From Lilian Violet Cooper to Australia’s other pioneering female military surgeons of World War I

From Lilian Violet Cooper to Australia’s other pioneering female military surgeons of World War I. Image: Fig. 1. Cooper and Bedford outside their tent in Serbia. Photo courtesy of the Alexander Turnbull Library New Zealand.

The war service of Lilian Violet Cooper, the first female surgeon of the Royal Australasian College of Surgeons, is well recognized. Not so well known however, are the other pioneering female doctors who also undertook work as military surgeons during World War I.

At least four of the 14 Australian female doctors that undertook overseas war service during World War I were engaged as surgeons and treated Australian, British and Allied casualties.

These women operated in London, in Egypt and on the frontlines of the Macedonian campaign. While none of these other women became Fellows of the Royal Australasian College of Surgeons, their war efforts deserve recognition.

Australia and the enlistment of female doctors

The Australian Army did not permit the enlistment of female doctors until the Second World War. However, during World War I at least 14 female doctors served overseas as military doctors.

Some joined British Royal Army Medical Corps units in France, Malta, Egypt or Salonika. Others were employed at Endell Street Military Hospital in London or worked with the Scottish Women’s
Hospitals in France and Serbia.

Several of these women worked as surgeons, some under harsh conditions, receiving casualties directly from the frontline.

The best known of these women is Lilian Violet Cooper who subsequently became a Foundation Fellow of our College and its first female surgeon.

This article will examine the war surgery contributions of Dr Cooper and two of her lesser-known surgical colleagues, Elizabeth Bennett and Vera Scantlebury (later Scantlebury-Brown).

Women’s professional situation

By 1914, Australian women had won their struggle for medical education; however, they were neither universally accepted nor welcomed in the profession. There were also significant barriers preventing women graduates obtaining suitable hospital posts. Surgical positions were particularly coveted, none of the early graduates were successful in obtaining one.

By 1915, there were 129 women listed in Butterworth’s Medical Directory, but when Australia’s Prime Minister, Andrew Fisher announced – ‘that we would stand with the Empire to our Last man
and last shilling . . .’ what was implicit in his words and the Australian Army’s war plans, was that women need not apply.

While the Australian Army accepted nurses and female physiotherapists (masseuses) for overseas military service, there was no place for women doctors.

Nonetheless, at least 14 Australian women found their way to serve as doctors in European theatres of war or in Egypt. They served as general doctors, surgeons and pathologists. They treated
military casualties in hospitals in England, Egypt, on the Western Front and in makeshift field units during the Balkans campaign.

Many of them ended up with as much responsibility as male doctors, and were subject to the same rigors of service, risks and dangers.

Two became prisoners of war, and all are inspirational examples of medical courage and leadership. Despite no recognition from their own country, a number of the doctors were awarded foreign medals; by British, Serbian and French Militaries.

Dr Pheobe Chapple, an Adelaide graduate, became the first woman doctor, and the only Australian woman, to be awarded a Military Medal for gallantry in the field.

Australian female military surgeons and the Serbian front

It is arguably on the slopes of the Kaymackchalan mountain range in Serbia that some of the most extraordinary feats of military surgery undertaken by women inWorldWar I were performed.

Four of those surgeons were Australian and the other was a native of New Zealand. Under the leadership of Sydney born Dr Agnes Bennett, these women worked with Britain’s Allies to support a campaign that has been largely forgotten.

Agnes Bennett 1872–1960

A graduate of Edinburgh University Medical College and one of the first medical colleges in Britain to admit women, Agnes found it difficult to carve out a career as a doctor in Britain. She wanted
desperately to pursue a career in surgery, but this proved impossible.

Residency jobs in surgery were much prized and it was virtually impossible for a woman to be considered, even if their examination grades were superior.

After a frustrating search for a suitable post, she secured a position in the Larbert lunatic asylum – a Dickensian institution where she worked for 15 months.

She fared no better on her return to Australia.

Fortune smiled however when she was offered and accepted a position in Wellington as the Chief maternity officer. She kept her dreams of practicing surgery alive and returned to Edinburgh for further postgraduate study, completing a degree in surgery in 1911.

