The following extract is the chapter on the German Red Cross taken from the American War Manual Number 5. It was published in 1918 by Lea & Febiger, Philadelphia and New York. The title was "Lessons from the Enemy - How Germany Cares for her War Disabled"

by John R. McDill, MD. FACS., Major, Medical Reserve Corps, U.S. Army.

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VOLUNTEER NURSING AND WELFARE

WORK UNDER THE RED CROSS.

In addition to the minutely thought-out official sanitary corps of the army with its punctiliously drilled personnel and its perfect equipment there was in Germany a vast system of semiofficial and volunteer relief organization ready to be put into service at the first call for mobilization. Germany had learned in her wars of 1864-66 that the many deficiencies in the sphere of voluntary nursing, which was inaugurated at that time, were due to a lack of a firm organization and adequate preparation during times of peace.   To correct these deficiencies became a matter of national concern.

ORGANIZATION. In the first place the Red Cross organization has existed in Germany since 1864, when the Geneva convention was founded. Even before the formal adjournment of this convention, the Central Committee of the Prussian Red Cross was made a permanent institution and by 1869 it combined all the German principalities at a time when the political union of the country was still unrealized.

In Germany the Red Cross is a democratic organization, every loyal German citizen taking an interest in its success. Its laws are closely connected with the political regulations of the country; its rights and duties definitely determined by the official medico-military authorities. But it is only one of several organisations interested in the volunteer nursing service. The others are the various confessional sister-hoods of trained nurses, both Catholic and Protestant, the Knights of St. John and of Malta and others, as well as the great "Vaterlandische Frauenverein" or National League of Women, one of whose chief activities is the training of women nurses and the "Organization of Voluntary Nurses" founded by John Wickern in 1866 for the training of men nurses.

THE VATERLANDISCHE FRAUENVEREIN was established in1866 by Queen Augusta of Prussia on the occasion of the peace celebration in that year. By appropriate organization it planned to preserve in times of peace all those forces which had been active during the wars just past in the relief of distress and suffering and to keep them employed in conjunction with the Central Committee of the Prussian Red Cross.

It aimed at a combination of relief workers throughout the entire kingdom and invited all women's organizations to affiliate themselves as branch societies. It became incorporated as a regular national society, its sessions to be held in Berlin. It was to devote itself first and foremost to the training of a competent nursing personnel during peace and to welfare work of the utmost scope and variety. This organization constitutes the women's branch of the German Red Cross and uses the Red Cross insignia. In 1914 the number of members amounted to 400,000 and the league owned property inclusive of real estate and institutions to the value of 20,000,000 marks. By September, 1916, there were 2335 branches throughout the Empire and a membership of 1,000,000 women. It has become a tremendously effective organization.

MEN NURSES. --The society for the training of men nurses and hospital attendants is also closely associated with the Red Cross and calls itself "The Organization of Voluntary Nurses in the War Work of the Red Cross." Its various branches belong to the national and provincial societies of the Red Cross which superintends its work and finances it, as the society itself requests no fees or donations from its members. Its personnel can of course be drawn only from those men who are unfit for military duty either in active service or in the reserve. The justification for its existence and activity in recruiting in times of peace is that it considers itself " the shadow of the army." It has also, however, demonstrated its great usefulness on many occasions in times of epidemic and disaster.

IMPERIAL INSPECTOR OF VOLUNTEERS. At the head of these various organizations is the Imperial Commissioner and Military Inspector of Voluntary Service, at present Prince Hatzfeld. This office was created in the campaign of 1866 by Emperor Wilhelm, in order to amalgamate the volunteer workers with the military department. During peace he has the supervision of the training of his army of workers so as to be ready at short notice for all emergencies in the event of war. Territorial delegates stationed in various parts of the country assist him in overseeing and planning the relief work. During the war his office is at Imperial army headquarters. His instructions and reports go back to his deputy military inspector at Berlin, who is connected on the one hand with the proper ministerial and influential authorities and on the other with the large group of voluntary workers, whose delegates at home and in the field are greatly increased in war times. For every important medico-military official in the sanitary department, a civilian of corresponding rank is appointed to represent the interests of the volunteers. The effective collaboration of these workers fits into the great web of the official work with a minimum of friction.

