… many a Sister, when the badly wounded first arrived, had to at times suddenly disappear into the pantry to control her feelings for those poor suffering boys …
– Emma Cuthbert (AANS)
The first indicator that nurses would play a variety of roles in the First World War occurred in Belgium at the onset of hostilities. Belgium was a neutral country and while France gave assurances that it had no intention of bringing Belgium into any conflict it may have with Germany, so too did Germany. This was to change at 7pm on 2nd August 1914 when a carefully crafted note was handed to the Belgian Foreign Minister, M. Davignon, from the German Minister in Brussels, Herr von Below-Saleske.305 The Belgians were advised that the French were amassing troops along the route, Givet-Namur, indicating that they planned to invade Germany by way of Belgium. The Belgians knew this was not the case but the Germans justified the adoption of the Schlieffen Plan by claiming that they had no alternative but to avert a hostile attack from France by entering Belgium.
The Schlieffen Plan had been developed decades earlier by Bismarck. In 1860 the German nation did not exist. Bismarck, the then Prime Minister of Prussia, saw the benefits of a united Germany and he instigated what was to become the Franco-Prussian War. The southern independent states joined Prussia and France was defeated. Consequently the two French provinces of Lorraine and Alsace were lost to a strong and united Germany. After this defeat, France had the foresight to strongly fortify its exposed German border, but the Germans had an alternative plan should Germany feel the need to invade France at a later date. This was known as the Schlieffen Plan and involved the movement of German troops through neutral Belgium to reach Paris.306 The Germans sought a reception of … benevolent neutrality … by the Belgians, as they did not want the Belgians to consider the movement of German troops through their country as an act of aggression.307 Belgium was given 12 hours to decide which course of action to take.
Belgium had an inadequate military force to deploy to its border with Germany. As a neutral country, Belgium considered its army to be unnecessary on economic and social grounds and was therefore unable to match the might of the German Army.308 Germany misinterpreted a policy of neutrality as a sign of passivity. Germany never imagined that Belgium would stand and fight, but having put into words the German intention to invade Belgium the Germans were beginning to consider the consequences of an antagonistic Belgian reception. They soon realised that their plan to get to Paris quickly and then deploy troops to the Russian border could be thwarted if the Belgians were uncooperative. This resistance could be manifested by destroying bridges and established transport and communication routes into Paris.309
Belgium took less than 12 hours to decide that it would not allow its neutrality to be compromised and steadfastly refused to allow Germans to enter Belgium. King Albert of Belgium had his suspicions about the motive of the German note, so he convinced the defence council that Belgium should not call upon other countries to assist with the repulsion of the expected invasion of Germany until Germans had marched upon Belgian soil.310 Despite the superiority of the professional German Army, which had for many years developed a level of competence by appreciating the importance of well-numbered and well-armoured military personnel, the objectives of the Schlieffen Plan failed.311
At 6am on 4th August 1914, Herr von Below-Saleske advised Belgium that Germany would enter Belgium under the guise that Germany was forced into this position to protect its own security. Belgium did not call upon France or Britain at this point as some considered the threat to Belgium to be a tactical ruse by the Germans. The French did not want to deploy its smaller army to Belgium only to have its border with Germany exposed and simultaneously opening France to possible international criticism by the suggestion that the French were the aggressors and entered neutral Belgium first.312 That evening Kaiser Wilhelm II announced for the first time to members of the Reichstag that … Our invasion of Belgium is contrary to international law but the wrong – and I speak openly – that we are committing we will make good as soon as our military goal has been reached.313 Given the Belgian-French border became the Western Front for the next four years it is difficult to imagine how the Kaiser envisaged making … good the wrong. Despite his admission about the illegitimate entry of German troops into Belgium, the Kaiser’s emotive and rousing speech was well received by his audience – as were many speeches made around the world on that day.314
The Germans had entered the fortified town of Liège on 5th August and demonstrated to the world what their new howitzer guns could do. By 20th August the Germans had entered Brussels while the Belgian Army had made a strategic retreat to Antwerp.315 It could be argued that the failure of the Schlieffen Plan occurred when some German troops were used to watch Antwerp instead of being deployed to envelope Paris from the left flank. The plan was to be modified a number of times due to confusion borne of poor communication. One example of this poor communication was when, on 25th August, the German General Moltke re-deployed four divisions to the Russian front as he thought the Germans had already had a decisive victory over France.316
Both sides were to reach a stalemate by the end of 1914.317 The trench lines were established and it would take four years, and a great deal of blood, before the French and Belgian countryside would again be anything more than the Western Front.318 Belgium was to be drawn into the war through aggressive occupation by the Germans. The impact of the German occupation of Belgium was to be profound. The injustice of the situation was noted by a young Australian soldier in his diary on 8th July 1916 just prior to battle when he stated … I am glad I am here to do my little bit towards avenging the wrongs of Belgium and France.319
The failure of the Schlieffen Plan resulted in the German and British allied forces being deadlocked by the end of 1914.320 The pristine countryside of Belgium and France would become a quagmire of corpses during the next four years as some of the bloodiest battles were fought on the Western Front. Kaiser Wilhelm II chose not to heed the advice of Bismarck and the Germans were fighting on two fronts against the French and the Russians.321 This situation was advantageous to the British and allied forces because it ensured the disbursement of German military resources, both human and weaponry. However, the Russians suffered severe setbacks during the early stages of the war and it was feared that they would not be able to hold the Germans back.322 Grand Duke Nicholas requested a diversion that would relieve the pressure on the Russian Army.
