Dr. .Tames A., associate di- rector of the Rockefeller coni- niissioii for the Prevention of 'I'nberculosis in France. 844 Millikcn, Sayres L., on Army Nurse C(>r]is uniforms, 359, .360 on nursing service at Camp Sevier, South Carolina, 409 INDEX 1533 Mingane, Mary Frances, nursing service in Greece, 1114 in Sanios, 1113 Mink, Dr., at Virgin Islands, 120.3 Minnesota, school nursing in, 11540, 1:J41 work of public health nurse in, 1.346, 1.347 Minnigerode, Lucy, aid to sick nurses. 10.30 charge of special units of nurses, 2.39. 240 on character of Russians received at Kief, loG, 157 on confidence of Russian patients toward Americans, ir)7 Delano Memorial Committee, 1050. 1051 in influenza epidemic, 975 inspection of Marine hospitals by, 1025 on rank for Army nurses, 1074 on Russian wounded, 158 on war risk insurance for nurses, 1037. 10.38 public health nursing service, 1020 return of, to United States, 158 supervisor of Mercy Ship Unit H, 150 volunteer helper, 241 Minnigerode, Powell, committee on memorial for Miss Delano, 1050 ^finsk. Poland. Red Cross relief work at. 1093 ^Nlinter, Commander .1. ^[., Commit- tee in Haiti, 1173 Mirman, INI., work with children in Toul, 705 Missimer, Florence, member of ope- rating team sent to line. 745 on conditions nt .louilly, 745 on field hospitals, 747 Mississippi, rural nursing in, 1229, 12.30 Mississippi flood disasters, 80, 129, 132 Missouri, nursing service in, 1917, 130 Misfiiuri. Red Cross services on, (il Mitcliell. Elizabeth C... child welfare work. France, 1918, 787, 813 nursing service in Montenegro, 110(1 Mitchell, Dr. SoUice, services of, in Florida vellow fever epidemic, 10 Mitylene, relief work in. 1114 Mixer, Knowlton, in Philippines, 1209 in i'uerto Hico. 1201 Mixsell. Dr. Itaymond, medicin-chef, Chdfrlrt Hospital, 779 Mobile Hospital No. 4, organized from personnel of Rase Hospital No. 21, 4()9 :Mobile Hospital No. 9. Relgium, 649 Mobile Unit No. 1, 6.50 Mobile Unit No. 5, service near front line, 450 Mobilization centre for nurses at Ellis Island, 416 Moer. Henry, National Advisory Committee on Insurance, 1041 :Mohun, Richard D. L., 140 iMollov, .lane C, on cantonment nursing. 394 recreation at Camp Devens. 396 ^Nlongazon. France. Rase Hospital No. 27 at. 500 Mongolia, nurses killed on, 409 Money, Ceneral Sir Arthur, 893 Monroe, Frederick C, on recruiting of nurses. 1001 Monroe, Marv, Cliautauqua nurse, 1055 Montauk. contract for nurses for, 38-39 organization of hospital services at. 00 tents for Red Cross contribution toward nursing service, 61 ^Montenegro, relief work in, 1102- 1107. 1183 Montparnasse, emergency canteen at, 837 Moodv, Mrs. :\[aude C, 302, .306, .371. 372. 374, 379. 383, 384 at cliildren's coionv on Russian Island, 932 Moore, .Tolm Bassett. Central Com- mittee. 230 Moore. .Idlm 1'".. Conference to con- sider nuisiiiL' [irdbleins. 254 Mooreliead. Lieut. -('(d. .bdin -L, 019 at .Xtnericaii Led Cross Hospital Nil. 11(1. at Ciiincy. I'rance. 010 Miiran. I'rederick A., vi-it to Virgin 's v.. Cnminittee on Dietitian Service, l-^laiiils. \-l :\[orL'an. Dr. A- Led Cms- L!7!i Moriiaii. Luth. Cunimittee for Me- iiKU-ial i''iind to American Nur-es. KUS 1534 INDEX Morgan, Ruth, Committee on Town and Country Nursing Service, 1264 director of Nursing Service, 564 establishment of nurses' club, at Paris. 563 on position of nursing profession, 564 Morrow, Colonel, chief surgeon of Second Division, in France, 604 Morrow, Judge W. W., Central Com- mittee, 230 president. Red Cross in San Fran- cisco, 1905, 129 !Morse, Elba L.. plan for recruiting nurses, 1063 Morse, Meda. death of, 1397 Morton, Ruth, chief nurse. Mobile Hospital No. 4, 469 Moselle Valley. 993 ^losher. Dr. C. D.. child welfare work at Corbeil. France, 799 Mother Angela of ^lound City, nurs- ing services of. in Civil War. 7 "Mother" Bickerdyke, Civil War nursing services of, 12 Mother Francis of Chicago, nursing services of, in Civil War. 7 Mother Gonzaga of Philadelphia, nursing services of, in Civil War. 7 Mother Anthony O'Connell, nursing services of, in Civil War, 7 Mott, Mrs. John R.. recruiting relief nurses for Poland, 1085 Moufflard. Mile., tuberculosis pre- vention work in Paris, 847 Mount, Miss. ai)pointed for Philip- pine service. 63 Mountain Division of Red Cross, 247 Mousseau, Dr.. public health work at Bordeaux. Franco. 790 Mulville. Josephine. Chautauqua nurse. 105.1. 1057. 1058 Mumford, John, aid in Ciiautauqua campaign, 1058 Munro, ^Ir.. on transfer of nutrition service to hoaltli service. 1437 Munroo, ^Nlrs. Ccorgc sjxmsor for American Auiljulaiiec at Xcuil- ly, France. 5:)5 Murlin. Major. Food and Nutrition Division of Army. 1400 Murphy. Colonel Fred T.. director, Base Hospital No. 21, 407 Murphy, Colonel Fred T., director of Medical and Surgical Depart- ment, American Red Cross in France, 824 ilurphy, IMajor Grayson, American Red Cross War Council, 612 appointed to General Pershing's staff, 531 Commissioner to Europe, 1917, 427 head of commission for Europe, 530 resignation of, as Commissioner for Europe, 1078 Murphy, [Mary, chief nurse at "Old- way House," Paignton, 429 Murray, General Arthur, acting- chairman of the Central Com- mittee, 360 chairman of Red Cross Central Committee, 337 Murray, Virginia, opened dispensary at Lyons, France, 785 Murv. Edith Agnes, chief nurse of Ellis Island: 416 on work at Ellis Island, 416 Muscle Shoals, Alabama, manufac- ture of nitrate at, 347 Muscle Shoals Sanitary District, Surgeon General Rupert Blue, on duties of Red Cross public health nurse, 403-404 Mutiuiliic MatcrncIIe, taken over bv Children's Bureau, 1918, 807 Napoleonic Wars, relief work of Sis- ters of St. Vincent de Paul in, 2 Nash, Jane E., National Committee on Red Cross Nursing Service, 249 Nassau Hospital, Red Cross services at. 61 National Advisory Committee on In- surance. 104 National Conunittee on Nursing Service. 127 National Committee on Red Cross Nursing Service, 95, 248, 249 duties of, 357. 376 evolution of "Mrs. Robb'g Com- mittee's Plan." 93 meeting June 16, 1917. 405, 406 action taken regarding enroll- ment of colored nurses. 405. 41(6 meeting Dec. 5. 1911. 405 action taken regarding enroll- ment of colored nurses, 405 INDEX 1535 National Committee on Red Cross Nursing Service, meeting held June 2(1, 1917, 405 enrollment of colored nurses, 405 nurses' enrollment plan, 102 National Kmerfrency Association of Women Pliysicians, ofTer of Spanisli-Anierican War services from, 40 National Red Cross Headquarters, building of. by Capt. James Scrymser, 12 National Red Cross ideals, original conception of, for United States, 13 National Red Cross Society, afiilia- tion with American Federation of Nurses. 94 Naval Affairs Bureau, American Red Cross, 091 Naval Hospital Corps schools, 712 Naval training units, in schools, 699 Navv base hospitals, equij)ping of, '(590 organization of, G91 Navy, in Eiiro])ean War, G85 Navy League. Women's Section, 209 Navy Nurse Corps. 080 assignment of Red Cross nurses Ui. 094 er|uij)ineiit of. 090. 09S Esther V. Hassan, first superin- tendent. (!.^0 insignia of. t')9.'). 097 regulations of. 71-') relations with American Red Cross Nursing Service. 0S9 re(|uireiiH'nts of. 0S7 salaries of. 0!t7 sci'\ici' in I],uio[)('nii \\'ar. 099 uiiifontw of. 0'.I4-0!I0 Xavy (>])('rating TeMiii Xo. 1. 741 Xa\>' (*|K'r:it iiig 1 Cam Xo. 2. 745 Xav\- station lios]iilals. oii^anization of. (;!)2 X'a\y units in schools. (;():i Xca'r l-:ast rrlici uoik, !t(i7 Xecleiiiaii. Dr. ( haihs. medical di- rector of l,e (ilaiidier eolonv. SIS X'elsoii. Malu>I. ndief wdrk in Mon- teiie-ro, 11(14 \v.,rk Ml r.alkaiis. lilt; Xelsoii. Mary ('.. child welfare WDrk at Toulouse. I'laiice. 