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  Blackwell saw the Civil War as a challenge to those involved with medicine and sanitation. She was particularly concerned about the lack of trained nurses for the Union army. Under her leadership, one of the first acts of the Women’s Central Association of Relief was to offer a course on basic nursing techniques at the New York Infirmary for Women. Blackwell and the WCAR committee chose a group of ninety-one women from a large number of applicants, including Georgeanna Woolsey and Harriet Dada. Woolsey was not sure she would pass the interview. Her family thought she was too young, too pretty, and too full of nonsense to be a nurse. Before going to her interview, she took the flowers out of her bonnet and the flounce off her dress so she would look like less of a “fly-away.” Finally, she passed, the examining board having inadvertently left the space blank where her age should have been.

  Blackwell gave her students nine lectures on subjects that included wound care and hygiene, but the heart of the program was a month working in the wards at Bellevue Hospital, where they learned practical nursing. Woolsey described the program as “a month’s seasoning in painful sights and sounds.” On May 14, 1861, she presented herself at the hospital for instruction, armed with a blue ticket that identified her as one of the WCAR’s students. She and twenty other women were led through the hospital in procession and assigned wards. Left in the middle of a long ward filled with beds of sick men, she panicked for a moment. Then she and her partner took off their bonnets and went to work.

  Her first day in the ward, she was shocked when the young house doctor barked at her, “Nurse, basin!” She handed him the basin promptly. Just as promptly, she fainted when she saw a wound probed for the first time. But over the course of the month she and her associates learned as much as they could in a short time. Their days began at six in the morning and lasted late into the afternoon. They heard bedside lectures from the house doctors as they made their rounds, wrote down everything they saw, and made elaborate sketches of all kinds of bandages and the ways of applying them. Woolsey bandaged everyone she met for practice, until she could make her “reverses” without a wrinkle. At the end of the month, she felt she and her fellow students were competent to deal with “any very small emergency, or very simple fracture.”7

  By the end of Blackwell’s course, her students may have been better trained in what to expect than many of the doctors who joined the army. Even with this level of training, Dix did not accept all of the women who completed Blackwell’s course, but most of them found a place to serve with or without her approval.

  Blackwell’s original ninety-one women were the only ones she trained as nurses for the Civil War. Shortly after the first class “graduated,” the United States Sanitary Commission was approved. Bellows and the other male leaders of the Sanitary Commission abandoned the WCAR’s goal of recruiting and training nurses in favor of what they saw as bigger issues than the care of individuals.

  Binding Wounds

  Most volunteer nurses did not arrive on the job “competent to any very small emergency, or very simple fracture.” Their skill levels were closer to those of Mary Phinney von Olnhausen, who recognized that she was horribly ignorant and could do no more than try to make the men comfortable.

  The most obvious skill nurses needed to learn, and the one they took the most pride in mastering, was how to dress and bandage a wound. Even as late as February 1865, when von Olnhausen could account herself an experienced nurse, she fluttered with pleasure when the army medical director who supervised the region where she was then stationed sent word that “his nine surgeons, after examining those wounds, said they had never seen wounds so well dressed and such bad wounds soon getting well; and, for himself, that I was the best wound-dresser in the country.”8

  Depending on the nature of the injury, dressing a wound could be more than a simple matter of replacing a soiled bandage with a clean one, as Elvira Powers realized soon after her arrival at Jefferson General Hospital in Indiana, when she was asked to hold a soldier’s gangrenous arm while a more experienced nurse changed the dressing. The wound had previously been packed with bromine-saturated oakum—a fibrous material made by unpicking tarred rope that some doctors of the time considered preferable to cotton lint as a dressing thanks to its superior absorption and the supposed decay-inhibiting qualities of the tar. Now it was time to remove it. The red and swollen elbow of the soldier’s arm rested in Powers’s hand while the senior nurse used a pair of pincers to pick off first the pus-soaked oakum and then burnt pieces of flesh from the edge of the raw wound. Powers remained steady until the man began to cry for mercy and his elbow quivered in her palm. Knowing from past experience that they might have another patient to care for in a moment if she stayed, she dropped the arm into the hand of another nurse “and mentally calling upon the heroism of all the braves [she] had ever heard” reeled to the tent opening. After a moment in the fresh air, the danger of fainting passed. “All laughed at me,” Powers reported ruefully, even the patient.9

