During 1917, 6 American units arrived in France for duty with the British Expeditionary Force. They were fully staffed with Officers, Nursing Sisters, N.C.O.’s and men of the American Medical Services.
     The first to arrive on May 25th was the Lakeside Hospital (No.4 Base Hospital U.S.A.) which took over No.9 General Hospital at Rouen. The Nursing Staff consisted of 64, including the Matron, Miss G. E. Allison and 4 civilian secretaries. Shortly after, 5 more units arrived, and took over British Hospitals as follows:-

     On 30.5.17 Base Hospital No.5 (5th Harvard Unit) took over No.11 General Hospital at Camiers. The Nursing Staff consisted of 64, including the Matron Miss C. M. Hall and 4 civilian secretaries.
      On 31.5.17 Base Hospital No.2 (Presbyterian Unit) took over No.1 General Hospital at Etretat. The Nursing Staff consisted of 65, including the Matron, Mrs. J. B. Christie, and 6 civilian secretaries.
      On 10.6.17 Base Hospital No.10 (Philadelphia Unit) took over No.16 General Hospital at Le Treport. The Nursing Staff consisted of 64, including the Matron Miss M. A. Dunlop and 4 civilians, 1 dietician and 3 secretaries.
      On 10.6.17 Base Hospital No.21 (St. Louis Unit) took over No.12 General Hospital at Rouen. The Nursing Staff consisted of 67, including the Matron Miss Julia Stimson and 1 civilian dietician.
      On 11.6.17 Base Hospital No.12 (Chicago Unit) took over No.18 General Hospital at Etaples. The Nursing Staff consisted of 64, including the Matron, Miss D. Urch and 4 civilians (2 dieticians and 2 secretaries.)

      Arrangements were made for each of these units to be met and conducted to the Hospital they were taking over. The British Matron and a few of the Nursing Staff (Assistant Matron, Home Sister, Night Sister, etc.) remained for a certain length of time to assist the American Staff in becoming acquainted with the ways of British Hospitals. A certain number of V.A.D.’s also remained, until the American staffs were up to full strength. Every possible arrangement was made to make the whole personnel welcome and feel at home as soon as possible.

     All six American units, on arrival in France were below British War Establishment (75 Nurses for 1040 beds), having an average Nursing Staff of 64 only.
      This was immediately represented to the D.G.M.S., and it was asked if the British Nursing Staff should be posted to these units to supplement the American staff temporarily. This was concurred in (D.G. No.479/48 of 29.5.17), and at the same time a report was called for as to the additional requirements of each American unit. The statement of requirements submitted was as follows:

No.1 General Hospital  8
No.9 General Hospital  25
No.12 General Hospital  65
No.11 General Hospital  25
No.18 General Hospital  25
No.16 General Hospital  36

     Meanwhile V.A.D. members were posted to these units to keep them up to strength, and remained until U.S.A.N.C. reinforcements arrived from America in answer to these demands.

     On November 1st, 1917, the 5th Harvard Unit was transferred from No.11 General Hospital, a camp in Camiers, to No.13 General Hospital, in the Casino at Boulogne.

     In October 1917, Miss D. Urch Chief Nurse*, No.18 General Hospital had to be admitted to Hospital with a severe septic condition of her leg. She was off-duty 2 ½ months, and Miss Spencer was appointed to act during her absence. On Miss Urch’s return in December 1917, Miss Spencer was still left in charge by the C.O’s orders. Miss Urch wrote to me on the subject unofficially, and the matter was represented to the head of the American Red Cross, there being no head of the American Army Nursing Service at that time, and she was transferred to the American Expeditionary Force.
     On 10.4.18 Miss J. C. Stimson, Chief Nurse* No.12 General Hospital, proceeded to Paris to take the appointment of Chief Nurse of the American Red Cross, Miss M. Taylor, who till then had been her Assistant, was appointed Chief Nurse of No.12 General Hospital.
     In May 1918, Miss C. M. Hall, Chief Nurse* No.13 General Hospital, was recalled to take up the appointment of Chief Nurse, American Red Cross, London. Miss R. Butler, her assistant, replaced her as Chief Nurse at No.13 General Hospital. (Chief Nurse being the title given to the Matron).
     In September 1918, Miss G. A. Allinson, Chief Nurse No.9 General Hospital, was recalled by her civil hospital, Lakeside U.S.A., a large training centre, and her place at No.9 General Hospital was taken by Miss E. M. Folckemer.
*Chief Nurse being the title given to the Matron.

