Nursing during the First World War

Following the outbreak of the First World War, the British Red Cross formed the Joint War Committee with the Order of St John. They organised nursing staff in the UK and abroad to support the naval and military forces.

Nurses during the war

The nursing of sick and wounded soldiers during the war was carried out by a number of trained and voluntary nursing staff. Trained nurses were licensed professionals who had spent years training in a hospital with a recognised school. In every large hospital there was a matron, sisters, nurses and probationers. Voluntary nurses – better known as Voluntary Aid Detachments (VADs) – were people who willingly gave their time to care for wounded patients. VAD members were not entrusted with trained nurses’ work except in an emergency when there was no other option. At the start of the war, VADs were known to have ‘fluttered the dovecotes of professional nursing’ due to their enthusiastic desire to nurse wounded soldiers. 

Their initial purpose was to support military and naval medical services during times of war. However, it was soon realised that detachments could play an important role during the First World War in caring for the large number of wounded soldiers. 

Governance

When the Joint War Committee took control of the VADs and trained nurses, these two departments were placed under the direction of Dame Sarah Swift, who had been matron of St Guy’s Hospital. 

From the outset of the war until November 1918, trained nurses were sent abroad at short notice under the banner of the Red Cross. Over 2,000 women offered their services in 1914, many declining a salary, and from this list individuals were despatched to areas of hostility including France, Belgium, Serbia and Gallipoli. From 1915 onwards they were joined by partially trained women from the VADs who were posted to undertake less technical duties. 

There are reports of unemployed trained nurses complaining that the wounded abroad were suffering from the lack of professional assistance whilst many women were simply waiting at home, keen to offer their services. Yet the War Office and the Joint Committee considered that with an escalating number of wounded servicemen being sent home, fewer nurses were required abroad. This resulted in an increase in the ranks of paid nurses being employed in hospitals at home. 

Formation of the Voluntary Aid Detachments (VADs)

On 16 August 1909 a scheme began to organise voluntary aid in England and Wales. The Red Cross’ role was defined as assisting the government in wartime by helping the territorial medical service. A similar scheme for Scotland followed in December 1909. 

The Red Cross and The Order of St John of Jerusalem organised voluntary aid detachments (VADs), made up of men and women, in every county to carry out transport duties and staff rest stations and hospitals. By October 1910, 202 detachments had been registered with over 6,000 volunteers.

Membership of the detachments grew still further on the outbreak of the First World War when the Joint War Committee was formed. VADs had to be between 23 and 38 years old. Women under 23 were rarely registered as nurses with the Red Cross, but the rule was not enforced for women over 38 who had no diminished capacity.

Voluntary Aid Detachments (VADs)

From the beginning of the war until the armistice, trained nurses were always available to be sent out by the Red Cross. Partially trained VADs, working under the Joint Committee, carried out duties that were less technical, but no less important, than trained nurses. They organised and managed local auxiliary hospitals throughout Britain, caring for the large number of sick and wounded soldiers arriving from abroad. 

Training was at the heart of the VAD. During peacetime, the volunteers had practised their skills by helping in hospitals and dispensaries and running first aid posts at public events. When war broke out they were ready to use these skills. A few VADs had already gained experience of nursing during the Balkan wars. 

The number of volunteers increased dramatically in the early years of the First World War and by 1918 there were over 90,000 British Red Cross VADs. 

Number of detachments on Foreign and Home Service in 1915:

• 7th January 1915: 217 Detachments on Foreign Service, 118 Detachments on Home Service
• 30th June 1915: 371 Detachments on Foreign Service, 915 Detachments on Home Service

Home Service

When a new auxiliary hospital opened, Red Cross headquarters were usually asked to provide nursing staff. Nursing staff were generally local residents, but some detachments travelled or moved to work in auxiliary hospitals across the UK. 

The first matron interviewed commandants who visited headquarters to discuss the supply of nurses for their hospitals and sometimes to report the behaviour of nurses. She also interviewed all nurses who arrived at headquarters from a hospital. In cases where they were sick, nurses were sent to hospital, home to friends or to the Queen Alexandra’s fund for sick nurses, which offered hospitality to nurses in need of rest or a holiday.

By courtesy of the railway companies, nurses going on holiday or sick leave and travelling in uniform were allowed one railway voucher every six months. This entitled them to a return ticket for a single fare. 

The first matron kept a record of the nurses sent out, the hospitals to which they were sent and whether the Joint War Committee or the hospital authorities were responsible for their salary. Nurses who were sent back because they had not performed satisfactorily were allowed three trials. If they did not get on at any of the three hospitals to which they were sent, they were either dismissed or advised to resign. 

Special Service

During the war a new system of ‘Special Service’ supplied Red Cross nursing members to Royal Army Medical Corps (RAMC) military hospitals. Previously staffed exclusively by army nurses and orderlies from the RAMC, the scheme introduced VADs to the military hospitals. The VADs were posted by the Joint Committee of the British Red Cross Society and the Order of St John at Devonshire House. Special Service VADs were also sent to Red Cross hospitals, both in England and abroad. 

