The Japanese Journal of American Studies, No. 24 (2013)

Professional Angels at War: The United States
Army Nursing Service and Changing Ideals of
Nursing at the Turn of the Twentieth Century

Yoshiya Makita*

I. Introduction
In 1898, Lillian Kratz spent the whole summer at an army field hospitalin Santiago, Cuba. Since April 24, when the United States Congress
declared a state of war with Spain, US forces had been fighting continuous
battles with Spanish troops in Cuba. The outbreak of the war stirred up
patriotic fervor in the United States and drew vast human resources into
the war effort.1 With a contract as an army nurse, Kratz got on a battleshipin New York harbor and traveled to Cuba. When the ship anchored in
Santiago harbor, Kratz later recalled, the horrific sight of the foreign
battlefield provoked a spiritual feeling in her heart: “To the right of us was
the desolate battle field, and as the sun gradually sank behind the horizon,
casting the reflection of its rays in purple and gold on San Juan hill where
our dead and dying still lay, and as the sun’s glow became fainter andfainter, it seemed to cast a benediction over all.”2
Copyright © 2013 Yoshiya Makita. All rights reserved. This work may be used, withthis notice included, for noncommercial purposes. No copies of this work may be
distributed, electronically or otherwise, in whole or in part, without permission fromthe author.
*Research Fellow, Japan Society for the Promotion of Science

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The reality of the war, however, soon shattered her naïve sentimentality.
Heavy rains intermittently soaked the nurses’ tents. An ever-present
cloud of flies annoyed nurses throughout their service and carried therisk of typhoid fever. After she was transferred to a yellow fever hospital,
Kratz herself became ill and was forced into a sick bed. Despite all thesehardships, she reflected, “We adapted ourselves to the conditions as
sensibly as we could and as they confronted us each day.”3 When the fierce
battles were over and the bulk of army soldiers returned to the UnitedStates, Kratz decided to further volunteer for the nursing service in thePhilippines and joined a contingent going to the islands. They sailed fromNew York and entered the Mediterranean, then passed through the Suez
Canal to the Red Sea, and finally headed to the Pacific islands across the
Indian Ocean. The long voyage around the world and her subsequent
service in the Philippine islands bestowed on Kratz a wide range ofexperience, which she “possibly could not have acquired any other way.”4
The voyage of Lillian Kratz from Cuba to the Philippines exemplifies the
emergence of a new type of army nurse who worked overseas in the age ofimperialism.
This essay examines the changing ideals of female nursing in the UnitedStates through an analysis of the organization of the army nursing service
at the turn of the twentieth century. With the rapid growth of training
schools in major cities on the East Coast after the 1870s, American womensteadily consolidated a system for the education of female nurses withhigher standards of nursing skills.5 The women superintendents of thesetraining schools advocated independence, self-discipline, and autonomy
in the field of nursing education, free from the intervention of male
physicians and hospital administrators. Reformist nurses inherited these
ideals of nursing education from the preceding British nursing reform
intricately linked with the work of the nursing icon Florence Nightingale.6
While divorced from her original philosophy, the icon of Nightingale still
foreshadowed one crucial aspect of the subsequent development of thenursing profession in the United States: The myth of “the lady with thelamp,” which represented Nightingale as a nursing angel in the battlefieldof the Crimean War, indicated a critical conjuncture of war with the statusadvancement of women nurses. In the late nineteenth century, in parallelwith the domestic institutionalization of nursing education, wartime
emergencies provided the thrust to propel the professionalization ofAmerican women nurses. During the American Civil War in 1861–65, boththe Union and Confederate armies depended on a large number of female

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nurses to care for sick and wounded soldiers. The army nursing service
offered an opportunity for women to prove their usefulness in national
affairs and laid the basis for the postwar development of professional
nursing education.7 When the army again opened up its doors to themilitary nursing service for women during the war of 1898, American
women nurses rushed back to army hospitals as professional caregivers.8
This essay illuminates the ways in which armed conflicts promoted theadvancement of the nursing enterprise as a female profession.
During the Spanish-American War in 1898, the battlefield became an
arena of contestation among women themselves. In the last decades of
the nineteenth century, as Susan Reverby demonstrates, internal frictions
caused by class differences rather than gendered solidarity of women
increasingly came to characterize the nursing field in the United States.9
The war sharpened ordinary divisions among nurses and exacerbatedalready heightened tensions between factions by mobilizing an assortmentof women, including untrained volunteers as well as trained graduates,
under the single category of “nurse.” Mary Sarnecky points out that thewartime mobilization of women nurses from diverse backgrounds caused
intense power struggles among nursing leaders.10 In addition to strained
relationships with male surgeons at army hospitals, women nurses faced
off against each other in the army service. But these power struggles
were not simply political battles for leadership in the nursing corps. Thisessay argues that bitter disputes among women nurses reflected a deepseated ideological conflict, which consequently prompted a conceptual
rearticulation of the nursing service as a gendered “profession.” The feudamong women army nurses mirrored competing visions on the nature ofnursing. While volunteers believed their innate womanhood to be a natural
source of their qualification as nurses, the leadership of trained nurses
considered it insufficient and instead insisted on professional credentials
for participating in the nursing service. At the center of this controversy
was Nightingale’s own conception of nursing as womanly devotion to theholistic care of the sick and wounded.11 A detailed analysis of the nursing
service during the war of 1898 reveals a critical trajectory in which
modern professional nursing emerged through modifying, resisting, andovercoming Nightingalean ideas of nursing.
The war in 1898 facilitated overseas ventures of American womennurses. After the war, quite a few nurses decided to continue their work in
the Caribbean and Pacific areas, which had become part of an expanded
American empire. The previous historiography has long tracked the

