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Heroines of Mercy Street
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Heroines of Mercy Street tells the true stories of the nurses at Mansion House, the Alexandria, Virginia, mansion turned war-time hospital and setting for the PBS drama Mercy Street. Among the Union soldiers, doctors, wounded men from both sides, freed slaves, politicians, speculators, and spies who passed through the hospital in the crossroads of the Civil War, were nurses who gave their time freely and willingly to save lives and aid the wounded. These women saw casualties on a scale Americans had never seen before, and medicine was at a turning point.
Heroines of Mercy Street follows the lives of women like Dorothea Dix, Mary Phinney, Anne Reading, and more before, during, and after their epic struggle in Alexandria and reveals their personal contributions to this astounding period in the advancement of medicine.
Table of Contents
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It is impossible to fully understand the American Civil War without looking at the role of medicine, both its triumphs and its failures. The death toll was high at more than twice the number of American soldiers who died in World War II. The new mass-produced weapons of the industrial age created mass-produced deaths on the battlefield, but even the new Gatling guns and rifled muskets could not compete with older killers: gangrene, typhoid, pneumonia, yellow fever, malaria, and dysentery. Disease counted for two-thirds of all Civil War deaths.
When the war started in 1861, the Union army's Medical Bureau—made up of thirty surgeons, eighty-six assistant surgeons, and a surgeon general who was a veteran of the War of 1812 and took office in 1836 under the administration of Andrew Jackson—was unprepared for the carnage that would follow. American medicine in general wasn't up to the task.
Europe was in the midst of a medical revolution, based on the application of scientific techniques of observation and measurement to medical questions. New instruments, such as the stethoscope (1816), the laryngoscope (1854), and the ophthalmoscope (1851), allowed physicians the opportunity to study a disease the same way the period's naturalists studied the structure of plants and minerals. In France, unfettered access to corpses for dissection gave doctors a more profound understanding of the relationship between nerves, muscles, organs, blood vessels, and bones in the human body. Medical scientists like Xavier Bichat and Pierre Louis supplanted the old medical theories of humors and temperaments with new ideas about how diseases worked—the first steps toward the development of the germ theory of disease. In England, physicians moved the techniques of observation and measurement beyond the human body to track the progress of a disease through a population, demonstrating the correlation between infected water and illnesses like cholera and typhoid. In the ten years following the Civil War, Joseph Lister would introduce carbolic acid as the first antiseptic, Louis Pasteur would pioneer the germ theory of disease and lay the foundations of the study of epidemiology, and Sir Thomas Allbutt would invent the first clinical thermometer—a revolutionary tool in light of how many deadly diseases initially manifest themselves as fever. But none of that was available to Civil War doctors and their patients.
In Europe, thousands of students went to Paris to study medicine, including young Americans interested in the possibilities of medicine as a science rather than medicine as an art. They attended lectures by noted physicians on subjects that included anatomy, physics, medical hygiene, surgical and medical pathology, pharmacology, organic chemistry, therapeutics, operative and clinical surgery, midwifery, diseases of women and children, and legal medicine. More important than the lectures was the clinical experience offered in the great Parisian hospitals. In addition to the benefits of following a physician on his daily hospital rounds, the sheer size of the Parisian hospitals meant that students could see a wider variety of the sick and the wounded in a matter of months than an American doctor would see in a lifetime in even the largest American hospitals. In 1833, for example, the twelve Parisian hospitals treated almost 65,000 patients, more than the entire population of Boston at the time.
By comparison, the United States was a medical backwater. Neither a license nor a medical degree was required to practice medicine, and many doctors had neither, instead learning the trade as apprentices to older doctors. In fact, a degree was no guarantee a doctor was well trained. The quality of American medical education went down in the early nineteenth century, as proprietary medical schools began to spring up in the 1820s in response to a rising population with a growing need for doctors. In most cases, the education provided by these schools consisted of two four-month terms in a two-year period; first- and second-year students attended the same lectures. There was no clinical work and no surgical demonstrations. Attendance was not required and examinations were minimal. Best described as entrepreneurial education, many of these schools were more concerned with generating fees than training doctors: a substantial "graduation fee" encouraged schools to allow students to earn their degree without regard to competence. Even the best American medical schools, often led by doctors who had studied in Paris, lagged behind European schools; medical students at Harvard, for instance, did not use microscopes in laboratory work until 1871.
