Little has been written about British military nurses during the Great War, and few primary sources have survived, which makes it difficult to piece together even the basic details of the organization and administration of the nursing services during this period. To understand the situation that existed during the war, it is necessary to be familiar with the different bodies of nurses that together formed the whole; the type of training and experience they had received, and how each one fitted in during wartime. The following is a brief description of the nursing services that worked under the auspices of the War Office during the Great War, caring for members of the British Expeditionary Force and other nationalities in British military hospitals at home and abroad.
Above: IWM Q8051 'Miss Minns on the Quai at Le Havre.' Miss Minns was one of the most senior members of QAIMNS, and the Principal Matron at Le Havre - this is the Quai D'Escale which was the main part of No.2 General Hospital.
1 Queen Alexandra's Imperial Military Nursing Service [QAIMNS]
QAIMNS or the ‘Regular' military nursing service was formed in March 1902, as part of a general reorganisation of the Army Medical Services, and included many existing members of its forerunner, the Army Nursing Service, which had provided nurses for military hospitals since 1861. Despite a reluctance in some quarters to welcome female nurses into military hospitals, they proved themselves an asset, both for their nursing expertise, and for their skill in training orderlies of the Army Hospital Corps and later the Royal Army Medical Corps.
From 1902 members of the service were employed in all military hospitals with more than one hundred beds, both in the United Kingdom and overseas. Standards for admission to the service were high, with women required to be between twenty-five and thirty-five years of age, British subjects, well-educated and having completed a three year nurse training in an approved hospital. Most importantly, they had to persuade the Nursing Board that they were ladies of good social standing [1]. In the main they were the daughters of army officers, clergy, professional men, merchants and farmers [2].
During its first twelve years, the service found difficulty in attracting enough candidates who were able to meet such stringent standards [3]. Consequently it was usually below establishment, and relied on members of the permanent QAIMNS Reserve employed on temporary contracts to fill gaps in home hospitals. In 1903 the War Office produced a list of just thirty-four hospitals in the United Kingdom considered to have nurse training schools of a high enough standard to supply trained nurses to the Army. [4] Yet within a year the lack of applicants forced a rethink, and the entry requirement was lowered to include any hospital with more than one hundred beds, provided candidates met all the other standards for entry. At the outbreak of war there were 297 members of QAIMNS - matrons, sisters and staff nurses - employed in military hospitals at home, and overseas in Malta, Gibraltar, Egypt, South Africa and China. During the Great War the establishment remained unchanged, as it was considered unwise to permanently employ more women than would be needed after the end of the war. Any women who left the service were replaced, but the many thousands of nurses recruited during the war joined on short-term contracts with clauses that enabled the War Office to end their employment at its convenience.
Life in army hospitals during peacetime was very different from that in civil establishments. Military hospitals were, in general, smaller, with the majority having less than two hundred beds, and the patients were mainly fit men under the age of sixty, suffering from minor illness or the result of accidents. No female probationers were employed, with nursing orderlies of the Royal Army Medical Corps carrying out most of the care in the wards. The rather specialised and insular nature of the life produced a nursing service of educated and adventurous women, experienced in the ways of the army, but with little experience in the organization and management of large, busy hospitals and considerable female staffs. During the war it soon became evident that a small number of these women, who were part of a professional elite in nursing circles, and who coped admirably with keeping order in military hospitals in peacetime, did not possess the skills to manage wartime units of up to 2,000 beds, or cope with the unrelenting pressures of casualty clearing stations. [5] Some found themselves transferred back to the United Kingdom from overseas, to undertake less demanding duties. More than seventy nurses who had resigned or retired from QAIMNS between 1903 and 1914, returned during the Great War to serve once more, with many of the older women among them taking up positions as matrons of the smaller military hospitals in the United Kingdom, thereby releasing experienced younger matrons for service overseas. The size and composition of the service remained relatively unchanged until the summer of 1919, when a steady expansion began which continued through the next half century.
