Ji ■ . LIBRARY ■i m: ■■■■ if. BOOK0000017974 NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland JOINT MEDICAL LIBRARY OFFICES OF THE SURGEONS GENERAL MTWDRAWN Pi FORRESTAL BUILDING OTSG, e°"" 367 mi'__.—..«ik»teianj*Mfe**iarib«MtM«iaM i < 11 11 11». .1 i miftli m r froo^rfcUv /tattle /Jarouriofii itfaifi- HISTORICAL DIVISION OFFICE OF THE SURGEON GENERAL, U.S. ARMY, S9-2fc ;tf* 30INT MEDICAL LIBRARY JiA Army/U.s, Air Eorce <@> 112 TEACHERS C 0 L , E G E COLUMBIA UNIVERSaSW /j NEWT YORK Department of Nursing and Health V •1> L5y dear General Ireland: In compliance "with the request conveyed through the circular letter relating to the Helical History of the War, I have prepared and am forwarding ;he history of the Array School of Nursing. I regret exceeiingly that the completion of the work should have been so delayed. My sincere appreciation of tl 3 privilege of preparing a history, makes me the more profoundly conscious of this crude, inadequate, and yet I fear, prolix presentation of the subject. To a limited extent \ have ventured to use the brief presentation, which I prepared fo] the annual report, but my belief that the experiment jusJ:fied itself seems to de- mand a fairly detailed account of \he various stages of its achievement, if it is to be of valve, should the future bring a similar emergency. I most earnestly hope that • ae history of the school, or some part of it, will find a j lace in the history of the war. I have the honor to be, Very sine i sly yours, ^ /«' / Annie W. Goodrich, r> Major General Merritte W. Irelaiu, -3 Washington, D. C. £ THE HISTORY 0? TOR Amflf SCHOOL OF NURSIHG ^^ I- '!■ " Introduction* The recommendation of surgeon General William S. GorgasjoT the establishment of an army school of nursing as the method of providing for the rapid expansion of skilled nursing service that the continuation of the war would inevitably demand was approved by Secretary of War Baker, Hay 25, 1918. To understand the plan and purpose of the school and the justifioation^MSits creation in the midat of the great war, compel *bv' ^backward glance at the nursing care of the 1 v- .n*i-•' -~*»*s*£fr*&amiQwa wars, in this oountry at leas? . w.w u**a ~i-tete^WSJwhich led to the step. f -f*"'*****0 *&* The history o\w'v.;..ll7-.-w^JiCL^^tt^7following the entrance of the United States into the conflict, present- ing as it does the immediate demand for a nursing person- nel in definite ratio of 10,000 nurses to 1,000,000 men: ■Nae rapid enrollment through the Red Cross Reserve: the numerical strength attained when hostilities unexpectedly ceased, gives convincing evidence of the place that the nursing profession has attained in the community during its less than fifty years of existence. Hot only for the first time in the history of wars in this country, was it possible to provide care for the siok and wounded through a professionally qualified nursing personnel, but for the first time also was there a demand for this personnel, in numbers in any measure approximating the personnel that would be required by a similar emergency in the civil com- munity. The Medical and Surgical history of the Civil War presents some 2,000 women as rendering assistance, oonoerning whom it is reported as follows: "Female nurses were borne on the rolls of many of the hospitals. According to the testimony of all the medical officers who have referred to this point their bejt service was rendered in connection with ex- tra diets, the linen room and laundry. Male help was preferred in the v/ards save in special cases of prostration and suffering where particular care was needful in the ad- ministration of dietetic or remedial agents«w (1) in......■»'" (1) Page 3 Medical and. Surgical History of the Rebellion p.957-960r. With but a single exception ;u- , other reference, scant at •best, as is maae to the nursing care, evidences only too clearly the dependence on enlisted men whose preparation was mainly through their own sickness experience, their fit- ness through their unfitness for other and much preferred servioes. (1) But if there was a failure to appreciate the olaoe of women in the wards of the military hospitals of the Civil War, attributable mainly, perhaps, to the complete ahsence of opportunities for preparation for the nursing field, no clearer or more comprehensive portrayal of the function and result of skilled nursing could be found, than the follow- ing almost prophetic presentation by the Medical Historian. Says this writer treating of the continued fevers: » "In fact, the closest study of the re- cord fails to show that the disease was in- fluenced bei^^c^ially by any system of medi- cation, or^ev^n jftct*individual remedies had a notable e"i-'«it on the result in individual cases. • . «* ■; r~:izt noV bCs^yfsfci, however, that profesi-unaJ care was.valueJpss i» the treatment 0: i»he continued/ fevers. Regula* tion of the!v^4-.t *?*£]^ J^te as wjll as |n the early stages of the disease"""n6*^^ubt saved many lives by lessening intestinal irrita- tion and promoting the cicatrization of ul* cerated patches. The administration of suitable nourishment au regular times saved the strength of the patient. Watchful care and control during the period of de- lirium not only preserved the patient from direct and immediate actual death, but pre- vented that involuntary violence of action and those unconscious exposures which would have tended to death by subsequent ex- haustion or local congestive processes. The removal of retained urine by catheteri- zation sometimes quieted delirium, relieved hypo-gastrio pain and prevented local injury. Careful nursing economized the patientfs strength by affording assistance in all his desired and permitted movements. The use of the bed peu certainly decreased the fa~ tality of continued fever. Exhaustion was "kepid in cases associated with active diarrhoeaj when, from want of facilities the patient had to leave his bed on every alvine movement* Moreover, sudden death was rot uncommon euaong asthenic patients who iuade th© effort to attend their neeea- fl) Annual Report rurg* '^n* U^.Arwy, 18,96-98, p.121 k; ■ .;.,-; .,g also ;■■ •■..■■ '• .. ■cUicr c: .'lug the night v,-.. . ■ ..k->-jl•:>:>> ■ .- .juioatica aught have re- sult...- L.to«n American women may wall feel proud of the record made by these nursas in 1898-99, for ©'very medical officer with whom they served has testified to their intelligence and skill, their earnestness, devotion and self sacrifice" ( gj Chile -i k- =iue ma- ^o taken with the historical ac* ouraoy of the statement relating to the source mainly res- ponsible for the f.o'-olopm^nt of. the trained mxra® in this or other countries it is true that in.these few years the profession of muring had sprung into existence. Upon the entrance of 1|his country into the world war in ordor to meet the demand that the new apprecia- tion of-trained'nursing ^rvice imposed, it became at once evident that a prcrrm must be evolved through which the nursir.g rescues of the country should be in- ventoried, distributed end supplemented, in order to most accurately and advantageously meet the growing needs of the TvT ^LledTanTsurg-History of the War of the Rebellion, Part Med.Vol.-T p. 5555* (2) Annual Re^rt. Surgeon (W'-ral U *S* Army, 1899-1900 tp.25. -, 5 . Early *,n the winter of 1917-18 the rapia transport- at on of men overseas, the heavy drafts entering c-anps in thxs country, with eons^qu^nt outbreaks of epidemics, an'i enrollment of nurses that di& not keep pace with t: 9 in- crease of the army, a growing publie uneasiness as to the nursing cere of the men in the camp hospitals, led to the following recommendations by the Committee on Hursing to the General Board of tke Council1 °That houses be rented and tramsporta- tion to the nearest town be provided when nec- essary to acoommodate the nurses in lieu of . . available tents, barracks, or other temoorary shelter; * That a regular quota of not less than one nurse to six acutely ill men bo provided; and That a reserve of not less than ZB over the prescribed quota be stationed at each hospital to meet emerge noies and Re cure spe- cial training in the military establishment. * ihu oommittsu further recoaanends that a tour of inspection be made by a qualified nurse to make observations regarding the nurs- ing service in the military ^nd naval hospit- als in the United States. . « (1) These recommendations approved by the General Medi- cal Board and coincident with a recommendation of a mem- ber of the Hospital Division of the Medical Department that a staff of women inspectors be developed, led to th^> p.p- pointment, by the Surgeon General, of a oluaf a&& ps^istont inspecting nurse in February 1918. On a?eaehln# Washington these inspectors found that the threatened shortage of graduate nurses had led to the favorahle consideration of a plan of supplementing the graduate force, similar to the English supplement, known as tad "VtA^'s", by ©nrolling through the Red Cross young women to be designated as nurses1 aides, at a salary cf $30.00 a month. Believing that this stop would inevitably defloct student3 from the nursing field, handicappir--; the hospital* still further and leaving the oountry at the end of the rar to faoe the heavy demands of reconstruction vith a reduced rather than an in- creased force of trained mirr^s (a professional group already inadequate to meet the rapidly growing needs of the country even in p^aco times], a stay of proceedings was requested until an inspection and report oould be made. This report of a joint inspwu-i;ign of five of the >.j\st capitals presented a aonp^ri^^;: of $ha. military hos- m . Report of the Chairman of the Committee on Medicine and Sanitation of the Advlr^ry nomihmion of the Council of National Defense, April 1, 1918f j». 