Historically military conflicts have always stressed the organization and resources of the

warring nations. Medical resources, specifically nursing, are no different. America’s military

conflicts have played a major role in shaping the development of nursing as a profession over the

past 115 years. World War II in particular brought about significant changes, including the

Bolton Act of 1943, and the establishment of Aerial Nurse Corps. The Bolton Act addressed the

shortage of nurses, and played a key role in expanding, subsidizing, and improving nursing edu-

cation in the United States through federal funding. The Bolton Act doubled the number of

nurses in the United States, and as a result, those who received free education provided their ser-

vices to aid civilians and soldiers. Advancements made after World War I in the nursing field

gained notoriety when applied to the war efforts in World War II. This was primarily seen in the

establishment of the Aerial Nurse Corps. World War II marked the first appearance of medical

air ambulance evacuations.

During the period of the 1940s, World War II brought unrest upon the nation, the United

States experienced the demands of a large scale war first hand, on their own soil as well as battle

grounds, requiring predominantly females to take on the role of nursing wounded and sick sol-

diers back to health. This role, of war nurse had historically, until late 1890s, been dominantly

male oriented. Females became the dominant gender in 1899, a year after the Spanish American

War. The splendid little war was a conflict that resulted in America’s intervention in Cuba. Dur-

ing the Spanish American War, men were called upon to serve as nurses. When the draft was in-

stituted on May 10, 1898, the U.S. was unable to recruit more than 6,000 male nurses which re-

sulted in the army contracting civilian women to fill the gap and care for troops. More than 1,500

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contract nurses served that year, but when the war ended the number of contracted female nurses

quickly decreased to 700, and by the following June only 210 contracted female nurses re-

mained1. The rapid decrease in contract nurses led to the introduction of a permanent Army

Nurse Corp in February, 18992. Establishing females as the dominant gender in the field of nurs-

ing. A historical look at nursing numbers presented in Table 1, shows how nursing has grown as

a percentage of the overall population. A closer look at the overall numbers shows that begin-

ning in the 1940s through 1960, the WWII male nurse population declined significantly as a per-

centage of overall nurses.

This was due to females being the only gender allowed to join the Army Nurse Corps during

WWII(). Men were expected to serve their country as members of the armed services. Men pos-

1 Tomblin, Barbara Brooks. GI Nightingales. Kentucky: The University Press of Kentucky, 1996. Print (page 2)2 Judd, D., Sitzman, K., & Davis, G. M. (2010). A History of American Nursing: Trends and Eras. Sudbury, MA: Jones and Bartlett Publishers (page 16)

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sessing nursing qualifications drafted through the Selective Service Act of 1940, usually did not

officially utilize their skill set as they were assigned other duties in the military. A survey of

thirty-five graduate male nurses drafted into the army revealed that only 40 percent were serving

in medical units.3 The restriction on men’s ability to join the Army Nurse Corps, as well as the

army not utilizing their medical skills contributed to the nursing shortage.

A combination of military fueled needs and a growing United States domestic population

created historical nursing shortages resulting in nursing specific initiatives by the US military,

US government, and even the private sector. At first the campaign to recruit nurses was success-

ful; in the peak month of April 1941, 689 nurses joined the Army Nurse Corps. By the fall of

1941, appointments outnumbered discharges by only fifteen.4 The Army Nurse Corps had fewer

than 1,000 nurses enlisted on 7 December 1941, the day of the Japanese surprise attack on Pearl

Harbor. Eighty-two Army nurses were stationed in Hawaii serving at three Army medical facili-

ties that infamous morning. One of the medical facilities, Tripler Army Hospital was over-

whelmed with hundreds of casualties suffering from severe burns and shock. Army and Navy

nurses worked side by side with civilian nurses and doctors, as a steady stream of seriously

wounded servicemen continued to arrive through the early afternoon, appalling shortages of

medical supplies became apparent. Army doctrine kept medical supplies under lock and key, and

bureaucratic delays prevented the immediate replacement of quickly used up stocks. Working

under tremendous pressure, medical personnel faced shortages of instruments, suture material,

and sterile supplies. Doctors performing major surgery passed scissors back and forth from one

