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  The opposite side of the fear that working in a hospital would erode female delicacy were concerns about the effect of women on the morals of the patients. One doctor beseeched Surgeon General William Hammond to issue an order prohibiting nurses from “throwing themselves into the Arms of Sick & Wounded soldiers and Lasciviously Exciting their Animal passions.”31 (Presumably these nurses had ceased to be ladies.) Another told the surgeon general he thought women in the hospital’s laundry and kitchen was a good thing. Not only were both the hospital and the men cleaner, but the moral effect of a woman’s presence rendered the patients “more amenable to control.” But when those same women became nurses “laying aside the natural delicacy of the sex, the proper respect for them is lost or forgotten and they become worse than useless.”32 In all hospitals, any question that a woman’s virtue had been compromised was grounds for dismissal, even when proven false.

  Some doctors resisted working with volunteer female nurses on the seemingly reasonable grounds of their lack of training: the same factor that made a difference in Summers’s reception of von Olnhausen and Reading. Looked at more closely, the question of lack of training becomes less clear. Soldiers who were assigned to nurse during their convalescence had no more training than the women they worked alongside, and could not even claim the domestic experience of nursing family members. Moreover, a large number of the doctors who volunteered for Lincoln’s ninety-day service were as ill trained for battlefield medicine as the nurses they objected to. John Brinton, who had studied in the clinic- and laboratory-based medical programs in Paris and Vienna, derided the quality of most of the medical volunteers he worked with during the war, saying that the doctors and nurses alike were seldom of any use. With no training, they did not know how to take care of the soldiers. In some cases, they barely knew how to take care of themselves in the context of war. He was particularly dismissive of the volunteer nurses, whether they came through Miss Dix or the Sanitary Commission: “helpless, irritable and unhappy; each one thinking herself of much importance, and acting under the direct orders of the Secretary of War, and very often indeed they had seen him before starting.” In his opinion, the doctors, for whom he at least expressed some sympathy, were often not much better.33 Doctors who objected to female nurses on the grounds of lack of training often agreed with Brinton that “good women nurses were a godsend; those who would really nurse and work,” by which he meant women who would do what they were told, not advocate for individual patients, and make no trouble.34

  By Brinton’s irritable standards, few of the volunteer nurses made the grade as “good women nurses.” Nonetheless, in the end, most of the women who took a nursing position in one of the army’s hospitals wore down individual doctors’ objections to their presence as they learned how to do the job. The longer a nurse was on the job, the more likely she was to conquer the prejudice of the doctors she worked with.

  Even Dr. Summers came to value von Olnhausen. In a letter dated January 1863, she proudly reported: “You will be glad to know the change in Dr. S’s treatment of me. I guess he finds it creditable to him to have some ladies around.”

  One night when they were expecting a batch of wounded, he came to her door and politely asked her to go through her ward with him. Von Olnhausen showed him around with considerable pride: clean beds and fresh clothing waited for the incoming men, the fires were bright and warm, and sponges, cold water, and medical supplies lay ready for use.

  Summers complimented her on the condition of the ward, and told her none of the other wards were in such good condition. She beamed. Then he turned to her and asked if he could come to her room for a few minutes as he had something to say to her. It was a startling request. At the time even middle-aged widows who bathed unknown men in the course of their workday did not entertain men to whom they were not related in their rooms. Nonetheless, she agreed.

  Once in the privacy of her room, Summers apologized for the fact that he had sometimes been rude to her. He said she thought he did not like her and then boomed in a voice “about three times louder than a bull,” “But madam, you are mistaken; I am more than satisfied; I would have you leave on no account; you have done and are doing more to elevate the tone of this hospital than anyone in it, and anything you ask for your ward or for yourself I will grant… with you…, madam, this house shall be the first hospital in the country.”35

  Signs of progress and professionalism appeared as the war went on, one doctor and one nurse at a time.

  Chapter 6

  Learning by Experience

  “Custom inures the most sensitive person to that which is at first most repellent, and in the late war we saw the most delicate women, who could not at home endure the sight of blood, become so used to scenes of carnage, that they walked the hospitals and the margins of battlefield, amid the poor remnants of torn humanity, with as perfect self-possession as if they were strolling in a flower garden.”

  —Mark Twain and Charles Dudley Warner, The Gilded Age1

  “It will be necessary to imbibe a little more of the heroic before I can be of much help during an operation… All laughed at me even to the patient; but it isn’t expected that a Yankee school-ma’am can be transformed into a dissecting surgeon in a minute, guess it will take about a fortnight.”

  —Elvira Powers, Hospital Pencillings2

  Few of the new nurses had training in either medical procedures or practice. Volunteers with no experience other than nursing a relative through a bout of measles, pneumonia, typhoid, or dysentery—all serious illnesses requiring dedication, courage, and, in some cases, a lack of queasiness—were plunged into the chaos of crowded hospitals and a stream of broken bodies that rose and fell according to the fortunes of war. Brains oozing from head wounds. Jaws half shot off. Gut wounds. Perforated lungs. Gangrenous limbs. When the wounded arrived—fifty, four hundred, or a thousand at a time—no one had the time or inclination to take a newly fledged nurse aside to show her how to dress a wound or explain the system. Many volunteers began nursing without even the most basic introduction to the work they were there to do.

