Hazards of Nursing During the First World War, 1914-1918

By Amanda Gwinnup

 

Introduction

Nurses served in every theatre of the First World War. They served at home in hospitals and convalescent homes, along the Western Front in Casualty Clearing Stations (CCSs), base hospitals, sick sisters’ hospitals, on hospital barges, trains, and ships while on the Eastern Front they served in base hospitals, stationary hospitals and on hospital ships. At each geographical location and in each type of medical unit there were various hazards that nurses faced. Nurses would have been in close contact with patients suffering from communicable illnesses and would have been stationed in areas where such diseases were prevalent. Infectious diseases could spread from patient to nurse. In addition to pathogenic dangers nurses also fell ill from stress and strain. Psychological illnesses such as neurasthenia had a multitude of symptoms that impacted a nurse’s ability to work. Symptoms such as headaches, insomnia, depression, and anxiety were all believed to have been caused by exhaustion.[1]

 It is a relatively common belief that nurses were restricted to zones of relative safety during the war. However, through the examination of diaries, memoirs and other primary source materials belonging to nurses historians have illustrated that women participated in the war in a varied capacity and in multiple locations including those that put them in harm’s way.[2] Denise Poynter states that historians have placed a ‘demarcation … between male and female experience’ of war based on the assumption that nurses served in relative safety some distance behind the front lines and that that assumption has perpetuated the view that since nurses were not on the front lines they were sheltered from the physical and psychological dangers of the war.[3] Poynter argued that women were in harm’s way throughout the war but focused entirely on the physical dangers commonly associated with warfare and limited her scope to nurses who served on the Western Front.[4] This paper does not focus on a single theatre of the war which allows for a deeper understanding of the hazards that nurses encountered and brings to the forefront the dangers that would have had a significant impact on nurses’ lives during and after the war.

This paper utilises the disability pension records and service records belonging to trained nurses who served in the Queen Alexandra’s Imperial Military Nursing Service and its Reserve (QAIMNS), the Territorial Force Nursing Service (TFNS), The British Red Cross Society (BRCS) and the records belonging to the semi-trained nursing members of the Volunteer Aid Detachment (VAD). It will begin with an examination of some of the most prevalent physical illnesses contracted by nurses which resulted in disability claims, such as malaria, tuberculosis, influenza and dysentery. This section will be the first to include an in-depth exploration of nurses and the physical illnesses they contracted in service between 1914-1918 focusing on tuberculosis and malaria. This section will provide some medical background information regarding the different illnesses in order to highlight the gap in historiography. It will be argued that illnesses could lead to lifelong complications and the inability to continue in the nursing profession. Section two will explore the dichotomy of nursing, in which nurses were instructed to be self-sacrificing and spend ‘upon [their] patients the very best [they had] to give…’,[5] yet needed to take care of themselves in order to remain capable to provide that care,[6] and examine why some nurses were reticent in reporting a developing illness. It will be argued that nurses could neglect their health for the sake of their patients and, in some instances, for the chance to remain at an overseas post.

The final section will examine the physical threat to life that nurses faced and will illustrate that nurses were in harm’s way in a variety of locations; enemy air raids and, in particular, the sinking of hospital and troop ships were dangers endured by nurses throughout the war’s many fronts. This section utilises the British Newspaper Archive as well as the pension and War Office records held at the National Archives and will focus on the dangers nurses faced when travelling by ship and will foreground an exploration of the sinking of hospital and troop ships by enemy action. The purpose of focusing on the dangers of ship travel is to demonstrate that there was no tangible ‘front line’ at sea and even though the intentional targeting of hospitals (on land and at sea) was illegal nurses’ lives were at risk and a number perished as a result. While some historians have discussed the sinking of ships in which the lives of nurses were lost, no one has examined, to any depth, the emotional and psychological repercussions that enduring an attack at sea had on the nurses who survived. It will be argued that physical dangers led to the development of psychological conditions in some nurses which was caused, in part, by the constant stress and strain they were subjected to by the extreme trauma and existential threat involved in the act of survival. This final section will conclude by placing the physical dangers against the emotional and psychological hazards that nurses encountered arguing that those stresses caused many nurses to suffer from life-altering disabilities.

The adversaries that know no sides: illnesses, pathogens and parasites

Researchers have been able to estimate the number of male combatants who contracted different diseases whilst in service but no such estimates exist for nurses and most histories involving research into the First World War and disease have focussed entirely on male combatants.[7] While it is not yet possible to estimate the total number of casualties among female ancillary staff during the conflict, it is possible to comment on the 300 nurse applications for pensions. A total of 223 of the total 300 nurse pension cases involve disability compensation for physical illnesses. The nurses who appear in the pension record would have been the severe cases, where the women survived the initial infection but remained debilitated while the nurses who fully recovered without any lasting effects would likely not have applied for a pension. Therefore, it is difficult to estimate rates of infection amongst nurses from the sources. However, through the examination of the pension records it is evident that a handful of illnesses appear to have caused long-term debility in sufferers, among whom varying degrees of disability were noted.

Rates of the contraction of illnesses depended on the geographical location. Nurses, much like the male combatants they cared for, who were posted to East Africa, Palestine, and Salonika would have been at greater risk of contracting malaria and those in Gallipoli and Mesopotamia would have encountered a range of enteric diseases as well.[8] Respiratory infections like influenza, bronchitis and tuberculosis were most likely to occur on the Western Front but were contracted in all theatres of the war.[9] Tuberculosis occurs the most frequently within the pension record with forty-two pension cases and was not region specific; however, pension records indicate that nurses often contracted the disease in Mesopotamia,[10] France,[11] and at home.[12]

Tuberculosis

Tuberculosis, which is most commonly caused by a bacterium called Mycobacterium Tuberculosis, is spread through the respiratory system from person to person as minuscule droplets are discharged by an infected person by means of sneezing, coughing and talking.[13] The bacterium can live for months on surfaces and can be resistant to minor disinfectants.[14] The disease can flourish in confined and poorly ventilated spaces such as troop ships, hospital trains and hospital barges.

