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Tuesday, 17 December 2013

Canada's Nursing Sisters and World War I

While the vast majority of Canadians in military service during World War I were male, a small group of females made a significant contribution belied by their numbers.  During the conflict, over 3000 women served as nurses with the Canadian and British Army Medical Corps.  Their official title - 'nursing sister' - reflected the profession's traditional connection with religious orders, though none belonged to such organizations.  This cadre of women played a vital role in the war's events, simultaneously transforming their profession in ways that none could have imagined.

The integration of nursing into the armed forces traces its origins to the Crimean War (1854-56), when Florence Nightingale's efforts convinced military authorities of the need for its inclusion in an organized medical corps.  Before the war's end, the British government established a nursing service that operated under a separate administrative structure within its military.

Canadian women first provided such services in 1870, when four volunteer civilian nurses accompanied Canadian troops to Red River, where they tended to soldiers who were injured or became ill during the first Metis uprising.  Fifteen years later, a larger contingent travelled to Saskatchewan with Canadian troops in response to the Northwest Rebellion.  In this instance, the federal government requested the creation of a formal 'medical and surgical department' to accompany the expedition.  Seven nursing sisters and one matron spent four weeks tending to sick and wounded soldiers in field hospitals established at Moose Jaw and Saskatoon.

After 1885, nursing sisters were part of every Canadian military force sent abroad for service.  When Canadian authorities organized a contingent for service in the South African War (1899-1902), four nursing sisters accompanied the initial 1000 volunteers.  The women were awarded the rank, pay and allowances of an army lieutenant and wore army uniforms throughout their service.  At the same time, in June 1899, the Canadian government authorized the formation of the Canadian Army Medical Department (later re-named 'Corps'), with a mandate to provide a complete range of medical services to men in uniform.

Canadian Nursing Sister Minnie Affleck and wounded soldiers, South African War (1899 - 1902)

As Canada sent an additional 6000 volunteers to South Africa over the next three years, the director of the country's armed forces suggested the creation of an official nursing corps within the existing Medical Department.  In response, the federal government authorized the formation of the Canadian Army Nursing Service in 1901.  Four additional nursing sisters joined the South African contingent, treating diseases common in tropical climates and infections caused by unsanitary conditions in addition to combat wounds.

In the years following the South African War, the Canadian military implemented additional changes to its medical services.  In 1904, the fledgling nursing contingent was incorporated into the 'Reserves', a section of the Canadian Armed Forces consisting of 'semi-permanent' members who supplemented regular troops in time of need.  A total of 25 women were selected as the nursing contingent's initial members.

Four years later, the Canadian government authorized the formation of the Canadian Army Nursing Corps (CANC)*.  Its first matron, Georgina Fane Pope, established procedures for recruitment and operation in addition to managing nursing services at several military hospitals across the country.  Under Pope's leadership, navy blue dresses, white aprons and vales - attire that earned nursing sisters the nickname 'Bluebirds' - replaced the drab army khaki worn in South Africa.

As the above developments suggest, Canada was able to respond to the military's nursing requirements at war's outbreak, although its resources were limited.  The nursing corps consisted of five 'Permanent Force' nurses and approximately 60 reservists.  As events progressed, it was quickly apparent that this small group was ill prepared for the demands placed upon it.

Prior to World War I, nursing was undergoing considerable change, with the opening of nursing schools across the country and establishment of professional associations.  While the occupation represented only 2 % of the entire female work force, there were signs of significant growth.  In fact, by 1921, the number of nurses in Canada quadrupled.  The war played a significant role in this process, accelerating the pace of change and laying the basis for the emergence of a modern nursing profession.

Georgina Fane Pope, CANC's first Matron-in-Chief
In April 1914, Margaret C. Macdonald, a native of Bailey's Brook, Pictou County, was appointed CANC's second Matron-in-Chief.  A veteran of both the Spanish-American and Boer Wars and a member of the organization since 1906, Matron Macdonald had studied the organization of Britain's military nursing corps, adopting it as the model on which to built a Canadian equivalent. 

Despite Macdonald's wealth of experience and valiant efforts, the CANC was poorly prepared for the demands placed on its services at war's outbreak.  The organization hastily assembled a contingent of military nursing sisters for overseas service while launching a nation-wide appeal for additional recruits.  A total of 105 nursing sisters sailed for England with the First Canadian Contingent in September 1914.  By war's end, more than 3000 Canadian women served with the Canadian or British nursing corps.

Matron Macdonald dramatically revised the nursing selection process, which she considered an obstacle to the corps' growth.  She advocated the establishment of military nursing courses in Canadian hospitals and insisted that recruits work in soldiers' training camps and military hospitals prior to service.  Macdonald believed that significant differences existed between civilian and military nursing practice, a judgment soon verified by the CANC's experiences in Europe.