DIVISIONS OF RED CROSS WORK. Everything connected with the Red Cross and its activities receives its authority from the proper national central offices. The divisions of the Central Committee which existed before the war and which are still retained are:

Division (1) for mobilization,

(2) for the volunteer staff of men nurses,

(3) for depot affairs,

(4) for women volunteer nurses,

(5) for collections and recruiting,

(6) for administration.

If there has been any change in the duties of these divisions it has been rather in the extent than in the kind of work. Since the war began, there have been added Division

(7) for prisoners,

(8) for exhibits of war booty for the purpose of raising funds,

(9) for health resorts and institutional care for the disabled,

(10) for welfare work divided into group

(a) for tuberculosis and contagious diseases, group

(b) for the care of infants and mothers and group

(c) for the care of families.

The work of these groups extends over everything that is necessary to the maintenance and retainment of health in families, and the training of a healthy, able-bodied rising generation. It provides for the training of grown children to a profitable calling and the employment of all who are able to work. This division also sees to the training, examination and graduation of girls and women as voluntary nurses, their vaccination and so forth.

There is also a Division (11) for the care of refugees and the families of interned Germans, and one (12) for securing employment for the disabled; this is closely associated with Division 9 and the two divisions work in cooperation with the Welfare Commission for the War Disabled. Finally there is a Division (13) for the financial provision for the disabled and their families supplementary to State aid or pensions; the latter concerns itself only with the actual injury and not with the special requirements of the pensioner, such as a large family, old and feeble parents, sick relatives and similar conditions.

The central offices set the boundaries and give the general directions according to which the branch associations are to act; they give advice where it is asked or where it is deemed necessary and they offer the help which often is needed to assure the success of their plans; but the local societies are otherwise practically independent and secure their own funds. This freedom greatly increases their efficiency.

TRAINING OF WOMEN NURSES. In 1905 when the Russo-Japanese war indicated that dreams of universal peace were not altogether capable of realization, Germany took stock of her nursing force, basing her needs in this regard on the strength of her army and the number of field sanitary formations which would be needed. Following the urgent advice of General Rothe of the Artillery, the central committee of the Red Cross working with the War Department urged the imperative necessity of increasing the nursing personnel.

The needs of the army were placed at 15,000 nurses. While the Imperial Register set the number of women nurses at 74,986, there were included in this number a high proportion of ill educated and poorly trained women acting as attendants in asylums, etc. About 26,000 in this total were Catholic Sisters; about 12,000 were deaconesses; the Red Cross counted between 3000 and 4000; the German Nurses' Association 3000. According to Dr. Koerning, member of the Central Committee of the Red Cross, a census in 1905 revealed that there were only 20,000 fully trained nurses in Germany, not including Bavaria, who would be fit for duty as war nurses and a large number of these would not be available on account of the needs of the home communities.

Thereupon the Central Committee of the Red Cross and the National League of Women, Vaterlandische Frauenverein, put forth every possible effort to increase the number of nurses. This effort received an especial impetus from the fact that in 1907 an examination was introduced by the state which laid down in writing the conditions under which recognition by the state was accorded to nurses after a training of one year. These test regulations were at once adopted by the Red Cross. Even this, however, did not produce enough nurses to satisfy the need. It was difficult to obtain a sufficient number of women who would undertake training for a profession for which in ordinary times the demand was limited.

Voluntary nursing forces for the express purpose of service in war had therefore to be enlisted and trained. After many tedious deliberations, regulations were issued in 1908 concerning the training of auxiliary nurses and nurses' aids. These created two classes; one of which, the auxiliary nurses or "sisters" as all nurses in Germany are called, received a half year's training and the other, the nurses' aids, a six weeks' training in practical and theoretical courses, with later supplementary courses. The auxiliary sisters are women whose domestic relations are such that they can be spared from home for half a year to learn nursing in the wards or operating rooms of hospitals and who can every two or three years give from six to eight weeks' service in a general or maternity hospital, but who cannot for some reason follow nursing as a profession. Usually they substitute for nurses out on leaves of absence or ill, but in war they relieve those who have been sent to active duty at the front.

