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Cultural History of Modern War
Containing trauma: Nursing work in the First World War
In this lucid and cogently-argued book, Christine Hallett explores the nature of the practices developed by nurses and their volunteer-assistants during the First World War. She argues that nurses found meaning in their complex and stressful work by identifying it as a process of ‘containing trauma’. Broad in its scope and detailed in its research, the book analyses the work of nurses from Britain, Australia, New Zealand, Canada, South Africa and the United States of America. It draws on highly personal letters and diaries drawn from archives and libraries throughout the world. This wide-ranging book explores a range of treatment scenarios, from the Western and Eastern Fronts to the Eastern Mediterranean, Mesopotamia and India. It considers both the efforts of nurses to provide physical, emotional and moral containment to their patients, and the work they did to maintain their own physical and emotional integrity.
- GenresNonfictionHistory
288 pages, Paperback
First published March 15, 2010
58 people want to read
About the author
Christine E. Hallett
18 books7 followersChristine Hallett is Professor of Nursing History at the University of Huddersfield, Chair of the UK Association for the History of Nursing, and President of the European Association for the History of Nursing. She is a trained nurse and health visitor, and holds PhDs in both Nursing and History.
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Displaying 1 - 4 of 4 reviews
January 9, 2021
"It was my business".
"It was my business to sort out the wounded as they were brought in from the ambulances and keep them from dying before they got to the operating rooms: it was my business to sort the dying from the nearly dying. I was there to sort them out and tell how fast life was ebbing from them. It was my business to create a counter wave of life, to create the flow against the ebb. The ebb of life was cold. When life was ebbing the man was cold: when it began to flow back, he was warm. My hand could tell of itself one kind of cold from another. They were all half frozen when they arrived, but the chill of their icy flesh wasn't the same as the cold inside them when life was almost ebbed away. My hands could instantly tell the difference between the cold of the harsh winter and the stealthy cold of death." Mary Borden The Forbidden Zone. Heinemann 1929.
Mary Borden's description of her work in a reception hut at her Casualty Clearing Station (CCS) at Hospital Mobile No1 for the French Army commences the Containing Physical Trauma, the first chapter in this very interesting, informative and sobering Containing Trauma - Nursing Work in the First World War by Christine Hallett.
Professor Hallett explores who (allied) military nurses were in WWI, what they did, how and in what conditions and locations. The work is well researched and benefits from contemporary first-person accounts or written published, and written and recorded recollections just after the war thru to the 1980s.
The book is arranged in an order that starts with Containing Physical Trauma and the reception - now known as Triage - and dealing with the men, their injuries and the conditions they arrived in: bloodied and broken, but also dirty, verminous with wounds already infected from dirt, clothing and shrapnel, bullets and other foreign matter, and often from having lain wounded in shell holes, trenches or bunkers for hours, sometimes even days. "In the first days patients were entrained with all the dirt, mud and blood of battle on them. All were fully dressed; many hadn't had their boots off their feet for five or six weeks, and only those who have done can know what it is to undress a heavy man, badly wounded and lying on a narrow seat of a railway carriage" Sister M Phillips, QAIMNS, Life on an Ambulance Train in 1914 (Army Medical Services Museum).
From this first chapter onwards, we read of nursing and the nurses who deployed to France & Flanders to Gallipoli, Salonika, Egypt & Suez to Russia, Africa and India, as well as working in numerous large and small hospitals and care centres in the UK.
We read of their roles and if they were trained nurse or volunteers; were they military, such as the wonderful Queen Alexandra's Imperial Military Nursing Service (QAIMNS) [and still wonderful today as the modern Queen Alexandra's Royal Army Nursing Corps]Red Cross, Voluntary Aid Detachment or even philanthropists such as the multi-millionaire Mary Borden.
Professor Hallett, herself a trained nurse, midwife and health visitor, shows us how the nurses learn how to contain and deal with physical trauma including controlling shock and haemorrhage, handling pus and gore, infectious diseases such as Typhus/Enteric and Influenza. From 24th April 1915 after its first use at St. Julien north-east of Ypres their jobs include controlling and treating the traumatic effects of toxic gas, often at great risk to themselves and their health.
There is much on the interaction with "their boys", and how they fought to keep them alive, helped them recovery and move to the next stage of care from CCS close to the front line onto hospital trains or ships to base hospitals and then to UK hospitals or recuperation hospitals and centres.