795 X'elson, Mary C, supervisor, work with children at Dinard, France, 709 Nelson, Marv K., Chautauqua nurse, 1055 director of public health nursing, 'VMr.i on work at American Red Cross hospital at St. Valery-en-Caux, 198 supervisor of Alliance Hospital, Vvetot, France, 19? supervisor, American Red Cross Hospital Xo. 109, at Evreux, 5.39, 009 volunteer service at St. V'alerv, 5.39 work at Ilopital Auxiliare, \o. S), 199 work of, in France. 559. 500 Nelson, Sophie C, chief nurse. Cha- teau iles //Z/es' hospital, 781 nursing director, 1195 Nesle. France, captured bv Germans, 191 S, 404 cliild welfare work at, 771 Neiifchateau, France, dispensary and hospital at, 492 traveling dispensaries at, 548 X'euilly, France, American Ambu- lance at. 5.35 American Red Cross Hospital Xo. 101 at. Oil X'eville. Ida K.. work at dock in- firmary at Hordeaux. 1012 X'evins. Georgia Marqtiis. Delano >remorial Committee. 1051 delegate to Xinth International Red Cross Conference. 1912. 124 director Potomac Divi-ioii of Red Cross. 240 lirst meeting of X'ational Conunit- tee on Red Cross X'ursing Serv- ice. 102 ]iea' Xurse Cor])s legislative elfort,' t;s. 7oard- nian and Dr. (Jeorge W. Crile, 327 embarkation of nurses, 413 emergencv detachments, 310, 310, 341 dtities of, 342 organization of. 341, 342 jiersonnel of. 341 value of. 342 enrollment of nurses, 320-323 e(iuipment and uniforms. 323. 357- 3S(; Fjureau of Nurses' Ivpiipment, 303 cabled requi St by General I'ersliinL: for nurses' equip- ment. .'iSl eipiipiiient iif nurses liv Amer- iean Keil Cni-.>. 415 uniform of .\nieriean Army nurse. '157. .'>7()-3SO extra-caiitdnmeiit zoiu- service, 34.")-:ifS ap|irn|iiian(in nf fund- for tini- f(ii-iii- and e(|uipnient. .'>72 coi'qM'r.il ii'ii of { . S. rublio ilea it !i Ser\'iie, Army, and lied ( r,.-,-. -.It^ 399 1540 INDEX Nursing Service, American Red Cross, extra-cantonment zone service, duties of nurses, 399, 403 in infectious and communi- cable diseases, 400-405 in pandemic of Spanish influ- enza (1918-1919), 403 hospital units, 310, 316, 327 equipment of, 340, 341, 344 establishment of, 340, 344 medical sections, 344 organization of, 340, 344 personnel of, 340, 341, 344 purpose of, 340 Ked Cross Chapters and, 340, 344 Red Cross nurses and, 344 surgical sections, 340, 341, 344 insignia, 357, 386 laundry allowance, 385 local Red Cross Chapter and base hospital unit, relation of, 334, 336 marine hospitals, 348 Mexican border service, 348-357 organization of units, 310, 315, 320-321 Red Cross Commission for France, insignia of, 374 Red Cross division offices, estab- lishment of, 342 Red Cross public health nurses, 399-400 regulations governing the em- ployment of American Red Cross in time of war, 334-335, 341 reserve nurses, for Mexican border service, insignia of, 352 requirements for enrollment, 351-352 removal of Red Cross from cap of, 376 uniform of, 368-369 wearing of brassard by, 368 responsibilities of American Red Cross, 415-416 Roman Catliolic Sisterhoods, uni- forms and insignia, 376-378 "safety suits," appropriation for, 384 salaries, 380 special units. 344-345 status of nurses, 356 subsistence of, provision for, 384- 385 Nursing Service, American Red Cross, supplementary and re- placement hospitals, 338 training school units, 342-344 types of assignment characteriz- ' ing war nursing service, 410 Nursing Service, American Red Cross, reorganization of, 564 report, annual, 1917, 136, 138 report of committees, 252, 253 " resolution on rank for Army nurses, 1073, 1074 Ruth Morgan, director of, 564 sub-bureau of Women's Bureau of Hospital Service, 564 Nutall, Mrs., in charge of Nueces nursing party, 33 Nutting, M. Adelaide, Advisory Committee of Army school of nursing, 285 aid to rural service, 1251 and embarkation of unit, U. S. Army Base Hospital No. 4 (Lakeside), 415 Chairman National Committee on Nursing of Council of National Defense, 264 Committee, Memorial Fund to American Nurses, 1048- Committee of Transfer, 1021 committee on settling war nurs- ing policy, 254 conference to consider nursing problems, 253 efforts towards Red Cross affilia- tion, 71 Federation representative. Com- mittee for affiliating Organized Nurses with Red Cross, 87 in Armv Nurse Corps legislative effort^ 68, 69 Instruction for women, 1354 Joint National Committee, 1047 Joint National Committee of Bureau of Information, 1016 letter on home nursing, 1354- 1355 letter to ^liss Delano endorsing war nursing policy, 258, 259 National Committee of American Rod Cross, 958 National Conunittee on Red Cross Nursing Service, 249 organizes Emergency Committee on Nursing, 264 publicity work in Student Nurse Reserve Campaign, 294 INDEX 1541 Nutting, M. Adelaide, president, American Federation of Nurses, 71. report on output of nurses from training scliools, 25;) re8oluti)n for rank of Army nurses, 1074 Superintendents' Society Commit- tee to efTect nurses' and Red Cross adiliation, 74 Town and Country Nursing Com- mittee, 1219 Town and Country Nursing Serv- ice, 121!) Work of Committee on Nursing, Nutrition Service, meeting of mem- bers; transfer planned, 1437 report of, 1438 O'Donnell, Grace, hospital train duty. oOO. (>3() O'Donnell, Marv A., work in Cuba, 64 O'Hara, Anne, nursing service in Serbia, 1119 O'Keefe, Elizabeth E.. reserve nurse on Mexican border, 3,)4-3;);') O'Lauglilin, Mrs. Callan, volunteer nurse, 241 O'.Mallev. Anno L.. Palestine Com- mission. 892 O'Neill, Dr. Frances, director, ClK'itrau . of State Nursing Assuciatioiis for Red Cross iiursiiiLT conuniltee, S(i Hoods. 19l;i. i:V2 (Ills. .loan, volunteer nurse. 241 Old Colony Club, mobili/.alion sta- tion for nurses. 420 "Old Howard .\ssociat ion." yellow fc\-er nursing siTxiees of. 14 Oldtiel.l. Mild. 'line, direct. ir of I'.u- reau of Public ilcaith NuisiuLr, i:!ii:! (lids. Colonel Koliert K.. Coininis- sioner for l-;uro|ie. 1079 on care of children abroad, 1178 Olds, Col. Robert K., resignation from European Commission, 1188 "Oldway House," Paignton, Eng- land, 14.'>, 14ti, 424. See also I'aignton, England, taken over by American Red Cross, 1918, as Militarv Hos- pital No. 21, 429 Oliver, -Marion L., home nursing course. 1305 organizrvice, 249 Osborne, C. (>.. Commissinn for Europe. .").'! 1 Osier, Sir William, consulting phy- sii'ian to Committee of the American WUmen's War Relief Fund. 140 Os/ii^ii) Coiimsco. Italy, 802 Otwill. Cohitul. coinmimder of 319th FiiL'ineers. 720 Oxiev. Nellie v.. Director of Public Health Nursing. 1303 Pacilic ni\i~ion of Pcd Cros-. 2 17 Packai'd, l!li/abelli. i-ecruitinLT relief nur>es for I'ldand. los.! 1542 INDEX Packard, Mary C, State Committee, Maryland, 112 Paderewhki, ^ladame, relief work in Poland, 1085, 1086 Padua, Italy, American Red Cross hospital at, 865 Page, Mr. Walter H., honorary presi- dent of London chapter, Amer- ican Red Cross, 425 Paget, Lady Arthur, Committee of American Women's War Relief Fund, 146 Paid nurse, form of Red Cross agree- ment for, 78 Paignton, England, analysis of cases treated at, 147 assignment of Mercy Ship Unit D to, 147 assignment of Mercy Ship Unit F to, 145 arrival of Unit F at, 145 withdrawal of American units from. 149 Palais d'Hiver, at Pau, France, 150 Palanka Hospital, Serbia, 1118 Palestine, American Red Cross Com- mission to, 891 Red Cross relief work in, 1130 relief nurses in, 1083 Palfrey, Dr. F. E., director of T\'- phus Research Hospital at War- saw, Poland, 1092 Palmer, F. B., school nurse in Minnesota, 1340. 1.341 Palmer, Miss, dietitian overseas, 1410, 1411 work in Albania, 1422 Palmer, Sophia F., 94 Chairman of American Revolution Committee in Rcjcliester, and superintending nurse, 40 Committee on memorial for Miss Delano, 1050 criticism of attitude of puljlic to- ward home coming nurses. 