Introduction World War II was the largest and most violent armed conflict in the history of mankind. However, the half century that now separates us from that conflict has exacted its toll on our collective knowledge. While World War II continues to absorb the interest of military schol- ars and historians, as well as its veterans, a generation of Americans has grown to maturity largely unaware of the political, social, and mil- i t a ry implications of a war that, more than any other, united us as a people with a common purpose. H i g h ly relevant today, World War II has much to teach us, not o n ly about the profession of arms, but also about military prepared- ness, global strateg y, and combined operations in the coalition wa r a gainst fascism. During the next several years, the U.S. Army will p a rticipate in the nation’s 50th annive r s a ry commemoration of Wo r l d War II. The commemoration will include the publication of va r i o u s materials to help educate Americans about that wa r. The works pro- duced will provide great opportunities to learn about and renew pride in an Army that fought so magnifi c e n t ly in what has been called “the mighty endeavor.” World War II was waged on land, on sea, and in the air over sever a l di verse theaters of operation for approxi m a t e l y six years. The followi n g es s a y on the critical support role of the Army Nurse Corps supplements a series of studies on the Army’ s campaigns of that war . This brochure was prepared in the U.S. Army Center of Military Hi s t o r y by Judith A. Bellafai r e . I hope this absorbing account of that period will enhance your appreciation of American achievements dur- ing World War II. GORDON R. SULLIVAN General, United States Army Chief of Staff The Army Nurse Corps in World War II More than 59,000 American nurses served in the Army Nurse C o rps during World War II. Nurses wo r ked closer to the front lines than they ever had before. Within the “chain of evacuation” estab- lished by the Army Medical Department during the war, nurses served under fire in field hospitals and evacuation hospitals, on hospital trains and hospital ships, and as flight nurses on medical transport planes. The skill and dedication of these nurses contributed to the extremely l ow post-injury mortality rate among American military forces in every theater of the war. Overall, fewer than 4 percent of the American soldiers who received medical care in the field or underwent evacua- tion died from wounds or disease. The tremendous manpower needs faced by the United States dur- ing World War II created numerous new social and economic oppor- tunities for American women. Both society as a whole and the United States military found an increasing number of roles for women. As large numbers of women entered industry and many of the professions for the first time, the need for nurses clarified the status of the nursing profession. The Army reflected this changing attitude in June 1944 when it granted its nurses officers’ commis- sions and full retirement priv i l eges, dependents’ allowances, and equal pay. Moreove r, the gove rnment provided free education to nursing students between 1943 and 1948. Military service took men and women from small towns and large cities across America and transported them around the world. Their wa rtime experiences broadened their lives as well as their ex p e c t a- tions. After the war, many veterans, including nurses, took advantage of the increased educational opportunities provided for them by the government. World War II changed American society irrevocably and redefined the status and opportunities of the professional nurse. Early Operations in the Pacific The Army Nurse Corps listed fewer than 1,000 nurses on its rolls on 7 December 1941, the day of the Japanese surprise attack on Pearl Harbor. Eighty-two Army nurses were stationed in Hawaii serving at three Army medical facilities that infamous morning. Tripler Army Hospital was overwhelmed with hundreds of casualties suffering from s evere bu rns and shock. The blood-spattered entrance stairs led to hallways where wounded men lay on the floor awaiting surgery. Army and Navy nurses and medics (enlisted men trained as orderlies) wo r ked side by side with civilian nurses and doctors. As a steady stream of seriously wounded servicemen continued to arrive through the early afternoon, appalling shortages of medical supplies became apparent. Army doctrine kept medical supplies under lock and key, and bureaucratic delays prevented the immediate replacement of quickly used up stocks. Working under tremendous pressure, medical personnel faced shortages of instruments, suture material, and sterile supplies. Doctors performing major surgery