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Pirogov and the Grand Duchess

This chapter is developed in the context of the Russian army, which was deeply permeated with corruption and graft. It was essentially an eighteenth-century army in the 1850s, fighting industrialized countries. The soldiers were basically all serfs; in the officer corps there were dramatic contrasts between ignorance and incompetence at one end and intelligence, energy, and cosmopolitan professionalism at the other. This was also true of the medical department and its nurses, the ‘feldshers.’ The internationally renowned surgeon Nikolai Ivanovitch Pirogov, who became director of the nursing service, is introduced, as is the widowed sister-in-law of the Tsar, Grand Duchess Elena Pavlovna, his patron at the imperial court. She had the daring idea of sending female nurses to work on the battlefield. Together these two individuals established the Sisters of the Exaltation of the Cross, a lay sisterhood of clinically trained nurses devoted entirely to military nursing. Local women had come forward to help with the nursing, but once the trained Sisters arrived they were so superior that the local women were relegated to minor roles. On arrival in the Crimea, Pirogov immediately began organizing and vastly improving the hospitals.

in Beyond Nightingale

Pirogov and the other principal surgeon, Christian Hübbenet, soon became highly dependent on the Sisters because they were so much more competent than the untrained local women. Pirogov divided the Sisters into three groups, surgical nurses, pharmacists, and housekeepers, and placed them in charge of hospital administration. He also introduced his famous triage, saving many more lives. Hard work and typhus soon decimated the Sisters and a number died. By early spring many doctors, including Pirogov, also fell ill and some died. A major problem now developed among the Sisters. They played mean tricks on each other and there was a great deal of infighting which Pirogov and the senior Sisters were unable to stop. Constant trench warfare, the sorties that the Russians sent into the allied trenches, and the increasingly lethal allied bombardment kept the Sisters and doctors working under fire at an inhuman pace. Pirogov and Hübbenet were amazed by the Sisters’ selflessness and their courage and coolness under direct fire, which the doctors at first thought quite uncharacteristic of women. Pirogov now taught the able nurses to do specific medical procedures, some of which Hübbenet thought they did better than the doctors.

in Beyond Nightingale
An absence of trained nurses and basic resources

The Ottoman Empire was far more backward than the Russian. Furthermore, there appears to be no information in the Turkish archives on the Crimean army’s medical department. Two British observers, Humphry Sandwith, who was a surgeon in the Ottoman army during the war, and Adolphus Slade, who was administrative head of the Ottoman navy from 1849 to 1866, provide most of the information we have about the Ottoman medical service. There seems to have been no effort to organize a nursing service. The commissariat supplied the medical service very badly, while the doctors were poorly trained and the orderlies totally untrained. Nevertheless, these doctors were anxious to learn and, equally important, they enthusiastically and devotedly cared for the Ottoman soldiers with their limited resources, giving them any nursing care they could and treating Russian prisoners with equal zeal.

in Beyond Nightingale

This chapter discusses the nature of the Crimean War, a war which incorporated much of the old eighteenth-century style of warfare, especially on the Russian side, but on the allied side saw the beginnings of twentieth-century industrialized total war. It demonstrates why this put the Russians, whose agrarian economy was based on serf labor, at an exponentially greater disadvantage, placing added burdens on the Russian nurses. In the Russian and Ottoman empires there had been little social change since the Napoleonic Wars, but the industrial revolution had produced significant changes in Britain, France, and Piedmont-Sardinia. At the same time, in these three countries a humanitarian movement was developing, and the populations were more literate and better able to put pressure on their governments, thus politicizing diplomacy and war service. The chapter explains the very major differences between military and civilian patients. It also includes an outline of the war as seen by a veteran soldier, and details the status of medicine and nursing in the 1850s.

in Beyond Nightingale

The purpose of this chapter is to examine La Motte’s work about the opium trade in order to analyze how she used her public health nursing experience to launch a crusade against it. During a trip to Asia in 1916–1917, she witnessed the impact of opium consumption and became preoccupied with exposing the corruption of the opium trade and its public-health implications. Over the next several decades she published dozens of articles and three books related to her observations and analyses of opium production and consumption, which form the basis of my analysis, using her writing to advocate for the abolishment of the opium trade. The chapter also examines how La Motte’s writings about World War One and the opium trade led to her being censored and put under surveillance by American and British authorities.

