The ladies, may God ever bless them, from the maiden of sixty to the young girl in her teens, moved like ministering angels among the sufferers, doing all in their power to relieve the soldier's pain and sufferings. — Henry Robinson Berkley Almost before the echo of the first gun fired on Fort Sumter had died away, scores of Northern women were offering their services to the government. Lincoln's call for 75,000 volunteers on April 14 was also answered by wives, sisters and mothers volunteering their aid to the sick and the wounded. As Frederick Law Olmstead, President of the Sanitary Commission described it: "the month of April, 1861 was distinguished not more by the universal springing of the grass, than by the uprising of the women of the land." Eager they were, but they were, for the most part untrained, unskilled and undisciplined. They were as green as the new recruits gathering in the Washington and other mustering places. The War Department, already swamped with a myriad of details it was inadequately staffed and wholly unprepared for, was uncertain what to with them. Dix Arrives When Dorothea Lynde Dix, nationally renowned for her work in founding insane asylums, walked into the office of Secretary of War Simon Cameron on April 19, 1861 she must have seemed a godsend. Dix was as well prepared for the task intellectually as any woman in the United States. She was acquainted with the work of the British Sanitary Commission and had visited Florence Nightingale's reformed hospital, the Scutari, in Constantinople. Her fame in having persuaded politicians to reform jails and establish insane asylum seemed to suggest she knew how to deal with practical men. At first Dix was restricted to providing nurses for the hospitals in and around Washington. Then in June she was named "Superintendent of Female Nurses," without territorial limits. This made her the first woman ever appointed to an administrative position in the federal government. In August Congress made female nurses legal and provided pay. The act provided for women to be substituted for men "in general or permanent hospitals when it seems desirable to the Surgeon General or the surgeon-in-charge." The salary was set at 40 cents a day and the nurse was to receive one ration. The flock of volunteers was so great that Dix's first task was to sort through the volunteers flocking into Washington and other areas. Dix set firm standards of fitness which had little or nothing to do with their potential fitness as nurses. The requirements, while strange to modern ears, were completely consistent with the canons of Victorian propriety — whose principal goals seemed to be the promotion of virtue and the prevention of any possibility of vice. Each candidate was personally examined by Dix. She demanded that each be over thirty years of age, healthy and "plain almost to repulsion in dress, and devoid of personal attractions." Potential nurses were required to renounce colored dresses, hoops, hair curls, jewelry and flowers on their bonnets. Each candidate was expected to know "how to cook all kinds of low diet." They must "look neat themselves, and keep their boys and wards the same. They must write and read for their boys, but not from any book or newspaper." (Emphasis in original text). All would-be nurses were told that they were expected to be in their own rooms at taps or nine o'clock unless working with the sick. They were forbidden to go to any "place of amusement" while off-duty. No nurse was allowed to have any patient or officer in their own room except on business and then the door must be completely open during the visit. In addition, the women had to be willing to take the forty cents allowed in salary and buy such additional as they might require and to use any remainder for the welfare of the patients. Since Western women could or would not come to Washington to be interviewed by Dix, she delegated powers of appointment to Mrs. D. P. Livermore of Chicago and James E. Yeatman of Saint Louis. The latter, a principal officer of the Western Sanitary Commission was considerably less rigid than Dix. Women? — in the Military? The decision to use female nurses was not universally acclaimed. Several conservative voices stridently condemned the use of women in the hospitals. Despite the well-known achievements of Florence Nightingale in the Crimean War, cynics claimed that women nurses would faint at the sight of blood. Others wondered aloud and in the press whether women would become hysterical and disturb the patients with their sobs. Another group claimed that the nurses would only get in the way of the doctors. Other concerns were raised that their lack of physical strength would prove inadequate to the task of lifting patients. Many objectors were distressed at the myriad affronts to feminine modesty that nursing entailed — particularly when "bathing the patients." Another group was deeply concerned that the women might be drawn to the hospitals not from willingness to help, but in the hopes of finding love there, as in some contemporary romances about the Crimea. For the most part the cynics and nay-sayers were ignored and overruled. Sheer necessity, born of the pouring into the hospitals of the wounded and the sick, soon made a mockery of such notions. Despite their zeal none of the volunteers that poured in were in the least bit trained. In fact there was not a single woman specifically trained to be a nurse in all of the continent. Despite this the government readily employed them in the general hospitals. They were infinitely better than the men available. Male Nurses In the hospitals uneven is a kindness. The males attending the sick evoked few pleasant recollections from those who underwent their supervision. At the war's start they were almost