Research into the connection between the prevalence of tuberculosis and the First World War was compiled in an American study during the 1940s and shows that prior to the outbreak of war in 1914 mortality rates from tuberculosis were on the decline through much of Western Europe but rose as the war progressed.[15]Mortality rates in England and Wales rose from 135 per 100,000 in 1913 to 162 in 1917 and 169 in 1918.[16]The total of new cases for 1918 was 90,573, with men aged fifteen to forty-five in the majority of those infected.[17] Godias Drolet illustrates through the data that the overall infection rate rose during the war but, in most countries, returned to near pre-war levels by 1920. Certain factors converged to facilitate the rampant spread of tuberculosis. The screening process for soldiers and nurses was rudimentary, comprising of a simple medical exam which meant that quiescent diseases might have been overlooked during the enlistment. There are few detailed accounts of what a medical examination consisted of for nurses entering the military nursing services, however the evidence suggests that pre-service medical examinations for nurses varied. Sister Charlotte Brook, TFNS (pensioned for tuberculosis), received a clear bill of health and vaccinations for typhoid from a Royal Army Medical Corps (RAMC) medical officer at the 3^rd Northern General Hospital before she was posted to Mesopotamia.[18] Brook’s medical statement was typed and the inclusion of vaccination information suggests a relatively detailed examination of her medical history before she was cleared for service. The War Office record for Sister Violet Barugh, TFNS, had a handwritten medical statement from a medical officer at the 1^st London General Hospital in which she was simply declared ‘fit for active service’ which suggests a less detailed medical examination and illustrates that there was not a uniform procedure to determine a nurse’s medical fitness.[19]

Thomas Daniel states that both the Central Powers and the Allies examined recruits for tuberculosis with radiographs,[20] however, John Murray contends that while radiography had ‘progressed considerably’ before the war, specialists were ‘unprepared for large-scale … screenings.’[21] G. Denis Shanks explains that pre-enlistment examinations of the chest resulted in many recruits being excluded from joining and therefore ‘procedures had to be relaxed.’[22] The soldiers considered fit for duty went off for training, travelling by trains and troop ships to every theatre of the war and may have been infected with tuberculosis, spreading the illness to those with whom they came into contact. To illustrate how poor the tuberculosis screening was, the French army discharged 86,000 soldiers within the first five months of the war due to suspected tuberculosis.[23] By the end of 1917, 20,000 British soldiers had been invalided out of service due to tuberculosis.[24] Other factors, such as gas attacks, have been cited as a possible reason for the increase in tuberculosis morbidity. Victims of gas attacks would have had weakened lungs and may have been more susceptible to contracting the disease.[25]

Contracting tuberculosis was life-changing for many nurses and for those who were dependent on steady work to survive financially the lack of consistent income could result in severe deprivations. VAD nurse Laura Baldwin served at home in Lincoln and abroad in Malta from July 1915 until September 1918. She began presenting with symptoms for tuberculosis in the autumn of 1917 with severe weight loss. In October 1918, she was medically examined at the QAIMNS hospital, Vincent Square, London where she was diagnosed with pulmonary tuberculosis and her case was transferred to the Ministry of Pensions.[26] Her illness prevented her from working and she explained that ‘I am quite unable to earn any money owing to my state of health and I’ve had to borrow to enable me to pay my current expenses.’[27] A year later she explained that she was ‘entirely without private means and as a result of my service for the Army Medical Service as a VAD member [I] am unable to earn any money at present.’[28]

Baldwin’s financial situation, that of having little to no private means, is significant because of the common misconception that nursing members of the VADs were mostly drawn from the middle and upper class. Prior to mass mobilisation in 1914 this had been the case as many VAD members were ‘daughters of industrialists and professionals; others from members of the landed gentry or aristocracy,’ whereas women from the working class were ‘effectively excluded by the requirement to buy one’s own uniform and pay one’s own expenses…’.[29] As the need for more semi-trained nurses increased more women were able to join, and for some, it was a financial sacrifice. Baldwin received a disability pension and treatment through the Ministry of Pensions until her death in 1981.[30]

The fundamental belief of service and self-sacrifice that many nurses subscribed to prevented some nurses from seeking medical assistance when they began to fall ill. Sister Annie Binnie of the TFNS was eventually awarded a 100 percent disability pension for life as a result of tuberculosis, although she did not apply for a pension until 1922. She first began coughing in 1916 while serving in France but ‘never reported sick during her period of service.’[31] Following the war she joined the nursing staff at the Cottage Hospital, Frimley, Surrey where the tuberculosis was finally diagnosed. A doctor certified her condition and explained that she would never be able to work to her previous standard; ‘I am of the opinion that the disease is at present quiescent and that she is careful of doing light work … I do not consider her fit for [the] nursing home duties which she performed previous to the Great War at a much higher salary than her present one.’[32]

The evidence suggests that Sister Binnie had a helpful support network through her employment at the Cottage Hospital. Doctor Attenborough, the primary doctor at the Cottage Hospital, attended to her medically and when she was unable to actively participate in the pension process due to ill health, such as requesting renewal forms, the hospital’s matron acted on her behalf.[33] She received institutional treatment at different sanatoriums, most notably the Palace Hotel in Switzerland, but she always returned to her place of employment and residence in Surrey.[34] She was still employed at the same hospital, under the leadership of Matron Foxall in 1939, a year before her death.[35]

Malaria

Malaria, much like tuberculosis, saw a steep rise in infection rates during the war although its morbidity rate was higher amongst soldiers than tuberculosis. It is estimated that between 500,000 and 600,000 allied troops were infected with malaria during the war; however, there is no estimate as to how many nurses may have been infected.[36]

The British Army knew of the dangers posed by malaria as a result of surveys conducted in the late nineteenth and early twentieth centuries and took measures to aid in the reduction of infection rates amongst its forces.[37] Once conflict began in the ‘malaria vector’ (Macedonia, East Africa, Mesopotamia and Palestine) the British diverted troops to drain and backfill ponds, sprayed petroleum to kill mosquito larva, introduced ‘larvivorous fish’ to eat the mosquito larva, built canals to drain the swamp lands and used special netting in the living quarters to prevent mosquitos from entering.[38] Although these preventative measures reduced the rate of malarial infection amongst allied troops the measures were not always implemented by British Command. Not all commanders were willing to spend their manpower on civil engineering endeavours which diminished the effect of the measures implemented.[39]

Prevention through altering the landscape was not always possible, such as in mountainous areas or during a ‘highly mobile’ campaign.[40] Mark Harrison states that in the autumn of 1918 the ‘British pursued the Turks into the malarious Jordon Valley … and in the weeks leading up to the armistice with Turkey … almost half the 40,000 strong British force was hospitalised with malaria.’[41] Other preventative measures included the consumption of quinine although Harrison reports that not all medical officers stationed within the malaria vector believed in its effectiveness due to the occurrences of men coming down with malaria even though they were reportedly taking quinine.[42] The ineffectiveness of quinine as prevention might have come down to the ‘lax discipline’ when it came to enforcing its consumption by the troops as some commanding officers ‘generally took a relaxed view’ to the administration of the medicine while ‘some were reluctant to enforce quinine consumption because of its unpopularity with the troops.’[43] Medical Officers believed that many soldiers avoided the quinine injections because they were considered ‘very painful’.[44] Myths surrounding the regular use of quinine existed in peacetime and may have persisted into the war years. One such myth, that taking quinine could cause sexual impotence, could have influenced the medicine’s unpopularity.[45]Those myths could prevent someone from receiving treatment for a genuine diagnosis which could result in a coma and/or death, especially for the Plasmodium falciparum variety of the infection.[46]

