Nurses, military (see also medicine, military). The connection between nursing and the military is a long-established one. In earlier centuries, extra-familial nursing provision was most commonly provided by volunteers with little or no training, usually by men and women belonging to monastic orders, or by laypersons associated with them. However, during the Crusades certain military monastic orders were established which also provided nursing care. Most notable among these orders were the Knights Hospitallers, who were also known as the Knights of St John of Jerusalem. Members of the sangha sect, a Buddhist religious order, have likewise traditionally adopted the responsibility for the care of the sick and injured in Buddhist countries. However, in post-Reformation Europe the role of nurse, with its close association with the dead and the dying, was generally regarded as a low-status occupation.
Modern nursing practice began in the mid-19th century. The German pastor Theodor Fliedner began one of the first formal training programmes for nurses in 1836, at Kaiserswerth, for the Order of Protestant Deaconesses. While other religious orders provided formalized nurse training in 19th-century Europe, Fliedner's school remains notable for having trained Florence Nightingale, Britain's most noteworthy nursing reformer. Kaiserswerth provided her with the impetus to organize proper nursing care during the Crimean war and to later establish a nurse training programme at London's St Thomas's Hospital. The Nightingale Training Schools for nurses and their founder's reputation, based on the battlefields of the Crimea, transformed the nurse's status and provided the foundation upon which the modern profession has been built.
Nurse education and training is traditionally based in hospitals, although in Britain and the USA there is now an increased emphasis on external college-based training. Typically nurse training prior to qualification lasts around three years, involving general training in medicine in addition to practical experience on wards, caring for patients under supervision. The standard of medical education for nurses in North America and western Europe is now high, while Britain in particular is noted for the high medical content of its courses. Many nursing duties are technical in nature. They range from implementation of complex treatment regimes to operating life-support systems in intensive care units. Some duties are dependent, under the direction of a qualified doctor or dentist, but there are many independent functions which nurses perform based on their own professional judgement. It can be argued that military nurses, like their doctor colleagues, tend to have greater licence than their civilian counterparts, especially during wartime. Since WW II there have been significant advances in medical practice and health care. The post-war explosion of technical knowledge in the field of health care has led to increased nurse specialization. Such areas include surgery, dentistry, and psychiatry.
Military and civilian nursing, like many other aspects of health care, are both complementary and interlinked. The American model, in particular, provides a good illustration of nursing development within the military sphere. The establishment of the Continental Army (later the US army) on 14 June 1775 saw the seeds sown for what became the US Army Nursing Corps. Shortly after, Maj Gen Horatio Gates reported to his C-in-C Washington that within his force ‘the sick suffered for Want of good female nurses’. Washington appealed to Congress to authorize a matron to supervise nurses to attend the sick and injured. On 27 July 1775 the scheme was approved and led to the creation of a hospital (medical department) providing one nurse for every sick or injured soldier, with a matron for every hundred patients. These women tending sick and wounded during the American independence war were not professional nurses in the modern sense, but they helped establish the path for recognized schools of nursing which began with the creation of civilian hospitals in America.
Following the war the size of the military establishment was greatly reduced with limited provision at regimental/garrison level, while patient care was handled by soldiers drawn from companies. There was little by way of a formal medical department until the War of 1812. In 1818 a Surgeon General, Dr Joseph Lovell, was appointed. By the start of the American civil war in 1861 a modern military Medical Department was well established, with patient care provided by stewards who equated to NCOs. It was not until the appointment of Dorothea Lynde Dix on 10 June 1861 as Superintendent of Women Nurses for the Union army, that female nurses re-entered the frame. Miss Dix was aided in her endeavours by Dr Elizabeth Blackwell, the first woman to receive a medical degree in the USA, who trained a number of women nurses prior to their engagement with the army. Throughout the American civil war, many women served as nurses in both Union and Confederate hospitals, including a large number of Catholic sisters.
After the war, soldiers continued to perform patient care duties and nursing functions in military hospitals as enlisted hospital stewards and privates in a part of the Army Medical Department. In 1891 formal instruction was introduced for members of the Hospital Corps at Fort Riley, Kansas, and with the onset of the Spanish-American war, congressional authority was again given to appoint contract women nurses. Military nursing had been almost dormant since the civil war. Many nurses were still members of religious orders.
