A SUITABLE WOMAN FOR THE JOB
It’s rare to find any reference to the background of women who served as military nurses during the Great War. Published sources often fail to highlight the differences between the small number of nurses who were part of the ‘regular’ Queen Alexandra’s Imperial Military Nursing Service [QAIMNS] and those who joined the Reserve after the outbreak of war on short-term contracts. Sometimes it seems as though these women appeared from nowhere, already hatted and caped and ready to take their part in the drama of wartime. They are given no beginnings, no childhood, no education, and a nurse training that can be guessed at but not confirmed. The reader is left to wonder if they were, perhaps, born as ‘Sister.’ The pre-war members of QAIMNS formed the heart of the military nursing services during wartime; their number was small, but their experience of army life was formidable. What sort of women were they? To give them a history before they put on their uniform of grey and scarlet, existing sources have been used to compose a group portrait.
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At the outbreak of the First World War, QAIMNS was just twelve years old, and although larger than its predecessor, the Army Nursing Service [ANS], it remained a small select body. Following its formation in 1902, sixty-five nurses already serving with the ANS were transferred to QAIMNS, and by the outbreak of the Great War another 466 women had been appointed to the new service. The wastage rate was high, with women leaving due to marriage, ill-health, or in search of a career change, and on the eve of war QAIMNS was 297 nurses strong. Few official records survive at The National Archives or elsewhere for members of the Army Nursing Service who joined between 1880 and 1902. Although census returns now offer increased opportunity for unravelling the background of members of this older cohort of military nurses, the information is not sufficiently comprehensive to allow a broad view of the group as a whole. From 1902 onwards a new register of entrants to QAIMNS included more detailed biographical and professional information. This allows some conclusions to be drawn regarding the background of the 466 women who joined Queen Alexandra’s Imperial Military Nursing Service between March 1902 and August 1914.
For appointment to QAIMNS as a Staff Nurse or Sister, women had to be between twenty-five and thirty-five years of age, well-educated, of good social standing, and with a three year training in a hospital approved by the Nursing Board. This last requirement caused considerable problems as the list included the names of only thirty-four hospitals throughout the United Kingdom, all large teaching hospitals, and it therefore excluded the vast majority of trained nurses from applying to join the service. At a meeting of the Nursing Board on 15 June 1904, Sydney Holland drew attention to the fact that the Service was losing good potential candidates and he urged them to consider each application on its merits:
Nurses may, in some cases, obtain a more thoroughly practical training in small hospitals than in large ones with Medical Schools attached. In the latter class much nursing work is carried out by students, whereas in small hospitals all the nursing and the dressings, as well as the sterilization of instruments and appliances, are done entirely by the Sisters and Nurses, who obtain thereby a familiarity with details of their profession which is not possible in those large hospitals which educate students for the medical profession. The lectures, too, given at the small hospitals are just as good as those given at the large ones, while the supervision by the Matron extends to matters of more minute detail than is possible in large hospitals. He urged that if a Nurse trained at a hospital of less than 100 beds applied for admission to QAIMNS the Board should consider her application on its merits.
In spite of an initial reluctance on the part of the Board, nurses were soon being appointed from smaller hospitals nationwide, though with the majority still coming from those with medical schools attached, particularly in London.
Despite this one concession, the insistence on women having good social connections was not relaxed. The application form asked for the names of 'two persons to whom reference can be made, one being a lady, not a member of your own family'. Some forms had the wording altered by hand to request that both referees should be 'ladies,' but as the years passed more emphasis was placed on one referee being the matron of the applicant's training hospital, with only one reference required to confirm their social suitability. During 1903 and 1904 the minute books of the Nursing Board demonstrate that while there was difficulty in recruiting sufficient nurses to fill available posts, there was certainly no lack of applicants. However, the majority failed either to provide a sufficiently good hospital reference, or more likely they failed to impress the interviewing panel, the reason for their rejection being spelled out in plain terms. Miss W. P. was merely 'too delicate for the work; could not go abroad', while Miss L. D. had 'an apparent want of social standing, and appearance unsuitable'. Miss W. was rejected on the grounds that she was 'a coloured lady from America'; Miss N. H. was 'flippant' and Miss M. M. 'Quite unsuitable; father an iron-plate worker; mother cannot sign her name'. These comments continued for nearly two years, until it was decided in June 1904 that any future observations on social status would be omitted, and replaced by comments such as 'not considered suitable' or 'not recommended.' Thus, by reason of the selection process, Queen Alexandra's Imperial Military Nursing Service became an elite within the profession, an organisation of well educated and expertly trained gentlewomen, and, as such, considered fit to work alongside doctors of the Royal Army Medical Corps in military hospitals both in the United Kingdom and abroad.