The majority of nursing recruits were born in Canada or the British Isles and raised in urban settings, where there was greater access to nursing schools.  For the most part, the women came from middle-class families whose fathers were 'professionals' by the day's standards - physicians, clergymen, accountants or businessmen.  They possessed a better level of education than average women of the time - most attended high school and some studied at university.  Some recruits previously worked as teachers, clerks or governesses before enrolling in nursing schools, which accepted only applicants 21 years or older.  The initial 1914 CANC recruits' average age was 24.

Priority was naturally given to women with civilian nursing experience, although their wartime duties proved to be dramatically different from such practice.  Candidates had to be single, in good health, and graduates of a recognized nursing school.  Upon selection, the women underwent four to six weeks' training in a military hospital - usually at Halifax, NS - where they received an introduction to the 'basics' of military nursing care.

Major Margaret C. Macdonald, CANC's Second Matron-in-Chief
Candidates subsequently completed a written and oral examination before becoming full-fledged members of the CANC.  While possessing the rank of Lieutenant, their authority as officers was limited to their hospital duties.  Unlike male medical officers, they could not make military decisions outside of a medical facility.  Despite their official rank, the women were commonly described as 'Nursing Sisters' throughout their service.  CANC nurses were the only Canadian women to hold a military rank and work under direct army control during the war.

There was considerable response to the CANC's recruiting efforts, as civilian salaries were low and job prospects in Canada poor at that time.  Enlistment promised regular employment at a respectable wage and appealed to young women's sense of patriotism and desire for 'adventure'.  While initial recruitment focused on members of the 'reserve' who already had experience working in military hospitals, increasing demand expanded the appeal to single women outside the military. 

As demand for nursing services increased, the CANC streamlined the recruitment process by waiving the initial examinations and six week's training.  As a result, 'military nursing' training was often limited to experiences on board ship during the short trans-Atlantic voyage, usually followed by a brief period of training in England.

During the course of the war, Canadian nursing sisters served in over thirty medical facilities in England, France and the Eastern Mediterranean (Gallipoli, Turkey, Alexandria, Egypt, and Salonika, Greece) as well as on board hospital ships.  The Canadian Army Medical Corps provided services at four levels, two of which actively involved nursing sisters.  The stages of care closest to the front line - field ambulance and casualty clearing stations - were staffed by male medical personnel and focused on 'first aid' treatment.  Nursing sisters occasionally worked at a clearing station in the company of a physician, but were never permanently assigned to this location.

Patients requiring further care or long-term treatment were evacuated to stationary hospitals relatively close to the front, mainly at locations in France along or close to the English Channel.   At each facility, a matron managed a staff of 16 nursing sisters who tended to patients in a facility designed to accommodate 250 patients, although actual admissions were often higher.

Canadian Nursing Sisters in working uniform, England.
Soldiers with serious injuries or requiring a lengthy convalescence were evacuated to general hospitals in England, facilities that held 500 or more beds and whose nursing staffs consisted of a matron and 72 nursing sisters.  It was common practice to rotate nursing staff between stationary and general hospitals, making service at several locations over the war's duration commonplace.  In some instances, a unit's nursing staff was dispersed to various locations in response to an urgent need.

Nursing sisters followed the same procedures as civilian hospitals in treating such conventional ailments as influenza, tuberculosis and dysentery.  In many ways, daily routines were also similar as staff disinfected wounds, changed dressings, served food, and tended to patients' hygiene and bodily functions.

Differences, however, greatly outweighed similarities to civilian practice.  Injuries never seen at home presented the greatest challenge as patients recovered from wounds caused by artillery shells, shrapnel and poison gas in addition to bullets.  Most nurses had neither training nor experience in providing such care.  Perhaps most challenging were the effects of prolonged exposure to combat on mental health.  "Shell shocked" soldiers suffered from insomnia, night terrors, incontinence and other symptoms caused modern warfare's impact on the human psyche.

Conditions at stationary hospitals presented another obstacle.  Unhygienic environments, limited quantities of potable water for basic hygiene and human consumption, and insufficient equipment were commonplace.  Personnel serving at the front also suffered the effects of unsanitary accommodations - trenches and occasionally hospitals were over-run with mites, fleas and rats.  Infectious diseases were responsible for almost 70 % of hospital admissions at a time when there were no antibiotics to combat infections or such conditions as meningitis.

Perhaps the most difficult aspect of military nursing near the front was the volume and pace of work.  During an offensive, dressing stations were crammed with wounded soldiers.  When finally evacuated to a stationary hospital, patients were often spread across the grounds outside the facility due to lack of beds.  Nursing sisters roamed from stretcher to stretcher, working long shifts caring for bleeding wounds and broken bones until 'normal' accommodations were available.

