The Confederacy’s military leaders, trained in the same system as their Union counterparts, were equally unprepared to care for the flood of casualties that began with the first Battle of Manassas (known as Bull Run in the North). The situation was made worse by the fact that the state’s rights ethos of the Confederacy meant that each state maintained control of its own troops’ welfare. Throughout the South, women with social clout and experience in running their family estates stepped forward to organize care at the local and state levels. In Tennessee, Mary Rutledge Fogg, descendent of two signers of the Declaration of Independence, wrote to the Confederate president Jefferson Davis demanding help establishing hospitals in Nashville, Memphis, and Knoxville. She also informed him, almost as an aside, that she had recruited a corps of women through the Ladies Tennessee Hospital and Clothing Association to act as nurses, whom she was sending to Virginia the next day. In Virginia, Letitia Tyler Semple, granddaughter of former president John Tyler, descended on Williamsburg in the summer of 1861 with the intention of helping sick soldiers. Discovering that the “domestic arrangements” of the hospital were unacceptable, she took over the kitchen, pantry, and laundry. She later also wrote to President Davis and requested that he appoint her female superintendent of not only the Williamsburg hospital where she was already filling that role, but two others as well. Juliet Opie Hopkins, who managed her father’s estate in western Virginia before her marriage to an Alabama judge, equipped and ran field hospitals near the front for the benefit of Alabama regiments, and took charge of both the provisioning and organization of the Alabama hospitals in Richmond. On a smaller scale, twenty-eight-year-old Virginia heiress Sallie Tompkins outfitted a Richmond house as a twenty-two-bed hospital where more than thirteen hundred men were cared for over the course of the war, with only seventy-three deaths—the lowest mortality rate of any military hospital in the war in either the South or North.
On September 27, 1862, the Confederate Congress passed an act intended to deal with the inadequacies of medical care for its soldiers. In conjunction with that act, a committee appointed by the Confederate senate to investigate complaints about military medical care reported an astonishing statistic regarding the impact of female nurses and female-run hospitals: investigators found that the mortality rate among soldiers nursed by men in male-run institutions averaged 10 percent, compared to a mortality rate of 5 percent among soldiers nursed in hospitals with a strong female presence.7 These numbers created a major change of attitude about female nurses within the Confederate congress, if not within the Confederate medical community. Senator Thomas Jenkins Semmes of Louisiana summed up their shared opinion: “I will not agree to limit the class of persons who can affect such a saving of life as this.”8
In response to the statistical evidence that patients fared better in hospitals run by women, the act created positions for women in the Confederacy’s general hospitals. Each hospital would have two matrons and two assistant matrons who would be in charge of the “domestic economy” of the hospital. Responsible for the housekeeping, cooking, and nursing staffs, these women were hospital administrators rather than what we think of as nurses today. (Kate Cumming, perhaps the best known of the Southern nurses, worked in the field hospitals in Mississippi after the Battle of Shiloh and served as a matron in Chattanooga; she admitted that she was a nurse for more than two years before she ever changed a bandage or dressed a wound.) In addition, each ward would have two ward matrons, who were responsible for preparing beds for incoming soldiers, administering medicine, and supervising the nursing and cleaning staffs—the functional equivalent of the male ward masters in the Union’s military hospitals.
The duties outlined in the 1862 legislation included little of what Mary Garland Holland considered “real nursing.” In fact, the act did not deal with hospital personnel below the level of ward matron, ignoring the people who actually took care of the patients. At the beginning of the war, convalescent soldiers provided most of the actual nursing, a practice that Cumming railed against on the grounds that nursing was a skill that had to be learned, and that the soldiers were rotated through the job the same way they rotated through guard duty.
As the war continued, the South suffered a manpower crisis that made the continued use of convalescent soldiers as nurses increasingly difficult. The Confederacy desperately needed to fill noncombatant jobs with individuals ineligible for military service, of which women were the largest and most underutilized group. As early as June 1861, individual hospitals ran newspaper ads looking for nurses, but women did not volunteer for hospital work in the numbers needed in the face of mounting casualties.
Hospitals soon turned to a group of noncombatants who did not have the choice of saying no: slaves. Brigadier General John Bankhead Magruder argued for the employment of female slaves as nurses on functional grounds, claiming that they combined the qualities needed for the perfect nurse: female tenderness, no aversion to menial labor, and the habit of subservience. The largest number of women who performed front-line nursing and other hospital work in Confederate general hospitals were black slaves, either impressed into service or hired out by their owners.
The nurses who worked at the Confederacy’s official hospitals were only a small part of the Southern nursing story.
With the war right on their own doorsteps, Southern women did not necessarily have to travel to one of the large hospitals to volunteer. With easy access to hometown hospitals, women often volunteered on a casual basis, just as women in Washington, DC, did after the First Battle of Bull Run. Some women who were unwilling to brave the hospital environment nursed a few soldiers at a time in their own homes.
