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Clara Louise Maass: Servant Leader Undaunted

Carol Emerson Winters

U.S. postage stamp issued in 1976 honoring Clara Louise Maass.

Clara Louise Maass (1876–1901) was passionate about nursing American soldiers during the Spanish–American War of 1898, especially those suffering from yellow fever. She qualifies as an exemplary leader as defined by Kouzes and Posner (2012). Even in her early 20s, Clara Maass was unaccepting of the current thought regarding the etiology of this mysterious, dreaded disease. She challenged the process by betting her life on the theory that immunity to yellow fever could be produced by inoculation under controlled circumstances.

Findings from Kouzes and Posner’s exploration of successful leaders suggest that they continuously look outside of themselves to seek challenging opportunities for innovative initiatives that will make “something meaningful happen” (Kouzes & Posner, 2012, p. 157). Exemplary leaders challenge the process and are convinced and convince others that growth, transformation, and improvement require changing every aspect of the status quo—people, processes, systems, and strategies. These mover-and-shaker leaders, in spite of resistance, mistakes, and delays, persist to generate new ideas, methods, and solutions. They experiment, take risks, and learn from their experiences. Exemplary leaders guide others through ambiguity, adversity, transition, recovery, and other seemingly unsurmountable challenges. Kouzes and Posner describe personal best leadership as being focused on significant departures from the past and new approaches of doing things in places yet to be discovered. They often do not seek or wait for permission or instructions before leaping on an opportunity (Kouzes & Posner, 2012, p. 160). Exhibiting a can do attitude and often outrageous courage, they accept the challenge with high purpose and motivation, which results in stirring things up.

Clara Louise Maass, a New Jersey native, was “possessed by an overmastering inner drive; hers was to serve humanity through seeking to free the world from the ravages of disease” (Herrmann, 1985, p. 51). She sought out opportunities to serve and welcomed and persevered the hardships of travel to nurse in unfamiliar, distant, tropical military bases steeped in known dangers of war and disease, much as her idol, Florence Nightingale, had done in the Crimea. In spite of stern admonitions, Clara Maass chose to deny herself personal pleasure, comfort, and health in her determination to offer nursing care to U.S. soldiers hospitalized from wounds and, more prevalently, tropical illnesses in Savannah, Georgia; Jacksonville, Florida; Manila, Philippines; and Santiago and Havana, Cuba. Upon arrival in Havana, she interviewed Dr. Walter Reed and other members of Havana’s Yellow Fever Commission about their experiments with yellow fever. Taking the ultimate risk, she sacrificed herself for the experimentation and advancement of yellow fever research by volunteering to be bitten by infected Stegomyia (Aedes aegypti) mosquitoes. Her death (a) gave credence to the theory that these infected mosquitoes were the vectors of yellow fever and (b) disproved the hypothesis that immunity to yellow fever could be produced by inoculation (immunization) in a controlled environment. Unfortunately, the results of the latter could not have been determined in any other manner.

SPENDING CHILDHOOD AS AN ADULT

Clara Louise Maass, though a “charming, animated and ambitious girl” (Guinther, 1932, p. 172), was no prima donna. She was born on June 28, 1876, in East Orange, New Jersey, into a poor family, which had immigrated to America with other Germans seeking religious freedom and better opportunities. While still a young child, as the eldest of nine children, Clara Maass was expected to assist her mother, Hedwig, with the housekeeping and childcare duties. The wages that her father, Robert, earned as a grocer, farmer, and seasonal worker in the East Orange hat mills, proved insufficient to support his rapidly expanding family.

At 10 years of age, Clara Maass, a student at Northfield Elementary School, sought employment as a mother’s helper in a private home. Her compensation was room and board and time off to attend school. A year later, her family moved to a farm in Livingston where she is remembered by her classmates for her “honey-blond hair and her eternal optimism” (Cunningham, 1968, p. 35). Clara’s family moved back to East Orange when she was 12 years old, where she attended East Orange High School and resumed her job as a mother’s helper. Three years later, at age 15, she abandoned her secondary studies in order to obtain full-time employment and to continue to help support her family. At the Newark Orphan Asylum, she worked 7 days a week feeding, dressing, and sewing for the orphans. Here she earned $10 a month, sending half to her mother.