Naturally, in war and with such considerable casualty numbers so many with dreadful wounds and injuries we also read of the ones that were lost, those who fought and seemed to recover only to die from their wounds, infection or disease. This latter, described under the sub-title Containing the process of dying, illustrates the care and how the nurses helped (or tried) to help those who are or would die to do so without pain.
Pain management, drugs, treatments and the use of equipment are all discussed - not of their suitability or efficacy but how the nurses worked with other medical staff to use, administer and learn how these affected and helped their charges. The techniques, tools/instruments and the drugs themselves are, much like today's highly skilled nurses, are managed, used, cleaned and care for; but the difference here is the mud, sand, snow, cold, water in wooden huts, tents or trains and ships.
Alongside pain management is a stand-alone chapter on Emotional Containment and how the nurses helped the wounded battle terror, shock and life changing injuries from amputations, blindness and internal injuries affecting diet, body function and mental state. "The dental department have done wonderful work. They build the framework of the face and jaws and then the surgeons finish the work by making new noses, lips and eyelids" Canadian nurse Agnes Warner.
The final chapter, Self-Containment, covers aspects such as The Physical and Emotional Presence of the Nurse that shows clearly how difficult the nurses' job was but also how important this important, skilled and often overlooked capability is. Alongside presence was cleanliness: cleanliness for medical and sterile purposes but also cleanliness as a calm, ordered haven from death, dirt and terror. "Men would fight their battles over and over again in their sleep. A man - an NCO probably - would suddenly jump from his bed and with a wild expression on his face, hiss between his teeth, lie down you bloody fools or you'll be seen, and similar things - you had to be careful getting him back to bed - he was certainly in a fighting mood and would give anyone a blow who interfered with him." Australian nurse Leila Brown.
The nurse, as Professor Hallett writes, kept the patient as whole as possible, before, during and after surgery. The nurses did sterling and valuable work. They undertook duties that for many modern nurses, though in a different time and place with vastly different technology, would be recognisable, especially in the mental and physical trauma that presented and needed care, attention, considerable intelligence and self-awareness.
Nursing in WWI was no picnic and starched uniforms and black & white photos should not fool us into thinking they were simple, ill-informed and over disciplined women doing some good where they could. Far from it. They were skilled, caring and simply very hard-working, dedicated ladies operating in dangerous locations and conditions whose work saved countless lives, or made the passage to death easier and less frightening.
===============
The Royal Red Cross medal/decoration was introduced to Military Nursing by Royal Warrant by Queen Victoria on 23 April 1883 and it was announced in the London Gazette on 27 April. The decoration is awarded to army nurses for exceptional services, devotion to duty and professional competence in British military nursing. A new class the Associate Royal Red Cross (ARRC) was announced in November 1915. In total, 6419 individual women received 6741 RRCs, Bars, and ARRCs during WWI (source http://www.scarletfinders.co.uk/174.html)
[British and Empire/Commonwealth] Nurses' courage under fire was also recognised with the award of the Military Medal (MM) following a change that allowed it to be awarded to women from 21st June 1916. By war's end fifty-five trained nurses of Queen Alexandra’s Imperial Military Nursing Service and the Territorial Force Nursing Service had become holders of the MM. (source http://www.scarletfinders.co.uk/121.html).
This superb website lists all British Army nurses who have died on military service, including WWI: https://britisharmynurses.com/in-memo...
In 2018 at the National Arboretum, the site of the UK's national armed forces memorial and numerous regimental, ship, squadron, association and military group memorials, a publicly funded memorial was unveiled to commemorate and record the names of the 1244 nurses and VADs who have died in service and operations: https://www.nursingtimes.net/news/cha...
"It was my business to sort out the wounded as they were brought in from the ambulances and keep them from dying before they got to the operating rooms: it was my business to sort the dying from the nearly dying. I was there to sort them out and tell how fast life was ebbing from them. It was my business to create a counter wave of life, to create the flow against the ebb. The ebb of life was cold. When life was ebbing the man was cold: when it began to flow back, he was warm. My hand could tell of itself one kind of cold from another. They were all half frozen when they arrived, but the chill of their icy flesh wasn't the same as the cold inside them when life was almost ebbed away. My hands could instantly tell the difference between the cold of the harsh winter and the stealthy cold of death." Mary Borden The Forbidden Zone. Heinemann 1929.
Mary Borden's description of her work in a reception hut at her Casualty Clearing Station (CCS) at Hospital Mobile No1 for the French Army commences the Containing Physical Trauma, the first chapter in this very interesting, informative and sobering Containing Trauma - Nursing Work in the First World War by Christine Hallett.
