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Chapter VII

Contents

CHAPTER VII

THE NURSING SECTION; RECONSTRUCTION AIDES

THE ARMY NURSE CORPS

The few hundred nurses who formed a part of the six base hospital units assigned to service with the British Expeditionary Forces, and the other nurses who arrived in France during the early period of the American Expeditionary Forces, were for five months under the general jurisdiction of the office of the chief surgeon, A. E. F., after that office was established in June, 1917,1 and of its personnel division after that division was created in July.2 On October 2, 1917, General Pershing cabled to the War Department a request that a competent member of the Army Nurse Corps be sent to Paris to serve as superintendent of nurses of the American Expeditionary Forces.3

The chief nurse of Walter Reed Hospital was selected for this assignment and, with an assistant, reported for duty on November 14, 1917, at headquarters, line of communications (then in Paris), and on the day following was assigned as chief nurse, line of communications.1 At the time in question, most of the nurses of the American Expeditionary Forces were on duty at base hospitals in France, and these (other than the six above mentioned) were under the administrative control of the chief surgeon, line of communications.4 When headquarters, line of communications, moved to Tours in January, 1918, the office of the chief nurse accompanied it as a part of the personnel division, office of the chief surgeon, line of communications.4 No member of the Army Nurse Corps served in the office of the chief surgeon, A. E. F., until that office moved to Tours and there absorbed the office of the chief surgeon, line of communications, in March, 1918.4 The office of the chief nurse then became a section of the personnel division, chief surgeon's office.4

On October 8, 1918, the Surgeon General notified the chief surgeon that authority had been received from the Secretary of War for the appointment of a director and two assistant directors of the nursing service in France, and for a director and two assistants for our nursing service in base section No. 3 (England).1 No such appointments were made in base section No. 3, however, for the chief surgeon of that section decided that so many administrators for the nursing service there were unnecessary and, therefore, continued in that section the office of chief nurse which had been established there June 17, 1918.1 The chief nurse of the American Red Cross in France, who formerly had been chief nurse of Base Hospital No. 21, was appointed director of the nursing service, A. E. F., and on November 15, 1918, reported to the chief surgeon, A. E. F., at Tours,1 thus replacing the chief nurse, A. E. F., who left, on December 2, to become assistant to the superintendent of the Army Nurse Corps in the Surgeon General's office.1 The chief nurse of base section No. 3 and a nurse who had been assistant to the chief nurse were appointed assistant directors of the nursing service, A. E. F., November 18 and December 14,


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respectively.1 The staff of the director of the nursing service, was further augmented by assigning to it, on January 13, 1919, a nurse from Base Hospital No. 7, who formerly had been matron of General Hospital No. 22, British Expeditionary Forces, and, on February 3, 1919, the chief nurse of Base Hospital No. 27, the duties of the last-mentioned member of this staff including both service at the central office and inspection of the nursing service in hospitals.1

Most of the nurses who served in the American Expeditionary Forces arrived as members of base hospital units, but others came in replacement units, and were not attached to any hospital until assigned in France.1 Others sailed as casuals (one group of these, which arrived in the summer of 1918, including 500 nurses) and a few as members of small organizations such as mobile operating units, psychiatric units, etc.; one group consisted of anesthetists.1

On August 11, 1917, the chief surgeon, when submitting to the chief of staff, A. E. F., an estimate of the medical personnel that would be necessary for an army of 1,000,000 men, calculated that the number of nurses required for such a force would be 22,430; however, at no time did the quota of nurses approximate this estimate.4

In the first six months after the United States entered the war a few more than 1,100 nurses arrived, of whom about half served in the six base hospitals assigned to the British.1 From November, 1917, until March 31, 1918, less than 900 others arrived, and there was a consequent shortage on that date of 400, even under the reduced priority schedule prescribed by the general staff, A. E. F.1 At this time there were only 2,088 nurses in France, of whom approximately 700 were under British control.1

The consequent shortage of nurses in the American Expeditionary Forces was due primarily to the great need for combatants and to lack of transport facilities.4 At times there were as many as 1,400 nurses in the mobilization station in New York, awaiting transportation, several groups being thus detained as long as three months.5 By the middle of April, when the shortage of Medical Department personnel had become so acute that a breakdown in its service was threatened, the shortage of nurses was estimated at 1,121.1 On May 3 a cable was sent asking that 555 be sent immediately.1

On June 30, 1918, nurses serving in Europe, or designated for foreign service, were distributed as follows:5 British forces, 755; French forces, 14; American forces, 3,323; awaiting transportation or en route to mobilization station, 1,258; total, 5,350. This number included nurses sent to the American Red Cross Military Hospitals Nos. 1, 2, and 3.5