Research into malaria and the war has thus far only focused on male combatants and, as stated previously, determining how many nurses fell ill from the parasite whilst on active service is challenging as there is very little evidence. Nurses were nonethless at risk of contracting malaria and at least twenty of the 300 pension files involve claims for disabilities resulting from malarial infection.[47] Christine Hallett states that malarial infection was particularly rife in Salonika.[48]  Precautions against infection were much the same for nurses as they were for male combatants with mosquito nets around their beds but nurses were reported to have worn ‘mosquito veils over their hats, mosquito gloves and thick puttees’ in a bid to prevent infection.[49]Hospital wards offered very little inherent protection as they were often large marquees with tarpaulin as flooring.[50]

The evidence suggests that contracting malaria was considered an inevitability. Nurse Eleanor Shortt was interviewed by the Imperial War Museum (IWM) in 1984 and when asked about the dangers of serving in Macedonia she answered, ‘you might get malaria … or sand fly fever or something like that’ in a matter-of-fact way.[51] The language used by the medical officers completing Medical Boards for the nurses in and around Salonika make it appear as though contracting malaria was a likely outcome of service in that region. One medical officer wrote that Staff Nurse Helen Shires ‘was there [Salonika] 15 months before contracting malaria in October 1917’ implying that fifteen months was an extraordinary length of time to pass before contracting malaria.[52] Staff Nurse Ethel Andrews on the other hand arrived in Macedonia on 11 August 1917 and on 14 August was admitted to 64 General Hospital suffering from a severe case of malaria in conjunction with possible sand fly fever.[53] Andrews was frustrated by her slow recovery and was not ‘resigned’ to be sent back to England when she was informed that the Macedonian climate ‘was not suitable for her.’[54] She was finally able to return to duty in December of 1917 but never fully recovered from malaria.[55] Upon her discharge from service her case was sent to the Ministry of Pensions and a 50 percent disability pension was awarded to her.[56]

Malaria could potentially hinder a person’s ability to find gainful employment as one could be ill sporadically as the symptoms flared for years after the initial infection. VAD Violet Chamberlain (née Bennet) was treated for malaria in 1916 and ten years later she still suffered through occasional attacks of the illness. She had ‘attacks of shivering. Headaches, vomiting and [high] temperature lasting for twenty-four hours’ which left her ‘weak and shaky for a further week.’[57] Sister Nora Hogan (née Corry) had frequent attacks of malaria following her resignation due to illness in January 1919. In 1923, she had notable tenderness around her spleen and was suffering from ‘frequent attacks of shivering and general weakness.’[58] Staff Nurse Olivia Beadle was awarded a temporary disability pension for the effects of malaria but this did not preclude her from volunteering to serve with QAIMNSR in 1940 illustrating her desire to serve once again in a time of war.[59] These women’s cases demonstrate that malaria severely impacted the lives of nurses who contracted it during the First World War and, while disability compensation was awarded in many instances, the medical officers in charge of the Medical Board for the Ministry of Pensions were reluctant to award permanent pensions for an unpredictable condition.

Self-care vs patient care

Not all illnesses were severe enough to necessitate hospital treatment. Minor ailments that only required a short rest in one’s quarters were likely not to have been reported to the matron in charge of the medical unit and are therefore unlikely to appear in nurses’ service records.[60] Without a written medical report a nurse seeking disability compensation would find it difficult to adequately prove that her disability developed as a direct cause of an illness she suffered whilst in service. Illnesses requiring admission to a general or sick sisters’ hospital, though, would have necessitated a Medical Board to approve the nurse’s return to duty. If the nurse was serving on the Western Front she was allowed twenty-one sick days for recovery and required clearance from the Medical Board to return to duty but if she had not recovered during that period she was sent back to England for further assessment and treatment.[61] However, once a nurse was sent back to England the likelihood of her being posted overseas again was low and for some nurses that possibility was enough to restrain them from reporting an illness.

Testimonial evidence in support of a pension claim for Sister Violet Barugh, TFNS, for asthma explains that she did not report her bronchial infection while serving in France but was instead invalided to England for a different condition, nephritis, an inflammation of the kidneys.[62] When Barugh was medically cleared for duty she was informed that she was to remain in England.[63] That was not the outcome she had wanted. She wrote to Dame Sydney Browne, Matron-in-Chief of the TFNS, ‘I have just heard from the War Office that I am not to return to France. I do beg that you will be kind enough to give me Foreign Service.’[64] Two weeks later she asked again, ‘… please don’t give me permanent Home Service. Could I not be given Transport Duty at some future date?’.[65] Sister Annie Binnie, pensioned after demobilisation for tuberculosis, began coughing in 1916 and lost weight but ‘never reported sick during her period of service’.[66] The prospect that an illness could prevent a nurse from returning to overseas service may have prevented other nurses, too, from reporting a suspected illness thus allowing a minor ailment to worsen increasing the risk to themselves and others.

Nurses were instructed to pay close attention to early symptoms of any suspected illness and to report, for example, a ‘sore throat … not only for the sake of the nurse, but also for the protection of the patients.’[67]VAD Emma Duffin recalled how she was reminded on her arrival to 15^th General Hospital, Alexandria by the hospital’s matron to report ‘the minute we felt ill as we would be doing her and ourselves no kindness if we held on till we broke down.’[68] The fear that a nurse might be found medically unfit was something that affected both the trained nurses and the semi-trained VADs. Vera Brittain described the various ailments she and her fellow VADs endured while training at Camberwell; ‘we all acquired puffy hands, chapped faces, chilblains and swollen ankles, but we seldom actually went [off] sick, somehow managing to remain on duty with colds, bilious attacks, neuralgia, septic fingers and incipient influenza.’[69] One evening while working on the ward Brittain ‘nearly fainted… and had to be put to bed in a Sister’s cubicle’ and while she waited for a medical officer to examine her she ‘lay awake half the night in terror’ that she might have been deemed too unhealthy to carry on nursing, but was cleared for duty following a few days of sick leave.[70] The likelihood of contracting an illness while serving as a nurse appears to have been understood by the women, although the possibility that of being deemed unfit to continue with their service was an outcome very few were willing to  accept.