TRAINING SCHOOL FOR NURSES

At a time when there were limited career options for women, 17-year-old Clara Maass, inspired by Miss Nightingale’s dedication in nursing soldiers during the Crimean War and her desire to help her economically struggling family, decided to pursue nursing. From early childhood, she was considered to have had “an unusual spirit of service which constantly grew and for which she sought expression in nursing” (Guinther, 1932, p. 173). In the fall of 1893, she applied to join the second class of the Christina Tref Training School for Nurses at Newark German Hospital. It had been publicized that applications would be accepted from women between 20 and 40 years of age with proof of physical ability, spoken English, and a minimum of a general school education. She was scrutinized by a young and stern head nurse, Anna Steebler, who approved of her small and wiry frame, coiffed and knotted hair, and her wire-rimmed glasses. Clara Maass also passed the other entrance requirements of being plain, unadorned, and accustomed to drudgery and hard work. It was expected that during the 2 grueling years of classes, offered predominantly in German and Latin (when the physicians taught), the female trainees (nursing students) would earn $5 per month. At the end of their first year, they could accept private nursing cases with their wages paid directly to the hospital. Upon graduation, they received a $100 bonus (Cunningham, 1968; Herrmann, 1985).

In 1894, Carrie Frank was the only nursing student out of six who graduated in the first class. A year later, at the age of 19, Clara Maass, along with her three classmates, Sophie Bruckner, Sarah Filer, and Madeline Gill, graduated in the class of 1895. After graduation, Clara remained at Newark German Hospital but supplemented her income with private nursing cases. Three years later, the hospital directors offered Clara Maass the head nurse position in recognition of her high-quality work (Cunningham, 1968).

THE SPANISH–AMERICAN WAR

On February 19, 1898, Spain blew up the U.S. battleship Maine, in the harbor in Havana, Cuba. On April 20, U.S. President McKinley demanded that Spain withdraw from Cuba and issued a declaration of war, which became known as the Spanish–American War or the War of 1898. During this war, American casualties were small, with 10 times more deaths occurring in the hastily constructed army camps resulting from the epidemics of typhoid fever, malaria, dysentery, and food poisoning. Nursing care of Cuban patients was provided by lower class servants whose work was considered so inadequate that the Spanish word for nurse, enferma, was considered a derogatory term (Herrmann, 1985).

Nurses were desperately needed and the Nurses’ Associated Alumnae of the United States and Canada, renamed the American Nurses Association (ANA) in 1911, offered their nursing services but the U.S. Army refused. It is conjectured that Army officials were prejudiced against women serving with them in the field. The primary objection to the nursing services offered by the Nurses’ Associated Alumnae was that this organization had only been in existence for a short time and it was not recognized as the representative body for nurses. Additionally, their proposal was received 1 day after the Daughters of the American Revolution (DAR) had volunteered. The DAR vice president and physician, Dr. Anita Newcomb McGee, had been appointed as director of the Army Nursing Service and acting assistant surgeon in the U.S. Army even though she had no administrative experience. After the war, Dr. McGee, Associated Alumnae, and influential citizens proposed bills to establish a permanent, sanctioned nursing corps to no avail. In 1900, after numerous surgeons testified about the work of the contract nurses during the war, the Army Reorganization Bill proposed that the Nurse Corps be a part of the U.S. Army Medical Department. Members would consist of hospital nursing school graduates supervised by a hospital nursing school graduate. The bill was finally passed on February 2, 1901, with Dr. McGee, a physician, having to resign as director of the U.S. Army Nurse Corps because she was not a nurse (Donahue, 1996).