2 Queen Alexandra's Imperial Military Nursing Service Reserve
A permanent reserve for QAIMNS was formed in 1908, but during peacetime recruitment proved difficult, never successfully competing with the popular Territorial Force Nursing Service. It was intended that the Reserve be held at a constant 500 members; in peacetime they would fill gaps in military hospitals caused by the under-establishment of the Regular Service, and, in the event of war, would be available to provide, at short notice, suitable nurses to supplement QAIMNS. Members were required to sign a contract for a period of three years, and paid a retaining fee of £5 per annum, or if actually employed, received allowances on the QAIMNS scale appropriate to their rank [6]. In the event, recruitment was slow and patchy, and on the eve of war there were less than two hundred nurses of the QAIMNS Reserve available for mobilization. However, the Reserve flourished following the outbreak of war, with trained nurses flocking to join the military nursing services on yearly contracts. By the end of 1914 more than 2,200 women had enrolled in the service, and in total more than 12,000 served with the Reserve at some time during the Great War in all theatres [7]. In the immediate post-war period, members were retained for employment in the increased number of military hospitals and also in Ministry of Pensions establishments. Some were engaged for the regular QAIMNS, their social and professional pedigree already established by their wartime service, but the majority were demobilized between January and September 1919, returning to civilian life to pick up the threads of their former lives, or venturing overseas to seek new opportunities.
3 Princess Christian's Army Nursing Service Reserve [PCANSR/ANSR]
The Army Nursing Service (ANS) was the forerunner of Queen Alexandra's Imperial Military Nursing Service, the latter replacing it by Royal Warrant in March 1902. The ANS was a small service and, from 1897, was supported by members of Princess Christian's Army Nursing Service Reserve, who were used to supplement the permanent members in military hospitals at home and abroad. During the Boer War, 1,376 members of the PCANSR were employed, with 805 seeing service in South Africa [8]. After the formation of QAIMNS in 1902 the relationship between the two services was uneasy, PCANSR being an independent service under the direct control of the War Office, with no official connection to QAIMNS. When QAIMNS's own Reserve was formed in 1908, members of the PCANSR ceased to be employed in military hospitals, and the nurses were graded in order to identify those women who were suitably qualified in all respects to be appointed to QAIMNS if the need arose. Recruitment to PCANSR ceased, and the running down of the service was anticipated. Yet in September 1914 there were still 337 names on the roll [9], and a number of these women mobilized, wearing the uniform of the QAIMNS Reserve, but still officially part of the PCANSR. During the course of the war all mobilized members signed contracts to serve as members of Queen Alexandra's Imperial Military Nursing Service Reserve, thus erasing the final traces of Princess Christian's own nursing service.
4 Territorial Force Nursing Service [TFNS]
The Territorial Force Nursing Service was established by R. B. Haldane in March 1908 following the Territorial and Reserve Forces Act (1907), and was intended to provide nursing staff for the twenty-three territorial force general hospitals planned for the United Kingdom in the event of war. Hospitals were allocated a staff of ninety-one trained nurses, and, allowing for the fact that some members might hold civilian positions preventing their immediate mobilisation, 120 women were recruited for each; two matrons, thirty sisters and eighty-eight staff nurses. The nursing staff of each hospital was under the control of a Principal Matron, who was a senior civil nurse already based in a local general hospital, and who continued to fulfil her civilian duties in addition to the administration of the territorial unit. This provided a total establishment of 2,760 women, who in peacetime went about their normal duties in civil hospitals and private homes, but with a commitment to the War Office and holding mobilization orders [10]. The Standing Orders for the TFNS closely mirrored those of QAIMNS, and the standards of entry were similar. The insistence on a full three year nurse training in an approved hospital remained, though it seems likely that when appointing staff, rather more emphasis was put on professional ability than on social standing.