While unable to offer troops to assist the Russians, Lord Kitchener, British Secretary of State for War, and Winston Churchill, then First Lord of the Admiralty, decided to proceed with a naval attack at the Dardanelles in a bid to open up the strait.323 This proposal, if successfully executed, would have achieved two objectives: force a relocation of Turkish and German troops away from Russia’s Army in the Caucasus and secure the Dardanelles which would facilitate the movement of troops and supplies to Russia via the Black Sea.324 The naval operation commenced in March 1915 but failed, as many drift mines caused a number of British and allied ships to sink.325 A decision to land a British and allied army on the Gallipoli peninsula a month later gave the Turks four weeks to prepare a more than adequate defence of their country. The Australians and New Zealanders (henceforth referred to as Anzacs) were to land north at Gaba Tepe.326
The Anzacs left their boats with a sense of anticipation but with no cultural or historical knowledge of the reality of war. They faced an enemy who had much to lose – their homeland. The Anzacs had left ships under the cover of darkness and faced a small beach but the Turks were in a perfect position to open fire from the overhanging slopes onto the geographically captive Anzacs who had limited access to shelter.327 During the first day, 8,000 Anzacs were held back by 500 Turks until nightfall when the Turks were reinforced by an additional 5,000 men.328 By the end of the first day the Anzacs, shocked, dazed and without clear orders about how to proceed, were told to ‘dig in’. They ‘dug in’ around the corpses of 2,000 of their comrades.329
While the AIF had been training in Egypt so too had the nurses of the AANS. Despite the conflict between the senior nursing and medical administrators many nurses had developed leadership skills as they began the process of changing their focus away from civilian and toward military nursing. There were Australian nurses who had travelled to England at their own expense and joined the QAIMNSR and they were already in France, assigned to British hospitals caring for the wounded during 1915.330 However, the majority of the Australian nurses spent 1915 caring for the casualties of the Gallipoli Campaign. They nursed the men on hospital ships, in tent hospitals hurriedly put together in Lemnos and in the main hospitals in Egypt.
Nurses did not land on the Gallipoli Peninsula but the AAMC, which included the future DMS Colonel Neville Howse, had a presence. It is difficult to imagine the suffering of the soldiers who had been wounded and left exposed to sniper fire. At the same time, it is near impossible to comprehend the bravery of the unarmed stretcher bearers who repeatedly sought out the wounded soldiers for rescue.331 Once rescued and quickly attended to by the doctors they … put the men on the hospital ships under fire. The stretcher bearers were shot down whilst carrying the wounded. 332
The high number of casualties and lack of medical and nursing care on the small piece of stony beach that was to be forever known as Anzac Beach, caused the medical officers great angst and the soldiers much hardship. A dispute developed between Dr Howse and the military authorities about the best way to ensure the wounded were taken off the beach and placed on the hospital ships. By his own initiative, Dr Howse took the heavily criticised step of placing 150 wounded men upon a refloated naval lighter and sent them out to sea after midnight.333 This certainly cleared some space on the overcrowded beach, but the naval ships, unlike the hospital ships were not protected by the Geneva Convention and … one lighter was turned away from several ships and drifted helplessly in rough seas in the early hours before dawn. Its pathetic casualties were rescued at 3 am by a naval patrol.334
The two main hospital ships which included nursing staff from the AANS were the Gascon, designated for serious cases, and the Clan MacGillivray, for the less serious cases.335 Once the battle began, the term ‘serious’ became blurred but during peacetime all cases would have been defined as in need of critical care because all the men were in pain, suffering from dehydration due to haemorrhage, subsequently cold and therefore at risk of developing wound shock.336 The hospital ships were white and were protected from enemy fire by the Geneva Convention. However, there were instances when … we were shelled solidly twice on the “Assaye”, that was when the troopships and men-of-war sheltered round us, and drew the fire …once we were putting lightly wounded onto another ship, the Turks thought we were transferring troops, and shelled us considerably… I do think the Turks could have hit us if they liked, but it seemed as if they wanted to warn us to behave like a Hospital Ship.337
Before the soldiers could get to a hospital ship they first had to be transported by a small launch that could get to a makeshift pier at the beach. The men were placed into these smaller, open ferry type transports, sometimes referred to as ‘lighters’, and then had to be transferred onto the larger hospital ships.338 One Australian nurse, Evelyn Vickers Foote, who had been assigned to the QAIMNSR with a number of other Australian nurses, nursed on the Assaye for four months and she provides some insight into the transfer of the wounded soldiers who arrived on the lighters. She recorded that the wounded … were often shelled coming over to us. It was terrible the shelling of the lighters. Shrapnel. You would get wounded men killed coming over on the lighters. However, she described the transfer procedure as being … awfully well done. There was practically no carrying. They were slung in coffin-like things in their stretchers, and put right down in the ward. The case was hardly disturbed at all. That was the most efficient thing in connection with the work.339
The AANS nurses on the Gascon, a British hospital ship, which moved between Gallipoli, Lemnos, Imbros, Alexandria, Malta, England and Salonica, found the sheer number of casualties overwhelming.340 Nursing on the Gascon equated to caring for soldiers immediately after battle with limited access to medical and nursing equipment.341 Six Australian nurses were attached to the Gascon on the day of the Anzac landing – Ella Tucker, Clem Marshall, Katherine Minnie Porter, Sophie Durham, Clarice Dickson and Daisy Richmond.342 Before the war was over, four of these six nurses were awarded the RRC. Sister Tucker recorded in her diary that 25th April 1915 was a … Red letter day. Shells bursting all round, we are off Gaba Tepe. The soldiers have commenced to land.343 During the next 36 hours, Sister Tucker and her colleagues would spend 33 hours applying dressings to 557 patients.344 Many of the men had lain on the cramped beach for hours and by … 2 pm on the afternoon of the landing there were 500 wounded waiting for clearance. Mid afternoon saw an increase in the number of serious cases, distinguished by a red tab tied to a tunic button, and at 5.30 pm the evacuation began again, and continued at high pressure until 11pm.345 The sight of these soldiers, who arrived on hospital ships after waiting far too long on the beach at Anzac, was difficult for the nurses to bear.