28. -6» pitals and the civilian hospitals maintaining the best standards, far from favorable to the ^former. A few inoidonts selected from the many that offered, were oited in evidence of this faot. Patients, it was stated, were permitted to go to the lavatories and were giv- en shower and tub bathe that would not with similar sick- nesses be permitted out of bed in oivil hospitals; one pa- tient fainting on returning from the lavatory one morning. i Again referring to the inadequate service of food in the wards; "What occurs as the result may be illus- trated by the following inoidont: a bowl of broth with a drinking tube was placed at the bedside of a pneumonia patient^ who has just had an intravenous injection• The broth was rapidly cooling, the patient quite un- able to help himself, and there was no one to assist him." It was felt that these eenjlitlons might in no small measure account for oollapse, QQiaplioations, and reinfec- tions - conclusions not the lees interesting whan read in the light of the deductions of the $ivil War historian pre- viously quoted, and that the failure to control them relat- ed directly to inadequate supervision, the authority vest- ed in the head nurse and the ratio of nurses to patients. Referring to the general administration the report states as follows: wIn the civil hospitals the control of all wards is vested in the superintendent of nurses who acts through the head nurse in each ward. She is responsible to the super- intendent of the hospital and in the medical staff for all matters relating to the nursing care of the patients ant is charged with the oversight and control of. the orderlies and maids. The system in the isase hospitals visited differs from this in th4t eaph ward' is under the jurisdiction of a w&tfd eurgeon working through a head nurse and. a ward master* 1 ' Che personnel of thft resident medical staff of these hospitals numbers nearly a hundred men from various medical sehpois and hospitals. The nursing matt represented, in no Base hospital visit* d, less that 40 training schools. The wird wasters have many of them never had anj previous hospital experience ♦ This leadt to a variety of -7- standards and methods. The failure to place the entire responsibility of the nursing care of the patients and the order and cleanliness of the ward upon the head nurse results in a constant shifting of responsibility, duplica- tion of work and general inefficiency. In many wards inspected in the early morning hours when the orderlies would ordinarily be attending to their cleaning duties, the ward master who belongs to this group, and if not supposed to do this work should have at least been overseeing it, was entering data in his record book. The service rendered by the ward masters and hospital corps men,constant- ly changing in numbers and personnel, is but little better and in some instances inferior to the ordinary orderly services in civil hos- pitals. A large part of this work is rele- gated to the patients. And again referring to the ratio of nurses to patients: "On the day of inspection the number of patients was 884, the total number of nurses 95, making a ratio of 1 nurse to 9 patients. This ratio of nurses provides good nursing • care for the acutely sick patients. It still leaves, however, nine wards without any nurse in the day time, and only seven that have the full time of a nurse at night. The provision that all acute medical and surgical cases shall be transferred to cer- tain wards, brings to these cases the best nursing care with the smallest number of nurses. We are, nevertheless, of the opinion that com- • plications, relapses and reinfections would be lessened and better methods and order be maintained by a ratio of nurses that more near- ly approaches the ratio found in civil hospit- als of Grades A and B. This number would, however, be wasted until the present oonfu- sion as to the duties and power of a head nurse and her assistants is definitely de- termined. Whether through observation,di- rect questions or casual conversation, the reasons are sought for the prevailing lack of standardization of ward procedures and the failure to maintain methods generally accept- ed as good, the almost invariable conclusion is that it is due to the constant misunder- standing concerning the administrative powers of the nursing staff. It was stated by the Chief Nurse that she transferred a nurse from a surgical ward be- cause as she was not permitted by the ward surgeon to assist at dressings and her work was almost exclusively limited to the making of beds, it did not seem advisable to permit her to remain. Let a ward be standardized and the respon- sibility of the head nurse established, a new ward surgeon with different methods and another attitude toward the ward master and hospital corps men, also possibly new, is put in charge, and the established system is immediately broken down. This leaas to apathy and indifferenoe on the part of even capable and well trained nurses. In order to proceed with the least pos- sible friction, they wash their hands of respon- sibility which the welfare of the patients de- mands should be theirs. (1) The report summarized as follows: "The entire staffing of a hospital with graduate nurses has not been found to complete- ly relieve the need of a supervisory staff un- der the most favorable conditions. In these hospitals such a staff is exceedingly essen- tial and would rapidly, if interpreting their function intelligently, overcome much of the shortage of equipment, and prevent the break- ing down of established methods and regula- tions. Uurses from many schools dropped in- to a system with which they are wholly unfami- liar and with no time to compare their own with other wards, are found accepting conditions that might be easily corrected. In civil hospitals . . . mo3t careful con- sideration is given to the selection of the head of the nursing staff, and women appointed of recognized professional preparation and ex- perience and established ability. We cannot speak in too high terms of the devoted and untiring service amounting in some instances to heroism, of the chief nurses and their staff. nevertheless we believe that many of the conditions that have existed now for months could have been limited to weeks if not days if women of the type referred to had been (1) Exhibit 1. Inspection of Base Hospital, Camp Meade, p.l -9- selected, especially had they been loiorn in the cities which are within a few miles from each one of these camps and could there- fore have availed themselves of local re- sources and interest. » It will be noted that the base hospit- als have not been favorably compared with the best oivil hospitals . . . The contrast pre- sented is a sharp one. In the civil hospitals • • • the bedside care of the patient is giv- en by a carefully selected group of women stu- dents, under the constant supervision of high- ly qualified instructors and supervisors. Their instruction proceeds in orderly stages from the simpler to the more difficult and im- portant procedures. Every effort is made to stimulate in the student an interest in the patient* .in the varying phases of the disease, in the result of the treatment, in the improv- ing of her own technique, and in increasing her powers of observation ana her body of knowledge, all of which bring to the patient the most com- plete and intelligent nursing care. In the base hospitals, the nurses, except in rare instances too few to give the bodside care demanded of the student nurse* must relegate the tasks, without time to instruct them, to the continually changing hospital corps men, who at best do not approach the task with any de- sire to excel in the field. The patient strug- gles to help himself or to 'help others in order to relieve both the nurse and the hospital oorpsman. The awakened interest in nursing through the war and the desire to render such care which is aroused in the minds of young women of education, should not be lost, but should be directed into channels through which they can render the widest and most enduring services. While i?ne military hospitals could not provide a oomplete professional preparation for nurses, muoh valuable experience could be obtained and the remainder could be easily provided through oivil hospitals. These hospitals offer no problems from the standpoint of maintaining a school that are not constantly met in civil hos- pitals. They offer certain advantages that will enable the bringing into existenoe of the most model schools of nursing that have ever been known. At this time the appeal of this service to -the young women of the country would be great. -10- It is therefore recommended that an Army Sohool of Nursing be created, and that we be permitted to present a detailed plan relating to the same. > That the Committee of Nursing of the General Medioal Board of the National Council of Defense be asked to act as an Advisory