After the first few months, the general rule was that nurses were only sent abroad after they had served for at least two months under the Joint War Committee in an auxiliary hospital at home and had received a favourable report. The quality of care by the Red Cross meant that every nurse employed to carry out work in a hospital overseas came up to the standard of a sister, staff nurse or even a matron in an average London hospital.

Selecting candidates

Nurses who wanted to be appointed completed an application form and would then appear before the selection board. After an interview, references were followed up. When applying to full-time nursing positions there were a number of rules for potential candidates:

• They had to have a certificate with three years training in a general hospital of at least 50 beds and a recommendation from the matron.
• Nurses with only two years’ training could work as staff nurses and be paid £40 per year.
• Where health certificates and references were satisfactory, candidates were put on the lists for Home or Foreign Service. A good knowledge of French was desirable for Foreign Service. All nurses had to be equally willing to perform night or day duty at home or abroad.
• Candidates were required to sign an agreement to serve in a home hospital for a period of six months at a salary of one guinea per week. Insurance, outdoor uniform, travelling expenses from London, board and lodgings were provided. Laundry cost 2s. 6d. per week, and lodgings at a hostel were provided between engagements.
• Indoor uniforms had to be provided by the nurses.
• On and after 7 June 1917, third-class railway fares to London were paid to nurses on their engagement and their fare home was paid on completion of their contract.
• After one year’s service with the Joint War Committee, the rate of pay was automatically increased by 16s. 8d. per month. This took effect from 1 July 1917 and applied to all nurses on the pay roll on 30 June 1916.
• The annual holiday was two weeks per year, exclusive of days spent travelling and sick leave.

Training

If a woman had to travel to her training, her travelling expenses were 18s per week. If she stayed in nurses’ accommodation she was told to bring the following (all marked with her name):

• One canvas or calico bag – six feet four inches by three feet – to be filled with straw at camp
• One pillow or pillow bag
• Two blankets
• One Macintosh rug is useful
• One enamel washing basin and a piece of soap 
• Two towels; one should be large for bathing
• One duster
• One knife, fork and spoon
• One enamel cup and saucer
• Two enamel plates
• Two tea cloths
• One brush for boots (1d nail brush will do)
• A bicycle lamp or a candle lantern

Small luxuries like: 

• A deckchair
• Air cushion
• Spirit lamp 

Probationary nurses were trained in nursing and first aid by Red Cross-approved medical practitioners. Classes and examinations were arranged locally by divisions until July 1916 when they were held at the College of Ambulance, 3, Vere Street, under an agreement with the owner, Sir James Cantlie. The fee to be examined was 1s 6d for evening candidates and 2s for day candidates. Two Red Cross Officers supervised the examinations. 

Tredegar House, No. 99, Bow Road was the London hospital’s training home for probationers before they were admitted to the wards of the hospitals themselves. Members had to stay at Tredegar House for seven weeks where they received instruction, board and lodging and half-a-crown a week for washing, but no other pay. They were examined on the sixth week. After passing the exams and receiving first aid and home nursing certificates, they were sent for a month’s trial in a hospital. If they passed the trial they were accepted into a hospital for “three months’ hard work” before they were accepted full-time.

Uniform

In 1909 the British Red Cross became involved in the VAD scheme. It was decided that volunteers should wear an official uniform to reflect this role. In 1911 a uniform sub-committee recommended the adoption of a standard uniform ‘having regard to economy, utility and the practical duties the Red Cross detachment would be required to perform on mobilisation’. 

The men’s uniform consisted of a blue tunic, breeches, wrap around leggings called ‘putties’ and a peaked cap. A greatcoat with the Red Cross emblem sewn on the breast was worn outdoors. At the outbreak of the First World War this uniform was issued to Red Cross volunteers in standard British army khaki green. 

The Red Cross women’s VAD nursing members’ uniform was described as:

• A blue dress of specified material (red canton for commandants, blue lustre for members) to be in one length from throat to ankle, and sufficiently full to be worn, when necessary, over ordinary dress. To be buttoned in front under a two-inch box pleat, slightly gathered in front at shoulder and neck and finished with one-inch-wide neck-band on which to fasten white collar. The bottom of skirt to have a two-inch hem and two one-inch tucks. The sleeves (commandant) to be a small bishop shape with a three-inch wrist-band and fastening with two buttons. The sleeves (member) shall not come below the elbow. Ground clearance (pre-1917) four inches; (1917–1930) six inches.
• A starched “Sister Dora” cap worn across the head.
• 1911–1915: “Sister Dora” pattern in one piece, having a three-inch hem to turn over in front, which is square, the other part being rounded, having a narrow hem and a flat tape stitched round from hem, and 12 inches in from the edge, through which a narrow tape is run for drawing up.
• 1915–1930: an oblong of white cambric or linen, unstarched, in two sizes, 28 inches by 19 inches, or 27 inches by 19 inches, hemstitched all round two inches from edge, placed centrally on the head, the front edge to be worn straight cross the forehead and the two corners of front edge brought straight round the head fastening at the back with plain safety pin over the folds. The Red Cross emblem at centre front was introduced c1925
• Stiff, white, stand-up shaped, linen collar of the improved “Sister Victoria” pattern, fastened by one or two white studs or a soft turned-down collar of white linen that may be worn with the working dress and fastened with a safety pin brooch bearing the Society’s emblem, viz. a shield with a red cross on white ground.
• For the nurses, white linen oversleeves, 15 inches long, fastening at cuff with one button and with elastic at elbow. For the commandant, stiff white linen oversleeves, fastening with one white stud.
• A white apron with the Red Cross emblem displayed on the bib. Made of linen, with bib pleated in band and continuing in straps (without join), cut in three widths and pleated in band at sides. On both sides is a large square pocket stitched on, the front part of pocket having a narrow strip continuing upward and stitched in the two-inch waist-band, fastening at back with linen button, the straps crossing over and also buttoning about five inches from either side of centre at the back. The Red Cross of Turkey twill, 4 inches in height and length, and of the authorised Geneva pattern, with each limb 1 inches square to be sewn on centre of bib, the bottom of apron being finished with a two-inch hem. Length to be the same as overall.
• A starched white linen belt, two and a half inches wide, starched, to be worn over apron.
• Ordinary black boots with black stockings.

Estimates for uniform material were requested from well-known firms and one was selected based on quality and prices. A permit was obtained from the War Office for the cloth to be purchased and an application had to be made to the controller of woollen and textile fabrics at Bradford. They allowed the selected firm a certain amount of cloth per week for making nurses’ uniform coats. When coats and hats were received from Home or Foreign Service they were inspected and if they were considered to be satisfactory, they would be cleaned and relined for re-use which saved hundreds of pounds.

Competitions

Competitions were regularly held during the war to test the VADs’ knowledge of nursing standards. The competitions were used to highlight the expertise of VADs and encourage funding from local residents. The competitions included tests in first aid and home nursing for women and first aid in the field and stretcher drills for men. A number of questions were also asked in order to test VADs. At Huntingdonshire in 1914 the following questions were asked:

• What are bedsores? What precautions would you take to prevent their occurrence, and if they occur, how would you treat them?
• How would you prepare a patient and a room for a major operation?
• Write a brief history of a case of enteric fever during the third week, giving a temperature chart
• How would you prepare a linseed meal poultice, an ice poultice, and a mustard poultice? What are the indications for their use?
• What do you mean by Crisis and Lysis? In what illnesses do they respectively occur?
• How do you make peptonised beef-tea?

War-service bars

Nurses were rewarded for their efforts with bars or stripes to display on their uniform.

• One year’s war service was signified with a bar, two and a half inches long, of red quarter-inch universal lace, to be worn horizontally on left forearm of jacket only, three inches from bottom of cuff.
• Two or three years’ war service – for each successive year’s war service a further bar may be worn a quarter of an inch below the last one.
• Four years’ war service – a bar, four inches long, of blue and white half-inch herring-bone pattern braid, shall be worn horizontally on left forearm of jacket, three inches from bottom of cuff, and shall replace the war service bars previously awarded.
• VAD military nursing member – members of detachments in possession of scarlet efficiency stripes awarded for service in a military hospital, or blue efficiency stripes awarded for service in a naval hospital, may wear the same on the right sleeve below the shoulder on the indoor uniform. Nursing members appointed to the grade of assistant nurse in a military hospital or naval hospital will wear the letters “A.N.” on the apron on right side of their outdoor uniform coats.
• Assistant nurse – members of detachments who have qualified under the Society’s rules for the position of assistant nurse are permitted to wear a blue stripe on the right sleeve below the shoulder in addition to the war service stripes worn on the left sleeve on indoor and outdoor uniform. The letter “A” in gilding metal shall be worn on the bib of the apron, a quarter of an inch above the Red Cross in the centre

Sources

• Reports of the Joint War Committee and the Joint War Finance Committee of the British Red Cross Society and the Order of St John of Jerusalem in England on Voluntary Aid rendered to the Sick and Wounded at Home and Abroad and to British Prisoners of War, 1914-1919. Published HMSO, 1921.
• The Red Cross: The Official Journal of the British Red Cross Society, No. 1, Volume 1, 15 April 1914
• The Red Cross: The Official Journal of the British Red Cross Society, Vol.2 No.6
• The Red Cross: The Official Journal of the British Red Cross Society, Vol. 2 No. 10
• Oliver, Beryl (1966) The British Red Cross in Action; London; Faber and Faber Limited.