The frustration felt by Alice Kitchen is evident when she commits her feelings to her diary while nursing on the Gascon in August 1915 during the Lone Pine offensive. She recorded … When I think of all the fuss and bother and all the “technique” we used to have over a clean abdominal operation, I wonder. These poor ones often have to do with such scanty nursing when there is a rush and two or three are urgently ill or even dying, you feel torn in two or three to have to leave them all.346 This frustration was borne from the chaos of caring for young, recently fit and healthy men who were suffering the trauma of terrible wounds which could not be imagined by civilian nurses. Principal Matron Grace Wilson was to record in her private diary that she believed it would be preferable for a loved one to die outright. She may have found this type of thinking reassuring when alone at night with her pen and paper, recalling the death of her own brother at Quinn’s Post in July 1915 at the hands of a sniper.347 Once on the hospital ship, Alice Kitchen regretted that … in many cases we could do little except help them die decently.348 Under the circumstances that was in itself a remarkable achievement.
One such soldier who was allowed to die decently was Major General Bridges who was wounded in the thigh by sniper fire in Monash Gully.349 After he was wounded on 15th May 1915 he was transferred to the Gascon where Clem Marshall (AANS), who who had been the Head Sister of the Sydney Hospital operating theatre prior to the war, nursed him.350 Major General Bridges refused to have his leg amputated and the wound became gangrenous resulting in his death while en route to Egypt on 18th May 1915. After his wound, and prior to his death, he was recommended for a knighthood but he died unaware of the honour.351 Sir William Bridges was the divisional commander and a respected leader in the AIF. Sister Marshall received a Mention in Despatches after working in the operating theatre for more than 22 consecutive hours after the Anzac landing.352 An emblem of bronze oak leaves denoted a Mention in Despatches from 1914 until the emblem was ceased on 10th August 1920. The emblem was worn on the ribbon of the Victory Medal by the recipients.353
After the landing at the Dardanelles and during the heightened media profile, newspapers were publishing emotive letters to the editor with claims that … Every Australian woman’s heart this week is thrilling with pride, with exultation and patriotic statements like ‘Thank God, I am an Australian’.354 Many Australian men who were recovering from the landing were repulsed by any such suggestion that they had participated in a glorious action.355 The nurses became well aware of the military failure of the landing as … twelve nurses worked aboard the Silicia which began loading on the 25th April and departed from Cape Helles on 29th April with 399 patients.356 It is not difficult to understand why it was deemed necessary by the authorities to ensure the nurses … were not allowed cameras on the ship.357 Nevertheless, photographs of the transfer of men onto the Gascon were taken.