Coun- oil in formulating a plan whereby euoh a sohool might be developed in the most effi- cient way." (1) This report led to the calling of a conference to consider the recommendation at which the following officers were present: Colonel W.H.Moncrieff; Colonel P.M.Ashbum; Colonel W.T.Longcope; Colonel Charles H.Mayo; Colonel Winford E.Smith, with Colonel Robert E.Noble. Chief of the Hospital Division, presiding. There were also present^ Jane Delano, Chairman American Red Cross Nursing Service; Dora Thompson, Super- intendent of the Army Nurse Cor];s; s. Lillian Clayton, President of the National Leaguo of Nursing Education; Elizabeth C. Burgess, and Annie Wt Goodrich, Inspecting Nurses. As a result of this conference, the chairman of the Red Cross Nursing Service, the superintendent of the Army Nursing Corps, and the chief inspecting nurse were appoint- ed a committee to prepare a plan ::or the suggested school. The committee after consultation with the nurse mem- bers of the committee on Nursing of the Council of National Defense, reported as follows: 1. The committee appointed by your or- der has interpreted its purpose to be: The creation of a plan whereby through an Army Sohool of Nursing the most complete nursing care may be provided for the sick and wounded soldiers at home and abroad, for the period of the war and for as Img thereafter as the Gov- ernment may decree. Also nurses for such other health fields as ma;1 be dc 'eloped by the medi- cal department. (1) liKhibit 2. Summary of findings, and Recommendations re- lating thereto, based :i the inspection of the Base Hos- pitals of CampjrTaylor, Jhexpnan, Devens, Upton and Dix. pp.2,4,6,12,13,14- -11- The plan to provide for an easy, con- stant and almost unlimited expansion of training fields and consequent increase in student and graduate nurses, in order that the arising demands of the service be fully met. Through the provision of the student body to have in the process of training large groups becoming increasingly compe- tent, thereby enabling the release of the most experienced nurses for the foreign and other demanding fields without lowering the efficiency of the base hospitals. To immediately raise the standard of the nursing oare of the sick in the base hospitals by the provisions of an increas- ed number of persons to render such care. 2. The plan as presented provides that the sohool, to be known as the Army School of Nursing shall be located in the office of the Surgeon General. Through this office the enrollment of 'the students will take plaoe and all matters relating to the general management of the school shall be dealt with. . The faculty presided over by the Bean of the school is to determine all questions relating to the course of instruction; the general administration of the school being entrusted to the Dean* It is suggested that an Advisory Council bo appointed composed of members of the Medi- cal Department, the superintendent of the Army and Navy Nurse Corps, the director of the Department of Nursing of the American Red Cross, the presidents of the American Nursing Association, the National league of Nursing Education, the National Organization for Public Health Nursing, the Dean of the Sohool of Nursing, and other members of the nursing profession conversant with the problems of nursing education to make recom- mendations ooncerning the appointments of the faculty, the relations between the mili- tary and oivil hospitals and other matters relating to the general policy of the schools. . The course of training will be given in the various base hospitals assigned as training oamps, each one of which will be a complete unit, having its own director, its staff of lecturers, instructors and supervisors and its teaching equipment. These units will be developed as rapidly as the needs of the service demand. The directors and such members of the teaching staff as shall later be deter- mined shall be members of the faculty. The course leading to a diploma in nursing shall extend over a period of three years. The experience in the mili- tary hospital will provide surgical nurs- ing, including orthopedic, eye and ear, and nose and throat; medical, including commu- nicable diseases and nervous and mental dis- eases. Experience in children's diseases, obstetrics and public health nursing will be provided through affiliation. It is beiieved that the complete oourse will attract the most intelligent and largest number of women to the sohool and will result in a more effioient service both in the military hospitals and in such public health f ielc.s as the Medical Depart- ment may assign nurses to. Upon the completion of the course the students would become members of the regu- lar Army Nurse Corps in the order of the vacancies, or should there be no vacancies, they would be placed on the list for appoint- ment as vacancies ooour. i They would bo eligible for state regis- tration, for membership in the American Nur- ses Association, the National Organization for Public Health Nurs.ng, enrollment in the nur- sing service of tho American Red Cross and for advanced courses in the toaohing adminis- trative and public health fields. A detailed outline of the plan is here- with presented together with recommendations concerning the neocssary circular and forms that will enable tie immediate development of such a school if tl : authorization for its es- tablishment is gr^'ited. f Signed) Doif Thompson,(bapt.Army Nurse Corps.) Jane Del'oo,(Director,i>uroau Nursing American / Rod Oroay). Annie V .Goodrich,, (ehairman, Chief InspectingNurse.) fa) Exhibit 3. Plan for the Creation and Operation of an Army School of -Nursing. -15- OPPOSITION TO THE SCHOOL The plan as presented was recommended by the Sur- geon General for the approval of the Secretary of War, but a vigorous opposition brought to bear by certain of the oivil community, and purporting to voice the opinion of the hospital authorities, the nursing profession, and the young women to be enrolled as students, delayed its accept- ance, a fact of too much historical importance to be en- tirely passed over. Endorsement 0f the Nurses Organizations.- While the matter was still under discussion in the War Department, the three national nursing organizations oonvening in Cleve- land, Ohio, the plan of the school was presented by Colonel Winford H. Smith, of the Surgeon General^ office, and a plan for the use of aides for the sick and wounded in the military hospitals, by Dr. S. S. Goldwater of New York. This enabled an open and full discussion of the question with the result that each of these organizations passed a resolution in favor of the establishment of the school. the Endorsement of,,Junior League. - At one of the meet- ings a forceful and eloquent presentation of the desirabili- ty of the school from the standpoint of the volunteer work- er, known as the aide, was given by Mrs. Chester I. Bolton, a young Cleveland woman, prominently associated with the public health field. ■ Mrs. Bolton through Mrs. Alfred Brewster - also ac- tively interested in National and State war work - obtained the opportunity of presenting the matter at the National Conference of the Junior League, then convening in Cleveland, an organization largely representing the so called Volunteer Aide Group, with the result that a motion in favor of the sohool was passed by the delegation. The Montreal (Canada) Junior League representatives reported: "That the young women who have served in the Voluntary Aid Detachment since the beginning of the war find themselves without a recognised profession, and urge that every possible effort be made in this country to give the young women going into nursing service proper training. with the resulting certificate or diploma." A strong letter of approval was later received from • Ella Lowoil Lyman, secretary of the Junior League of Boston. Says *LUs Lyman in olocings -~4- "The aides at present are untrained, un- tried and not needed. Nurses are still a vi- tal need. Would not any young woman who is truly in earnest and wants to be of service to the country in caring for the sick, enter one of these training schools, and when the war is over have a training which will always be use- ful whatever walk of life is hers?" Official telegraphic information on the disappro- val of the school by the General Staff (1) resulted in the appointment by the joint boards of the three nursing organi- zations of a committee, with Mrs. Clarence Brewster as chairman, to obtain a rehearing of the case ~bj tho Secretary of War. Through the efforts of Mrs. Bolton and Mrs. Brewster acting for this committee further consideration was given the matter, and on May 25, 1918, the following memorandum was approved by the Secretary of War. 1. As the result of the conference call- ed by you and held in your office yesterday afternoon. May 23rdt you approved in principle of the establishment of an army school of nursing for the purpose of providing a large body of young women who may be trained to render ade- quate and skilful nursing services to the sick and wounded soldiers and as supplementing the supply of trained nurses who are available. 