5. CASUAL GROUPS "A" and "B"
     In February 1918, a group of 99 Nurses of the U.S.A.N.C. were sent to France to be attached to British units for duty. This group, designated as "Casual Group A" arrived in France on 26.2.18, and the nurses were distributed to Hospitals in the Rouen Area.
     A second group of 87 Nurses "Casual Group B", arrived in France on 2.7.18, and were distributed in different areas, according to requirements. Major Veeder, U.S.A. No.12 General Hospital was officially responsible for all correspondence in connection with these "casual" nurses.
      Great difficulty was experienced in providing suitable accommodation for these ladies, who arrived without camp kits. Repeated demands and enquiries were made for them, but it was not till November 1918, that 175 kits arrived. On account of this lack of kits, it was found impossible to employ these ladies in front areas, and this caused some disappointment.
      On August 11th, Major Borden Veeder O.C. No.12 General Hospital, to whom all matters in connection with the movements etc. of the casual groups were referred, notified me that in accordance with instructions received from American Headquarters, a Mobile unit was to be formed from No.12 General Hospital staff, and this meant that 20 Nurses would be recalled at short notice for duty with the American Expeditionary Force. Owing to the rapid growth in numbers of the American Army, there were no Nurses available for replacement at present, and the instructions received from General Ireland were to the effect that these replacements should be obtained from the Casual groups serving in Imperial units.
     The question of replacing casualties in the Hospitals staffed by American personnel, by nurses of the casual groups, had already been referred to the War Office, and on about August 15th the required authority was received. (War Office Letter No.L.121/Drafts 1/666 of 9.8.18.) The casualties in the six established Units, caused by the formation of Mobile Units, and their departure to the American Expeditionary Force were thus automatically replaced.
      On September 13th, with the approval of General Ireland, a request was put forward, asking that the casualties caused in Imperial units, nursed by British personnel, by the withdrawal of 90 Nurses on this system should be replaced by new drafts of American Nurses. The reply received from the War Office dated October 5th, to this application, was to the effect that the vacancies would be filled as soon as possible, but that this would not be done at present, as the Hospitals of the American Expeditionary Force were suffering from shortage of nurses.
     On October 11th, 20, and on October 12th 28 U.S.A.N.C. Nurses reported for duty in part replacement to fill vacancies caused by the calling up of the Mobile Hospitals and other casualties.
      Later in the year, during December, before the return to America of the six original units, 60 of the Nurses attached to the mobile Units returned to their original units in the B.E.F. These were consequently much overstaffed, and were a total (the 6 units together) of 114 above strength. An urgent application was, therefore, put forward on December 30th, requesting that the American authorities be approached with a view to obtaining their consent for the reduction of these units to their normal strength, and the immediate transfer to the American Expeditionary Force of all surplus American Nurses.
The authority was obtained, and during January 1919, all the "Casual Nurses" remaining in British units were in accordance with instructions, transferred to the Mare-sur-Allies.
      The assistance given by these Nurses of the "Casual Groups" was much appreciated. At first there was a little discontent amongst some of them owing to their disappointment at not being posted to one of their own units to work together, but they soon settled down, and worked loyally in conjunction with the British Staff.