The wounded began to flood into the hospitals in Egypt and some soldiers finally reached the nurses at Mena House who noted that … The wounded have arrived today. We have just admitted over 100 today. Most of them – hundreds – have gone to Heliopolis … Two more train loads are coming up tonight. All the S.A. men were in the 3rd Brigade. They say there are only about 200 left who are not wounded or killed.358
Not all AANS were stationed at Australian hospitals. As one staff nurse recounted that … in the middle of April 1915 a number of the Nursing Sisters of No.2 General, were detailed to go to British hospitals in Alexandria. I was among four to go to No.17 General Hospital at Victoria, not far from Alexandria. I stayed at this hospital until the following August, and I must say, those few months abroad will always stand out as the most trying that I have experienced abroad.359
The nurses working on troopships, at Lemnos, in the main or auxiliary hospitals in Egypt, with British or Australian staff, had the same experience. There was a universal lack of preparedness for the human consequences of battle. Emma Cuthbert (AANS) was working at 1 AGH at Heliopolis Palace and she recorded her feelings:
Wednesday we received our first wounded men at 6.30 pm. The big red crescent train arrived just at the back of the hospital, and our excitement was great when we saw our poor wounded boys getting out & being helped out and as they arrived I just felt that I could not meet them all crippled & wounded, but they were all so wonderfully jolly & brave and just loved to tell you all about the fight. They were all received in the big entrance hall where they were first given hot cocoa & biscuits and then at the same time their particulars were taken – name, no. nature of wound etc. & then alloted to the various wards where they had a bath and change of clothes which were greatly appreciated – we thought these cases were bad, but it was three days later we got the seriously and dangerously wounded ones, so many came we had not enough room, so, the less seriously wounded ones, were all ordered up and get dressed and go down to the Auxiliary Hosp. and this had to be repeatedly done, sometimes the wounded would just arrive, have some food, a bath, get dressings done, and get to bed with many exclamations of delight at all this care and good surroundings, when they would almost immediately be ordered up again to get dressed for an Aux. Hosp. as train loads of severely wounded were just about to arrive, and never once were hard words spoken of this treatment by the boys. Their general remark was “We know they are badly wounded Sister, we saw them lying there in the field waiting for help, when we were just able to walk or crawl away”. The wounded were so many more than we expected or than we provided for, that the strain and rush of work and keeping up supplies of dressings was terrific, and many a badly wounded boy would arrive only half clad, and the whole situation was so new to us, that many a Sister, when the badly wounded first arrived, had to at times suddenly disappear into the pantry to control her feelings for these poor suffering boys, and their wonderful patience and endurance, and kindly sympathy and care for each other, really seemed to make it harder for the women to bear. But we soon, very soon, realised that there was work, and [sic] abundance of work to be done, that we were in the very midst of war, and must learn to take the days and their sights and happenings, just as they arrived and every moment was precious, and therefore must not be spent in giving way to ones feelings, and so one and all learnt to face these sights of strong young manhood arriving with his body in a torn and wounded condition. It was a hard school, perhaps, learning from ones own kith and kin from a peaceful far away country, but it stood us in good stead in the many years of war that were ahead of us. 360
The allied troop trains that crossed the desert were marked with a ‘Red Crescent’ which was the equivalent for the Turks as the ‘Red Cross’ was for the allies.361 The impact on the nurses themselves was dramatic because within a short time they had been exposed to terrible wounds as well as news of the deaths of so many young men, many of them known to the nurses. It is difficult to comprehend the strain of awaiting the next casualty train and being relieved to find your beloved brother is not among the wounded or dying and then … One of the men asked if Sister Campbell were here because he wanted to tell her about her brother being killed, and it was poor old Campbell herself he asked. It was such a shock, but she went on working just the same until 10.30.362 It is of small wonder that one of the few references to the nurses in the Official History relates to this period of time when … The Australian nursing sisters at No. 1 Australian General Hospital at Heliopolis and No. 2 at Mena slaved to such an extent that those of the wounded who knew them previously were shocked at the change which the strain had produced in them.363
The future Matron-in-Chief of the AANS, Evelyn Conyers, was then Acting Matron of 3 AAH.364 She recalled:
… the patients did not arrive in too clean a condition from Gallipoli, so a large bath room was erected, plunge and shower, and one end was a room were [sic] the patient stripped and left all his clothing and kit. He then proceeded to the bath room, where he was provided with cleansing apparatus, and from there he went to a third room, where pyjamas, shoes and a bag, kindly provided by the Red Cross, were given to him. The bag contained all requirements in the way of a brush and comb, tooth brush, tooth paste, etc. He was then shown to his bed in whichever ward he had been allotted. His clothing was taken charge of by the Quartermaster, and perishable articles, such as boots, being placed on one side. The rest of the clothing was sent to a steam disinfector, and subsequently washed.365
The importance of utilising the available physical and human resources needed to care for the men who had endured such hardship and trauma is well reflected in the practical approach outlined by Miss Conyer’s narrative. However, the danger of trusting memory is highlighted by her narrative. Matron-in-Chief Conyers stated that … I was selected as acting Matron of No.1 A.A.H. Heliopolis. This Hospital consisted of 1,500 beds, and was erected on the Heliopolis sports ground but it was actually 3 AAH.366 1 AAH was a 1,200 bed hospital at Heliopolis but was located in the grounds of the disused amusement park, Luna Park.367
The medical and nursing contingencies were poorly planned for the Gallipoli Campaign. Soldiers who had been ‘slightly-wounded’ at Gallipoli were to be evacuated to the island of Lemnos for treatment so they could be returned to the front within a few days.368 Unfortunately, this policy was not put into practice and many of the slightly wounded men were sent to the well-equipped and adequately staffed hospitals in Egypt while seriously wounded men were despatched to the make-shift facilities at Lemnos.369 The ability of Australian hospital trained nurses to adapt to military nursing is clearly demonstrated by the actions taken by these same nurses who were faced with the appalling conditions at Lemnos. Their inherent professionalism came from common sense and hard work which was matched by a true compassion for their patients.
