From hand maiden to right hand—the birth of nursing in America

AORN Journal,  Oct, 2003  by Victoria L. Holder

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Editor's note: This is the second in an ongoing series about the history of perioperative nursing in the United States, especially as it relates to military action. Part one of this article appeared in the September issue of the AORN Journal.

As an occupation, nursing did not exist in the United States before the Civil War. It had been less than a decade since Florence Nightingale was appointed superintendent of the Hospital for Invalid Gentlewoman in London and since she had volunteered her time and skills to help clean up and organize hospitals in the Crimea. It was not until the Civil War that the United States needed women to serve as primary caregivers outside their homes. New types of weaponry and ammunition caused catatrophic injuries, leaving soldiers on both ides of the conflict shattered, torn apart, and crying out for someone to help them. Officials on both sides did not believe the car would last more than a few weeks, so hey made no provisions for medical supplies or care for wounded soldiers. Only when the woods were littered with broken bodies and mangled limbs and the ground was soft with blood did authorities understand the necessity of caring for he wounded.

Organizations and aid societies, such as the US Sanitary Commission, were formed to do what the government was ill-equipped to do (eg, inspecting army camps for unsanitary conditions, improper food preparation, and general cleanliness). Makeshift aid stations were established, along with field hospitals red larger general hospitals. Order was being created to help handle the mass casualties of war.

For the first time in US history, women were asked to come out of their homes and serve as suppliers and caregivers for the armies. They could no longer abide by societal norms that said their place was in the home. They were needed, and they suddenly found themselves in situations that required real strength, stamina, and fortitude. Florence Nightingale, who had paved the way with her efforts during the Crimean war, and Dorthea Dix, who had worked to improve conditions for the mentally ill, were pioneers and role models for young women who wanted to do their part in the war effort.

DORTHEA DIX

Dorthea Dix, a 59-year-old woman from Massachusetts, was in New Jersey when she heard war had been declared. Dix already had a reputation for improving conditions for patients who were institutionalized as criminally insane. She went directly to Clement Alexander Finley, MD, the acting surgeon general, and bluntly told him that she wanted to organize an Army Nurse Corps under the auspices of the war department, something similar to what Nightingale had done in the Crimean War just a few years before. At first, Finley was reluctant to allow Dix to become involved because, until that time, military nursing had been strictly a male bastion.

Dix continued to argue her point, however, even visiting President Abraham Lincoln to plead for her cause. Her persistence paid off. On April 23, 1861, two weeks after the war began, she was appointed to the war department and assigned to help organize military hospitals in Washington, DC. She accepted the position, even though it did not come with a paycheck, d began recruiting women for the US Army Nurse Corps.

Many of the women who volunteered for the Army Nurse Corps were young, attractive, and single. Dix was concerned about placing these young women in such close quarters with young men, so she issued a statement to the press that said,

   No woman under 30 years need
   apply to serve in government hospitals.
   All nurses are required to be
   very plain-looking, women. Their
   dresses must be brown or black with
   no bows, no curls or jewelry, and no
   hoop-skirts. (1)

Nurses assigned to military hospitals during the Civil War had three primary tasks. They helped with what was called the special diet--not to be confused with being a cook. The term special diet often referred to a physician's orders for the type of diet prescribed for the patient. Assistant surgeons would make rounds in the wards and order diets, such as light, half, or full, and the amount of whiskey to be administered. A full diet consisted of poultry, beef, ham, fish, and vegetables. A lighter fare usually comprised soup or broth, tea, and toast. (2) As part of the special diet, the nurses guarded and rationed medicinal alcohol as needed for discomfort.

They also cared for the physical needs of patients, which included bathing, changing linens and clothing, and handling and distributing supplies. In addition, they helped ensure patients were cared for both emotionally and spiritually. They often wrote letters for disabled patients or cradled dying young men in their arms, serving as surrogate mothers, sisters, and wives.

CLARA BARTON

The Army Nurse Corps provided women an opportunity to serve in the war as nurses, but some women were uncomfortable with the restrictions of the US Army Nurse Corps or could not meet Dix's stringent requirements. These women had to be more creative in their efforts to provide help.