the sudden rush into them of grand ladies who were naught but little
Miss Greenhorns in more arrogant guise. These women had not the
faintest notion of subordination, or of the mental and spiritual
discipline involved in nursing. Their conception, in a word, was the
unreal conception of Miss Greenhorn. They, too, were devotees of the
Florence-Nightingale-Mary-Pickford canned brand of dream. They had not
left their beautifully appointed homes to carry slops, et cetera, but
to nurse the gallant British and French lads! And for a time doctors
and nurses were driven almost to insanity under the double pressure
of caring for the wounded, and training--or quietly assassinating and
smuggling down a well some dark night!--these ignorant ladies who
descended on the hospitals like an Egyptian plague. Nor were all of
the untrained, emotional incompetents of English origin. America sent
her quota--women who from infancy had never obeyed anything outside of
their own vagrant fancies, who were congenitally incapable of sinking
their own personalities and becoming privates for the good of the
cause. They wanted to be colonels at the very least or they wouldn’t
play, and a field-marshal’s baton was even more to their taste. Boss
was the middle name of every one of them. They had elephantiasis of the
mind. Such a person in the minor position of nurse’s aid can disrupt
the entire ward of a hospital, which, more than any other branch of
service, resembles the army in its authorities, its hierarchies and
gradations of rank, and the severe monotony of the daily routine.
For a time there was such a Great Person in our ward at the American
Ambulance, the sort who “my-good-man’s” the soldiers. As for the rest,
she blandly did what she pleased, and set the nerves of all of us on
edge in consequence. For what she didn’t please to do, we had to, you
see!
One afternoon the head nurse said to her:
“Mrs. X, will you disinfect that bed?” And it was none the less a
command even though it was issued mildly in the interrogative form.
Mrs. X responded in her best drawing-room drawl:
“Oh, my deah Miss C., I am so sorry! But it is my tea time! And
besides, really that is not my bed, you know!” With which piece of
insolence she drifted languidly off to tea.
“What am I to do with her?” exclaimed the head nurse despairingly to
the ward doctor, who had witnessed the insubordination.
“Shoot her at sunrise,” he suggested jovially. “This is a military
organization. Shoot her at sunrise, and put over her grave: ‘Here lies
a deserter. Shot for refusing to obey a superior officer in action.’”
Of course he was right. That is precisely what should have been done to
her. And I would have joined the firing squad with pleasure--for I had
to disinfect that bed!
To be strong, healthy, adaptable, able to sink one’s identity and
to take orders--these are some of the natural qualifications of
a successful volunteer aid. In addition she must be prepared for
disagreeable tasks. The sight of blood, of poor fellows smashed to
pieces, the hideous stench of gangrenous wounds, the screams of the
dressing hour--these are the inevitable concomitants of a surgical ward
in war-mangled Europe to-day, and are sufficiently disagreeable. But
these are not what I mean. I mean the monotonous, prosaic, inglorious
tasks that everybody loathes but somebody has to perform. And that
somebody, eleven cases out of ten, is the nurse’s volunteer aid. For
you have not read thus far without discovering that the position of an
auxiliary resembles closely that of a printer’s devil. Not his the high
responsibility of getting out the paper or deciding the politics of the
editorial page; his not to reason why, his but to be on the living,
red-hot jump every second of the time or get sacked by his irate boss.
In one respect, however, the printer’s devil has the haul over the
nurse’s assistant, for he receives a weekly envelope, while she labors
for love.
As a specimen of these monotonous tasks, an English volunteer aid
confessed to me that for two months in an English base hospital, three
miles behind the lines, she did nothing all day save carry heavily
loaded trays of food from the diet kitchen to a certain table in the
corridor. Day after day, from eight in the morning until seven at
night, back and forth, back and forth, remote, solitary, with aching
shoulders, this plucky young private drudged. Never a wounded soldier
did she see. At times the hospital shook under German bombardment; but
so far as romance and illusion were concerned, she might as well have
been a slavey in a twilight basement restaurant beneath the dull roar
of the Sixth-Avenue elevated trains. Another young woman told me that
for six weeks she carried nothing but bedpans. And at the American
Ambulance, the _auxiliaire_ who roomed next to me had a job of which I
did not envy her the possession. Every evening she used to offer to
trade it in even barter for mine. And every evening I refused to take
a cowardly advantage of her generosity. The position which my friend
was so generous with was up in the operating room. And it was her
particular duty to carry off the amputated members in a basket.