1013, 1014 death of. 1050. 1210 editor. American lournnl of Xiirs- i;i. 71. 391 (fForts towards R(hI Cross affilia- 1 ion, 71 Xiitidiial Committee of Americiui INil Cross. 958 Xalidiial Coimuittce on Red Cross Nursing Service, 95 nil non-enrollment of volunteer nurses, 100 Palmer, Sophia F., resolution for rank for Army nurses, 1074 services for nurses' enrollment in Red Cross, 76 State Committee of New York, 110 Paris, dispensaries at, 802, 810 work for refugees in, 834 work of Children's Bureau at, 801 Park Hospital, origin of, 35 Parkhill, Clayton, demand of, for nurses. 58 Parmelee, Eva Jean, on air raid at Dannes Camiers, France, 453 wounded in line of duty, 1031 Parris Island, Naval hospital at, 708 Parrish, Major Robert E., in com- mand of U. S. Armv Evacuation Hospital No. 17, 948 Parson, Commander A. L., Commit- tee in Haiti. 1173 Parsons, Ellen. State Committee of Illinois. 110 Parsons, Emily E., Civil War nurs- ing record of, 10 Parsons, Louisa, death of, in British Army Service, 65 Parsons, Maud, chief nurse of Base Hospital No. 105, 996 Parsons, Mrs. Ethel S., director of Bureau of Public Health Nurs- ing, 1303 director of Public Health Nursing in Southwest. 1304 National Committee on Red Cross Nursing Service, 249 Parsons, Sara E., chief nurse. Base Hospital No. 6. 493 work of. to secure rank for Army nurses, 1071 Parsons. Miss, nursing school in Prague. 1149. 11.52 I'ascoe, Marv, dietitian overseas, 1404 I'aterson. Jessie G.. Palestine Com- mission. 892 I'atmore. Amy Florence, chief nurse. Base Hospital No. 8. 49() Patras. (Jrcece. infant welfare work at. 1115. 1116 Pnltcn. W. S.. director, Department (f Military Affairs. 535 i'atti rsdii. Klsie. State Conunittee of NCn \uvk. 1 10 I'attirsoii. Fldi-cme ^I.. chief nurse iif tlie Roumanian Commission, 882 INDEX 1543 Patterson, Florence M., at National Headquarters, 240 nursing service in Houmania, 1120 on departure from Ruumaiiia, 1!)18, 887 on Roman Hospital, Rounmnia, 883-88;) work with iiervice dc Santi\ 584 work on Student Nurse Campaign, 2!:5 Patterson, Colonel Robert U., as- sistant director Veterans' Bu- reau, lO.'U Base Hospital No. 5, 452 chief of Bureau of Medical Serv- ice, 206 director of Bureau of Medical Service, 231 National Committee on Nursing Service, 127 selection of surgeons for Mercy Siiip expedition by, 140 Pau, France, arrival of American units at, 150 as recruiting station, 151 assignment of INIercv Ship Units A and B to, 150 burial of soldiers at, 153 eases received at, 152 closing of American Red Cross hospital at, 154 inspecti(m of hospital bv tourists at. 152 record of work of American units at, 154 volunteering of American units from, for Serbian typhus epi- demic. 154 Pavilion liellevuc, St. Cloud, hospi- tal. (HO Peabddy, Dr. Francis, Roimianian (nnuiiissidii, SS2 I'earce. Dr. K. M., chairman, Na- tis. 245, 24r> I'eniisylvania, on Red Cross nursing standards, S;5 Pension Galilee, Paris, nurses' club, 502 Pepoon, .Margaret A., National Com- mittee, 111 National Committee on Red Cross Nursing Service, 95 Pepper, George \\ barton, conference to consider nursing proljlems, 254 Pepper, Mrs. Geo. Wharton, Wo- man's Advisory Conunittee, .'500 Pepper, Margaret, 151J Percy, Dr. Karlton G., chief of American Red Cross dispensary, 709 Perkins, Major James H., Commis- sion for Furojje. 530, 012, 1078 on qualifications of head of Nurs- ing Service, 5(2 Perkins, Colonel Robert P., director of Commission to Italy, 859 Perkins. Dr. Roger G., Roumanian Commission, SS2 Peronne, France, cajjtured bv Ger- mans, 1918. 404 Perry, Miss, delegate to Nintli In- ternational Red Cross Confer- ence, 1912, 124 Pershing, (Jeneral, 348. 381 attitude on rank for Armv nurses, 1073 Persons. \\'. Frank, National Com- mittee on Red Cross Nursing Service, 249 Peter Pent Rrigliani I'nit. V. S. Armv i>ase lios])ital No. 5, 452 ' Peters. Florence M.. cliild welfare wt)rk. France. 1918, S09 Petrograd. i-ece]itio!i of American Red Ci-oss units at. 155 I'etrola. Doris, on conditions at l''\i-('ii\ lios])ital. 5:J9 Pettit, Getiovcva. on wori<; at ilattie-l)Ui-g, 19(IS. 130 Plu'Ian. Marie '1'.. cliief nurse, jtub- lie liealtli work in l'"raiu'e. 702 dispensary \\(iik ;it Paris, S(i3 on .Im7. Ciisinii- at Toul. 7i>7 iclicf \\(irk in Crete, lilt; ill Cri.'.e, 112 State ( (Uiunittee of New "\'ork, 1 111 Plulp-. lirar,'. ciiirf nur-e, I'ase Hos- pital Nu. ti;, r.iis Pliila.Irlpliia, i ii..>pital .\> 1 ti'i-.; General 1. 7o:i 1544 INDEX Philadelphia Red Cross Society, work of, in Johnstown flood. 18 Philippine Islands, nursing service, 120.). 1206-1209 Philippine nursing service, contract form for, 63 Philippine war nursing, conditions in. 69 Phillips. Lawrie L., chief nurse. Base Hospital Xo. 23, 503 Phillips. Laura. Chautauqua nurse, 10.5o Physicians in France, 1917, 758 Phvsio-therapv, development of, due to the war, 344-345 Plessis-Robinson, tuberculosis hos- pital at, 851 Picardy. second battle of, 466, 578 Pickett. Elizabeth, aid in Chautau- qua campaign. 1058 Pierce. Kathcrine X., head of Samaritan Hospital in Troy, nurses' recruiting work of. 50 Pierson. Miss, letter on Home Xurs- ing course. 1356 Pinard. Professor, child welfare work. Paris. 815 Pindell. ^liss, efforts for Red Cross afliliation. 71 Pinder. Kthel. assistant to !Miss Harrington on work in Siberia. 930 director of Public Health Xursing in Southwest. 1304 public health nursing service, 1303 Piatt. Philip S.. director of Educa- tional Service. 783 Playground, at Corbeil. France, 801 Plummer. Samantha C, Spanish- American and World War serv- ice. 65 Podgoritza. ^lontenegro, Red Cross aid at. 1103-1105 Pohlc. St(']>lianie, work of, at Irkutsk. 944 Poilu. 152-153 Poland, child welfare work in, 1189- 1190 condit idus in. 1 179 nursing scliool for. 1154. 1155 Red Cross relief work in, 1077, lOSfl r1 srance, 772 I'oupnnnirre sanatorium. 814 Powell. Louise ^I., X'ational Commit- tee on Red Cross Xursing Serv- ice. 249 Power. Annie, d<'veloping Red Cross workroom, 296 INDEX 1545 Prague, nurses' school, 1150-1152 niirsinfj school at, 1149 Pratt, Helen, on conditions at Evac- uation Hospital No. 4, G45 Preston, Alice, (il!) recruiting relief nurses for Po- land, 1085 Preston, Ralph, American Relief Clearing House, 531 Commission for Europe, 531 Prince Mercea Hospital, Roman, Ron ma Ilia, 883 Prison trains, in Siberia, 021-022 Pritchard, Mary, on cantonment service at Charlotte, North Carolina. 400-402 on comnuinicahle diseases, 402 Pruzana, Poland. Red Cross relief work in. 1087 Przyhylowska. Mme. Marya, recruit- ing relief nurses for Poland, 108.-) Psycliiatric and Orthopedic Base Hospital Units, 372 Public Health 'Surse, 1225 Public healtli nurses, appointments as. 1301. 1302 status of. 278 Public Health Nursing, 1028, 1240- 1202 after war: expansion; policy; re- organization, 1293-1.351 aims of Rural Nursing Service, 12.K-)-12G3 Division of. 1020 education for, 1245-1251 Dr. Clark on funds for, 1280- 1287 extension of. 1270 fund for. disbursements of, 128S- 1289 needs for. 1287-1288 history of. 1211-1239 in Ita'ly, 8G8 Miss Clement's report for 1913. 1222-1224 Miss Gardner's studies and visits, towns in Europe, 1187 name cliaiiged from Red Cross Town and Country Nursing Service to. 347 National organization for; rela- tions with Red Cross, l;!2(i- 1330 need to enhirge field staff for. 1314 purposes of, 2(>(> Public Health Nursing, report of June, 1920. 1029. 1.307-1309 requirements for, 1238-1240 salarv for, 1027 sciioo'ls for, 1241-1244 training for, 1253-1254 uniform of. 1028 United States, 1023 Putney, London, convalescent home for Americans, 438 Quain. Dr. E, M., Bismarck, North Dakota, organization of Surgi- cal Section No. 1, American Red Cross Hospital Lnit. 341 Quinn, Lotetta C. ciiild welfare work, France. 