The Civil War and Nursing

Vivid, dramatic images of Civil War nurses permeate history books into the American psyche: Clara Barton in a blood-soaked scrubs, working tirelessly alongside surgeons amputating legs and arms. Louisa May Alcott gave water to crying soldiers, cradled their heads in her arms, and scribbled as they dictated letters home. Sally Tompkins, a captain within the Confederate army, who insisted on absolute cleanliness on the hospital she ran in Richmond, Virginia. Dorothea Dix and Mary Ann Bickerdyke get up to surgeons and administrators who wish to ensure their nurses and patients get the respect and resources they deserve. Phoebe Pember did the identical thing within the South, sometimes with a gun she kept in her pocket.

The birth of a career

“The Civil War launched the nursing profession in the United States.” says Dr. Jane E. Schultz, professor of English, American studies, women’s studies and medical humanities at Indiana University-Purdue University in Indianapolis and writer of “Women on the Front: Hospital Workers in America’s Civil War.” and “This is the Birthplace of Souls: The Civil War Nurse’s Diary of Harriet Eaton.”

The work of Civil War nurses proved that, contrary to the Victorian view of the time, women could provide excellent care to men to whom they weren’t related without damaging delicate sensibilities or reputations, say historians of nursing and the Civil War. It also convinced Americans in places of influence of the worth of making a trained nursing force to supply care in military and civilian hospitals. But the birth of this career had its pains. During the war, a various group of men and ladies cared for wounded and dying soldiers. But post-war, these exciting stories of heroines breastfeeding during war helped persuade Americans that girls were more “natural”? suitable for caring for the sick. Nearly eight years after the top of the war, the primary American nursing schools were established? modeled on the Florence Nightingale schools in England? they only admitted women, just about all of them white.

“Women’s involvement in nursing was a great thing, but it came at a price that we are still paying”? says Barbara Maling, M.D., associate professor at Longwood University in Virginia and writer of diverse articles on Civil War nursing. Today, if someone says “nurse,” most individuals consider a lady, he says.

In the United States before the war, just about all nursing care was provided at home. “Is it part of a woman’s job to take care of her family when she was sick?” says Sylvia Rinker, M.D., professor emeritus at Lynchburg (Virginia) College. But nursing outside the house, she says, “was looked down upon because it exposed women to contact with strange men.” When the Civil War broke out, most nursing duties were assigned to convalescent soldiers who were capable of carry them out, and to women in religious orders whose higher calling allowed them to look after soldiers on either side without scandal.

Buoyed by Nightingale’s success within the Crimean War, the Union Army added a small corps of 100 nurses trained by Dix, already famous as a reformer and advocate for the mentally ailing, and Elizabeth Blackwell, the nation’s first female physician.

Hoop skirts were banned because they caught on dressings and pulled them off wounded men, says Rhonda Goodman, Ph.D., ARNP, FNP-BC, who wrote an article about Civil War nurses for the magazine Advances in nursing science journal. He says the Dix Edict “was one of the first examples of evidence-based medicine.” in nursing.

Hospital Stewards, 2nd Division, ninth Corps, Petersburg, VA.

The demand for nurses is exploding

But historians say the civil war quickly became too vast and sophisticated for governments on either side to limit the number of ladies willing to serve within the military. “When the war gained momentum, no one other than Dix was able to stop it.” says Edward J. Halloran, RN, PhD, FAAN, associate professor on the University of North Carolina at Chapel Hill School of Nursing.

The exact variety of Civil War nurses is difficult to find out. While many historical sources estimate there have been 2,000 on all sides, Union Hospital records indicate that there have been not less than 21,000 women on the payroll through the war, Schultz says. Some women volunteered for aid organizations or religious groups. Others followed their husbands or brothers to the battlefields. Some, including Harriet Tubman, were freed and escaped slaves, although they were rarely called nurses even in the event that they cared for patients, Schultz says. “Black women were more often called laundresses or cooks than anything else”? she says.

Many widowed and incomeless women sought work as paid staff in hospitals or field camps for the Union or Confederate armies, Schultz says. Military documents and records show that paid staff far outnumbered volunteers, although few wrote accounts of their work, he says. Their titles and pay varied, often by race and sophistication, with nurses at the highest receiving $12 a month and laundresses at the underside earning about $6, he says. But the responsibilities were essentially the identical. Most of the hospital staff scrubbed the floors; washed bedding; bathed patients; distributed food, water and medicine; cleaned and dressed wounds; and comforted the sick and dying. Educated women wrote and sent letters dictated to them by wounded soldiers.