Jeopardy at sea

Nurses were exposed to the physical dangers typically encountered during war. The pension records provide a glimpse into various disabilities resulting from or connected to air raids,[71] naval attacks,[72] and gas attacks.[73] In addition to the possibility of causing bodily harm those physical dangers and their constant threat could cause emotional and mental harm. Sister Elizabeth Whyham (neé Eadie) was injured in an air raid while serving in Etaples in May 1918. She received shrapnel wounds from flying debris and was pinned under an iron beam resulting in damage to her back as well as a broken arm.[74] Her physical wounds healed but her psychological wounds lingered with ‘nervous symptoms due to shock.’[75] VAD nurse Alice Dixey claimed that her neurasthenia was attributed to the air raids she endured near the 24^th General Hospital in Etaples.[76] Sister Gertrude Molison (neé Nicholds) was left ‘very nervous and depressed…emotional, tearful and apprehensive’ for years following the mining of the hospital ship, Galeka, that she had been on board.[77] VAD Dixey’s pension application was denied based on lack of medical evidence,[78] Sister Whyham improved and was eventually able to continue nursing,[79] but Sister Molison was unable to return to her profession or to take on ‘any other work that would bring in a livelihood.’[80]

[Figure 1] Artist depiction of the sinking of the Glenart Castle[81]

The mining or torpedoing of hospital and troop ships appears to have been a particularly traumatic event and would have been a danger faced by any nurse travelling by ship. Attacking medical units such as CCSs, base hospitals and hospital ships was illegal and against The Hague Regulations of 1899 and 1907. Article 5 of the 1907 Hague Convention states that ‘in bombardments by naval forces all the necessary measures must be taken by the commander to spare as far as possible … hospitals, and places where the sick or wounded are collected, on the understanding that they are not used at the same time for military purposes.’[82] Mines and torpedoes are two different forms of explosives. Mines were indiscriminate as they were placed in the water and would damage any ship whether military, hospital or civilian that made contact with it. Torpedoes were fired directly at a target with intent to damage.

 The sinking of hospital ships caused public outcry in the British Isles and was reported on heavily. The first British hospital ship to have struck a mine and sunk was the Anglia in 1915. The ship was transporting roughly four hundred wounded servicemen to the port of Dover, where many of the patients were unable to help themselves as they were ‘cot cases’.[83] One nursing sister lost her life in the disaster,[84] however the press focused on the ‘heroic nurses’ who ‘gave no thought to their own safety, but laboured with the men to transfer their patients to the waiting boats.’[85] Attacks on hospital ships were relatively infrequent, however, due the illegality of the attacks which caused the loss of non-combatant lives. The British press reported such attacks comprehensively and created an impressive historical record. The Salta, for instance, struck a mine near Le Havre on 10 April 1917. The hospital ship was empty of wounded but a total of fifty-two lives were lost, nine of them nurses.[86] According to War Office records belonging to the deceased nurses they had only been stationed to the Salta for four days. Although it is not explicitly stated within the historical record it is worth considering the very limited time those nurses had spent on the ship: they would likely only have a had a few opportunities to practice evacuation drills. Eight of the nine nurses who perished on the Salta were declared missing presumed drowned, and only one body was recovered for burial.[87]

Naval mines were indiscriminate; however, they were meant to be anchored in place. The Dublin Daily Express hypothesised that the mine that sunk the Anglia might have broken free of its tether during a bad storm stating that damage from water mines were ‘one of the dangers that, however safeguarded against, will sometimes prove beyond control.’[88] The damaging of hospital ships by mines was reported as an accident and if lives were lost, as a tragedy, but the intentional attack by a torpedo was reported as a horrific crime. The mining of the Salta was reported alongside the sinking of hospital ships the Asturias (one nurse was reported as a casualty)[89] and the Gloucester Castle (patients and crew all survived) by German torpedoes. [90] The Aberdeen Press and Journal stated

Only a few weeks ago the Asturias was sunk, and the Admiralty now announces that the Gloucester Castle, another vessel of a similar character, has likewise fallen a victim to a German submarine, while the Salta, also employed on hospital service, has been destroyed by a mine. It cannot be pretended, of course, that the Asturias and the Gloucester Castle were sunk by mistake. Both vessels when attacked were lighted from stem to stern, and displayed all the usual recognised signs denoting their character.[91]

The way in which the mining of the Salta was reported in this article follows the general view that it could be excused as accidental, while the intentional torpedoing of the Asturias and the Gloucester Castle was considered as an ‘especially revolting’ act perpetrated as part of Germany’s ‘general war policy.’[92]

The sinking of HMHS Glenart Castle on 26 February 1918 by German U-boat torpedo just off the coast of Wales was declared an ‘act of Hun fiendishness’ by The Graphic.[93] An artistic rendition (figure 1) of the sinking ship depicts a horrific scene in which the ship is on fire and only a few lifeboats are visible.[94] There were fourteen nurses stationed aboard the Glenart Castle and eight perished; Matron Kate Beaufoy, Staff Nurse Edith Blake, Staff Nurse Elizabeth Edgar, Staff Nurse Charlotte Edith Henry, Sister Rose Elizabeth Kendall, Staff Nurse Mary MacKinnon and one other nurse.[95] The nurses’ bodies were never recovered and all were declared ‘missing presumed drowned.’ [96] Staff Nurse MacKinnon’s father was outraged that the hospital ship did not have an armed escort and demanded answers from military command as to why ‘they [crew of the Glenart Castle] were left to the mercy of murderers who [have] broken every law.’[97] The sinking of the Glenart Castle and the death of those eight nurses became an event that was used as a rallying cry to bolster support for the British war effort in, what would turn out to be, the last months of the war. The Bishop of London, Arthur Foley Winnington-Ingram, stated that ‘the cries of the drowning nurses will echo in our ears forever and will brand us as a nation of cowards if we cease to strive that such appalling wickedness may be made impossible for all time.’[98] Intentional attacks on hospital ships were viewed as cowardly crimes and were particularly poignant because of the relatively large number of nurses who were killed in any single attack but many nurses survived naval attacks. Six of the fourteen nurses aboard the Glenart Castle survived the sinking of their ship: however, the survival of such attacks was rarely reported on and as a result not much is known about the survivors. Sources for the fates of nurses on other ships is more accessible through the pension records.