1918. 809 Quintard, ^Irs. Lucy \V,. appoint- ment of. to Camp Wikoff, Mon- tank Point. 51 in Armv Nurse Corps legislative effort," 08 St. Luke's Hospital, service record of, 49 work at ^lontauk, 60 work in Cuba, 04 Race, Ethel V.. dispensary at Boule- vard Belleville. 809 ' Rainey, Paul. Commission for Eu- rope. 531 Raitt. EHie. Connnittee on Red Cross Dietitian Service, 1379 Raker. Congressman, bill to secure rank for Armv nurses. lOGG, 1070 Ranileli. Palestine, hospital at. re- organized by Palestine Com- mission, 901 Randolph. Mary, develoiung Red Cross workroom. 29(i Ranger, Olive, Palestine Commis- sion. 892 Wadi Surar Hospital. Palestine. S!S Rank for Army nurses, liills to se- cure. PltKi ( / .s< ,/. J'npahir. at I-vian-les-l?ains, 775 Ratlibone. Aiuiie S.. on conditions at evacuation o{ Amiens, March. 19 IS. s;n on work witli Srrrici- dv Suniv, .")S7 woi'k at .\niicii~, I'rancc. 774 Itai lihi.nc. Iti.licit ('.. lUucau of lu- suraiice. liii;! 1546 INDEX Raub, Mademoiselle, child welfare work, Paris, 815 Raumo, Finland, reception of Amer- ican Red Cross units at. 155 Readjustment and Liquidation of European Activities, Committee of, 1079 . Reconcentrados, plans for relief of, 25 Reconstruction aides, 277 Recreation huts, established in France, 514 Recreational facilities arranged by Florence Nightingale, 4 Recruiting of nurses, 069 Red Cross, origin of idea, 1 reorganization by Congress, 74 Red Cross, steamship. See Mercy Ship expedition, naval personnel of, 140 sailing of, for World War, 139 "Red Cross Bulletins," article by Mabel Boardman, 75 Red Cross Bulletins, report of lec- tures, 79 Red Cross class-work plans, 82 Red Cross emblem, protective reso- lutions concerning use, 85 Red Cross expedition on S.S. Lam- pasas, 32 Red Cross Hospital, metamorphosis of, into Park Hospital, 35 Red Cross Hospital and Training School for Sisters, 21, 22 Red Cross Hospitals, defects in serv- ice. 23, 24 final history of, 35 loss of prestige, 30 male attendants in, 23 Red Cross Xurses, appointment of, 84 field hospital service, 51 first unit in United States, 15 Red Cross Nursing Reserve, in Mis- sissippi floods, 80 Red Cross Nursing Service, anticipa- tion of service. 20 intensive organization of, 139. See also Nursing Service. National Committee of, 95 Red Cross nursing standards, S3 Red Cross Organization, first unit in I'nited States. 13 in 1898. 25 Red Cross Ilclief Sliip, State of Texas, 25 Red Cross Sisters, requirements, 22 work with American forces, 28 Red Cross Society for Maintenance of Trained Nurses, 27 Red Cross Society of New Orleans, yellow fever regulations, 14 "Red Cross visiting nurse," 1225 Red Cross workroom, first. 296 Reed, Dr., on work at La Courneuve, 806 Reed, Elizabeth, chief nurse at Ve;-a Cruz, 1914, 128 Reed, Henrietta R., at Asile Caserne, Luxembourg, 622, 623 at dispensary at Crenelle, France, 804 head nurse in dispensaries, France, 1918, 809 Reed, Dr. Theodore, in Serbia, 1122 Reed, !Major Walter, head of Yellow Fever Commission, 13 Reeducation of Mntilcs, Bureau of Civil Affairs Department, 757, 854 Reeves, Anna, 127 Nursing Staff, 235 Reeves, Commander I. S. K., on work of nurses at Santo Do- mingo, 1200 Refugees and Relief Bureau of Civil Affairs Department. 757 work of, in France, 825 Refugees in France, provision for, 839 work among, 830 Reid, ^Irs. Whitelaw, Army Nurse Corps legislation, 67, 68 article by Mabel Boardman, 47 cliairnian. Committee on Nurses for Philippines, 62 chairman. Committee on Nursing, Auxiliary No. 3, 47. 55 Committee of American Women's War Relief Fund. 146 established iiospital in France. 538 interview with President McKin- lev, 56. 57 London Chapter. A. R. C. 425 National Committee on Red Cross Nursing Service, 95. 127 Town and Countrv Nursing Com- mittee. 1215. 1216, 1219 resignation from. 12()4 Reineckc, Miss, work at Davton floods. 1913, 133 Relief in tiie Near F!ast, American Committee for, 907 INDEX 1547 Relief work, of Red Cross type, early examples of, 2 Sisters of Charity of St. Vincent de Paul. 2 volunteer for, early German, 2 Helitjious Orders, in Spanish-Amer- iean War nursing, 44 Renault. Dr., child welfare work, Paris, 815 Reorganization of Red Crgss, 1,3:51-0 Reutinger, Anna L., National Com- mittee on Red Cross Nursing Service, 249 on Helgian refugees, 161 on (Jennan Heifer inner, 165 on (terman wounded, 166 at Gleiwitz. 162 on mental attitude of German wounded, 164 on Russian and German military movements about Gleiwitz. Ki.l supervisor of Mercv Ship Unit I, 162 Revigny. France, hospital at. 52.") Rhoads, Major T. L., work at Dav- ton floods. 1013, 134 Rliodes, ^lari*^ R.. in charge of nurses' equipment. 575. 577 Rice. Captain A. A., 610 Rice, Marion M., at Ilopital Anx- ilinre, A'o. 3',. 100 volunteer service at St. Valery, 530 iJich, Mabel, supervisor of Alercv Ship Tnit C. 158 Richards, l.inda, in Army Nurse Corjjs h'gislative effort, 68 llichards. Dr. Theodore \V.. aid in organizing work on hospital supplies. 207 conference to consider nursing probk'ins, 254 l)e|jartment of Alilitarv Relief, (ISO director of Supplies Rureau. 231 N'alional ("onnnittee on Red Cross Nursing Service, 127. 240 on e<]uipping Navy base hospitals, tlOO llicliards. Mrs. 'l'heo(hire \\'., aid in preparinu: sample hospital suj)- plies. 20S head of Washington. 1). C. work- room for liosjiital supplies, 2I'0 Tuliardson, i.iiiiia .. in Serbia, 1117 on welfaic work at Paris. S02 Rotlichild. IJaroii (;ohlschmidt. Kil Rothrock. .Mrs. Anna E.. cliief nurse. Near East Relief for Asia Minor. 907 Rothrock, Mrs. Anna E., resignation in Constantinople, 1170 school for nurses in Constanti- nople, 1168, 1169 Rouen, France, air raids at, 449 General Hospital No. 12, British Expeditionary Forces, 467 Red Cross dispensary at, 816 U. S. Army Base Hospital No. 4 at. 442-452 U. S. Army Base Hospital No. 21 at, 467 Roumania, American Red Cross Commission for, 882 in Balkan War, 876 effect of European War on, 875 entrance of, into European War, 1916, 877 nursing service in, 878 relief work in, 1126-1130 treaty with Russia, 1918, 886 Roussy de Sales, Cotmtess de, French representative at Cannes Conference (1919), 1138 Rowland, Adeline H. (Mrs. Robert Gourlay), at National Head- quarters. 240 Roumanian Commission, .882 work in French hospital, 589 Rove, France, captured bv Germans (1918). 464 Rue Censier dispensary, Paris, 805 Rulon. Blanche S., chief nurse, U. S. Armv Base Hospital No, 27, 500, "636 Rural Nursing Service, 1211, 1235, 1239. 1255-1203 Russell, ^lartha M., chief nurse, American Red Cross Commis- sion for France, 379, 380, 482, 540, 671 committee on choosing candidates for medal, 1130 tuberculosis prevention work in France, 845 Russell, Martha, work in France. 547. 574 Russell Sage Foundation aid in cooperation witli Rural Nurs- ing. 1226 Russia, American Red Cross com- niissidu, 677 American Red Cross work amon.L'^ ])risoii('rs in, at request of (icr man Govei-nment, 225 nurses of, !>2(l Russian Hospital, Jerusalem, 893 INDEX 1549 Russian Island, children's colony on, 032 Russian Island Hospital, 913 reorganized, 931 Russian wounded, ir)7-158 Rust, Captain Arniistead, in com- mand of S.S. Red Cross, 140 Rutley, Edith, Spanisli-American and World War service, 65 Rutley, Sophia, cantonment duty, 380 Rutty, Isabelle E., work on the Lani' pasns expedition, 31-32-33 Ruzickova, Franciska, American training as nurse, 1150 Ryan. Dr. Edward W., in command of commission for Serbia, 1100 conference to consider nursing problems, 254 director of Serbian unit, 141, 170 on evacuation of Belgrade by Serbs, 178 ill with typhus, 181 investigates condition of Red Cross imits at C.evgeli. 