Dispatches from the Desk of Clara D. Noyes, RN
Reflections on a Leader in the History of Red Cross Nursing
By Roger L. Noyes
“Woman Heads Red Cross Aid: World-Wide Activities Center at Desk of Miss Clara D. Noyes,” states the headline in a 1927 Associated Press (AP) article.
“The broad desk at which Miss Noyes sits is a keyboard contacting nurses in all corners of this country and nursing organizations in a score of countries abroad,” including correspondences with a Red Cross nurse in the Philippines “who tells of riding through swamps to isolated parts of the islands upon the only conveyance that is suitable for such a trip – a water buffalo.”[i]
The writer of this 1927 profile saw Clara Noyes’ desk as a metaphor: a hub for the management of Red Cross nursing and relief activities that were then occurring at multiple, far-flung reaches of the globe. Yet this very object, the desk itself, exists quite literally today in my own home, having once been possessed by an extraordinary individual, Clara Dutton Noyes, RN, who ran the Red Cross’s nursing operations during an era of unimaginable global conflict, economic depression, and natural disaster.
Its wood, lightly stained and adorned with modest stylistic ornaments, is a work of both eloquence and practicality, like the woman who owned it many decades before I would.
In many ways, I suppose that I, too, see this desk as a metaphor.
My grandfather’s aunt Clara Noyes (1869-1936), an inductee into the American Nurses Association Hall of Fame, was widely recognized for her work as director of the Red Cross Nursing Bureau during World War I. There she was responsible for the enrollment, organization, assignment and training of nurses to duty – as many as 21,000 nurses by the war’s end.
She continued in this role as nursing director for 20 years after the armistice, helping to manage post-war public health activities in Europe, establishing nursing schools around the world, and overseeing several domestic and public health nursing response efforts, such as the Mississippi Flood of 1927 and the care of indigent populations during the Great Depression.
An 1896 graduate of The Johns Hopkins School of Nursing, Clara Noyes also founded the nation’s first midwife school, was a published authority on nursing issues of all kinds, and was editor of the American Journal of Nursing where she wrote about her experiences helping nurses respond to global and domestic catastrophes alike. Her incredible career earned her honors from the International Red Cross, the Saunders medal for “distinguished service in the cause of nursing,” the Florence Nightingale Award, medals from the French and Bulgarian governments, and many other distinctions
Being a writer, I like to imagine her also having some small role in American literary history when, on January 2, 1918, Clara Noyes received an enthusiastic letter from Agnes von Kurowsky Stanfield who was “anxious to volunteer for active service” in World War I.[ii] With Clara Noyes’ approval, Ms. Stanfield enlisted for duty in Europe where one of her patients turned out to be 19-year-old Ernest Hemingway. It is believed that Hemingway saw Ms. Stanfield as the inspiration for characters in A Farewell to Arms and other literary masterpieces.[iii]
But Ms. Stanfield’s enthusiasm serves more than just the literary imagination. One can easily ascertain that Clara Noyes, in her role mobilizing nurses for the war effort, received many such letters from women, like Ms. Stanfield, who were eager to serve their country. In fact, this enthusiasm appears to have even raised an existential concern about the future of nursing. “Everyone seems to have gone mad,” Ms. Noyes wrote her colleague, M. Adelaide Nutting, in a 1917 correspondence. “There are moments when I wonder whether we can stem the tide and control the hysterical desire on the part of thousands, literally thousands, to get into nursing … The most vital thing in the life of our profession is the protection of the use of the word nurse.”[iv]
At the time, modern professional nursing was still in its relative infancy. Its practice had been defined in large part by the work of icons like Florence Nightingale during the Crimean War in the 1850s. Therefore, just as modern nursing had its roots in warfare, Clara Noyes’ own observations reveal that the personnel demands of global conflict in the early twentieth century threatened to redefine nursing yet again. And in many ways it did: young nurses found themselves pressed into new levels of trauma care as they assisted the wounded at hospital base stations in Europe and back home.
Clara Noyes gave several detailed accounts of the war operations in articles that appeared regularly in the American Journal of Nursing. Those articles are, in part, chronicles of her department’s nursing deployment activities but they are also a call to duty for young nurses. From reading these dispatches, it also appears that Ms. Noyes’ initial concerns about the “hysteria” of nurses applying for service were tempered by the growing need for personnel as the war stretched on.
