To say that World War I was gruesome is to understate the obvious. Updated weapons—like the 600-bullets-per-minute, rapid-fire machine gun, with a range of more than 1,000 yards—decimated infantries. Chlorine gas, phosgene, and mustard gas maimed more than killed, but caused devastating lung and skin damage. Hellish flame throwers terrorized troops. Deadly ordinance destroyed armies and landscapes. Even today, buried bombs from the Great War remain a threat in parts of Europe where wildfires have caused them to explode.

Millions of soldiers who survived the onslaught were wounded and maimed. Many suffered from “shell shock,” now better understood and accepted as Post Traumatic Stress Disorder (PTSD). And, for the first time in history, deaths from wounds surpassed deaths from disease.

In response, medicine and medical science innovated. Doctors in the field and hospitals devised new methods to save lives with improved antiseptic treatments. Surgeons learned to reconstruct shattered faces. Dentists rebuilt jaws. Orthopedists created lighter-weight prostheses to replace lost arms, hands, and legs. Blood transfusions, a technique in use prior to the War, became safer and more effective with the discovery of coating the inside of the blood storage vessel with paraffin to delay clotting and preserve supplies. By the end of the War, this enabled wounded soldiers to receive transfusions closer to the front lines, giving them better odds of surviving transport to field hospitals.

Dr. Harvey Cushing

Among the innovators was the American neurosurgeon Harvey Cushing, who came to the American Ambulance Hospital in Paris in 1915. In Line of Flight, Cushing inspires Camilla to follow in his footsteps, after she witnesses him removing shrapnel from a patient’s brain with a giant magnet.

I discovered Cushing’s surgical technique in his diary, From a Surgeon’s Journal 1915-1918 (Little, Brown, and Company, 1936) where he describes the procedure. The magnetic probe was large and cumbersome, and on this particular day, April 29, 1915, Cushing tried several times, unsuccessfully, to draw out a tiny fragment of shrapnel from a wounded soldier’s brain. An assistant had the idea to enhance the probe’s reach by attaching a large wire nail, about six inches long with a rounded tip, to the probe. I’ll let Cushing describe what happened, next:

Well, there was the usual crowd in the X-ray room and approaching corridor, and much excitement when we let the nail slide by gravity into the central mechanism of smiling Lafourcode; for at no time did he have any pressure symptoms, and all of these procedures were of course without an anæsthetic. . .

[After developing the X-ray plate to see if the nail and missile were in contact] we finally traipsed into the first-floor operating room, where Cutler mightily brings up the magnet and slowly we extract the nail—and—there was nothing on it! Surpressed signs and groans. I tried again, very carefully—with the same result. More sighs, and people began to go out. A third time—nothing. By this time I began to grumble . . .

I had taken off my gloves and put the nail down; but then—let’s try just once more! So I slipped the brutal thing again down the track, 3 ½ inches to the base of the brain, and again Cutler gingerly swung the big magnet down and made contact. The current was switched on and as before we slowly drew out the nail—and there it was, the little fragment of steel hanging on to its tip! Much emotion on all sides . . .

Cushing was a gifted writer as well as a pioneer of neurosurgery, and his account of his war experiences is as vivid as this excerpt. Discovering his journal was a gift. He not only inspired one of my lead characters; he inspired me, as well.

Illustration of the magnet from Cushing’s Journal

Evelyn Herwitz writes about the journey of writing her first novel—a work of historical fiction set in World War I—the vagaries of the creative process, and her quest for publication, at evelynherwitz.com.

Top Image: “WWI: nurse and patient outside stationary hospital, Rouen” from photograph collection of Lieutenant Colonel G.J.S. Archer, RAMC. 1914. Via Wiki Commons.

In October 1914, two-and-a-half months after Germany launched WWI in Europe, Dr. Mary M. Crawford, a graduate of Cornell University (’04) and Cornell Medical College (’07), set sail for France—one of six American surgeons journeying to Paris to assist in medical treatment of combatants at the American Ambulance Hospital at Neuilly-sur-Seine.

In Line of Flight, Dr. Crawford becomes a mentor to Camilla, who expands her goals beyond nursing to become a physician after the War. Dr. Crawford’s vivid descriptions of her experiences at the American Ambulance were published in 1915 and 1916 as “Letters from a French Hospital” in the Cornell Women’s Review (Vol 1, No. 2–5). Her words helped me to envision and recreate the world inside the hospital, and inspired some of the events and characters in my novel.

She was a woman of her times, and her sense of noblesse oblige is on full display in her letters; and yet, I found her to be a fascinating trailblazer who deeply cared for her patients and believed in her mission. Here are a few excerpts—about devastating injuries, medical innovations, a Zeppelin attack, fear of the War’s escalation, and the courage and grinding stress of life at the American Ambulance:

12 November 1914

“The days are so full, the nights seem so short, that letters can’t be written. Tonight I’m sad. I have a dear young French boy who is wounded in the arm, he had a terrific hemorrhage before he came to me, and tonight he has just had another fearful hemorrhage. Luckily I was in the next ward and rushed in in time to get a tourniquet on his arm. Now he is quiet, the bleeding has stopped, and I’ve begun giving him saline and stimulants. We shall probably transfuse him if he lives. I do hate to lose these poor fellows.”