Image courtesy Sue Light: A mixed group of Territorial Force Nursing Service nurses - Matron, Sisters and Staff Nurses
Although originally intended for home service only, in 1913 members of the TFNS were given the opportunity to notify their intention of willingness to serve overseas if required [11], and the sudden need for a large number of nurses to accompany the British Expeditionary Force to France in 1914 resulted in some members proceeding overseas during the early weeks of the war. Because of the pre-war method of forming complete hospitals with nurses of all grades, many of the TFNS nurses who served during the Great War had long experience in nursing, holding positions of great responsibility in civil life. Among them were women who, on the outbreak of war, were working as assistant matrons and senior sisters in some of the United Kingdom's great institutions, including St. Thomas' Hospital in London, and the Edinburgh Royal Infirmary. Despite initial wariness by the two Matrons-in-Chief of QAIMNS [12], it soon became evident that many of these women coped admirably with the management of large hospitals and female staffs. They quickly adapted their skills to meet the new and complex needs of casualty clearing stations and field ambulances, becoming some of the war's most able nurse-managers. Over the course of the Great War, 8,140 women served at some time as mobilized members of the Territorial Force Nursing Service, and of these 2,280 served overseas. [13]
5 Civil Hospital Reserve [CHR]
During the early years of the twentieth century the War Office realised that in the event of war there would not be enough military nurses to meet the needs of the Army. Queen Alexandra's Imperial Military Nursing Service was a small, select group, and though adequate to staff the larger military hospitals in peacetime, the numbers were completely inadequate for wartime. In 1906 the QAIMNS Nursing Board considered ways to solve this problem and produced a ‘Report on the Expansion of the Nursing Service to meet the needs of War.' [14] Their solution was to increase the size of the QAIMNS Reserve, and to make retired members of the regular service liable to recall in the event of war. However, neither of these plans proved successful, and predicted numbers continued to fall short of requirements by approximately eight hundred. In 1910, the War Office appealed to the civil hospitals for help, and, in 1911, this resulted in the formation of the Civil Hospital Reserve, to ‘supplement the nursing services in the military hospitals of peace garrisons.' [15] Some of the largest of the United Kingdom's hospitals invited their trained nursing staff to offer their services to the War Office, and a register was drawn up of suitably qualified women who were willing to mobilize on the outbreak of hostilities, on the understanding that their jobs would be protected, and they would be able to return to their former roles at the end of the war. In August 1914, six hundred women were ready for mobilization with the Civil Hospital Reserve. [16] Although they were originally intended for service in home hospitals only, many soon found themselves serving with the British Expeditionary Force in France and Flanders and wearing the uniform of the QAIMNS Reserve. There was no further recruitment to the CHR during the war, and over the course of the next four years almost all these members transferred, serving under contracts with the Reserve.
6 Assistant Nurses
Image courtesy Sue Light: A more casual mixed group with patients
Before 1919 there was no register of nurses, or national regulations covering standards for nurse training. During the 1860s and 1870s training was normally for one year, and it was considered that most of what was essential could be learnt in that short time. During the last two decades of the nineteenth century the realisation dawned that a longer period of training was necessary to produce a 'professional' nurse. However, hospitals were not compelled to train nurses for three years, with the result that nursing became a two tier system, with those who had completed three years' training in a general hospital often regarded as ‘proper' nurses, while others, including women trained in fever nursing, the care of children and the mentally ill, were sometimes seen as professionally less qualified. During the early days of the Great War there was little understanding of how long the conflict would last. However, by early 1915 it was evident that there were not enough fully trained nurses to staff the ever-increasing number of hospitals and casualty clearing stations at home and abroad, and it was decided to employ partly-trained nurses in military hospitals. Applications were accepted from women who held certificates showing that they had completed an approved two year training in fever, children's or mental nursing, or were certified midwives, and they worked under the trained nurses of QAIMNS and the TFNS at a reduced rate of pay. Assistant nurses were not numerous, but their specialized experience proved particularly useful in the nursing of patients with infectious diseases and mental illness, and in the care of the civilian population and refugees abroad.
7 VADs [Members of Voluntary Aid Detachments]
Following R. B. Haldane's Territorial scheme of 1907, new possibilities arose of cooperation between voluntary agencies and the Army, and on the 16 August 1909 the War Office issued its ‘Scheme for the Organisation of Voluntary Aid in England and Wales.' This set up both male and female Voluntary Aid detachments to fill certain gaps in the territorial medical services, with a similar scheme for Scotland following in December 1909. Detachments were ‘organised for their local Territorial Force Association by the Red Cross, and to receive preliminary training in first aid and nursing from the St. John's Ambulance Association' [17], and after October 1914 this responsibility was transferred to the Joint War Committee of the British Red Cross Society and St. John of Jerusalem, a wartime amalgamation of the two organizations. The scheme proved popular, particularly with women, and immediately prior to the outbreak of war, there were 1823 female detachments and 551 male detachments registered with the War Office [18].