The Aragon: trauma at sea for survivors

Nurses also travelled by troop ship to overseas locations. Troop ships, unlike hospital ships, were considered valid targets under The Hague Regulations and fell victim to enemy action. VAD Mary Elizabeth Thomas was travelling on the troop ship Aragon in December 1917 to take up her hospital post in Egypt. The ship reached its destination on 30 December 1917 but was ordered to wait outside the port of Alexandria due to congestion. The Aragon was struck by a torpedo while awaiting its signal to approach the safety of the harbour and began listing immediately. VAD Thomas was eventually pensioned for neurasthenia as a result of her experiences on 30 December 1917.[99] In a letter to the Ministry she wrote

 

… as times goes on I am continually breaking down, and suffering from nerves which makes me lose self-confidence. It was my one ambition after the War to go in for a general training as a nurse but my illness kept me back. The result I have had to give up the idea of being trained. I was on the Arogan [sic] going out to Egypt. When she was torpedoed and have suffered from shock and nerves since then when I get run down. Therefore, I can only take on light work which means little “pay” and my continual illnesses has cost me quite a sum since the war.[100]

Thomas was originally diagnosed with cardiac debility following diphtheria although her original medical boards conducted in Alexandria while she was still a member of the VAD state that she was ‘suffering [from] … post diphtherial debility and a very [marked] degree of neurasthenia’ with the conclusion that she ‘will not be fit for duty for a considerable time and that she is unsuitable to spend another summer in Egypt.’[101]

The account of the sinking of the Aragon is preserved in letters to family which were published in British newspapers and in the diary entries of two nursing members of the VAD, siblings Kit and Eve Dodsworth.[102] While VAD Thomas does not provide any testimony as to the harrowing situation she endured, the words from these other witnesses illustrate the magnitude of the situation and the lasting effect that participating in such an event could have.

The Aragon had approximately 2,000 souls on board, 1,800 male officers, soldiers and crewmen and 200 female nurses (professional and VAD). While on board the passengers had daily evacuation drills which ensured that an emergency evacuation would go smoothly and without panic.[103] Shortly before eleven in the morning the Aragon was struck by a torpedo. The anonymous account of a VAD written as a letter to her parents and subsequently published in multiple British newspapers explains how she was in her cabin preparing to disembark when the torpedo struck. A ship’s steward was nearby and is quoted as exclaiming ‘My God, we got hit.’[104] Kit and Eve Dodsworth were standing on the deck ‘when suddenly there was a terrific crash and a lot of dust and bits of wood were blown up into the air over the aft well-deck.’[105] The anonymous VAD made it to the evacuation area and was quickly lowered in her assigned lifeboat ‘which was a shaky business’.[106] The nurses were the first to evacuate the ship while the men remained awaiting their orders to do the same.[107]

As the nurses’ lifeboats were lowered soldiers snapped to attention and saluted the women,[108] and while the boats were being rowed clear of the sinking ship the anonymous VAD reported that she heard soldiers sing as the stern of the ship disappeared beneath the water.[109] The Scotsman reported that the singing men had been Scottish soldiers awaiting their turn to evacuate. The newspaper claims that the men sang out “Sing me a song o’bonnie Scotland, Any old song will do” as they bravely ‘stood unmoved, showing no sign of fear or alarm.’[110] A nearby destroyer, the HMS Attack positioned itself to aid in the rescue of the men still on board.

The Aragon had sunk within fifteen minutes[111] forcing most the of men on board to jump into the water.[112] HMS Attack ‘picked up hundreds of’ the Aragon’s men but was torpedoed as well ‘right amidships … clean in half.’[113] Men from the Aragon who had been pulled from the water on to the destroyer were sent back into the water which was now covered in oil. The oil ‘sickened them … and made them unconscious, and it covered their bodies so that it was impossible to pull them out of the water.’[114] In total 610 men lost their lives in the sinking of the Aragon and the HMS Attack.[115] All 200 nurses, including VAD Mary Elizabeth Thomas, survived the ordeal and as the trawlers made their way to shore the crew of the HMS Cornflower, anchored in the harbour, lined the deck and cheered the women.[116]

Once the nurses reached land they were billeted to a hotel and given something to eat. In the stillness of their rooms, with the clothing they had been wearing as their only possessions the nurses now had time to consider the events of the day. Kit wrote that ‘all our nerves were gone’ as she along with many other nurses were standing on the balcony outside of their rooms crying.[117]

The following day another troopship was sunk in the same location. In the letter penned by the anonymous VAD she conveyed that event to her parents, ‘Another ship was torpedoed in exactly the same place. She went down in five minutes. There were 40 sisters on board, and they were all in the water. A good many, I believe, were drowned. I know they brought eight sisters into the mortuary of the hospital.’[118] The troop ship that sank on 31 December 1917 was the Osmanieh. In that instance 199 souls were lost, and eight of the deceased were nurses;[119] VAD nurses Catherine Ball, Winifred Maud Brown, Gertrude Bytheway, Una Marguerite Duncanson, Lilian Midwood and Hermione Angela Rogers[120]; Nurse Margaret Dorothy Roberts of QAIMNSR; and one other nurse whose identity could not be confirmed by this researcher.[121]

There is no way of knowing what the nurses who had survived the sinking of the Aragon, might have been thinking at the news that eight nurses perished in the same place less than twenty-four hours later. The evidence does suggest that many were likely aware of the sinking, as they were still in the area gathering necessary items before taking up their posts. The events that transpired on 30 December affected VAD Thomas for at least a decade. She had entered a nurse training program after the war but owing to her neurasthenia she was unable to complete it. Her ‘ambition’ to become a fully trained nurse never came to pass. She was still struggling with depression, anxiety, a ‘feeling of suffocation’ and a loss of confidence when she was examined for her Final Award Assessment in 1927.[122]

 Conclusion

The First World War brought many challenges for the nurses who tended the sick and injured soldiers. Nurses were in close contact with patients suffering from highly communicable diseases like tuberculosis, influenza and dysentery and as illustrated in this article those illnesses led to life altering disabilities for a number of the sufferers. The many fronts of the conflict brought nurses to challenging locations in which certain diseases spread with ease. Malaria was considered a veritable inevitability in regions where it was common and severely impacted the lives of the twenty nurses whose pension records have been preserved.

Nurses put their work and duty to their patients above their own health. They remained on duty and continued to work even if they felt unwell. Many ignored the developing symptoms of chronic illness in themselves in order to continue treating soldiers in overseas locations. Their determination to remain on duty led some to develop lifelong disabling illnesses impacting their heath and their ability to earn a sufficient income.

The brutalities of war reached nurses as well and had lasting effects on the women who endured them. Naval attacks were sometimes indiscriminate and, in some cases, illegal such as the intentional torpedoing of hospital ships. Nurses on board those ships had to struggle to save patients and some paid the ultimate sacrifice. For the nurses who survived those harrowing ordeals the psychological toll lasted for years, and in at least one instance, prevented someone from furthering her career.

 

Endnotes

[1] Ben Shephard, A War of Nerves: Soldiers and Psychiatrists, 1914-1994 (Great Britain: Pimlico, 2002), 9-10.

