Memories of a nurse on the front lines

On April 15, Boston Children's celebrates the 100-year anniversary of the Hunnewell building, the hospital's longest continually occupied structure. To commemorate the occasion, Children's Today will feature a two-part series on Hunnewell and the staff, patients and innovations that contributed to Boston Children's history.

It didn't take Sarah Fish long to realize that she preferred night duty at the hospital - at least during the air raids. On those nights, she and other on-duty nurses would extinguish the ward's lights and don long coats and shrapnel hats, lest the white of their nursing uniforms catch the eye of an enemy pilot passing overhead. Accustomed as she was to the raids - by then she could tell Allied and German planes apart by sound alone - she had no desire to spend any more time in the trenches dug between the hospital's wards than she absolutely had to. They were hot and, in the stillness of the country night, oppressive. Worse yet, their narrow contours tended to amplify the sound of the base's anti-aircraft guns.

Sarah was 28 years old in May of 1918 when she boarded a boat bound for France by way of London and New York City. War had been raging across Europe for almost four years and by the time Sarah left, the U.S. government had ramped up its recruitment of women to serve as nurses overseas several times over. Sarah, then a three-year graduate of Boston Children's School of Nursing, became one of nearly 10,000 educated nurses assigned to overseas duty when she was deployed as part of a contingent of clinicians from the Harvard Surgical Unit. Their destination: the No. 22 General Hospital in Dannes Camiers, France.

On a boat to France

Aboard the SS Megantic in 1918

Dannes Camiers was, and still is, a small township some 150 miles north of Paris on the northern French coast - England was only a few hours away by boat. It was also just five miles north of Etaples, the principal depot and transit bay for the British Expeditionary Force in France. The hospital at Etaples was a major destination for wounded soldiers, as it was for German fighter pilots.

Only weeks before, an air raid had blown apart one of the hospital's wards, reduced six more to ruin and badly damaged three others, leaving the hospital completely demolished.

"Most of the nurses have been at Etaples, and the Huns [one of many colorful nicknames Allied supporters had for the Germans] have been unmerciful," Sarah wrote in her diary on June 8, the day she arrived. Only weeks before, an air raid had blown apart one of the hospital's wards, reduced six more to ruin and badly damaged three others, leaving the hospital completely demolished. When Sarah and other nurses stopped at Etaples on their way back to No. 22 from Paris days later, they discovered two new American flags gracing the entrance to a nearby cemetery - a new and final home for fellow nurses serving the war effort.

Dannes Camiers was less strategically important and fell prey to air raids less often. For Sarah and the clinicians and soldiers at No. 22, signs of the war revealed themselves in other, surprising ways. When she arrived, Sarah found no patients at No. 22, although she had seen many ambulances on her way to the hospital. Much of the equipment was at least partially packed for quick transport in an emergency and the trenches snaking in between the wards and circling the hospital were new additions - until recently, the nurses and other staff would run to the hills during air raids.

Before they went to sleep, the nurses would set heavy clothes next to their beds; they were to put them on and run into the trenches in the event of an air raid. The nights she spent in those narrow depressions were among Sarah's worst memories of her time in France. Nurses tending to badly injured soldiers in certain wards were often spared from that experience because their patients could not be moved. Instead the nurses lowered them to the floor, where the sandbags piled around the edge of the building offered a measure of protection from German guns.

A hospital at a crossroads

Inside a ward at Dammes Camiers

At the time Sarah was serving overseas, nursing in the United States was still in its infancy; the profession had existed in England for almost a decade before the first American nursing schools were created. Boston Children's School of Nursing, one of the first nursing schools in the country, was officially established in 1889, although hospital medical staff had been training nurses since 1871.

It was the standard practice at the hospital during the 18 years in between to admit two or three women into the nursing program at a time to earn their certificates of recommendation. Women admitted into the hospital's program were given room and board and were required to complete six months of study and pass an examination in order to earn their certificates. Nursing education at Boston Children's continued this way until 1891 when a group of seven students received the school's first diplomas.