always soldiers of the line, sometimes detailed from nearby garrisons but usually convalescing individuals. Those detailed to the hospitals from their units were almost certain to be the "bottom of the barrel." No colonel was willing to lose a good soldier form his regiment, even temporarily. Hence the hospitals filled with the misfits, troublemakers and discipline problems detailed to the last place they should have been sent. Convalescing patients were frequently so enfeebled, demoralized and fretful that they behaved callously to bedridden patients. In both instances the men lacked training and unlike their female counterparts, desire and inclination. The obvious solution to assuring quality — establishing a regularly enlisted hospital corps, its members chosen and trained to nursing, was discussed. This group could have been formed from those too young or old to serve, or whose health would not allow them to serve in a line unit, without any lessening in the available manpower. But it was completely and fervently resisted by the Regular army hierarchy. The regular army preferred things differently and allowed only feeble substitute measures. A typical example was a program initiated in 1862. A so-called hospital corps of civilians was hired on short contract for $20.50 per month. Its members were put in uniform, and organized into squads of eleven under squad chiefs. There all resemblance to a military unit ended. The men hired frequently disappeared before the end of their contracts. Those who remained were prone to neglect, if not abuse, their patients by withholding food and other items and then selling them. Getting work out of this group was left to the hospital stewards, who had some background in hospital matters and were not apt to frequent transfer. Their authority was exercised through ward masters, who supervised the work of an individual ward. Experience suggested the value of specialization hence routine duties were divided as follows: two waiters, two night nurses, one to sweep and clean the floors, one to clean the walls and windows. Another was responsible for keeping up the fires and maintaining the lights. One more was assigned the duty of cleaning the bathrooms and toilets and one more to dispense medicines. The remaining men, along with the rest were to tend the sick, bathing those too ill to care for themselves. Sometimes they would assist in dressing wounds. The value of convalescents in lieu of detailed or contracted men was questionable. The principal problem with the convalescent system was that it included men whose principal qualification was their relative health, not their interest or aptitude to the task at hand. Poorly, if at all trained, they learned through experience. Then, just as the men obtained enough learning and practical experience to be of help they would be returned to their units. About all that can be said in favor of the convalescent system is that it kept the men from returning to their units too early and gave them something to do. What is a Nurse Supposed To Do? The duties of the female nurses were never clearly defined. Dix perceived of them as "head nurses" and inculcated this into her recruits. The failure to clarify their role from the onset led to conflict. Arriving at hospitals the first semi-trained women expected to be treated as "head nurses" supervising the work of the men. When they arrived at the hospitals they were assigned menial tasks such as dishwashing. Affronted at this they appealed to Dix who stirred the pot by insisting that her nurses stand on their dignity as "second only to the ward surgeon." It led to clashes where the women were snubbed, threatened, starved and in an increasing number of cases sent back to their indignant superintendent. To a certain extent the surgeons were correct in their assessment of these nurses as "permitted nuisances." The nurses were untrained, undisciplined and didn't seem to know precisely what it was they were supposed to be doing. Discipline was lacking. From their own accounts, the nurses did not always obey orders and sometimes substituted their own home remedies for the physician's prescriptions. Others fed men the food they wanted but were not supposed to have, while some lavished attention on favorite patients, ignoring the rest. A few took advantage of the weakness of the patients in order to reform them or to push upon them a particular brand of religion. Expecting "silent obedience" in the Nightingale tradition, the surgeons were often confronted with women who though they knew better, when few of them knew anything. The duties of Civil War nurses were extremely diverse. Many of the surgeons resented their presence and because they often came without training in their proper duties they were frequently assigned any housekeeping duty that needed to be done, such as scrubbing wards or supervising laundry. Generally they would be called upon for direct patient care only in moments of crisis, such as when a trainload of wounded troops arrived and hundreds had to be washed, fed and quickly put to bed. As a general rule interaction with patients was primarily confined to providing comfort rather than medical care. Dix, on the other hand, expected the same women nurses to supervise the wards (including the male nurses) to dress wounds and to administer medications. "Official" nurses never served on the battlefields or in the field hospitals. This was the province of the male medical nurses and staff. There were always a handful who might be detached temporarily to handle an emergency but in general they were kept away. Most of the problems with Dix's nurses could be laid at Dix's feet. Dix was a tireless, goodhearted, kind woman who spurned a salary, lobbied constantly on behalf of her nurses' welfare. She