1 December 1914

“To-day the electro-magnet covered itself with glory. We drew a huge piece of shrapnel right out of the middle of a man’s lung with it. Dr. Blake was so skillful. The way in was curved, so he took the steel end, put it in a vise, and bent it correctly, and then managed to get it in the right way. It was like some super-thrilling fishing!”

16 December 1914

“I am tired to-night. I’ve taken a bath and washed my hair, which is an undertaking, for this water is very hard and you have to use ammonia and borax to get results. Two days ago Dr. B. gave me charge of nine dental cases. They are the men who have fractures of the upper or lower jaws besides other wounds. The American dentists here are doing wonderful work—some of the most brilliant that is done in any department. I have a camera now and am going to photograph all of these poor fellows together. Such deformities you never saw. The whole front of one man’s face is gone; how we are ever going to build him a new one I don’t see, but as soon as he is ready we’ll begin grafting and plastic work generally.”

13 January 1915

“I must write you just one more story that came to me at the Ambulance just a little while before Xmas. We had a French soldier brought in frightfully wounded. One leg had to be amputated, and besides that he had a half dozen other wounds. His dog came with him, a hunting dog of some kind. This dog had saved his master’s life. They were in the trenches together when a shell burst in such a way as to collapse the whole trench. Every man in it was killed or buried in the collapse and this dog dug until he got his master’s face free so that he could breathe, and then he sat by him until some reinforcements came and dug them all out. Every one was dead but this man.”

22 February 1915

“Somehow I’ve not been able to write a word these last few days. We’ve had plenty to do and I’ve been tired at night. We all discuss the chances of the United States being dragged into the War. Every day we rush for the papers to see how many more ships have been torpedoed. It is a ghastly business all around. I’m glad I’m not planning to come home yet, for I’d hate to be blown up. How awful it would be if an American ship were destroyed and war declared.” [Note: Britain’s R.M.S. Lusitania was torpedoed by a German U-Boat a few months later on May 7.]

16 March 1915

“I’m startled to find that I’ve let more than a week go by without telling you all about the Zeppelin raid. Except in my postals to Father, I mentioned that we had thrills. It was a most wonderful occasion. Every one felt that it was worth crossing the Atlantic for just that one night. The bugles blew the alarm about one o’clock. Immediately all the electricity in the A. A. was turned off while in the street men were running around turning off the old gas lamps by hand. Neuilly has not progressed to street electricity. Almost immediately the search lights were flashing everywhere and the guns of the forts began to boom. Suddenly right over the Ambulance appeared a Zeppelin, lighted by the searchlights. The Eiffel Tower guns began shooting too, and in the dark the trail of the shells could be seen. So the ambulance was shot over in two directions. It was a curious sensation. No fear but tremendous excitement. Lots of us on the Terrasse watching and groaning as we’d see the shots pass too low. Zeppelin No. 1 passed out of sight and then No. 2 appeared, even lower down than the first. I assure you that guns booming in earnest sound very different from practice or salutes. Last sight of all was a flock of biplanes with searchlights on their front, patrolling the sky. We tumbled into bed at last, tired but exhilarated. A bomb had been dropped only three streets away from the Ambulance, so we really were in a little danger. Paris is full of tales about How and Why the Zeppelins managed to get here at all. And some sort of military investigation is going on. . . .

“Here we are in the midst of a rush of work that is awful. Not that we aren’t glad and able to do all that comes to us, but awful in what it signifies. The fighting in Belgium at present is the most frightful since the beginning of the war. The English, the Canadians, the Zouaves, and at the back, the French territorials are in a death grapple with the maximum force of the German army. For the last five days, the freshly wounded men, right off the battlefield, have been pouring into Paris alone about 500 a day! This is only a small percentage of the whole. We have been taking them in at the rate of 15 or 20 a day, as fast as we can empty our beds, or get extra ones. We are full up now, but each day we send out older cases to make room. We are getting the Zouaves, the best soldiers France has, and generally a pretty nasty proposition to go up against. These men say it is a massacre on both sides. . . .

“With all this we keep getting rumors from high official sources that on the French front things are going wonderfully. They look for a sudden and complete crumpling up of the German line. The wounded say the same thing as they come in from Arras in a different way. The French are fighting magnificently and are, I believe, a better machine today than the Germans. The waiting and working blindly seem more than we can stand sometimes. I would to Heaven the end were in sight!”