Doctors relied on emetics, purgatives, bloodletting, and the painkilling properties of whiskey, which they administered to patients in the absence of anesthesia. (Civil War nurses often complained that doctors dipped into the whiskey supply for their own use as well. One Confederate nurse dubbed struggles between doctors and nurses over control of medicinal liquor the "wars of the whiskey barrel."1) Many of the medicines in common use dated from the time of Hippocrates, who laid the foundations for Western medicine in the fifth century BCE; some were the ancestors of modern wonder drugs, but others were close kin to the cure-alls made and sold by patent medicine charlatans. Opiates were widespread and legal despite the known dangers of addiction. Doctors had used ether and chloroform as anesthetics for twenty years, but dosages were still uncertain, and it was difficult to secure the necessary supplies on a reliable basis during wartime given the complexities of military logistics.
For the most part, neither doctors nor their patients had any experience with hospitals. Hospitals were charity institutions and existed only in the largest cities: New York, Boston, Philadelphia, Washington, DC. Doctors in smaller towns and cities would never have practiced at a hospital. Even in large cities, female family members attended the ill at home if at all possible, perhaps with the support of a visit by a doctor. If surgery was needed, doctors often performed the procedure on the kitchen table, which was probably cleaner than most hospital operating theaters and certainly cleaner than the surgical instruments used, which doctors carried in plush-lined cases that were germ breeding-grounds.
Only the poor and the desperate went to a hospital when they were ill. As one medical student put it shortly before the war, "The people who repair to hospitals are mostly very poor, and seldom go into them until driven to do so from a very severe stress of circumstances. When they cross the threshold they are found not only suffering from disease, but in half-starved condition, poor, broken-down wrecks of humanity, stranded on the cold, bleak shores of that most forbidding of all coasts, charity."2 Infection and cross-infection were so common that some diseases were known as "hospital diseases"—not surprising since the same bed linen would be used for several patients. The smells were so bad that the rough hospital nurses of the antebellum world, who typically belonged to the same economic classes as their patients, inhaled the finely ground tobacco known as snuff to make working conditions more tolerable.
Nursing as a skilled profession barely existed in the mid–nineteenth century, with the exception of a few religious orders. Most women could expect to care for ill or infirm family members or friends at some point in their life. A few would serve as paid nurses in the homes of the well-to-do, as temporary domestic servants who performed the same services a family member might perform in a less wealthy home. Such work was for the most part the domain of American-born, poor, white, older women—often widows. Women who took up hospital nursing were a large step down the social scale from private nurses, cleaning, feeding, and watching over patients who were society's most marginalized people in an institution that many rightly feared as a death trap. British nursing advocate Florence Nightingale summed up the public perception of hospital nurses: women "who were too old, too weak, too drunken, too dirty, too stolid or too bad to do anything else."3 Most of the limited jobs open to poor and working-class women in urban America—mill worker, seamstress, milliner, laundress, and especially domestic servant—required proof of a good moral character. Losing a job without a reference was an economic calamity. Hospital nursing was the penultimate step in a downhill slide: a job for women who had few options left other than the street. At Bellevue Hospital in New York, women arrested for public drunkenness or disorderly conduct were sentenced to ten days in the workhouse. Once they dried out, these "ten-day" women could be paroled if they agreed to work as nurses in the Bellevue wards.
The reputation of nursing as no job for a respectable woman began to change with Florence Nightingale's groundbreaking work in the Crimean War in 1854 and her subsequent publication of the best-selling Notes on Nursing in 1859. Her efforts in the war caught the public imagination, thanks to publicity from the new breed of war correspondents spawned by the telegraph, the steamship, and daily newspapers aimed at the middle classes. Using the benefits of her fame, Nightingale set out to change the perception of nursing, which she considered a calling rather than a job. She opened a nursing school in London in 1860. Students included not only "probationers," scholarship students drawn from the lower middle classes, but also "Lady nurses," higher-class (or at least wealthier) women who paid their own expenses and expected to become instructors and supervisors. Her example inspired young American women with dreams of glory. As one young woman put it soon after the beginning of the war, "It seems strange that what the aristocratic women of Great Britain have done with honor is a disgrace for their sisters to do on this side of the Atlantic."4
Nightingale's success also forced the army Medical Bureau to change its practices regarding nursing. Before the Civil War, convalescent enlisted men who were not yet able to return to their military duties performed any nursing required by ill or wounded soldiers, a system that would continue side by side with female nurses throughout the Civil War. The lessons of the Crimean War made it clear to at least some Americans that such ad hoc nursing was not enough. Nightingale's version of nursing could be seen as an exalted version of a woman's household duties. Recuperating soldiers did not have the domestic skills to ensure well-cooked food for special diets or meet the new standards of clean wards, clean sheets, and clean men. Female nurses, trained or not, would be needed to care for ill and wounded soldiers.