     The pay and allowances due to American Medical personnel lent to the Imperial Government were defined by War Office Letter 24/America/5(F.1) dated 16.7.17. In this letter it was stated that Army Funds would bear all charges except pay proper, clothing, and personal equipment. Thus the Nurses of the 6 units staffed by American personnel and the Nurses of the Casual groups "A" and "B" all received pay, uniform and equipment from the American authorities, but Field, Washing and Board Allowances from the British. In the case of the casual groups considerable difficulty was experienced over the question of camp kits, as already stated, but eventually these were supplied through the American Red Cross. When the 6 units were disbanded, instructions were issued that all mess books and mess balances were to be handed over to the A/Principal Matron of the area, to be passed to this office, in order that any accounts which it had not been possible to settle before the unit closed might be adjusted with the Command Paymaster.

     Members of the U.S.A.N.C. when sick were admitted to the Sick Sisters’ Hospitals and dealt with in the usual way, with the exception that Nurses found unfit for further service, if able to travel by passenger train, were sometimes sent, at the request of the American authorities, to American Headquarters, Paris, for disposal. In all cases, those unable to travel by passenger train were evacuated to the United Kingdom by Ambulance transport in the usual way.
     It is regretted that the following deaths occurred amongst members of the U.S.A.N.C. attached to British units:

R/Nurse F. A. Hinton No.18 General Hospital on 20.1.18 of cerebro-spinal meningitis.
R/Nurse H. Fairchild No.16 General Hospital on 18.1.18 of appendicitis.
R/Nurse A. Roberts No.1 General Hospital on 17.1.18 of septicaemia.
R/Nurse E. Groves No.9 General Hospital on 19.10.18 of influenza.
R/Nurse M. L. Pepoon No.18 General Hospital on 24.11.18 of septicaemia.

     In October 1918, during the worst epidemic of influenza, several ships arrived at Havre with a good many cases on board. Unfortunately, 2 nurses, reinforcements from these ships on their way to the American Expeditionary Force, died soon after admission to hospital. They were:

R/Nurse R. Rapp Base Hospital No.59 A.E.F. on 4.10.18 of pneumonia.
R/Nurse C. Trank Base Hospital No.58 A.E.F. on 8.10.18 of malignant measles and pneumonia.

     Three other nurses from the same ship were placed on the Seriously Ill List suffering from influenza, but fortunately they recovered.

     The system of leave followed by the American units on their arrival in France was that leave in France was granted locally by the C.O’s. As the difficulty of keeping accurate records was great, a circular was sent out on 12.11.17 by D.M.S., L of C, requesting that all leave applications might passed through the usual official channels to this Office. The American authorities objected, however, to this, and the D.G.M.S. ruled that they should continue to grant leave in France as before, but in accordance with American Headquarters instructions, but that this Office should be informed when such leaves were granted.
     With regard to leave to the United Kingdom, a circular was sent by A.G. in March 1918 (A.G./441/461/P.S. dated 3.3.18) ruling that applications for leave to the United Kingdom for American Nurses attached to the B.E.F. should be forwarded to G.O.C. L of C., and that this leave would come out of an allotment of 1 per day, which had been granted to American Headquarters for that purpose. This circular was amended by A.G. No.B.A. 8300/25 of 13.10.18, which stated that recommendations for American Nurses’ leave should be forwarded direct to Headquarters, American Mission G.H.Q. This system proved most unsatisfactory as the allotment was not nearly sufficient for the number of U.S.A.N.C. nurses then in the B.E.F. (696 in November 1918), and an urgent appeal that the matter might be reconsidered, was sent from this office in November. It was pointed out that the names had been sent in as many as 4 times to American Headquarters before approval was obtained, and a long waiting list was accumulating. It was requested that authority might be obtained for leave to be granted from this office to American Nurses service with the BEF (as to British and Dominion Sisters) from the allotment given to the Nursing Services, which would necessarily have to be increased. This authority was obtained (A.G. 2715/P.S. dated 22.11.18) and the daily leave allotment increased from 30 to 33. In this way it became possible to work off the leave due to American nurses, and to cope with further applications as they were received.
     Owing to transport difficulties, the American authorities encouraged the Nurses to take their leave in France rather than in the United Kingdom, and a number of the U.S.A.N.C. Nurses were able to take leave at the Convalescent Homes in the South of France. During the winter of 1917-1918, 40 thus spent periods of ordinary or sick leave in the South of France, and 43 during the winter 1918-1919. Besides this, many American Nurses spent their leave at H.R.H. Princess Victoria’s Club in Paris, and at the Convalescent Homes in the North of France.