The women who joined Detachments were a mixture, being a wide range of ages and with different sorts of life skills. As a group they were very much defined by being middle or upper middle-class - in the main they were the daughters of local gentry, landowners, army officers, clergy, and professional men, and also included a good sprinkling of women with an aristocratic background. The majority were young women who had never had any paid employment, and of those who eventually went on to wartime service more than three-quarters had either never worked outside the home, or had done work which qualified them for payment of a minor nature [19]. Following the outbreak of war members of female detachments staffed VAD hospitals and auxiliary units, and individual members quickly came to be referred to by the initials of their organization. As the number of medical units both at home and broad escalated, the difficulties of keeping so many hospitals fully-staffed became increasingly difficult. In the spring of 1915 the War Office agreed that VADs could be employed in the large military hospitals at home to augment the trained staff, and by early summer of that year in general hospitals overseas as well [20]. During the course of the war more than 90,000 women served as VADs in some capacity; 10,000 worked in hospitals under the direction of the War Office, and of those, 8,000 served overseas, in France, Malta, Serbia, Salonika, Egypt and Mesopotamia [21].
8 [SMP]
Special Military Probationers were women who had little or no formal training as nurses, and they served under almost identical conditions of service to members of Voluntary Aid Detachments and did similar work. However, these women were recruited and employed by the War Office, and had no ties with the Joint War Committee of the British Red Cross Society and St. John of Jerusalem.
These eight groups of women combined to form a highly-trained and professional body which, for more than five years, met the nursing needs of the British Expeditionary Force, its Allies, its prisoners of war and at times the civilian population abroad. At a time when trained nurses were in short supply, the British military nursing services never wavered in their commitment to provide the best possible nursing care to sick and wounded soldiers, in conditions unknown to them before the war. The experience was to stand them in good stead for the future.
References:
[1] Regulations for admission to the Queen Alexandra's Imperial Military Nursing Service, 1904
[2] The National Archives, WO25/3956, Professional qualifications and recommendations for appointments of Staff Nurses
[3] The National Archives, WO243/21, The Nursing Board, Queen Alexandra's Imperial Military Nursing Service, Proceedings and Reports, Volume 2, p.67
[4] The National Archives, WO243/20, The Nursing Board, Queen Alexandra's Imperial Military Nursing Service, Proceedings and Reports, Volume 1, p.vii
[5] The National Archives, WO95/3989, 5/1/16. Entry in war diary of Matron-in-Chief states: Then to Casino, which was not in its usual state of perfection, Miss Worthington being in charge, and seemed quite unable to manage. The teas were being given anyhow. She didn't know how many Staff she had. It is unfortunate that such a senior Sister has no administrative powers. A nice woman, liked by everyone, but no manager. This is one of several similar comments in the war diary on the capabilities of members of QAIMNS.
[6] The National Archives, WO243/26, A Scheme for the Organization of a Reserve of Nurses, 1908
[7] Army Medical Services Museum, undated report with handwritten notations, signed by Anne Beadsmore-Smith, Matron-in-Chief, QAIMNS, 1919-1924
[8] Macpherson, Major-General Sir W. G., History of the Great War based on official documents, Medical Services, (The Naval and Military Press Ltd. 2009, reprinted in facsimile from the 1923 original edition), Volume 1, p.34
[9] Ibid., p.35
[10] Standing Orders for the Territorial Force Nursing Service, 1908
[11] The National Archives, WO123/55, Army Order 92 of March 1913
[12] Dame Ethel Becher, Matron-in-Chief, War Office, and Dame Maud McCarthy, Matron-in-Chief with the British Expeditionary Force in France and Flanders
[13] Army Medical Services Museum, op.cit.
[14] The National Archives, WO243/24, The Nursing Board, Queen Alexandra's Imperial Military Nursing Service, Proceedings and Reports, Volume 5, p.39
[15] Macpherson, Major-General Sir W. G., op.cit., p.35
[16] Ibid., p.35
[17] Summers, Anne: Angels and Citizens, (Routledge & Kegan Paul, London 1988), p.247
[18] Reports on Voluntary Aid rendered to the Sick and Wounded at Home and Abroad and to British Prisoners of War, 1914-1919, (Joint War Committee of the BRCS and St. John of Jerusalem, HMSO 1921), p.190
[19] Imperial War Museum, ‘Women and Work' collection, BRCS 10/5/4
[20] The National Archives WO293/2, Army Council Instruction 101 of March 1915
[21] Reports on Voluntary Aid rendered to the Sick and Wounded at Home and Abroad, op.cit., p. 180
Contributed by Sue Light