It turned out to be easy to find them. Thousands of women volunteered over the course of the war, though there was never any official call for nurses in the North. The largest number of volunteers came after the First Battle of Bull Run in July 1861, but women continued to volunteer well into 1864. By one estimate, more than twenty thousand women served as nurses during the war, not including an unknown number of uncompensated volunteers.5
The popular image of a Civil War nurse is a single Northern woman, old enough to be considered a spinster but young enough to have the energy for the work, from a middle- to upper-class family, with an inclination toward philanthropy or reform. In fact, they were as diverse as the new and expanding nation from which they were drawn: teenaged girls, middle-aged widows, and grandmothers; society belles, farm wives, and factory girls; teachers, reformers, and nuns; free African-Americans and escaped slaves; new immigrants and Mayflower descendants. Some worked from patriotic zeal or a sense of adventure; others took the work because they needed the money. (The Union army paid $12 a month plus board, rations, and transportation, when it paid at all.) What they had in common was the physical capacity to do the work and a willingness to serve
Heroines of Mercy Street: The Real Nurses of the Civil War will focus on one Union hospital and the nurses who passed through it. Mansion House Hospital was located in Alexandria, Virginia, which held the distinction of being occupied by Union troops longer than any other Confederate city. The women who worked at Mansion House can be seen as a microcosm for the medical experience of the war. Its nurses did battle with hostile surgeons, corrupt house stewards, dirt, filth, inadequate supplies, and their own lack of training. They fought to make sure their patients received the care they needed along with minimal comforts, wept for those they lost, raged at the enemy, and raged even harder against the indifference and inefficiency that left wounded men lying on the battlefield without care. They learned to dress wounds, bathe naked men with whom they had no familial relationship (not an easy adjustment to make at the height of Victorian prudery), and evacuate the building in case of fire. Worn out by the grinding nature of the work and exposed constantly to diseases, they themselves fell sick, often with no one to nurse them in their turn. At least one Mansion House nurse fell in love with a soldier and was forced to leave the service. Some lasted less than a month; others made the leap from volunteer to veteran. By war's end their collective experience, along with that of nurses across the country, had convinced Americans that nursing was not only respectable but a profession.
Dorothea Dix Goes to War
"This dreadful civil war has as a huge beast consumed my whole of life."
"[Dorothea Dix] is energetic, benevolent, unselfish and a mild case of monomania; working on her own hook, she does good, but no one can cooperate with her for [she] belongs to the class of comets, and can be subdued into relations with no system whatever."
—George Templeton Strong2
The Civil War began at 4:30 a.m. on April 12, 1861, when troops of the two-month-old Confederate States of America fired on Fort Sumter, an unfinished red brick fortress built on a man-made granite island in the entrance of the harbor at Charleston, South Carolina.
The fort, held by sixty-eight Union soldiers under the command of Major Robert Anderson, had become the emotional focal point of the conflict between North and South in the weeks since South Carolina became the first state to secede from the Union on December 20, 1860. The small garrison was cut off from resupply or reinforcement, but the soldiers there refused to surrender the fort to Confederate control. Anderson, a Kentucky native and former slaveholder, was praised as a hero in the North and reviled as a traitor in the South. President James Buchanan, at the end of his term of office, was unwilling to trigger civil war by attempting to relieve the besieged unit and equally unwilling to trigger a public outcry by recalling the troops from Sumter. "If I withdraw Anderson from Sumter," he said in late December 1860, "I can trail home to Wheatland [Pennsylvania] by the light of my own burning effigies."3 He chose instead to leave the problem for his successor.
