In 1908 as part of his general army reforms, the new Secretary of State for War, Lord Haldane, established on a county system, a new part-time army of volunteer soldiers formed into a Territorial Force.  These men who had previously constituted the old Volunteers were fully trained soldiers albeit with full time jobs.  “Saturday Night Soldiers” had been a term part mockingly applied to them and indeed, joining the Territorial Force had been a good way to meet other young men of similar age and background whilst still learning how to shoulder arms.  As well as the regular weekly drills and meetings, there was an annual summer camp which “The Terriers” attended and indeed many of them were at camp when war was declared in August 1914.  The men of the Territorial Force were liable to be called to full-time service in the event of war but were only obliged to undertake home defence duties.  In actual fact, when war was declared, the majority of men serving with the Territorial Force, volunteered to fight overseas.  As early as September 1914, Territorials from the 14th London (Scottish) Regiment and The Honourable Artillery Company were fighting alongside the Regulars and by year end, twenty one further battalions of Territorial soldiers would also arrive in France.

 

All this though, was in the future and Haldane could not have envisaged in 1908 that one day his Territorial Force would play such an important role in a world conflict, or that it would acquit itself quite so well as it did, earning the respect of the initially sceptical Regular Army men.

 

In 1909, hard on the heels of Haldane’s army re-organisation, The War Office issued its own “Scheme for the Organisation of Voluntary Aid in England and Wales”.  The scheme recognised the need to provide sufficient medical back-up to supplement that of the Territorial Force, acknowledging that efficiency would not be realised unless all voluntary aid was coordinated.  Responsibility for the Voluntary Aid Detachments (VADs) was to be borne by the Territorial Associations, which were directed to entrust the work to the British Red Cross Society (which had also adopted the County system as the basis of its constitution). 

 

Detachments were divided into those for men and those for women.  A men’s detachment was led by a commandant and also included one medical officer, one quartermaster, one pharmacist and four section leaders each responsible for 12 men.  That gave a total of 56 men per detachment.  It was responsible for areas such as preparing means of transport by road, and converting local buildings and villages into suitable clearing stations and hospitals.  If called upon to do so it would also establish hospitals for the slightly wounded close to the area of operations, the men of the detachment operating as stretcher bearers and to a certain extent as male nurses.  After their enrolment, men studied first aid by lectures and practical demonstrations and were subsequently instructed in duties connected with transport and camps.

 

The women’s detachments were less than half the strength of that of their male counterparts.  They too were led by a commandant (who could be male or female and not necessarily a doctor) and comprised one quartermaster, one trained nurse as lady superintendent and 20 women of whom four were to be qualified as cooks.  The women’s detachments, it was felt, would be far more suited to the less arduous task of forming railway rest stations.  Perhaps still clinging to the notion of a legion of domestics rather than nurses, they were to prepare and serve meals and refreshments for sick and wounded soldiers and to take temporary charge of the more severe cases who were unable to continue their journeys.  In addition to a course in first aid, women were taught home nursing which extended to further tuition in hygiene and cookery and occasionally involved practical training in an infirmary.  The women would also be called upon to identify buildings which would be suitable for use as temporary hospitals and they learned how to obtain or improvise the necessary equipment and supplies.

 

In 1910 the regulations were expanded and around the same time, the scheme was also extended to Scotland.  County associations were now “empowered and recommended to delegate the formation of and organisation of detachments to the British Red Cross Society” or, if they declined to involve them, to “employ such other means of raising the detachments and of continuing the instruction as they may think fit”.  In practice this meant calling upon a brigade or county company of the St John Ambulance Association.  In both cases however, the only responsible body that the War Office recognised was the county association itself.  Local branches of the British Red Cross Society within each county appointed a county director of voluntary aid detachments who was at liberty to raise as many detachments as he felt were needed.  Following the pattern of The Red Cross Society of Japan, detachments would then be registered and consecutively numbered by the War Office – even numbers for women’s detachments, odd numbers for the men.  They would form part of the Technical Reserve and would be inspected once a year.

In a series of four British Red Cross Society manuals published between 1912 and 1914, the authors had laid down procedure on everything from treating a sting by a centipede to operating a portable steam disinfector.  By far the most well thumbed volumes were those dealing with first aid and nursing, both of them written by James Cantlie, Honorary Surgeon-Colonel of the RAMC (Territorial Force) and an authority not to be trifled with.  As early as page three of the Nursing Manual he set the tone for the way in which the nurses should conduct themselves in their improvised wards in the matter of that most trying of creatures, the patient’s relative.

 

“When the patient is very seriously ill from any cause the nurse may have a trying and annoying time with relatives.  If a patient is seriously ill the nurse should not leave the room when the visitors are present.  Moreover she must watch that the visitors give nothing to the patient, and slip no food, sweetmeat, or fruit beneath his pillow.  The hint, ‘Nurse, you may leave the room’ should be tactfully evaded if the patient is seriously ill, or during convalescence in typhoid fever.  Of course, much depends on who the visitor is, but few relatives are proof against the fervent appeals which patients are apt to make for this or that form of something to eat… Beef tea, chicken jelly, calf’s foot jelly etc should always be home-made when given to invalids; the bought preparations are not ‘just as good’ and should have no place in a sick room unless the home-made products cannot be obtained, as during war.”