181 on retaking of Belgrade bv Serbs, 179 Rvan. John D., director general of Military Relief, 364, 541 estate of, at Putney. England, used for convalescent home. 438 Rykert, Miss, superintendent at Post-Graduate during Spanish- American War period, 49 Ryley, Violet, committee on Red Cross Dietitian Service, 1379 Sag Harbor, Home for Convalescent Soldiers, Red Cross services at, 62 St. Barnabas Guild Club of Nurses, offer of Spanisli-Ainerican War services from, 40 St. Crois, Red Cross work at. 1203 St. Etienne. France, Chnutalonrttc hospital. 1919. 789 dispensary opened, 1918. 788 St. .Tolin. Nlrs. Alici'. cliief inirso of Siberian Coiiunission. 912. 933 closing program at N'ladivostok. 952 on coiulitioiis in Vladivostok. 914 on Czci'li campaign in ."Liberia. !>](') on o(]uipmcnt of Tunioii Hospital, 923 on withdrawal from Verkhne- I'dinsk, Siberia, 950 St. John, Mrs. Alice, work of, at Chita, Siberia, 950 St. Nazaire, France, diet kitchen service at, 1413 dock infirmary at, 1012 U. S. Army Base Hospital No. 1 at, 487 U. S. Army Base Hospital No. 101 at, 487 St. Sulpice, Paris, work for refugees, 836 St. Thomas, Virgin Islands, Red Cross Work at, 1203 St. Valery-en-Caux, American Red Cross vohmteer nurses at, 539 hospital at. 199 Froncli Military Hospital No. 43 bis. American Red Cro.ss unit in charge of, 198 Salaries of nurses, 697, 1027, 1031 Salem fire, 135 Salomon, Mrs. William, offered J^n- don home for hospital, 430 Samos, relief work in, 1113 Samuel, Mary, superintendent at Roosevelt, during Spanish- American War period. 49 San Francisco County Nurses' Asso- ciation, opening of Red Cross State Branch by. 85 San Francisco earthquake and fire (1906). 129 volunteer nursing service in, 82 Sanatorium I^f^ge, tuberculosis hospi- tal. S4S Sanborn. Miss, efforts for Red Cross athliatioii. 71 Sanders, Dr. Cliarles H., director of Mercy Ship I'nit 1. 162 Sandliills Hospital, in P'lorida yel- low fever epidemic, 16 Sandinaier. Barbara. 240, 1110 Sanger. Johnetta B., one of first six arniv nurses, appointment of, 41 Sanitation. 3. 8 Santo Domingo, Red Cross relief work in. 1199 Sarishury Court, England, U. S. Arinv Base Hospital No. 40 at, 4:{S ' Saunders. Josephine, appointed to (h'velop reronstruction aides, 277 Savenay Hospital Center. Miss De- lano's operations at. 1001 I'. S. Arinv Base Hospital No. 8 in. 49()-499 1550 INDEX Savenay Hospital Center, U. S. Armv Base Hospital No. 18 in, 486 Sawyer, Margaret, Bureau of Dieti- tian Service, 1432 nutrition member of National Committee, 1437 Scattergood, J. Henry, director, American Friends, France, 827 SchaflFer, Margaret E., one of first six Army nurses, appointment of, 41 Schaub, Miss, work in Hungary, 1197 Scheitlin, Marion G., aid in Chau- tauqua campaign, 1058 Schenck, Mrs. E. G. H.. State Com- mittee of New York. 110 Schereschewsky, J. W., Committee on Rural Nursing, 121G Schiff, Jacob H., Board of Incor- porators of American Red Cross, 1213-1214 Schiff, Mr. and Mrs. Jacob H., loan of estate for convalescing nurses, 1033 Rural Nursing Service, 1215, 1276 Schneider, Anne E., at Field Hospi- tal No. 27, Chateau-Thierrv, 656 Scholarship and loan fund for nurses. 1279-1281, 1283, 1284, 1288, 1290 Schools for Nursing, Army, 960, 963- 905 in Europe, 1191-1193 in France. 521-523 in Greece, 1182 in Poland. 1159. 1160 in Warsaw, Poland, 1163, 1164 Naval Hospital Corps, 712 navy units, 093 Schuyler, Loiiisa Lee, on Civil War lack of trained nurses, 5 executive, "Women's Central Asso- ciation of Relief," 6 member of Army Nurse Corps, leg- islation committee. 67 Scott, Charles E.. Central Commit- tee of American Red Cross, 1007 European Inquiry Commission, 1188 Executive Committee American Red Cross. 1007 Scrymsor. Capt. James, gift of Na- tional Red Cross Headquarters by, 12 Scutari, Red Cross aid at, 1108 Sedgwick, Dr. John P., member of Children's Bureau, France, 758 work of Children's Bureau at Toul, 766 Sedlacek, Mary, Chautauqua nurse, 1055 Selective draft, 390 Selective Service Law, 389 Sellenings, Dr. Oscar H., child wel- fare work at Marseilles, France, 791 Sellier, Henri, work for tuberculosis prevention in France, 851 Semenoff, General, 919 Sennott, Katherine G., Hospital Unit "S." 496 Serbia, American Red Cross work in, at request of German govern- ment, 225 child welfare in, 1190, 1191 conditions in military hospitals, 188 entry into World War, 176 relief work of American Red Cross, 1100, 1117 typhus epidemic in, 154, 179, 183 Serbian patients at Belgrade Red Cross hospital, 185 Service de Sajite, A. L. F. Fitzgerald in charge of work with, 583 nurses assigned to, 579-595 Sewny, Mrs. L. C, Palestine Com- mission, 892 Seymour, Nina Louise, death of, in line of duty, 1032 Shackford, Clara L., supervising nurse, Bureau of Tuberculosis, France. 846 Shaneman, Mary E., nursing service in Santo Domingo, 1199 Shaw, Agnes, appointed for Philip- pine service, 63 Shaw, Sara E.. appointed for Philip- pine service, 63 on nursing system in Italy, 858, 862-864 story of Lampasas experiences, 33, 34 Shaw, steamship, collision with A (/ui fan in, 727 Slieelian, Mary E., chief nurse at Old Colony Chib, 420 Shelton. Nina, nursing service, A. E. F., at Chateau-Thierry, 034 INDEX 1551 Sherman, Elizabeth F., work at Hal- ifax explonion, 1017, 136 Ships, convoy system of transporta- tion, 718 "Shock teams," 658 Shott. Rutli, dietitian overseas, 1410 Siirady, Mrs. (Jeorjre H., pioneer member of Auxiliary No. '.i, 47 Shurley, Dr. Burt E., director, Base Hospital Xo. 36, ^^0\ Siberia. American Red Cross relief work, <)10, i)2n, 1130 American troops sent to, 911 conditions in, 920-022 educational nursinp service in, 934 typhus epidemic in. 1918, 918 Sibonev. refusal of Miss Barton's aid at* 27 Sicily, earthquake in, 1908, 131 Martha Washington Hospital in, 865 Sick nurses, caro of. 1034. 103;i Siclirs. Mary, ill with typhus, 191 Sijjray. Countess. 173 Silliman, Mrs. Clias.. aid in propar- iu'T saniph> liospital supplies. 208 Simmonds. Emily Louise, on sani- tary conditions in military hos- pitals in. 187 Simon. Marjjaret B.. work in Pliila- delphia buildinj; disaster. 1009, 131 Simons. Olive M.. cliild welfare work. France. 1918, 809 nursing service in Haiti. 1171 Sims. Rear Admiral W. S.. com- mander of American naval oper- ations overseas, 718 Singer. Paris, loaning of ''Oldway House" by. for hospital pur- poses. 146 Sister Adeline Taylor, nursing serv- ices of. in Civil War. 8 Sister Chrysostom. 665 Sister Isabella. t)(i5 "Sister." as title of nurses on Mercy Sliip expedition. 142 Sisterhoods, nursing services of, in Civil War. 7 Sisf.Ts. Red Cross. 22. 23 Sisters of St. \'iiici'nt de Paul, in N'apcdennic Wars. 2 Skinner. Mrs. Robert P.. L of nurses' equipment. 3S1 organized Base Hospital X'o. 18, 486 Town and Countr^ Xursing Com- mittee. 1210 Smitli. Colonel Winford H., training of Army nursi's. 2S6 on uniforms of Roman Catliolii' Sisterhoods, 377-378 w,Mr nursing policy. 254 Smith College i'nit. ranteen of, for refii;.'ees in Paris. ^^2 Smitliie, Dr. P. A., IGS 1552 INDEX Smythe, Eva Louise, dispensary at St. Etienne, France, 1918, 788 Snively, Emily C., Sanitary Unit No. 5, 402, 403 Snively, Mary, early nursing super- intendent, 19 Snively. Dr. H. H., senior director of Units C and H, 158 Snoddv, Dr. Cary A., director of Red Cross hospital at Vienna, 167 on arrival of Austrian wounded at Vienna, 168 on effectiveness of projectiles, 170 German prison work in Russia, 166 senior director of American Red Cross Units, 166 Snow, Mary, in Serbia, 1117 Snyder, Juliet, child welfare work, France, 1918, 809 in dispensary at Rue de Pre-Saint Gervais, 808 Societe de Secours aux Blesses Mili- taires, 848 Societe de Secours aux Rapatries, at Lyons, 782 Society for Maintenance of Trained Xurses, 60 Society of Public Utilitv of Geneva, 6 Society of Spanish-American War Xurses, 46 Society of Superintendents of Train- ing Schools for Nurses, 20 Sofia, Bulgaria, niirses' training school at, 210 Soldier-orderlies. 