[2] Diane Atkinson, Elsie & Mairi Go to War: Two Extraordinary Women on the Western Front (London: Preface Publishing, 2010); Alison Fell, Women as Veterans in Britain and France After the First World War. (Cambridge: Cambridge University Press, 2018); Alison Fell and Christine Hallett (eds), First World War Nursing: New Perspectives. (London: Routledge, 2013); Christine Hallett, Containing Trauma: Nursing Work in the First World War (Manchester: Manchester University Press, 2009); Christine Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford: Oxford University Press, 2014); Margaret Higonnet, Nurses at the Front: Writing the Wounds of the Great War. (Boston: Northeastern University Press, 2001); Janet Lee, War Girls: The First Aid Nursing Yeomanry in the First World War (Manchester: Manchester University Press, 2005); Lyn MacDonald, The Roses of No Man’s Land (London: Penguin, 2013); Yvonne McEwen,  In the Company of Nurses: The History of the British Army Nursing Service in the Great War (Edinburgh: Edinburgh University Press, 2014); Sharon Ouditt,  Fighting Forces, Writing Women: Identity and Ideology in the First World War. (London: Routledge, 1994); Anne Powell, Women in the War Zone: Hospital Service in the First World War (place: The History Press, 2009).

[3] Denise Poynter, ‘The Report of her Transfer was Shell Shock’: A Study of the Psychological Disorders of Nurses and Female Voluntary Aid Detachments Who Served Alongside the British and Allied Expeditionary Forces During the First World War (Unpublished DPhil thesis, University of Northampton, 2008), 49.

[4] For more on the dangers of the Western Front and nursing see Christine Hallett, Nurses of Passchendaele: Caring for the Wounded of the Ypres Campaigns 1914-1918 (Barnsley: Pen & Sword, 2017).

[5] Amanda Gwinnup, ‘Hidden Disabilities and Invisible Illnesses: Identity and Agency in Britain’s Disabled First World War Nurses’ (Unpublished DPhil thesis, University of Huddersfield, 2022), 8.

[6] Ibid, 40-71.

[7] Hugh Pennington, ‘The impact of infectious disease: a look back to WW1.’, Future Microbiology 14:3 (2019), 165-168. Pennington states that an estimated 113,000 of British and Dominion soldiers died of disease. See also Christine Hill, Sickness and Service: The British Army and the First World War (Unpublished DPhil thesis, University of Central Lancashire, 2004).

[8] Mark Harrison, ‘Britain’s medical war: a brief comparison of health and medicine on several fronts’, Medicine, Conflict and Survival 30:4 (2014), 297.

[9] Ibid, 296.

[10] Charlotte Brooke.  PIN 26/20015. Ministry of Pensions. The National Archives (hereafter TNA). Citations relating to the pension and/or War Office records appear in a shortened form when the information was gained from analysis of the entire record. When the citations appear in a long form it is because the information was gained from a specific source within the record. The need for a long citation is particularly important when referencing the pension record as each record has a number of different contributors and transparency of the sources is of particular interest to the author of this article.

[11] Annie Binnie. PIN 26/20009. Ministry of Pensions. TNA.

[12] Daisy Burgess. PIN 26/20021. Ministry of Pensions. TNA.

[13] Thomas Dormandy, The White Death. A History of Tuberculosis (London: Hambledon, 1999), 1, 211.

[14] Dormandy, The White Death, 211.

[15] Godias Drolet, ‘World War I and Tuberculosis. A Statistical Summary and Review’, American Journal of Public Health and National Health 35/7 (1945), 689-697.

[16] Drolet, ‘World War I and Tuberculosis’, , 691. Drolet’s data was taken from the civilian population.

[17] Ibid, 692.

[18] Charlotte Brook. Medical Statement, RAMC Medical Officer, 29APR1926. War Office (hereafter WO) 399/10017, TNA.

[19] Violet Barugh. Medical Statement, RAMC Medical Officer, 5 May 1915. WO 399/9662, TNA.

[20] Thomas Daniel, ‘The History of Tuberculosis’, Respiratory Medicine, 100 (2006), 1867.

[21] John Murray, ‘Tuberculosis and World War I’, American Journal of Respiratory and Critical Care Medicine, 192/4 (2015), 411.

[22] G. Dennis Shanks, ‘How World War 1 changed global attitudes to war and infectious diseases’, The Lancet 384 (2014), 1703.

[23] Murray, ‘Tuberculosis and World War I’, 411.

[24] Chancellor, Tuberculosis (British Army), Hansard (1918).  Available at:https://hansard.parliament.uk/Commons/1918-06-18/debates/fda429bb-0694-4b45-847f-5dc944d5390c/Tuberculosis(BritishArmy) [Accessed 20 January 2022].

[25] Murray, ‘Tuberculosis and World War I’, 412; Hallett, Containing Trauma, 63-64.

[26] Laura Baldwin. Form No. 19, Baldwin, 11 November 1918. PIN 26/19998, TNA.

[27] Ibid.

[28] Laura Baldwin. Correspondence, Baldwin, 19 October 1919. PIN 26/19998, TNA.

[29] Hallett, Veiled Warriors, 19.

[30] Laura Baldwin. PIN 26/19998, TNA.

[31] Annie Binnie. Proceedings of a Medical Board, Ministry of Pensions, 16 October 1922. PIN 26/20009, TNA.

[32] Annie Binnie. Correspondence, Dr Attenborough, 12 October 1922. PIN 26/20009, TNA.

[33] Annie Binnie. Correspondence, Matron Foxall, 11 May 1923. PIN 26/20009, TNA.

[34] Annie Binnie. Notification of treatment, 21 April 1926 – 7January 1927. PIN 26/20009, TNA.

[35]  Ancestry, [n.d.], Annie Binnie, 1939 England and Wales Register. Available at: https://www.ancestry.co.uk/discoveryui-content/view/17483917:61596 [Accessed 07 December 2023].

[36] Justin Fantauzzo, ‘ “Malaria Has Spoilt It”: Malaria, Neuropsychiatric Complications, and Insanity in ex-Servicemen in Post-First World War Britain’, Social History of Medicine 5 (2022), [page/s]; Bernard Brabin, ‘Malaria’s contribution to World War One – the unexpected adversary’, Malaria Journal 13:497 (2014), 6. Nurses and civilian aid workers were not included in these estimates.

[37] Ronald Ross, Report of the Prevention of Malaria in Cyprus (London: His Majesty’s Stationery Office, 1914); Mark Harrison, ‘Medicine and the Culture of Command: The Case of Malaria Control in the British Army during the two World Wars’, Medical History, 40 (1996), 439-440.

[38] Harrison, Medicine and the Culture of Command, 440.; Brabin, ‘Malaria’s contribution to World War One’, 8-9.

[39] Harrison, ‘Medicine and the Culture of Command’, 441.

[40] Ibid. 440.

[41] Brabin, ‘Malaria’s contribution to World War One’, 9.; Harrison, ‘Medicine and the Culture of Command’’, 441.

[42] Harrison, ‘Medicine and the Culture of Command’, 441.

[43] Ibid. 442.