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progress of the American nursing enterprise within the national borders.12
But some historians now point to the importance of understanding the US
history of nursing as part of global history. The international activitiesof American women nurses constituted a crucial part of what Warwick
Anderson calls the global circulation of modern ideas on health andmedicine at the turn of the twentieth century.13 Julia Irwin indicates that
American nurses transmitted a distinctly American idea of professional
nursing overseas through their international involvement and that nurses’
border crossings played a principal role in expanding American influenceabroad in the early twentieth century.14 Yet, the “American idea” of nursing
itself was not monolithic and involved differing trends of thought at the
moment of its exportation. The global circulation of nursing ideas in factbrought on ideological discord and dissension, in which Nightingaleanideals again became a focal point of contention. By inquiring actual
experiences of American women nurses in their overseas service, thisessay demonstrates that the professional ideal of American nurses was
not just transmitted outside the United States but rather nurtured andconsolidated through confrontations with competing ideas on nursing intransnational milieus.
In this transnational history of American nurses, this essay focuses on
the ideas and practice of Anita Newcomb McGee, a woman physician who
headed associations of female nurses during the Spanish-American War in1898 and the Russo-Japanese War in 1904–05. Born into the respectable
Newcomb family in Washington, D.C., in 1864, McGee devoted the earlyyears of her career to scientific research in anthropology and medicine.15
While conducting anthropological research on religious communities,
McGee entered the medical school of Columbian (now George
Washington) University and earned a degree in medicine in 1892.16 During
her senior year, the medical school decided to abolish its coeducation
policy and discontinue admission of female students. This decision deeply
shocked McGee, and thenceforth gender-biased discrimination against
women within the medical profession became her long-standing central
concern.17 The outbreak of the war in Cuba offered McGee an opportunity
to show the professional usefulness of women to medical circles. To
establish the military nursing service as a professional undertaking ofcompetent women, she organized a female nurse corps in the US Armywith strict standards for enlistment. When the Russo-Japanese War later
broke out in the Far East, McGee herself traveled to Japan and attempted
to transplant her standards of the profession into Japanese army hospitals.
Through an analysis of Anita McGee’s venture of military nursing, thisessay unveils the process through which American women nurses forged
an ideal of a gendered profession through their wartime service abroad.
The development of the army nursing service illustrates a transnational
momentum in the professionalization of American women at work at the

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turn of the twentieth century

Ii. Organization of the US Army Nursing Service in 1898
The war of 1898 inspired Anita McGee with the idea of launching a unitof trained nurses in the army. Soon after the battle began in Cuba, McGeesuggested to the National Society of the Daughters of the American
Revolution (DAR), a patriotic organization for women of which she wasa vice-president general at that time, that the society should establish a
special board to recruit trained women nurses for the army as a part oftheir patriotic commitment.18 After winning the approval from the nationalboard of the DAR, McGee got in contact with George M. Sternberg, theSurgeon General of the US Army, whose wife was also a member of the
DAR. Even before the official declaration of war, numerous letters fromwomen offering their service as army nurses had already flooded the officeof the surgeon general, and Sternberg decided there was merit in McGee’s
proposal to sift through the applications to form a pool of competentnurses for the army.19 As one of the leading bacteriologists in the country,
Sternberg foresaw the future need for a large force of assistants at army
hospitals and applied to Congress for authority to employ additional
women nurses by contract on April 28. Sternberg then authorized McGee’splan with the reservation that women nurses should be dispatched tohomeland hospitals that sheltered army soldiers and not to field hospitals
abroad. 20 McGee immediately set up the DAR Hospital Corps, anexamining board of which she became the director. With its headquartersin Washington, D.C., the DARHC sorted through the applications for army
nurses that had arrived from across the nation and judged the eligibilityof each applicant under the supervision of the Surgeon General of the US
Army.21
McGee set up strict standards in screening for the army nurses
and attempted to exclude untrained women. “The necessity for theestablishment of a standard which should give only to graduate nurses
the official recognition of the Government” appealed to McGee.22 Her
eligibility criteria included requiring applicants to be graduates of
established training schools for nurses and to be between thirty and fifty
years of age. In addition, applicants had to present endorsements of theirmoral character and nursing ability from the superintendents of theirrespective schools, and preferably a recommendation from a member of
their local DAR chapter. Women nurses who met these requirements and72

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accepted appointments in the US Army received railroad fare to their placeof duty and thirty dollars a month along with free accommodations. To
secure the administrative autonomy of trained nurses from male surgeons,
McGee also created the new position of “chief nurse.” As an equivalent
position to a superintendent of nurses at a civil hospital in peacetime, achief nurse was to assume full responsibility for the direction of all womennurses at each army hospital. Control of the female nursing workforce
was thus to be kept away from male medical staff.23 Meanwhile, McGee
flatly refused applicants below her standards in order to dispel the imageof women army nurses as amateur volunteers. The rejection letter from theDARHC bluntly stated, “It is not anticipated that the services of anyone
who is without hospital training will be required.”24
In the preceding Civil War of the 1860s, women nurses often publicizedand socially justified their engagement in military nursing as a wartime
extension of their domestic service buttressed by their innate feminine
virtues.25 These Civil War nurses earnestly desired to follow FlorenceNightingale’s example in the Crimean War. Herself an ardent opponent ofslavery, Nightingale continuously sent her moral and practical support toUnion nurses who were engaged in “a good baptism of fire for a country
and a great regenerator of the national character.”26 Dorothea L. Dix, aphilanthropist renowned for her insane asylum reform, aspired to be an
American Nightingale and worked as the superintendent of nurses in theUnion Army in an effort to emulate her British predecessor.27 The sameaspiration filled the minds of Southern women as well. Kate Cumming, aScottish-born Alabamian who joined the nursing service of the Confederate
Army, expressed it in her journal: “Is the noble example of Miss
Nightingale to pass for nothing? I trust not. What one woman has done,
another may do.”28 Nightingale’s assertion that any woman who had someexperience in the care of someone, including family and relatives, could
potentially become a nurse inspired these women.29 As Jane Schultz points
out, this equation of nursing with domesticity facilitated the participationof women in military nursing during the Civil War. But the emphasis
on womanhood as the basis for nursing practice blurred the differences
between nurses, cooks, and laundresses, and consequently impeded theestablishment of professional authority of female nurses. 30 It was thisimage of army nurses as a rank of housekeepers that McGee endeavoredto break down and replace with the idea of professional nursing during the
Spanish-American War.
The first call for nurses came from the Army Surgeon General to serve