2. It is my understanding that you ap- prove of the army nursing school plan; that you prefer to have oiieua pupil nurses paid a small monthly allowance similar to the custom in oivil hospital training schools, this to be in addition to the uniforms and books which will be supplied by the Government; that the surgeon General is authorised to pro- ceed at onoe to inaugurate the plan and to es- tablish at first a limited number of schools in order that the plan may be demonstrated as workable before proceeding to the establish- ment of schools in all or as many of the mili- tary hospitals as may be necessary 3. I have already put the machinery in motion and steps are already being taken look- ing to the starting of the first school at an early date. (1) Exhibit 4. Telegram from Surgeon General. - ,5- 4* In order that I may have your authori- zation in writing, I respectfully request that such written authority be furnished either by your approval of th,s memorandum or in such man- ner as you may decide. Respectfully submitted, (Signed) W. C. Gorgas Surgeon General, U.S.A. (Approved) Baker May 25, 1918 Noted - C of S AG 680.1 Army School of Nursing (Misc.Div.) 1st Ind FHM-EEL War Dept.,A.G.O* May 28, 1918 - To tho Surgeon General of the Army, 'inviting attention to the fore- going approval of the Secretary of War. By^ order of the Secretary of War. . Roy B. Harper T^ l~ £-<=_T< n 2_ O i,??C£ *2 iJ^H^ate the Plan and to es~ wSSi ~ that the plan may be demonstrated f,.?06?^ t0 the establishment of oitals a^m^\0r aS many of the ^litary hos- - piuaxs as may be necessary." itr +A +?* Was felt that i21 Grd@* to proper- llnU?Z the plan> botl1 as *o the response from the women of the country and as to the ef- in°L°* ^e civil hospitals, it was necessar^ to proceed as though the plan were in'■ fSlfopsra. 3 Jm, It Wil1 be apparent that anything short ZLV^Z Pr°Sram, as for example the announco- 11 Ltoa?.av1^mited nam^ of schools were to be established, would fail to bring the uni- versal response from all parts of the country 52i ~2«ld Pr9Ve?t any accurate judgment as to the response and the effeat on the oivil hospitals* 4.It'is always in our mind that you do not wish to work undue hardship on the civil hospitals and that we ar£ to proceed cantious- ly» I assure you that cxr actions are govern- ed accordingly, and that you neod feel no con- cern in the matter. The School plan will cause less disturbance ir. civil hospitals than any other which has oeen offered. This statement is supported by the fact that the plan was unqualifiedly endorsed by the Ameri- can Nurses* Association, uhe National League for Public Health Nure/ng^ and tho ifotiov^i League for Nursing Edvjation in joint session, held recently in Cleveland, These organiza- tions are composed of the superintendents of nurses and training frhools of the oivil hos- pitals of the countr: and they are the people who would be most af .'jcted by anything which curtails the supply if nurses to civil hos- pitals. The civil | capitals are co-operat- ing splendidly, and, m tho other hand, every precaution has been taken to protect the civil hospitals. Our application blanks require a statement to the efi'iit that the applicant has no connection, actxuf or tentative, with any civil hospital* life l'r have been refused who have had such oonne^.on. 5. It is our > lief that adequate meas- ures have been take to safeguard the civil hospitals. Throue.(the efforts of the Nurs- ing Committee of tl \ council of national De- fense, several thou$-nd more pupils have enter- ed civil hospitals t*an in zny previous year. -17 Vassar College and two or three other uni- versities are recruiting and giving intensive probation courses to prospective pupils of civil hospitals as Jell as the Army Sohool. Vassar, alone, nov/ has five hundred pupils dn training, all of whom are signed up to enter civil hospitals in the autumn. 6. We have arranged through the Nursing Committee and the V/omen's section of the Coun- cil of National Defense, for a campaign, to be . carried out next month for the purpose of en- rolling 25,000 women who agree to accept train- v ing in nursing either in the civil hospital training schools or the Army Training School, depending upon the needs of each. This plan is well developed, comprehensive, and it is confidently believed will safeguard the entire situation, both from the oivil and military standpoint, 7. I have gone somewhat into detail in order that you may know that we fully appre- ciate your interest and your desires and are co-operating in every possible way. We are sure you need feel no anxiety concerning the effect on the oivil hospitals any more than to realize that they are bound to be affect- ed by the war in spite of anything which can be done, not so much from the nursing side as from the lack of employees, due to the with- drawal of the man power o;: the country from civil occupations. » 8. At a recent meeting where the Army Nurse Sohool plan was presented, there were three distinguished medic*1 officers of our Allies, including Sir Arbithnot Lane and Colonel 3ruce of the English and Canadian Armies. They not only approved the plan, but a request has just been mile through the Brit- ish Embassy, for details if the plan to be furnished those officers br ocnsic.oration in their own Armies as th?/ consider it far superior to any othor pla i yet proposed or abopted. 9. It may interest * >u to know that as the result of no groat ef \ »rt at publicity, already, in a little more ;han three weeks, between five thousand and dx thousand let- ters of application or rotj.osi.* for information <\nd necessary papers have ' een received. The first school will bo open' at Camp Devens about July 15th, and then thers at Walter -18- Reed Hospital, Camp Sherman, Ohio, Camp Wadsworth, S.C., Camp Meade, Lid., and .Camp Dodge, Iowa. These will demonstrate the practicability of thb plan and others will only be established)if found to be a practical solution of the problem, and as the need arises. [ Respectfully submitted, W.C.Girgas, Surgeon General, U.S.A. This recommendation was {returned by the Secretary of War with the notation: "Readfwith interest and a grovel," The tension was much relieved whin in August General" J.M.T. • Finney, reporting for the medical department of the A. E. F... brought a request for a student iody as a supplement to the • graduate nurse force, General Finney emphasized the need of an expansion of nursing service :ar exceeding the original estimate, and at this time the definite quota was fixed up- on of 25,000 graduate nurses enrolled in the Army Nurse Corps, with 5,000 students on duty by Jan. 1, 1919, and a nursing personnel of 50,000, 15,Q00 of which were to be stu- dents by July 1, 1919. S ORGANIZATION OF $HE SCHOOL The authorization of the'establishment of the school, brought into immediate existence a division in the Surgeon General's office, designated as the Army School of Nursing, and administered by the chief inspecting nurse, under the title of Dean, who was directly Responsible to the Hospital Division. The work fell into three ^bureaus: General Informa- tion, Credentials, and Inspectioxj, with a professional per- sonnel of nine and a maximum clerical staff of thirty. Bureau of General Information.- This bureau direct- ed by Ellen Stewart, R.N., for Eiany years superintendent cf the Clarkson Memorial Hospital azia Training School, Omaha, Ne- braska; was flooded with inquiries following a brief an- nouncement of the school in the offficial bulletin, and an ex- cellent and widely disseminated sirticle in the press by David Lawrence. Through the Committee! on Nursing of the National Council of Defense, 25,000 annourfcements of this school were issued by a private printing company wii&tin a week, (1) ana the_____ (1) Exhibit 5. Announcement of! tho Army School of Hursing. -19- the small printing department at the Walter Reed Hospital put out 10,000 each of the various forks recuired by the applicant for admission, within a few days thereby enabling a rapid en- rollment of students. ' Bureau of Credentials.- , The requirement of four years seoondary woric or an educational equivalent for admission to the school, and the giving of credits for advanced work, demand- ed careful and accurate evaluation of credentials.. ?or the direction of the bureau the releas > was sought and obtained from the Red Cross office, Washing ;on, of Helen Scott Hay, a graduate of the Northwestern University, Evanston, 111., and the Illinois Training School, Cnictgo; a woman of Ion- and wide experience in teaching and executi re branches of the nursing field. Assisting her were Mary A. Samuel, recently superin- tendent of nurses of the Lakeside hospital, Cleveland, Ohio, and Evelyn Howard, formerly superintenlent of the New London Hos- pital, Conn., together with severs, college women of the Cleri- oal Staff. • Through the courtesy of phe United States Commission- er of Education, the privilege was! accorded of consultation with Dr. Samuel Capen, concerning fhe status of the various schools and colleges. Bureau of Inspection— JDhe bureau was charged with the standardization of nursing -carp and equipment for the mili- tary hospitals, where students were to be placed, the mainte- nance of the eduoational standards! of the school and the re- ports on civil hospitals and other institutions in connection with student affiliation. Pending the decision as the inspection of the base hospital C. Burgess, Inspector of Registere Department of Education of the Sta this service for the period of the Burgess made twenty inspections, el opinion that the school would not al supplement of the graduate nurs! portant factor in raising the stani ;o the creation of a cchool ,s was continued by Elizabeth Training Schools of the ;e of New York, released for war. At this time Miss oh one strengthening the »nly prove the most effectu- staff, but would be an im- ard of nursing care. The extent and variety of the field demanding not only hospital experts but training! and experience in inspec- tion, the release was sought and obtained of Anna C. Jamme, Director of the Bureau of Nursing Registration of the Califor- nia State Board of Health, and Indfe L. Albaugh, Secretary of the Board of Examination and Registration of Nurses of thr> State of Connecticut. One hundred and twenty-six inspections and visits were made 'in this counter during the year, the THE AEMY L -20- eipaing of the armistice, with a conseouent rapia d, crease in the nursing service, obviating the necessity of i;he in- spection of the military hospital overseas, originally in- cluded in the functions of this bureau. The Advisory Council.