Hope Weatherhead (AANS) found … Lemnos Island looked very desolate from the boat, only white tents everywhere, and not a blade of grass to be seen. The ships’ people tried to find out from H.Q. on the Island what was to be done with the fifty sisters which they had on board, no one seemed to know anything about our coming or what to do with us. However after waiting two days on the boat, two barques came alongside to take us to the Island.370 The state of disorganisation seemed to be universal for the nurses who arrived at Lemnos such as when Florence Maud Howitt (AANS) did … arrive in the middle of the night on a Tug, and as there was no accommodation we slept on the ground for that night.371 The experience of Charlotte Donnelly (AANS) was slightly different as she arrived at Lemnos and was … met by a party of boys blowing bugles. We marched on with them, to the camp, and found nothing but a few tents as our equipment had not arrived.372 In many ways this was a more civilised welcome than that received by Lilian Leitch (AANS) who found … our patients were nursed on the ground in the open and it was on this ground that we slept, How we longed for a hole for our hips.373 Regardless of the type of reception the nurses received on arrival the state of confusion and lack of preparedness for nursing the casualties from the Gallipoli Peninsula was typical at Lemnos during the campaign. The leadership of Matron Grace Wilson restored confidence in the situation for the nurses who considered what they were there for and decided to get on with it.
Lack of consultation with nursing staff about the physical location of the hospital tents meant that nurses endured unnecessary hardship. For instance … The Hospital which was all canvas was situated on top and side of a hill, the bottom row of tents were about two minutes walk from the bay, there was no beach there, and the tide did not rise and fall like in most places, but remained the same, needless to say the water was very dirty on account of the hundreds of ships in the Harbour. It was impossible for one to bathe.374 This situation compounded the problem of caring for the soldiers who were often blood soaked and needed to have their dressing changed on arrival at Lemnos. Florence Howitt (AANS) found that … when the patients came in, we had nothing for them and had to tear up sheets and towels … we had to use sanitary utensils to wash them in and this chaos continued for three weeks, until the equipment arrived.375
The men from Gallipoli had endured the trauma of the landing, being wounded, being transferred back onto a lighter and then being loaded in a coffin-like sling onto a hospital ship to finally arrive at Lemnos. The nurses felt the pressure to care for these soldiers but found that they had no provisions to even provide basic needs such as clothing, water, food and shelter. They needed to get these things in order before they could consider the provision of basic nursing care such as dressing changes, pain relief and the observation of signs of change in condition for the prompt identification of the development of wound shock.376
Hope Weatherhead was assigned a medical line of tents and her description of the condition of the patients would cause anyone, but particularly any nurse, to pause and seriously reflect upon the appalling medical and nursing contingencies for those soldiers who were to be embraced in Australia as Anzac heroes. She recorded that:
I shall never forget my first impression of my ward – the first man inside of the door was sitting up in bed with quite two loaves of bread and jam, spread out all over his bed which he had cut up, he was still cutting a loaf in his hand, I noticed that he seemed very short of breath, and appeared to be very ill; I could see at once he was well advanced with pneumonia. So I said what is the matter with you Laddie? he replied: “I do not feel very well, but somebody must help to get the breakfast ready, the bakehouse is a long way off and the orderly has gone to draw tea and get the porridge.” When I got a glance of the Ward with all those sick men just looking after themselves as best they could a lump came into my throat and I had to go outside for a few minutes. We managed to get the breakfast over; such as it was, the bread was so heavy and sodden that it was not fit for fowls food. I scarcely knew where to start first, for most of the patients seemed to be very ill; there was nothing in the way of conveniences in the tent. All they had was beds, all but six were on mattresses down on the ground with a tarpaulin under them, there had been a heavy storm two days before we arrived at the island, the water flowed down the side of the hill and ran into the tents, most of the mattresses on the ground were soaked. There was no means of getting them dry so the men had to remain on them.