Accounts of military nurses during the Great War often describe them as ‘young’ and Ian Hay provides a typical example when he comments: “Here are some characteristic extracts from the diary of a very young Nursing Sister, begun upon August 14th, only ten days after the declaration of war. They will strike a reminiscent chord in the heart of many a ‘Q.A.’ of those days.” Perception of age is a subjective matter, but as a group those members of the ‘regular’ service did not conform to a popular view of ‘very young,’ even in August 1914. The birth dates of the women who mobilized covered all years from 1859 to 1889, with more than three-quarters of them between thirty and forty-five years of age, and only thirty-five being under the age of thirty. As the war progressed and the shortage of trained nurses reached critical levels, the average age of new applicants to both the regular service and the Reserve went down, but the minimum age for appointment of twenty-five years was, on the whole, maintained, with only a handful of younger women being accepted. In August 1914 it was a service of mature women, experienced both as nurses and in the ways of the army.
Florence Nightingale once suggested that the best nurses were found among the ranks of the daughters of small farmers and a study of the profession of the women’s fathers shows that farmers figured highly, although not in top spot on the list. From the earliest days of the Army Nursing Service (1861) it was an unwritten rule that when engaging new staff, preference should be given to the daughters and widows of military officers. Although the service included a fair proportion of women with a military family background, there seems to be no evidence that there were ever enough such candidates to form a majority. From 1902 this information was recorded for each applicant to the service, and it shows a wide range of occupations. The women were very conscious that they had to impress the Nursing Board, and their own interpretation of their father’s profession did not necessarily agree with the information offered in census returns, a few being guilty of ‘gilding the lily.’ From a total of 465 women for whom this information is available, the top twenty out of fifty-eight categories are:
MINISTER OF THE CHURCH [all denominations] - 57
FARMER - 56
MERCHANT - 47
ARMY OFFICER - 40
CIVILIAN PHYSICIAN/SURGEON - 34
SOLICITOR/LAWYER - 25
ENGINEER - 19
GENTLEMAN/LANDED PROPRIETOR/INDEPENDENT MEANS - 20
BANK OFFICIAL - 16
CIVIL /COLONIAL SERVICE - 16
OFFICE CLERK/MANAGER - 12
MANUFACTURER - 11
TEACHER - 10
SHOPKEEPER/SALESMAN - 8
MERCANTILE MARINE - 7
ROYAL NAVAL/MARINE OFFICER - 7
LAND AGENT/ESTATE AGENT - 6
MILITARY DOCTOR - 6
ARTIST/MUSICIAN - 5
JOURNALIST - 5
This shows that half of all the women  had a father in one of the first five categories, and within the ‘unique’ professions, i.e. where only one example can be found, they include a lithographer, a relieving officer, a museum curator, an indigo planter and the manager of a salmon fishery. Ethel Becher, Matron-in-Chief at the War Office throughout the Great War, was the daughter of an officer in the Bengal Staff Corps; Maud McCarthy, Matron-in-Chief in France and Flanders, the daughter of a solicitor, and Anne Beadsmore Smith, who replaced Miss Becher at the War Office in 1919, gave her father’s profession as ‘Gold and Silver Merchant.’ Overall it shows a diverse range of professions drawn almost entirely from the middle classes.
As befitted their family background, the majority of the women who joined QAIMNS between 1902 and 1914 were privately educated. Many improvements had taken place in the education of women as a result of the report of the Schools Enquiry Commission, published in 1867, and the latter decades of the century saw a rapid increase in the number of schools for girls. Of the 466 women, forty were educated exclusively at home, either by governess, private tutor, or by their father, eighteen of these being the daughters of clergymen. As might be expected the older members of the service are more likely to be included in this group with no experience of school life. The remainder attended a wide variety of establishments, including Cheltenham Ladies’ College (4); a number of different Clergy Schools (9); the London Orphan Asylum (2); Girls’ High Schools and Grammar Schools in large towns and cities throughout the United Kingdom, and many small private institutions. More than ten per cent of the group also spent part of their education at colleges and finishing schools abroad, in France, Belgium, Germany and Switzerland, and their language skills would stand them in good stead during wartime.
As already mentioned, it had been decided in 1902 that admission to QAIMNS would be restricted to applicants who had trained in one of just thirty-four hospitals approved by the War Office. It was believed that these prestigious hospitals would not only provide a better nurse training, but due to their reputation and high status, the competition for places at the schools of nursing would result in a high standard of entrant, and offer a ready-made pre-selection process for the army. The original list of institutions, approved in 1903 was as follows:
Charing Cross Hospital; Guy’s Hospital; King’s College Hospital; The London Hospital; Middlesex Hospital; Royal Free Hospital; St. Bartholomew’s Hospital; St. George’s Hospital; St. Mary’s Hospital; St. Thomas’ Hospital; University College Hospital; Westminster Hospital.
