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Within the army's medical services, doctors and nurses were assigned to four types of patient-care units: field ambulances, evacuation posts, stationary hospitals, and general hospitals. Wounded soldiers were first taken to the field ambulances, infirmaries located close to the front, staffed by soldiers who gave only first aid. Patients were immediately transported to medical evacuation posts for a more complete examination by a physician. In theory, no nurse was supposed to work so close the hostilities, although some did so under specific circumstances — for example, to accompany a surgeon posted to one of these facilities. It should be noted that field ambulances and evacuation posts were not equipped to hold patients for more than a few hours.
Operating Room, No. 2 Canadian General Hospital, Le Tréport, France
Unidentified drivers servicing a St. John Ambulance Association ambulance, No. 2 Canadian General Hospital, Le Tréport, France. 1917
Nursing sisters and wounded soldiers at the Anglo Russian Hospital in the Dmitri Palace
Patients were then transported to the stationary hospital, located relatively close to the front, managed by a matron-in-chief in charge of 16 nurses. These hospitals had about 250 beds. Those with serious injuries requiring a long convalescence or suffering from various diseases were sent to general hospitals, permanent buildings located in Great Britain that could house more than 500 patients. The nursing staff in these hospitals was composed of a matron-in-chief and 72 nurses. The nursing units rotated between various stationary and general hospitals; a nurse might change posts several times during her military service. In addition, a nursing unit might be broken up and its members allocated to various hospitals depending on personnel needs determined by the circumstances of the war.
With regard to the nursing work itself, it was the conditions surrounding administration of care, rather than nursing techniques in themselves, that were different from those in civilian society. Working conditions were considerably more rigorous because of the irregular pace of often massive admissions, a normal consequence of the advance or withdrawal of troops, which added to the already heavy load of care for those with diseases and accidental injuries. Nurses also had to deal with a lack of hygiene and insufficient equipment and personnel, but this shortfall was explained mainly by the irregular influx of injured soldiers, which made it impossible to know how many patients to be prepared for at any given time.
During an offensive, a dressing station close to the line of fire might be completely overwhelmed. Under cover of night, trucks filled with muddy wounded soldiers would be unloaded and handed over to the nurses, who, between stretchers crammed together or beside soldiers lying on the ground, had to try to staunch hemorrhages, set bones, and ensure the survival of their patients until they were transported farther behind the lines to receive appropriate care. The daily work of the nurses in units farther from the front was just as laborious. Climatic conditions and life in the trenches favoured the outbreak of epidemics, so many beds were occupied by soldiers suffering from infectious diseases, which in fact accounted for almost 70 percent of cases admitted to hospital.11
In this context, we cannot conclude that World War I was synonymous with a medical revolution in terms of practical nursing work and administration of care. Of course, certain techniques — blood screening, blood transfusions, and urinary screening for certain diseases — were developed and began to be widely used during this period and some specialized disciplines — psychotherapy, physiotherapy, orthopedics, and dietetics — were in their infancy. But the fact remains that nurses were performing the same actions as in civilian hospitals: administering treatment for known diseases such as tuberculosis, influenza, and dysentery; changing dressings and disinfecting wounds; and, of course, seeing to the well-being of patients by providing food and tending to the body, and dispensing various ministrations and comforting words.
Another element had a considerable impact on military nursing: modernization of warfare techniques. The means used during military operations, such as poison gas, shrapnel, and bombardment, often caused injuries that represented medical challenges previously unknown to nurses. Along the same lines, the new combat tactics, the duration of the war, and the dropping morale of the troops were responsible for a constantly growing number of mental illnesses that manifested themselves in night terrors, insomnia, bed-wetting, and other symptoms. At the time, physicians did not have medications to prescribe for such conditions, and nurses had to call on their specific strengths to do what they do best in administering treatment: applying compresses, washing eyes, and applying balms for gas burns, providing comfort and a receptive ear, creating a warm and familial environment, and prescribing rest and diet for the most disturbed patients.
For the nurses, care provision at the front represented a major professional challenge at the technical, personal, and moral levels. Working in such unsanitary conditions, and at such a feverish pace, went counter to what they had learned in their professional training, with its emphasis on extreme cleanliness and personal attention accorded to each patient, and this at a time when hospital stays were very long. As a consequence, nurses often found themselves facing moral dilemmas for which they were not prepared, such as deciding to leave a dying patient alone to see to the pressing needs of those who had a chance to survive.
The high mortality rate of patients was another reality that military nurses had to face. Although they had dealt with death before, they had never been confronted with the loss of so many patients, especially ones so young, at once. Isolation — being far their families and friends — was another difficult aspect of life at the front. On top of this was exhaustion, which also affected the nurses' health.
11 Nicholson, Canada's Nursing Sisters, 73.