That the quality of neither the hospital's care nor its nursing education had declined was a major source of pride for the entire institution.

By the turn of the century however, the hospital's home on Huntington Avenue could no longer keep pace with its tremendous growth and the board began the process of relocating to Fenway. In order to accommodate the increasing patient load - the relocation expanded the hospital's capacity to 145 beds from only 60 - the board dedicated the East Wing of what became the Hunnewell building to the School of Nursing, space enough to house 70 nurses.

Four months after the school reopened on Longwood Avenue - and with Sarah a year away from completing her studies - war officially broke out in Europe. Life at the school and around the hospital as a whole, already hectic with the stress and work of relocating patients, equipment and staff to Fenway, grew only more complex. New additions to the staff size were soon offset by the departures of physicians, surgeons and later nurses for London, Paris, Etaples and other key cities. Unfazed, the Sisters of St. Margaret, an English organization tasked by the hospital's board with administering the nursing school, were determined to do more with less.

Yet, across the Atlantic and for the first few months anyway, Sarah found herself confronted with the exact opposite problem.

A bug in Europe

An ambulance at Dammes Camiers

Why No. 22 should be so quiet was no mystery to Sarah. "At present all Northern France is in the grip of an unknown influenza bug," she wrote. "We hear that 10% of the British Army [is] sick and that the talked-about German drive in this section is being held back because so many Germans have it." That unknown bug was the Spanish Influenza and in 1918, it was tearing through Europe, claiming the lives of civilians, soldiers and medical staff alike. But the full force of the epidemic - it would go on to claim more lives than the war itself - was enough to stop the war only momentarily and by summer's end, it would make itself known to Sarah.

When she returned from duty a few months later, Sarah returned to the U.S. and to Boston Children's to find the hospital a changed place.

After September, Sarah writes, "work never ceased." Although Dannes Camiers fell victim to fewer and fewer air raids, "the wounded poured in day and night, Americans among them - and such wounds!" Abdominal and knee wounds were frequent and amputations common, although most men had to be treated for multiple wounds. Sarah had by then developed a perpetual backache and the medical team had long since stopped thinking of time as either on-duty or off-duty.

Maybe it was because of the fresh country air or the relative peace of Dannes Camiers or maybe even the attention of their nurses - some wasted no time inviting nurses to picnics and dinners - but the soldiers that Sarah and others treated at No. 22 did their best to keep spirits high. That became a much easier task when news of the armistice reached the hospital. Sarah writes: "When the day came we heard only rumors and it was not until 6 p.m. that suddenly every whistle in Dannes Camiers burst forth in a mighty sound. It was the most particular dramatic moment I had ever felt and I started to weep but instead went back to the boys, who took it all very quietly, and we sang Tipperary over and over again."

More with less

Sister Fish with her roommate at Dammes Camiers, Sister GatesWhen she returned from duty a few months later, Sarah returned to New England and to Boston Children's to find the hospital a changed place. The School of Nursing, overseen for 44 years by The Sisters of St. Margaret, was now under direct hospital management and forming stronger partnerships with neighboring nursing schools, including the Simmons School. For its contributions to the war, the school had received a bronze Edith Cavell and Marie dePage medal from the Belgian government.

That the quality of neither the hospital's care nor its nursing education had declined was a major source of pride for the entire institution. It was enough to prompt at least one director to declare that, since the hospital had fared so well with so many serving overseas, the staff must not have been working hard enough in the decades before the war - and that, with the return of so many, the quality of care should get even better.

The year she returned, Sarah became assistant superintendent of the school (acting superintendent during the summer) and married Charles P. Woodsworth, with whom she would go on to raise two daughters. If her decision to later join the Red Cross to recruit nurses during the Second World War is any reflection on her experience in France, it's that she considered her time there a positive experience. In one of her last entries during her time in Dannes Camiers, Sarah ended simply that she felt "only too thankful that I could go to France when I did, that I have had such a wonderful experience even if only for a comparatively short time and also thankful for my dear friends."

All photographs courtesy of the Boston Children's Archives Program.