The points thus far in the natural qualifications of a nurse’s aid
are health, resiliency, ability to take orders and to stick at mean,
disagreeable jobs. Let us add a final one that is really the keystone
of the entire arch. For without it the others are as sounding brass and
tinkling cymbals. Nor is it acquirable: it is a grace, a gift. Some
successful doctors and nurses possess it to a high degree; others,
lacking it, turn into dried-up turnips. There was a certain young
surgeon in the hospital who undoubtedly possessed this qualification.
Whether he was an expert technician I do not know, for he left the
hospital before I arrived and it was only the soldiers’ memory of him,
the reflected echo of his personality, that I received. But that was
sufficient. They loved him. “Ah, mees,” they would exclaim, “do you
know Docteur James d’Amérique? _Non?_” And they made me feel that not
to have known him was a profound personal loss. “Ah, how he was kind!
How he was good!” they would murmur fondly, and they would drag forth
a tiny snapshot of him for me to look at, and laugh with delight at
beholding his face. “See, mees! Here he is! Aha! Bonjour, Docteur
James!” They wished me to share with them the fragrance of that
memory. One could not ask for a better epitaph than the tribute paid
by these _poilus_ to the unknown Docteur James d’Amérique! Another did
not possess this gift. Brusque, impatient of address, he would pull
away the gauze sticking to an infected wound with an abruptness that
invariably raised a howl; and exclamations of “_Brutal!_” “_Imbécile!_”
“_Sale cochon!_” followed his ministrations down the ward. “Oh, shut
up! Shut up! Shut up!” the doctor would retort in English. Now the
soldiers did not know exactly what “Shut up” signified; without doubt
in their minds it was some extremely naughty English profanity. But
they had their revenge. They nicknamed him “Docteur Shut Up.” That was
his epitaph.
A nurse who failed in this one respect they dubbed the old
_mitrailleuse_. I have seen them sham sleep when she approached their
bedsides for a chat. There was one, however, whom they loved. She was a
slim, gold-haired Scotch miss, not much higher than the bedposts, but a
grenadier for all that, and the quality I am speaking about rayed out
from her in an almost visible aura. Not that she was “soft” or easy
with the men. On the contrary, she cracked a whip over them and made
them walk a chalk line of discipline, which they did with an open,
unabashed delight in her. They would feign all sorts of ailments to
lure her to their bed for a chat and massage.
“I suffer bad here, mees!” they would begin. “No, not there--higher
up. No, _chère_ mees, not there. No--yes! _Voilà! Parfaitement!_
A-ah! _Mais, continuez, continuez!_” And not a thing the matter with
the frauds! But they sunned themselves in her presence and all but
fought for her smiles. That little Scotch miss had a way with her.
Moreover, she loved her job. She loved it from the ground up, over and
under and beyond and through. She loved it in all of its aspects and
ramifications; she loved it in all the hours. She had the faculty, the
gift I have been attempting to describe. She had a vocation. And unless
one possesses in some degree this natural delight in humanity, in sick,
diseased and often dirty humanity, the hour soon strikes when nursing
begins to pall.
Thus far I have dealt only with the natural qualifications that a young
woman should possess if she desires to do volunteer nursing in this
war. All those who, after searching their inmost hearts with sincerity,
cannot pass on the above-mentioned points with an all-round grade of
at least seventy-five per cent, need waste no further time on this
article. They may get out of the procession right now and go round next
door and sign in for canteen cooking, or join the hoe brigade. Step
lively, please!
At the present moment there does not exist in the Red Cross
organization any course of instruction that has for its direct and
primary object the training of volunteer nurses’ aids for work in
surgical hospitals here or abroad. There does not exist in the Red
Cross curriculum, as it is now constituted, any course that is adequate
for the present crisis. The teaching manuals are the same that were
in use before the war, unrevised, unchanged. They were not written
with war in mind. Their purpose and goal is not our purpose and goal.