 

Patients, Dr Cantlie advised, were to be washed at least once a day.  The best time of day to do this was early in the morning and the earlier the better.  In hospitals this could see the washing routine commencing at five or six o’clock and in private houses like Hickwells, it would be one of the last duties of the night nurse before she retired from her shift at eight or nine o’clock.  Kettles would have to be boiled and three or four large towels set aside for each patient.  Flannels were preferred to sponges for a sponge could become easily infected and furthermore the quantity of water held in it was difficult to estimate.  If nurses were not careful with a sponge, squeezing it too hard was liable to soak not just the patient but the bed and pillows as well. 

 

To painstakingly wash, dry and then change a sick or injured man was a laborious duty which the nurses nevertheless undertook without complaint.  The greatest difficulty, Doctor Cantlie warned, was with relatives who were liable to complain if the nurses decided to give their patients a short hair cut.  “The mother,” Dr Cantlie reasoned, “often objects to her child losing its curly locks, thinking only of her own feelings and not at all of the benefit it would be to the child.”  In the case of patients struck down with typhoid, the implications of not cutting the hair short were even more severe.  “It is legend amongst nurses” Dr Cantlie warned, “that if a male patient at the age of say 20 to 25 contracts typhoid and does not have his hair cut short at the commencement of the illness, he will be bald before he is 30.”

 

In addition to washing and changing the patient, beds would also have to be made once a day where possible and the sheets changed, sometimes frequently.  For seriously ill men and particularly those with fractures of the lower limb or spine, this might be impossible to do, but the nursing manual described in great detail precisely how a nurse should manoeuvre a patient when undertaking the bed changing routine.

 

As well as publications offered for general sale, there were of course also official rules and regulations which were laid down by the authorities.  The following information is extracted from 1917 regulations issued by The British Red Cross at Devonshire House, which governed the employment of nursing VAD members in military hospitals.  The tone was set from the very beginning, with the instruction, (printed in capitals): TO BE KEPT FOR REFERENCE.

 

1. Selected nursing members must be thoroughly recommended as in every way suitable to be employed in the Wards of Military Hospitals, and must be willing to be so employed under the following conditions.

2. They will be required to work under fully trained Nurses, and will be under the direct control of the Officer in charge and the Matron of the Hospital in which employed. Their duties will be similar to those carried out by probationers in Civil Hospitals. These include sweeping, dusting polishing of brasses, cleaning of ward tables and patients' lockers, cleaning of ward sinks and ward utensils, washing of patients' crockery and sorting of linen. These, and any nursing duties which they are considered qualified to perform, will be allotted to them by the Matron of the Hospital. (A.C.I. 1244 of 1916).

3. They must be between 21 and 48 years of age for Home Service, and 23 and 42 for Foreign Service.

4. They will be required to live in quarters provided by the Nursing Staff of the Military Hospitals, under the control and supervision of the Matron.

5. They will be required to adhere strictly to the Time Tables in force in the Military Hospitals, and to the Regulations and Standing Orders for the Services, so far as such orders concern them. (Q.A.I.M.N.S. and T.F.N.S.)

6. They will wear the washing uniform of their detachments at all times when on duty.

7. The Uniform Allowance of paid V.A.D. nursing members employed in Military Hospitals will in future be issuable at the rate of £2 10s. 0d. half-yearly, instead of £2 as at present. The allowance will be issuable in advance at the beginning of each six months' engagement (i.e. no allowance will be issuable in respect of the month's probationary service. The first issue of the increased rate will be made, in the case of ladies at present serving, from the first day of their next six months' of service. Any member breaking her engagement within six months of its commencement will be required to refund £1 5s. of the allowance. (A.C.I. 519 of 1917).

VADs were to be appointed for one month on probation and, if deemed satisfactory for further service by the Matron, were to sign an agreement to serve for six months or the duration of the War, at home or abroad.  Their salary would be £20 per annum rising to £22, 10 shillings for those who, on completion of their current agreement, entered immediately on a subsequent term of six months' employment. Increments of a further £2 10s would be paid each six months until Probationers reaced the maximum rate of £30 per annum.

Seven days’ leave would be granted during the first six months and 14 days for the second six months.  A first class railway warrant would also be issued to nursing members proceeding to a military hospital but no further travel concessions were allowed except on normal termination of contracts.

The regulations closed with a customarily severe entreaty aimed primarily at those Probationers who wanted to work overseas.

"Unless there is any exceptionally good reason for their not doing so, members are expected to renew their contract in the Hospital to which they have been appointed, if asked to do so by the Matron.

"Much time, money and energy are wasted moving to the restless manner in which members move from one Hospital to another every six or seven months. It is exceedingly difficult to Matrons if their VAD. probationers are continually changing. Members renewing their contracts have just as good a chance of being sent abroad by the Matron-in-Chief as they would if they were on the books of Devonshire House."