was also a poor administrator. She did nothing to either systematically organize or train the nursing establishment she was creating. Whereas Nightingale had spent her time in the hospitals and organized the functions, duties and responsibilities of nurses. Dix visited the hospitals only rarely to check on her nurses, nor did she appoint anyone to this task. She spent most of her tenure touring the East Coast and appealing for relief supplies and then spent days distributing them. When a new nursing candidate would arrive, Dix would spend up to an entire day interviewing the applicant. If she approved the nurse would be sent to a hospital without any notification to the surgeons that they were about to receive a new nurse. Communications between Dix and the rest of the medical establishment —especially the Surgeon General's office — were poor. Attempts to rectify the issues of the role of nurses or to deal with the inevitable issue of the unfit were met by Dix's indignant refusal to consider the possibility that her nurses might be in error. She insisted that her nurses' could only be removed for cause and the only cause she seemed willing to consider was moral turpitude. The surgeons, who wanted to be able to dismiss the nurses on their own, complained to the Surgeon General about Dix's intransigence and ignored her nurses. This prompted the Surgeon General in the fall of 1862 to consider a different management system. Dix's medical enemies were too numerous to be removed, the alternative — dismissing her was impossible given the strong support of then Secretary of War Stanton. Eventually Stanton came to realize that something had to be done and approved the issuance of General Order 351 on October 29, 1863. The order, ostensibly a compromise, was in reality a victory for the surgeons. If a nurse was discharged the hospital commander had to give specific reason and no nurses were to be employed except those hired by Miss Dix —"unless specially appointed by the Surgeon General". The last clause was the crux. Joseph K. Barnes, the Acting Surgeon General wasted no time in showing how he intended to use it. In Dix's presence, Barnes assured a young girl who had failed of regular appointment by Dix that henceforth he would enroll any woman requested by a hospital "irrespective of age, size or looks." The change served to maximize confusion in what was already a disordered system. Nurses would come from a variety of sources, with some answering to Dix, the remainder to anyone of a variety of authorities, including none whatsoever. Of the approximately 9000 nurses who served in the Civil War, 3,214 were appointed by Dix and the surgeons and held legal status as employees of the army. A second group were several hundred Roman Catholic nuns, the first beneficiaries of the end of Dix's ironhold on nursing appointments. Fervently anti-Catholic, Dix had insisted that Protestant women be given priority over all Catholics regardless of qualifications. In the West this stricture was ignored. Nuns were in use as nurses from the fall of 1861 when groups from convents in Indiana and Michigan had taken over the nursing in hospitals at Cairo and Paducah. They replaced regular women nurses in the large general hospital at Mound City, IL in 1862 and shortly after that in Memphis. Nuns also staffed the first Navy Hospital ship, the captured Confederate steamer Red Rover after conversion served with the federal flotilla on the muddy waters of the Mississippi from June 10, 1862. The medical officer aboard accepted some nuns who had volunteered to nurse the wounded after the aborted first siege of Vicksburg in 1862. In effect, these Sisters of the Holy Cross were the first navy nurses. Nuns first appeared in the Eastern hospitals in 1863. Two large general hospitals — the Satterlee at Philadelphia and the Cliffburne at Georgetown were completely staffed by them. Another group of 60 nursed on the hospital boats plying the York peninsula. The soldiers commonly referred to them as "Sisters of Charity" but in reality they came from four orders: the Sisters of Charity, the Sisters of St. Joseph, the Sisters of the Holy Cross and the Sisters of Mercy. Some lacked prior nursing experience having served as school teachers but a higher proportion of nuns, many of whom were immigrants, had more real nursing experience than any other group. Surgeons and hospital administrators liked them not only because of their technical competence but because of their willingness to readily follow orders and submit to discipline. As to their technical competence, a distinguished surgeon, writing forty years later, remarked —"We should not think them particularly skilled at the present day, but they were very good for their day." A third group consisted of those employed for short periods to do menial hospitals chores. A fourth group consisted of black women employed under the General Orders of the War Department from 1864 onward. An estimate of the numbers in the third and fourth group was set by the Federal Pension Office at about 4500. A fifth group was made up of an unknown number of uncompensated women volunteers. A sixth group consisted of women camp followers. The seventh and last group was women employed by the various relief agencies. Very few of these women had actual hospital experience and little qualification more than physical strength and a willingness to serve. There were those who pushed for minimal standards of selection and training, but the need was too great. The end result was that the Union nursing corps remained a motley group of women who shared little more than their lack of qualifications. Nurses were as likely to be the wives of generals and governors as destitute charwomen. They were volunteers paid and unpaid, soldier's wives and