  For a wound to heal, dead and infected matter had to be removed, a process that could be undertaken with surgical tools, topical disinfectants like bromine, iodine, or common vinegar, or as Powers discovered, bandages that would pull infected tissue away when changed. In some cases dressings needed to be changed many times a day. Hannah Ropes, writing to her daughter Alice several weeks after arriving at Union House Hospital, told her, “I have now learned how to take care of a shoulder wound. They are slow to cure and must have many dressings a day. Indeed, I had no idea it was such a slow and painful process—the uncertainty about what is in the wound, the waiting for the indications suppuration alone furnishes.”10

  Exploding cannon balls shattered soldiers’ arms and legs. Falling horses crushed them. They received an occasional bayonet stab or saber slash. But musket balls caused the vast majority of wounds at roughly 94 percent. The soft lead bullets known as minnie balls, in particular, caused far worse damage than a modern steel-jacket cartridge would. With a hollow cylindrical base and a rounded conical nose, minnie balls flattened when they met human flesh, tearing through muscle and bone. When hit, bones would splinter and shatter into hundreds of spicules: sharp, bony shreds that the force of the bullet drove through muscle and skin. These bullets usually lodged in the body and almost always left an infected wound that would seldom heal and often lead to amputation.

  It was a rare nurse who could bring herself to help at amputations. Mary Newcomb, who amputated a soldier’s finger when no doctor was available and claimed, “I believe I could have taken off an arm or leg without flinching” was an exception.11 Amanda Akins Stearn’s experience was more typical. She viewed her first amputation on June 18, 1864, after she had been in service in Washington’s Armory Square Hospital for fourteen months. A soldier under her care needed to have his arm amputated and she “suddenly came to the determination to witness it,” if she could find the nerve and someone to accompany her. She and two other nurses, Sisters Grigg and Israel, attended the operation. Israel felt faint and had to leave the room for a time, but soon returned. Stearns managed to stay until they tied off the arteries. At that point her legs began to shake and a wave of nausea came over her. She decided it was prudent to leave. She retreated to the ward, where she sat for a while with some camphor, one of the ingredients used to make smelling salts. Eventually the ward master walked her back to her quarters. According to Stearns, Sister Grigg was made of sterner stuff and “never wavered to the end.”12

  Tending the Whole Man

  Bandaging wounds, “putting up” splints, and assisting at amputations were the most dramatic part of nurses’ work. But, in fact, most of the soldiers who ended up in the Union army hospitals were struck down by an enemy more insidious than a minnie ball from a Confederate musket. Infectious diseases, including pneumonia, cholera, malaria, dysentery, and typhoid, accounted for 64 percent of the deaths among enlisted men in the Union army. (The rate was lower among officers, who enjoyed better-quality food and less crowded living conditions,
but were also twice as likely as enlisted men to be killed in action.) Providing fluids, nourishing food, clean bed linens and clothing, and physical and emotional comfort was often as important as any medical treatment.

  Many of the tasks women undertook in the hospitals were domestic chores writ large: feeding patients, making beds, overseeing and sometimes doing laundry. Writing two years after the war, Jane Hoge, one of the leaders of the Chicago branch of the United States Sanitary Commission, claimed that women’s domestic skills were essential to running a hospital: “The right of women to the sphere which includes housekeeping, cooking and nursing has never been in dispute. The proper administration of these three departments makes the internal arrangements of a hospital complete.”13 Hoge wrote about the domestic aspect of nursing from the perspective of a woman who did not empty bedpans on a regular basis during the war. Women who put in their time on the hospital floor took a less elevated position on the daily chores of nursing.