Not everyone who volunteered for what could be more broadly described as “hospital work” actually nursed soldiers in the sense of providing medical services. “Lady visitors” were the most common variation: women from the community who brought comfort to the soldiers in the form of food and entertainment. They read the Bible to patients, helped them write letters, and occasionally washed their faces, “soothing a fevered brow” being an approved action for a lady. Emma Crutcher, a young Mississippi wife who served as a lady visitor while her husband was at war, outlined the distinction between a lady visitor and a nurse when she promised her husband, “I shall never take on myself anything that a servant can do as well, and never do anything that a lady may not with perfect propriety do.”9 In short, no mopping up bloody floors, no emptying bed pans, and definitely no bathing of strange men. (Crutcher found it hard to hold to this lofty standard in the face of the realities of hospital life. Even though she did not touch the patients, she became infested with lice, which apparently were unable to distinguish ladies from other women.)
The most important contribution to medical care in the war made by Confederate women was the wayside hospital, an innovative combination of infirmary and travelers’ aid station for wounded soldiers as they traveled home from the front. By the end of 1861, women’s organizations had opened such hospitals across the South and served thousands of soldiers. A group of fourteen women in Union Point, Georgia, provided hot meals and nursing care to more than 20,000 men in their wayside medical facility over the course of two years. Louise Medway of North Carolina estimated the Soldiers’ Aid Society in Wilmington fed and dressed the wounds of six to eight thousand soldiers a month in a similar facility. The wayside hospitals provided a substantial contribution to the war effort by any standard.
The experience of nursing did not have the same post-war impact in the South as it did in the North either.
The war destroyed the Southern economy, and the types of jobs many Northern nurses took after the war, such as teaching and social work, were scarce. Even women eager to work could not find jobs. Previously wealthy women, caught between the need to earn a living and the social stigma attached to working for pay, found it difficult to translate the skills they utilized during the war into work.
There was no great surge of reform. Women who played philanthropic
roles before the war seldom had the funds or the opportunity to do so in the postbellum South. No one founded nursing schools.
The main vestige that remained of Southern women’s work in the war was the transformation of the hospital and ladies’ aid associations that collected supplies and ran wayside hotels into groups dedicated to building memorials for the Confederate war dead, another way to tend to the wounded South.
Acknowledgments
It’s been a privilege to write about the nurses who served during the American Civil War. I’m grateful for the chance to tell their story and to the people who helped me do so:
My editor at Little Brown, Malin von Euler-Hogan, whose suggestions and questions made Heroines of Mercy Street a better book.
Lisa Wolfinger and Lisa Goodfellow Bowe of Lone Wolf Media, who graciously shared their research for PBS’s Mercy Street. That jumpstart was invaluable.
Rick Richter from Zachary Shuster Harmsworth, who put the team together and kept the lines of communication open.
Melissa Totten, who tracked down the photos with patience and imagination.
Jay Kreider who produced the index.
David Wilk, who gently nudged when needed, made sure nothing was forgotten, and transformed the computer files into a book, with the help of the team from Booktrix, including Barbara Aronica-Buck, Gray Cutler, David Kessler, and Rare Bird’s Tyson Cornell and Alice Elmer.
And last but never least, my husband, Sandy Wilson, who read drafts, asked questions, listened while I talked through the tough spots, suggested improvements, and provided pizza and a beer when needed.
About the Author
PAMELA D. TOLER is a writer with a PhD in history from the University of Chicago and a fascination with historical figures who step outside the constraints of their time. She is the author of Mankind: The Story of All of Us and The Everything Guide to Understanding Socialism. She lives in Chicago.
Appendix A
Circular No. 8
Washington, July 24, 1862
No candidate for service in the Women’s Department for nursing in the Military Hospitals of the United States, will be received below the age of thirty-five years, (35) nor above fifty.
Only women of strong health, not subjects of chronic disease, not liable to sudden illnesses, need apply. The duties of the station make large and continued demands on strength.
Matronly persons of experience, good conduct, or superior education and serious disposition, will always have preference; habits of neatness, order, sobriety, and industry are prerequisites.
All applicants must present certificates of qualification and good character from at least two persons of trust, testifying to morality, integrity, seriousness, and capacity for care of the sick.
Obedience to rules of the service, and conformity to special regulations will be required and enforced.
Compensation, as regulated by Act of Congress, forty cents a day and subsistence. Transportation furnished to and from the place of service.
Amount of luggage limited within small compass.
Dress plain—colors brown, grey, or black, and, while connected with service, without ornaments of any sort.
No applicants accepted for less than three six months’ service; those for longer periods always have preference.
D. L. Dix,
Approved:
William A. Hammond
Surgeon General.
Circular No. 8 Regarding Requirements for Female Nursing Applicants, 7/14/1862. National Archives
Appendix B
Letter of Commendation for Mary Phinney von Olnhausen’s Service in the War
This letter was addressed to Mary Phinney von Olnhausen’s brother-in-law:
U.S.A. Gen’l Hospital
Smithville, NC, July 4, 1865
Sir, I have recently received from the office of the Surgeon General, U.S.A., a Circular Order, directing me to forward to him “the names of those ladies who have rendered valuable services, gratuitously, for more than three years past, in attendance upon sick and wounded soldiers in Hospitals.”