passed scissors back and forth from one table to another. Doctors and nurses used cleaning rags as face masks and operated without gloves. Nurses at Schofield Hospital and Hickam Field faced similar diffi- cult circumstances. The chief nurse at Hickam Field, 1st Lt. Annie G. Fox, was the first of many Army nurses to receive the Purple Heart. Established by General George Washington during the Revolutionary Wa r, this decoration originally was for “outstanding performance of duty and meritorious acts of ext r a o r d i n a r y fide l i t y .” After 1932, howev- e r, the medal was usually restricted to those wounded or injured by en e m y action. Although unwou n d e d , Lieutenant Fox received her medal for “her fine example of calmness, courage, and leadership, which was of great benefit to the morale of all she came in contact with.” The cita- tion foreshadowed the nurses’ contribution to World War II. Throughout 1941 the United States had responded to the increas- ing tensions in the Far East by deploying more troops in the Philippines. The number of Army nurses stationed on the islands grew p r o p o rt i o n a t e ly to more than one hundred. Most nurses wo r ked at Sternberg General Hospital in Manila and at Fort McKinley, 7 miles outside the city. Howeve r, a few nurses were at Fo rt Stotsenberg, 75 miles north of Manila, and two worked at Camp John Hay, located 200 miles to the north in the mountains. Several nurses wo r ked on the island of Corregidor. The Japanese attacked the Philippines on 8 December, Philippine time. Clark Fi e l d, adjacent to the Army hospital at Fo rt Stotsenberg , suffered a three-hour air raid during which planes, barracks, and field shops were bombed. The hospital escaped damage, but the large num- ber of casualties from the air attack overwhelmed the small staff. The chief nurse at Stern b e rg sent several of her nurses to Stotsenberg to help cope with the emergency. They remained at Stotsenberg until 27 December when they received orders to evacuate to Manila. By that time Japanese forces had landed on the main island of Luzon and were approaching the city of Manila from the north. All of the nurses sta- 4 tioned outside of Manila reached the city except for two nurses strand- ed at Camp John Hay, who were taken prisoner by the Japanese. General Douglas MacArthur, commander of U.S. Army Forces in the Far East, declared Manila an open city and ordered the nurses to the island of Corregidor. MacArthur planned to hold Corregidor and the Bataan Peninsula and await supplies and reinforcement from the United States. He sent forty-five nurses from Corregidor to the Bataan Peninsula to prepare two emerg e n cy hospitals for U.S. and Fi l i p i n o forces fighting on Bataan. General Hospital 1, near Limay, receive d casualties directly from the front lines. The hospital consisted of six- teen wooden buildings and was originally well supplied. More than 1,200 battle casualties requiring major surgery (traumatic amputations and head, chest, and abdominal wounds) were admitted to this hospital within a month. Those patients strong enough for evacuation were sent to General Hospital 2, located near Cabcabin on the Real River. This hospital was out in the open, with no tents or buildings. Only a canopy of trees sheltered thousands of patients from Japanese aircraft. The Japanese bombed Hospital 1 on 29 March, scoring a direct hit on the wards and killing or seriously wounding more than one hundred patients. A nurse remembered the force of the bomb. “The serg e a n t pulled me under the desk, but the desk was blown into the air, and he and I with it. I heard myself gasping. My eyes were being gouged out of their sockets, my whole body felt swollen and torn apart by the vio- lent pressure. Then I fell back to the floor, and the desk landed on top of me and bounced around. The sergeant knocked it away from me, and gasping for breath, bruised and aching, sick from swallowing the smoke from the explosive, I dragged myself to my feet.” The sight that met her eyes was appalling. Patients had been blown out of their beds. Bodies and severed limbs hung from the tree branches. Although the nurses knew that nothing could be done to prevent further air attacks, they carried on. With each passing week the number of patients in both hospitals increased, and available supplies decreased. Lack of adequate food and clothing left American and Filipino troops susceptible to malaria, d y s e n t e ry, beriberi, and dengue feve r. Increasing numbers of troops suffered from malnutrition. By the end of March each hospital, built to accommodate 1,000 patients, was treating over 5,000. The day before the U.S. and Filipino forces on Bataan surrendered to the Japanese, the Army evacuated its nurses to Malinta Tu n n e l Hospital on the island of Corr eg i d o r. Japanese pilots subjected the island to heavy bombing for weeks following the surrender of Bataan. 