- In accordance with the plan of the school, tEe Surgeon General appointed an advisory council, on which sat - representing the medical department of the Army - Colonel 0. L. Furbush, Colonel W. T. Longcope and Colonel Winford H. Smith, and later Colonel William Welch and Colonel R. B. Miller; representing the nursing profession were M. Adelaide Nutting, chairman of the Committee on Nurs- ing; Jane A* Delano, chairman Red Cross Nursing Service; Clara D. Noyee, president of the American Nurses Association; Lillian Clayton, president of the national League of Nursing Education; Lillian D. Wald, hon. president of the National Organization of Public Health Nursing; Lena S. Higbee, su- perintendent of the Uavy Nurse Corps; Dora S. Thompson, su- perintendent of the Army Nurse Corps; Anna C. Maxwell, su- perintendent of the Presbyterian Hospital Training Sohool; and Annie V', Goodrich, Dean of the Army Sohool of Nursing. Two meetings of the council were held during the year. At the second in February 1919, a resolution recom- mending the creation of a permanent Sohool by Congress was passed and referred for approval to the Surgeon General, to- gether with a tentative dra^t of a bill incorporating the essential requirements for the establishment of a school of high standards and on a sound basis. (1) Faculty.- The faculty which comprised the nurse di- rectors and instructors, the medical lecturers and such otner assistants ae were reauired in the development of tue sohool at the various military hospitals v/here students were placed, despite the handicap of ccntinued changes, an inevitable con- comitant of war, was, nevertheless, on the whole*,a brilliant one; for gathered togeonor in one military hospitals were highly eouippeu scientist ue ana men notea in one various branches in medicine, many of whom gave most generously of their time to the student body. Three conferences of tho nurse members of the facul- ty were authorized by the Surgeon General, the last - of special value - being called in Chicago, in conjunction with the convention of the National league of Nursing Education, thereby making possible a discussion of nursing problems af- fecting both the civil and military schools, and strengthen- ing the co-operation between the two. (2) ,j_; Exhibit 7o Tentative draft of . till to create an Army School of Nursing, (2) Exhibit 8. lUmrfces of se?--l conference of Directors. -21- PROGBAMMR OP EXPANSION The first literature concerning the school was issued on June 7th., on June 17th., seventy-five applications had been filed. Applications continued to come in in increasing numbers, the maximum received in bne waek being 1,249 and by November 18th, the date of the1 signing of the Armistice. 10,689 had been received, of whici 5,267 had been accepted, 3,185 declined, and 2,219 were still under consideration; - 1,099 students were on duty in tvnnty-five military hospitals, and 567 students were ready for assignment immediately upon the withdrawal, for overseas duty, of a sufficient number of graduate nurses to provide the necessary accommodations. For a brief period, following the signing of the Armi- stice, the acceptance and assignment of students continued bringing the accepted applications up to 5,869 and the num- ber of students on duty to 1,578 in thirty-two military hos- pitals on December 21st, 1918. U. S. Student Nurse Reserve:- From the outset the Red Cross divisions rendered active assistance in recruiting stu- dents for the Army School, but the heavy enrollment of gradu- ate nurses that the continuation of the war would inevitably necessitate and the importance of a largely increased student body both in the civil and military hospitals, in order that the release of the graduates be effected, without imperilling the sick in this country, mn.de imperative a definite and ex- tensive recruiting campaign. Such a campaign was umiertakon by the Roman's Committee of the Council of National Defence, "co-operating with the Surgeon General of the U. S. Army, the American Red Cross and the Nursing Committee of the Council," under the title of the United States Student Nurses Reserve. The programme, directed by Hannah J. Patterson, provided for an intensive campaign, extending from July 29th to August 11th, for the enrollment of 25,000 young women pledged to hold them- selves in readiness until April 1, 1919, to enter either a civilian school of nursing or the Army Sohool, if called, with the privilege of expressing a preference as to the school; only students meeting tho atre and educational requirements were, however, placed on the waiting list of the Army school.(1) (;■ ■ Exhibit 9. U. S. Students Jurse Reserve. The effect of the campaign upon enrollment iu the Army school of nursing is shown bylthe following chart..... A GRAPHIC CHAPT OF APPLICATIONS FILED WEEKLY Note - Fstablifchment of School author! i ' Hoy 26th.2 First applications issued June t ... As the full quota chaired was not realized within the period of time allotted, the various state committees were authorized to continue the enrollment until the nee>' ceased* College Preliminary Course* -A further and not less important plan was developed by the~Ainerican Council on Ed- ucation, at the instigation of Dr» Ht-nry licCracken, presi- dent of Vassar College, with the approval of the surgeon General, whereby intensive preliminary courses of twelve weeks following the Vassar plan were to be established at higher educational institutions, the American Council on Education undertaking to assist in recruiting etude::.is. The estimated quota was 2,000 students by October 1st, ...jIQ; 4,000 by January 1919 and 5,000 by April 1919. A number,of col- leges had signified their readiness to give these courses, while others had the matter under favorable consideration, when the cessation of hostilities* after definite evidences of a rapid decision in the military service led to its abandonment. (1) This group would have bq-en a valuable addition to the Btudent body, relieving ifche Army school of the three months preliminary course and making th<» student of immediate assist- ance in the hospital ward. Civil School Students.- As a means of further in- creasing the nursing personnel through a student body, and • to steady the situation in tie c.;vil hospitals by giving their students a place in the Gr >at War programme, an opportu- nity was opened in August to the sohottis of tho fifty base hospitals first sent oversea.j, t > send such a number of their senior students as could be spar>I, through affiliation with the Army Sohool of Nursing, for ..amediate service overseas. A course in the military hospitals of four months was also arranged for the senior ind intermediate students of other civil schools, through 'lich, if adjusted satisfac- " torily, they would be prepared fn..- overseas service immeid- ately unon graduation «• or could ">e sent earlier, ix neces- sary; it being desired that the utuaents in the Army jjhcool of nursing should have been in t*3 service, if po-.;;ible, a year before b^ing sent oversea;. Information and regu- lations relating to the course hai been ispuod, and a number of civil schools had signified t-air desire to send students - when hostilities ceased. Host: it a 1 A s s 1 s t ants # - \\ order to conserve all avail- able material, Itrwas also decid?; to enroll as hospital as- sistants, wome\. disqualified for Overseas service by marriage or over aget. tjute ser- vice for the student body. to avoid complications and confu- sion relating to eligibility and placement and to injure an increasing competency of service through instruction and su- pervision, this group was entered as a division of the Army sohool of nursing* (1) » Red Cross Aides.- The increasing shortage of nurses overseas,"''"ancTthe constant pressure for aides, due presumably to the failure of those in charge on the other side to under- stand both the potentialities of the school, and that the shortage related to transportation rather than an exhausted or inadequate graduate nurse supply, together With the anxi- ety caused by the Influenza epldemiq, led to the suggestion of the enrollment of practical nurses as less likely to affect the enrollment in the school* ik reply to which Colonel Smith prepared a memorandum^ 'Which r/as endorsed by General * Hoble and which read in part as follows; "I recommend against the enrollment of the practical and experienced nurses because they represent a class now more needed than ever in community life, because of the with- drawal of graduates. ♦ . • Eathar than call upon the practical nurses so-called, X recommend: lv Pushing the Amy school of nursing which is the strongest part of our programme. 