When Abraham Lincoln took office on March 4, the garrison at Sumter had less than six weeks of food left. Lincoln's cabinet told him it was impossible to relieve the fortress and urged him to evacuate Anderson's troops as a way of reducing tension between North and South. Popular opinion screamed for Lincoln to reinforce the "gallant band who are defending their country's honor and its flag in the midst of a hostile and traitorous foe."4 With public opinion eager for action, and no sign that delay would improve the chances of reuniting the country, Lincoln chose to resupply the garrison but not send reinforcements unless the Confederates attacked either the fort or the supply ships, a compromise that pleased no one.
Shortly after midnight on April 12, with resupply ships on the way, the Confederate government gave Anderson until 4:00 a.m. to surrender. Anderson refused. At 4:30 a.m., the bombardment began. Although they had neither the men nor supplies to mount a meaningful defense, the Union forces held out for a day and a half before surrendering.
Almost before the echoes of the first gun shots died away, President Abraham Lincoln called for 75,000 militia volunteers to serve for ninety days, certain that would be enough time to put down what he described as a state of insurrection, not a state of war. The public's response was immediate and overwhelming. Men thronged the army's recruiting offices. The first two Massachusetts regiments marched toward Washington and Fort Monroe two days after the president's call; two more followed within the week. Individual states filled their recruitment quotas and offered more. The governor of Ohio, having raised the thirteen regiments requested, telegraphed the War Department to say, "without seriously repressing the ardor of the people, I can hardly stop short of twenty."5
Citizen soldiers were not the only volunteers to respond to the president's call. Even though Lincoln had said nothing about nurses—and had certainly not called for women to come to their nation's aid—Dorothea Lynde Dix, a fifty-nine-year-old reformer dedicated to improving the treatment of prisoners, paupers, and the mentally ill, set out immediately to volunteer her services to create an army corps of female nurses to care for wounded soldiers, modeled on the group of nurses who followed Florence Nightingale to the Crimean War.
A Useful Life
Dorothea Dix was born in1802 in a small frontier settlement in northern Massachusetts (now a part of Maine). Her childhood was difficult and often lonely. Her grandfather, a successful Boston doctor, had purchased thousands of acres of undeveloped land with the intention of building new towns, and he sent her father, Joseph Dix, to manage the property. By the time Dorothea was born, he had carved out a small piece of farmland from the wilderness and built a plaster-chinked log house. It would have been a hard life even if Joseph Dix had been a dedicated farmer—and he wasn't. Instead of concentrating on farming and developing the land, he became an itinerant Methodist minister and was often away from home, supplementing his meager income by selling printed copies of his sermons. Dorothea had the hated job of cutting and folding the printed sheets and sewing them into pamphlets. Her mother was no help; she took to her bed after the birth of Dorothea's second brother and remained a semi-invalid who suffered from what sounds to a modern reader like debilitating bouts of depression. As the oldest of three children, Dorothea became responsible for much of the work of the frontier household at a very early age.
When Dorothea was twelve, she escaped to Dix Mansion, her widowed grandmother's home in Boston. Life was better with her grandmother, but the two Dix women soon butted heads. The senior Mrs. Dix was determined to turn her backwoods granddaughter into a lady, and Dorothea rebelled. After two years, Mrs. Dix realized she didn't have the strength to take care of a strong-willed teenager and sent Dorothea to her great-aunt Sarah in Worcester, forty miles west of Boston.
In a warm and loving environment for the first time, Dorothea thrived with her relatives in Worcester, but she was used to working. She needed more to do than the picnics, garden parties, and teas that occupied her contemporaries there. With her aunt's permission, she opened a school for young children in an old printing shop, where she taught reading and writing, Bible studies, and the kind of manners she herself had resisted learning in Boston. Dix was only fourteen, but the school was a success, with as many as twenty children attending at a time.
She ran the school in Worcester for nearly three years, until her grandmother, now seventy-three, asked her to come back to Dix Mansion. In 1819, she returned to Boston where she made an unobtrusive debut in society, studied with private tutors, attended public lectures, and discovered the Unitarian religion, which flourished in Boston during the period. She also met Anne Heath, whose friendship would be a constant comfort for the rest of her life. In 1821, she convinced her grandmother to allow her to open a charity school in the barn behind Dix Mansion. When the school proved to be a success, she opened a second one within Dix Mansion itself, aimed at students who could afford to pay tuition. During this period she also began to write textbooks for children. One of these, Conversations on Common Things, published in 1824, enjoyed a surprising success; by the time the Civil War began, it had been reprinted sixty times.