961 Soldiers' families, assisted by Flor- ence Nightingale, 4 Soukup, Eleanor, on Persian sanita- tion and customs, 159-160 South Carolina, rural nursing in, 1228 Southampton, England, U. S. Army Camp Hospital No. 36, 436 Southmayd, Col. F. R., work in yel- low fever epidemics. 14 Southwestern Division of Red Cross, 246 Spanish-American War, Red Cross services in, 25 Spaulding, Helen M.. child welfare work. Franco. 1918, 809 Hopifril Auxiliare, Vo. 3'/, 199 volunteer service at St. Valery 539 Special Service Group, 278, 279, 281, 282 Spelman, Lillian M., Palestine Com- mission, 892 Wadi Surar Hospital, Palestine, 898 Speyer, Mrs. James, ex-ofEcio mem- ber of Committee on Nurses for the Philippines, 62 pioneer member of Auxiliary No. 3, 47 "Splint teams," 658 Springport, Mich., nursing service at, 1917, 136 Stack, Elizabeth, work at Angel Island, 64 Stambaugh, Isabelle, on casualty clearing station team, 465 wounded at Amiens, 465, 1031 Stanley, Anna S., conferences on school nursing, 1335 director of Public Health Nursing in Southwest, 1304 Starr, Lida G., appointment to Manila, 59 appointment to Philippine service, 63 work of, at General Hospital, Fortress Monroe, 59 State Associations of Nurses, sug- gestion for substitution of for State Nursing Committees, 86 State Committees, for enrollment of nurses, 106 organization of, 110 State Health Departments, relation to Red Cross, 1318-1321, 1326 State Nursing Committees, in effec- tiveness of, 86 State Societies of Nurses, entitled to Red Cross membership, 112 State of Texas, as Red Cross Relief Ship, plans for, 25 Statistics, death toll of various countries, 985 numbers serving in American Red Cross, 1919, 1131 numbers of soldiers sent home after Armistice, 1009 nurses needed (1918), 967 percentage of deaths due to dis- ease, 986 Steelman. Katherine, volunteer work in Siberia, 915 work at Irkutsk, 945 Stenliolm, Alice F., service on Virgin Islands, 1204 INDEX 1553 Stern, Frances, social service work, France. 1918, 80!) Sternburf^. Siirf^eon (General Georj^e Miller, and the Red Cross, 2!t demand tliat Cuban nurses be im- mune to yellow fever, .SI first action from, toward recofj^ni- tion of Army Nurse Corps. 4(5 on orif^in of Army Nurse Corps, :Ui-.38 to Mrs. Whitelaw Reid, on plan to use Red Cross nurses in base iiospitais, f)? Sternberjjf Hospital, Cliickamauga, Ri'd Cross services at, 01 Stevens, Dr. Marion, in Serbia, 1117 Stevenson, Mrs. Beatrice V.. in de- fense of Home nursing teacliing, 81 on Red Cross health education, 81 services for Red Cross enrollment, 70 State Committee of New York. 110 work in Brooklyn for Home Care Nursing. SO Stcvensdn, W. C, in charge of ad- ministration, Chiitelet liospital, 77!) work at Evian-les-Rains. 777 Steward. Leohi. member of operating team sent to line. 74;') Stewart. Isabel M., League of Nurs- ing Education Aidi-s course at \'assar, 'iOS vork for National Committee on Nursing. 20.") Stewart. Misses, volunteer helpers. 241 Stiies. Mildred C... chief dietitian at (Jreat Lakes Naval Training Station I?ase Hospital. i:i!t7 Stillinan. Miss Cliarlotte. .'502 Stilhnan. Dr. Stanley, directnr of r. S. Naval Base Hospital No. 2. 721 Stirnsnii, .lulia C. career of, :n2-3i:?. .JOO. 010 Stiiiisoii. .Julia, camjiaign for re- cruiting nurses. liitJO chief nurse. American Red Cross in l-'rance. ")04. .")00 chief nurse, Hase liospital No. 21, 407 dean of Artny Nursing School. 2^0 Delano Memorial ( oniinit t ee. ]n.")l in eniergeiu y liospital at douy-sur- Morin, tiiiC. Stimson, Julia, International Con- ference at Cannes (191!)), 1137 National Committee on Nursing Service, 127 National Committee on Red Cross Nursing Service, 249 on care of sick Army nur.ses, 10.34 on conditions at American Red Cross Hospital No. 104, Beau- vais, France, .'jOC, .'599 on hospital train service, 642 on nurses assigned to emergency hospitals, 017 on nurses' ecpiipment for military nursing service, .575 on position of chief nurse of American Red Cross, ")07, .'iOS on qualifications for hospital train service. 043 on tour of Beauvais area, 581 on work with Army nurses, 628 superintendent of Armv Nurse Corps. 311. 312 work at Dayton fioods, 1013. 134 Stimson. .Major, takes over dietitian service, 1427 Stirk. Miss. Philippine service, 63 Stock. Pauline I., on "shock" work, 0.")9 Stone, Frances A., appointment of, as Assistant Superintendent at the Sternberg C S. Field Hos- pital. rr2 service of. 04 Storrs. ('(donel Ronald, military go\'ernor of .Jerusalem. 893 Straight. Mrs. Willard, Town and Countrv Nursing Committee, 121!) Strode. Elizabeth Coombs, on Shock" work. 0.-)S Strong. Anna 11.. Advisory Commit- tee of Nightingale School, 1049 League of Nursing Education aids ])reparing course at Vas- sar, 2(iS National Connnittee on Red Cross Nursing Service. 24!) Strong. Anne Hervey. revision of textbook. ];if>S Strong. Major .J. N.. head of Vladi- vostok hospital. !):3.3 cliief nurse at Vladivostok hospi- tal. !3!) sails for home from Siberia, 052 T(nnsk, Siberia, American Red Cro.sa activities at, 1)42 Torney, Dr. (ieorge 11., appreciation of Miss I)(dano's work in Army Nurse Corps. !8 surgeon general of United States Armv, 325, 320 Torrance,' Rachel. 1100 chief nurse, American Red Cross, in fireat Britain, 441 in Serbia. 1117 organization of Nurses' Training School at Sofia, Bulgaria, 1!)15, 21!) Roumanian Commissitm. S82 visit to devastated area. !)80 work in Czecho-Slovakia, 1 I'M Tottenham. England. V. S. Base Hospital No. 2!), 438 Toul, France, dispensaries estab- lished at, 7()8 maintenance of jiroject. 771 work of Children's Bureau in. 705 Toulouse. France, child welfare ex- position, 1018. 705 Touniiur. S.K., burning of, l(i5 Town and Counlrv Nursing Service. 237. 210. 121S. 12l!t. 1225, 1230. 1238, 1230. 1204-12(;0. 12()8, 1271. 1272, 1277. 127S Towne. Miss, ajiiiointed for Philip- ]nne service. 03 Townsend. Howard, on special com- mitti'e for closer cociperation be- tween Red Cross and Covern- nient . 57 Trained nurses, lack fif. in Civil Uar. 5 Transfer. Couimitfee of. 1021 Trans-Siberian Railroa.l. itlO. '027 rraiis|ior1at iIS Travis. Dr. ( at lieriiie. as-istant. Mabel Cror.itch Baliv Hospital, 210 1556 INDEX Treport, France, evacuation of, 466 U. S. Army Base Hospital Ko. 10 at, 459 Treves, Sir Frederick, on organized volunteer aid for Red Cross, 324 Triage, 664 Trippett, Josephine, Pelham Bay Training Station, 717 Trudeau, Edward T., Sanatorium, 851 Tuberculeux de la Guerre, 844, 848 Tuberculosis, work of the American Red Cross to combat, 843 et seq. Tuberculosis Association, National, cooperation with Red Cross, 1326-1330 relation with Red Cross, 1321- 1323 Tuberculosis Bureau of Civil Affairs Department, 757, 843 Tuberculosis, Commission for Pre- vention of, in France, 844 Tuberculosis hospitals aided by American Red Cross, 848 Tuck, Mrs. Edward, president, Tu- herculeux de la Guerre, 844 Tucker, Katherine, Committee of Transfer, 1021 Tulloss, Clara, ill with typhus, 190 Tumen, Siberia, evacuated because of Bolsheviki, 942 Tumen Hospital, Siberia, 923 Tupman, Mrs., delegate to Ninth International Red Cross Confer- ence, 1912, 124 Turczynowicz, Mme. Laura de Goz- dawa, recruiting relief nurses for Poland, 1085 Turkey, 889 Turkish Municipal Hospital at Jerusalem, 894 Turnbull, Dorothy, chief nurse of American Red Cross Hospital No. 104, at Beauvais, 598 Turnure, Major P. R., 345 Tuscania, Steamsliip, torpedoed, i;jl8, 720 Tuttle, Jennie L.. work at Davton floods. 