With the outbreak of the Spanish–American War, Congress authorized employment of women who were nurses on a contract basis, providing them with $30 per month, room, and board. Dr. McGee preferred that the contract nurses be graduate nurses endorsed by their own schools who had passed health examinations and received clearance by the DAR. Approximately 8,000 volunteer nurses became contract nurses, with 1,600 being graduate nurses. Large numbers of the Catholic orders served, especially the Daughters of Charity. The first contract nurses were appointed in May of 1898 and they were stationed in army hospitals located in the southern United States, Puerto Rico, Cuba, Hawaii, and the Philippine Islands. Heretofore, these army hospitals were staffed by corpsmen who were lacking in training and experience. The corpsmen engaged in unsanitary practices, such as using the same bucket for food and excrement, thus spreading diseases throughout the camps (Donahue, 1996).

Because she could not enlist in the military, Clara Maass became one of the first to apply as a U.S. Army contract nurse. Ms. Maass requested that a physician she had worked with at Newark German Hospital write a letter to certify that he had known her as a nurse. His letter stated that he had known her for 5 years and that she was a “dutiful, diligent, and conscientious nurse who recognized the responsibilities of her profession” (W. J. Roeber to Whom It May Concern, September 15, 1898). On her application to become a contract nurse, Clara indicated that she desired appointment in the Army rather than the Navy; could leave on October 1; had not had yellow fever; was a 1895 graduate of a training school for nurses; had no other hospital experience other than Newark German Hospital; but she had nursed continuously since graduation; had experience in invalid cookery with her private duty patients; was 22 years old, White, 5 feet, 4¾ inches tall, weighed 134 pounds; was single; had no tendency to disease; and had been successfully vaccinated in 1894 (Clara L. Maass, Application for Contract Nurse, Record Group 112, Entry 149). Her characteristic patriotism and love for adventure, which had been denied to her in childhood, or her quest to increase her earnings may have prompted her to apply. While she waited to be called, knowing that she would be leaving Newark German Hospital during a shortage of nurses and funds, she worked in excess of 12 hours a day without pay. Here was one of the first indications of her adult self-abnegation (Cunningham, 1968; Guinther, 1932; Herrmann, 1985).

Clara Maass signed her contract October 1, 1898, along with U.S. Surgeon General George M. Sternberg and received her first assignment as a contract nurse to the field hospital of the Seventh U.S. Army Corps in Jacksonville, Florida (Contract for Services as Nurse—Clara L. Maass, October 1, 1898). The fighting had ended when she arrived in Florida, but she nursed hundreds of wounded and diseased soldiers. Most were ill from malaria, dysentery, and typhoid fever. Soldiers who were febrile were prohibited from returning to their homes for fear that they would spread the diseases to those in their home state. Because typhoid fever was prevalent at Newark German Hospital, Clara Maass was familiar with the care of these soldiers and the requisite long, tedious hours. Three nurses from Pennsylvania shared her tent: Lucy Vandling from Williamsport; Utilie Scheerer, the eldest, and Minnie Lenox, both from Philadelphia. They named and labeled their tent with signs that read Camp Cubra Libra and Potatoe Patch Tent. They often teased the soldiers who guarded them from American and Spanish would-be suitors (Cunningham, 1968).

NURSING SOLDIERS WITH YELLOW FEVER

From Jacksonville, Clara was transferred to Savannah, Georgia, in November of 1898 and then to Santiago and Havana, Cuba, in early 1899, where she had her first brief exposure to yellow fever. The sailors there called this disease Yellow Jack, referring to the Navy’s yellow quarantine flag, whereas the Spaniards dubbed it el vomito negro (the black vomit) for the blood secreted into the victim’s stomach by breaking blood vessels. The U.S. and Spanish soldiers were ravaged by the uncontrollable yellow fever, but the Cuban soldiers were not as affected, as many had acquired immunity from frequent exposure (Iglesias, 2002). Clara Maas left Havana on January 21, 1899, and on February 5, 1899, Clara Maass was honorably discharged and her contract annulled (Clara L. Maass, Service Record, Record Group 112, Entry 149). She then returned home to New Jersey to resume her private nursing practice (Guinther, 1932). Within a week of arriving back in Newark, Clara wrote to Dr. McGee, director of the Army Nursing Service and acting assistant surgeon, requesting to enter the service again. She implored the director that she would go any place where she was needed, but if nurses were needed in the Seventh Army Corps in Jacksonville, Florida, she preferred to go with them, as she had just come from there. On February 6, 1899, she again wrote Dr. McGee stating that she had seen in the newspapers that the bill regarding the corps of nurses had been passed and that she wanted to enter her name as an applicant for a position in the service. She added that she would be willing to go to “any part to nurse” and had returned to this country from Cuba where she was in the service about 4 months (Clara L. Maass to Dr. Anita N. McGee, February 1, 1899; February 6, 1899). To support her case, Clara requested that Miss Carrie E. Rogers write a letter to Dr. McGee, a fellow member of DAR, on behalf of