[44] Shanks, ‘How World War 1 changed global attitudes’, 1702.

[45] Harrison, ‘Medicine and the Culture of Command’’, 439.

[46] Remington Nevin and Ashley Croft, ‘Psychiatric effects of malaria and anti-malarial drugs: historical and modern perspective’, Malaria Journal,15:332 (2016), 1. Brabin states that on the Italian Front, where fighting was reportedly brutal, some soldiers attempted to contract malaria by purposefully not consuming their quinine rations in order to earn a reprieve from the battlefield. Brabin, ‘Malaria’s contribution to World War One’, 11.

[47] Andrews. PIN 26/19990, TNA; Beadle. PIN 26/20002, TNA; Bennett (née O’Connell). PIN 26/20008, TNA; Brazil. PIN 26/20014, TNA; Chamberlain (née Bennet). PIN 26/20030, TNA; Hogan (née Corry). PIN 26/20109, TNA; Hollow. PIN 26/20110, TNA; Hudson. PIN 26/20117, TNA; Lally. PIN 26/20143, TNA; Penney (née Gillespie). PIN 26/20201, TNA; Pullan. PIN 26/20213, TNA; Shires. PIN 26/20240, TNA; Smith, R. PIN 26/20245, TNA.

[48] Hallett, Veiled Warriors, 153.

[49] Ibid. 154. See also Malcolm Linfield, Battling disease in Salonika: the story of Nurse Alice Emily Linfield, Away from the Western Front [n.d.].  Available at: https://awayfromthewesternfront.org/research/women-away-western-front/battling-disease-in-salonika/ [Accessed 25 October 2022].

[50] Hallett, Veiled Warriors, 154-5.

[51] Eleanor Shortt. Imperial War Museum (hereafter IWM) Audio interview, IWM, 1984. Catalog 8296, reel 1.

[52] Helen Shires. Medical Board, RAMC, 23AUG1918. PIN 26/20240, TNA.

[53] Ethel Andrews (née Wormald). Medical case Sheet, RAMC, 1917. PIN 26/19990, TNA.

[54] Ibid.

[55] Ethel Andrews (née Wormald). Casualty Sheet, QAIMNS, August6 1917 – April 1919. WO 399/9243, TNA.

[56] Ethel Andrews (née Wormald). Award Sheet, Ministry of Pensions, May 1920. PIN 26/19990, TNA. Her pension was reduced to twenty per-cent in 1921.

[57] Violet Chamberlain (née Bennett). Report of a Medical Board on Officer or Nurse, Ministry of Pensions, 14 July 1926. PIN 26/20030, TNA.

[58] Nora Hogan (née Corry). Proceedings of a Medical Board, Ministry of Pensions, 6 March 1923. PIN 26/20109, TNA.

[59] Olivia Beadle. Correspondence, Beadle, 25 March 1940. WO 399/475, TNA. She was denied on account of being past the maximum age limit therefore it was suggested that she apply to BRCS to volunteer.

[60] Sue Light, Sickness and Convalescence. The Fairest Force – Great War Nurses in France and Flanders [n.d.].  Available at: http://www.fairestforce.co.uk/21.html [accessed 7 September 2022].

[61] Ibid.

[62] Violet Barugh, Correspondence, Nursing Colleague, 11 June 1926. PIN 26/20000, TNA. and Violet Barugh, Medical Board, RAMC, 17 December 1918. PIN 26/20000, TNA.

[63] Violet Barugh, Correspondence, 5 February 1919. WO 399/9662, TNA.

[64] Ibid.

[65] Ibid.

[66] Annie Binnie, Proceedings of a Medical Board, Ministry of Pensions, 16 October 1922. PIN 26/20009, TNA.

[67] Isla Stewart and Herbert Cuff, Practical Nursing. (London & Edinburgh: William Blackwood and Sons, 1899), 12.

[68] Trevor Parkhill(ed.), The First World War Diaries of Emma Duffin (Dublin: Four Courts Press, 2014), 34.

[69] Vera Brittain, Testament of Youth (Glasgow: Collins and Sons, 1980), 175.

[70] Brittain, Testament of Youth, 183.

[71] Agnes Grieve. PIN 26/20085, TNA.; Alice Dixey. PIN 26/20052, TNA.; Elizabeth Whyham (neé Eadie). PIN 26/20277, TNA.

[72] Mary Elizabeth Thomas. PIN 26/20260, TNA.; Annie Molison (neé Nicholds). PIN 26/20177, TNA.

[73] Violet Barugh. PIN 26/20000, TNA.

[74] Elizabeth Whyham (neé Eadie). Statement as to Disability, Ministry of Pensions, Unknown Date. PIN 26/20277, TNA. The date is unknown but this form was generally completed when an individual was demobilising from the military. Her demobilisation is known to be 31 January 1919, therefore this form was likely completed around that time.

[75] Ibid.

[76] Alice Dixey. Correspondence, Alice Dixey, 14 July 1922. PIN 26/20052, TNA.

[77] Annie Molison (neé Nicholds). Proceedings of a Medical Board, Ministry of Pensions, 4 October 1920. PIN 26/20177, TNA.

[78]Alice Dixey. Correspondence, Ministry of Pensions- Director General of Awards, 13 July 1922. PIN 26/20052, TNA.

[79] Elizabeth Whyham (neé Eadie). Ministry Memo, Ministry of Pensions, 21 December 1926. PIN 26/20277, TNA.

[80] Annie Molison (neé Nicholds). M.P.O. 420 (Nurses)- Application by a disabled nurse for an Alternative Pension. Annie Molison, 4 July 1921. PIN 26/20177, TNA.

[81] Anonymous, ‘The Last Act of Hun Fiendishness’, The Graphic, 9 March 1918, 299. Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0000057/19180309/014/0013 [accessed 20 January 2023].

[82] International Humanitarian Law Database, [n.d.], Practice relating to rule 28 Medical Units. Available at:https://ihl-databases.icrc.org/en/customary-ihl/v2/rule28 [accessed 15 February 2023].

[83] Anonymous, ‘Hospital Ship Sunk’ Ballymena Weekly Telegraph, 20 November 1915, 2. Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0001704/19151120/030/0002 [accessed 20 February 2023].

[84] McEwen, In the Company of Nurses, 107.

[85] Anonymous, ‘Hospital Ship Disaster: Heroic Nurses of the Anglia’, Aberdeen Evening Express, 18 November 1915, 4. Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0000445/19151118/042/0004 [Accessed 20 February 2023].

[86] Cruickshank, WO 399/917, TNA; Dawson, WO 399/2122, TNA; Foyster, WO 399/288, TNA; Gurney, WO 399/3398, TNA; Jones, WO 399/4396, TNA; Mann, WO 399/5581, TNA; Mason, WO 399/5694, TNA; McAllister, WO 399/5073, TNA; Roberts, WO 399/7079, TNA; Yvonne McEwen states that eight nurses died in the sinking of the Salta. McEwen, In the Company of Nurses, 161.