3 Tomblin, Barbara Brooks. GI Nightingales. Kentucky: The University Press of Kentucky, 1996. Print (page 12)4 Tomblin, Barbara Brooks. GI Nightingales. Kentucky: The University Press of Kentucky, 1996. Print (page 7)

3

table to another. Doctors and nurses used cleaning rags as face masks and operated without

gloves. The chief nurse at Hickam Field, 1st Lt. Annie G. Fox, was the first of many Army

nurses to receive the Purple Heart. Established by General George Washington during the Revo-

lutionary War, this decoration originally was for "outstanding performance of duty and meritori-

ous acts of extraordinary fidelity."() After 1932, however, the medal was usually restricted to

those wounded or injured by enemy action. Although unwounded, Lieutenant Fox received her

medal for "her fine example of calmness, courage, and leadership, which was of great benefit to

the morale of all she came in contact with."5

Even with the contributions of outstanding nurses such as Lieutenant Fox, the demand for

nurses continued to rise as training for thousands of new soldiers took place at boot camps across

the country. Enrollment into nursing school could not stay proportional to the increased troops

due to a lack of federal funding. Student nurses were required to work at hospitals for three years

with no income, while having to pay tuition. Meanwhile, the military recruited thousands of

young men and gave them free training for all kinds of jobs. This angered females. If a woman

wanted to join the Army Nurse Corps, she had to first become a registered nurse at her own ex-

pense, creating a general sense of frustration, and resulted in the enrollment of student nurses to

plateau.

As a result of the shortage of nurses, on July 29, 1941, a conference of representatives

from five nursing associations was held at Army Nurse Corps Headquarters. Many members who

were present realized that in the years since World War I the expansion of nursing was to the

5 “The Army Nurse Corps.” U.S. Army Center Of Military History. United States Army, n.d. Web. 12 Nov. 2013. <http://www.history.army.mil/books/wwii/72-14/72-14.HTM (paragraph 3)

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point that, in a time of war or crises, not just one association would be able to direct and manage

a nursing program. Therefore the five associations decided to band together and establish a Nurs-

ing Council for National Defense, with Major Julia Stimson as president.6

Major Julia Stimson had served twenty years of service in the Army Nurse Corps, and

quickly embarked on her first project, surveying nursing resources. This proved to be no easy

task when one considered that the 1941 U.S. Census did not include student nurses in the gradu-

ate nurses’ classification.7 Major Stimson’s efforts and initial difficulty carrying out her survey

resulted in the state nurses’ associations carrying out the survey with the financial support of the

U.S. Public Health Service. Three quarters of the nurses surveyed responded to the question-

naires, but of these 290,000 active member nurses, only 100,000 were deemed professionally

qualified to serve in the military.8

Efforts made by the Nursing Council for National Defense proved to be insignificant

without the help of federal funding. Without financial aid for supporting students, the nursing

schools could not substantially increase their enrollment. To try to meet the need for financial

support, Ohio Representative Frances Bolton, pushed for a program that would train nurses at the

government’s expense. She worked hard to try to introduce fairness and incentives into the situa-

tion, and formulated a bill where the government paid for students who agreed to serve in some

capacity of nursing for the duration of the war, plus six months. Bolton arranged for federal

funds for nursing education in the amount of $1,250,000 to be included in the 1943 Appropria-

tions Act. The Act became effective on July 1, 1943, providing funds which aided students in

6 Tomblin, Barbara Brooks. GI Nightingales. Kentucky: The University Press of Kentucky, 1996. Print. (page 11)7 “Biographies of the Superintendents and Chiefs of the ANC.” Army Nurse Corps Association. N.p., n.d. Web. 7 Oct. 2013. <http://e-anca.org/bios/Stimson.htm>. (paragraph 2)8 Tomblin, Barbara Brooks. GI Nightingales. Kentucky: The University Press of Kentucky, 1996. Print. (page 9)

5

need, and provided refresher courses for inactive nurses.9 The Bolton Act’s primary purpose was

to ensure that the United States had enough nurses to care for the needs of its citizens on both the

home and war fronts.