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in Key West on May 7, 1898. By July 15, the DARHC had sent out atotal of forty-seven trained nurses to homeland hospitals.31 The numberof women nurses dispatched by the DARHC remained relatively small
during the early months of the war. But the circumstances surroundingarmy nurses changed drastically during the summer months when rampant
infectious diseases seriously undermined the physical strength of US
soldiers. Typhoid fever raged virulently from August to September,striking army soldiers at camps and in hospitals.32 One historian estimatesthat 20,738 US soldiers out of a total of 274,717 contracted typhoid fever
and that 1,590 died of the disease during the war. The epidemic accounted
for 87 percent of the total deaths from disease in the US assembly camps.33
Surgeon Nicholas Senn stated that “the outbreak and spread of typhoid
fever in our home camps, so early during the campaign, is responsible
for more deaths and suffering than any other cause. Many of our soldiers
carried the infection with them to Cuba and Porto Rico, and were taken ill
on the transports or soon after landing.”34
The war in the Caribbean increasingly took on the character of afight against disease, which accordingly generated a huge demand fornurses at army hospitals. The extensive prevalence of typhoid fever
forced the army medical department to reinforce its medical workforce
by employing additional surgeons, and the number of contract surgeons
more than tripled from 151 on June 30 to 512 on August 31. 35 Yellow
fever further debilitated the regiments in Cuba and Puerto Rico. “In lessthan two weeks after our army landed in Cuba,” observed surgeon Senn,“yellow fever made its appearance. . . . In less than two weeks from its
appearance nearly 500 fever cases, most of them yellow fever, impaired
the fighting force and seriously taxed the limited resources of the medical
department.”36 In tandem with the spread of infectious diseases amongarmy soldiers, demand for army nurses skyrocketed. The number of female
nurses working at army hospitals grew rapidly from 326 on August 15 toalmost 1,000 by the end of the month.37 As the shortage of medical staff
and facilities gradually became apparent, female trained nurses extended
their field of service from homeland hospitals to camp and field hospitals
abroad. Female nurses consequently increased their presence in army
hospitals, which forced the US Army to incorporate the activities of thesenurses more fully into its organization. On August 29, Anita McGee got
appointed to the position of Acting Assistant Surgeon General of the Armyand became the first woman to hold that post in the US military history.
As a result, the DARHC was disbanded and women nurses came under the

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supervision of McGee’s new military office.38

III. Toward the Bond of Gendered Profession
While the rampancy of infectious diseases among US soldiers led to
an increase in the number of army nurses, the epidemics caused a severe
setback, in the eyes of Anita McGee, to the maintenance of professional
standards of nurses. In the summer months, the workload at army hospitals
far exceeded the nursing capacity of caregivers. Florence M. Kelly, agraduate nurse dispatched to Sternberg Hospital in Chickamauga, Georgia,
described the extreme conditions surrounding army nurses: “Sometimes
upwards of 300 patients would be admitted in a day, most of them coming
a long distance over rough roads and under a broiling sun in heavy, horsedrawn ambulances ... and perhaps would have to lie, four in an ambulance,
for many hours, a feast for the flies, before they could be removed to thebeds which were being vacated by patients almost as ill, in order to givethe newcomers a chance.”39 In the face of the acute growth in the demand
for nurses, McGee found it increasingly difficult to secure enough trained
nurses for army hospitals.40
The large demand for women nurses at army hospitals gradually eroded
McGee’s standards of professional army nursing. At army hospitals where
yellow fever raged most severely, the nursing service required caregivers
to be immune to the disease through previous experience of infection. But
McGee was not always able to secure enough immune nurses for these
hospitals. When yellow fever appeared among US soldiers in Santiago,
McGee failed to provide the required number of immune nurses. To meetthe urgent need, Surgeon General Sternberg hired Namahyoke Sockum
Curtis, an African American nurse, to recruit immune nurses in the South.
On July 13, Curtis began her search for immune nurses in New Orleansand other Southern cities that had previously experienced outbreaks ofyellow fever, and finally secured thirty-two African American nurses who
were immune to the disease for army service. Eventually, a total of eighty
African American women joined the army nursing service throughout
the war.41 Yet, probably with her latent racial prejudice, McGee criticallyviewed these “colored women without hospital training” as below her
professional standards.42
In the wartime emergency, McGee had to compromise her professional
ideals. The shortage of trained nurses in the army forced her to relax theeligibility criteria for army nurses to include female nurses who graduatedProfessional Angels at War

75

from small training schools without hospital residence, institutions
specializing in certain illnesses, and schools attached to insane asylums.43
Under the pressure of the enormous labor demand, McGee also came toaccept the offers of nursing service from Catholic nuns of the Sisters ofCharity in Emmitsburg, Maryland.44 Even with making these concessions,the demand for nurses still exceeded the supply, and Sternberg finallydecided to authorize chief surgeons at understaffed hospitals to make onsite contracts with volunteer women at their discretion, regardless of theofficial qualification standards.45 These volunteer nurses employed bysurgeons at their respective hospitals “proved not to be of the same class as
their companions in the service,” McGee complained, adding that “irregularnurses are not subject to control and discipline and do not hold the samehonorable position as do women who have Governmental authority for
their presence with the army.”46
To maintain the caliber of army nurses in these adverse circumstances,
McGee often had to pit herself against other organizations that sent
volunteer nurses to army hospitals without official contracts. The mostprominent among these organizations was the Society for the Maintenanceof Trained Nurses in New York, commonly known as Auxiliary No. 3of the American Red Cross. McGee distrusted the nursing ability of thevolunteer women offered by the Auxiliary and insisted that “these nurses
were to be selected by herself; a proviso which gave the permission a
distinctly personal [character].” 47 Auxiliary officials in return publicly
expressed their opinion that they “do not attach any importance to thereport published to the effect that the military authorities will not allow
women nurses to attend the sick and wounded” and that their “nurses will
go wherever they can do good, and that when it becomes apparent thatthey can render assistance in the hospitals, their services will be gladly
accepted.” 48 At the actual sites of nursing, frictions recurrently arose
between trained nurses and volunteer women. Margaret Berry, a graduate
nurse dispatched to Tampa, Florida, bitterly reported to McGee “a greatlack of harmony between the two sets of nurses” at the workplace andcondemned the “open partiality and favoritism” accorded to volunteer
nurses of the Auxiliary. 49 The volunteer service of Auxiliary women
seemed far from McGee’s professional ideals. Even a volunteer who got
an Auxiliary appointment complained that her duties as “assistant nurse”
were “menial work only,” including “washing of floors” and “cooking.”50
Keenly aware of the necessity to prevent the intrusion of untrained
volunteers into the army nursing service, McGee visited New York