  On Mary Phinney von Olnhausen’s first night at Mansion House Hospital, the wounded from Cedar Mountain flowed through the door, ragged, mud-caked, and bloody. Their bandages looked like they had not been changed since someone first dressed their wounds. And their faces were drawn with exhaustion and pain. Von Olnhausen had no chance to find her way around the hospital or learn her duties. Instead an orderly showed her into the surgical ward and someone told her what to do, but not how to do it. As a young woman she had been the unofficial nurse and surgeon for every scrape and wound suffered by her venturesome neighbors. It was not adequate preparation for dealing with the effects of cannon shells, bayonets, and the new deadly bullets known as minnie balls on the human body. Faced with carnage on a scale she had not been able to imagine, she wanted to throw herself down and give up. It seemed like a hopeless task. How could she do anything to help them? The only thing she could do for them now was learn: she followed the doctors and watched as they examined and dressed soldiers’ wounds. “So I began my work,” she wrote in her unfinished memoir, “I might say night and day.”3

  Von Olnhausen’s experience was not unusual.

  Hannah Ropes, later Alcott’s supervisor, arrived at the Union Hotel Hospital in Washington the morning of July 4, 1862, just as the wounded from the final days of the Seven Days’ Battles began to reach the city. She ate a slice of boiled beef and a loaf of bread and caught a few moments’ sleep before the hospital sergeant woke her up to tell her the wounded were on the way and the hospital staff needed to get ready. Most of the nurses were away for the evening, so Ropes and a young doctor hurried to make beds and prepare supplies for 150 men, including clean shirts, drawers, and stockings. Only six patients arrived that night. The staff went to bed, expecting to be called out again at any moment. Morning came, and still no wounded arrived.

  It was afternoon before Ropes heard “a quick step over o
ur private stairs in a wing of the “castle” and a voice: “All of the nurses report at the office of the surgeon.” When she and the other nurses ran down the main hall stairs they saw “from the broad open entrance into the hall, to the base of the staircase, there bent, clung, and stood, in dumb silence, fifty soldiers, grim, dirty, muddy and wounded.” She does not seem to have been as overcome by the prospect as von Olnhausen, perhaps because the men reminded her of her son “in fifty duplicates.” Ropes’s first job was to stand by the doctor while he took the name of each soldier and assigned him a bed. (Georgeanna Woolsey would have approved. She argued constantly with surgeons on the hospital transport ships that it was important to learn the name of each wounded man as he arrived.) Like Mansion House, the building was poorly designed for its new purpose. Men had to be led or lifted up the great staircase to the ballroom and banquet hall on the second floor that served as wards. Once there, the nurses divided them up and washed them. It took four hours.4

  Alcott arrived at Union Hotel hospital that December. Unlike von Olnhausen’s experience at Mansion House, she had the luxury of three days to learn her way around the wards before the wounded from Fredericksburg arrived. It wasn’t long enough. Her nursing career began with the death of a patient. Then another nurse left unexpectedly, and she was plunged into responsibility for a forty-bed ward, housing one man with pneumonia, one with diphtheria, two with typhoid, and “a dozen dilapidated patriots, hopping, lying and lounging about.” She spent her time washing faces, serving rations, giving medicine, and sitting on a very hard chair while her patients stared at the new nurse, who tried to hide her discomfort under “as matronly an aspect as a spinster could assume.” It was not quite what she had expected. There was no romance in bathing fevered brows. In fact, she was a little bored. So when she heard wounded were “in-coming,” she felt a thrill of excitement, for just a moment. Then she “peeped into the dusky street lined with what I at first had innocently called market carts, now unloading their sad freight at our door… and I indulged in a most unpatriotic wish that I was safe at home again, with a quiet day before me.”5

  It was job training of the roughest, least structured kind.

  Dr. Elizabeth Blackwell’s Nurse Training Program

  At the beginning of the Civil War, the primary source of trained nurses in the United States were the nuns who staffed twenty-eight Catholic hospitals throughout the country, several hundred of whom served in army hospitals over the course of the war. There were no nursing schools in the United States, although at least two programs existed in Europe: the school in Kaiserwerth, Germany, where Florence Nightingale trained, and Nightingale’s own school at St. Thomas Hospital in London, which opened in June 1860.

