Technology and Culture

Easing Pain on the Western Front: American Nurses of the Great War and the Birth of Modern Nursing Practice By Paul E. Stepansky. Jefferson: McFarland and Company, 2020. Pp. 244.

Paul Stepansky revisits military nursing history to position the Great War as the moment when advanced-practice nursing first emerged. Though the advent of "modern" nursing is associated with Florence Nightingale's mid-nineteenth-century education reforms, Stepansky joins the ranks of social historians who are more focused on technique, practice, and technology—as opposed to education and class identity. His book helps to refocus attention on the actual care performed at bedside. In the context of wartime, the author mines first-person narratives to extract nurses' own accounts of their "actual caregiving activities" in the American military hospital system. He situates their reactions, opinions, and memories at the center of efforts to meet the medical challenges of the first total war.

War is traumatic, and the author begins with a chapter called "Epiphanies," which describes episodes of personal transformation as nurses awaken to the scale and horror of the challenges ahead. But the book then subordinates elements of personal biography to technical and practical elements of bedside military nursing, taking inspiration from Christine Hallett's work on British nursing practice during the First World War. It follows with chapters on the evolution of wound care and management, total palliative and convalescent care, the treatment of mustard gas burns and poisoning, the debilities of shell shock, and the ultimately futile attempts to limit the spread of pandemic influenza as the war drew to a close. The focus on nursing practice foregrounds the rapid development of emergency interventions that required expedited adoption. Nurses, caught up in the exigencies of wartime medicine, expanded many elements of their work, including their scope of surgical practice, their technical expertise, their diagnostic role, and their decision-making process around medication.

Stepansky animates his analysis and supports his argument from an enormous collection of life writing. Indeed, the greatest contribution of this work is its bibliography, an impressive collection of published and unpublished memoirs, letters, diaries, and casual reminiscences put to paper by the nurses who participated in the war effort. What emerges is a lively, enthusiastic, and sometimes quite detailed exposition. Demonstrating a broad understanding of military nursing practice, the author offers comparative analyses that situate First World War nurses' practices against experiences in other key conflicts: the American Civil War, the Boer War, the Second World War, and Vietnam. He includes several Canadian nurses who trained in the United States, and often draws practical comparisons [End Page 620] between and among nursing practices as they evolved among the military hospital systems of different Allied forces.

The technical descriptions and comparative elements are the strongest parts of the book. Nurses were readily integrated into anesthesiology in American military hospitals, for instance, in contrast to the experiences of their British counterparts. American nurses on the western front were also on the front lines of convalescent and post-operative innovation. Nursing care required constant attention to Carrel-Dakin wound irrigations, critical for preventing infection in a pre-antibiotic era. And as Stepansky points out, such care often included minor post-operative bedside surgery done independently and sometimes with minimal formal training.

The author openly admires his subjects and often adopts the rhetorical styles of his subjects and their era, especially when describing nurses' commitment to duty and responses to new "psychologically unassimilable" injuries. This is part of what makes Caregiving on the Western Front an engaging read, but the celebratory tone detracts from critical analysis. One must acknowledge the affective power of war narratives. But how do these different forms of life writing compare across categories? Since most sources are published memoirs, how might these narratives have been polished and shaped to conform to a genre of war memoir...