In the January 1918 edition of the Journal, for instance, she provides data on the number of nurses then assigned and mobilized for assignment from base hospitals and units in the Navy and Army service. She then writes: “this is no small achievement, no mean accomplishment. To secure these nurses and prepare them for duty has meant hard, exacting and patient work for all concerned … But more must be done. Present estimates provided by the Surgeon General indicate that thousands of nurses will be required if the war continues. New units will be organized and the nurses now in service will need relief. The present enrollment, 15,000, large as it appears, is not adequate.”
For those nurses assigned to duty, she writes in the same article, “the primary object of the service is to care for the sick or wounded soldiers or sailors wherever they may be … The nurses of this country have a heavy responsibility placed upon their shoulders. By virtue of their special preparation, they cannot evade this moral obligation.”
Having defined the moral obligation, her article then turns to a plea, noting of the would-be nurse that “the sick soldier in the cantonment is now calling for her more loudly than is his brother in France. It may be your brother or cousin or father. What are the readers of this magazine doing about it? Have you enrolled in the Red Cross Nursing Service? If not, why not?”[v]
Equally dramatic was her writing about the Red Cross response efforts to calamities like the Mississippi Flood of 1927, which is considered to be one of the most destructive river floods in American history, engulfing parts of 10 states: Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, Tennessee, Texas, Oklahoma and Kansas.
When the AP asked Clara Noyes “how it was done and if she wasn’t awfully busy” deploying nurses to the flood, she quips: “Why no, not any busier than usual. All I do is press a button and things happen.”[vi]
Despite this ironic quip in response to a somewhat dismissive question about her important work, Clara Noyes’ own writings about the actual flood response were anything but glib as she conveys the enormity of her task and that of the nurses under her charge. In the October 1927 edition of the American Journal of Nursing, Clara Noyes offers this gripping account of the disaster, which is reminiscent of stories told by home care nurses who have responded to more recent natural disasters like Superstorm Sandy in New York State in 2012, the 2011 tornado in Joplin, Missouri, and other calamities:
Refugees had been streaming into the camps – and at the peak of the disaster the Red Cross was maintaining 138 camps with a population of 600,000 homeless – as fast as the levees broke inundating homes and farmlands. Each boatload carried the burden which the nurses carried … literally tons of quinine were administered in an effort to prevent malaria and thousands were inoculated daily against smallpox and typhoid with the result that a possible, serious epidemic was forestalled … Nurses frequently went from house to house in boats, caring for those who were marooned on second and third stories. One nurse went her rounds in hip boots! Another reported that she wore out her hypodermic needles during the rush of inoculations and not being able to secure more, immediately, kept her eyes alert for the first grindstone that appeared above the water, salvaged it, and sharpened them to continue her work. Alone, they presided at childbirths on levees and in box cars![vii]
This account of the Red Cross response to domestic flooding reads very much like a description of warfare. The nurses she describes here seem little different in their steely resolve from the field soldiers fighting battles in Europe a mere ten years prior – and, of course, little different from the nurses who tended to war wounds under Clara Noyes’ leadership. No doubt the experience of deploying nurses to care for the wounded in military service helped inform Clara Noyes’ strategy for domestic response efforts like the Mississippi Flood 0f 1927. But history also shows us that the Red Cross was already planning for these kinds of domestic operations, even as they were equipping nurses for the grip of global war.
Nurse leaders like Clara Noyes and her mentor, Jane Delano, understood that the demands of the war effort needed to be balanced by a parallel effort of domestic planning at a time when the world was not only rocked by violence but, soon enough, a flu pandemic and the population health needs of individuals suffering in the Great Depression.
This is why, in 1917, the Committee on Nursing of the Council of National Defense endorsed a plan for domestic nurse recruitment efforts and the establishment of a special practice designation known as the “Home Defense” nurse. As part of its plan, the Red Cross ensured that 6,000 public health nurses remained on call for domestic incidents. And so, when the flu outbreak reached pandemic levels in 1918, a plan was ready for mobilization. That year, Clara Noyes telegraphed all Red Cross divisions with the following terse message: “Suggest you organize Home Defense nurses … to meet present epidemic … Provide nurses with masks.”[viii]
If Clara Noyes didn’t quite “press a button” to make things happen, as her ironic quote to the AP would later suggest, there is nevertheless a kernel of truth in her remark. Clearly, leaders at the Red Cross had created a system and infrastructure to ensure that the domestic response effort was as close to automatic as it could possibly be.