And, as the textbooks have remained unaltered, it is inevitable that
the various courses of instruction based upon them should be more
or less beside the point, congested with material that is useless
or irrelevant, and barren of certain fundamental facts which every
volunteer aid should know. Sometimes when these lessons are given by
nurses or doctors who have seen actual war service they are of more
value, but these are exceptional, random cases; and in general the
courses, instead of hitting the bull’s-eye of to-day’s grim necessity,
are faced off in another direction and shooting at an imaginary mark.
There are four courses of instruction in the Red Cross curriculum that
have a bearing, more or less indirect, on the subject of volunteer
nursing in surgical hospitals during the present war. Let us glance at
each in turn.
Most popular of all is the course in First Aid. This is the course
that nearly every woman in the land flew at and swallowed down whole
at the outset of the European conflict, and, it is safe to say, with
very slight benefit. This is not surprising, for First Aid was not
the proper choice. To teach nursing is not its object. The punishment,
so to speak, does not fit the crime. Almost purely educational
in character, it is designed for the accidents and emergencies
of our ante-bellum, peaceful past rather than for the precise,
up-to-the-minute scientific requirements of our belligerent present.
And from the point of view of the nurse’s assistant there are entire
chapters that should be ruthlessly scrapped. Methods of resuscitating
a drowning man; cures for snake bite; the way to tell an intoxicated
gentleman from one who has merely fallen down in the street in a
fit--these matters are interesting and valuable in their place;
but their place is not in a manual used to instruct in the art of
nursing under present conditions. It would seem advisable that the
First-Aid manual be taken in hand by some eminent surgeon who has
seen war-hospital service during the present year--for example, Dr.
George W. Crile, head of the Cleveland Hospital Unit, that was recently
ordered to France--and blue-penciled unsparingly with actual conditions
in mind. The residue, plus a chapter on the recent discoveries and
improved methods in caring for wounds, such as the treatment of burns
from liquid gas, and the Carrel-Dakin system of antiseptic irrigation
of infected wounds, to mention but two examples, would form an
invaluable nucleus of instruction.
The second course in the Red Cross curriculum is that known as
Elementary Hygiene and Home Care of the Sick. “The primary object of
this course,” according to the pamphlet, “is to teach women personal
and household hygiene in order that they may acquire habits of right
living which will aid in the prevention of sickness and the upbuilding
of a strong and vigorous people, and to give them simple instruction
in the care of the sick of their own homes which will fit them to
render intelligently such service as may be safely entrusted to them.”
Admirable three years ago in peace times, but not at all what we are
after now. Here again, so far as the purpose of the volunteer nurse is
concerned, the emphasis, as in First Aid, is on the wrong foot from the
start-off. There are entire chapters that might be omitted with profit,
such as the house, the care of the house and the laundry, the household
medicine closet, the hygiene of infancy and childhood. They should be
dropped, and a more thorough, intensive and leisurely training be given
in actual conditions prevailing in war hospitals of to-day.
In addition to these courses there are two others of minor importance.
One in Home Dietetics is entirely too elaborate for the simple
requirements of the nurse’s aid, who needs to know only the general
food values and the compounding of invalids’ drinks. Three or four
lessons in connection with the nursing course should amply cover this
field. The fourth course, the Surgical Dressings, is practical but
limited.
These are the popular courses given under the auspices of the Red Cross
to-day. Each, taken by itself, has grave defects; and even when all
four are combined there is such a ponderous dead weight of irrelevant
material, pre-war nursing and medical junk, that for practical purposes
it would seem better to throw them all out of the window and devise
another course, a course compounded of the valuable elements of all
four, but thorough, scientific, modern, and above all specifically
adapted to the actual conditions of the present fight.
