The Brave Nurse Who Fought Infectious Diseases in San Francisco and WWI

Elizabeth Ashe meeting a nurse and baby at the American Red Cross nursing home near Paris, France during World War I. At the time she was acting as Chief of the Nursing Service of the Children's Bureau of the American Red Cross.    (Library of Congress/ American National Red Cross Photograph Collection/ ARC, R.C. Commission to France)

On August 16, 1917, Elizabeth Ashe found herself in Northern France, close to the front lines of World War I, in the middle of an air raid.

“The Tocsin [siren] sounded and the fearsome took to the cellar,” the nurse wrote in a letter three days later.  “I figured it is as dangerous as crossing Market Street...”

The casual bravery exhibited in that letter was present throughout Elizabeth's life, and enabled her to transform innumerable other lives for the better. Whether taking care of the most disease-ridden communities in her native San Francisco, or helping impoverished new mothers and soldiers in France, Elizabeth's life was spent in enthusiastic service of others. So enthusiastic, in fact, she spent three years persuading the Red Cross to send her to France in the first place. (They had been hesitant to send a woman in her mid-40s to serve in such a dangerous region.)

Born in 1869, Elizabeth Haywood Ashe had bravery woven into her DNA. Her grandfather, North Carolina governor Samuel Ashe (whom Asheville is named after), served as a lieutenant in the American revolution. Her uncle was Civil War admiral David Farragut, a Southern Unionist who captured New Orleans in 1862. Her parents, Richard and Caroline, were pioneers who arrived in San Francisco in 1848, just in time for the gold rush.

Elizabeth became a community activist in her teens, while teaching Sunday School at what later became Grace Cathedral (then at the intersection of California and Stockton). During her classes, she got to know her neighbors from Telegraph Hill—mostly Irish, Italian, German and Latin American immigrants who frequently lived in overcrowded, unsanitary conditions without heat or plumbing. Elizabeth, born of privilege, found herself deeply concerned about those communities, particularly when it came to the number of unsupervised and sometimes working children she encountered.

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When epidemics of diphtheria, tuberculosis, whooping cough and typhoid fever broke out, Elizabeth wasn't discouraged from staying and working in the area. Instead, she and her friend Alice Griffith established the city's first settlement house—an organization designed to assist struggling families with healthcare, daycare and education. Elizabeth was just 21 at the time. (Today, the house lives on as the Telegraph Hill Neighborhood Center.)

Elizabeth graduated from the School of Nursing at Presbyterian Hospital in New York just four years before the 1906 earthquake. Her work helping city residents recover from the fiery aftermath left such a grim and permanent impression on her that everything she did afterward seemed somehow manageable. In Intimate Letters from France and Extracts from the Diary of Elizabeth Ashe, 1917-1919, one of Elizabeth's war-time letters, to Alice Griffith from "Somewhere in France," states:

No other women have ever been so near the lines… We visited several demolished villages en route… Christ on his crucifix in many villages is the only thing erect, where women and little children by thousands must work in the fields under shell fire wearing gas masks to protect them… [It] did not make the dreadful impression on me I anticipated, it is not a circumstance to our fire.

During her time in France, Elizabeth tackled the country's high infant mortality rate by educating new mothers everywhere, from Paris tenements to country farms. She taught them the best ways to care for babies, including prenatal hygiene, healthy feeding and infection avoidance. In the course of doing so, she helped establish a clinic in Paris, advised those working in "orphan asylums" and still somehow found the time to teach French children how to play leapfrog.

Remarkably, Elizabeth spent her days off during that time tending to injured soldiers at Neuilly's American Military Hospital, writing home of the hellish conditions:

The wounded continue to pour in night and day, it is impossible to handle them properly. I am duty in the receiving ward (a big garage which holds about 100 stretchers, packed so closely together you can’t step between.)

When Elizabeth's fascinating collection of unedited wartime letters was released, it served two purposes: to raise money for further health education programs in France, and to give readers a bird's-eye view of the horrors of war. When the San Francisco Chronicle reviewed it, it declared the book “not only informative, but essentially human. One sees the routine life of the nurse both in base hospitals and nearer the firing line... Brave girl."

One of the most notable things in Elizabeth's letters was her ability to always find beauty, even in the midst of war and destruction. One, dated July 23, 1917, states: "Just how much I can tell you of yesterday’s attack, I don’t know, but we tumbled out at 7am, clad hastily… The firing lasted about thirty minutes. The shots went all over and around us, but except for a few broken windows, no damage was done." Just two sentences later, she writes: "The coast is very lovely. With glasses we can see quaint houses and we smell the new mown hay."

On her return to San Francisco in July 1919, Elizabeth went back to work at Hill Farm—also known as the Bothin Convalescent Home for women and children—that she had established in 1903, and then expanded in 1910 with the help of steel magnate and philanthropist, Henry E. Bothin.

Remarkably, just one year later in 1911, alongside Alice Griffith, Elizabeth also opened the Arequipa Sanitarium for tuberculosis patients. The facility, designed by San Francisco doctor Philip King Brown and prestigious architectural firm Bakewell and Brown, was established after Elizabeth and Alice managed to raise $20,000 from wealthy donors.

For decades, Arequipa had a long waiting list for admission, due in part to its state-of-the-art facilities and low costs for patients. However, as demand for its services dropped over the years due to medical advancements in the fight against TB, Elizabeth found new ways to use the space. In 1948, she gave a building to the San Francisco Girl Scouts for troop camping and, by 1959, the organization had taken over the entire property and added a swimming pool. The center was officially renamed the Henry E. Bothin Youth Center in 1963, and Camp Bothin—which offers programs for kids of all ages—continues to operate there to this day.

Elizabeth Ashe died in 1954, but her legacy of community service remains scattered across San Francisco and the North Bay, with the continued existence of organizations she worked tirelessly to establish. There can be no doubt that this most generous woman would be thrilled to see the longterm impact she made.

In one letter dated Sunday July 22, 1917, Elizabeth—known to her closest friends as Betty—humbly wrote:

Did I tell you that Miss Maxwell, in introducing me to a group of nurses, told them that I had humanized her training school, had showed them that all nurses did not have to be made after the same pattern?

I felt that I had not lived in vain.

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