  Each of the domestic tasks brought its own challenges. Feeding patients, for instance, was seldom as simple as delivering trays to the bedside. Nurses coaxed along patients who had trouble digesting or were particularly weak with glasses of eggnog, milk punch, beef tea, and an occasional sip of brandy and water. The more disabled patients required physical help to eat or drink. Even carrying trays from kitchen to ward could be a challenge at some of the hospitals that had been converted from other uses, like Mansion House. Von Olnhausen groused about having to go up and down four long flights of stairs ten or fifteen times a day because she didn’t have the facilities to even warm a drop of water in her ward. “If it were not for this,” she wrote, “I would like my ward better than any other in the house; but it takes the wind.”14

  Who cooked what for the patients was a political issue for hospital staffs as much as a nursing chore. Field nurses and those on the transport ships often had to cook simply because there was no one else there to do it. Georgeanna Woolsey reported she once cooked and served 926 rations of farina, tea, coffee, and “good rich soup, turkey, chicken and beef,” made from home-canned goods sent by the women of the Sanitary Commission, in a single day.15 In the general hospitals, much of the cooking was assigned to untrained convalescent soldiers, which may explain the quality problems that von Olnhausen complained of to the inspector general in September 1862. The day before he arrived, she told him indignantly, the bean soup and beef tea, both staples of the hospital kitchen, were so salty no one could swallow a second spoonful. The beans were so hard they would have made anyone who managed to eat them violently ill.16 Lucy Campbell Kaiser, the only woman stationed at Jefferson Barracks Hospital in February 1862, not only served as nurse and superintendent, but took it upon herself to instruct the “half-sick” soldier who acted as cook,17 perhaps as a matter of self-defense. Outraged nurses would sometimes take over the kitchen when military cooks failed to produce meals appropriate for men who were too sick to eat, often triggering a confrontation over the control of kitchen equipment.

  Illnesses, particularly those that affected the gastrointestinal system, made it hard for patients to tolerate the so-called full, or common, diet served to active soldiers and invalids alike, which was often heavy, greasy, and coarse. One medical officer attached to a regiment described it as “death from the frying pan.”18 In 1864, Annie Turner Wittenmyer, state sanitary agent for Iowa, convinced the army to hire experienced women to superintend “special diet” kitchens in the general hospitals, a change that raised both the quality of convalescent food and the status of cooking as a hospital job.

  Born in 1827, Wittenmyer was the energetic young widow of a well-to-do merchant in Keokuk, Iowa. Well before the war began she was already actively engaged in benevolent activities in her hometown. She had a particular interest in free education for underprivileged children, a concept she expanded to include having her students washed and clothed. The outbreak of war gave her the opportunity to expand her scope.

  As the corresponding secretary of the Keokuk Ladies’ Soldiers’ Aid Society, Wittenmyer was not only active in collecting supplies for the military camps and hospitals surrounding Keokuk, which was the hub of Iowa’s military activity. She was also a key figure in the effort to coordinate Iowa’s relief work through the Keokuk society and distribute their supplies to Iowa regiments. She regularly traveled to wherever Iowa regiments were based, bringing with her bandages, medicine, clothing, and food and collecting information about what the troops needed most, first as a representative of the aid society and later as the official state sanitary agent.

  The need for special-diet kitchens was brought home to her on one of these trips. On a visit to a hospital in Sedalia, Missouri, in the winter of 1862, she found one of her brothers among the patients, a sixteen-year-old boy whom she had thought was a hundred miles or more away. One of the hospital attendants was serving breakfast in the ward. Her brother waved the breakfast away with a look of disgust.

  “If you can’t eat this, you’ll have to do without; there is nothing else,” the attendant told him and moved on to the next patient. Wittenmyer examined the meal: a dingy wooden tray that held a tin cup of strong black coffee and a leaden tin platter on which a piece of fried fat bacon swam in its own grease next to a slice of bread. She couldn’t blame her brother, who was ill with typhoid and dysentery, for refusing the meal.19

  She nursed her brother back to health and began to think about a system for providing wounded and ill soldiers with nourishing food that would tempt failing appetites. It was early in 1864 before she was able to give her full attention to the project. Having wound up her duties as the Iowa State sanitary agent, she convinced the United States Christian Commission to fund the creation of special-diet kitchens in military hospitals, with herself as the supervising agent.