2* Calling upon the civil hospitals to send affiliating pupils, as many have indi- cated their desire to do^ 3. Calling upon the civil hospitals to give preliminary trainlr,?. to hospital assistants, the group already authorized* This group to include married women be' ween £1 and 40 whose husbands are overseas txni single women betvoen 35 and 45. This will establish the machinery for training a larger gr; rp should necessity arise. This course to cover six weeks or two months* 4- in order to me it the present emergency requirements I recommend that the Hed Cross se- lect with care 1,500 of heir nurses1 aides who have had the oourses In 1 ome nursing and first aid * X.I Exhibit 11. Anuw^s.<;:fiant ] ..jpifcal Assistants. -25- and who are between 35 and 45 years of age, and 'chat these be sont alt once overseas to supplement the nurses ovbr there. This wi;„l meet the emergency and lpave the field open here for the development of o$ir program for the Army sohool and hospital assistants. 5. That an appeal be issued at once in the name of the Surgeon General to all young women of the country calling them to service, e-Ithqr through" enrollment in the Army School or oivil schools or as hospital assistants, ac- cording to the group in which they fall, and making plain to them that this is their great- est service and also emphasizing that the pupils will be sent overseas as soon as ready and as needed* (1) At the request of the Had Cross the age limit of the 1,500 aides was reduced to thirty, it having boen ascer- tained that only about seven per cent, of the accepted appli- cants for admission to the Army school exceeded that age. The Development of the Training School Units.- The rapid development of the school, obviously so necessary, and made possible by the immediate and heavy enrollment of stu- dents was greatly delayed and hampered by the unfamiliarity of the chief nurses with the training school field, the large number of executives^ and instructors, that had been sent overseas and the consequent shortage of sueh personnel in the civil schools. A further difficulty came through fail- ure to provide a graded service for tho nurse corps, anala- gous to the grading of the commissioned personnel, and an almost universal system of control and direction in civil in- stitutions; this omission made the positions of head nurse, supervisor, night superintendent, etc, undesirable, since they entailed increased responsibility without increased au- thority or salary; the omission to furnish the chief nurses with any data, other than the meagre efiiciency records, re- lating to the general education and the professional prepara- tion of the graduate nurse personnel and the branches of nurs- ing in whioh they had had experience was a still further handicap in the selection of an efficient supervising staff. The greatest obstacle in the school development was due, how- ever, to the slow transportation of graduate nurses overseas and consequent inadequate housing capacity. (2) '"his delay was, in a measure, overcome by a circular letter, informing the commanding officers that in the future, students would replace the graduates sent overseas, and or- dering that quarters he found as immediately as possible, as (1) Exhibit 12. Memorandum for Bri^t^Gen, Robert 22* Uoble. (C) Chart of Uursing Staff.* inhibit l$* -26— it was imperative that t*;e course be begun, and the efficient cy of the students thereby hastened. Chief nurses released for overseas duty wer^ replaced by those who had held executive positions in civilirai schools, while the release was sought and obtained of several well known nurse educators. Miss Caroline Mine, superintendent of nurses of the Presbyterian Hospital, Philadelphia, established the unit at the base hospital, Ramp Dix; Miss H. II. Riddle, supt. of the Hew ton hospital, Mass*, with Miss McCrea, instructor at the Massachusetts general, took charge at the base hospital, Camp Devens. Miss Robina Stewart was released by McDonald College, Canada, for the chief nurseship at Y/alter Reed,- Miss Saliie Johnson, supt. of a training school at the Albany hospital, acting as director of the student body. The John Eoplins Hospital released their director of nurses of the Phipps department of psychistry, Miss Rffie Taylor, to es- tablish the work at Camp Maade. Miss Mary MeZenna, supt. of nurses of St. Francis &e Zavier infirmary, S.C., directed the work at Camp Jackson, Miss Mary Roberts, -with the lake division of the Red ^ross, assisted by MissKarriet Friend, the latter being released by the State Uelical Board of Ohio, established the unit at the base hospital, Camp Sherman. The largest unit was developed at tho base hospital, Camp Grant, by Muss Anna V/illiamson, previously chief nurse at Fort McHenry. (1) Thus an adequate number of executives were obtained and, in the majority of eases, abstractors of pedagogi- cal as well as professional preparation were secured. A notable contribution was tiie privilege of the four months preliminary course at Teachers cjollege, Columbia University, for the training school unit at JJ.S.A- General Hospital no. 1, made possible by the authorities, of the college through the omission of all tuition fees fo| these students. Too high a tribute cannot be paid to the wor.on whose energy and resourcefulness overcame innumerable difficulties - difficulties increased and, indeed, made almost insurmount- able bv the terrible epidemic trfat s^ept through the camps ^ust at the inception of the sen©ol. The enthusiasm and initiative of tho chief nurse at the base hospital, Miss Marie Lduis, graduate of the depart- ment of nursing and health, Teachers College, Columoia Univer- sity jfc former superintendent of |he training school of the Lonf Island College hospital, ahly assisted hj Miss Harriet Gillette - brought the first' uni-t of the army school into (1) Exhibit 14. Report of tlio Arry School of nursing, ~u/ 9. Army Base Kospit?.!, Ca:- v ir°ni;» -,7- exintence, on July 25, 1918, and pointed the way for the development of the others. (1) The timely issuance of the Standard Curriculum, prepared by the Education Committee of the national League for Nursing Education, made possible a uniform course of instruction through the most comprehensive presentation of the subject that has yet been prepared. The necessary text and reference books and a class room equipment, ex- celling that of most schools were authorized and, despite the delays consequent upon a war situation were, in the main, promptly delivered. r The way in which the camp buildings met the needs of the school is presented by one of the inspectors as follows: "Class Rooms and Equipment.- Class rooms and equipment for teaching have -been in some instances especially good. The large double barracks afforded the best example of a teach- ing center with its two large rooms on each floor,entrance halls, closets for linen, uten- sils, urug3, solutions and other equipment. In these instances one room is taken for lec- ture purposes which is furnished with students1 tablet chairs, good blackboard space on ■ walls, skeleton, charts, models, etc. Another room for demonstration purposes is fitted with four, sometimes six beds, Chase doll, camp chairs and full equipment for demonstra- tion needs* The diet laboratory in the third room is fitted with cabinets for groups number- ing from fifteen to twenty-four^ electric plates, cooking utensils and a coal or gas range. Instruction in dietetics is carried on by the hospital dietitian who may also teach chemist- ry and uses the laboratory for that purpose* The fourth room is fitted for a study room • with reference books, writing desks and other fitting equipment, or where there is no Red Cross Uurses' Recreation Eouse is utilized for recreation purposes. All equipment for teaching which is supplied by the medical supply department is, ample and of good quality. (X) Exhibit 15. List o£ Directors, January 1919. 28- . i.ani i ii.iMiin ..j.wa»M»il .1 i.mn^HWWI i l i 111 **>!>—IWiM*MMi hi " -I---<*A, 111 -.a; -IJ w I s . i KiiiJ ■ L£ ieV:i «.»■ »di ri^ • fcg rv-^ &WjO~~""3Is .|.(T1*5*«.