Clara Maass was persistent in her efforts to become a member of the U.S. Army Nurse Corps. In another letter to Dr. McGee, she wrote that she appreciated her placing her name on the list of eligible nurses. She also reminded Dr. McGee that she was “willing to serve at any time and any place” (Clara L. Maass to Dr. Anita N. McGee, August 14, 1899).

Clara was neither ignorant nor naïve about her choice to continue her perilous work nursing yellow fever victims. Newspapers in the 1880s carried official bulletins reporting the devastation caused by yellow fever epidemics in the southern states. Yellow fever terrified people throughout the Western Hemisphere. In the United States, it had been recorded in New York as early as 1668. In the 1790s, Philadelphians fled the city, as did the residents along coastal regions during the Civil War in the mid-1860s. In 1879, much of the South was panic-stricken. When thousands fled the river city of Memphis, Tennessee, 47 policemen were ordered to prevent looting and all but seven died from yellow fever. Though tuberculosis, typhoid, and dysentery were responsible for more deaths, yellow fever was more feared because of its unique characteristics: high fever, muscle pain, backache, shivers, anorexia, nausea, and vomiting. It could create mild, flulike symptoms lasting about a week or it could progress, as it did in 10% to 60% of cases, into a period of intoxication wherein liver failure occurred, resulting in jaundice and vomiting of dark, digested blood. Yellow fever spared no one, rich or poor, young or old, clean or filthy. It disrupted everyday life, commerce, and communication (Jusino, 2012).

Clara Maass nursed her patients diagnosed with yellow fever according to a regimen of universal rules consisting of strict bed rest in a supine position to minimize exertion and to decrease bowel perforation. Sufficient ventilation increased the antiseptic action of fresh air through an oxidation process that occurred when interacting with noxious substances or organisms. As symptoms appeared, so did implementation of more specific treatments. Purgatives were given at the onset of disease to rid the body of systemic toxins; cold sponging, ice packs, baths, and ice water enemas treated high fevers; rectal alimentation was given for vomiting; application of mustard poultices relieved epigastric pain; and dry champagne, brandy, or eggnogs were administered by tube to provide nutrition or to settle an irritable stomach. In addition to offering these treatments, nurses were expected to encourage and soothe their patients while maintaining their own health and immunity to disease by their cleanliness, cheerfulness, and temperance (Herrmann, 1985).

Clara Maas had witnessed firsthand the consequences of yellow fever after the Spanish–American War and read the widely publicized reports of the returning soldiers who had contracted this disease. By 1899, J. C. Wilson’s textbook, Fever Nursing, was in its third edition. Clara knew of and accepted the concomitant risks of her nursing practice abroad. She was fully informed of its all-consuming nature, leaving few opportunities for pleasure and exploration. Further, her bilingual competence in German and English were worthless in the countries where she chose to serve (Herrmann, 1985).