     Surgical teams were supplied to front areas by all the 6 units nursed by American personnel, and in this way a number of the Nursing Staff did duty in front areas for short periods.
     On 17.6.17, Miss B. McDonald U.S.A.N.C. whilst doing team duty at 61 C.C.S. was wounded by a bomb and unfortunately lost her right eye. She was evacuated to the Base, and when sufficiently recovered, proceeded to Paris for treatment. Later she returned to duty with her unit, (No.1 General Hospital).
     Several members of the U.S.A.N.C. were serving at the front at the time of the March retreat, and took part in the general hurried evacuation. Reserve Nurse I. Stambaugh (No.16 General Hospital) attached to a surgical team at No.42 Stationary Hospital, Amiens, was unfortunately slightly wounded in the leg by a bit of shrapnel, during a bombing raid. She was evacuated to Abbeville where she soon recovered.

     All the 6 American units were chosen as Training centres for women anaesthetists, on account of the experience they had already had in America, where many nurses undergo a course of training in anaesthesia. At No.9 General Hospital, Reserve Nurse M. Roche was appointed instructor in anaesthetics, and did valuable work in this capacity.
In the first course of anaesthetics, only 3 members of the U.S.A.N.C. were trained – Reserve Nurses H. Q. McFarland, B. Connelly, and E. Colquhoun. These sisters were unable to proceed to a C.C.S. for the final month’s course owing to the Military situation in March, so they completed their course at No.9 General Hospital and were certified competent. Later, Sisters Colquhoun and McFarland both worked in front areas with surgical teams.
      In the second course, Reserve Nurses A. Carson and L. Kieninger received instruction at No.12 General Hospital, and were subsequently posted to 47 C.C.S. for the final month’s course. Here their training was considerably interrupted by the very active operations then in progress (July 1918), and they were granted an extra 10 days in which to complete their instruction before being certified competent..
     Besides these members who followed the recognised courses under the British authorities, the six American units continued to give their nurses instruction in the administration of anaesthetics, and they had been accustomed to do in their own training schools.

     The majority of the American units brought with them a Dietitian. The duties of these members consisted of:
(a) Supervision of general diets – preparation of food, manner in which served, quantities required for each ward, supervision of dining-hall for patients etc.
(b) Provision of special diets.

     The Dietitian visited the wards daily, and obtained from the Sister-in-Charge particulars of patients requiring special diets (nephritis, gastritis, operation cases etc.). She then prepared these special diets from supplies which were partly obtained from the Quartermaster’s Stores, and partly through the American Red Cross. In most units she worked in a special diet kitchen.
      This scheme proved most successful, being economical as well as raising the food value of the rations provided by the Army.
     The American Chief Nurses very kindly gave assistance in supplying particulars in regard to the work and training of Dietitians, and a British Sister spent some weeks in an American unit in order to gain some experience of their duties.

     The American ladies (classed as civilians) who did most valuable work in this capacity were:-

Miss F. Bettman No.16 General Hospital (Philadelphia Unit)
Miss R. Watkins No.12 General Hospital (St. Louis Unit)
Miss A. T. Upham No.9 General Hospital (Lakeside Unit)
Miss E. M. Hulzizer No.13 General Hospital (5th Harvard Unit)

     In the Birthday Honours List, June 1918, 3 members of the U.S.A.N.C. were awarded the R.R.C. 2nd Class.