^*>>***^3 r ^;;;;;.T> i jfr/r „ J. " | Oil Tuij3r j. a \ - '1K N ... \ « X i.l LCI t"uV\V \ V X L l5P¥-T^~•• •■, > ■i^ti^* n- -:^s m^fmaemwtmmmmmmm^mn^mmmmmtn^rmmm*** J< iiwii""ip|jpj(jlf y nny Mwniffi-um u-un i in umh>wwwww»*www^wmww—w ip,«p»-»»i «,j,. ^ ; .ijtrjrr ., iltiliitiiifiiiifc iii'-rn-"--- --......... '■■■ «—• ->i*iWiifo.i*iM»ii . ... ^^THT Base Hospital, ia dMMli^—MMialMIMtti.Ml np Sherman, Ohio. £9- In some instances where there was overcrowd- ing or where construction did not lend itself as readily as in the double barracks1 arrange- ment, the directors used their ingenuity in converting dormitories, disused dining rooms and kitchens into class rooms and laboratories. In one instance part of the patients' mess hall was partitioned off and made an excellent class and demonstration room combined, as al- so an indoor drill room. Again, when in the delays of military procedure in getting equip- ment and proper construction it v/as interest- ing to find the eagerness with which people outside the military organization came to the rescue in order that the students should not be hampered or class work retarded. The Red Cross in several instances gave the cooking laboratory equipment, had the desks and chairs built, and in one post saw to the construction of quarters for the students. photograph #2. Diet Kitchen, Base Hospital, Camp Grant, 111. ! -30- The American Library Association in several camps generously provided text and reference books where these were not forthcoming rapia- ly through the re^lar channels. In one case an individual came to the rescue contributing books as well as furniture, and not the least interesting feature of the assembling oi teach- ing equipment has been the ingenuity shown by camp talent. Conspicuous was the contribu- tion by a patient who made a set of colored anatomical,charts while awaiting the arrival of the Frohse charts and which were later ex- hibited during a conference in Washington. lvlany other examples, too numerous to enumerate, served to show the great interest of the various organizations and of individuals at the bane hos- pitals, both in the instruction and general com- fort and welfare of the students. -.51- Hot less interesting is the presentation of the ad- aptation of the student to the life in the military hospital. Problems of the Student fturses.- v/hen the proposition for estaoiisning an army school of t nursing, and training students in our camp hos- pitals was first launched a general impression prevailed that this would be a dangerous under- taking from the social standpoint, inasmuch as the army nurse herself, even though in service under an established army nurse corps, had no army status, viz., rank. It was hazardous, but the need was pressing to an extreme. a large number of young and recent graduates had been obliged to face the unusual conditions of camp life with perhaps less preparation for meeting such conditions than many of the stu- dents enrolled in the army school who had pre- viously been thrown on treir own resources, or who had passed through college, or had been in the teaching field. Therefore, it was felt that with proper guidance from the directors, instructors and social directors of the units, the students would not b j at any less disad- vantage than those in 6u:* civil schools. The students were qaick ;d adopt a plan -of self government under the advice of their director and instructor and assumoi the responsibility in maintaining the good landing of their indi- vidual groups. It has loen an interesting picture to see how this 3 ns v/orked out in the various units and the pro>Iem of their social life brought under their >wn control. Tho social activities have s.\>wn a variety of fea- tures. In some music ha; been dominant, in others the drama; glee <;'.ubs have been organ- ized, playlets written a>t carried out; in some groups drill and oui.oor sports have been emphasized. Students ii; all of the units have drilled every day, or at 3 east three times a week, out of doors v/hen ■ te weather was good; if not, indoors with ope; windows in the form of setting up exerc: i es. In an inter- esting group of one hundred in one of our northern camps, students ire outfitted from the Quartermaster's Department with leggings, coat and overseas cap fo: outdoor drill and hikes* to **^ /^ft^^W*) >t ^'fiZt^ ^6% r*-*. 0 **A-/«"*T- : x~*XyXx !V '-■>-■* r' -»— £*. --X& ' "V -" ~ s > j-* b. j • X ' ' •' " - ■f • ■**■ ' "*- M *er> r * x;r .XX' ^xu . .:**. iK1- i -33- Iheso wholesome forms of exercise and recreation create a splendid unit and take care of the leisure time after study and ward duty; when brought under the control of the student body Itself has promoted a strong class spirit and unity. The Red Cross Recreation House, de- signed for the uses of the nurses of the array nurse corps, is, as a rule, given over to the Btudents on one or two evenings of the week that they may receive their visitors, have dances, or other form of entertainment as they arrange for. (1) ** '•'* ««a. ^ Mf rf< M ft xf m j\ >'-."v.'..,l.ii'- P x ■{WW-'Vx ' Xl\ W Li*; • «rf"« —i *■ » * * v ""* •$&/y*:- ■*: Vr*.ftW.V# • •• V .f '<■•■■ - ' " '. ■* >., ~WT PITT if* X* VX' : v >'£>&> nugi. . ■i^.wt.i.,^, .»i. ■a. ■TI^>W(|«W*»*PWW|(IWipil» ^k , *.; Photograph #5. Base Hospital, C|mp Sherman. 7TT" Public Health - Michigan State Board of Health,Mch.1919. pp.98-99. The Army Schoo|. of nursing by Annie C. Jarame. -34- Uniform.- A military . thorized oy the Adjutant C nera: lamp, superimposed on the Caduc< er of nurse training schools - "Lady of the lamp." [Iform and insignia were au- the latter being a bronze , a tribute to the found- .orence nightingale - the State Regulations of the* School.- The educational re- quirement lor aomission and thejperiod of professional edu- cation entitles the graduates oif the school to nurse regis- tration, except that those students to whom credit for collegiate or technical work has; been given will not be eligible in those States requiring a full three years1 course in a hospital. A statement of this fact being made in the announcement of the school, several students have relin- quished such credit. Inasmuch as the Regents of the University of the State of Hew York require registration of schools de- siring the admission of their students upon graduation to the registration examination, or credit for courses cov- ered, should a student desire to complete her course in a registered Training Sohool in Hew York State applica- tion for recognition of the Army School was made. A cer- tificate of approval of the report of the dean of the Army School of Hursing was returned to the Surgeon General un- der date of December 12th, 1918, which certificate pre- sented, the conditions upon which the formal registration of the school depends as follows; "First.- Upon its assure! permanency. # Seoond.- A competent desm, whose appoint- ment is made sclely on merit and fitness. 9 Third.- Adequate service for teaching pur- poses, which must include training in obstetrics, jediatrics and di- etetics, as weli as surgery and general medical nursing." Until these questions ar-a definitely settled and the school formally registered, a cerfcificate from the Surgeon General, upon the recommendation of the dean of the school will be accepted for its face valie of training received, providing such training covers a period of not less than a year. Ir formal ratification of the report of (the) dean I an ma>cing this certificate, approved by the president of tho university, and placing thereon vie seal of the University of iTow York* -35- A copy of this certificate ot approval is being placed in the permanent records of this department, as a guide to those who shall have the administration of the issuing of certificates for admission to oi.r state examination for cer- tificate of registered nurses. R< spectfully, ^AUGUSTUS S. D0Y/1IIHG Assistant Commissioner and Director of Professional Education. Continuation of the Coujse.- The close of the fis- cal year (July 15, 1919) presented 741 students remaining to complete the course, leading to the diploma of the school - 573 on duty in fifteen military hospitals and 168 absent in the affiliating schools. The total number assigned to duty in the military hospitals was 1800. The percentage of with- drawals was not high considering the large number of stu- dents previously engaged in the occupational fields. A study of 4,869 accepted candidates showed that 3,820 were so engaged, of whom 1,805 were teachers. The statistics obtained from 97, of 112 students assigned to one base hospital, showed the average age to be 23.9 - 820 had been in the occupational field, 70$3 being teachers (hav- ing had from one to twelve years' experience) the remainder' representing fourteen other fields, such as librarian, tech- nician, sooial workers of various types, etc. The average earning capacity per month being 367.00. To the discipline resulting from college training and from experience in other fields is undoubtedly attribu- table the ease and efficiency with which these students ad- apted themselves to the demands tf the school and the military situation. Affiliation with civil erhools of nursing.- The res- ponse of the civil hospitals to "* he request for experience in the services not obtainable ii the military hospitals, was generous both as to opportunity i nd in the adjustment required to meet- the needs of the army scJool; affiliation being ef- fected with the leading hospitals able to give the required experience in Hew York, Baltimoii, Philadelphia, St.Louis, Washington, Chicago, Boston, Llirseapolis, Cincinnati, Hew- ton-ilassachusetts, and San Francisco. The credit allowed for iX vancod work reducing the term fn -f.:,o school and the admittance Df the entire body of stu- dents within a period of six moi1 as necessitated, in order that the full experience be obtt|aed by each student seeking a diploma, an earlier admission i ;> the affiliating courses than is customary for the special ho^itals £ maternity- especially) •»56- to* permit. These requirements adjustment of the students to ory and Is evidence of the valu« been for overseas duty had the lave been relaxed but the work has been satisfact- the student body would have w&r continued. thi The Contribution of the submitted to the surgeon General presents the contribution of the "It is obvious that made no appreciable cont standpoint of numbers - vice in the war. The ment lies in that it peradventure the great lished and tried out under the medical orapid expansion of nurs by a similar ezaergenoy. Johool..