Canadian Nursing Sisters 'under canvas - No. 2 Canadian General Hospital, Le Treport, France.
Nursing sisters were also affected by the high mortality rate among patients, as compared to civilian experience.  Witnessing the tragic deaths of so many young men produced considerable stress, compounded by the fact that these young women worked far from family and friends.  Nursing sisters commonly suffered from exhaustion and mental fatigue, problems that often necessitated a leave from service.

Nursing sisters worked and lived under the conditions of war.  Rationing and shortages reduced the availability of such basic goods as sugar, butter, coffee and chocolate.  While personnel in England and parts of France were billeted in houses - and occasionally in villas or castles - nurses close to the front were usually accommodated in canvas tents or wooden huts. 

Working in a war zone also placed nursing sisters 'in the line of fire'.  Stationary hospitals sometimes found themselves within range of enemy artillery, particularly during enemy offensives.  The most significant incident occurred near Etaples and Doullens, France in May 1918, when enemy aircraft dropped bombs on five Canadian stationary hospitals, killing six nursing sisters. 

The greatest loss of life among nursing sisters occurred on June 27, 1918, when a German U-boat spotted the British hospital ship Llandovery Castle off the coast of Ireland as it was returning to Liverpool, England after transporting wounded soldiers to Halifax, NS .  The German submarine torpedoed the ship, surfaced and fired its machine gun at survivors huddled in lifeboats.  Of the 258 Canadian crew and medical staff on board, only 24 survived.  Fourteen nursing sisters were amongst the dead, by far the largest number killed in a single incident during the war.

An additional twenty-two nursing sisters died of sickness or disease during the war years.  The total number of casualties remains a matter of considerable debate.  In the years immediately following the war, military authorities reported a total of 47 deaths amongst nursing personnel.  Since that time, this statistic has been frequently revised, recent sources claiming that the total may be as high as 76.

Funeral procession of Gladys Maude Mary Wake, one of six Nursing Sisters killed at Etaples, France - May 1918
In the midst of such challenges, nursing sisters formed a bond of solidarity, friendship and loyalty.  Their rank permitted them to fraternize with military officers, providing another level of support.  Perhaps most rewarding was the high regard in which their patients held them.  Soldiers frequently referred to the young women who tended to their needs during the most difficult of circumstances as 'angels of mercy'.

Nursing sisters stationed in England were able to enjoy a variety of diversions when not working.  Dancing, dining and sports were common, with tennis a particularly popular activity.  Nurses also adopted the British tradition of  'afternoon tea' as a welcome break from the daily demands of hospital work.  Others took the opportunity to travel to various parts of Europe during leaves.  Such activities no doubt helped the women cope with the stresses of wartime nursing.

By war's end, a total of 3,141 Canadian women enlisted with the CANC, 2,504 serving overseas.  Their performance in dangerous circumstances did not go unnoticed.  Nursing sisters received a total of nine Military Medals for 'gallantry under fire', the majority of which were awarded for actions during the May 1918 Etaples bombings. 

Nursing sisters' contributions during the war demonstrated their critical role in delivering military medical care.  Their work also had a dramatic impact on public attitudes at home, earning their occupation recognition as a legitimate profession.  While many nursing sisters married and raised families after returning home, some remained single and continued to work in health care.  Whatever their post-war paths, nursing sisters's significant contribution to Canada's war effort is widely acknowledged today by historians and citizens alike.

*: Various sources refer to the 1904 organization as the Canadian Army Nursing Service (CANS), although most use the term 'Corps'.  For the purpose of this overview, the latter term and acronym CANC are employed from that year forward.

*****
Sources:

Allard, Genevieve.  The Call of Duty: Canada's Nursing Sisters.  Library & Archives Canada, Ottawa.  Available online.

"Angels of Mercy" - Canada's Nursing Sisters in World War I and II.  McMaster University.  Available online.

Canada and the First World War: Nurses.  Canadian War Museum.  Available online.

Canada's Nursing Sisters. Veterans' Affairs Canada.  Available online.

Canadian Nursing Sisters.  Canadian Great War Project.  Available online.

For further information on Canada's nursing sisters, visit the following websites:

Canadian Nursing Sisters Index.  Canadian Great War Project.  An alphabetical index of nursing sisters who served with the Canadian Army Medical Corps during World War I.

Finding the Forty-Seven: Canadian Nurses of the First World War.  Author Debbie Marshall's blog endeavours to present the stories of nursing sisters who lost their lives while serving overseas.

National Film Board of Canada: Images of a Forgotten War - Hospital Bombed by German Planes.  This six-minute film records the funeral procession, ceremony and burial following the May 19, 1918 bombing of two stationary hospitals at Etaples, France.  Six Nursing Sisters were amongst the personnel killed in the attack. 

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