  Ironically, it was easier for an American woman to become a doctor than a trained nurse in the years immediately before the Civil War. Although most medical schools remained closed to women, the first certified female doctors founded women’s medical schools in Boston, Philadelphia, and New York in the 1850s and 1860s. By 1861, there were more than two hundred women in the United States with a medical degree. It was not an easy career path. Even after earning a degree, most graduates of women’s medical colleges were denied access to the wards of big-city general hospitals—which remained the best place to obtain clinical experience—and most found it difficult to attract patients to a private practice unless they worked with their fathers or husbands. Barred from working in existing institutions, female doctors created separate women’s medical institutions like dispensaries and hospitals, aimed at the same population of urban poor served by the larger general hospitals. The first of these was the New York Infirmary for Women and Children, founded in 1857 by physicians Elizabeth and Emily Blackwell and Marie Zakrzewska.

  Born in England in 1821, a year after Florence Nightingale, to a family of reformers, Elizabeth Blackwell was the first woman in the world to become a doctor with a degree from a certified medical school. Her family moved to the United States while she was child, where they eventually settled in Cincinnati, Ohio. As far as contemporary opinion was concerned, Blackwell’s ambition to become a doctor was even more shocking than Nightingale’s desire to become a nurse. Unlike Nightingale, her family supported her aspirations, but she met with far more resistance from the world at large. Twenty years after Blackwell received her degree, many people still shared the opinion of Professor Thomas Laycock of the University of Edinburgh, who “could not imagine any decent woman wishing to study medicine;—as for any lady, that was out of the question.”6 In addition to a general perception that medicine was no job for a respectable woman, many male doctors discouraged women from entering the profession because they were afraid they would lose female patients to female doctors, especially for intimate problems. In fact, Blackwell’s desire to go into medicine was inspired by a friend dying of what was probably uterine cancer and who wished she could have been examined by a female doctor rather than undergoing the embarrassment of being examined by a male.

  Blackwell was lucky enough to find an experienced physician willing to teach her despite her gender—the same career path taken by most of her male counterparts, who typically apprenticed with established doctors for several years before opening their own practice or attending medical school. After two years of study as an apprentice, she moved to Philadelphia, then the center of medical study in the United States, and began applying to medical schools. She had plenty of individual mentors, but they made no difference. Twenty-nine medical schools refused to admit her. She became so frustrated that one of her advisors, Dr. Joseph Pancoast, suggested she attend his classes in Philadelphia disguised as a man, a solution she rejected because it would only give her the knowledge and not the degree. Finally, Geneva Medical College in upstate New York accepted her as a student.

  Her acceptance at Geneva was a fluke. While in Philadelphia, she had impressed a famous physician, Dr. Joseph Warrington, who recommended her as a student to Geneva. The school’s administrators didn’t want to accept her but they also didn’t want to upset Dr. Warrington. They decided to let the students vote on whether to let her in, sure they would reject her. By all accounts, the students believed the application was a joke perpetrated by a rival medical school. To the administrators’ surprise, and perhaps horror, the students unanimously voted to admit Blackwell. In January 1849, after a year of study, she graduated first in her class, at the age of twenty-eight.

  Her degree did not immediately open doors for other women. In fact, after the newly established American Medical Association censured Geneva Medical College for issuing her degree, the school’s president announced that Blackwell’s acceptance had been an experiment, not a precedent. The college subsequently refused to accept any more female students, including Blackwell’s sister Emily.

  In the fall of 1849, Blackwell went to Paris, motivated by the same quest for clinical experience that drove many of her male contemporaries abroad. In Paris, she once again faced a male medical establishment hostile to the idea of female doctors and was unable to obtain permission to attend clinical instruction. And once again, well-intentioned men suggested she attend clinical demonstrations dressed as a man.

  Instead she decided, with great reluctance, to accept the advice of Pierre Louis, a French physician now known for his contributions to what would become epidemiology and the modern clinical trial. At his suggestion, she entered La Maternité, then the world’s leading maternity hospital and training school for midwives, where she could gain more practical experience in obstetrics in a short time than she could get anywhere else. For four months she lived in a dormitory with twenty Frenchwomen, most of them ten years younger than she was and, by her standards, uneducated in anything other than their chosen profession. In many ways the program was more difficult than most American medical schools at the time. It was certainly more focused. In addition to a full course of lectures, students spent several days each week en service—working in the maternity wards and clinics. They were not allowed newspa
pers or any books unrelated to medicine. It was a world entirely separate from that experienced by male medical students in Paris. Near the end of her studies at La Maternité, Blackwell contracted a serious infection that cost her the sight in one eye and ended her hopes for a career as a surgeon.

  After Paris, Blackwell spent several months as a clinical student at St. Bartholomew’s Hospital in London. She returned to New York in the summer of 1851, where she realized her struggle to be a doctor had just begun. In some ways getting a medical education had been the easy part. Her private practice was slow to develop, and she was not allowed to work in the city’s hospitals, not even the women’s wards. She faced more than institutional roadblocks. Because many people believed “female doctor” was a euphemism for abortionist, landlords did not want to rent her office space, and she received anonymous hate mail. Finally she started her own dispensary on New York’s East Side, which later developed into the New York Infirmary for Women and Children. The infirmary had three goals: to provide medical treatment to women and children by women physicians, to give clinical instruction to female medical students, and to train nurses.