- The annual report ■ for the year 1918-1919 a permanent institution for all the students wii:, be given at Walter Reed and Letterman, or p ter Reed. Had it been ; tossible through one school in part as follows: 1,800 student nurses ribution - from the o the nursing ser- of this experi- without the well estab- of a sohool would be in the g service required v Llue dem >nstrated a tset mac dnery depart lent i: Lg Upon the establishm >nt of the sohool as ;he preliminary course ssibly only at V/al- s to give a three months1 : the difficulties and or two well equipped pos intensive course, many o all of the breakdowns thjt occurred would have been averted. Attention need hard! y be called to the exceedingly desirable re erve corps the graduates of such a schoi 1 would form and from which could be selected • he executive so great- ly needed and in such in< reased numbers in war times. Not all the graduates would re- main in the service. r is probable that not even all the gradual s demonstrating executive ability could 1 e assigned to military posts in times of peace, but all would be con- versant with military me- hods, while a post graduate course in admin: strative work is quite possible of develo] ment. An executive experience that inclu&edlboth the civilian and military hospitals w|uld be of peculiar value in times of war. most important stablished machine- In addition to thes contributions (the well ry of a school and a resJrve nurse corps conversant with the mili"|ary system) are several scarcely less important ones. E aftermath of war - as well as war itself will always mean a greatly increased need of nurses. As an efficiency measure the -37- sohool is, therefore, of much value through its prevention of waste of effort and expe- rience on the part of those women Intending, or through the interest aroused deoiding, to make nursing their profession. Even those who are impelled by purely patriotic reasons and who do not intend to continue in the field will be the gainers through this method, and their services, not less than the services of 1&Qse who desire pro- fessional preparation, will rapidly Increase in value. time of war,would ithod of increasing Not only have the >portunity of re- to date their sur- •st valuable store of The extension to the largest possible number of the very unusual experience in the nursing field that inevitably offers in the military hospitals : in itself justify this i the nursing strength. graduate nurses had an < freshing and bringing u] gical technique, but a r unique experiences has blen added to their sum total of nursing knowledge; while many hundreds of nurses to bel have shared in this. A treatment that extends!through tho healing of a wound to the restoration of function, and even to adaptation tl a new means of live- lihood, and that concern! itself with the mental readjustment not less than the physical cure, has not been a feature of case treat- ment in many, if any, ci 'ilian hospitals. These students will, it rould seem, inevitably think in these terms, an . through this fact bring to their nursing a and wider usefulness* Another service to the school is the mainta An English officer writ!; ig of the hospital much broader vision e rendered through ning of the morale. ut a great war must in the field, a se- re and of resting; situation says: always be, to the armies ries of periods of press and the difficulty to belovercome is in meet- ing the medical needs of l;fche former when re- quired." Tos meet the njede of the.^ftHe&s of resting*1- is not less Important or less difficult than adjustlnglto the periods of pressure. Activities sjimuleited to the -nth degree, suddenly wilh nothing to ex- pend themselves upon, ari a dangerous propo- sition for both men and jomen. Work, physi- cal or mental, is the onjy safeguard. In no hospital where a training sohool unit was es- tablished were all the classes omitted for more than three weeks during the epidemic. -*.-0~ The necessity of the stulents their books and the inst -ucto sors to their instructio: sure of the emergency be one of the most importan establishing and tion, and preventing the whioh is likely to follow emergency. maintai: ing The contrast between a c ing a school of nursing of a hig returning to rs and supervi- es soon as the pres- ins to lighten, is factors in re- a normal situa- loss of balance upon such an vilian hospital maintain- standard and a military hospital providing its nursing care, through a graduate nurse staff assisted by hospital Icorpsmen, has already been presented, unfavorably to the la*iter. A careful analysis of th< geon General does not, it is bel: nurse force as adequate to rende: demanded in the civil hospitals peace and in at least one of the; of securing desirable hospital c< The history of recent wa: definitely presents this group aj bers and preparation, and freque: type for the bedside case of the indispensable and heroic service In this case - since whai ment for if not to meet the exigel seem that a course adapted to the| men render in time of war should nursing care of the soldiers in tj be rendered by the graduate or st hands - In this war certainly - i| Annual Reports of the Sur- ged, present the graduate the kind of nursing care high standard, in times of reports the difficulties ismen is indicated. including the last, very inadequate, both in num- ;ly of an undesirable lick, but as rendering an .n the field. is the military establish- cies of war - it would service the hospital corps- e developed, while the mes of peace or war, should ident nurse, into whose m.ost effectively fell. The introduction of the siudent body brings to the care of the siok a group, seeking!to become efficient in the nursing field; it relieves the gladuate nurse from the performance of procedures that she has already mastered du- ring her own student days, givinglher the broader and de- veloping interest of supervisor, feacher and chief administrator* That the placing of the sludents in the base hospit- als greatly quickened the interest of the nursing and even the medical staff, and was an important factor in the standar* diaation of the nursing technique! ample testimony is borne to by the reports of commanding o|ficers, chief nurses and instructors, as is also the very lefinite, and during the influenza epidemic, the arduous services they rendered. I ;-»».'riWS>"'^ wAsmtiftTSN, e. c, -39- The permanent establishment of a school to meet the needs of future wars, would not, perhaps, be justifi- able, but the care of the siok in the hospital through a Bchool of high standard, has lon?g been accepted as the most efficient method in the civil oopmunity. Since in times of peace the wives and children pt the commissioned person- nel are cared for in the militarir hospitals, an army of even 100,000 men would offer adequatef experience for a large student body. The plan of the Burgeon General for the de- velopment of the array medical soiiool - which includes the sohool of nursing, will make pospible a school of unequalled standards and one which will undoubtedly attract a dosirable grado of students and oommand ana retain the interest of a highly qualified executive and tlaohing personnel, thereby insuring the best nursing care fir the sick in the military hospitals. HOHOR ROLL DIED IN THE SERVICE OF* THEIR COUNTRY ...... B- ' .........■ ■ ■ Dorothy Crosby..........Sept. Constance Shields.......Oct. Selam Voight............Oct. Bessie Edwards..........Oct. Eloise Eagleton.........Oct. Alice M. Baker.......*•.Oct* Fyvie Home.. ...*••*.•. .Oct* Christine Colburn.......Nov. Nellie Anderson.........Nov* Katherine Rowell.. ♦.....Deo. Lena Stanford.••«......*Deo. Pearle Poole.......•♦.••Doc* Prlsoilla Crooker.....•.Jan* Agnes Nohr••••••••••♦•••Jan. Beverly Bird.....• • ♦ • •..Feb. Annamae Kochnich. • •.....Jan. Dorothy Gustavson..•♦• ♦.Feb* Neville Eberly..........feh* Jfoaxde Andrews • .......•• .Maroh pearl Ely......•..♦♦.♦♦.March Mary Agnes Wilson......Feb. Curran, Lola Dot.......-Feb. Carter, Fay Smith..*••••June 23* 6* 11J 13j 19 i £8* 19, 23,, 30,' *•!' 19,* E7tf 24,1 4,* 31,1 13,/ 13, 20, \ 1918........Camp Devens. 1918........Camp Grant• 1918........ Camp Hancock* 1918.•......Camp Meade. 1918........Camp MaoArthur. 1918....... #Fort Riley. 1918........Fort Riley* 1918........Fort Riley. 1918........Camp Wheeler* 1918........Camp Greene* 1918........Fort Sam Houston. 1918••■*♦. ..■•Fort Sam Houston. 1919......,. 6amp Dovens. 1919,,..♦♦.*Camp Grant. 1919........Gamp Meade* 1919.......•Fort Oglethorpe. 1919........Fort Sara Houston. 1919........Camp Sherman * 1919........Fort Riley. 1919....... .Camp Grant. 1919 ...... •■ *Camp Taylor. 1919......••Camp Taylor. 1919......♦ .Fox Hills (Bellevue Hospital) <2 Annie Y7. Goodrich, Dean of the ^riny School of Nursing, May 1918-July 1919. y t 1000017^714 Goodrich, Annie W. AUTHOR History of the Amy School of 493 Guj (n.d.) TITLE Nursing. roov 4 JIlbtR '~&rn^hsr<) DATE DUE j/\nuarv 16 2001 BOOK0000017974 ■J%*>.* sr—.-trTcr.- -•> i