By: Mary Sheintoch
The trauma of war not only imparts both physical and psychological wounds on the people fighting in conflicts but also serves as a potent impetus to the public at large who has witnessed the tragedy to change certain social constructs in order to improve the future for its descendants. The United States Civil War which spanned the years 1861-1865 accomplished such a task by advancing the nursing profession from invisible unrecognized domestic labor to a valued vocation that served honorably in an expert capacity. The dramatic contributions nurses made prompted many people in positions of power to institute reforms that resulted in a vastly improved healthcare delivery system as well as training schools for nurses all at a time when modern medicine itself was still in its infancy. It must be noted, however, that any comprehensive analysis of this period of nursing history will reveal some movement backward as well. Unfortunately, some of the negative consequences that arose in the post-Civil War era continued to adversely affect the nursing profession for years to come.
At the time that fighting broke out at Fort Sumter in April, 1861, most nursing care was largely provided for at home by female family members under the supervision (perhaps) of the local doctor who visited the ill or injured patients and dispensed medicines and treatments. Victorian influences prevailed which specified that “women concern themselves with home, church, women’s clubs, women’s reform groups, and their female relatives and friends” (Lesniak, 2009, p. 34). Thus, the profession of nursing as a secular vocation largely did not exist. Any nursing that was done outside of the domestic arena was usually performed by religious orders or institutions. During wartime, male soldiers themselves cared for sick and dying men in the most rudimentary fashion.
However, conflict in Europe spurred advances in the nursing profession as Florence Nightingale’s work during the Crimean War not only shed light on improved nursing practices, but demonstrated the idea that genteel women of good family could effectively provide much needed care outside the confines of the home. Similarly, nurses during the Civil War performed their duties not only in military hospitals, but in army camps and even on the battlefield (Quincealea, 1997). The important effort to save lives and comfort the dying was, in effect, done out of necessity in professional, albeit crude, settings. Consequently, “the war served as the beginning of moving the profession from the home to the hospital and clinic” (Weatherford, 2010, p. 2).
After the conclusion of the war, powerful voices in medicine and government recognized the need for trained nurses and, therefore, formal programs of learning emerged as the United States began the painful process of reconstruction (Quincealea, 1997). As the public acknowledged the important contributions nurses made during the previous conflict and society relaxed some of its strictures regarding women’s roles outside the home, several models of schooling were developed which reflected the goals and values of the people who conceived them. In general, these educational systems trained subsequent generations of nurses thereby providing the skilled workforce needed to staff the rapidly modernizing hospital system.
During the years following the war as the hospital system became more efficiently institutionalized, “three major nursing organizational schemes developed….[which] designed educational and organizational systems consistent with its own particular view of nursing” (Baer, 1985, p. 32). For instance, Nightingale schools emerged which professed the philosophy that training should occur within a framework that was somewhat self-directed. These bodies were governed by women managerial boards that were separate from the hospital system. Interestingly, there was strong emphasis placed on the notion that the ideal student candidate be female, sober, industrious, and above all, genteel. A second model arose at Boston City Hospital under the supervision of Linda Richards that directly placed the student nurses under hospital command. This arrangement required that nurses exist in a subordinate role subject largely to male medical domination. Finally, a third approach under the auspices of Isabel Hampton came about which actually aspired to a more autonomous professional ideal. All in all, great strides were made in the field of nursing education taking it from a non-existent state to a recognizable institution.
Unfortunately, there were negative consequences of this progression forward that adversely impacted nursing for quite some time. Historical research now documents that care-giving duties were performed by a wide range of people that included men and people of color of both genders (Domrose, 2011). This diverse group made significant contributions often at the expense of their own health and well-being. Walt Whitman, for instance, suffered from the physical and emotional scars he received during his nursing service for the rest of his life. He eventually died of a complicated range of maladies that were directly attributed to his war work (Hsu, 2010). Countless others performed grueling and often dangerous drudgery with little recompense. Regrettably, much of the credit for nursing advancements went solely to white women of the upper class which, in effect, discounted the sacrifices of so many.
Furthermore, the close association that connected femininity with nursing ultimately became the basis for tension as manifested by nursing’s desire for greater self-determination and respect in the face of degrading demands for subservience from the medical establishment. In essence, the perception that females possessed natural ability to nurture and care for others “ultimately undermined their struggle for greater autonomy” (Schultz, 2004, p. 3). An unfortunate expectation developed that nurses should perform a servile role solely under the direction of mostly male medical professionals. This assumption naturally made future attempts to establish a profession separate from medicine more difficult.
The Civil War was a pivotal event not only in America’s experience but in nursing’s narrative as well. What was primarily domesticated tasks performed by female familial caregivers evolved into an occupation that took place in settings far from the comforts of home. Ultimately, the conflict prompted the formation of a hospital system that was a harbinger of modern times. This organizational structure required skilled nurses to staff the facilities and, thus, gave rise to the need for nursing education. Different modalities emerged which educated generations of women who gave rise ultimately to a true profession. Like many developmental processes, this progression was not always entirely smooth. There were missteps along the way that did negatively impact the vocation for some time. However, the strength of the nursing profession ensured that reflection upon the past provided wisdom and guidance for a brighter future.
Baer, E. D. (1985, Jan-Feb). Nursing’s Divided House – An Historical View. Nursing Research, 34(1), 32-38.
Domrose, C. (2011, May 2). The Civil War and Nursing. Nursing Spectrum, pp. 25-32.
Hsu, D. (2010). Walt Whitman: An American Civil War Nurse who Witnessed the Advent of Modern American Medicine. Archives of Environmental and Occupational Health, 65, 238-239.
Lesniak, R. G. (2009, Jan-Mar). Expanding the Role of Women as Nurses During the American Civil War. Advances in Nursing Science, 32(1), 33-42.
Quincealea, B. (1997). Nursing at War: Catalyst for Change. Annual Review of Nursing Research, 15, 217-36.
Schultz, J. E. (2004). Women at the Front. Chapel Hill and London: The University of North Carolina Press.
Weatherford, D. (2010). The Evolution of Nursing. Retrieved from http://www.nwhm.org/blog/the-evolution-of-nursing.