She goes on to describe how she made sense of the scene and began to restore some semblance of order and she … spent most of the first day finding out the complaints of the patients, and making the beds which the patients said had not been made since they got into them. After making the patients as comfortable as possible I got the orderly and a few convalescent patients to get some boxes and tins from the Q.R.M. Stores to make cupboards and tables … as I found it impossible to carry on with everything kept on the floor.377
Once the basic needs of the men were met the nurses began to develop nursing strategies to maximise recovery and minimise further harm to their patients. If a nurse is working in a ward dedicated to one disease type, they can develop a routine which maximises the opportunity to provide basic nursing care to each patient. However, the nurses at Lemnos could not even do this because they were faced with … many very sick men; many were suffering from Dysentery, various … Fevers, Rheumatics, Gastritis and Pneumonia. I worked all day, as time off duty with things in such a pitiful state was not to be thought of … according to the stories Sisters had told of that night when we retired, each one found their Ward in the same pitiful condition.378
Throughout the war, especially at Gallipoli and Lemnos, dysentery was a serious medical problem. Heat, flies, cramped conditions and poor sanitary conditions prevailed amongst men who had been weakened by the war experience. Dysentery is a lower intestinal infection which causes fever, stomach cramps and the discharge of loose stools that are often streaked with blood and pus. Bowel movements can occur up to 30-40 times per day causing additional, severe pain to the soldiers.379 The treatment for dysentery is antibiotics and sulphonamides – neither had been discovered at the time.380
Given the limited knowledge base associated with microbiology at the time it is interesting that there were two courses of treatment for the two different types of dysentery. Susan Arnold (AANS) recalled… the treatment for the amoebic dysentery was a hypodermic injection of emetine in the morning, and at night, they had Bismuth emetine and Iodine powders. This treatment was carried out for twelve days and then the patient was given a rest. They would have another twelve days treatment and then another rest, until they had three courses. 381
The above treatment was at odds with that used by the nurses at the 42 BGH which was … injections of anti-dysenteric Serium, [sic] daily for three days, with a light milk diet. Good results followed.382 However, this was likely to have been the appropriate treatment for … bacillary dysentery [which] was treated with anti-dysenteric Serium [sic] in very severe cases. In most cases they cleared up with Sodii Sulph. treatment, i.e., one drachm, hourly for six doses. 383
While it was probably reassuring to know the appropriate treatment for dysentery, the nurses at 3 AGH Lemnos, did not have any equipment or provisions for administering it. As was often the case during the First World War the management of the condition rested with the nurses and the most important nursing procedure was to prevent dehydration. This would be achieved by providing adequate fluids and monitoring the level of outgoing fluids against the intake of fluids. This proved difficult at Lemnos because … the water was very bad, and we had no way of sterilising it. We had many dysentery patients from the Peninsula, and the water made them ill.384 Many deaths occurred due to an inadequate supply of clean water – many preventable deaths.
A soldier who was physically ill as opposed to wounded often feared being referred to as a malingerer and would postpone seeking medical attention. Normal conditions for soldiers included having to find their own meals, sleeping in flea-ridden bedding, no ready access to latrines while battling the symptoms of diseases like dysentery and being grateful if maggots managed to clean their wounds.385 However, if a soldier was ill and not wounded it was near impossible to receive treatment from a doctor or even the Red Cross.386 Despite these conditions the soldiers were reluctant to leave their mates and it would appear that a wound was considered the most legitimate reason for hospitalisation. Soldiers who suffered shell-shock would be evacuated quickly as their behaviour was often considered to be a danger to other men. This included a propensity to run into on-coming enemy fire which was also a serious danger to the mates who would try to rescue them.387
Apart from the risk of dehydration for the soldiers the inadequate supply of food placed an additional burden upon the nurses. They found the initial days extremely confronting due to the extensive range and level of disease. Furthermore, the frustration of knowing that suitable accommodation and equipment was available a short distance away at the AGHs in Egypt where the soldiers had a better chance of survival was difficult to come to terms with for the nurses. Hope Weatherhead recalled that … many of the Sisters cried themselves to sleep, and no wonder when one thought of the people in Egypt only a few hours sailing away, living in luxury and these hundreds of men, many of whom had been practically starved for several months on the Peninsula and then came off, many were too weak with starvation to walk … and were put into such a hospital.388 This situation has many similarities with the experiences of another nurse in another war – Florence Nightingale in the Crimean War.
Although in many ways inadequate, at least 3AGH was established at Lemnos is time to cope with the proposed August offensive on the peninsula. The military objective was to capture the Sari Bair range and the ground to the north.389 Therefore, the nurses at Lemnos also had to deal with an additional wave of wounded. Fortunately … the nursing staff had included in their kit a few odds and ends such as small methylated spirit stoves, methylated spirits, cotton wool, bandages, and a few instruments.390 Despite these extra provisions it is difficult to imagine that they were in any way adequate because the … theatre was going day and night, and in about six weeks time we were fully fitted up.391 When the equipment finally arrived Florence Howitt was … transferred to the theatre. There was not very much here, and we had to make shift with anything we had. The cases were all kinds, – Laminectomy and amputations.392 There continued to be a lack of consultation between the medical, nursing and military authorities four months after the landing.393
Apart from the strain of over-work the nurses were also at risk of disease, dehydration, starvation and exposure to the elements. The living conditions were primitive due to a combination of extremes in weather and inappropriate accommodation. The nurses … lived in single bell tents, two in a tent and … there was a terrible wind at times, and the tents got blown down on many occasions.394 The winds were particularly troublesome and the bell tents had to be continually re-erected to provide shelter to the patients. In daylight this would have been a problem but imagine when … the night-time was very cold and we had blizzards when I was night superintendent and the tents were frequently blowing down.395
The intense workload meant that time off was rare which was just as well because there were not even any seats in the messing quarters.396 A more immediate problem was the near absence of any food in the messing quarters. The nurses … lived on bully beef and biscuits, as we could not get food. The navy were very good to us, and used to invite us out, and give us afternoon tea, etc., and decent food.397 This situation did not change although the type of food did, but it remained … scarce, and we had rice three times a day with marmalade on it, and had it not been for the boats in the harbour, we should have starved.398 The nurses not only survived this ordeal – they found opportunities to provide diversions to aid the rehabilitation of the men and to form a close-knit community of nurses.