Birmingham General Hospital; Birmingham, The Queen’s Hospital; Bristol General Hospital; Bristol Royal Infirmary; Addenbrooke’s Hospital, Cambridge; Cardiff Infirmary; Leeds General Infirmary; Liverpool General Infirmary; Manchester Royal Infirmary; Newcastle-on-Tyne Royal Infirmary; Radcliffe Infirmary, Oxford.
Aberdeen Royal Infirmary; Dundee Royal Infirmary; Edinburgh Royal Infirmary; Glasgow Royal Infirmary; Glasgow Western Infirmary.
Belfast, Royal Victoria Hospital; Dublin, Adelaide Hospital; Dublin, Mater Misericordiae; Dublin, St. Vincent’s Hospital; Dublin, Sir Patrick Dun’s Hospital; Dublin, The Richmond Hospital.
During the first decades of the twentieth century most provincial hospitals were small, and the War Office’s insistence on selecting candidates only from those hospitals with more than one hundred beds greatly restricted the pool from which they had to choose. London predominated on the ‘approved’ list, and the training schools of the nurses actually appointed to QAIMNS shows an even greater emphasis on a London training. Of the total number of women in the group (466) 204 were trained at a London hospital, with only five other cities even reaching double figures; Liverpool (28), Dublin (21), Edinburgh (19), Glasgow (18) and Cambridge (13). At that time it was usual for women to choose a hospital away from home for their training, and those members of QAIMNS who trained in London came from all over the United Kingdom. By 1914 many knew each other from student days and in later years they retained the common bond of their nurse training. Even after 1904 when the rules on training hospitals were relaxed, London continued to predominate, providing not only well-trained nurses, but also women whose social background and education were found acceptable both to the country’s most eminent hospitals and to the army.
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SERVICE IN SOUTH AFRICA
Few women born after 1877 would have been old enough to have completed their training in time to serve during the Boer War. Within the whole group, forty-four women served in South Africa at some time between 1899 and 1902, and of those, thirty-seven went on to serve during the Great War. By that time some of them had already resigned or retired from the service but returned after mobilization, many being given charge of the smaller military hospitals in the United Kingdom in order to release younger women for overseas service. It is difficult to assess whether their previous experience gave them any advantage in such different wartime conditions, but having a South African medal ribbon displayed on their cape may have entitled them to a certain respect, for their staying power at least, if not for their personal qualities alone. 
These were the women who formed the heart of the service in August 1914 and filled the most senior positions both at home and abroad. Their long experience and organisational skills were essential in successfully managing large hospitals under conditions never encountered before, and also in acting as a role model for the thousands of nurses employed on short-term contracts. However, their peacetime life in army hospitals did not necessarily equip them for the hard work and privations of the Great War, and some found it difficult to cope with the stresses of unrelenting warfare over several years. Despite this, by 1919 few had fallen by the wayside and most were still there to provide a firm foundation for QAIMNS’ post-war expansion. During the inter-war years it is evident from the records that there was a relaxation in the standards previously set by the War Office for admission to the service. Fewer nurses came from families of high social status, and more were trained in smaller provincial hospitals and local authority infirmaries. It was to be a different mix of women going forward to the next war.
 The National Archives, WO25/3955: Holds limited information for a small number of women.
 The National Archives, WO25/3956: Professional qualifications and recommendations for appointments of Staff Nurses.
 Regulations for Admission to the Queen Alexandra’s Imperial Military Nursing Service, HMSO, 1916
 The National Archives, WO243/22, page 29: The Nursing Board, QAIMNS, Proceedings and Reports
 The National Archives, WO243/21: The Nursing Board, QAIMNS, Proceedings and Reports
 Hay, Ian: One Hundred Years of Army Nursing ( Cassell and Company, London, 1953)
 Seymer, Lucy Ridgely: Florence Nightingale’s Nurses (Pitman Medical Publishing Company, London, 1960)
 The National Archives, WO33/208: Discussions of Committee on re-organisation of Army medical and Army nursing services.
As an example, Flora de Stourdza-Zrinyi entered her father’s occupation as ‘Count of the Austrian Empire and Colonel of Austrian Hussars.’ Arthur Zrinyi was a naturalized British subject, born in Moldavia, and census returns show him living in Church Stretton over many years, and at that time employed as ‘Assistant Overseer and Collector of Taxes.’
 Vera Brittain describes Matron Elizabeth Ann Dowse as ‘a sixty-year-old “dug-out” with a red cape and a row of South African medals,’ and later, after describing Miss Dowse’s heroic actions during the sinking of the Hospital Ship Britannic, adds ‘How seldom it is that this type of courage goes with an imaginative heart, a sensitive, intelligent mind!’
Brittain, Vera: Testament of Youth (Victor Gollancz, London 1933)
 The National Archives: WO25/3956, op.cit.