Bolton also attempted to increase the supply of Nurses through the creation of the Student

Cadet Nurse Corps. A student nurse who joined the Cadet Nurse Corps was eligible for a govern-

ment subsidy that paid for her tuition, books, uniforms, and a small living stipend. In return, par-

ticipants in the Corps pledged to actively serve in essential civilian, military or other Federal and

government services for the duration of the war plus six additional months. Any young woman

interested in becoming a nurse was eligible for the Cadet Nurse Corps, as long as she could meet

the basic requirements which included; she was between the ages of seventeen and thirty-five, in

good health, and had graduated from an accredited high school with good grades. Members of

the Cadet Nurse Corps were required to complete their training within thirty months instead of

the traditional thirty-six months. "Pre-Cadets," traditionally known as "Probies," were in the first

nine months of their training. "Junior Cadets" were in the middle twenty-one months of their

schooling and "served while they learned" by attending classes and then applying their classroom

knowledge in the wards of local hospitals. During the final period of training, members of the

Corps were known as "Senior Cadets."10 These students were placed where they were most

needed, many in civilian, federal or military hospitals. The results of the Cadet Nurse Corps in-

cluded a dramatic rise in the number of nursing students, a greater public recognition of

9 Tomblin, Barbara Brooks. GI Nightingales. Kentucky: The University Press of Kentucky, 1996. Print. (page 10)10 “Biographies of the Superintendents and Chiefs of the ANC.” Army Nurse Corps Association. N.p., n.d. Web. 7 Oct. 2013. <http://e-anca.org/bios/Stimson.htm>. (paragraph 4)

6

nurses,changes in the manner in which nurses were educated and trained and a greater sense of

equality for female nurses.

Overcoming a shortage of qualified nurses proved to be a difficult obstacle. The number

of nursing school graduates rose by 1940, but the demands for health and hospital service had

also increased. During the period of post-World War I, the United States experienced advances

in medicine and technology, allowing females to develop new skill sets and practice more devel-

oped forms of nursing. When World War II approached, the army utilized these skills, primarily

in the Army Air Corps formation of an ambulance battalion, with the addition of flight nurses. In

1940, the first air ambulance battalion was proposed and in May 1942, a medical air evacuation

squadron was activated at Fort Benning, Georgia.11

The idea of including trained flight nurses originated in 1932 with Lauretta Schimmoler.

In 1930, Schimmoler received her pilot’s license, and while flying over a tornado ravaged area in

Lorain, Ohio, she thought that aid could be delivered more quickly if it was administered by avi-

ation-trained nurses. Her efforts to convince the Red Cross of the usefulness of her Aerial Nurse

Corps failed in 1940, but attracted the attention of Army Air Surgeon, General Grant. He devel-

oped the concept of military flight nurses as part of Med Evacuation squadrons. On November

30, 1942, the U.S. Army made a nationwide appeal for graduate nurses and airline hostesses,

ages 21 to 35 and physically qualified for flying, to volunteer for the Army Nurse Corps and into

the air evacuation units.12 Applicants for the Aerial Nurse Corps received specialized training at

11 “Aerial Nurse Corps Plan to Form Unit in Sarasota.” Herald Tribune [Sarasota] 30 Sept. 1940: n. pag. Print. (paragraph 4)12 Kalisch, P. A., & Kalisch, B. J. (1978). The Advance of American Nursing. Boston, MA: Little, Brown and Company..(page 36)