5 One nurse recalled, “the air in the tunnels was thick with the smell of disinfectant and anesthetics, and there were too many people. Several times the power plant supplying the tunnel was hit, leaving us without electricity or lights. It was pretty ghastly in there, feeling the shock of each detonation, and never knowing when we would be in total dark- ness.” Each shell or bomb which hit the area above the hospital loos- ened more dust and dirt and raised the dust level in the tunnel. Ov er c r o wding further diminished air quality as the 500-bed hospital was expanded to 1,000 beds. Once Maj. Gen. Jonathan M. Wainwright, commanding U. S . forces on Corr eg i d o r, decided that surrender was inev i t a ble, he ordered as many nurses as possible evacuated to Australia. On 29 April twenty nurses left the island on two Navy planes. Only one of the planes reached Australia. The second made a forced landing on Mindanao Lake, and all aboard were taken prisoner by the Japanese. On 3 May a submarine picked up ten Army nurses, one Navy nurse, and the wife of a naval officer and took them to Australia. When the U.S. Army on Corregidor surrendered to the Japanese three days later, there were still fifty-five Army nurses working at Malinta Hospital. In July the Japanese took the nurses to Santo Tomas Intern m e n t Camp in Manila where they joined the ten nurses whose plane had made a forced landing on Mindanao Lake. The sixty-seven nurses remained prisoners of war until U.S. troops liberated them in February 1945. Recruitment and Training Six months after the Japanese bombed Pearl Harbor, there we r e 12,000 nurses on duty in the Army Nurse Corps. Few of them had pre- vious military experience, and the majority reported for duty ignorant of Army methods and protocol. Only in July 1943 did Lt. Gen. Brehon B. Somervell, Commanding General, Army Service Forces, authorize a formal four-week training course for all newly commissioned Army nurses. This program stressed Army organization; military customs and courtesies; field sanitation; defense against air, chemical, and mechanized attack; personnel administration; military requisitions and correspondence, and property responsibility. From July 1943 through September 1945 approximately 27,330 newly inducted nurses graduat- ed from fifteen Army training centers. Nurse anesthetists were in short supply in every theater of opera- tions, so the Army developed a special training program for nurses 6 U.S. Army nurse instructs A r my medics on the p roper method of giving an injection, Queensland, Au s t ralia, 1942. ( DA photograph) interested in that specialty. More than 2,000 nurses trained in a six- month course designed to teach them how to administer inhalation anesthesia, blood and blood derivatives, and oxygen therapy as well as how to recognize, prevent, and treat shock. Nurses specializing in the care of psychiatric patients were also in great demand. One out of every twelve patients in Army hospitals was admitted for psychiatric care, and the Army discharged approximately 400,000 soldiers for psychiatric reasons. The Surgeon General devel- oped a twel v e- w eek program to train nurses in the care and medication of these patients. P u blic health administrators as well as the American publ i c b e l i eved that the increasing demands of the U.S. armed forces for nurses were responsible for a shortage of civilian nurses. Responding to these concerns in June 1943, Congress passed the Bolton Act, which set up the Cadet Nurse Corps program. The U.S. government subsidized the education of nursing students who promised that fol- lowing graduation they would engage in essential military or civilian nursing for the duration of the war. The government also subsidized nursing schools willing to accelerate their program of study and pro- vide student nurses with their primary training within two and a half years. Cadet nurses spent the last six months of their training assigned to civilian or military hospitals, which helped to alleviate the critical nursing shortage. Possible assignments included hospitals run by the A rmy, Nav y, Veterans Administration, Public Health Service, and Bureau of Indian Affairs. The Cadet Nurse Corps training progr a m was extremely successful and enjoyed enthusiastic public support. By 7 1948 when the program was discontinued, more than 150,000 nurse graduates testified to its value. In December 1943 the U.S. War Department decided that there were enough nurses in the Army Nurse Corps to meet both ex i s t i n g and anticipated future