In the years when the US military was not involved in conflict, nursing numbers were drastically reduced. However, a proper structure for military nursing was established. In August 1898 a Nurse Corps Division had been established and this was formalized by Congress in February 1901, when the Nurse Corps (female) became a permanent corps of the Medical Department, with an authorized strength fixed at a mere 100 nurses. This remained unchanged for ten years after which it increased to 125 (1912) and to 150 (1914). Rules, regulations, conditions of service, salaries, uniforms, and training had all been introduced by April 1917, when the USA entered WW I. At this time there were 403 nurses on active duty. In comparison, by 30 June 1917 there were 1, 176 nurses on duty and one year later, 12, 186 nurses (2, 000 regular army and 10, 186 reserve) were on active service at 198 stations around the world.
When, on 8 September 1939, a state of Limited Emergency was declared because of the war in Europe, there were just 625 regular army nurses on active duty. In response the authorized Army Nurse Corps (Regular) establishment was raised to 949 while a further 15, 770 nurses, enrolled with the first Reserve of the American Red Cross Nursing Service, were, it was hoped, available for service if required. In May 1941, the increased threat of a global conflict led to the declaration of a state of National Emergency and once more it became necessary to activate reserve nurses.
On entering WW II, the US faced a critical shortage of registered nurses. It was deemed more expedient and more economical to bolster those instructors and facilities of existing civilian nursing schools rather than to reconstitute the Army School of Nursing or raise from scratch similar military hospital-based schools. In addition the Cadet Nurse Corps was established. It comprised student trainees, who were neither a part of the armed forces nor the civil government. Nor did their training and effort constitute federal service, and thereby qualify them for future benefit. The Corps' pledge ‘to be available for military or other Federal, governmental, or essential civilian services for the duration of the present war’ was not legally binding but rather a statement of intent. A total of 169, 443 joined the Cadet Nurse Corps of which 124, 065 graduated in this remarkable scheme involving 1, 125 of America's 1, 300 nursing schools. It was only by adopting such measures that the US army was able to field the huge number of nurses that it did.
Developments in Britain were similar. In 1860 Florence Nightingale established a training school for military nurses at the Royal Victoria Hospital, Netley. The Army Nursing Service was founded in 1881 and Princess Christian's Army Nursing Reserve in 1897. During the Second Boer War 1, 400 nurses, most of them reservists, served in 22 general hospitals. Post-war reforms saw the formation, in 1902, of Queen Alexandra's Imperial Nursing Service. Its members, reinforced with reservists and volunteers—like the unqualified nursing assistants of the WW I Voluntary Aid Detachments—served with much distinction, and at no little risk, in two world wars. The service was reorganized to form Queen Alexandra's Royal Army Nursing Service (‘QAs’ for short) in 1949, and its members gained formal military rank—rather than simply ‘equivalent status’—the following year. Non-commissioned members were recruited in 1950, and in 1992 male nurses—previously part of the Royal Army Medical Corps—were transferred to the corps.
Military nurses, their corps formalized in a similar manner to that which characterized the nursing services in the British and United States armies, served widely in both world wars and in the hundreds of conflicts which have marked the world since 1945. On the one hand they play an essential part in the provision of effective medical care which, in itself, gives a powerful boost to morale. But on the other their contribution is more primal. They have provided charm and romantic attachment in areas where both are conspicuously lacking: as US sailors in the musical South Pacific sing, ‘There is nothing like a dame.’ FM Montgomery was not alone in maintaining that the presence of female nurses had a palpable effect on morale: no male, he argued, could nurse quite like a woman. Geneviève de Galard-Terraube, a French Air Force nurse, was marooned at Dien Bien Phu after her plane was destroyed. She worked tirelessly in the underground hospital, changing filthy dressings, cleaning maggots from wounds, and soothing the dying. Maj Paul Grauwin, the senior medical officer, was sure that men remembered their self-respect and bore their pain more stoically when she was present. WW I nurses were affectionately nicknamed ‘The Roses of No Man's Land’, and in just the same way Galard-Terraube earned her own place in the affection of survivors.
Bibliography
- Conde, Marlette, The Lamp and the Caduceus (Washington, 1975).
- Flikke, Col Julia O., Nurses in Action (Philadelphia, 1943).
- Grauwin, Paul, Doctor at Dien Bien Phu (London, 1955)
— Peter MacDonald/Richard Holmes