At the outbreak ofWorldWar I, Agnes was aged 42 years, and had an established medical practice in New Zealand. When her three brothers were enlisted for service with the Australian Imperial Force, she returned to Sydney intending to join them.

Offering her services to the Australian Army, she was roundly dismissed by the recruiting medial officer who told her patronizingly that if she wanted to help with the war effort she would be ‘better to go home and knit’.

Dr Bennett was used to rejection, but was understandably furious. She paid her passage to England departing mid-1915 with the intention of working with Dr Helen Sexton, a doctor from  Melbourne who had set up a tented hospital in Autiel in France funded from private donations.

However, her plans changed when the ship docked at Alexandria. Confronted by the sight of wounded Australian and New Zealand Army Corps (ANZAC) soldiers, she made a snap decision. Agnes
had travelled with her own surgical instruments and immediately offered both her instruments and herself to the commander of medical services in Alexandria.

Initially attached to the New Zealand Medical Corps in Egypt at Pont de Koubbeh and Choubra with the rank of Captain, Bennett became the first woman surgeon appointed to any of the British or
Empire services.

The hospitals in Cairo and Alexandria were understaffed and overcrowded.Wounded from Gallipoli and casualties from the failed assault on the Dardanelles were evacuated there, often with hastily applied field dressings still in place and their wounds almost universally septic. There, she was doing what she had wanted for so many years, working as a surgeon.

As the focus of the war changed in early 1916 and Australian forces were diverted to the battles of the Western Front, Agnes offered her services to the Scottish Women’s Hospitals (SWH).

Dr Elsie Inglis, founder of the SWH had mentored Bennett during her time in Edinburgh. Knowing of her character and talents both as a surgeon and an administrator, and her recent experience in Egypt, Inglis offered Bennett command of a new field hospital that was to be set up just behind the front line in Greek Macedonia, where Britain’s Allies the Serbs and the French were fighting German backed Austrian troops.

Bennett signed on as a senior surgeon with a salary of £200 per year plus expenses and was appointed Commanding Officer of the latest SWH. With her would work a number of other Australians – both doctors and nurses as well as ambulance drivers and volunteer orderlies.

Her surgeons included a New Zealander Dr Jessie Scott, who later became a prisoner of war, Dr Lilian Cooper from Queensland and later Dr Mary (Clementina) De Garis from Geelong.

Dr Bennett established a 200-bed field hospital under canvas near Ostrovo in Northern Serbia. For the operating theatre, she availed herself of a barn, with a small area portioned off for X-rays. A secondary operating theatre was established in an adjacent tent. Within the first week of operations, 160 injured soldiers from the Third Serbian Army were brought to the hospital. In the first few
days alone, more than 10 amputations were performed – a harbinger of the workload that would soon follow.

The Serbian winter campaign of 1916–1917 was particularly harsh. The Serbs were dying of starvation. Soon too, the hospital suffered from shortages of local supplies and the effects of cold. The
surgeons operated in woolen mittens rather than rubber gloves as their fingers stiffened with the cold.

It was into this environment, that on the 18 September 1916, Dr Lilian Violet Cooper and her companion, Miss Josephine Bedford arrived from Australia.

Lillian Violet Cooper 1861 – 1947

Lilian Cooper studied at London School of Medicine forWomen and in 1890 successfully undertook the conjoint examination of the Royal College of Physicians and Surgeons in Edinburgh and
the Faculty of the Physicians and Surgeons in Glasgow.

Migrating to Australia in 1891, Cooper became the first female doctor in Queensland.

By 1911, Cooper had a thriving practice and her reputation as a doctor was well established.

However, keen to advance her own surgical skill and learn new techniques, she undertook a study tour to the United States and Britain. She visited the Mayo Clinic in Minnesota to observe one of the foremost stomach surgeons of the time, Dr William Mayo and his brother Dr Charles Mayo, recognized for his skill in surgery of the head and neck.

In England, she had the opportunity to observe the work of Sir Berkely Moynihan, a noted British abdominal surgeon, and Sir Arbuhnot Lane who was undertaking pioneering work using steel plates to fix fragments of fractured bone. She obtained a higher degree (MD) awarded from Durham University.

Described as a ‘tall, angular, brusque, energetic woman, prone to bad language’ stories about her outspokenness, swearing and abrupt manner were legend. She had however established a reputation as being meticulous, hard working and possessing seemingly tireless capacity for work.