A special text-book was issued by the Red Cross Central Committee which was elaborated with the permission of the respective authorities by following the military text-book for sanitary forces. By this means the training of the volunteer nurses proceeded along the same lines as that of the sanitary corps. Experience has fully justified this as a wise procedure.

Within forty-eight hours after the call for mobilization in few months of war so developed some of them that the Red Cross Society announced that all those who after four months' service were found competent should be promoted to the position of auxiliary sister. Another important step was taken in the spring of 1915 when they were given the opportunity to complete their training and at the same time were given credit for the period of their service in the war. While the principle which led to the introduction of nurses' aids was fully justified it was early recognized that the few weeks of training was insufficient, and their instruction has been continued under the local Red Cross branches of the Vaterlandische Frauenverein and has developed into a two years' course. At the end of this time they receive a diploma and an official brooch, can wear the full uniform and are registered as graduate army nurses and become a part of the system of national defense. Distinguished service medals for merit are awarded these women by the Emperor.

The Red Cross nurses work in all hospitals, both Red Cross or Association Hospitals as they are called and the military hospitals up to and including the line of communications hospitals. Wherever it is advisable they are under the supervision of the Deaconess nurses. These are usually mature women who have received several years of training in the various deaconess training schools throughout the empire, which are all modeled on the famous institution at Kaiserwerth. Many have had years of experience in the big clinics in every department of work. They live in the hospitals and have charge of the "stations" or sections of patients.

The Red Cross nurses are of the best type of young women from twenty to thirty-five years of age; they are nearly all of the best families and live at home when on duty in their home towns; but can get any meals they may want in the hospitals. Their instruction is not up to the standard of that in America but their desire to learn is intense, and as they are all educated they are capable of training to any degree. They are the only material from which reliable war nurses in large numbers can be developed in any country.

The older trained professional nurses cannot be relied upon as a class to carry the burden of all the work of war hospitals, demanding long and irregular hours, changes of stations, sometimes involving hardships and new environments in a foreign country with a foreign language. The mature, experienced, trained, professional nurse should bear the same relation to the younger army nurses that officers do to their soldiers. Their positions should be those of superintendents, chief nurses, dietitians, anesthetists or matrons, and all should be selected with reference to their ability to manage young people and to instruct them during their courses of training. The latter qualities are most important and should be insisted on or discontent, unhappiness and failure in discipline will seriously disturb the service.

The pay of a nurse in Germany is a little more than one mark per day, paid every three months, when they receive 99.90 marks. A corps of 50,000 nurses thus costs the Empire for salaries only $3,650,000 a year. In America an equivalent number of nurses would cost the government for their salaries $3,0405645.

MEN NURSES. -- Men nurses and hospital helpers to the number of 15,000 were also ready at the day of mobilization. These, recruited from all classes and trades and professions, a large number coming from the academies and universities

had, previous to the war, received a theoretical and practical course in nursing, each of six weeks' duration and had kept in practice by frequent drills and attendance at hospitals and clinics. Their work in war is done chiefly in the home and line of communications zones; they need not be active on the battlefield nor in the field hospitals. Their services may be required in accompanying the wounded and sick on the trains. One nurse accompanies from 12 to 20 wounded. They wear Red Cross uniforms and are divided into companies of 41 men each.

All these organizations for voluntary nursing had, even in times of peace, received their assignments from the Imperial Commissioner and considered it a sacred duty to prepare themselves for the event of war. They practised year in and year out during vacations and spare time to perfect themselves in nursing and transport duties.

PERSONNEL. -- By February, 1917, the Red Cross personnel amounted to 179,000: 40,000 were men nurses, 30,000 of whom were in the line of communications; 62,000 women nurses, 11,000 in the line of communications; 1,000 women laboratory assistants, 700 in the line of communications; 5000 kitchen personnel, 1500 in the line of communications; 45,000 bearers, 35,000 in home hospitals; 2500 supply depot personnel, 1800 at home; 700 clerks, 600 at home; 500 disinfectors, half at home; the balance consists of laborers and workers of all kinds.

