The 1850s and 1860s in America saw the rise of the “sentimental domestic idea.” Women were held up as examples of purity, piety, and submissiveness. In the American antebellum period, precise and strict rules were recommended for women’s socially acceptable and appropriate behavior.
But the Civil War would change the social, economic, and political landscape for women from every walk of American life—perhaps nowhere more so than in the field of nursing. Women demonstrated remarkable adaptability in the savagely altered wartime world, responding to the great need of the nation while acquiring and utilizing skills to ease the pain of the country.
“At the beginning of the war, a ‘nurse’ meant a soldier recovering in hospital from a wound or injury, untrained in healing, who aided doctors with miscellaneous duties,” Dr. Robert D. Hicks of the College of Physicians of Philadelphia explained. “The idea of women handling the bodies of men not related by family was unthinkable. By the end of the war, the term meant women who aided doctors by cleaning and feeding patients and occasionally assisting doctors in their surgeries and treatments.”
When the Civil War erupted, the governments of the divided country had not prepared for a lengthy and epic combat situation and its resulting casualties. Arrangements had not been made for transporting or treating tens of thousands of wounded and sickened men. The armies had no well-organized medical corps or field hospital plans. An officer’s wife might accompany her husband to the battlefield, or a mother attend to care for a wounded son or husband, and either might choose to remain and care for the increasing number of wounded.
The number of wounded soldiers multiplied, and epidemic diseases ravaged the troops. Newspaper reports about the lack of medical treatment and supplies in the army camps and hospitals inspired thousands of women to volunteer on the battlefields and hospitals. They began to appear seemingly everywhere, in both cities and remote locations to provide care to wounded or sick soldiers. They were not always welcomed by doctors. The Union Army in particular was opposed to having women onsite, believing that they were inexperienced, incompetent, and disorganized. Southern tradition found the intimate physical contact of nursing to be highly inappropriate for women.
It was true that most of the women probably had no prior experience with the kinds of devastating wounds and ailments the men were experiencing, but they were willing to learn and insistent on becoming part of the solution, arguing that the war “was as much a woman’s war as it was a man’s war.” The women of North and South pressed on in areas that had previously been closed to Victorian women, and it is estimated that more than 21,000 women served in Union military hospitals and a comparable number in the Confederacy, where 10% of the nursing women were African American. More than 3,000 women acted as paid nurses and many thousands more worked as unpaid volunteers. They were Catholic nuns, immigrants, formerly enslaved people, wives and daughters. The war created a way for women to take an active role in the relief effort from outside of the home and family, assume leadership roles in sanitary commissions, provide clerical assistance in government and business, and provide invaluable services in caring for wounded soldiers.
The Union formalized an arrangement in 1861, appointing Dorothea Dix as “Superintendent of Female Nurses of the Army.” Dix was among the American women who had traveled to Britain, Turkey, and Crimea to learn from the legendary Florence Nightingale, who was already transforming nursing in Europe. The American Civil War brought a new need and mission to the 59-year-old Dix, who had already made her mark as an advocate and reformer for prisoners and the mentally ill. Horrified by the large-scale violence, Dix took a train south to Washington, D.C., and gained a meeting with the U.S. secretary of war, Simon Cameron. She offered her services as a nurse to the Union Army, but Cameron, impressed with her assertiveness, organizational skills, and tenacious nature, appointed her the superintendent of Union Army nurses instead, a position she held until 1865.
Dix powered through a field of resistance and during the course of the war appointed and arranged for the training of more than 3,000 nurses. As the first woman ever to serve at such a high level in a federally appointed position, she dove into the work, helping to set up field hospitals and aid stations. She was thought to have impossibly high standards for her nurses, but she continued to advocate for them to receive more formal training and increased work opportunities and responsibilities. She took good care of her nurses, the women who were extremely critical to advancing the role of nursing in the war and in medicine overall.
In the South, Captain Sally Louisa Tompkins, also known as the “Angel of the Confederacy,” became, at the age of 28, the first woman to be commissioned into the Confederate Army—also the first woman in American history to be formally inducted into the military. She ran a home-turned-hospital in Richmond. The medical practices of the private Robertson Hospital reflected Tompkins’s compassionate and meticulous dedication to cleanliness and care and its reputation began to spread. It was said that wounded soldiers in Richmond would beg for admittance to the Robertson hospital and commanders were known to send their most critical cases there. In order to avoid accusations of malingering and dodging of military service, Confederate President Jefferson Davis issued regulations requiring all hospitals to be under military command and the private hospitals were, for the most part, forced to close. In a stunning move that broke military and social tradition, he allowed Tompkins to continue her work and keep her excellent facility open by commissioning her as a captain in the Confederate States Army. She was then legally able to sustain the hospital’s operation and to obtain her medical supplies from military stores. Tompkins operated the Robertson Hospital throughout the war, treating 1,334 wounded men with only 73 deaths in its 45 months of existence, a survival rate of 94.5%, thought to be the highest of any Confederate military hospital during the war.