Miss B. Macdonald (Presbyterian Unit)
Miss N. Eisenhard (Lakeside Unit
Miss N. J. Roche (Lakeside Unit)

     After the arrival of U.S.A. Troops in France, a slight difficulty arose owing to the decision of the U.S.A. Government that British decorations could only be conferred on American subjects in recognition of some special exhibition of valour in the Field. Owing to this, the recommendations put forward for the Gazette of January 1919, were withheld. However, late in December 1918, correspondence was received from the Military Secretary stating that ‘intimation has now been received that the restriction does not apply to American ladies engaged on nursing services’ and requesting that the names should be put forward. A list was then put forward, containing the following recommendations for members of the U.S.A.N.C. which have not yet been gazetted.

R.R.C. 12
A.R.R.C. 33
Mentions 54

     In addition, the names of 9 ladies, (civilians) who had done valuable work with these units as dietitians and secretaries, were forwarded for the Order of the British Empire (Class5).
     In May 1918, the Military Medal was awarded to two Nurses of the U.S.A.N.C.
Miss E. J. Parmalee (5th Harvard Unit) No.11 General Hospital
Miss B. Macdonald (Presbyterian Unit) No.1 General Hospital

     Miss Parmalee had been on night duty at No.11 General Hospital during a bombing raid in September 1917. The ward in which she was working was hit, an orderly beside her killed, and her wrist watch cut off at the strap. She continued working all night, and only reported next morning in the operating theatre to have a small fragment removed from her eyelid. There were about a dozen holes in her garments.
     Miss Macdonald as already stated, was wounded at No.61 C.C.S. in August 1917, whilst on team duty. She was on night duty in the operating theatre, and was wounded by an exploding bomb dropped by enemy aircraft. A fragment penetrated her right eyeball causing instant blindness. "At the time of the raid, before being wounded, she displayed conspicuous gallantry and continued at her duty in the operating theatre until she was wounded." This lady holds the R.R.C. 2nd Class, the Military Medal and the American Distinguished Service Order.

     No.1 General Hospital ceased to admit patients on 3.12.18, and on 2.1.19 the Matron (Mrs Christie) and the nursing staff proceeded to St. Nazaire to report to the American Base. The Hospital closed on 4.1.19.
     In January 1919, information was received that the remaining five units were about to close, and instructions were received from American Headquarters for the Nursing Staffs to proceed to Vannes Morbihan.
     No.9 General Hospital ceased to admit on 17.1.19 and the Nursing Staff proceeded to Vannes on 17.2.19, and 3 succeeding days.
     No.12 General Hospital ceased to admit on 17.1.19 and the Nursing Staff proceeded to Vannes between 27.1.19 and 7.2.19.
     No.13 General Hospital ceased to admit on 17.1.19 and the Nursing Staff proceeded to Vannes between 17.2.19 and 21.2.19.
     No.16 General Hospital ceased to admit on 17.1.19 and the Nursing Staff proceeded to Vannes between 17.2.19 and 21.2.19.
     No.18 General Hospital ceased to admit on 17.1.19 and 14 of the Nursing Staff proceeded to Coblenz on 7.2.19 and the remainder to Vannes on 16 and 17.2.19.