EQUIPMENT AND TRAINING. -- In regard to the material equipment for voluntary nursing, the planless gropings toward possibilities of help that heretofore have characterized volunteer work were gradually eliminated. So far as possible the military authorities had set definite requirements concerning the sort, extent and place for various services and the societies had endeavored to follow them even before the war. Orders for the establishment and management of private and association hospitals and convalescent homes of the Red Cross had been given by the proper. central executive committees long previous. By publishing the patterns for the making of hospital and sick-room linen, clothing, under wear for the patients and other sewing products, the societies were enabled not only to prepare in peace but also to take hold of the pertinent tasks without delay. A part of the instruments and implements required, particularly those that would be difficult to obtain after mobilization, were bought before the war and were held in readiness according to the directions of the printed publications; the rest were bought after the outbreak of war. Joint practice of the women's societies with the men's divisions were responsible for the fact that almost everywhere a knowledge of what was absolutely necessary and what was dispensable was broadcast, so that after the mobilization orders were published hardly a single question was asked of the Central Committee of the Red Cross, showing that there was no doubt in the minds of the workers. Everything went along its regulated way apparently as if from habit, even the places of refreshment along the way were ready when the troops were ready to march.

RED CROSS BARRACKS.--In one special field the Red Cross had for years worked out a well-planned preparation for war; it had collected portable barracks for the erection of hospitals, especially for contagious or suspected contagious diseases. The Central Committee had stored for some time numerous barracks with full equipment in order to be prepared at any time for the outbreak of contagious diseases.

Such barracks can be erected and equipped within a few hours where they are needed and fulfil their purpose in any weather and any climate. They have proved themselves equally efficient in the ice fields of Siberia and in the burning heat of a South African sun and have been tried out hundreds of times in Germany. A part of the men of a sanitary division and of the associations are perfected in the erection of these barracks and a certain percentage are trained for the process of disinfection.

RED CROSS TRANSPORTATION OF THE SICK. The voluntary nurses and the men orderlies had by long practice perfected themselves in the handling and transportation of patients. Besides the hospital and assistant hospital trains which the military authorities held in readiness and sent with the first load of surgical supplies to the front, the Red Cross immediately after the outbreak of the war set to work their association hospital trains which had been held in readiness according to military instruction. In Bavaria, Wurtemberg and Baden these trains were dispatched at once by the national societies of the Red Cross. The German Central Committee delivered its four society trains promptly on the fifteenth mobilization day and the Prussian Committee its six trains on the twenty-second and the twenty-ninth mobilization days. Quite a number of additional association hospital trains were furnished by the various provincial and national societies of the Red Cross and up to this day such trains are prepared and equipped with a regular army staff. To enable the speedy and careful transportation of wounded from the dressing centers and field hospitals to the frequently distant railroads, hospital trains and ships, automobiles in large numbers were offered and used. But up to date it has not been possible to meet all requirements; especially is this true on the Eastern front where conditions are not yet quite as well regulated as expected. Lately, voluntary service has endeavored to stop the gaps that are here and there still noticeable.

Early in the war the Red Cross erected in conjunction with the General German Automobile Club several auto stations, each consisting of six auto trucks, for the transportation of provisions and articles of luxury from the line of communications zone to the fighting troops and field hospitals and to take the wounded back to the hospitals. A part of these auto stations have been disbanded because they seemed dispensable here and there after the change in the war situation. The rest remained; in fact, their staffs and numbers have been increased considerably. The transportation of the wounded at home from the railroad stations to the hospitals is for the greater part in the hands of local Red Cross societies and is being improved continually. Early in the war a charitable woman in Berlin donated an electrically heated and lighted automobile which could hold eight soldiers lying or twenty sitting. A large number of these were later employed.
FUNDS AND LOTTERY.--It can be readily understood that the financing of the varied activities of the Red Cross is a tremendous undertaking. To obtain voluntary gifts through collections the "Imperial Commissioner and Military Inspector " immediately at the beginning of the war urged the people to donate liberally and designated the places where such contributions would be received. Following this, came appeals from the various branch societies for gifts from home and abroad. A popular and successful source of income is the national Red Cross Lottery which is held under governmental auspices every three months. One million marks worth of chances are sold, two-thirds of which goes to the Red Cross Society and for expenses and one-third to the prize fund to be divided among the holders of the winning tickets. Tag-days are numerous, in fact every day is tag-day in Germany. Up to June, 1916, the German Red Cross had expended 426,000,000 marks, 15,000,000 of which came from the United States.