By 1914, she had pioneered her way through opposition and prejudice, and demonstrated a remarkable strength of character

As a surgeon, the doctor displays a skill, a coolness and a celerity which is not readily understood by those who have not learned that some women can in an emergency, summon up a nervous force and willpower above that of the other sex, . . . She has worn down all that barbaric opposition which once existed against her in her capacity as a lady doctor, by sheer good nature and hard work

– a character which would later be needed during her time as a battlefield surgeon.

At the age of 55, Cooper responded to the call of the SWH advertisement in the British Medical Journal, and decided to join Agnes Bennett as military surgeon in Serbia. Like Bennett, she was offered an honorarium of £200 per year, plus expenses.

Cooper arrived at the height of hostilities. As the impacts of the winter campaign intensified, the journey from the front line became more precarious and patients were dying en route. Despite the
obvious risks, Bennett decided the only course of action was to set up an advanced dressing station closer to the front line. This would allow the most seriously injured patients to be stabilized and
undergo surgery immediately.

The ideal choice was Dr Cooper. Dobraveni dressing station, little more than a makeshift camp, opened a week before Christmas 1916.

The conditions were appalling by anyone’s standards: They make their own mess-house from petrol cans; the kitchen was made by piling stones up in the fashion of the dry-stone walls of Scotland, the roof being hammered out cartridge cases. The wards and staff quarters were tents; temperatures were sub-zero.Wood was brought by mules from a mountain some kilometers away – a 5-hour trip in each direction. One sister recorded that often her hands were too cold to write and the tea froze in the cup if they were slow at drinking.

The wounded were transported to the dressing station by mules; usually two casualties seated in makeshift seats on either side. It was a rough journey, with no pain relief, each step jolting a fracture or jarring a chest injury.

Cooper and the other women were in constant danger, as well as grossly overworked. Located less than 6 miles from front line positions of the enemy, and within range of the guns, the only means of retreat was by foot – a walk of 14 miles down the mountain. Air raids were common as German bombers searched for Serbian infantry formations in the mountains.

The dressing station comprised 40 beds under canvas tents and a makeshift operating theatre in a shed. Casualties slept on modified pallets made of straw and blankets stretched over an iron frame to elevate them off the ground. For sicker patients, the beds were elevated on empty shell cases, making tending the casualties less back-breaking.

Here, 5000 feet up Mt Kaymackchalan overlooking the minarets of Monastir,14 Dr Cooper performed operations day after day – a marvel of endurance in the harshest of conditions. Cooper saw this as the culmination of her life’s work – performing real surgery, and making a real difference. Despite the immense strain of long hours, she performed multiple amputations, removed shell fragments, bullets and other schrapnel. Conducting life and limb saving surgery, patients were stabilized and then transported by motor ambulance to the main hospital at Ostrovo. Countless lives were saved in this way.

From mid-January to the beginning of March – a period of 6 weeks – the ambulances carried down 1840 patients from the dressing station. Over the ensuing 7 weeks, a further 523 casualties were
admitted of whom 60 died from their wounds. During her eight month period at the 40-bed dressing station, only 16 of the 144 patients Dr Cooper operated on died.

The effects of the conditions eventually took their toll. No doubt contributed to by her age and the bitter conditions under which she worked, Dr Cooper became gravely ill with bronchitis. No  longer well enough to continue, she was replaced by another Australian woman, Dr Mary De Garis who enlisted with the SWH after the death of her fiancée earlier in the war.

The incredible service of this Australian-led team, while unrecognized at home, was not overlooked by those they served. In March 1917, Drs Cooper, Bennett, Scott and De Garis were each
awarded the Order of St Sava – Serbia’s order for humanitarian service.

The citation for Cooper (Order no. 2218 of the Commandant of the Third Serbian Army dated 12 March 1917) reads:

The doctors of the 3rd Surgical Field Hospital [including] Dr Lilian Violet Cooper, . . . have shown . . . very zealous and very diligent care of our most seriously wounded soldiers, carrying out their work with extraordinary will and a real love for our fighting men. In the name of all the officers, non-commissioned officers and soldiers of my Army, I thank them for all the services they have rendered to my soldiers.
Signed Commandant, General Vashish

Some months later, Agnes Bennett fell victim to malaria and was forced to withdraw her team to Britain. Just before leaving Ostrovo, the hospital was shelled. Patients and staff alike were
wounded and the operating theatre set ablaze. Bennett was the last Australian to leave but in the days that followed the hospital was overrun by Bulgarians who massacred the remaining staff and
patients.