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and persuaded Auxiliary officials to select nurses following her official
standards and to file the applications with her central office for review. Yet
the adversary relationship between the two groups of women continued
until the end of the war.51
The tension between volunteers and trained nurses in part reflected theirconflicting visions on the nature of nursing. While volunteers perceived
nursing service as an expression of the feminine virtues in caregiving withwhich all women were innately endowed, McGee and the trained nurses
under her supervision considered nursing a profession involving special
skills and knowledge. Referring to Florence Nightingale’s philosophy on
the development of nursing, McGee maintained that the nursing service
had developed through four distinct stages in its history. 52 Nightingale
explained that nursing the sick had its origin in charity, typified throughthe service of religious orders. Nursing then gradually degenerated intoa trade, which midwives and disreputable nurses practiced for pecuniary
benefits. The reform efforts by Nightingale and her followers in Britainchanged this disgraceful situation and brought in the new notion ofnursing as a calling, a divine mission of women nurses to the world. For
Nightingale, “every woman is a nurse,”53 when care is provided with areligious sense of calling. Nightingale taught her nurses to do every choreand “drudgery” with religious earnestness, “whether in having a draincleaned out, or in ventilating a hospital ward.”54 To this Nightingaleanidea of nursing as a sacred calling, which ideologically endorsed amateur
efforts of private volunteer agencies during the war, McGee counterposed
the concept of profession as the final form of nursing in its historicaldevelopment, and insisted that the vocational status of women nurses as
a profession should derive exclusively from their expert knowledge andskill.55 If a female nurse “did anything she could, including dishwashing,”
insisted McGee, the woman was more of “a servant than [she] was anurse.”56
In theory, the professional ideal of nursing could have fostered agender-free association of caregivers who fulfilled the requirements of theprofession. But in practice, the frequent confrontation with male medical
staff resentful of the female service in the army inevitably attachedgendered nuances to McGee’s conception of the nursing profession. At Fort
Hamilton, surgeon L. M. Maus acidly reported that “the [male] hospital
private takes no interest in his duties as a nurse, nor can he be expected to,so long as he is brought in contact with the female nurse.”57 To countervail
the opposition from male surgeons and attendants, women nurses neededProfessional Angels at War77

to maintain solidarity along gender lines. Yet McGee envisaged theprofession, even though gendered in practice, as consolidated behindprofessional standards, and expected her nurses to convince army surgeonsof their efficiency as a profession by demonstrating physical fitness,expertise, and moral discipline in their daily work.58 When a surgeon at
Fort Meyer, who had “violently objected to having any women nurses,”changed his mind and finally attempted to retain the women nurses at
his hospital, McGee stated with satisfaction that “his conversion wascomplete.”59 By establishing professional standards in the army nursing
service and differentiating trained nurses from the untrained, McGee
broke up the cohesion of sisterhood that united nurses solely as womenand replaced it with a new bond of the gendered profession for the expert
status of women army nurses.

IV. Nursing beyond Borders
While the nursing service in the Spanish-American War enhanced
the professional status of female army nurses, the war also marked the
beginning of international activities by these women nurses. Although
the number of women nurses in active service gradually decreased after
the middle of September 1898, 686 women nurses were still in service at
the close of 1899, and the number of women who served as army nurses
prior to July 1899 reached 1,563 on aggregate.60 Consequently, the US
Army finally reached a decision to absorb the female nurse units as apermanent constituent of the military organization. Section 19 of the
Army Reorganization Act in 1901, drafted by Anita McGee, conferred
the status of regular military organization on the US Army Nurse Corps
and thus institutionalized the activities of women nurses under a female
superintendent. After the enactment of this bill, McGee resigned from hergovernmental post and launched the Society of Spanish American War
Nurses (SAWN) to claim veterans’ benefits for women army nurses.61
Integrated into the national military organization, women army nurses
extended their field of service beyond the territorial borders along theimperial expansion of the United States. After the Spanish-American
War, the US Army continued to send women nurses to hospitals in Cuba,
Puerto Rico, Hawaii, and the Philippines. During the Boxer Rebellion in
1900–1901, these American nurses also engaged in the nursing service in
China.62
In the course of this rapid growth of the military nursing service

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outside the US mainland, Anita McGee herself decided to visit Japan inorder to support Japanese nurses during the Russo-Japanese War in 1904.
When war appeared unavoidable between Japan and Russia, McGee
approached the Japanese government and asked for permission to join thenursing service for Japanese soldiers at army hospitals in Japan. At first,
the Japanese government was reluctant to accept her offer of service.63
In February 1904, however, Takahira Kogorou, the Japanese ministerin Washington, D.C., received a telegram from the Japanese Ministryof Foreign Affairs that the Red Cross Society of Japan (RCSJ, NihonSekijujisha) would make arrangements to receive McGee and some othernurses as its guests.64 Leaders of the RCSJ anticipated that the expeditionof American women nurses would have the effect of raising the morale ofJapanese Red Cross nurses during the war.65 The Associate Society of the
Red Cross in Philadelphia also supported McGee’s nursing expedition byserving as a liaison with the RCSJ.66 Having secured support from these
Red Cross societies, on April 1, McGee left Seattle with a small teamof graduate nurses on the steamship Shawmut and arrived at the port of
Yokohama three weeks later.67
The professional careers of the American nurses who accompanied
McGee to Japan reflected the growth of the army nursing service that
had expanded overseas after the war of 1898. For her service in Japan,
McGee selected nine women nurses who were veterans of the SpanishAmerican War: Mary E. Gladwin, Genevieve Russell, Sophia E. Newell,
Alice Kemmer, Minnie Cooke, Adelaide Mackareth, Adele Neeb, Ella
B. King, and Elizabeth R. Katz. According to the nursing records ofthese nine women nurses, all but Sophie Newell had experience in theoverseas nursing service in Cuba, Puerto Rico, or the Philippines during
and after 1898.68 Alice Kemmer, for example, worked at army hospitals
from August 1898 to June 1900, initially in Chickamauga, Jacksonville,
and Savannah in the South, then in Havana and later in Santa Monica andPresidio in California. On July 1, 1900, Kemmer left San Francisco to join
the nursing service in the Philippines. Yet, on August 4, she found herself
landing on the Chinese shore, due to a change of order during the voyage,and engaged in the nursing service at Tianjin and Beijing during the Boxer
Rebellion. In late May 1901, Kemmer finally reached the Philippines
and worked at Santa Mesa Hospital, Manila, until June 1902.69 For these
women nurses who had previously worked overseas, the expedition to
Japan was only an extension of their already internationalized service.
While the nursing careers of these American women represented theProfessional Angels at War