1913, 134 Twiss, Mrs. C. V., State Committee of New York. 110 Twitchell, Dollv, Chautauqua nurse, 1053 Tye. Menia S., National Committee on Red Cross Nursing Service, 249 Tylski, Stella, Municipal Hospital at Cracow, Poland, 1096, 1159 Tymon, Mary Margaret, nursing service in Greece, 1111, 1115 Tvplius epidemic in Serbia, 154, 179, 918, 1119 work of sanitary commission of Rockefeller Foundation and American Red Cross in, 183-184 Typhus Research Hospital at War- saw, Poland, 1092 ZJmbria, Steamship, carried unit of Base Hospital No. 102 to Genoa, 668 Uniforms, of Navy Nurse Corps, 694-696 of Public Health Service, 1028 United States, in European War, 485 et seq. U. S. Army Base Hospitals: Hospital No. 1, St. Nazaire, France, 487 Vichy, France, 505 Hospital No. 2, :6tretat, France, 454 Hospital No. 4, 442-452 unit of, at Rouen, France, 442- 452 Hospital No. 5, Dannes Camiers, France, 452 transferred to Boulogne-sur- Mer, 453 Hospital No. 6, Bordeaux, France, 493 Hospital No. 8, Savenav, France, 496-499 Hospital No. 9, Chateauroux, P'rance, 499 Hospital No. 10, Le Treport, France, 459 Hospital No. 12, Dannes Camiers, France. 469 Hospital No. 13, Limoges, France, 508 Hospital No. 14, Mars-sur-Allier, France, 511 Hospital No. 15, Chaumont, France, 493 Hospital No. 17, Dijon, France, 494 Hospital No. 18. Bazoilles, France, 4SS temporarily assigned to Sav- enav, France, 485-486 Hospital No. 19, Vichy, France, 509 INDEX 1557 U. S. Army Base Hospitals: Hospital No. 20, Chfltedguvon, France, 506, 507 Hospital No. 21, Rouen, France, 467 Hospital No. 23, Vittel, France, 503 Hospital No. 24, Limoges, France, 504 Hospital No. 27, Mongazon, France, 500 Hospital No. 29, Tottenham, Eng- land, 438 Hospital No. 32, Contr^xeville, France, 503 Hospital No. 33, Portsmouth, Eng- land, 436 Hospital No. 36, Vittel, France, 501 Hospital No. 37, Dartford, Eng- land, 437 Hospital No. 40, Sarisbury Court, England, 438 Hospital No. 46, Bazoilles, France, 508 Hospital No. 82, Luxembourg, 623 Hospital No. 101, St. Nazaire, France, 487 Hospital No. 102, on Italian Front, 665 Hospital No. 202, 741 Hospital No. 204, Winchester, England. 432 Hospital No. 449, Alars-sur-Allier, France, 511 U. S. Armv Base Section No. 3, Eng- land, 426 U. S. Army Camp Hospital No. 34, Romsey, England, 433 Hospital No. 35, Winchester, Eng- land. 428 Hospital No. 36, Southampton, England. 436 Hospital No. 40, Liverpool, Eng- land. 432 U. S. Army Medical Corps, coopera- tion with American Red Cross, (>31 in France. 1917, 484 United States General Hospital. Fortress Monroe. 7 U. S. Navv, activities of, at Cihral- tar. 7"l9 hospitals of, equipped by Ameri- can Red Cross, 720 Nurse Corps. 686 overseas service of, 718 U. S. Navy, participation in North Sea activities, 719 personnel of, 1917, 698 training of personnel for Euro- pean War, 698 training units in schools, 699 U. S. Navv Base Hospital No. 1, 694, 728, 733 Hospital No. 2, Strathpeffer, Scotland, 721 Hospital No. 3, Edinburgh, Scot- land. 722 Hospital No. 4, Whitepoint, Ire- land, 725 Hospital No. 5, 728 U. S. Navy Hospital, at Guam, 732 United States Public Health Service, 398, 399, 1023 United States Sanitarv Commission, 6-9 Civil War relief work of, 6 L'pham, Anne T., first dietitian over- seas, 1381, 1382 Upjohn, Anna Miles, child welfare work. Lyons, France, 784 Urch, Daisy D., chief nurse, Base Hospital No. 12, 469 Uskub, sanitary conditions at, 188 Utley, Grace, at Mabel Grouitch Baby Hospital, 216 Valence, France, dispensary at, 842 playground established at, 842 Van Blarcom. Carolyn C., American Red Cross parade. New York, 420 Army Nurse Corps uniforms. 361, 3t).S Nursing Service. Atlantic Divi- sion. American Red Cross, 244, 245, 362, :{()."). 371, 383 resignation of. 372 Van de Vrede, Jane. Committee on memorial for Miss Delano, 1050 division director of luirsing. 10:58 for Nortli and Soutli Carolina, Florida. (kH)rgia and Tennes- see. 24(i public healtli nursing service, 1303 on Red Cross ai(h' plan, 10.12 Van DuziT. Charlotte K.. Bureau of Public Health Nursing. 1302 van Dyke, Dr. Henry, 1(11 Van Ingen, Frances 1"., chief nurse of I'. S. Navv Rase Ho-^pital No. 1. 734 1558 INDEX Van Ingen, Frances F., on conditions at Brest, France, 738-740 on Aliss Delano's talk to nurses of Navy Base Hospital No. 1, 998 on organization of staff of U. S. Navy Base Hospital No. 1, 734 on U. S. Navy Base Hospital No. 1 at Brest. *736 reception to Miss Delano at Brest, 996 Van Meter, Anna R., Bureau of Dietitian Service, 1436 Van Schaick, Dr. John, Commission for Europe, 531 Commissioner to Belgium, 817 Vanderbilt, Mrs. William K., spon- sor for American Ambulance at Neuilly, France, 536 Vassar College nursing course, 268 Vaudling, Marjory, at Le dandier, 819 Vaughan, Mrs. Elsbeth H., at Na- tional Headquarters, 240 nursing direction, 1195 school at Dorpat, 1194 work in Baltic States, 1197 Vaughan, Victor C, on rank for Army nurses, 1069 Verkhne-Udinsk, provost guard hos- pital under American Red Cross, 947 withdrawal of American Red Cross from, 949 Vernon, Miss, State Committee of West Virginia, 110 Veterans' Bureau, Nurse Corps of the, 1030 Veuille-les-Roses, convalescent home at, 195 Vichv, France, Base Hospital No. 1 at, 505 Base Hospital No. 19 at, 509 Vickerv, Dr., in charge U. S. Navy Base Hospital No. 1, 734 Vienna, established Red Cross hos- pital at, bv Mercy Ship Unit K, 167 closing of, 171 record of, 171 shortage of food and supplies in, 169 treatment of Red Cross unit at, 169 welcome of Red Cross unit at, 173 Vilctoria Theater liospital. Hce (Heiwitz. Vilna, Poland, equipment of Polish Army hospital at, by American Red Cross, 1092 Violet, Hospital, at Lyons, 624 Virgin Islands, nursing service in, 1202-1204 Visiteuses d'enfants, training of, 811 Visiting nurse, Albania, 1108 Visiting Nurse Association, 1310 Vittel, France, U. S. Army Base Hospital No. 23 at, 503 U. S. Army Base Hospital No. 36 at, 501 Vladivostok, American Red Cross activities in, 917, 939 American Red Cross emergency service in, 912 closing of nursing program at, 952 Fortress Hospital in, 913 Morskoi (Naval) Hospital at, 933 Refugee Hospital in, 927 reorganization of, 932 revolution of Nov. 18, 1920, at, 933 Voluntary Aid Detachments. British Nursing Service, 478, 480 Volunteer nurses, in Red Cross service, 21, 78 U. S. Army regulations for, 99 Volunteer nurses' aides. 271-274, 959 Von Wedikind, Dr. L. S., in charge U. S. Navy Base Hospital No. 1, 734 Voor, Dr. John, in Serbia, 1117 Wadhams, Colonel Sanford H., on buildings for hospitalization in France, 511 Wadi Surar, Palestine, hospital at, 898 refugees at, 898 Wadley, ^Vlary F., Army Nurse Corps legislative effort, 68 nurses' recruiting work of, 50 Wadswortl). Eliot, acting chairman, Red Cross Central Committee, 337, 387, 388, 389 conference to consider nursing problems, 254 equipment of Army Nurse Corps. 364 Executive Committee of American Red Cross. 1007 Wald, Lillian D., Advisory Commit- tee of Army school of nursing, 285 INDEX 1559 Wald, Lillian D., chairman, Com- mittee oil Home Nursing, 21).") conference on nursing problems, 254 Committee on Rural Nursing, 1210 Emergency Committee on Nursing, 2(>4 Joint National Committee of Bu- reau of Information, 1010, 1047 National Committee on Red Cross Nursing Service, 249, 958 public liealth nursing service, 1212-1215, 1220 Red Cross enrollment, 77 Representative in Conference at Cannes (1919), 1137 scliolarship and loan fund for nurses, 1281-1283 Town and Country Nursing Com- mittee, 1219 Walker, Evelyn, on dock infirmary at Bordeaux, 1012 public liealth work at Bordeaux, I'Vance, 790 Walker, Dr. May E., in charge of dispensary for refugees at Limoges, France, 837 director of American Red Cross children's Iiospital at Limoges, France, 837 Wall, Emma L.. National Committee on Red Cross Nursing Service, 249 State Committee, Louisiana, 112 Wallace, Elizabetli, child welfare work at Marseilles, France. 