Throughout the 1820s and 1830s, Dix suffered from respiratory problems, fatigue, and depression. Her poor health made it difficult to teach on a regular basis. In 1836, she suffered a serious physical and emotional collapse and was forced to close her school. Her doctor and friends encouraged her to take a restorative trip to England, where she convalesced for eighteen months in the home of fellow Unitarian William Rathbone. At Rathbone's home, Dix was introduced to a circle of reformers concerned with the social problems created by a half century of industrialization in England, among them utopian socialist Robert Owen, prison reformer Elizabeth Fry, and Samuel Tuke, founder of the innovative York Retreat, an asylum for the mentally ill that emphasized humane treatment, healthy diet, exercise, and productive work. Dix's involvement with the Unitarian congregation in Boston had already introduced her to ideas of liberal Christianity and social reform, but now she discovered a new way of thinking about social problems that utilized direct observation and data collection to argue for change.
Dix was not well enough to make the trip home until the fall of 1837, several months after the death of her grandmother. Between the money she inherited from her grandmother and the income she received from her books, she had enough money to allow her to devote her time to reform and charitable work. Being a woman of independent means would be a crucial element in her success as a reformer.
For several years after her return, she traveled in search of both a home and a cause. She found her true calling at the age of thirty-nine, when a friend asked her to take over his Sunday school class for women inmates at the East Cambridge Jail. On March 28, 1841, she arrived at the jail, prepared to lead the twenty waiting inmates in a Bible lesson, a prayer, and a hymn. When the lesson was over, she asked the jailer for a tour of the facilities, a standard activity among the nineteenth-century reform community. What she found shocked her, particularly the section of the prison where the mentally ill were kept in small cells without furniture and no stove to keep the inmates warm. When she asked why they didn't have heat in their cells, she was told it was unnecessary and dangerous: because they weren't in their right minds they didn't feel the cold, and, besides, they might start a fire and burn down the prison.
Outraged, Dix took the matter to the county court. Women were not allowed to speak before the court, but they were allowed to state their case in writing. Dix described the conditions she had seen and appealed to the court to at least provide stoves for the inmates. At first she was greeted with anger and disbelief, but she wrote letters to prominent Bostonians and finally caught the attention of Samuel Gridley Howe, who was doing similar work on behalf of disabled children, and of Boston legislator Charles Sumner. When they took up Dix's cause, both the public and the court listened. The mentally ill inmates of the Cambridge jail got their stoves.
While she campaigned on behalf of the inmates of the East Cambridge Jail, Dix began to investigate how the mentally ill were cared for elsewhere. For a year and a half, she traveled across the state of Massachusetts, investigating conditions in every poorhouse and prison, public and private, that she could gain access to. She quickly learned that the conditions at East Cambridge were not unusual; in fact, in many places they were much worse. The wealthy could pay for attendants to care for mentally ill family members at home or pay for them to be housed in private hospitals, but the poor had nowhere to go. In 1841, there were only fourteen mental hospitals in the country. Most of the mentally ill were housed in prisons and poorhouses, and even those housed in asylums were often brutally treated. Appalled, she set out to reform the treatment of the mentally ill in Massachusetts, replicating her East Cambridge campaign on a larger scale.
Dix had found both her cause and her mode of operations: painstaking investigations, dramatically written descriptions of conditions, and the help of powerful men to apply pressure on the political system. Between 1843 and 1845, she traveled more than ten thousand miles and visited hundreds of institutions, often at the request of concerned citizens in other states who wanted help in undertaking asylum reforms.
By the time the Civil War began, Dix had spent twenty years working to change the way people thought about the mentally ill. She traveled almost continuously at a time when few people traveled more than a few miles from home and women seldom traveled alone. Railroad companies gave her free passes, and freight haulers carried her packages to prisons, hospitals, and asylums at no charge. Most importantly, she had convinced politicians at every level of American government to support prison reform bills and to build insane asylums. She had even worked for reform at the federal level. In 1848, she lobbied for a bill to grant the states more than twelve million acres of public land to be used for the benefit of the insane, deaf, dumb, and blind. The bill passed both houses of Congress. President Franklin Pierce ultimately vetoed the bill, but Dix made important connections in Congress in its pursuit, a fact that meant her proposal for an army nursing corps got a fair hearing.
- On Sale
- Feb 16, 2016
- Page Count
- 304 pages
- Little, Brown and Company