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expansion of the US Army nursing service overseas, Japanese nursing
practices reflected international currents of contemporary nursing thought.
In the Asian island far away from her home country, McGee encountered
Japanese physicians and nurses imbued with Western ideas of modern
nursing, with which she was definitely familiar in the United States. Soon
after she arrived in Tokyo, McGee must have learned that Takagi Kanehiro,
her attendant in Japan, was a graduate of the medical school of St. Thomas
Hospital in London and was the founder of the first training school for
nurses in Japan. Oyama Sutematsu, the director of the Ladies’ Patriotic
Association that entertained McGee’s nurses in Tokyo, studied nursing at
the Connecticut Training School for Nurses in the United States.70 With
support from foreign missionary societies, Japanese nursing education had
already developed under the strong influence of Nightingalean thought.71
At some training schools, missionary nurses, such as Linda Richards who
graduated from a training school in London and became one of the firstformally trained nurses in the United States, taught Nightingalean ideas ofnursing to Japanese women. Aside from these private training schools, the
RCSJ opened its central hospital in Tokyo and started training of womennurses in 1890 by introducing Western methods of nursing.72 During her
stay in Japan, McGee witnessed the rapid transplantation of Western
nursing ideas, which in truth mirrored a certain ideological section ofAmerican nursing enterprises.73
The ongoing westernization of the nursing service in Japan, or the
spread of Nightingalean methods in effect, posed the same problem for
McGee as she had previously faced during the Spanish-American War. On
May 1, 1904, the Japanese army headquarters ordered McGee to become
the superintendent of nurses at the army reserve hospital in Hiroshima,
the chief military base in the western region of Japan. In late May, McGeeand her nurses began their actual service with Japanese Red Cross nurses
at the first division in the hospital.74 Through the daily supervision ofJapanese women nurses at the wards, McGee made critical observations
for the nursing service in the Japanese army and described the expertise ofJapanese Red Cross nurses as “much less than that of our army nurses.”75
Although admitting to the devotion and sincerity of Japanese nurses,
McGee considered the nursing service by Japanese women who did any
menial chore and worked nearly thirty hours at a time as deviated fromher standards of professional nursing.76 In her report to the RCSJ, McGee
articulated her observations on Japanese nurses by referring again to thecompeting concepts of calling and profession. In Japan, where “the ideas

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of Miss Nightingale are more closely followed,” the ideal of “calling”
stood as the leading principle of nursing with special emphasis on the“ethical aspect” of the service. In contrast, McGee allegedly declared thatthe notion of “profession” dominated the nursing service in the UnitedStates, where “skill and knowledge” were the only objects to be attainedin the training.77 Projecting her experience during the Spanish-American
War onto the Japanese army nursing service, McGee opposed here again
the Nightingalean idea of nursing as a calling, and attempted to proselytize
Japanese women nurses to her ideal of profession.
The actual hospital work brought ample opportunities for McGee toinculcate her professional ideals into Japanese women nurses. On thehospital wards, McGee introduced a three-shift system in the nursing
service. She also prohibited her nurses from doing laundry and otherdomestic chores and instead asked the chief surgeon to employ additional
attendants for these routine services.78 A Red Cross official consequently
came to avow that “driving trained women nurses to do drudgery such as
hauling and cleaning, which requires no training and skill but physicalstrength, is not only a serious disadvantage for the whole economy but
a blatant waste.”79 The daily service of American nurses itself exerted
considerable influence on their Japanese coworkers. On July 11, Genevieve
Russell boarded the hospital ship Hakuaimaru at the port of Ujina anddeparted for the battlefield in northeast China to bring sick and woundedsoldiers back to homeland hospitals. Throughout the voyage, heavy storms
assailed the hospital ship and exhausted medical staff on board. During
this tough mission, Russell cared for as many as sixteen severe patients on
her own and surprised Japanese nurses with her professional skills.80 With
the approval of Red Cross officials and the practical examples of American
nurses, McGee arduously attempted to inculcate her ideal of professional
nursing into the nursing service of the Japanese army.
The nursing service in the Far East resulted in elevating the senseof profession among American nurses themselves as well. Under the
auspices of Japanese Red Cross officials, McGee and her nurses attained
supervisory power as “model nurses” for Japanese women and had
responsibilities over the daily operation of hospital work, which otherwise
they would not have been able to acquire at male-dominated hospitals in
the United States.81 Adelaide Mackareth wrote with delight that the service
in Japan “is quite stimulating and very much rewarding, especially when I
am continually assigned a number of duties which critically affect the fateof patients.”82 The overseas service emancipated American women nurses

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from the subordinate position to male physicians that they had in their
homeland.83 Their increasing authority as instructors for Japanese womennurses accordingly strengthened their self-awareness as professionals.
When McGee fixed the date of return to the United States as early October
1904 in order to attend the SAWN annual meeting in St. Louis, five
American nurses opposed her decision and directly solicited Japanese
officials to extend their term in Japan for another six months.84 Ella King
deemed it irresponsible to “go home now when the work is hardest and
we are just beginning to be of some slight use.”85 By reasoning it as aprofessional obligation to prioritize their service for Japanese patientsat hand over political concern for veteran army nurses, these American
women insisted on an extension of their stay in Japan. Far remote from thehierarchical constraints of medical circles in the US mainland, the overseas
activities nurtured the professional identity of American women nurses.

V. Conclusion
At the turn of the twentieth century, armed conflicts prompted
rearticulation of nursing as a gendered profession. With the SpanishAmerican War in 1898 and the consequent acquisition of overseas
colonies, the United States emerged on the global stage of imperial rivalry.
This outward expansion of the state as a world power triggered the rapid
growth of the US Army nursing service. Anita McGee played a pivotal rolein this development. Though herself not a trained nurse, McGee climbed
the ladder of the military caste system as a physician and contributed as
the Acting Assistant Surgeon General to enhancing the status of womennurses in the army.86 Through repeatedly confronting Nightingalean ideas
about nursing, first in the Spanish-American War and later during the
Russo-Japanese War, McGee created a new bond of women nurses as aprofession.
McGee’s ideal of nursing reflected and indeed forwarded an ideologicalshift toward professionalization in the American nursing field. As Patricia
D’Antonio points out, American women nurses at major hospitals
gradually departed from the old Nightingalean notion of womanly care andput more value on professional skills and knowledge in the late nineteenth
century.87 Yet political rivalries within the nursing field, between trained
nurses and the untrained, or between those affiliated with large institutions
and those working at small and specialty hospitals, seriously hampered
this shift.88 The emergencies caused by war provided McGee with the82