DEPOTS FOR GIFTS.--Depots for the reception of gifts are established in the line of communications and here they are turned over to the military authorities and the responsibility of the Red Cross ceases. Military exigencies sometimes prevent the delivery of these gifts. This has given rise to criticism of the Red Cross. The question whether and where woolen underwear, provisions and certain articles of luxury are needed is primarily answered by the military authorities; they alone are deemed competent to judge whether or not the shipments to the fighting troops are permissible and is expedient. Military necessity peremptorily demands that the transportation of munitions and provisions shall take precedence of all else. In addition to the furnishing of a voluntary nursing personnel and its care for the comfort of the soldiers at the front, the Red Cross and the affiliated women's societies find an inexhaustible field of activity in ameliorating the harshness of war for those at home.

DOMESTIC SCIENCE SCHOOLS FOR GIRLS. Previous to the war the National League of Women had, in conjunction with the Chamber of. Agriculture, established domestic science schools. These schools were to acquaint the young girls from the class of small farmers, labourers and others with the most essential fundamentals of domestic science. Their value in the present scarcity of food has been inestimable.

MASS FEEDING OF THE PEOPLE. Information to the entire population on the subject of national nutrition is disseminated by the league and the mass feeding of the people by means of war kitchens and "goulash cannons" has also come under their supervision. At these public kitchens one litre of very palatable meat and vegetable thick soup prepared according to a fixed caloric value is sold for 30 pfennigs; for the average appetite it is nearly enough for two meals.

GAMES AND RECREATIONS. The furnishing of recreation and amusement for the soldiers both in the trenches and the hospitals is regarded as an important feature of welfare work. "The soldiers in the field want games," was the information that came back from the trenches soon after the outbreak of the war. To forget the fearful realities of his life, the soldier needs diversion in his hours of rest and relaxation. At times he is too exhausted to read and simple games fill a great want. Games in the hospitals have a much greater usefulness than is generally realized. The Woman's League has therefore made a systematic course in wholesome, interesting games a part of the army nurse's training course.   Printed outlines have been prepared of the games suitable for the various kinds of welfare work carried on by the society. In this are listed games suitable for the trenches, for blinded soldiers, for the children in municipal playgrounds; games for adolescents and entertainments of all kinds for the disabled and convalescents.

The games for the trenches mentioned are checkers, chess, dominoes and similar well-known games played on boards with dice and figures. These are made as small as possible so as not to overburden the soldier's knapsack. The boards are made of stiff oilcloth or leather and can be folded up, the figures are kept in small linen bags. Puzzles, card games of all kinds, including the educational series are also very popular. Booklets containing riddles, puzzles, and amusing tricks of all sorts are furnished. In the hospitals, for patients who are not bed-ridden, games involving active motion are planned and many long-forgotten simple games have been revived; light gymnastics with music are also found to be valuable. For the blind many books, magazines and games are provided. Through entertaining games the blind are most apt to regain their cheerfulness and self-confidence.

After their interest in life has been thus reawakened it becomes easy to train them in useful remunerative occupations. These are some of the endless activities of the women of Germany, and so well have they performed their tasks of relief work and so vital to the existence of the army in the field has been the efficient cooperation of "The Army of the Empress" at home that larger spheres of usefulness are being opened to them every day. Not only are they taking the place of men in the performance of work in every trade and .occupation but their assistance is being sought in high administrative offices in the government. The war will mean the emancipation of the German woman from her heretofore limited life.

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