Harris & Ewing Collection
(Library of Congress)
An educational leader
Beyond disaster response, Clara Noyes was also a champion of nursing and public education. A scan of newspapers from the 1920s finds her writing columns for a general readership about “The Essentials of Home Nursing” to educate the public about hygiene, nutrition, bathing, care of newborns and their mothers, ambulation and other matters in her public health education role, with such advice as “How Bed-Bath May Be given Without Chilling The Patient.”[ix]
She was also very concerned about the lack of training opportunities for maternal-infant care at a time when 40 percent of childbirths occurred in the home. “In one of our largest and most progressive cities,” she wrote, “the midwife is forbidden by law to practice, yet by some strange interpretation she is required to register all births occurring in her practice.”[x]
She added: “For years in America the medical profession has fought the midwife, struggled to suppress her, restrict her, eliminate her and what not, yet the midwife continues to flourish.”
As a solution to the issue, Clara Noyes looked to home care nursing:
The large number of nurses engaged in district nursing are engaged in instructing the prospective mother and giving nursing care during pregnancy and puerperium. They find themselves seriously handicapped at times, not so much from lack of knowledge, but from lack of legal recognition. If our visiting nurse were also certified midwives would not the mothers and babies of the less favored classes be infinitely safer in their hands? … By virtue of her special training in the care of the sick, in observation of symptoms, in bacteriology, hygiene, sanitation, dietetics, feeding of children and surgical technique, she is particularly well fitted to receive this higher technical training.
Sitting here at my own desk and reading Clara Noyes’ words about the role of home care nurses, I realize that she played an important role in defining and communicating the strengths and values of home nursing as a profession and as an essential component of public health. While the tone and style of her writing differ from mine, reflecting the language and attitudes of her time, many of her sentiments are nevertheless congruent with messages I have often found myself communicating in my own writing on home care.
As I pause on this thought, it fascinates me to realize how Clara Noyes and I both ended up sharing not only a common ancestry, but also a desk – and, more importantly, an extension of what that desk represents: a common orbit of professional focus, much of it through the written word. Hopefully, with this very article, my own desk can “be a keyboard contacting nurses in all corners of this country,” as the AP wrote about Clara Noyes’ reach in domestic and global affairs.
When Clara Noyes passed suddenly in 1936, her obituary ran in newspapers nationwide, noting her many achievements and important role in the history of Red Cross nursing. But I am particularly struck by a report in the June 3, 1936 edition of a newspaper covering Old Lyme, Connecticut, a town that was settled two centuries earlier by her ancestor and mine, the Reverend Moses Noyes, who was instrumental in the origins ofYale College.
“Miss Noyes, who was 66 years old, was stricken by a heart attack while driving her car to her duties in Washington. Her niece, Miss Lucy Lay Noyes, riding with her, prevented a collision by pulling the emergency break.”[xi]
To the very end, Clara Noyes was engaged in her life’s work “driving her car to her duties in Washington.” And even her death, like much of her work in life, involved a crisis that would have been even bigger had it not been for the quick thinking of someone by her side, acting in the most urgent of moments.
About the Author: Roger Noyes is Communications Director for the Home Care Association of New York State (HCA). In this piece he reflects on the life and work of his grandfather’s Aunt Clara Noyes, a major figure in the history of Red Cross nursing. He can be reached at email@example.com.
[i]"Woman Heads Red Cross Aid." The Milwaukee Journal. September 7, 1927. p. 2.
[ii]Letter from Agnes von Kurowsky to Clara D. Noyes. January 2, 1918. Records of the American National Red Cross, 1881-2008, National Archives and Records Administration.
[iii]"Critic's Notebook; Was She or Wasn't She? A Diary of Hemingway's (Probable) Muse." New York Times. October 17, 1989.
[iv]Noyes, C. Correspondence to M. Adelaide Nutting. Columbia University, New York: Nursing Archives, Teacher's College. April 8, 1917.
[v]Noyes, C. “Department of Red Cross Nursing,” American Journal of Nursing, Vol. 18, No. 4 (Jan., 1918), pp. 317-321.
[vi]"Woman Heads Red Cross Aid." The Milwaukee Journal. September 7, 1927. p. 2.
[vii]Noyes, C. “Department of Red Cross Nursing,” American Journal of Nursing, Vol. 27, No. 10 (Oct., 1927), pp. 857-859.
[viii]“‘Alert to the Necessities of the Emergency.’: U.S. Nursing During the 1918 Influenza Pandemic.” Public Health Report. 2010; 125 (Suppl 3): 105-112.
[ix]Noyes, C. “Essentials of Home Nursing,” The Independent, St. Petersburg, FL., Jan. 23, 1920. p. 3.
[x]Noyes, C. “The Midwifery Problem,” American Journal of Nursing, Vol. 12, No. 6 (Mar., 1912), pp. 466-471.
[xi]“Miss Clara Noyes, Red Cross Nurse Head, Dies Today.” The Day, New London, CT., June 3, 1936. p. 10.