Yoshiya Makita

opportunity to promote professionalism in foreign battlefields. By setting
the foundation for professional army nursing, McGee opened the door for
American women nurses to work overseas. When they were in Japan andaway from domestic quarrels, McGee and her nurses were able to build
their identity as professional caretakers. The overseas growth of army
service helped advance the professionalization of American nursing. When
McGee and her nurses finally ended their service in Japan in October 1904,
many of these American nurses chose to continue their overseas activities.
Kemmer returned to Manila directly from Japan, while Cooke, King,
Mackareth, and Russell went on to Panama to join the nursing service in
the Canal Zone.89 Deeply intertwined with international conflicts, modern
professional nursing spread beyond borders.

Notes
1
For the progress of the war in 1898, see Joseph Smith, The Spanish-American War:
Conflict in the Caribbean and the Pacific (New York: Longman, 1994); Sebastian Balfour, The End of the Spanish Empire (Oxford: Clarendon Press, 1997), 11–63; LouisA. Pérez, The War of 1898: The United States and Cuba in History and Historiography(Chapel Hill: University of North Carolina Press, 1998).
2
Memoir of Lillian Kratz Kuehn, typescript, RG 112, Records of the Office of theSurgeon General, Entry 230, Anita Newcomb McGee’s Office Files, 1898–1936, National Archives and Records Administration, Washington, DC (hereafter, NARA).
3
Memoir of Lillian Kratz Kuehn.
4
Ibid.
5
Jane E. Mottus, New York Nightingales: The Emergence of the Nursing Profession
at Bellevue and New York Hospital, 1850–1920 (Ann Arbor: UMI Research Press,
1981).
6
For the ideas and activities of Florence Nightingale, see Mark Bostridge, FlorenceNightingale: The Making of an Icon (New York: Farr, Straus and Giroux, 2008);
Edward Cook, The Life of Florence Nightingale (London: Macmillan, 1913); Irene
Sabelberg Palmer, “Florence Nightingale: Reformer, Reactionary, Researcher,” inNursing Issues in the Twenty-first Century: Perspectives from the Literature, ed.
Eleanor C. Hein (Philadelphia: Lippincott Williams & Wilkins, 2001), 26–38; Brian
Abel-Smith, A History of the Nursing Profession (London: Heinemann, 1960), 17–35,
61–80.
7
Jane E. Schultz, Women at the Front: Hospital Workers in Civil War America(Chapel Hill: University of North Carolina Press, 2004).
8
Mercedes H. Graf, “Women Nurses in the Spanish-American War,” Minerva:
Quarterly Report on Women and the Military 19, no. 1 (Spring 2001): 3–38; Philip
A. Kalisch, “Heroines of ’98: Female Army Nurses in the Spanish-American War,”Nursing Research 24, no. 6 (November/December, 1975): 411–29.
9Susan Reverby, Ordered to Care: The Dilemma of American Nursing, 1850–1945(New York: Cambridge University Press, 1987).
10
Mary T. Sarnecky, A History of the US Army Nurse Corps (Philadelphia: Universityof Pennsylvania Press, 1999), 33–34.

Professional Angels at War

83

11
Lauren M. E. Goodlad, “ ‘A Middle Class Cut into Two’: Historiography andVictorian National Character,” ELH 67, no. 1 (Spring 2000): 143–78; Charles E.
Rosenberg, “Florence Nightingale on Contagion: The Hospital as Moral Universe,” inExplaining Epidemics: And Other Studies in the History of Medicine, ed. Rosenberg(New York: Cambridge University Press, 1992), 90–108.
12See, for example, Mottus, New York Nightingales; Reverby, Ordered to Care;
Barbara Melosh, “The Physician’s Hand”: Work Culture and Conflict in American
Nursing (Philadelphia: Temple University Press, 1982); Jo Ann Ashley, Hospitals,
Paternalism, and the Role of the Nurse (New York: Teachers’ College Press, 1976).
13
Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, andHygiene in the Philippines (Durham, NC: Duke University Press, 2006), 7; “Where Is
the Post-Colonial History of Medicine?,” Bulletin of the History of Medicine 72, no. 3(1998): 522–30.
14
Julia F. Irwin, “Nurses without Borders: The History of Nursing as US International
History,” Nursing History Review 19 (2011): 78–102. See also Irwin, “Humanitarian
Occupations: Foreign Relief and Assistance in the Formation of American International
Identities, 1898–1928” (PhD diss., Yale University, 2009); and “Nation Building andRebuilding: The American Red Cross in Italy during the Great War,” Journal of the
Gilded Age and Progressive Era 8, no. 3 (July 2009): 407–39.
15
In 1888, McGee married William John McGee, the chief geologist of the Atlantic
coastal plain division at the United States Geological Survey. See Yoshiya Makita,“McGee, Anita Newcomb (1864–1940),” in An Encyclopedia of American Women at
War: From the Home Front to the Battlefields, ed. Lisa Tendrich Frank (Santa Barbara:
ABC-Clio, 2013), 380–82.
16
For the early years of Anita Newcomb McGee’s career, see Cindy Gurney and
Dolores J. Haritos, “Anita Newcomb McGee, 1864–1940,” in American Nursing: A
Biographical Dictionary, ed. Vern L. Bullough, Olga Maranjian Church, and Alice P.
Stein (New York: Garland, 1988), 217–20; Gloria Moldow, Women Doctors in GildedAge Washington: Race, Gender, and Professionalization (Urbana: University of Illinois
Press, 1987), 33–35, 122, 127; Sandra A. Yerkes, “Anita Newcomb McGee, MD”(July 1977), typescript. Anita Newcomb McGee Collection, Bio File, Otis Historical
Archives, National Museum of Health and Medicine, Silver Spring, MD.
17
Moldow, Women Doctors in Gilded-Age Washington, 60–70.
18
McGee’s Journal, entry 26 April 1898; Resolution of the National Society of theDaughters of the American Revolution, 26 April 1898, RG 112, Entry 229, Journal of
Dr. Anita Newcomb McGee, 1898–1936, NARA. As to McGee’s early commitment
to the activities of the DAR, see Moldow, Women Doctors in Gilded-Age Washington,
145–47.
19
George M. Sternberg to Anita Newcomb McGee, 28 April 1898, RG 112, Entry
229, NARA.
20
McGee’s Journal, entry 28 April 1898; Report of Committee to Obtain Information from the Surgeons General of the Army and Navy; W. K. Van Reypen to McGee,
28 April 1898; and Sternberg to McGee, 28 April 1898, RG 112, Entry 229, NARA;
Report of the Surgeon General of the Army to the Secretary of War for the Fiscal Year
Ended June 30, 1898 (Washington, DC: Government Printing Office, 1898), 102.
21
Memorandum of Alice Pickett Akers, 30 April 1898, RG 112, Entry 229, NARA;
McGee, “Women Nurses in the American Army,” paper read at the Eighth Annual Proceedings of the Association of Military Surgeons of the United States, September 1899,
typescript, 1, RG 112, Entry 230, NARA.
22
McGee, “Standard for Army Nurses,” pamphlet, 1, RG 112, Entry 230, NARA.