While the military, medical and nursing administrators were continuing to argue about the administration of 1 AGH in Egypt, Matron Grace Wilson was demonstrating true leadership on Lemnos. Grace Wilson (1879–1957) was born and educated in Brisbane and undertook her nurse training at Brisbane General Hospital, a Nightingale School of Nursing.399 Prior to the First World War she had travelled to and worked in England and France, returning to Brisbane Hospital and becoming the matron in June 1914.400 She had a distinguished career within the AANS and was the Principal Matron of the 1 MD (Queensland) when the war commenced. On 26th May 1915 the Mooltan left Sydney with sufficient staff and equipment for 3 AGH and Miss Wilson was the matron.401
While at Lemnos she was visited by General Fetherston who was the Director-General of Australian Army Medical Services (AAMS) and was investigating the controversy at 1 AGH between Matron Bell and Lieutenant Colonel Ramsay Smith. Following the investigation, General Fetherston recommended, amongst other matters, the creation of leadership positions within the AANS to improve the management and ultimately the conditions of the AANS nurses.402 The AANS senior nursing positions were reformed when Colonel (later Sir) Neville Howse was appointed DMS of the AIF. After Miss Bell returned to Australia, a Matron-in-Chief of the AANS was appointed and was answerable to the DMS.403 General Fetherston was so impressed by the quality of the nursing care delivered at Lemnos under such adverse conditions he offered the position of Principal Matron of AIF, Cairo, to Matron Grace Wilson but she refused.404
Initially, in 1915 when most of the AANS were stationed in Egypt during the Gallipoli Campaign, Fetherston appointed Acting Principal Matron Jessie McHardie White as Principal Matron of the AANS in England. After Miss Wilson’s refusal he appointed Miss Evelyn Conyers as Principal Matron of the AANS in Cairo.405 In April 1916, when a large contingent of soldiers and nurses were transferred to France, the Headquarters (HQ) of the AIF moved to Horseferry Road in London. Miss Conyers was transferred to London where she was to administer the AANS in England, France and Egypt.406 In May 1916, Miss Ethel Tracy Richardson was appointed the Matron-in-Chief of the AANS and complemented the staff of the Director-General in Melbourne. Miss Richardson was responsible for the administration of the AANS nurses in Australia, on hospital ships and sea transport.407 Despite having been on active service in Egypt and England in 1914–15, her appointment was contentious.408 The controversy centred on the fact that Miss Richardson only joined the AANS to go on active service and was not an original member or an ‘efficient’ of the AANS when it was formed in 1902.409 It remained unclear who was responsible for the administration of the needs of the AANS nurses in India and Salonica.410
It could be argued that Miss Wilson’s suitability for any leadership position was validated by her decision not to accept General Fetherston’s offer, which would have meant leaving her nurses who were working under adverse conditions at Lemnos.411 After the evacuation from Gallipoli, 3 AGH was transferred to England then ventured to France. In 1918, Miss Wilson was the acting Matron-in-Chief while Miss Conyers was on furlough.412 She became the Matron-in-Chief of the AANS from 1925–41 which was at this stage a part-time position.413 Miss Wilson also led a contingent of the First World War AANS nurses to the coronation of King George V.414 During the First World War, Miss Wilson received a Mention in Despatches four times, was awarded the RRC and was appointed a Commander of the Order of the British Empire (CBE) in 1919. Grace Wilson was also awarded the Florence Nightingale Medal for distinguished nursing service (see Photograph 7).415 However, her most important and enduring contribution is best related by the nurses who served with her, nurses who found her to do … her best in all our interests and I believe she had a very uphill task of it.416 Another nurse identified Miss Wilson’s ability to … understand many things without having to be told – and she was very human too.417
During the early phases of the Gallipoli Campaign the idea that moving the wounded from one location to another equated to medical management seems to have dominated the logic of those in charge. Despite the horror of the landing there appears to be little evidence that the preparation for the care of the wounded during the Lone Pine offensive in August 1915 was any better organised. There was a dependence upon the existence of a hospital ship in the harbour without too much attention being paid to the appropriate level of staff or the adequate provision of food, water or nursing equipment on the ship.418 Even the nurses working in the main AGHs in Egypt had insufficient rations provided for the influx of casualties after the Battle of Lone Pine.419
The Battle at Lone Pine was part of the feint which was designed to enable a second attempt at taking the Dardanelles – it has achieved folklore status in Australia. 420 Ultimately it resulted in allied soldiers going over the top of their trenches directly into machine gun fire from the opposing Turkish trenches. For a period of time there was confusion as the Australians and Turks found themselves in common trenches. The Turkish reinforcements directed a concentrated assault on the Lone Pine trenches that had been taken by the allied force. Within four days, 80 Australian officers, 2,197 allied soldiers and approximately 5,000 Turks were killed. 421
Ella Tucker (AANS) was still serving on a troopship and while at Mudros on 4th August 1915 could see eight hospital ships in the harbour. On 7th August they received orders to proceed to Anzac and at 11pm began collecting the wounded. She found that they … ran short of gauze and had to cut up lint … for dressings and did not have … sufficient linen to change the beds … resulting in the … boys are black and so are the beds.422 Mary Dwyer (AANS) found on her arrival in Egypt that … the wounded poured in from Gallipoli after the 4th August stunt they were poor worn out creatures after their trying time on the peninsula.423
