THE NURSING BOARD
QUEEN ALEXANDRA’S IMPERIAL MILITARY NURSING SERVICE
QUEEN ALEXANDRA’S IMPERIAL MILITARY NURSING SERVICE
AN ADDRESS BY THE CHAIRMAN, SURGEON-GENERAL W. TAYLOR, C.B., DIRECTOR-GENERAL, A.M.S., ON THE HISTORY OF THE ARMY NURSING SERVICE, DELIVERED AT THE FIRST MEETING, AND PUBLISHED AT THE REQUEST OF THE NURSING BOARD.
CROWN COPYRIGHT: THE NATIONAL ARCHIVES WO243/20 [April 1902]
Perhaps it will be useful if I give a brief sketch of the gradual growth of the Army Nursing Service.
To Miss Florence Nightingale must, I think, be given the honour of being the pioneer of the employment of female nurses in military hospitals.
It was due to her personal devotion, and to the self-denying service of herself and of the staff of nurses, at the seat of the war in the Crimea, 1854-56, that public opinion was attracted to the valuable services rendered by female nurses to our sick and wounded soldiers.
At the close of the war a Royal Commission was appointed to enquire into the regulations affecting the sanitary conditions of the military forces, and the medical treatment of the sick and wounded of the Army.
On the 1st October, 1858, a Royal Warrant was published, establishing rules for the future admissions, promotion, and retirement of Medical Officers of the Army, but no provision appears to have been made for the establishment of a staff of female nurses.
At that time the regimental hospital system was in full operation, the sick being attended to by regimental hospital orderlies, or men of the Medical Staff Corps, afterwards designated the Army Hospital Corps. These men were at that time generally retired soldiers or pensioners.
Not long after the Crimean war nurses were employed at the General Hospital at Fort Pitt, Chatham; and on the transfer of the Army Medical School to Netley the nursing establishment of the hospital at Fort Pitt went with the school and hospital, Lady Jane Shaw Stewart being then the Matron or Lady Superintendent.
On the 3rd February, 1866, a Royal Warrant consolidated several Warrants then in force was issued, in which provision was made for the appointment of female nurses to any military general hospital.
It appears that a small number of nurses were subsequently employed at Chatham, Netley, and Woolwich. Mrs. Deeble was appointed Lady Superintendent at the Royal Victoria Hospital, Netley, on 1st November, 1869, in succession to Lady Jane Shaw Stewart, and Miss Caulfeild was appointed Lady Superintendent at the Herbert Hospital, Woolwich, on 1st September, 1877, she having been already employed as nurse since 1st July, 1874.
Mrs. Deeble retired on 2nd November, 1889, on a pension of £240 a year. She was succeeded at Netley by Miss Norman, who had already served as nurse since 20th September, 1882.
Miss Caulfeild retired on 1st September, 1894, on a pension of £80 a year, and the post of Lady Superintendent at Woolwich was abolished.
During the wars in South Africa and Egypt since 1878, the staff of female nurses has, from time to time, been temporarily augmented for service in those countries.
Previous to the present war in South Africa, the supply of temporary nurses for service with the various field forces in that country and in Egypt was secured partly by Mrs. Deeble specially engaging the services of specially trained nurses, by Miss Nightingale nominating several, and several being appointed under the auspices of the National Aid Society.
On the 21st February, 1880, the Council of the National Society for Aid to the Sick and Wounded in War addressed the Secretary of State for War, and stated that they "having in view the value of the service rendered during the recent war in South Africa by the female nurses trained at Netley, and sent out by the Government, are desirous to train a staff of nurses for work in military hospitals." These nurses were during the whole period of their connection with military hospitals to be paid and subsisted by the Society, though subject to the orders of the Director-General and the local medical authorities. The term of their services was limited to four years, one of which was to be spent in the process of training, and the other three in active duty in the hospitals. When this term should be completed they would make way for new comers, so that the reserve brought into being by a voluntary agency might rapidly increase.
It will be seen that the original scheme of the Society was to obtain for some of its nurses the advantages of a course of training in military hospitals, in order that a species of nursing “reserve” might be called into existence, which should prove an auxiliary to the regular nursing staff in the time of war. Owing , however, to the difficulty of finding quarters in hospitals for these nurse of the Society the scheme was much retarded in its progress; in fact, no real “reserve” was formed.