[87] Dawson, WO 399/2122, TNA. According to War Office records Dawson is buried in plot 17, row D, grave 281/24 in Etaples Military Cemetery and details of her funeral service are provided within the War Office records.

[88]Anonymous, ‘The “Anglia”’, Dublin Daily Express, 18 November 1915, 4. Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0001384/19151118/074/0004 [Accessed 20 February 2023].

[89]Anonymous, ‘The Asturias: Hospital Ship Torpedoed’, Leicester Evening Mail, 28 March 1917, 1. Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0003329/19170328/006/0001 [Accessed 20 February 2023].

[90] Anonymous, ‘Hospital Ship Torpedoed’, Berk and Oxon Advertiser, 20 April 1917, 2.  Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0002298/19170420/023/0002 [Accessed 20 February 2023].

[91] Anonymous, ‘Sinking of Hospital Ships’, Aberdeen Press and Journal, 14 April 1917, 2. Available at: https://www.britishnewspaperarchive.co.uk/viewer/bl/0000576/19170414/003/0002 [Accessed 20 February 2023].

[92]   Ibid.

[93] ‘The Last Act of Hun Fiendishness’, 299.

[94] The Wartime Memories Project [n.d.], HMHS Glenart Castle during the Great War.  Available at:https://wartimememoriesproject.com/greatwar/ships/view.php?pid=3095 [Accessed 6 February 2023.

[95] Beaufoy, WO 399/494, TNA; Blake, WO 399/683, TNA; Edgar, WO 399/2459, TNA; Evan, WO 399/2584, TNA; Henry, WO 399/3760, TNA; Kendall, WO 399/4543, TNA; MacKinnon, WO 399/13088, TNA.

[96] Beaufoy, WO 399/494, TNA; Blake, WO 399/683, TNA; Edgar, WO 399/2459, TNA; Evan, WO 399/2584, TNA; Henry, WO 399/3760, TNA; Kendall, WO 399/4543, TNA; MacKinnon, WO 399/13088, TNA.

[97] Mackinnon. Correspondence, John MacKinnon (father), 29 April 1918.  WO 399/13088, TNA.

[98]‘The Last Act of Hun Fiendishness’, 299.]

[99] Mary Elizabeth Thomas. Report of a Resurvey Board, Ministry of Pensions, 28 August 1926. PIN 26/20260, TNA.

[100] Mary Elizabeth Thomas. Letter, M.E. Thomas, 3 August 1926. PIN 26/20260, TNA.

[101] Mary Elizabeth Thomas. Medical Board, R.A.M.C, 27 January 1919. PIN 26/20260, TNA.

[102]Anonymous, ‘Gallantry of the Troops’ Liverpool Daily Post, 31 January 1918, 5. Available at: https://www.britishnewspaperarchive.co.uk/viewer/BL/0000649/19180131/087/0005?browse=False [Accessed 14 June 2021]; Anonymous, ‘Nurse’s Vivid Picture’, Birmingham Mail, 31 January 1918, 2. Available at: https://www.britishnewspaperarchive.co.uk/viewer/BL/0000644/19180131/030/0002?browse=False [Accessed 14 June 2021]; Kit Dodsworth, Private Papers of Eve and Christine Vaughan-Philips, Winter 1918/19, IWM; Burgess, Diary Entry, 30 December 1919, cited in Powell, Women in the War Zone, 355-357; Anonymous, ‘Gallantry and Discipline on Sinking Ship & Nurse’s Graphic Story’, The Scotsman, 31 January 1918, 5. Available at: https://www.britishnewspaperarchive.co.uk/viewer/BL/0000540/19180131/150/0005?browse=False [Accessed 14 June 2021].

[103] ‘Gallantry of the Troops’, 5, which includes an account of the sinking of the Aragon, as told by Lieutenant H. O. Hinchliffe.

[104] ‘Nurse’s Vivid Picture’, 2.

[105] Kit Dodsworth, Private Papers of Eve and Christine Vaughan-Philips, Winter 1918/19, IWM.

[106] ‘Nurse’s Vivid Picture’, 2.

[107] ‘Gallantry of the Troops’, 5.

[108] Kit Dodsworth, Private Papers of Eve and Christine Vaughan-Philips, Winter 1918/19, IWM.

[109] ‘Nurse’s Vivid Picture’, 2.

[110] ‘Gallantry of the Troops’, 5.

[111] Kit Dodsworth, Private Papers of Eve and Christine Vaughan-Philips, Winter 1918/19, IWM.

[112] ‘Gallantry of the Troops’, 5.

[113] ‘Nurse’s Vivid Picture’, 2.

[114] Kit Dodsworth, Private Papers of Eve and Christine Vaughan-Philips, Winter 1918/19, IWM.

[115] Anonymous, ‘Lost British Ships’, Huddersfield Daily Examiner, 30 January 1918, 4. Available at: https://www.britishnewspaperarchive.co.uk/viewer/BL/0000901/19180130/067/0004?browse=False [Accessed 14 June 2021].

[116] Kit Dodsworth, Private Papers of Eve and Christine Vaughan-Philips, Winter 1918/19, IWM.

[117] Ibid.

[118] ‘Nurse’s Vivid Picture’, 2.

[119] Anonymous, ‘Transport Lost: Heavy Death Roll’, Liverpool Daily Post, 31 January 1918, 5.Available at: https://www.britishnewspaperarchive.co.uk/viewer/BL/0000649/19180131/087/0005?browse=False [Accessed 14 June 2021].

[120] British Red Cross [n.d.], Catherine Ball.  Available at: https://vad.redcross.org.uk/record?rowKey=9888 [Accessed 16 February 2023];

Winifred Brown.  Available at: https://vad.redcross.org.uk/record?rowKey=29906 [Accessed 16 February 2023];

Gertrude Bytheway. Available at: https://vad.redcross.org.uk/record?rowKey=34664 [Accessed 16 February 2023];

Una Duncanson.  Available at: https://vad.redcross.org.uk/record?rowKey=65148  andhttps://vad.redcross.org.uk/record?rowKey=65147 [Accessed 16 February 2023];

Lilian Midwood. https://vad.redcross.org.uk/record?rowKey=150495 [Accessed 16 February 2023];

Hermione Rogers. Available at: https://vad.redcross.org.uk/record?rowKey=178927 [Accessed 16 February 2023].

[121] Roberts. WO 399/7086, TNA.

[122] Mary Elizabeth Thomas. Report on a Final Award, Ministry of Pensions, 30 June 1927. PIN 26/20260, TNA.