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23
Circular letter, April 1898; Circular letters “F” and “N,” no date, RG 112, Entry
229, NARA; McGee, “Women Nurses in the American Army,” 1, 4.
24
Circular “E,” no date, RG 112, Entry 229, NARA.
25
Alice Fahs, “The Feminized Civil War: Gender, Northern Popular Literature, andthe Memory of the War, 1861–1900,” Journal of American History 85, no. 4 (March
1999): 1461–94; Kristie Ross, “Arranging a Doll’s House: Refined Women as Union
Nurses,” in Divided Houses: Gender and Civil War, ed. Catherine Clinton and Nina
Silber (New York: Oxford University Press, 1992), 97–113.
26
Nightingale to Harriet Martineau, 30 September 1861; and quotation fromNightingale to Dennis R. Alward, 22 February 1865, in The Collected Works of
Florence Nightingale, vol. 15, ed. Lynn McDonald (Waterloo: Wilfrid Laurier
University Press, 2011), 598, 601.
27
Thomas J. Brown, Dorothea Dix: New England Reformer (Cambridge: Harvard
University Press, 1998), 280–323; Louisa May Alcott, Hospital Sketches (Boston:James Redpath, 1863), 77.
28
Kate Cumming, A Journal of Hospital Life in the Confederate Army of Tennessee
from the Battle of Shiloh to the End of the War (Louisville, KY: John P. Morton & Co.,
1866), 11.
29
Florence Nightingale, Notes on Nursing: What It Is, and What It Is Not (London:
Harrison, 1860), 79.
30
Schultz, Women at the Front, 3.
31
McGee’s Journal, entry 7 May 1898, RG 112, Entry 229, NARA. See also “To
Nurse the Wounded,” Washington Evening Star, 14 May 1898; “Nurses Off for Key
West,” Washington Post, 15 May 1898; and “New Hospital Corps,” Washington Times,
17 May 1898.
32
Vincent J. Cirillo, Bullets and Bacilli: The Spanish-American War and Military
Medicine (New Brunswick, NJ: Rutgers University Press, 1999); Walter Reed, Victor
C. Vaughan, and Edward O. Shakespeare, Abstract of Report on the Origin and Spreadof Typhoid Fever in US Military Camps during the Spanish War of 1898 (Washington,
DC: Government Printing Office, 1900). See also Cirillo,“Houseflies as Carriers of
Typhoid Fever in 19th- and Early 20th-Century Military Camps,” Perspectives in
Biology and Medicine 49, no. 1 (Winter 2006): 52–63; Matthew Smallman-Raynor andAndrew D. Cliff, “Epidemic Diffusion Processes in a System of US Military Camps:
Transfer Diffusion and the Spread of Typhoid Fever in the Spanish-American War,1898,” Annals of the Association of American Geographers 91, no. 1 (March 2001):
71–91.
33
Cirillo, “Fever and Reform: The Typhoid Epidemic in the Spanish-American War,”
Journal of the History of Medicine and Allied Sciences 55, no. 4 (October 2000): 363.
34
Nicholas Senn, Medico-Surgical Aspects of the Spanish American War (Chicago:
American Medical Association Press, 1900), 173.
35
Reed, Vaughan, and Shakespeare, Abstract of Report on the Origin and Spread of
Typhoid Fever, 3.
36
Senn, Medico-Surgical Aspects of the Spanish American War, 155.
37
McGee, “Standard for Army Nurses,” pamphlet, 2, RG 112, Entry 230, NARA.
38“Lieut. Anita N. McGee,” Washington Post, 30 August 1898; McGee, “Standard
for Army Nurses,” 2; McGee, “Women Nurses in the American Army,” 1.
39
Florence M. Kelly, “A Spanish War Nurse Remembers,” Alumnae Journal of New
York City Hospital School of Nursing 37 (July 1926): 24.
40
McGee, “Women Nurses in the American Army,” 1–2; McGee, “Standard forArmy Nurses,” 2–3.