sister who come to see their friends and remained without any clear commission or duties; women sent by State agencies and aid societies, women assigned by Dix or any woman who felt some reason to attach herself to a hospital. Every type of woman was to be found in the wards, from a drunken swearing English nurse at Alexandria to the gently bred Louisa May Alcott. A half dozen were the wives or widows of generals, such as Arabella Griffith Bellow. Katherine Wormelely was the daughter of a British admiral, the three Woolsey sisters were the daughters of the President of Yale. Most were the wives, daughters and widows of respectable substantial middle class citizens. A number were teachers or home missionaries. Other were form the lower classes. "Mother" Bickerdyke, perhaps the most famous of them all, was a hired housekeeper when the war started. Some were eccentric, some were old and crotchety, most were self sacrificing. Nursing in the Confederacy In the Confederacy the bulk of the nursing duty fell to the rough hands of infantrymen who were detailed against their wishes to this duty. Many of them were convalescents — selected because of their relative health rather than their skill or interest. This gap in medical care was due to the South's slow recognition of the desirability of women as regular members of the medical department of the army. It was not until September 1862 that the Confederate Congress bestowed any official status on the women volunteers. Primarily this was an outgrowth of the region's culture. In the Confederacy there was widespread public prejudice against women serving in the hospitals and more fervently enforced that in the North. It was generally held that an occupation involving such intimate contacts with strange men was unfit for self-respecting women to pursue. There was no tolerance whatsoever of young, unmarried women in these positions. "The simple truth," wrote one young woman in withdrawing her application, "is that my family is much opposed to my doing so, especially my brothers. ... The boys have heard so much about ladies being in hospitals that they cannot bear for me to go." Even Kate Cummings, the South's most famous and resolute nurse, was overcome with misgivings: "There is a good deal of trouble about ladies in some of the hospitals of this department. Our friends here have advised us to go home, as they say it is not considered respectable to go into one." The degree of social resistance, which relented in the North after women demonstrated the foolishness of the arguments, never really relented in the South where less than a thousand nurses served. The professional status of the Southern volunteers was even less. The Confederate War Office refused to grant them the title of "nurse" as bring undignified for a "lady". Instead they were called matrons. Their duties were more restricted than their Northern counterparts and direct patient contact was limited. For the most part, with some notable exceptions, Southern matrons were confined to cooking, making bandages, doing laundry and sewing. Untrained, But Undaunted Nursing demanded a price for its practitioners in the Civil War. Some would remain psychologically scarred from the suffering and trauma they witnessed. Other would contract illnesses from the patients and the environment they worked in. Louisa May Alcott, of Little Women fame, came to work in a Union hospital. Within a month she contracted typhoid fever. Surgeons plied her with calmolel which gave her mercury poisoning that brought loss of teeth and hair as well as a deterioration of her nervous system. She never fully recovered. Others died from smallpox, measles and malaria. The nurses of the Civil War may have been untrained, but they were undaunted. The nursing system may have been defective. The doctors may never have fully approved. But there were certain parties to the experiment who deemed it an unqualified success — the patients. The patients loved them. The basis of their approval was not too well reasoned and was rather sentimental and undiscriminating. The nurse's tenderness with the dying was appreciated as was their usually cheering conversations, which was in marked contrast to the gloomy matter of fact toughness of male nurses. Their true role was as mother-substitutes and unquestionably they made hospital life more bearable. Concerns about the rough nature of soldiers vanished with reality. One union nurse wrote shortly after her work in a makeshift Gettysburg hospital: "I have been for weeks the only lady in a camp of 700 men, and have never been treated with more deference, respect and kindness." Several weeks later, with the emergency under control, one group of women nurses left the hospital camp for home. Two regimental bands in gratitude escorted them to the railroad depot. The romantic concept of the nurse as guardian angel watching through the night and ceaselessly concerned with patients, may have been replaced by the reality of the scrub brush, soap and water and the tireless cooking of gruel and custard. But, the untrained nurses of the Civil War conferred on the women of the United States a great practical gift. Their efforts and their sacrifices and their positive effect upon the sick was a watershed event in the social history of the nation. Their efforts, flawed as they might be, opened the gate of a profession to women at a time when their economic options and careers opportunities were scarce. Nursing in the American Civil War: Rules and Regulations Back to Cry Havoc #10 Table of Contents Back to Cry Havoc List of Issues Back to MagWeb Master Magazine List © Copyright 1994 by David W. Tschanz. This article appears in MagWeb (Magazine Web) on the Internet World Wide Web. 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