Professor Hallett explores who (allied) military nurses were in WWI, what they did, how and in what conditions and locations. The work is well researched and benefits from contemporary first-person accounts or written published, and written and recorded recollections just after the war thru to the 1980s.
The book is arranged in an order that starts with Containing Physical Trauma and the reception - now known as Triage - and dealing with the men, their injuries and the conditions they arrived in: bloodied and broken, but also dirty, verminous with wounds already infected from dirt, clothing and shrapnel, bullets and other foreign matter, and often from having lain wounded in shell holes, trenches or bunkers for hours, sometimes even days. "In the first days patients were entrained with all the dirt, mud and blood of battle on them. All were fully dressed; many hadn't had their boots off their feet for five or six weeks, and only those who have done can know what it is to undress a heavy man, badly wounded and lying on a narrow seat of a railway carriage" Sister M Phillips, QAIMNS, Life on an Ambulance Train in 1914 (Army Medical Services Museum).
From this first chapter onwards, we read of nursing and the nurses who deployed to France & Flanders to Gallipoli, Salonika, Egypt & Suez to Russia, Africa and India, as well as working in numerous large and small hospitals and care centres in the UK.
We read of their roles and if they were trained nurse or volunteers; were they military, such as the wonderful Queen Alexandra's Imperial Military Nursing Service (QAIMNS) [and still wonderful today as the modern Queen Alexandra's Royal Army Nursing Corps]Red Cross, Voluntary Aid Detachment or even philanthropists such as the multi-millionaire Mary Borden.
Professor Hallett, herself a trained nurse, midwife and health visitor, shows us how the nurses learn how to contain and deal with physical trauma including controlling shock and haemorrhage, handling pus and gore, infectious diseases such as Typhus/Enteric and Influenza. From 24th April 1915 after its first use at St. Julien north-east of Ypres their jobs include controlling and treating the traumatic effects of toxic gas, often at great risk to themselves and their health.
There is much on the interaction with "their boys", and how they fought to keep them alive, helped them recovery and move to the next stage of care from CCS close to the front line onto hospital trains or ships to base hospitals and then to UK hospitals or recuperation hospitals and centres.
Naturally, in war and with such considerable casualty numbers so many with dreadful wounds and injuries we also read of the ones that were lost, those who fought and seemed to recover only to die from their wounds, infection or disease. This latter, described under the sub-title Containing the process of dying, illustrates the care and how the nurses helped (or tried) to help those who are or would die to do so without pain.
Pain management, drugs, treatments and the use of equipment are all discussed - not of their suitability or efficacy but how the nurses worked with other medical staff to use, administer and learn how these affected and helped their charges. The techniques, tools/instruments and the drugs themselves are, much like today's highly skilled nurses, are managed, used, cleaned and care for; but the difference here is the mud, sand, snow, cold, water in wooden huts, tents or trains and ships.
Alongside pain management is a stand-alone chapter on Emotional Containment and how the nurses helped the wounded battle terror, shock and life changing injuries from amputations, blindness and internal injuries affecting diet, body function and mental state. "The dental department have done wonderful work. They build the framework of the face and jaws and then the surgeons finish the work by making new noses, lips and eyelids" Canadian nurse Agnes Warner.
The final chapter, Self-Containment, covers aspects such as The Physical and Emotional Presence of the Nurse that shows clearly how difficult the nurses' job was but also how important this important, skilled and often overlooked capability is. Alongside presence was cleanliness: cleanliness for medical and sterile purposes but also cleanliness as a calm, ordered haven from death, dirt and terror. "Men would fight their battles over and over again in their sleep. A man - an NCO probably - would suddenly jump from his bed and with a wild expression on his face, hiss between his teeth, lie down you bloody fools or you'll be seen, and similar things - you had to be careful getting him back to bed - he was certainly in a fighting mood and would give anyone a blow who interfered with him." Australian nurse Leila Brown.
The nurse, as Professor Hallett writes, kept the patient as whole as possible, before, during and after surgery. The nurses did sterling and valuable work. They undertook duties that for many modern nurses, though in a different time and place with vastly different technology, would be recognisable, especially in the mental and physical trauma that presented and needed care, attention, considerable intelligence and self-awareness.
Nursing in WWI was no picnic and starched uniforms and black & white photos should not fool us into thinking they were simple, ill-informed and over disciplined women doing some good where they could. Far from it. They were skilled, caring and simply very hard-working, dedicated ladies operating in dangerous locations and conditions whose work saved countless lives, or made the passage to death easier and less frightening.