Many of the soldiers and nurses described in their letters, narratives and diaries the natural beauty that surrounded them. It was as if the horror that had befallen humanity contrasted so dramatically with nature that it made it more beautiful. Maud Kellett worked on the Gascon in September 1915 and found … The sun-sets were most glorious … even more beautiful than at Lemnos, in as much, as the last ray of the after glow disappeared, the whole side of the mountain facing us, began to shimmer with myriads of lights, from the dug-outs. Viewed from the deck of the “Gascon” by night, Anzac Cove was indeed a most picturesque sight, and one could hardly realise what a deadly inferno it was, until the guns began to talk. 424
She soon found the pressures of work diverted her focus back to the needs of her patients when they:
… began to arrive about 6 pm, in barges, mostly medical-cases, and I was one of the night-Sisters, (Two did night-duty, one forward, and one aft). I was most interested watching the searchlights, from Cape Belles, and the Monitors lying near us, playing on the Peninsula. (My cases were all walkers, and were accommodated on the deck, thus I had a good view of that nights military operations.) The star shells too, were most fascinating, one would be a red colored, perhaps the next green, and then a white one, they would burst, and float in mid-air for sometime. I learnt afterwards they were signals. I feared from the terrible firing, especially about 3 am. there would not be a single soul alive, and was greatly relieved and surprised in the morning, when the barges arrived, to find so few wounded. The poor boys, no matter what their wound or illness was, felt, once they reached the ship, their troubles were ended. Their gratitude for the little you would do for them, was simply wonderful, and their great patience was an object lesson to us all. I will remember one poor boy, who was admitted about 7 pm, very badly wounded, indeed, (was hit about three minutes to six, and was to have been relieved duty, at six o’clock), and in a most collapsed condition, asking “where the ship was making for,” when he was told Alexandria, he gave a great sigh of relief, and said, “Now I shall be alright”, alas, he died about 2 am, before we had started, and was buried at sea 8 am, the next morning, a special barge taking the body some distance from where we were anchored.425
The nurses’ and soldiers’ correspondence and official records are littered with examples of near misses or a chance hit. It became the luck of the draw if you were wounded, contracted an illness or endured an accident – whether you lived or died. Some soldiers may have had a premonition while others had so many near misses that they began to believe they were not destined to die in war.
It has been suggested that the main theatre of war was in Europe and the Middle East Campaign was a mere sideshow.426 However, the lack of British organisation during the Gallipoli landing that resulted in the terrible ordeal for the Australian, New Zealand and British soldiers at the Dardanelles was to create the origins of Australia’s military pride. The reasons for this are diverse and many historians have suggested that it was related to Australia as a nation having its first experience of war.427 Australians were loath to evacuate the peninsula in December 1915 despite enduring some of the most horrific conditions imaginable. Soldiers were angered to hear that they may be asked to leave the place that will forever be known simply as Anzac. One soldier was reluctant to depart before the final evacuation because … Les and I have both been here from the start and we came to the conclusion that we were not getting a fair deal by being sent away before the final flutter, so I went to Major Granville who explained matters saying that only a certain number of men are to remain here after tonight and Les and I are staying, but go into the trenches tomorrow. Les goes away with the first lot tomorrow night and he thought I was to remain with a few others to the last, so I am satisfied once more.428 Soldiers were not at all anxious to leave their dead mates at Gallipoli.
The planned evacuation was kept secret even from the men. The usual type of withdrawal was not possible at Gallipoli because the enemy was often visible from the trenches. Hence, if the front-lines progressively moved back the Turks would be made aware of the retreat. General White decided on a bold plan to withdraw the rear lines and hold the front-lines for as long as possible. This progressive withdrawal had been occurring for some time prior to the official order which was received by the Anzac force on 8th December 1915. By this time the force had already been reduced to 36,000 men and 97 guns. The final evacuation of 10,000 men took place on 18th and 19th December.429 Unlike the landing, the evacuation of Gallipoli was a military and strategic success but, ironically, the nurses on Lemnos … had elaborate preparations for the wounded from Gallipoli, but fortunately there was not one casualty.430
Germany for its part was preparing an unprecedented assault on Verdun in France and preferred the British troops to remain in Egypt and limit the enemy reinforcements on the Western Front.431 This was achieved to some extent by inciting native unrest in Egypt against the British but mainly by Turkish advances across the Sinai Desert through Palestine toward Egypt. The men who had originally thought they were headed for France only to be diverted to Gallipoli now found themselves back in Egypt.
The nurses of the AANS were also reorganised and some were retained in Egypt while others were transferred to France and England. Later recruits would find themselves in Salonica, India and on transport duty. A new phase of warfare was about to be experienced by the Australian soldiers and new types and levels of injuries, diseases and conditions would prevail on the battlefields of France. Just like the soldiers who thought they had endured the worst conditions a war could offer at Gallipoli, the Australian nurses were to discover a different war and different demands awaited them in Europe.
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