Because of the increase of our combat activities in the ensuing weeks, Medical Department personnel was engaged to such an extent that on July 27, 1918, the chief surgeon reported that the resources of the Medical Department were practically exhausted in so far as personnel was concerned, and on August 10 a cable was sent from general headquarters, requesting absolute priority for medical organizations, including 2,312 nurses.1 During that month, 1,000 nurses arrived in France.1

Under date of September 21, the personnel division reported that the shortage of nurses continued to be acute; all hospital units were short of nurses and demands were being made by camp hospitals for large numbers of them


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because of the epidemic of influenza.6 It was impossible, of course, to furnish all the nurses requisitioned by various organizations.6

When the armistice was signed there was a total of 8,587 nurses on duty overseas, the number short of actual needs being approximately 6,925;7 the number of patients in hospital under treatment on November 12 totaled 193,026, distributed in 153 base hospitals, 66 camp hospitals, and 12 convalescent camps.8 The number of nurses on duty in the hospital centers, where the largest number of patients were grouped at this time, was as follows:1 At Mesves hospital center where patients in 10 base hospitals and in the convalescent camp numbered 20,186 on November 16, the center's peak day, there were 394 nurses.1 At Mars hospital center, on November 16, in six hospitals and in the convalescent camps, 14,302 patients were cared for by 493 nurses.1 At Allerey, on the 17th, in 6 hospitals and in the convalescent camp, there were 17,140 patients, cared for by 360 nurses, and at Toul on the 28th of November, in 7 hospitals there were 10,963 patients, cared for by 320 nurses.1 The maximum number of nurses at certain centers at one time was: Mesves, 650 on January 4, 1919; Mars, 642 on December 4, 1918; Toul, 438 on February 1, 1919.1

Between November 11, 1918, and January 25, 1919, when the greatest number of nurses was on duty in the American Expeditionary Forces, nearly 1,500 nurses arrived-more than the total number received in 1917.4 The greatest number of nurses reached in the American Expeditionary Forces was recorded in the week ending January 11, 1919, when their number totaled 10,081, including approximately 700 on duty with the British.4 This total should show as of the first week in December, for there were no arrivals subsequent to that date.7 At this time the strength of the American Expeditionary Forces was approximately 1,750,000 men.9 With the exception of casual nurses who were separated for various reasons, the first group which left France was that with Base Hospital No. 2, which sailed early in January, 1919.1 From that time the return of nurses was gradual, averaging from January through April, 1919, about 200 nurses a week.1 During the last week of April over 800 nurses sailed.1 No chief nurse was appointed for any of the sections of the Services of Supply except base section No. 3.4

One of the important developments of the nursing service in France was the appointment of a chief nurse at some of the hospital centers.1 This plan, which was not prescribed in orders from higher authority, developed at the several centers independently, in an informal manner in November, 1918, and was a natural result of the grouping at each center of several hospitals under a general command.1 It developed to different degrees in the several centers and was apparently of value in every place where it was tried, except that in one or two instances the center chief nurse was unable to secure cooperation.1 The plan was adopted at the following centers:1 Allerey, Bazoilles, Beau Desert, Mars, Mesves, Nantes, Savenay, Toul, Vichy.

Center chief nurses acted as assistants to the director of nursing service. At Mesves her duties were prescribed as follows:1

1. To assist the commanding officer of the center in such matters pertaining to the nurses of the center as he may see fit to assign to her.


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2. To assist in the distribution and readjustment of nurses within the center, according to the pressure of work in the various hospitals.

3. To keep informed by frequent visits of the conditions in the hospitals of the center, as they affect the nursing personnel such as quarters, the mess, means of recreation, care of sick nurses, etc.

4. To bring to the attention of the director of nursing service, after consultation with the commanding officer of the center, any matters which seem to need special adjustment.

5. To act as chairman of a committee of chief nurses of the center. This committee will make suggestions for regulations governing the conduct, and social relations of nurses, which shall be, as far as possible, uniform for the entire center. These suggestions should be presented to the commanding officers for their approval and indorsement. The object of this committee will be to promote the welfare of the nurses within the center, and to maintain a high standard of service and conduct within the Army Nurse Corps.

6. To act as hostess of the center. In that capacity she will meet each new chief nurse arriving at the center and see that the latter has all information that will assist her in the performance of her duties. She will also, in cooperation with the commanding officers and chief nurses of the center, endeavor to promote a wholesome social life among the nurses.