NURSING AMERICAN TROOPS IN THE PHILIPPINE ISLANDS

The 1898 Treaty of Paris officially ended the Spanish–American War and culminated in Spain’s ceding the lands of Puerto Rico, Guam, and the Philippines to the United States (Herrmann, 1985). In 1899, American troops were stationed in the Philippines to quell an insurrection. Clara Maass continued her quest to serve as a nurse in the Philippines, writing in a letter to Dr. McGee dated September 1899:

Dr. McGee responded to Clara Maass 4 days later, telling her that she was always glad to give the nurses information about prospects where it was possible, but that she was not able to foresee what the surgeons at different hospitals would do. Dr. McGee thought that it was probable that, early in the next month of October, the call for nurses would come for Manila, since most of the Western reapplicants had been appointed and those from the East would be sent next. She advised Clara Maass not to go to Chicago at that time as it might be an unnecessary expense (Anita N. McGee to Clara L. Maass, September 26, 1899).

Clara wrote yet another letter to Dr. McGee on November 1, 1899, informing her that she was “still very anxious to go to Manila and as I hear of so many nurses who were with the 7th Army Corps going, it makes me more anxious than ever.” She requested to go with her nurse friend in Cuba, Miss Kane from Reading, Pennsylvania, on the Logan on November 20 (Clara L. Maass to Dr. Anita N. McGee, November 1, 1899). It is uncertain whether Dr. McGee suggested that Clara petition the surgeon general, or whether she chose to go over Dr. McGee’s head, but on November 8, 1899, Clara Maass sent the following letter to U.S. Army Surgeon General George Miller Sternberg, in Washington, DC:

True to one who challenges the process, Clara Maass was relentless in her efforts to be sent to the Philippines as a contract nurse. Ten days later, she followed up her letter with a telegram to Surgeon General Sternberg: “Can I be sent with nurses on Logan. See application to Surgeon General November eighth recommended by Major Kilbourne. Wire answer my expense. Clara L. Maass” (Clara L. Maass Telegram to George M. Sternberg, Surgeon General, November 18, 1899). Surgeon General Sternberg responded by sending her a telegram at her mother’s house in East Orange, New Jersey, summoning her to Manila, Philippines (George M. Sternberg to Clara Maas, November 20, 1899). Within 2 hours, she gathered a few belongings, took a train to Hoboken, ferried across the Hudson River, and taxied to the pier to board the Army ship, Logan, just as the last visitors were exiting the gangplank.

Once again in the capacity of a contract nurse, Clara Maass reported to Reserve Hospital in Manila on January 5, 1900. Most authors writing about Maass have based their information on the publications of Guinther (1932) and Cunningham (1968). They describe Reserve Hospital as one similar to the field hospital in Florida with its long rows of beds filled with soldiers sick and dying from typhoid fever, malaria, and the most mysterious yellow fever. They indicate that Clara was deeply affected by the heavy loss of life from yellow fever at Reserve Hospital (Burstyn & Women’s Project of New Jersey, 1990; Chavez-Carballo, 2013; Cunningham, 1968; Guinther, 1932; Herrmann, 1985; Iglesias, 2002; Kyle & Shampo, 1980; Newcomb, 1975; Samson, 1990). Tigertt (1983), a retired general and researcher of communicable and infectious diseases in the military, argued many years later that yellow fever had never been recognized in the Philippines.

ANNULMENT OF NURSING CONTRACT AND RETURN HOME TO NEW JERSEY

After several months of strenuous nursing in the Philippines, the Army sent Clara Maass home to New Jersey in April 1900. The circumstances of her dismissal are divergent. Guinther (1932) and Cunningham (1968) wrote that, while in the Philippines, Clara Maass was stricken with dengue fever and hovered between life and death. They reported that, because her recovery was so slow, the Army sent her home to recover. Dengue (also called break bone fever) is characterized by agonizing joint and muscular pain and was considered to be highly contagious. Now we know that it is a virus transmitted by a species of the Aedes aegypti mosquito and that decreased pain and full recovery of former strength is a slow process.

