First world war nurses’ achievements were overlooked, just as nursing is undervalued now

Nurses on the Western Front were highly skilled professionals, says historian Christine Hallett

Nurses on the Western Front were highly skilled professionals, says nursing historian Christine Hallett

Nurse Nellie Spindler

On 21 August 1917, staff nurse Nellie Spindler came off a night shift at a field hospital close to the village of Brandhoek in Flanders; she handed over the care of her patients to the day staff and walked the short distance to her sleeping tent. The nurse who had shared the tent with her had been sent ‘down the line’ to a base hospital the day before, apparently suffering from debility and shell shock. So Nellie settled down alone, to sleep on her narrow stretcher bed. 

About 11am, several bombs were dropped on the hospital compound. A piece of shell casing tore through the canvas wall of her tent, wounding Nellie so severely that, despite the best efforts of her medical and nursing colleagues, she could not be saved. She died in the arms of her matron, Minnie Wood, at about 11.20am.

Highly trained for a demanding environment

The Brandhoek Advanced Abdominal Centre, where Nellie nursed and died, was one of the most sophisticated field hospitals on the Western Front. It was also one of the most dangerous – located just three miles from the front line at Ypres and consisting of three casualty clearing stations (CCSs). Nurses were in short-supply; only the most highly-trained and reliable were posted to CCSs, and most could only remain for about six weeks before they began to suffer from exhaustion. 

'Nurses' intricate and highly responsible clinical work finds almost no place in the written record'

Following Nellie’s death, the centre was evacuated, and all patients and staff were moved several miles west to St Omer. But many more nurses were to die in similar circumstances before the Armistice of November 1918.

Nellie Spindler has become emblematic of the work and sacrifice of first world war nurses for many reasons: she was a fully-trained professional, whose work was vital to the rescue of wounded men on the Western Front; she was young – only 26; she had bravely volunteered to work close to the front line in the ‘zone of the armies’ where danger was acute; and her death was needless. 

Invisible professionals

Because of a shortage of wood for front-line trenches and duckboards, very few nurses in the so-called ‘zone of the armies’ had wooden huts in which to sleep. Nellie’s vulnerability – sleeping under canvas, while shells landed all around her – epitomises the invisibility of the professional nurses of her time. Not only does their intricate and highly responsible clinical work finds almost no place in the written record; their needs, along with those of colleagues and patients, were largely invisible to an army high command that would later be accused of being indifferent to the value of human life.

So, we might ask, was Nellie’s death – and those of nurses like her – simply a wasted sacrifice? In the 100 years since the end of the first world war, we have become accustomed to its association with needless loss of life. But an understanding of the work of professional nurses can enable us to tell a different story. Nurses were saving lives. And many died themselves as a result.

More than self-sacrifice 

These nurses are now remembered, alongside those who died during the second world war, on the new nurses' memorial at the National Arboretum in Staffordshire. But their participation in the two world wars should not be seen merely in terms of self-sacrifice. They saw their clinical practice close to the front line as an act of responsible risk-taking. 

The memorial to nurses at the
National Arboretum. Picture: Getty

The recognition, in the autumn of 1914, that both wound-shock and anaerobic bacterial infections were taking many lives, prompted the senior medical officers of the Royal Army Medical Corps to place CCSs (then known as ‘casualty clearing hospitals’) close to the battlefields, to enable surgery to take place within hours of men being wounded. 

But such surgery was impossible without the participation of fully trained expert nurses, who resuscitated and hydrated patients who would otherwise have died before reaching the operating theatre. They prepared them for surgery, gave vital assistance during operations, and supported patients’ recovery from the toxic anaesthetics, ether and chloroform. Wartime advances in wound-treatment were rapid and extensive, and nurses played vital roles in these.

Diverse interventions

Alongside their expert surgical interventions, professional nurses also (with the support of military orderlies) provided the fundamental nursing care that preserved lives and enabled bodies to be rebuilt. And they provided significant and life-saving emotional care to their patients, in spite of a lack of direct training for such work.

'Ambulance volunteers are remembered in GCSE history, military nurses are not'

The centenary of the first world war has been marked by a number of efforts to remember the important contribution that was made by these highly-trained, courageous and altruistic women. Yet the failure of their own contemporaries to recognise the full scope and impact of their practice is mirrored in a lack of attention to nurses’ work today. 

It is difficult to clearly demonstrate the link that exists between nurses’ expert clinical work and patient survival and recovery. Today’s historians and school curriculum-writers are still failing to recognise the pivotal importance of nursing work – as illustrated by the fact that volunteer ambulance workers are mentioned in the Edexcel GCSE curriculum, while professional military nurses are not.

The road to regulation

Yet, perhaps some progress has been made. In the nursing profession itself, much has been achieved. Books and articles have been written; ‘living-history projects’ fronted by today’s professional nurses have achieved a high profile at national commemorative events; exhibitions have been held.

In their own time, first world war nurses made the point that women could work close to the front line on active war service, helping to win, by their example, not only votes for women through the extension of the franchise in 1918, but also a legally-sanctioned register for their profession on 23 December 1919. 

By recognising and highlighting the significance of first world war nurses’ achievements, we can make visible the previously hidden nature of their work, revealing the legacy of a profession that is continuing to perform essential and life-saving work today.

Christine Hallett is professor of nursing history at the University of Huddersfield. She is the author of several books on first world war nursing, including Nurses of Passchendaele (Pen and Sword, 2017)

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