===============
The Royal Red Cross medal/decoration was introduced to Military Nursing by Royal Warrant by Queen Victoria on 23 April 1883 and it was announced in the London Gazette on 27 April. The decoration is awarded to army nurses for exceptional services, devotion to duty and professional competence in British military nursing. A new class the Associate Royal Red Cross (ARRC) was announced in November 1915. In total, 6419 individual women received 6741 RRCs, Bars, and ARRCs during WWI (source http://www.scarletfinders.co.uk/174.html)
[British and Empire/Commonwealth] Nurses' courage under fire was also recognised with the award of the Military Medal (MM) following a change that allowed it to be awarded to women from 21st June 1916. By war's end fifty-five trained nurses of Queen Alexandra’s Imperial Military Nursing Service and the Territorial Force Nursing Service had become holders of the MM. (source http://www.scarletfinders.co.uk/121.html).
This superb website lists all British Army nurses who have died on military service, including WWI: https://britisharmynurses.com/in-memo...
In 2018 at the National Arboretum, the site of the UK's national armed forces memorial and numerous regimental, ship, squadron, association and military group memorials, a publicly funded memorial was unveiled to commemorate and record the names of the 1244 nurses and VADs who have died in service and operations: https://www.nursingtimes.net/news/cha...
October 19, 2018
Un ouvrage très complet sur une question presque philosophique qui se pose dans les soins infirmiers, celle de la réhabilitation de l'unité de l'individu blessé ou malade. Une unité qui comprend deux plans: de part un constituant physique, qu'il se doit de rétablir par des méthodes de soins adaptées, dans la foulée des innovations médicales de la Première Guerre; d'autre part, la notion de rétablissement mental des patients, stimulé par les efforts mis en place par les infirmières afin de créer les conditions propres au rétablissement d'une unité mentale. Ce "containment" se joue aussi dans le domaine de l'hygiène autour du corps des blessés et malades, ainsi que de leur nutrition, afin de rétablir cet espèce d'equilibrium pré-hospitalisation, que gouvernement, personnel médical et patients eux-mêmes cherchent à rétablir afin de leur permettre de repartir sur le front.
Un ouvrage intéressant, donc, qui ne cherche pas à juger desméthodes, ni à en mesurer l'efficacité, mais bien à cerner les pratiques établies par ces infirmières du front afin de faire face à ces déchirures de corps et d'âmes qu'elles ont vu quotidiennement défiler.
Un ouvrage intéressant, donc, qui ne cherche pas à juger desméthodes, ni à en mesurer l'efficacité, mais bien à cerner les pratiques établies par ces infirmières du front afin de faire face à ces déchirures de corps et d'âmes qu'elles ont vu quotidiennement défiler.
February 25, 2013
A fascinating and detailed account about an often overlooked group of First World War heroines.
December 19, 2023
WOW! What a book. The following passage is from page 228, the final paragraph of the book, and it's a doozy.
"Nurses literally 'held people together.' Just as shellfire and shot created rents in the body, emotional distress created rents in the psyche. If the physical holes were too many, or too great, the physiological system would be unable to sustain itself; if the emotional and mental ones were overwhelming, they could lead to despair, a process of spiritual disintegration. Nurses prevented, where possible, both physiological collapse and spiritual fragmentation, permitting their patients to heal. To present it simply: the doctor solved the patient's problem (insofar as a solution was possible); the nurse sustained the patient while his problem was being solved. Where a solution was not possible, the nurse kept the patient alive anyway. And where life was not possible, the nurse protected the patient's integrity as a human being while he died. The process was one of 'containing trauma'."
The whole book was an argument proving this point leaning heavily on the writings of WWI nurses and VADs, and I found her convincing. This book was priceless in my research and a fascinating read.
"Nurses literally 'held people together.' Just as shellfire and shot created rents in the body, emotional distress created rents in the psyche. If the physical holes were too many, or too great, the physiological system would be unable to sustain itself; if the emotional and mental ones were overwhelming, they could lead to despair, a process of spiritual disintegration. Nurses prevented, where possible, both physiological collapse and spiritual fragmentation, permitting their patients to heal. To present it simply: the doctor solved the patient's problem (insofar as a solution was possible); the nurse sustained the patient while his problem was being solved. Where a solution was not possible, the nurse kept the patient alive anyway. And where life was not possible, the nurse protected the patient's integrity as a human being while he died. The process was one of 'containing trauma'."
The whole book was an argument proving this point leaning heavily on the writings of WWI nurses and VADs, and I found her convincing. This book was priceless in my research and a fascinating read.
Displaying 1 - 4 of 4 reviews