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85

41
Sarnecky, A History of the US Army Nurse Corps, 31. See also Darlene Clark Hine,
Black Women in White: Racial Conflict and Cooperation in the Nursing Profession,
1890–1950 (Bloomington: Indiana University Press, 1989); and Mary Elizabeth
Carnegie, The Path We Tread: Blacks in Nursing Worldwide, 1854–1994, 3rd ed. (NewYork: National League for Nursing Press, 1995).
42
McGee, “Women Nurses in the American Army,” 2.
43
McGee, “Standard for Army Nurses,” 2–3.
44
McGee, “Women Nurses in the American Army,” 2; McGee, “Standard for Army
Nurses,” 3; Mercedes H. Graf, “Band of Angels: Sister Nurses in the Spanish-American
War,” Prologue 34, no. 3 (Fall 2002): 197–209.
45
McGee, “Women Nurses in the American Army,” 2.
46
McGee, “Standard for Army Nurses,” 3; McGee, “Women Nurses in the American
Army,” 2.
47
McGee, “The Status of the Army Nurse of 1898,” pamphlet, 3, RG 112, Entry 230,
NARA.
48
New York Times, 8 July 1898.
49
Margaret M. Berry to McGee, 9 August 1898, RG 112, Entry 230, NARA.
50
New York Times, 13 August 1898.
51
McGee, “The Army Nurse Corps and Auxiliary No. 3,” typescript, RG 112, Entry
230, NARA.
52
Florence Nightingale, “Sick Nursing and Health Nursing,” in Hospitals,
Dispensaries, and Nursing: Papers and Discussions in the International Congress ofCharities, Correction and Philanthropy, June 12th to 17th, 1893, ed. John S. Billingsand Henry M. Hurd (Baltimore: Johns Hopkins Press, 1894), 444–63.
53
Nightingale, Notes on Nursing, 3.
54
Elizabeth Robinson Scovil, “Florence Nightingale and Her Nurses,” American
Journal of Nursing 15, no. 1 (October 1914): 13–14. See also Florence Nightingale to
Her Nurses: A Selection from Miss Nightingale’s Addresses to Probationers and Nursesof the Nightingale School at St. Thomas’s Hospital (London: McMillan & Co., 1914).
55
McGee, “The Growth of the Nursing Profession in the United States,” pamphlet,
RG 112, Entry 230, NARA.
56
McGee, “The Army Nurse Corps and Auxiliary No. 3.”
57
Record No. SGO 58529: Extract from letter of Major, L. M. Maus, Fort Hamilton,
3 June 1899, RG 112, Entry 230, NARA.
58
McGee, “Standard for Army Nurses,” 3–4.
59
McGee, “Fort Meyer. 4th Story,” typescript, RG 112, Entry 230, NARA.
60
McGee, “Women Nurses in the American Army,” 3.
61
McGee, “Official Status of Spanish War Nurses Prior to the Economy Act ofMarch, 1933,” typescript, RG 112, Entry 230, NARA.
62
Committee of the Spanish American War Nurses, “Nursing in the Spanish
American War,” pamphlet, 3–4; McGee, “The Nurse Corps of the Army,” pamphlet, 3,
RG 112, Entry 230, NARA.
63
Kogorou Takahira to McGee, 31 October 1903, RG 112, Entry 230, NARA.
64
Takahira to McGee, 15 February 1904, RG 112, Entry 230, NARA.
65
Nihon-Sekijuji, no. 135 (15 April 1904), 18.
66
J. Wilks O’Neil to Masayoshi Matsukata, 4 March 1904, file B-329: S-250, NihonSekijujisha Bunsho (Records of the Japanese Red Cross Society), Japanese Red Cross
Toyota College of Nursing (hereafter, NS).
67
McGee’s Journal, entries April 1 and 22, RG 112, Entry 229, NARA.

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68
Nursing Records of Mary E. Gladwin, Genevieve Russell, Minnie Cooke, Adelaide
Mackareth, Sophia E. Newell, Adele Neeb, Ella B. King, Alice Kemmer, and Elizabeth
R. Kratz, file B-329: S-250, NS.
69
Nursing Record of Alice Kemmer, file B-329: S-250, NS.
70
Fuki Koba, “Takagi Kanehiro to Eikoku Ryugaku: Eikoku no Iryou, Kango no
Eikyou,” Shin-Satsumagaku: Satsuma to Ryugakusei, ed. Center for International
Cultural Studies (Kagoshima: Nanpou-Shinsha, 2006), 97–153; Akiko Kuno,
Rokumeikan no Kifujin Oyama Sutematsu: Nihonhatsu no Joshi Ryugakusei (Tokyo:
Chuoukouron, 1993), 138–42.
71
Aya Takahashi, The Development of the Japanese Nursing Profession: Adopting
and Adapting Western Influences (London: Routledge Curzon, 2004), esp. 36–53.
72
Michiko Kameyama, Nihon-Sekijujisha to Kangofu (Tokyo: Domesu-shuppan,
1983).
73
See, for example, memorandum concerning the reception of Mrs. McGee and her
nurses, 14 March 1904, file B-328: S-249, NS.
74
Terms of service, Japanese Ministry of War, 1 May 1904, RG 112, Entry 230,
NARA; Takeo Ozawa to Narinobu Hirayama, 1 June 1904, file B-328: S-249, NS.
75
McGee, “Work at the Army Reserve Hospital of Hiroshima,” 15 July 1904,
typescript, 4, RG 112, Entry 230, NARA.
76
Report of Anita McGee on the Japanese Red Cross nursing, file B-330: S-251, NS;
Chunichi Shinbun, 19 July 1904.
77
Report of Anita McGee on the Japanese Red Cross nursing.
78
The Second Relief Squad, Monthly Administrative Report (June 1904), file B-453:
S-374, NS; McGee’s Journal, entry 10 October 1904, RG 112, Entry 229, NARA.
79
Memorandum on the method of nursing under Dr. McGee, n.d., file B-328: S-249,
NS.
80
The Second Relief Squad, Monthly Administrative Report (July 1904).
81
Nihon-Sekijuji, no. 139 (15 June 1904), 12; Emergency relief memorandum, no.
1670, 4 June 1904, file B-329: S-250, NS. Quotation from Nihon-Sekijuji, no. 135 (15April 1904), 18.
82
Adelaide Mackareth to Takeo Ozawa, 14 July 1904, file B-328: S-249, NS.
83
The similar effect of overseas service on nurses’ vocational status could be foundin the colonial Philippines. See, for example, Mabel E. McCalmont, “Hospitals andNursing in the Philippines,” American Journal of Nursing 10, no. 2 (November 1909):
94; and Catherine Ceniza Choy, Empire of Care: Nursing and Migration in Filipino
American History (Durham, NC: Duke University Press, 2003), 23.
84
McGee to Takagi, 28 June 1904; Ozawa to McGee, 4 July 1904; Memorandum
no. 2348, 25 July 1904; Gladwin, Russell, Mackareth, King, and Katz to the RCSJ
headquarters, 29 July 1904; Mackareth to Ozawa, 1 September 1904, all in file B-328:
S-249, NS.
85
King to Ozawa, 6 August 1904, file B-328: S-249, NS.
86
Judith Bellafaire and Mercedes Graf, Women Doctors in War (College Station:
Texas A & M University Press, 2009), 28.
87
Patricia D’Antonio, American Nursing: A History of Knowledge, Authority, and the
Meaning of Work (Baltimore: Johns Hopkins University Press, 2010), 3.
88
Reverby, Ordered to Care, 121–42.
89
Minnie Cooke to the headquarters of the RCSJ, 7 February 1905; Russell to
Ozawa, 5 May 1905; memorandum no. 1, 27 June 1905, file B-330: S-251, NS.