It may be argued that the necessary eliminations will be made by each
individual. But to let the immature, embryo nurse decide what she will
and what she won’t eliminate is a dangerous business in practice. It
would be all right in peacetime, when she does not have to try it out
on the dog. But she might elect to eliminate the wrong detail, and
then find herself in the quandary of Miss Greenhorn, with a human
life hanging in the scales. For though in theory an auxiliary has no
authority and no responsibility, in actual practice that is far from
being the truth. There are hours, even days, in the absence of the
nurse, when the entire care of the ward falls on the shoulders of
the assistant, with the head nurse looking in at rare intervals. In
textbooks untrained persons are not supposed to be in positions of
responsibility. In this or that emergency “Call the doctor!” or “Call
the nurse!” they say. But suppose the doctor is up in the operating
room, blocks away. Suppose the nurse is off duty. Suppose also that
the nurses in the adjacent wards are down at lunch. For such precisely
was the stage setting of a mishap that occurred in the jaw ward of the
American Ambulance. The auxiliary was alone in the room. Suddenly,
without warning, one of the jaw cases began to hemorrhage from the
mouth and nostrils. Bright arterial blood spurted high as the ceiling
and stained adjoining beds. In less than ten minutes the man was dead.
What should the auxiliary have done? The event proved that in that
particular case not a whole regiment of doctors could have saved the
patient; but the responsibility was there. And it is for just such
tight corners of actuality that a volunteer nurse should be prepared.
And for such preparedness the teaching manuals and the lectures based
upon them should deal, not with the diffuse and general matters of
health, but exclusively and incisively with the realities of the
present crisis. In addition, it should be noted that the Red Cross, in
connection with its nursing course, “hopes that a limited number of
hours of practical experience will be provided by the base hospitals”;
but such practical experience is not deemed essential to a certificate.
Aside from these courses, there is a course given by the Young Women’s
Christian Association of New York City, which for practical purposes
covers the requirements of the present situation in an almost ideal
fashion. It is, in fact, the most admirable course of instruction on
the market--scientific, modern, intensive, complete. It is called the
Trained Attendant Course, and is given by Johns Hopkins nurses of the
highest standards of excellence, who are trained teachers as well. The
course covers eleven weeks of daily instruction and practice, with an
obligatory companion course in invalid cookery.
With the natural and technical qualifications of the volunteer nurse’s
aid thus disposed of, one may look about and query where suitable
material is to be found. The answer is at hand: In the colleges.
College women of the two upper classes form a compact body, already
listed, easy to mobilize. Young, supple, adaptable, mentally and
physically fit, with a background of discipline behind them, they are
excellent instruments for the purpose. Sharpen them to a point by an
adequate course of instruction, and three months should produce a corps
of workers sufficient for a year. These might then be registered and
called upon at need.
It is a feature of the present disaster that no one can gauge the
future. One man’s guess is as good as another’s. It is safe to say that
two years ago no one foresaw that to-day the United States would be in
the arena as the protagonist of democracy. Nor can anyone predict with
assurance what the next two years will hold: Whether we shall have a
big expeditionary force in France; whether by that time we may not be
fighting on our own soil; or whether the whole infernal business may
not burst like a bubble before the month is out. But this much seems
certain--American surgery and American hospitals are counted the best
in the world both in the preventive and in the follow-up field. And
since our entry into the war the governments of the United States,
Great Britain and France have had under consideration a proposition for
placing the entire French ambulance service, and later on the entire
British ambulance service, under the United States army medical corps.
So there you are, dear procession, right up against your job! I hope
you like its dimensions. As the darky says, “You done chawed off a
mouthful!” And that is all for this time, except--God bless you, girls!
Go to it! And remember, it’s our own men this time!
THE CHILDREN OF THE WAR ZONE
“Guard well the little ones to-day, Marthe. Don’t let them out of sight
or play too far from home. You know Emile hates to wear his gas mask.
He tears it off and hides it, the naughty rogue, soon as the back is
turned. There! Listen! It has commenced again--the bombardment!”
Marthe’s mother, a short, stocky French peasant with a heavy,
weather-roughened face and deep-blue eyes, held up her hand for
attention; and Marthe, a slim gypsy child of seven, dirty and unkempt,
with great gleaming black eyes and an uncombed mat of curly black
hair, cocked an indifferent ear to listen; in fact, she was somewhat
scornful of her mother’s continued terror of that distant muffled roar.
Heard thus, ten kilometers or more away, it was not unlike the shock
of a heavy surf breaking on a rocky coast. For three years now Marthe
had heard that sound. She had heard it near at hand when a big shell
had exploded bang! right on top of her own house and knocked all one
side out open to the sky--after which they had dragged the furniture
downstairs and lived in the cellar; she had heard it farther off when
bing! bang! the spire of the old mossy stone church across the way had
crashed down into the street and all of the saints save only Mother
Mary and her little Son had tumbled, face down, from their niches; she
had heard it the last thing at night when she went to sleep, and she
had risen to its sound in the morning.
