From handmaiden to right hand—World War I and Advancements in Medicine

AORN Journal,  Nov, 2004  by Victoria L. Holder

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Editor's note: This is the sixth in an ongoing series about the history of perioperative nursing. The first two articles in this series appeared in the September and October 2003 issues of the AORN Journal. The third article in the series appeared in the February 2004 issue of the Journal, the fourth article appeared in the September 2004 issue, and the fifth article appeared in the October 2004 issue of the Journal.

By the time World War I ended, strides had been made in the fields of medicine, surgery, and nursing. New ways of organizing hospital facilities had been introduced, along with the concept of triage. The terrible injuries inflicted by modern weapons called for advancements in the fields of anesthesia, infection control, and surgery. The needs of survivors, who were left with missing limbs or horrible scars, led to the establishment of the fields of plastic and reconstructive surgery.

Nurses also made strides forward. Women from America, Britain, and France were eager to help those wounded in battle. Many were sheltered young women from good families, and they probably were not prepared for the harsh conditions they encountered. They endured long hours, poor housing, frigid cold, and the risk of injury or death, often for little or no pay. They helped care for young men whose bodies had been mangled by shrapnel and men who were dying from infectious diseases. Although they encountered far too much blood and death for what was considered a properly raised young woman at that time, these nurses persevered and, in doing so, won the respect of their comrades-in-arms.

HOSPITAL FACILITIES

As the war in Europe started, hospitals began to spring up throughout Great Britain, France, and Belgium. Buildings that had been churches, schools, and hotels began to prepare for the wounded.

   Stately homes and country houses
   were transformed into convalescent
   homes for officers, and the London
   houses of the rich became private
   hospitals financed by their owners
   and by contributions from wealthy
   friends. (1) (p39)

THE AMERICAN HOSPITAL. One of the first hospitals used to house the wounded was in Neuilly, a suburb of Paris. (2) This small hospital, known as the American Hospital, had been set up in 1910 by a group of Americans living in the area, and when the war broke out, money, equipment, automobiles, and American volunteers all were forthcoming.

When French officials learned of the hospital's intent to care for wounded Allied soldiers, they offered a much larger building, which had been intended for use as a school. Although the building still was under construction, it was only six blocks from the original facility, and

   its large, well-lighted, and well-ventilated
   rooms were transformed into
   hospital wards, operating rooms,
   dormitories, and offices; a multitude
   of doctors, surgeons, and nurses
   were brought over from the United
   States; and thus the American
   Ambulance Hospital in the Lycee
   Pasteur, with accommodations for
   more than 600 wounded soldiers,
   came into being. (3) (p3)

BASE HOSPITAL NO 20. As the United States entered the war, US physicians and nurses began moving whole hospital units overseas. One such hospital was Base Hospital No 20. The officers, nurses, and enlisted men at this hospital came almost entirely from the University of Pennsylvania, Philadelphia. Staff members included 22 medical officers, two dentists, one chaplain, 65 nurses, and 153 enlisted men. (4) The enlisted men had been trained in Philadelphia hospitals and served as orderlies in wards, ORs, laboratories, and x-ray departments. The nurses received their military training at Ellis Island. (4)

The unit sailed for France on the steamer Leviathan on April 24, 1918, taking with them $25,000 worth of equipment and $100,000 in cash." Although Base Hospital No 20 initially was set up to care for 250 patients, staff members quickly realized that the number of casualties likely would be double that number. Adjustments were made quickly, and within a month, the first trainload of 400 patients arrived. Staff members worked together efficiently and "within an hour and a half every patient had been undressed and put into bed." (4) (729)

When the call came for emergency medical and surgical care at the front, special teams of surgeons, physicians, nurses, and enlisted men from the unit were sent. They were under fire from the enemy, but their service and skills were needed desperately.

As the war progressed, the hospital unit expanded with the addition of various hotel buildings and equipment. The original nursing staff of 65 continued to perform their duties. In fact, not a single member of this hospital team was lost during service in France. This was unusual considering the epidemic numbers of patients who contracted influenza. (4). Base Hospital No 20, however, was noted for successfully combating the influenza epidemic because of staff members' diligent antiseptic precautions and sterile technique.