Behind the Battle of Gettysburg: American Nursing Is Born

The battle of Gettys­burg cannot only be characterized as the turning point of the Civil War, for it was so much more. During the war, with casualties high and the need undeniable, women entered hospitals to care for the wounded, but – shockingly­ – were made to feel unwelcome. These resolute women, though, stood fast, and pro­ceeded to establish a new profession. When the war reached Gettysburg in 1863, two years after the first gunfire at Fort Sumter, women’s di­verse efforts in the delivery of medical care had been unified. It had taken those two years for physicians and military authorities to decide that they desperately needed the help of nurses to tend to the victims of war. For that reason alone, Gettysburg can legitimately be called “the birthplace of mod­ern nursing.”

As the seeds of the nursing profession took hold at Scutari in the Crimea, so, too, the American conflict provided fertilizer for nursing’s growth – nationally and inter­nationally. While the carnage at Gettysburg shocked the world, women of varied edu­cation and experience joined talents to save the wounded. The value of their service and their own recognition of their capabilities lead to the rise of educational programs and career opportunities.

Traditionally, the American woman was tightly bound to the family in the nineteenth century, and the presence of her nurturing and organiza­tional skills undoubtedly pro­vided the stability required for men to build communities and establish institutions. The Civil War drastically changed that. For the first time, women recognized the value of their natural skills beyond their small, insular world.

When the death rate of troops, resulting from disease and injuries, first became known, it sorely embarrassed President Lincoln. By the end of the war a total of 2,213,678 men had fought in the conflict, 162,000 had been killed in battle, and nearly a half mil­lion more had died of wounds, illnesses or accidents. Care of the wounded was primitive, a secret the military attempted to hide, but descriptive letters from hospital-bound soldiers to families and fiancés were widely circulated. The women of the nation were ready for action.

The savagery of war burst upon the North when Union and Confederate armies met at the little Adams County bor­ough of Gettysburg in one of the Civil War’s bloodiest bat­tles. Most of the women who aided the wounded remain unknown, their identities clustered under the titles of the organizations with which they were affiliated. A few recorded their activities during that and other battles, and from these sparse writings developed ideas of social re­form and the concept of nursing education, leading to the beginning of a new profession.

Individuals and groups did distinguish themselves at Gettysburg. Dorothea Dix, appointed superintendent of the Army Nurse Corps, won little gratitude or recognition for her efforts, but the mem­bers of her organization were present, the only group which could claim any level of educa­tion in the specialty of nurs­ing. The U.S. Sanitary Commission, the Christian Commission, the Patriotic Daughters of Lancaster, the Daughters of Charity (of Em­mitsburg, Maryland) and many individuals answered the call from a town stained with the blood of thousands of wounded soldiers, but most of their identities are lost. How­ever, these nameless humani­tarians helped lay the foundation of modern nursing.

Under intense pressure from the Women’s Central Relief Association and Ladies Aid Societies, which wanted to apply Florence Nightingale’s successful principles of health care to America, Lincoln agreed to the establishment of the United States Sanitary Commission. Created on June 9, 1861, by Secretary of War Simon Cameron and signed into law by the president four days later, the commission was broadly empowered to establish its own rules and regula­tions, subject only to the approval of the Secretary of War. The commission evolved into an association of lay people – both men and women – who moved quickly and without formal orders, traveling anywhere and per­forming whatever duties were necessary. Camps were crowded and dirty, supplies were scarce and ambulances and nursing teams did not exist.

The commission inaugu­rated a system for collecting and distributing supplies, planned camps, implemented camp sanitation, tended the wounded, equipped hospital trains and rallied farmers to contribute produce for soldiers as a preventive of scurvy. Within a year of its existence, the commission helped dra­matically improve the health conditions of the troops.

When the number of wounded continued to in­crease during the war and the military’s prejudice against women lingered, Lincoln called on the Roman Catholic Sisters to assist with the care of the wounded. His decision to select the Sisters was based on the fact that they were organized, accustomed to discipline and obedient to authority. The Sisters seemed particularly qualified, having given aid during several epi­demics in the nation’s history. Furthermore, they seemed safe from the possibility of roman­tic indiscretions.

Having accepted Lincoln’s plea, the Sisters cared for soldiers in army and religious hospitals and on the battle­field, working under fire. Prejudice against religious orders was less obvious than that against other women, and the Sisters were respected for their efficiency by the govern­ment and the army officers who gave them carte blanche to obtain medical supplies. It has been written that even the crudest hospitals became models in the hands of the Sisters. When it became known that the battle of Get­tysburg had taken place, twenty-six Sisters from the convent of the Daughters of Charity in Emmitsburg, ten miles south, traveled to the battle site and assisted the Sanitary Commission and the Army Nurse Corps.

Contributing heavily to the war effort, especially at Get­tysburg, was the Christian Commission, an extension of the Young Men’s Christian Association. It assumed many of the same responsibilities as the Sanitary Commission and coordinated with all other relief organizations to aid the troops. During the fighting at Gettysburg, the Christian Commission hurried to the town, assigned to locate the Second Army Corps Field Hospital. This directive indi­cated that a broad plan had already become operational before they arrived. It was known that wounded men were lying in the fields, but any effort to reach them was met with fire from rebel sharpshooters.