Nightingale’s influence

The war launched the recognition of Nightingale’s writings in America. Blackwell used Nightingale’s Notes on Nursing in his training program, and Northern nurses packed the small volume of their carpet bags when traveling to hospitals in Union. Confederate officials published Nightingale’s dietary guidelines in military hospital manuals. Nurses on either side worked to create the sanitary environment she championed. Many, nevertheless, were also bought into Nightingale’s contention that nursing was the exclusive domain of ladies, especially distinguished middle-class women. “She actively promoted the division of labor.” – says Maling.

Nightingale’s teachings on sanitation and household chores assigned to women and slaves? cleansing, cooking, washing, feeding? have proven to be helpful in stopping the spread of infections and diseases. “Women were already using sanitary methods that had no scientific name,”? – says Schultz. Diseases corresponding to dysentery, smallpox, malaria and typhoid killed more soldiers than were mortally wounded. Although surgeons made great strides in understanding surgery through the Civil War, medical practices on the time probably killed more people than they saved, historians say. While surgeons prescribed laxatives or toxic substances corresponding to mercury to sick soldiers, nurses brought fresh water and beef tea to hydrate and nourish them. Halloran argues that the death rate from disease through the Civil War was much lower than through the Crimean War. “This was all due to sanitation efforts?” He says.

Although women won praise, the overwhelming majority of nursing care through the war was provided by men, Maling says. Wounded soldiers tended to look after more severely wounded comrades on battlefields and in hospitals. Other men? black and white ? worked as paid nurses or ward stewards. Halloran claims that U.S. Sanitary Commission records show that it employed nurses and nurse practitioners. The most famous male “nurse”? it might be the poet Walt Whitman, who volunteered to go to Washington hospitals, writing letters, bringing food and cigarettes, and giving money to young soldiers who touched his heart. Although there are reports of soldiers complaining about attendants, Maling believes that almost all men provided excellent care through the war. “I think men had a terrible reputation for providing nursing care during the war.” she says. Some of the negative stories were told by women who saw nursing as their domain, she says.

Historians say soldiers preferred nurses because they felt as in the event that they were being cared for by a mother, wife, or sister, just as they’d be at home. “So many early Civil War responsibilities involved comforting dying men, and that was always seen as a motherly quality?” – says Rinker. Although some surgeons fought battles with Dix and Bickerdyke, others lavished praise on their nurses, calling them “angels.”

Planter medical supply boat on the General Hospital wharf on the Appomattox River near City Point, Virginia.

After war

After the war, some volunteer nurses went on lectures and wrote books and articles describing men’s gratitude for a girl’s touch. These accounts created a general impression that Civil War nursing was mainly performed by elite white volunteers and blurred the roles of black, immigrant, working-class and male nurses, Maling says. “Nursing became a women’s profession after the Civil War?” she says. “We got rid of our minorities and our people who were such a strong part of them.”

The combination of Nightingale’s work, medical advances, hospital developments and inspiration from Civil War nursing stories created a perfect climate for skilled nursing education, Halloran says. Just a few years after the top of the war in 1865, the president of the American Medical Association called for the creation of a women’s nurse corps along the lines of the Nightingale. US Sanitary Commission? who coordinated volunteer medical aid for the Union through the war? lobbied for the creation of the nation’s first official nursing schools in New York, Connecticut, and Massachusetts.

Linda Richards, who cared for her wounded Civil War veteran husband for 4 years, began formal training after his death and have become the nation’s first nursing school graduate. Most women who cared for wounded soldiers through the Civil War didn’t train as nurses after the war ended, and in the event that they did, there isn’t any record of it, historians say. Some, including Dix and Barton, moved on to other matters. Dix returned to supporting individuals with mental illness. Barton founded the American Red Cross. Many probably returned to their homes and farms. “Did they do their job”? – says Schultz. But those untrained Civil War nurses? volunteer and paid, men and ladies, black and white? have left their mark on the career. They provided a caring presence to sick and dying patients that the very best of nursing, with all its science and professionalism, still embodies today, Goodman says. “The whole aspect of care is timeless.”

Cathryn Domrose is a author.