The following paper presented in September of 1899. The paper addresses the work of the Daughters of the American Revolution in co-ordinating the appointment of Contract Nurses.
In the days of peace, between, the Civil War and the Spanish wars, nursing in the Army was done entirely by men. At the end of March, 1898 there was a body of 520 Hospital Corps men in all degrees of training as nurses for Army work, as well as 100 Hospital Stewards and 103 Acting Stewards, who may be considered the equivalents of graduate nurses from civil hospitals. This number, barely adequate for an army of 25,000 men in time of peace, was, of course, wholly inadequate in time of war for an army of ten times that size, and although it was planned to greatly increase the Hospital Corps, it was evident that such raw material could not do the work of trained nurses. Therefore, to supply the approaching necessities of the army, the United State Congress, in April, 1898, at the requester the Surgeon General, authorized him to employ, nurses under contract and made an appropriation for their payment. No restriction was made as to sex, but at that time it was the opinion of the War Department that but few women nurses would be needed and that their services would be limited to the general hospitals. Several hundred women, mostly untrained, had already applied, but the force of the Surg0eon General's office was too limited to permit of any examination of their qualifications.
Knowing these facts, the writer suggested to the National Society of the Daughters of the American Revolution (of which she was a Vice President General) that that organization should act as an examining board for women nurses for the Government. The Surgeon Generals of both Army and Navy promptly accepted this offer of the "Daughters," and in April the "D.A.R. Hospital Corps" was organized, with the writer as-Director.
The standard adopted for appointment to Army service was that of graduation from a training school, combined with suitable endorsements., the chief reliance being placed on a recommendation of the superintendent of nurses under whom the applicant had graduated. Women physicians were also considered
The first nurses were appointed on the 10th of May, and ordered to the General Hospital at Key West, and -before the 15th of July, 47 had been asked for 'by surgeons at different General Hospitals and had been selected by the "Daughters" for appointment by the Surgeon General. About this time the Yellow fever appeared among the Santiago troops, and nurses were urgently needed there. The Surgeon General, therefore, employed the wife of the Superintendent of a Washington Hospital, and sent her to New Orleans to procure the services of immunes, both male and female, The majority of the nurses s appointed wee colored omen without hospital training, a considerable number of whom were sent to Santiago in July and August. The "Daughters" also supplied a few trained immune nurses for this service.
During the month of August an epidemic of typhoid broke out in the camps which had been established as places of instruction for the volunteer troops, It also became evident at that time that these camp hospitals had lost their original character and become practically stationary, and consequently the objection to the employment of women nurses in them had disappeared. During that month, therefore, and especially in its latter half the demand for nurses grew to an -entirely unexpected degree, and the roll of army nurses reached about 1,000 names. Not only did they go to General and Field Hospitals, but, whenever the Surgeon in Charge of a Division or Post Hospital so requested, trained nurses were assigned to duty under him. During the Fall it became not uncommon for regiments or larger divisions of troops when they moved to Southern camps, or Cuba to take with them the trained nurses attached to their hospitals, and no. inconvenience or difficulty has been reported as ensuing.
It is needless to refer to the great value of the work rendered by these trained assistants to the Medical Department of the Army, since surgeons, patients, and the public at large have been most enthusiastic in their expressions of appreciation. Scarcely a training school in the Uniited States but sent home of its best representatives for this work and the women adapted themselves to camp conditions and to many sorts of discomfort in a manner that quite altered the many preconceived opinions.
During the greatest stress of the work, valuable assistance in securing the services of nurses was rendered to the Government through the "Daughters" by a number of organizations, The Sisters of Charity merit prominent mention in this connection, as they furnished from their order 200 Sisters, many, of whom had much hospital experience. A few of the Sisters from four other Catholic organizations and one Protestant Episcopal Sisterhood also served for a time. The Society for the Maintenance of Trained Nurses, which as Auxiliary No. 3 to the American National Red Cross Relief Committee of New York, in August, and for a few months thereafter, examined the credentials of a large number of applicants and was unique in its work of furnishing money for the transportation of nurses and for their comfort while waiting orders in New York City and while serving at certain Army hospitals. Much valuable aid was rendered by the superintendents of training schools, although it is an interesting fact that no organization of trained nurses has rendered any noteworthy assistance. In spite of the overcrowding which had previously been complained of in the nursing profession there was much difficulty at the time of greatest stress and need in securing enough suitable applicants to fill the demands of the camps. The Chief Surgeons at Montauk, Jacksonville, Lexington and San Francisco were therefore authorized to secure women nurses without regard to training and in, this way few undesirable appointees unavoidably crept in.
In addition to the Army Nurses, temporary help was s accepted at a few hospitals from women who were not connected with the Medical Department. That such should be the case is much to be regretted, as irregular nurses are not subject to control and discipline and do not hold the same honorable position as do women who have Governmental authority for their presence with the army. However, the zeal of womankind is such that some exceptions of this kind were almost inevitable.
The volunteer work of the Daughters of the American Revolution and of the societies which were co-operating with them, was necessarily limited to the selection of nurses for appointment. By the end of August, 1898, it became necessary to establish an Army Nurse Corps Division of the Surgeon General's office, and the writer was therefore appointed an Acting Assistant Surgeon and assigned to duty in charge of that Division.
After the middle of September, at which time 1, 200 nurses were in. service, there was a gradual decrease resulting from the control of the typhoid fever, and later from the mustering out of the Volunteer Army. At the close of 1898 there were 686 women nurses in service, and on the 1st of July, 1899, there were 202, which number has not greatly varied up to the present time, They are stationed at General, Field and Post hospital and camps in the United States, Porto Rico, Cuba, Honolulu and the Philippine Islands and on the Hospital ship "Relief." The total number of women who served as Army Nurses prior to July 1, 1899, was 1,563, and the number of applications at that date had almost reached 6,000.