Bennett worked until the end of the war at a British military Hospital in Southampton.17 Returning home as doctor on one of the troop ships, she accompanied wounded ANZACs back to Australia.

Australian female military surgeons and Endell Street Military Hospital, London

Endell Street Military Hospital, London; the brainchild of Drs Elizabeth Anderson and Flora Murray was the only military hospital run by women within the history of the British Army. This  unique hospital had 573 beds, 15 surgeons, physicians and specialists and a staff of over 180, all of whom (with the exception of a small unit of Royal Army Medical Corps orderlies and their sergeant-major) were women. It was a hospital where female doctors treated male patients – a circumstance that had never occurred on such a large scale.

Endell Street was run as a professional military hospital. Although the women did not have commissions, they did have rank and uniforms and drew pay and allowances from theWar Office. Opened in 1915, the hospital remained operational until 1919 and some 26 000 patients – mostly British but also Australian, Canadian and Dominion troops passed through the wards (Fig. 2).

The Australian female doctors that served at Endell Street during the war were Rachel Champion, Emma Buckley, Eleanor Bourne, Elisabeth Hamilton-Browne and Vera Scantlebury.

Vera Scantlebury 1889–1946

Unlike her more experienced colleagues in Serbia, Dr Vera Scantlebury was aged 28 when she travelled to London and accepted a position at Endell Street.

Vera was appointed as a Lieutenant and Assistant Surgeon. Her experiences are recorded in a prolific 19 volumes of diary letters written between March 1917 and February 1919. They provide great insight into the conditions of her service, and record her own personal journey from a somewhat naïve and inexperienced doctor to a mature surgeon and clinician.

Her youth and inexperience were immediately recognized.

Despite her own initial confidence, Vera struggled with the emotional turmoil of her position. Her first 6 months at Endell Street were personally and professionally challenging. Her writing illustrates her angst in coping with a military structure, her separation from her fiancé in Australia and the professional challenges of war surgery.

At present my mind is a confusion of military etiquette and rules, unusual methods for arrangements for operating etc – a fury and turmoil in my brain against this dreadful war causing this inexorable suffering.
I am not at all keen on military surgery but suppose I will get used to it and do it better than at present but I think it is horrible.

She was also closely mentored in surgical technique by the hospital’s Commanding Officer, Dr Elizabeth Anderson. Vera’s letters vividly demonstrate her progress from a nervous assistant surgeon
dealing with her first case of gunshot wounds (involving chest injuries) in May 1917:

Opened and drained wound – Did it badly- clumsy – fingers all thumbs. Practically told so by CO. Good for me I suppose. . . .

to eighteen months later blithely listing her day’s activities as tying off a femoral artery, repairing a damaged shoulder joint, repairing a gunshot wound to a hip joint, performing a secondary amputation and setting a fractured scapula. At first she coped by studying anatomy textbooks at night. Later, she frequently practised her surgical techniques in the anatomy dissection room at the London School of Medicine for Women.

Experience with complex injuries would have not been common at the time, even for male surgeons. Weaponry used at the Front characteristically caused long bone fractures with extensive soft
tissue damage and a high proportion of casualties arriving at Endell Street were orthopaedic cases with sepsis.

Major abdominal surgery was often required and head injuries were common, particularly in the early years of the war, some requiring craniotomy for extraction of bullets or elevation of depressed skull fractures. Many patients went straight to the operating theatre, with around 20 operations being performed a day at the hospital.