Similarly, as prescribed by regulations, a chief nurse was designated for each hospital where a group of nurses was on duty, whether mobile, evacuation or base, and whether it was part of a center or operating independently.1

Experience showed that the nursing units definitely organized by a head nurse in civil hospitals and colleges, among women who were accustomed to work together were more quickly efficient than were those composed of casuals gathered from many sources.1 The latter, with no previous division of assignments according to the particular qualifications of each member were inevitably handicapped at first by a lack of mutual acquaintanceship.1

RECONSTRUCTION AIDES

The employment of reconstruction aides was an innovation during the World War, and it was not until during the armistice that any great use of them was made overseas.

A memorandum published December 31, 1917, by the Surgeon General, covering the organization under the division of military orthopedic surgery, and giving the duties, status, etc., of the "woman's auxiliary medical aides," was given application in the American Expeditionary Forces. These aides were engaged in physiotherapy work.10 Their designation was changed to "reconstruction aides," and some of the provisions for their employment were modified by the Surgeon General on January 22, 1918.11

On May 3, 1918, the Surgeon General authorized the chief medical officer of each army or separate auxiliary force12 to appoint head aides, not to exceed two to each hospital, from among the reconstruction aides serving overseas.

On May 21, 1918, the chief surgeon, A. E. F., initiated a cabled requisition for 30 reconstruction aides for service in overseas orthopedic hospitals.13 This request received a favorable reply,14 but several months elapsed before they began to arrive in numbers. This led the senior consultants to try and secure them through the American Red Cross. On July 13, the director of professional services was notified that the senior consultants of special services should look far enough ahead to prevent the employment of aides from the Red Cross, thus necessitating that organization cabling to the United States for replacements.15


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Requirements for reconstruction aides who were engaged in occupational therapy work, were outlined in a circular published by the Surgeon General, August 8, 1918.16

Early in August a request was cabled that 20 reconstruction aides be sent over with each base hospital, half of them to be trained in physiotherapy and half in occupational therapy.17 These aides were to be carried as civilian employees and not included in the reports and returns of nurses.18 Toward the end of that month the senior consultant in orthopedic surgery was notified that the Surgeon General was organizing reconstruction aides in groups of 20 members each and that these groups would be sent as fast as possible to the American Expeditionary Forces, as enumerated units, for further reassignment there.19 A reconstruction aide unit arrived at Havre, October 19.20 Certain aides had arrived before that date18 but from that time forward their numbers increased considerably. Upon arrival they were assigned to hospitals and hospital centers.

The supervisor of reconstruction aides was at first located at Savenay21 but in January, 1919, joined the chief surgeon's office at Tours.1 All occupational therapy aides for overseas service were versed in simple bedside handicrafts.22

The reconstruction aides were under the direct supervision of the director, nursing service, their function being to carry out instructions in the rehabilitation of wounded in methods of physical and occupational therapy.a When practicable they were quartered at the hospitals and were entitled to rations, to the laundering of uniforms, to transportation; also they were entitled to $4 per day when traveling. They were authorized to purchase Quartermaster Department supplies on written approval of the commanding officer, but were not entitled to heat and light.23 The reconstruction aides had the same pay as nurses, and increase of pay was applied to them as well.24

On December 29, 1918, there were 200 reconstruction aides serving in the American Expeditionary Forces, distributed among 20 base hospitals.25 By March 15, 1919, this number had been reduced to 93, of whom 71 were engaged in physical therapy and 22 in occupational therapy.26 These aides were then attached to 10 hospitals distributed among 6 hospital centers.26 On May 1, 1919, there were 109 aides in the Services of Supply (55 occupational, 54 physiotherapy) distributed among 14 hospitals. Thirty other reconstruction aides were at that time on duty with the Third Army in Germany.27

On June 18, 1919, the chief surgeon, Third Army, was notified that reconstruction aides were not now considered civilian employees and that they were to be returned to the United States before June 30.28

aSee Circular No. 56, chief surgeon's office, Nov. 19, 1918, quoted in the appendix.


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PERSONNELa

(July 28, 1917, to July 15, 1919)

ARMY NURSE CORPS

    Bessie S. Bell, chief nurse, A. N. C.
    Julia C. Stimson, director, nursing service.
            Nina E. Shelton, assistant director, nursing service.
            Blanche S. Roulon, chief nurse.
            Arma E. Coffee, assistant chief nurse.
            Marion G. Parsons, nurse.

SUPERVISOR, RECONSTRUCTION AIDES

    Marguerite Sanderson

REFERENCES

(1) Report from Julia C. Stimson, Res. A. N. C., director of nursing service, A. E. F., to the Surgeon General, U. S. A., May 31, 1919. Subject: Nursing activities, A. E. F., on the Western Front, from May 8, 1917, to May 31, 1919. On file, Historical Division, S. G. O.