The more likely version of Clara Maass’s dismissal by the Army from her work as a contract nurse in Manila, Philippines, can be found in documents housed in the National Archives and Records Administration (NARA) in Washington, DC. There is no mention in any reports of her having contracted dengue fever while serving as a contract nurse in Manila. On March 21, 1900, Clara Maass wrote Colonel Charles R. Greenleaf, chief surgeon, Department of the Pacific and 8th Army Corps, requesting that her contract be annulled “on account of ill health” and that she receive transportation to the United States on the next transport (Clara L. Maass to Charles R. Greenleaf, March 21, 1900). On March 23, 1900, Major and Surgeon William R. Hall stationed at the First Reserve Hospital in Manila also sent a letter to Chief Surgeon Greenleaf informing him that if Miss Maass was unmarried, she should have her contract annulled. His letter explained that Clara Maass’s roommate, Rose Kane, friend with whom she had requested to travel to the Philippines, had reported that Clara Maass had confided to her that “she was pregnant and that she would have an abortion produced,” which she had done 3 days before on March 20, 1900. Hall reported that Clara Maass was “boasting that no one could prove it” and that was why head nurse McCloud compelled her to ask for an annulment of her contract. Hall also maintained that, at the time of his writing, Clara Maass was attempting to contradict her roommate and to force the head nurse to resign her position. He cautioned that Clara Maass, her “confederate,” and the Army officer involved would attack the character of all who opposed them (William R. Hall to Charles R. Greenleaf, March 23, 1900). There can be no doubt that this behavior was challenging the process.

Three days after writing her initial letter to Chief Surgeon Colonel Greenleaf, Clara Maass wrote him a second letter to respectfully inform him “that after thinking the matter over and considering what a hot-bed for gossip this is, I have decided to ask for the annullment [sic] of my contract and receive transportation to take effect as soon as possible” (Clara L. Maass to Charles R. Greenleaf, March 24, 1900).

A week later, Colonel Greenleaf sent a letter to the U.S. Army Surgeon General George Miller Sternberg in Washington, DC, stating that he had the honor to transmit papers in the case of contract nurse Clara Maass, who would be sailing on April 1, 1900, on the transport Sherman, under orders to report by letter to the surgeon general on her arrival at her home for annulment of her contract. He added that after Clara Maass requested annulment of her contract, he was contacted by civilians who informed him that she had been charged with immorality and was forced by the head nurse to request that her contract be annulled. Thinking that this had the potential to become a public scandal, he had requested an official report from the commanding officer at the Reserve Hospital, W. R. Hall, which should be kept confidential. He assured Sternberg that he was looking into the matter and would report his findings at a later date. In the future, he was ordering that all matters and communications related to the conduct and discipline of the contract nurses be sent directly to himself (Charles R. Greenleaf to George M. Sternberg, March 30, 1900). Surgeon General Sternberg’s response to Chief Surgeon Greenleaf’s letter of March 30, 1900, clarified “that nurses about whom there was ‘unpleasant gossip’ should be ordered home at the earliest opportunity.” He cautioned that there be no talk of this kind in regard to the Army nurses in the Philippines. Further, he directed that the “confederate” of Miss Maass should also be sent home if this had not already been done. He also supported the return of efficiency reports prepared by the chief nurses on a regular basis, quarterly, and when a contract was annulled. This would expedite the prompt return of nurses reported as unsatisfactory to the United States (George M. Sternberg to Charles R. Greenleaf, May 3, 1900).

Thus, according to a memo written by Surgeon William R. Hall at First Reserve Hospital and handwritten Service Record notes, Clara Maass left the Reserve Hospital in Manila on March 29, 1900, and proceeded on the transport Sherman to the United States (W. R. Hall to Charles R. Greenleaf, March 29, 1900). More details were provided in her Service Record that she arrived on April 30, 1900, at General Hospital in San Francisco, California; left San Francisco for New Jersey on May 5, 1900; and her contract was officially annulled “for cause” on May 7, 1900 (Clara L. Maass Service Record, Record Group 112, Entry 149). An undated note (author anonymous) accompanying vouchers for the final pay for Clara Maass was sent to Surgeon General Sternberg indicating that she was sent home from Manila by Colonel Greenleaf and that the papers had been filed with Dr. McGee:

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