in Ellen N. La Motte

This chapter investigates La Motte’s experiences nursing in a French military hospital by using primary sources such as diaries and letters. By incorporating these items, this chapter documents La Motte’s understanding of the meaning of the war and how she originally recorded her reactions to caring for gravely injured patients and working with an international nursing group. It also studies how she transformed her initial impressions into the sketches that constitute her book, The Backwash of War, published in 1916. A reading of the published work alongside her diary allows for an investigation of how those accounts differ and how her representative practices evolved in regard to her memories of World War One. Taken together, her powerful depictions of the inside of a military hospital offer the opportunity to examine how personal and professional experiences and motivations intersected to forge distinct memories and narratives of the failures and triumphs of hospital work during the Great War.

in Ellen N. La Motte
La Motte and nursing, 1898–1913

Chapter 1 examines the milieu in which La Motte studied, the Johns Hopkins Training School for Nurses, where she began a curriculum that reflected the school’s desire to professionalize nursing and teach the latest nursing standards. Many of the women associated with the nursing school in its early years were also involved in social reform, and the models they provided of socially engaged nursing practitioners undoubtedly had a profound effect on La Motte as she eventually found her place in the anti-tuberculosis campaign in Baltimore, first as a visiting district nurse and then as an executive in the Health Department. It also discusses her development as a writer and speaker after her graduation from nursing school and examines her writings, such as her published articles about the best approaches to tuberculosis nursing, to see how she positioned herself in the debates about the most effective ways to combat tuberculosis as she developed her public voice as a nurse and reformer in these years. Through an examination of these issues, the chapter builds a picture of how La Motte progressed professionally through her work as a vocal advocate for public health.

in Ellen N. La Motte
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The end of campaigning, 1930s–1961

The conclusion discusses La Motte’s life from the 1930s until her death in the 1961. The Great Depression forced her and Emily Chadbourne to return permanently to the United States, where they settled in Washington, DC and New York State. La Motte’s publications slowed in the early 1930s, then ceased as she turned her attention to investing in real estate in the Georgetown area of Washington, DC and pursuing intellectual interests, such as business affairs or working for a brief time with the National Woman’s Party, while enjoying her circle of friends. It also offers a final summative reflection on the significance of her long career.

in Ellen N. La Motte
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Nurse, writer, activist

Ellen La Motte: nurse, writer, activist, is a biography of La Motte that traces the arc of her life, from her birth in Louisville, Kentucky, in 1873 to her death in Washington, D.C. in 1961. It integrates original unexamined sources such as diaries, unpublished manuscripts, and publishing contracts along with primary sources—letters, newspaper articles, health department reports, and public records—with an examination of her prolific published writings, about topics as diverse as tuberculosis nursing, women’s suffrage, nursing during the Great War, and the opium trade. It considers of how she developed as a nurse, writer, and activist once she entered the Johns Hopkins Training School for Nurses in 1898 and grew into a potent force in the anti-tuberculosis campaign. Gaining experience speaking and writing on behalf of controversial causes, La Motte put her talents to use on behalf of the fight for the vote for women, nursing during World War I and the anti-opium campaign.

This chapter focuses on La Motte’s decision to leave London in the fall of 1913 to move to Paris, where she stayed until the outbreak of World War One, living in the bohemian Montparnasse district while completing the culmination of her nursing work, The Tuberculosis Nurse, and attempting to develop her skills as a writer of short fiction. After the completion of the book, La Motte intended to leave nursing behind permanently and to become a writer of short fiction, a form she had been exploring for several years, as her unpublished manuscripts reveal. The start of the war in August 1914, right at the time La Motte had returned to the United States after living in Europe for more than a year, led her back to Paris and to a prolonged search to find a nursing position. During more than six months of searching, La Motte’s diary reveals that she encountered significant frustration finding a position. By drawing on her unpublished manuscripts, letters, and a diary, this chapter examines her personal and professional frustrations as she tried to put her great skills to use as a war nurse.

in Ellen N. La Motte