The fatality among the trained nurses has been extremely small, the deaths numbering only five. Five of the 250 Catholic Sisters also died, as did three out of about 100 untrained (immune) nurses. All except two deaths wore from typhoid fever.
The work of 1899 has been to organize the "Army Nurse Corps" and to perfect the nursing records of the war. The applicants for appointment include large numbers of nurses who have, in previous service, become familiar with army duties, and these applications are a most encouraging indication of the success of the work.The organization of the Corps is still incomplete in some details, but a satisfactory basis for its general regulation has been evolved from experience. The rules governing this matter were issued from the Surgeon-General's Office on June 20th last, and bore the approval of the Secretary of War. They provide as follows regarding the qualifications for appointment:
To be appointed in the army as a nurse must be qualified therefor,
physically, mentally, and morally, as hereinafter provided:
1. She must present a physician's certificate of health on a blank form which will be furnished by the Surgeon General.This circular also states that:
2. She must be a graduate from a training school for nurses which gives a thorough professional education, both theoretical and practical, and requires at least two years' residence in a Hospital.
3. She must be endorsed by the present Superintendent of nurses at the hospital from which she graduated and also by the one under whom she was trained. Blanks for these endorsements will be furnished by the Surgeon General and are to be returned directly to him.
Women not under army contract will not be permitted to serve as nurses in Army hospitals unless in an unforeseen emergency, and in such case the medical officer in charge of the hospital will immediately report the fact to the Surgeon-General for his action.
On entering the service the nurse signs a contract to serve for at least one year, unless she should sooner be discharged, and she receives for service in the United States, $40,00 a month; for service outside the States, $50,00. Besides this, each nurse receives quarters and rations, as well as all transportation expenses to and from her home and when traveling under orders; and is further entitled to 30 days leave of absence with pay, for each year of service. She is also cared for during illness. This compensation as compaired with that given to graduate nurses in civil hospitals is very fair, and quite satisfactory to the nurses themselves. A uniform and badge have lately been prescribed for the army nurses.
In Cuba, during the past summer, a number of trained nurses have been called upon to care for yellow fever patients, and in some instances have contracted the disease themselves, though fortunately no fatalities have ensued. At hospitals especially provided for yellow fever patients, only immunes to that disease are stationed, and it is often necessary to appoint women for this purpose who are not graduates of training schools. Such appointments, however, are considered temporary.
At each hospital, a nurse of executive ability and tact is appointed by the Surgeon General as Chief Nurse, her duties being, so far as army conditions permit, equivalent to those of a Superintendent of Nurses in a civil hospital. The Surgeon in Charge of each hospital reports changes in status and number of nurses, but the Chief Nurse herself reports on their efficiency, health and conduct. These reports are sent to the Surgeon-General through the Surgeon in Charge of the hospital, who is directed to make his own remarks thereon,. The provision for Chief Nurses has been found of the utmost importance to the success of the Corps, and, as the duties of the women holding this position are often difficult, they have increased salary in proportion to their responsibilities. At small hospitals, where there are not over four nurses, the Chief Nurse in expected to do her share of ward duty, and receives no increase in salary.
At many Army hospitals, the nurses, or expert women who are appointed especially for the purpose, have been utilized as dietists, and have had charge of the cooking for patients. This plan has proved most satisfactory in its results. In August, 1899, a new departure was inaugurated at the school for Hospital Corps men at the Washington Barracks, Washington, D.C. One of the nurses, who had been a dietist at 7th Army Corps Hospital, Jacksonville, was assigned to duty as instructor in diet for the sick, and she is now engaged in teaching large classes of newly enlisted Hospital Corps men how they should prepare water, milk, gruels, jellies, etc., and also how elements of the Army ration can be prepared so as to be suitable for the sick, when nothing else is obtainable, Fifteen lessons are given, of an hour each, and the result of this work, when these Corps men are scattered through the camps in the Philippine Islands will be noted with much interest. So much have they appeared to be interested in, and to profit by the lessons at the Washington Barracks that the new school for Hospital Corps men near San Francisco, has also a woman nurse as instructor in diet cooking.
Perhaps one of the most important features provided for in the present organization of the Nurse Corps is the body of reserve nurses, which consists of women who have served in the Army at least four months, and whose record has been thoroughly satisfactory in every respect. They are to be transferred to the active list when their services are needed, especially in time of war, and the list will practically be a roll of honor. The reserves wear the badge of the Army nurses, but are not paid except when on active duty.
In Europe as a general rule, a limited number of women nurses is
employed in Army hospitals in time of peace, and provision is made through
religious and secular channels, for a large increase in case of war.
In our country the religious sisterhoods have but a small surplus beyond
their own needs. The Red Cross Societies in foreign countries are
great organizations under Government control, through which all aid to
the Army must come, but we have nothing similar to them in the United States,
nor are they indeed altogether compatible with the liberal instincts of
our people. It follows that the only satisfactory method of dealing
with this question are, so long as the nursing profession is in feminine
hands, is by the organization of a regular Army Nurse Corps of women, with
both active and reserve lists. It is really not an exaggeration to
say that the establishment of this Corps, under the Surgeon-General, is
one of the noteworthy results of the Spanish War.
McGee, Anita Newcomb, "Women Nurses in the American Army" Proceedings of the 8th Annual Meeting of the Association of Military Surgeons. Delivered as a speech at Kansas City, Missouri in September , 1899. The original is now housed in the National Archives.
Photo Of Muriel Galt, courtesy of the National Park Service.
Freidel, Frank, The Splendid Little War. (Boston: Little, Brown and Company, 1958). 297 (photo of nurses aboard RELIEF)