And familiarity had bred contempt. It was part of the everyday tissue
of her life, common as the Boches’ avions, which went sailing high
overhead in the sky, tiny as minute dragon flies, and disappeared into
fleecy clouds. For Marthe and her mother lived in a little village in
the war zone, just in front of a line of concealed French batteries
which the enemy had long been striving to demolish.
And when the Boches became enraged at their failure in locating the
French batteries which roared nightly defiance they would deliberately
turn their guns upon the defenseless civilian villages in between,
abandoned by all save a few old people and poor families who had
nowhere else to go; and perhaps they would kill an old woman or mangle
a child playing in the deserted streets; after which sport, encouraged
and refreshed, they would go after the French batteries again. Jean, a
village boy, had explained all this to Marthe. His entire family had
been killed in an explosion, and since then he had turned into a wild,
moody character, following the army or roaming the countryside.
Marthe listened to the distant struggle of artillery and then she
shrugged her shoulders and said calmly: “It is not near. To-day it is
not as near as yesterday. I do not think they will bother us any more.
For yesterday Jean and I went through the village and counted, and
every single house had been hit. They have finished with us, _maman_!
If the guns do not come after us this afternoon may I take Emile and
gather flowers for the shrines?”
Her mother shook her head. The frugal breakfast of soup over she was
fastening on her apron of coarse ticking to go to work in her field. It
was for the sake of that precious plot of five hectares of wheat that
she had stayed on in the village, taking fearsome chances, after the
enemy had started to gas the entire district and the French orders of
evacuation had come.
“You would let little Emile be gassed,” she murmured reproachfully,
“while you run off to gather flowers!”
“_Zut!_ They have not gassed us for ten days. And it is cold down here,
_maman_. Even in the middle of the day it is cold--and dark. Emile
sneezes all the time. And he is getting as white as plaster.”
Her mother sighed. “Very well,” she consented grudgingly, “you may go.
But for an hour only. I do not like it, though. Tie Emile’s mask behind
his back where he cannot find it.”
“Yes, _maman_. But they are not going to gas us any more. Jean said so.”
“That Jean!” cried her mother angrily. “What does he know about it?
Even the good God Himself does not know any more what they will do!
And I will not have you playing with that scamp, that _jeune sauvage_.
He is not respectable. Chasing all over the country! Following the
soldiers! _Hélas!_ What is our poor country coming to? A fine crop of
young vagabonds we shall have after the war!”
She thrust into her pocket a hunk of dark sour bread and a fragment of
cheese, kissed Emile and Marthe, caught up from the mattress a pallid,
somber-eyed girl baby, and went out to the field.
Left to herself, Marthe took Emile, climbed the few steps leading up
from her cave home and sat watching the German aëroplanes. They passed,
singly or in groups, frequently. The thin drone of their motors coming
from the north could be heard long before even Marthe’s keen eyes could
pick out the black speck far up in the pale-blue ether. The thunder of
artillery had grown fainter and died away. Certainly Jean was right.
What was the fun of shooting at houses that were already knocked down?
[Illustration:
_Copyright, 1917, by The Curtis Publishing Company._
_Photograph passed by the Committee on Public Information. Reproduced
from The Saturday Evening Post of Philadelphia._
REFUGEES FROM THE GASSED DISTRICTS]
That afternoon, with Emile clinging to her fingers and every now and
then looking up with a delighted smile into her eyes, Marthe led the
way to the ruined church. From the leather belt which secured the
boy’s diminutive black cotton apron dangled the gas mask. According
to orders Marthe had tied it behind his back, and at every step it
bobbed up and down like an absurd little antiquated bustle. The sun
shone brilliantly. It was an ideal day in which to be out of the
cellar. Arrived at the church, with its small inclosed garden of silent
inhabitants, Marthe ensconced Emile, always obedient, smiling and
tender, upon a grave close under the wall of the old stone chapel, and
then rambled off to gather bouquets for the shrines.