This Order was designed, I suppose, to secure some public and striking recognition of the services alluded to. I think this is right.
But there is a class of ladies who have rendered extremely valuable services to the sick and wounded Union soldiers in hospitals, but who do not come within the terms of the Order above mentioned. The Volunteer Nurses, who worked under the supervision of Miss Dix, received, from the Government, twelve dollars per month. Many of the women were so self-sacrificing and faithful and efficient, that we who live to enjoy Freedom a second time won, and, I hope forever won, can scarcely manifest adequately, our gratitude to these women.
And among all the female nurses whom I have known or heard of, not one is better entitled to eminent and substantial notice than is Mrs. Mary Von Olnhausen of Lexington, Mass.
From my own observation, and from the statements of our lamented friend, Surg. J. B. Bellangee, I conclude that the services rendered by this lady to the sick and wounded soldiers, and thus to the Government, and to us all, have been quite equal in value to those afforded by any other person in her sphere of labor.
Her whole soul has been in the work. She very early acquired a marvelous dexterity in the management of the wounded. Thus, with her wonderful physical endurance, she was able to do more good than any nurse I ever knew. She was literally untiring in her labors. By her zeal and usefulness and general deportment, she entitled herself to the respect of us all.
Soldiers who owe their lives to her skillful attention are scattered, now, over nearly all the Northern States. They will remember her with gratitude. I presume that is all she will wish for. I suspect that Mrs. Von Olnhausen is not ambitious for notoriety or fame. But I take the liberty to suggest that the citizens of Massachusetts may with propriety, and honor to themselves, offer to Mrs. V. O. some substantial testimonial, which shall manifest their appreciation of her services and at the same time do her good. She is in every way entitled to all she will receive, and ought to feel no delicacy in accepting it.
This statement of mine is prompted in part, by hearing that the friends of Mrs. George, a Female Nurse, who “died at her post” in Wilmington a short time since, and purchased, for presentation to her, a home in the State in which she had been a resident. To me this is suggestive. A fee simple, in a piece of land, is worth a thousand golden trinkets.
I suppose you know Mrs. V. O. and are her friend. So, without apology for writing to a stranger, I simply hope that you and her other friends may some time act upon the suggestion given. I know many who you will never see who will gladly take part with you.
Yours respectfully,
J. M. Palmer
Surg., 3d N.Y.V. In Charge Hosp.
Endorsed:
Med. Dir’s Office
Newburn, NC, July 17, 1865
Mrs. M. Von Olnhausen has served in hospitals under my direction for nearly two years past, and I take pleasure in endorsing all the statements of Surg. Palmer. This lady has won the respect and confidence of all brought in contact with her; and by her devotion to the sick and wounded soldiers has deserved all a grateful country can do for her.
D. W. Hand
Colonel and Med. Dir., Dept. N. C.
August 2, 1865
I most cheerfully endorse all that has been said herein of Mrs. Von Olnhausen. I believe that this lady has done more good in the hospitals than any other female nurse I ever saw or of whom I have ever heard.
I. N. Palmer
Bt. Maj. Genl. U.S.A. (late Comdg Dept. of NC)
Suggestions for Further Reading
Alcott, Louisa May. Hospital Sketches. Bedford, Mass: Applewood Books. 1993. Originally published 1863.
Giesberg, Judith Ann. Civil War Sisterhood: The U.S. Sanitary Commission and Women’s Politics in Transition. Boston: Northeastern University Press, 2000.
Hancock, Cornelia. Letters of a Civil War Nurse: Cornelia Hancock, 1863–1865. Ed. Henriett
a Stratton Jaquette. Lincoln, Nebraska: University of Nebraska Press, 1998.
Hilde, Libra R. Worth a Dozen Men: Women and Nursing in the Civil War South. Charlottesville, Virginia: University of Virginia Press, 2012.
Humphreys, Margaret. Marrow of Tragedy: The Health Crisis of the American Civil War. Baltimore: Johns Hopkins University Press, 2013.
Leonard, Elizabeth D. Yankee Women: Gender Battles in the Civil War. New York: W.W. Norton, 1994.
Oates, Stephen B. A Woman of Valor: Clara Barton and the Civil War. New York: Free Press, 1994.
Ropes, Hannah. Civil War Nurse: The Diary and Letters of Hannah Ropes. Ed. John R. Brumgardt. Knoxville: University of Tennessee Press, 1980.
Rutkow, Ira M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House, 2005.
Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. Chapel Hill and London: University of North Carolina Press, 2004.
Notes
Introduction
1. Quoted in Drew Gilpin Faust, Mothers of Invention: Women of the Slaveholding South in the American Civil War (Chapel Hill: University of North Carolina Press, 1996), 100.
2. V. M. Francis, A Thesis on Hospital Hygiene, for the Degree of Doctor of Medicine in the University of New York (New York: J. F. Trow, 1859), 145.
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