After a year at the American Ambulance, Dr. Crawford returned to Brooklyn, N.Y., where she had been Chief Surgeon at Williamsburg Hospital and had established a private practice before embarking to France. She helped to raise funds for French hospitals, as well as founded the medical department at the Federal Reserve Bank of New York, which she led as medical director from 1919 until she retired in 1949. She married Edward Schuster, an attorney who specialized in Latin America. Dr. Crawford also served as an alumna trustee of Cornell, vice president of the American Women’s Association, president of the Cornell Medical College Alumni Association, and co-founder of the American Women’s Hospital Service. She died in New York on November 17, 1972, at 88 years old.

Image Credits:
American Ambulance Hospital, Wikki Commons
Dr. Mary M. Crawford, Wikki Commons

Evelyn Herwitz writes about the journey of writing her first novel—a work of historical fiction set in World War I—the vagaries of the creative process, and her quest for publication, at evelynherwitz.com.

Uniforms are cultural artifacts. They encapsulate social values, priorities, gender biases, romanticized ideals, and more. Practicality factors in, too. During WWI, for example, combat soldiers stopped wearing bright colors that had characterized European military uniforms for centuries, in order to make themselves less visible to the enemy in trench warfare.

As I built the world of 1915 for my novel, I researched uniforms of the period—not only for soldiers, but also for nurses in France, where much of the story takes place. In the process, I uncovered a wonderful book, French Fashion, Women & the First World War edited by Maude Bass-Krueger and Sophie Kurkdjian, a companion volume to the exhibition by the same name at the Bard Graduate Center Gallery in New York, September 5, 2019 – January 5, 2020.

Here I found photos and illustrations of French nursing uniforms, as well as the history behind them. No surprise. It’s complicated.

One glimpse of a WWI-era French nurse, and you immediately think of nuns, due to the short, habit-like veil that concealed most or all of the woman’s hair. But nuns, who had publicly tended the sick in France since the sixth century, had been banned from hospital service after the French Revolution. According to Johanne Berlemont’s and Anaïs Raynaud’s “Nurses’ Uniforms” essay in French Fashion, nuns returned to clinic work in the 19th century, only to be virulently opposed by radical republicans, who perceived them as “bigots with narrow moral conceptions” and who campaigned to oust them from military hospitals. By the early 1900s, the secularization and professionalization of nursing was complete, and nuns no longer worked in French hospitals.

Nurses’ uniforms, however, still echoed nuns’ habits. Berlemont and Raynaud note that Louis Pasteur’s discoveries about the importance of sanitized hands, equipment, and spaces in medical settings also influenced uniform design:

“Nuns preferred dark habits, which hid dirt, but hygienic doctors rejected these because it was difficult to detect possible soiling, and so the white cotton apron replaced the dark wool dress. Cotton was chosen for its easy cleaning and maintenance. Even though the length of the skirts and coats was not specified, photographs show that they were worn to just above the ankle. Veils were simplified so that nurses could work with ease, but eventually they were replaced by a cap that hid the hair for hygienic as well as moral reasons. Because nurses were expected to suppress any hint of sexual passion, hair, a traditional agent of feminine seduction, was hidden in order to conform with moral restrictions placed on women working in such close proximity to men.”

Secular nurses serving in French military hospitals were drafted into service on August 2, 1914, reporting to doctors in hospitals or at the front. As casualties mounted, however, more help was needed. Civilian nurses joined their ranks, and non-professional volunteers, typically wealthy women, helped care for the wounded behind the lines and back home. Berlemont and Raynaud observe, however, that these volunteers, who scored high-society points through charitable work, were not roundly appreciated:

“For some upper-class women, serving as nurses meant that they could exhibit their charity in broad daylight as they cared for the wounded. However, as a group they were frequently mocked by their colleagues and the press who were unable to see beyond social hierarchies to the sincere and important involvement of volunteers. Many worked with ambulances on the front line and in hospitals at home, and their work enabled the health-care system to function.”

Trained nuns, too, were ultimately allowed back into hospitals, given the overwhelming need for good nursing care. A romanticized notion of nurses as ministering angels took hold of the public imagination. In magazines, posters, and postcards, they were often portrayed as saintly women—but also, sometimes, as sex objects for men’s fantasies. Nurses’ uniforms became symbols of purity and elegance (and forbidden sex), and were embraced by women’s fashion magazines, to the point that the French Minister of War issued a decree in March 1915 that regulated when the uniform could be worn.

The evolution of the French nurse’s uniform also reflected women’s emancipation during the War. From the dark, heavy habit of a religious penitent to the light, cotton dress and bib with Red Cross insignia, these changes in fashion reflected the need for easy-to-clean, comfortable, affordable work-wear that enabled French nurses to play their essential role in caring for millions of sick and wounded.

Evelyn Herwitz writes about the journey of writing her first novel—a work of historical fiction set in World War I—the vagaries of the creative process, and her quest for publication, at evelynherwitz.com.

Image: Bain News Service, Publisher. French Red Cross nurses. [Between and Ca. 1915] Photograph. Retrieved from the Library of Congress.