In 1882, a staff of nurses was appointed to the Guards Hospital in London; and subsequently Egypt and Aldershot were added to the stations where female nurses were attached to military hospitals.
It was not till 1881 that it can be said, the inauguration of the “Army Nursing Service” commenced, and it was not until 1884 that a code of Regulations for the “Female Nursing Service,” was published. In Army Order 113, March, 1888, it was notified that Regulations for the “Army Nursing Service” would be issued to all concerned.
As a result of Lord Morley’s Committee, the Proceedings of which were published in 1883, it was decided that a staff of female nurses should be appointed to every military hospital of 100 beds or over. This led to a large increase of the female nursing staff, in order to meet the requirements of military hospitals at Aldershot, Gosport, Portsmouth, Devonport, Dover, Shorncliffe, Canterbury, Dublin, Curragh, Gibralter and Malta.
London [Guards Hospital], Chatham, Woolwich, and Netley were already provided.
As you are all aware, by Her Most Gracious Majesty’s decision, the “Army Nursing Service” is now designated “Queen Alexandra’s Imperial Military Nursing Service.” Since the year 1897 there has been associated with it the “Army Nursing Service Reserve,” the organization and success of which is almost entirely due to the indefatigable labours and untiring energy of Her Royal Highness the Princess Christian.
Now, ladies and gentlemen, the foregoing epitomises the history of the nursing service of the Army, from its commencement up to our own day. It will be well to glance at the position and responsibilities of this service as it now exists, and it will be well to bear in mind that in the extension of the nursing service of the Army throughout the world there have hitherto been two centres of development, viz., England, and since 1886, India. Moreover, we have to recollect that in the organization of any service of this description the circumstances of war are not to be considered apart from the conditions of peace.
The Army Nursing Service consists of a Lady Superintendent, 19 Superintendents, and 68 Sisters. Nurses in the civil sense have not existed. The nurses proper have been specially trained members of the Medical Corps, who have been divided into three classes, first, second and third, second and third classes corresponding to the probationers in civil life. This condition has been devised to comply with the conditions of uncivilized warfare, in which we are so constantly engaged.
The Lady Superintendent was located at Netley. She was required to undertake the military training of the Sisters newly appointed, to supervise the nursing arrangements in the Royal Victoria Hospital, and to inspect (when required) the nursing arrangements in other hospitals.
Superintendents generally are held responsible for the conduct and discipline of their Sisters, the latter being directly responsible to the Superintendents; they in their turn receiving orders relative to nursing arrangements from the Medical Officers in charge of the cases. The allotment of the specific duties of the Sisters, and their appointments to wards is in the hands of these Superintendents, who, however, also take wards. The Sisters are responsible for the personal cleanliness of the patients, the administering of foods and medicines. They take part in the training of the privates of the corps in nursing duties.
It may not be inappropriate to consider what are the defects which we believe exist in the apportionment of the duties of the Superintendents and Sisters, and of the Army nursing arrangements generally. We may state, in a general way, that the defects we discover are to be traced to a too great attention to the requirements of war rather than to the necessities of peace, or, in other words, that the power and responsibilities of the male nursing staff in peace have been unnecessarily dominant, because of their complete predominance in war, especially uncivilized war. This arose no doubt from the fact that Great Britain has been constantly engaged in this form of warfare. It is, of course, quite plain that in such wars as these the nursing at the front and that on the lines of communication must be performed by male nurses.
It has now been recognized that a further extension of the female nursing system in peace is necessary, and that the utility of female nurses in war is capable of an extension hitherto not contemplated. Granting these principles, we are in a position to appraise our own defects. In general terms we may express them as –
1. The power and responsibilities of our female nurses are too restricted
2. A large part of the hospital administration for which women are particularly adapted has not been vested in the Superintendent.
3. The authority of the Sister in her ward has been too limited.
4. The responsibility for the training of orderlies in nursing has never had full recognition.
We believe that an extension of powers of the Matron, of the Sisters, and of the Nurses in Military hospitals will be of enormous advantage to the Officer in charge of the hospital, through him to the General Officer Commanding, and ultimately to the Army at large.