7

Bowman Air Field in Kentucky.13 There, the women learned the effects that flying had on the

body because unlike today, the cabins of military aircraft were not pressurized. They learned

that men with certain types of wounds should not fly above a certain altitude, and that the dosage

of some drugs had to be increased or decreased to compensate for the effects of altitude. The

course also demanded tough physical education, including parachute drills, simulated bombing,

simulated strafing, and other requirements necessary due to the aerial nurses exposure to com-

bat.14 The planes used by the flight nurses that carried out the wounded also brought in the fresh

troops; therefore, the planes could not legally bear the Red Cross logo, making the transport

planes legitimate targets for opposing forces.15 The work was considered both challenging and

very dangerous. The intensive training provided at Bowmen Field proved to be successful as the

Aerial Nurse Corps grew and nurses were deployed. In 13 months of operation in the South Pa-

cific, the aerial nurses successfully evacuated over 37,000 men and reportedly lost only 1 pa-

tient.16

The addition of flight nurses on air ambulance battalion squadrons, represents a signifi-

cant advancement in the nursing field instigated by the pressure of WWII. The war required a

new form of medical care to save soldiers lives whose faces were half shot off, or limbs were

missing, that would not survive a long drive through terrain to the nearest hospital. The location

and size of the war required females to administer treatment while on flight to nearby hospitals.

13 Weatherford, Doris. History of Women in America: American Women and World War II. New York: Facts on File Inc., 1990. Print. (page 13)14 Weatherford, Doris. History of Women in America: American Women and World War II. New York: Facts on File Inc., 1990. Print. (page 13)15 ”Nursing Training Program,” Congressional Record-House, 78th Cong., 1st sess., 1943, Vol. 89 pt. 2, p. 2776 ff; Vol 89, pt. 4, p. 446116 “The Army Nurse Corps.” U.S. Army Center Of Military History. United States Army, n.d. Web. 12 Nov. 2013. <http://www.history.army.mil/books/wwii/72-14/72-14.HTM

8

Aleda E. Lutz is one of the most recognized volunteer Army Flight Nurses. Lutz served on the

802nd Airborne Medical Air Evacuation Squadron, providing help to 3,500 soldiers over her 196

missions in Europe, Africa, and Italy. In the majority of her letters home to her nephew, Paul Va-

sold, Lutz described the gruesome details of her patients, the constant fear of being so close to

battle, and the honor she felt from saving lives. Her very first letter home depicts her first evacu-

ation of eight soldiers from Anzio Beachhead, where the C-47 plane was taking on constant fire

from the German Army. As the nurses attempted to evacuate the wounded soldiers, one of her

fellow nurses took a gun shot to the arm, illustrating for Lutz the true dangers of war. Even

faced with the risk of losing her own life Lutz willingly boarded the planes that flew into the bat-

tle fields. Writing at the end of the day to her nephew, “the risk of my own life, is meaningless

when every day I save 10 to 12 men. I can sleep at night knowing that I have served my country

honorable, and willingly wake the next morning to do it all again.”17 Self-sacrifice earned lieu-

tenant Lutz spent over 814 hours in the air, more than any other army nurse, and earned six battle

stars. Lutz was said to be the most highly experienced flight nurse in the Army Air Corps at the

time of her tragic death on, November 1, 1944. Lieutenant Lutz was transporting 15 wounded

soldiers in a C-47, from Lyon, France to a hospital in Italy when a violent storm resulted in the

pilot to lose control and the plane to crash into the side of a mountain. Lutz is distinguished as

the first female killed in action in World War II and was awarded the Air Medal four times, the

Oak Leaf Cluster, the Red Cross Medal, and the Purple Heart. She was also the first women

17 Jamieson, E. M., Sewall, M. F., & Suhrie, E. B. (1966). Trends In Nursing History: Their Social, International and Ethical Relationships (6th ed.). Philadelphia, PA: W.B. Saunders Company. (page 66)

9

awarded the Distinguished Flying Cross in a World war, our nation’s second highest military

honor.18

The advancements made during World War II played a pivotal role in the growth of the

nursing field in post-war years. A historical look at nursing numbers presented in Table 1, shows

how nursing has grown as a percentage of the overall population. A closer look at the overall

numbers shows that beginning in the 1940s through 1960, the post WWII male nurse population

declined significantly as a percentage of overall nurses.