demands on the Army. Consequently, the Army i n s t ructed the American Red Cross, which throughout the war had been responsible for the recruitment of nurses for the Army Nurse Corps, to stop recruiting. The Red Cross sent telegrams to local volun- teer committees in every state advising them to discontinue their sus- tained drive to enlist nurses. During the spring of 1944 intensive planning for the Allied inva- sion of France and the high number of anticipated casualties gave the Army second thoughts. Late in April the War Department advised the War Manpower Commission that it was revising its earlier decision to stop recruiting nurses. A new quota for the Army Nurse Corps was set at 50,000—10,000 more than were then enrolled. The Surg e o n General promptly announced that the Army Nurse Corps was 10,000 nurses short, leading some critics to charge that American nurses were shirking their duty and avoiding military service. Yet nurses wh o responded to the much publicized “shortfall” and tried to enlist were hindered by the collapse of the local Red Cross recruiting networks. In his January 1945 State of the Union Address President Franklin D. Roosevelt remarked that there was a critical shortage of Army nurs- es and that medical units in the European theater were being strained to the breaking point. He proposed that nurses be drafted. A nurse draft bill passed in the House and came within one vote in the Senate before the surrender of Germany. In the interim, the enrollment of over 10,000 nurses in the Army Nurse Corps early in 1945 rendered the measure superfluous. Black Army Nurses The Army Nurse Corps accepted only a small number of bl a c k nurses during World War II. When the war ended in September 1945 just 479 black nurses were serving in a corps of 50,000 because a quota system imposed by the segr egated Army during the fast two years of the war held down the number of black enrollments. In 1943, for example, the Army limited the number of black nurses in the Nurse C o rps to 160. Army authorities argued that assignments ava i l a ble to black nurses were limited because they were only allowed to care for black troops in black wards or hospitals. But unfavorable public reac- 8 tion and political pressure forced the Army to drop its quota system in 1944. Subsequently, about 2,000 black students enrolled in the Cadet Nurse Corps program, and nursing schools for blacks benefited from increased federal funding. The first black medical unit to deploy overseas was the 25th Station Hospital Unit, which contained thirty nurses. The unit went to Liberia in 1943 to care for U.S. troops protecting strategic airfields and rubber plantations. Malaria was the most serious health problem the troops encountered. Although malarial patients required an intensive amount of care, much of this work was routine and could be rendered by trained corpsmen. The nurses felt superfluous, and unit morale declined. The nurses were recalled late in 1943 because of poor health and low morale. Some were sent to general and station hospitals in the United States; others went to the 383d and 335th Station Hospitals near Ta gap, Burma, where they treated black troops working on the Ledo Road. Another group of fifteen nurses deployed to the Southwest Pacific Area in the summer of 1943 with the all-black 268th Station Hospital. In June 1944 a unit of sixty-three nurses went to the 168th Station Hospital in England to care for German prisoners of war. By the end of the war, black nurses had served in Africa, England, Burma, and the Southwest Pacific. At the Front Early in the morning of 8 November 1942, sixty nurses attached to the 48th Surgical Hospital climbed over the side of a ship off the coast of North Africa and down an iron ladder into small assault boats. Each boat carried 5 nurses, 3 medical officers, and 20 enlisted men. The nurses wore helmets and carried full packs containing musette bags, gas masks, and canteen belts. Only their Red Cross arm bands and lack of weapons distinguished them from fighting troops. They waded ashore near the coastal town of Arzew on D-day of Operation TORCH with the rest of the assault troops and huddled behind a sand dune while enemy snipers took potshots at anything that moved. That evening they found shelter in some abandoned beach houses. These p o o r ly constru c t e d, noisome structures seemed like a safe haven in which to rest. Before the night was over, however, their commanding o fficer ordered them to an abandoned civilian hospital, where they began caring for invasion casualties. There was no electricity or run- ning wa t e r, and the only medical supplies ava i l a ble were those the nurses had brought themselves. The hospital was under sporadic 9