     In January 1918, two American ladies, Mrs. August Belmont and Mrs Harriman, interested in the American Red Cross, came to France and were conducted by Miss Wilton Smith RRC, QAIMNS round the various Bases, where they were given the opportunity of meeting the American Matrons and their Staffs.
      It was also in January 1918, that Miss Kathleen Burke, Hon. Delegate to the U.S.A. of the Scottish Women’s Hospitals, visited France, and was conducted round some of the Hospitals and C.C.S.’s. This lady has collected a large amount of money for the Scottish Women’s Hospitals by lecturing in the U.S.A.
      In July 1918, Miss Anna Maxwell, Director of the School of Nursing Presbyterian Hospital, New York, arrived in France on a visit to the British Front, with Miss Given Wilson, also of New York. They were conducted round Havre by the Matron-in-Chief, B.E.F., and were also given the opportunity of seeing the work of the Nurses in other Bases.
      In September 1918, arrangements were made for Miss J. C. Stimson, Chief Nurse, American Red Cross, to visit some of the C.C.S.’s in the British Army Zone, in order to gain more experience of British methods in nursing administration. She spent from the 14th to the 27th September in inspecting the various units with me, and also in talking with members of the U.S.A.N.C. serving with the British, and she afterwards wrote a most interesting report on her observations.
      In January 1919, Miss Jane Delano, Chairman of the Nursing Service, American Red Cross, (from Washington) arrived in Paris, and it was arranged that she should visit British units where American nurses were working. Unfortunately after she arrived in France, she became seriously ill, and died in Paris after a short illness.

     All questions relating to moves, sickness etc. of American Nurses attached to the B.E.F. were reported to Miss Bessie Bell, Chief Nurse, American Headquarters, Paris; and Miss Martha Russell, Chief Nurse of the American Red Cross, was also in constant communication with this Office. Later, Miss J. C. Stimson was appointed Director of American Nursing Service in France, and all official correspondence was addressed to her.

      All matters in connection with the administration of Nurses of the Casual Groups "A" and "B" were arranged with Major Veeder, U.S.A. Army St. Louis Unit.

      The D.G.M.S. arranged that I should meet General Ireland, Chief Surgeon to the American Expeditionary Force, and on September 3rd, I had the honour of lunching with him and Miss Stimson and Miss Ruth Morgan in Paris. Questions affecting the American Nurses serving with the British Expeditionary Force were discussed, the method of granting leave, of evacuation of sick sisters, and the distribution of reinforcements at the time; and the General expressed himself more than satisfied with the arrangements which had been made by the British for the benefit of the American Nursing Service.
     The interest shown by General Ireland and the sympathetic and ready assistance which has always been given both by Major Veeder and Miss Stimson in all matters in connection with American Nurses serving with the B.E.F., have been very highly valued, and have done much to make the administration work smoothly and happily.
     After the departure of the American Nurses from the B.E.F., a letter of appreciation and thanks for the assistance given to the Nurses of the U.S.A.N.C. who had been attached to the British, was received from General John J. Pershing Commander-in-Chief to the American Forces, a copy of which is attached. The letter was a source of much pleasure, and it was felt to be a great honour that the work accomplished in conjunction with the American Nurses should have been brought to the notice of their Commander-in-Chief.

E. M. McCarthy
British Troops in France and Flanders

American Expeditionary Force
Office of the Commander in Chief
April 25th 1919

My dear Matron

     Now that active operations are at an end and the American Nurses on duty with the British Expeditionary Forces are being returned to their homes, I desire to express my personal appreciation and thanks, and – in the name of American womanhood – that of the U.S. Army Nurse Corps to you for the kindly interest and solicitude you so uniformly displayed in their welfare and comfort while attached to your Forces.
     I am confident that your energetic efforts to promote their contentment were largely responsible for such measure of success as they have achieved in their mission of mercy among you.
     To me it was always a source of keen gratification to hear of the efficiency and high ideals with which they carried out their work under your supervision.
     I want you to know that they, fully as much as I, appreciate the efforts you have put forth in their behalf.
     I regret that an opportunity has not offered to thank you in person for your many acts of kindness to these American women committed to your administrative care and guidance while fulfilling their duties that brought them overseas.

Believe me, my dear Matron,
Very sincerely,

sgd.  John J. Pershing

To the Matron-in-Chief, Dame E. Maud McCarthy, G.B.E.
British Expeditionary Forces