The scale of World War II left the United States in a panic, scrambling to obtain medici-

nal care for troops on the battle field, particularly female nursing, a resource that was crucial in

aiding wounded and sick soldiers. Multiple factors affected to the deficit, among them was the

growing troop size, medical advancements on the home front, and financial barriers restricting

growth. As the war progressed, the nursing field was transformed through the influx of workers

as a result of the passage of the Bolton Act, the establishment of the Aerial Nurse Corps, and the

increased demand for medical personnel. The Bolton Act helped to provide students with finan-

cial needs to get proper training to become a nurse. The Act succeeded through the creation of a

Student Cadet Nurse Corp. A student nurse who joined the Cadet Nurse Corps was eligible for a

government subsidy that paid for her tuition, books, and uniforms as well as a small living

stipend. In return, participants in the Corps pledged to actively serve in essential civilian, mili-

tary or other Federal and government services for the duration of the war. The Bolton Act played

a key role in expanding subsidizing, and improving nursing education in the United States

18 “The Army Nurse Corps.” U.S. Army Center Of Military History. United States Army, n.d. Web. 12 Nov. 2013. <http://www.history.army.mil/books/wwii/72-14/72-14.HTM (page 4,6)

10

through federal funding, and as a result helped to double the number of nurses in the country. As

the population of nurses grew, advancements that were made after World War I in the nursing

field, gained notoriety. This was primarily seen in the establishment of the Aerial Nurse Corps.

World War II also marked the first appearance of medical air ambulance evacuations.

As World War II progressed, America experienced an increase in the demand for Nurses

to aid in war efforts. Tens of thousands were called upon to serve duty in the Army Nurse Corps.

Significant battle, injuries as well as soldiers plagued with sickness drove nursing efforts from

American soil onto international battle fields. The nursing field was transformed through the in-

flux of workers as a result of the passage of the Bolton Act, the establishment of the Aerial Nurse

Corps, and the increased demand for medical personnel.

11

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Aerial Nurses Will Study Sky Aubulance The Milwaukee Sentinel Oct 19, 1940

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“Biographies of the Superintendents and Chiefs of the ANC.” Army Nurse Corps Association. N.p., n.d. Web. 7 Oct. 2013. <http://e-anca.org/bios/Stimson.htm>.

Brunk, Q. (1997). Nursing at War: Catalyst for Change. Annual Review of Nursing Research, 15, 217-236.

History and Collections. Women In Military Service For America Memorial Foundation, n.d. Web. 22 Sept. 2013. <http://chnm.gmu.edu/courses/rr/s01/cw/students/leeann/historyandcollections/history/lrnm-rewwinurses.html

Jamieson, E. M., Sewall, M. F., & Suhrie, E. B. (1966). Trends In Nursing History: Their Social, Interna-tional and Ethical Relationships (6th ed.). Philadelphia, PA: W.B. Saunders Company.

Judd, D., Sitzman, K., & Davis, G. M. (2010). A History of American Nursing: Trends and Eras. Sud-bury, MA: Jones and Bartlett Publishers

Kalisch, P. A., & Kalisch, B. J. (1978). The Advance of American Nursing. Boston, MA: Little, Brown and Company..

12

”Nursing Training Program,” Congressional Record-House, 78th Cong., 1st sess., 1943, Vol.

89 pt. 2, p. 2776 ff; Vol 89, pt. 4, p. 4461

Pace, LaCoya. The Nursing History Chronicle Special Edition. N.p.: n.p., 2012. Print. PENN Nursing Science. University of Pennsylvania, n.d. Web. 22 Sept. 2013. <http://www.nursing.upen-

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