Vera kept notes on some of her cases. She corresponded regularly with Kingsley Norris, her unofficial fiancé back in Australia and compared cases with her brother Cliff, who was posted to
the Australian 29 Casualty Clearing Hospital in France. These notes record both her own anxieties as a surgeon, and illustrate the types of surgical cases:

I wish I knew more about knees. I have a man with a small bullet in the joint – I think so, X Ray not back. In 3 weeks swelling less- though some fluid no temp. I think rest and masterly inactivity the treatment. Cliff says they do not drain knees in France even when pus is in them. At Endell Street I saw opened wound washed out with saline then spirits then B.I.P paste then closed. Cliff says they use formalin and glycerine 20% in France and close. They are not like ours – pneumococcal joints at the C.H. which need drainage

By May 1917, she was in charge of two surgical wards and performing more complex operations as primary surgeon, rather than assistant.

2nd patient GSW – removed the sequestra – cleaned up with BIP and put in two drains of gause very lightly. Very sick. Pulse poor vol.

This newfound independence strained her long distance relationship with Norris and her difficulty is evident as she asked herself:

Shall I give up medicine when I marry? Yes-No-Yes-No-Yes-No-all the days of life

In the end, she continued to renew her six monthly contracts and to remain in England, the ‘silken cords of honour’ keeping her there for the duration of the war. Her relationship with Kingsley however did not make the distance.

After the war

Following demobilization, there was still no role for women in the remains of the Australian Imperial Force. The female doctors returned to civilian posts but Lilian Cooper was the only one to
continue in surgical practice in Australia.

Lilian Cooper became a Foundation Fellow of the Royal Australasian College of Surgeons (admitted as number 128) on 17 June 1927. This was the supreme accolade for a woman who had worked so hard to be accepted as surgeon – to have been elected by her colleagues as one of the top 200 surgeons in the country. She proudly headed her stationary: Lilian Violet Cooper MD, FRACS. Her
memory is honoured by the Mt Olivet Hospital, donated by Miss Bedford as a lasting tribute, along with double gothic stained glass windows – the Soldier Windows – in St Mary’s Church,  Kangaroo point.

Agnes Bennett continued to work. Hoping that finally her experience would be recognized, she tried again to find a surgical position in Sydney, but with no more success than she had before the war.

She returned to New Zealand, set up practice in St Helen’s and became the first medical woman superintendent of a public hospital and a leader in maternal and infant health.

Her sense of adventure and desire for professional challenge remained undiminished. She undertook periods of work in the remote Chatham Islands and with the Royal Flying Doctor Service
in Burketown in North Queensland.

Later, after her services had been rejected again in World War II (this time by the New Zealand Army) she signed on as a lecturer with theWomens’ Services. She also undertook a medical rescue mission to Antartica – an environment at least as hostile as the mountains of Serbia.

Agnes Bennett was awarded the Officer of the Most Excellent Order of the British Empire for services to Medicine. She died in 1961 in Wellington.

Vera Scantlebury (now Scantlebury-Brown) used her newfound self-confidence to pioneer infant welfare in Victoria. Her time in Endell Street hospital had not only imbued her with a personal
confidence, but also an understanding of large scale logistical management and planning.

Elizabeth Hamilton-Browne, a Lieutenant surgeon with Scantlebury at Endell Street, subsequently served with no. 19 General Hospital in Egypt then as Medical Officer in France, in charge of 500 American women clerks who had been lent to the British Army. She became Vice-Principal and Professor of Surgery of the Dufforin Hospital, Calcutta, India before retiring to Australia.

Mary De Garis returned to Australia and became a respected obstetrician and gynaecologist in Victoria.

Conclusion

In addition to overcoming the professional and gender bias of the times, these female pioneers of Australian military surgery who served in the World War I, had shown that there:

was really nothing that a woman doctor could not do in a war zone. They treated virtually every kind of wound and disease they underwent the same hardships, privations and dangers as men, [became prisoners of war], took part in devastating retreats, and worked under shells and bombs.

None of this valuable experience advanced their career prospects as military surgeons. It was another 20 years before the Australian Army commissioned its first female doctor (a medical administrator), and almost 70 years before it deployed a female surgeon on operations. In the amnesia that follows war, their achievements were simply forgotten. The surgical contribution of these pioneering Australian female doctors during World War I stands as a testament to their courage, leadership and sense of service and deserves recognition by this College and by Australian society.

This paper was originally published as, Australia’s female military surgeons of World War I. The author gratefully acknowledges support from the Department of Veterans Affairs and the Australian Army History Unit to research this paper. 

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