  The concept of the special-diet kitchen, like so many of the nursing innovations in the Civil War, was first introduced by Florence Nightingale in the Crimea. The idea was that the surgeon would prescribe the appropriate diet for each patient who required what was known as a low, or special, diet. Menus were divided into full or common diet, half diet, and low or special diet to meet the needs of convalescent, sick, or very sick patients. It was a labor-intensive project: the special kitchen at Benton Barracks Hospital in Missouri produced 62,000 special-diet dishes in the month of August 1864 alone.20 As was often the case with improvements proposed by women, surgeons resisted the change at first, but soon saw the positive results of the new system. By the end of the war, the army had established more than a hundred special kitchens, in which “delicacies” such as toast, chicken, soup, milk, tomatoes, jellies, tea, gruel, and vegetables supplemented or replaced the standard hospital menu.

  The innovation of special-diet kitchens improved the quality of patients’ food, but did not end conflict between nurses and cooks in all cases. Amanda Akin Stearns’s memoir includes a detailed and running feud with “those ‘fiends’ who preside in that kitchen”21 at Armory Square Hospital in Washington.

  The same gastrointestinal illnesses that inspired the creation of the special kitchens also drove the most time-consuming of hospital tasks: cleaning. While memoirs and letters often speak of mud and blood, for the most part they maintain a polite silence on the other common element of military life in the Civil War—diarrhea. An average of 78 percent of the Union army suffered from diarrhea, nicknamed the “Tennessee quick-step” by the troops, over the course of the year. Even with the best efforts at camp hygiene and sanitation, the practical effect of that statistic was cholera, typhoid, and more diarrhea.

  Nurses, supported by convalescent attendants, occasional chambermaids, and an army of laundresses, fought to keep hospitals clean in the face of a seemingly endless flood of filth. It was a monumental task, even by standards of cleanliness that required the patient’s undergarments to be changed just once a week and saw nothing wrong with reusing lightly soiled bandages. Ward floors were dry-scoured clean with sand. Bedpans were emptied whenever they were used. (Thi
s seems obvious to a modern reader, but evidently some nurses and attendants needed to be trained to do this.) Keeping a supply of clean shirts, clean underwear, clean sheets, and clean bandages required a heroic effort—especially when a given patient might require nurses to “put three clean dressings and a shirt on him daily,” all which would need to be thrown away because they were so stained with blood and pus. The newly constructed general hospital at Portsmouth Grove, Rhode Island, reportedly boasted a steam washing machine that could mash and mangle four thousand pieces of laundry a day,22 an innovation that improvised hospitals like Mansion House could only envy. A report on the condition of hospital transport ships, presumably written by a male sanitary inspector, concluded: “Whitewash and women on a hospital ship are both excellent disinfectants.”23

  For many nurses, and their patients, one of the most uncomfortable tasks was bathing wounded soldiers, a process that often led to blushing on both sides of the sponge. Ropes, writing to her daughter Alice in August 1862, told her bluntly that “wounded men are exposed from head to foot before the nurses and they object to anybody but an “old mother.”24 Alcott, an old maid by the standards of the time if not an “old mother,” made light of what for many unmarried women was a truly shocking experience. She was prepared to deal with her first rush of wounded soldiers until her supervisor gave her a basin, sponge, towels, a block of soap, and instructions to tell them to strip off their socks, coats, and shirts, wash them as fast as she could, and put clean shirts on them. Alcott was stunned: “If she had requested me to shave them all, or dance a hornpipe on the stove funnel, I should have been less staggered; but to scrub some dozen lords of creation at a moment’s notice…” Having already reminded herself she was there to work, not weep, she then “drowned her scruples in her washbowl” and prepared to scrub.25