(2) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 28, 1917. Subject: Weekly war diary. On file, Historical Division, S. G. O.

(3) Cable No. 197, par. 3, from Gen. John J. Pershing, to The Adjutant General, October 2, 1917.

(4) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1, 1919. Subject: Activities of the chief surgeon's office to May 1, 1919. On file, Historical Division, S. G. O.

(5) Annual Report of the Surgeon General, U. S. Army, 1918, 429.

(6) Weekly war diary, chief surgeon's office, A. E. F., September 21, 1918.

(7) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April 17, 1919. Subject: The Medical Department, A. E. F., to November 11, 1918. On file, Historical Division, S. G. O.

(8) Final report of Gen. John J. Pershing, September 1, 1919, 77.

(9) Report of  "Strength of the A. E. F. by months as shown by the consolidated returns for the A. E. F.," January 12, 1924. On file, A. G. O., Returns Section, Miscellaneous Division.

(10) "Circular of information concerning the woman's auxiliary medical aides," the Surgeon General's Office, December 31, 1917. On file, Historical Division, S. G. O.

(11) "Circular of information concerning the employment of reconstruction aides, Medical Department, U. S. Army," the Surgeon General's Office, January 22, 1918. On file, Historical Division, S. G. O.

(12) Memorandum from the Surgeon General of the Army to the Supply Division, S. G. O., May 3, 1918. Subject: Approval of letter of appointment for reconstruction aides. On file, Historical Division, S. G. O.

(13) Cable No. 1153-S, subpar. A, from General Pershing to The Adjutant General of the Army, May 21, 1918.

(14) Cable No. 1434-R, par. 4, from The Adjutant General of the Army, June 3, 1918, to General Pershing. On file, A. G. O., World War Division, chief surgeon's files, (231.238).

aIn this list have been included the names of those who at one time or another were assigned to the division during the period July 28, 1917, to July 15, 1919.
There are two primary groups-the heads of the division or the section and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.


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(15) Third indorsement from the chief surgeon, A. E. F., to director of professional services, A. E. F., July 13, 1918; on letter from the senior consultant, orthopedic surgery, A. E. F., to the chief surgeon, A. E. F., July 11, 1918. Subject: Reconstruction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(16) Circular, "Reconstruction aides in occupational therapy," Office of the Surgeon General, August 8, 1918. On file, Historical Division, S. G. O.

(17) Cable No. 1546-S, par. 9, from General Pershing to The Adjutant General of the Army, August 2, 1918.

(18) First indorsement from the chief surgeon, A. E. F., to the commanding officer of Base Hospital No. 9, August 6, 1918; on letter from the commanding officer, Base Hospital No. 9, A. E. F., to the chief surgeon, A. E. F., August 2, 1918. Subject: Reconstruction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(19) Letter from the chief surgeon, A. E. F., to senior consultant in orthopedics, August 28, 1918. Subject: Reconstruction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(20) Telegram from senior consultant in orthopedic surgery, A. E. F., to the chief surgeon, A. E. F., October 15, 1918. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(21) Memorandum from the commanding general, A. E. F., to the chief surgeon, A. E. F., November 4, 1918. Subject: Contract and oath of office taken by reconstruction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(22) Cable No. 267-R, par. 3, from The Adjutant General of the Army, to General Pershing, November 14, 1918. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(23) Second indorsement, from the chief surgeon's office to the commanding officer, Base Hospital No. 94, U. S. A. P. O., 713-A, France, January 30, 1919; on letter from the personnel officer, Base Hospital No. 94, to the chief surgeon, A. E. F., January 30, 1919. Subject: Pay of reconstruction aides. On file, A. G. O., World War Division, chief surgeon's files (231.238).

(24) Telegram from the chief surgeon, A. E. F., to the chief surgeon of the advance section, A. E. F., December 21, 1918. On file, A. G. O., World War Division, chief surgeon's files (248).

(25) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to the chief surgeon, A. E. F., December 29, 1918. On file, Historical Division, S. G. O.

(26) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to the chief surgeon, A. E. F., March 15, 1919. On file, Historical Division, S. G. O.

(27) Report from Marguerite Sanderson, supervisor of reconstruction aides, A. E. F., to the chief surgeon, A. E. F., May 1, 1919. On file, Historical Division, S. G. O.

(28) Telegram from the chief surgeon, A. E. F., to the chief surgeon of the Third Army, June 18, 1919. On file, A. G. O., World War Division, chief surgeon's files (230.366).

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