791 Walling, Willoughby. Central Com- mittee of American Red Cross, 1007 Walsli, Adelaide ^\.. State Commit- tee of Illinois, 110 Walsh. Elizabetli, Chautauqua nurse, 1055 talks on nursing, 1059 Wither, Louise M., head nurse of \'iliia Railroad hospital in INdand. 1093. 1159 Walton, Tsaliel Jean, public health nursing work. (i5 vice jiresident. Society of Spaiiish- -American War Nurses. 40 \\'ar Cnuiicil. Aiiicricaii Red Cross, 2.{S. 403 \\'ar l)t'])artineiit. appropriation for r(>coiist ruction aides. 277 at'itudf on rank for Arinv nurses, ln72 War Department, Red Cross services ai(e|)ted, .June, 189S, 29 rej)ort on services of colored nurses, 408 War nursing, jxdicy of Red Cross, 254-258 War Relief Board, handling of Nursing Service, 94 War Risk Insurance, Bureau of, 1030, 1033. 1037, 1038 War wounded, agreement in Society of Rulilie Utility of Ceneva, War Zone Bureau of Civil Affairs Department, 757, 854 Ward, Admiral Aaron, in charge of Mercy Ship expedition, 140 Ward. Dr. Edwin. St. John, survey of conditions for Turkish gfiv- ernment. 889 Ward, Virginia, at National Head- quarters. 240 Wardwell, William T., American National Red Cross Relief Com- mittee, 20 president. Red Cross Hospital and Training School f(jr Sisters, 22 Warner, Lena A., State Committee, Tennessee. 112 Warsaw, conditions for hospital, 1150 Nurses' School at, 1101. 1103, 1104 Wartowsky, Doris, pulilic health work 'in Poland, 1094 \\'as]iburn. Mattie ^L. chief nurse. I'. S. Aniiv Base Hospital No. ^3. 430 Washington, D. C, instruction for women, 1352 ortrani/.ation airainst influenza, 970 Walerburv, Ruth C, work in \'ir- gin Islands, 1203. 1204 Waters. Florence M.. 112!) ^^'aters. "S'ssabella fJertrude, ehief of division of Public llealtli Nurs- ing. 1017. 101 S cniiijiilation of public liealth nurs- ing agencies by. 04 vice president. Sdcicty of Spanisli- Anicrican Wnr Nurses, 40 Wnlkiiis. Rachel, diitilian overseas. PN'.i Wats.m, Dr. Pnymond M.. cMcf ,.f denial (!c]iartniciit at Hospital \'iolct. 7s5 Watson, Pehecca, 1S3 1560 INDEX Watt, Dr. James, member of operat- ing team sent to line, 745 Watt, Richard M., on committee to secure Red Cross ship for World War, 140 Weber, Elizabeth, appointed super- visor of Mercy Ship Unit F, 148 W^eeks, Mrs. Robert W^olcott, volun- teer helper, 241 Weill-Halle. Dr.. child welfare work, Paris, 812. 815 Weill-Raynal, Madame, child wel- fare work, France, 1918, 812 Weir, Ruth, nursing service in Rou- mania, 1127 on work at Neufchdteau, 492 Weir, Wilhelniina, nursing services of, in Florida yellow fever epi- demic, 16 Welch, A. A., National Advisory Committee on Insurance, 1041 Welch, Lettie G., director Mountain Division of Red Cross, 247 home dietetics, 14.31 Welch, Dr. William H., committee on settling war nursing policv, 254 in Arniv Xurse Corps legislative effort! G9 National Committee on Nursing Service, 127 Waller, Clarion, chief nurse at A. R. C. :vrilitary Hospital No. 4, Liverpool, 428 Wellington, Gertrude E., National Emergency Association of Wo- men Physicians, 40 Wellnian, ^lahel, home dietetics, 14.30 Wells, Edgar IT., Commission for Great Britain, 427 Wells. Mrs. F. N., volunteer helper, 241 Wells, Colonel TI. Gideon, command in Pucliarest, Red Cross service, 1120 resignation in Roumania, 1128 Roumanian Commission, 882 Welsh, Mabelle S.. 147 supervisor of Mercy Ship Unit F, 140 Wentzel, Leslie, in Albania, 1108 Wrstor< r. steamsliip, torpedoed, July, 1918, 7:50 Wetherill, ^Irs. Richard, volunteer helper. 241 Wharton, Mrs. Edith, vice-president Tuberculeaux de la Ouerre, France, 844 Whedon, Rhobie, service in Belgrade, 1120, 1179 Wheeler, Mary C, National Commit- tee on Red Cross Nursing Serv- ice, 249 State Committee of Illinois, 110 work at Dayton floods, 1913, 134 Wheeler, Dr. Ruth, chairman, Na- tional Committee on Red Cross Dietitian Service, 1433 Committee on Red Cross dietitian service, 1378 nutrition member of National Committee, 1437 on needs for dietitian "sifting out," 1396 White, Edna, Committee on Red Cross Dietitian Service, 1378 nutrition member of National Committee, 1437 White, Eleanor R., chief nurse. Offi- cers' Hospital in France, 538 White, Emmet W., Philippine Islands, "1206 White, Grace, nursing service in Haiti, 1173 White, Lillian L., director Pacific Division of Red Cross, 247, 1038 ^^^lite, May Loiiise, head nurse, Rialvstok Orphanage Hospital in Poland, 1094 nursing school in Prague, 1152 Wliite, Dr. William C, chief of Tuberculosis Bureau of Amer- ican Red Cross, 845 tuberculosis prevention work in Italy. 867 Wiggin, Dr. William E., chief of Nose and Throat Department, Hospital Violet, 785 child welfare work at Le Glandier, 820 Wiggin, Mrs. Laura, at Hospital Violet, 785 cliild welfare work at Le Glandier, 820 Wilcox, IMabel I., chief nurse of wel- fare work with Belgian children at Havre, 822 Wilkes-Barre, Pennsylvania, work against influenza, 977 Wilkinson, ^liss, delegate to Ninth International Red Cross Confer- ence, 1912, 124 INDEX 1561 Wilkoiiski, Paulino II., relief work in Poland, 10!);) VVillard, Mrs. Mary Hatch, Metro- politan Nurses Club, 40 Williams, Major Chas. T., Commis- sioner for Russia. 678 on military situation in North Russia, (i78 Williams, John Skelton, Central Committee, American Red Cross, 2.30. 1007 Williams, Kathrvn, service in Ser- bia, 1117 Williams, Katherine, on work in last ^ Wood. Kiiiinn M.. N. ar Ka-t relief \M.rk. !Hi7 Palestine Connnissioii. 892 work at Constiuitinoplr. llS(t work at rvanileli. Palestine, 901 1562 INDEX Wood, Helen B., killed at sea, 470 Wood, Major General Leonard, ap- preciation of Miss Delano's work in Army Nurse Corps, 98 Wood, Mrs. Leonard, Board of In- corporators of American Red Cross, 1007 Woman's Advisory Committee, 300 Wood. M. E., work of, at Fort Hamilton, 60 Wood, Margaret, on child welfare work in France, 825 Woods, Vena M., on American Red Cross Children's Hospital at Limoges, France, 837 Woodward, George, National Ad- visory Committee on Insurance, 1041 Woodward, J. H., National Advisory Committee on Insurance, 1042 W^ormeley, Katherine P.. book by, on "Sanitary Commission," 8 Wright, Dr. Dudley D'Avergne, chief medical officer of Alliance Hos- pital, Yvetot. France, 196 Wright, Elizabeth, in Santo Do- mingo, 1190 Wrigley, Alma E., National Commit- tee on Red Cross Nursing Serv- ice, 127, 249 Wyckoff, Lieutenant H, M., Com- mission to North Russia, 678 Wyman, Surgeon General, member Executive Committee reorgan- ized Red Cross, 74 Yellow fever, in Cuban Red Cross Hospital, 30 medical history of, in U. S., 13, 14, 15, 16, 17 Yellow Fever Commission, appoint- ment of, 13 Yerres, Tuberculosis Sanatorium at, 848 Young, Miss, work at the Detention Hospital, Camp WikoflF, 60 Young, Mrs. Charles, instruction for women, 1352 Young, Edith, child welfare work, France, 1918, 809 Yvetot, France, Alliance Hospital at, 195, 196 Zacca, Miss, relief work in Greece, 1111, 1112 Zamoyska, Countess, School of Domestic Science in Poland, 1095 Zichy, Countess, 173 Zlenkier, Miss, service in Warsaw, 1156 n THE LIBRARY University of California SOUTHERN REGIONAL LIBRARY FACILITY 405 Hilgard Avenue, Los Angeles, CA 90024-1388 Return this material to the library from which it was borrowed. Se UCSOUTHFR^RCn,n,., , A A 000 035 082 7