The Second Army Corps Hospital was merely a dumping ground for the wounded, with men lying, unprotected, side by side on the ground. The Ambulance Corps duti­fully carried the wounded to the proper locations, but nurs­ing care was limited. Many of the men lost their clothing in battle and others had their clothing torn off to halt bleed­ing. Christian Commission members sent the message to the nation that they desper­ately needed bandages, sponges, stimulants and lint­ – a fibrous substance from laundered rags used to make pressure and absorptive dressings.

The name of the Christian Commission is specifically mentioned in reports from various organizations, sug­gesting that its efforts were well coordinated with other groups. Even though few people with true legal status were present and lines of au­thority were ill-defined, its work was carried out purpose­fully. The Christian Commis­sion’s contribution to the rise of nursing was its ability to make working materials availa­ble to those who rendered care. The members of the commission were responsible individuals who respected and supported those who deliv­ered care to the sick. By their attitude alone, they helped nursing evolve into a respect­able occupation.

The medical director of the Army of the Potomac, Jona­than Letterman, worked at Gettysburg with a meager staff of surgeons, making it unlikely he could accurately survey area field hospitals in order to assign volunteers who arrived hourly. There was one person present, though, who kept on the move, constantly supervis­ing care, but never becoming intimately involved with de­tails. She attracted followers who seemed to be accepted as authorities, by volunteers who willingly carried out orders. That person was Dorothea Dix.

Dorothea Dix was a social reformer. Years before Fort Sumter was fired upon, she had become aware of the un­speakable conditions in which the mentally disturbed existed. She spent years drawing atten­tion to their plight and be­seeching government officials to improve the situation. Long before the Civil War, Dix had earned the respect of many of the nation’s leaders.

When word of the firings on Fort Sumter became known, everyone – including President Lincoln – thought the conflict would be short. Both Dix and Lincoln were caught in the trap of their misconception.

As a patriotic citizen who had already gained national recognition, Dix decided to volunteer her services to orga­nize an Army Nurse Corps. On April 23, 1861, Secretary of War Cameron accepted her offer, and by June she had been commissioned superin­tendent of U.S. Army Nurses, the first American to receive such an appointment. Dix’s first task was to study the facilities of the military hospi­tals and the available staffing. She found few supplies availa­ble to care for the wounded. Fortunately, soldier-aid soci­eties were forming and Ameri­can women feverishly made clothing and bedding to parti­ally satisfy the needs of the soldiers.

Dix communicated with Dr. Elizabeth Blackwell, who had taken steps to establish a one month nursing course in New York Hospital. Blackwell, the first woman accepted to an American medical school, was able at the start of the war to establish the course in antici­pation of the need for the services of trained women. One hundred young women entered the course.

Perhaps Dix’s eagerness to win the support of federal officials in Washington led her to make several poor decisions concerning recruitment. Her strongest objection to enlisting young women was the danger that they might corrupt the soldiers’ morals. Dix drew a profile of the type of mature volunteer who was suitable: one willing to give services and time, and meet part of the expense; associate by twos; and respond for duty at any hour, day or night.

Women were determined to become a part of the war ef­fort, and their resoluteness created many problems. Wives followed their spouses, with or without official sanction, join­ing the inevitable trail of camp followers. Dix urged organiza­tions to refrain from sending help unless it was requested. Her new profile of enlistees became: no women under thirty, plain looking women dressed in brown or bJack, no hoop skirts, no bows, no curls and no jewelry.

Fortunately, individuals rejected by Dix continued their efforts without her blessing and distinguished themselves by making significant contri­butions. They courageously challenged the military with their efforts and, particularly, by their willingness to reveal the facts. Other women re­ceived the courage from them to challenge the system that wanted to shut women out. Clara Barton, truly a maverick, established her own following. She and twenty women ar­rived at Gettysburg on July 6 after attending the wounded at Antietam and Fredericksburg. Her group worked in the field hospitals and, apparently, their efforts were well received.

Despite the flaws in Dix’s judgment, her friends consid­ered her to be a keen judge of character. She trusted the screening skills of Blackwell and gladly accepted the women who had participated in the one month course at New York Hospital. At that time the course consisted of nine lectures on ventilation, cleanliness, food, care of help­less patients, observation of symptoms, surgical dressings, bandages, personal habits, precautions, and moral and religious influence.

Dix’s team grew to one hundred and eighty nurses in the Washington area. She was well aware of the resistance by officers and surgeons to the presence of women, and to the best of her ability she at­tempted to ameliorate any hostile situation by adhering to the wishes of the war department.

Although Dix subscribed to the rules and regulations es­tablished by the Secretary of War, he later undermined her authority by making appoint­ments to which she had not consented, and attractive women arrived on the battle­field. Historians do point to the weakening of Dix’s author­ity by these actions, but now capable young women had the opportunity to serve and later change the format of their world. Without the rebellious­ness of the Woolseys, a promi­nent New York family that had a strong impact on the origins of the nursing profession, the early nursing schools estab­lished after the Civil War might not have developed as early as they did. Further­more, by placing younger women on the battle scenes, the nation had the advantage of their energy, and they were more readily accepted by the surgeons.

The size of the Gettysburg battle site was but one of the problems that arose. Forty­-three thousand soldiers were killed or wounded in a town that had little food and medi­cal supplies. Few professionals in history have ever encoun­tered such a problem, much less a woman who had no technical nursing education or skills. The problem was compounded when twenty-five supply wagons were misdi­rected from Antietam, and the officer in charge of medical care had few available materi­als to begin relieving the situa­tion. One train traveled daily between Hanover and Balti­more, making transportation of the wounded and acquisi­tion of medical supplies pain­fully limited.

Dix immediately grasped the scope of the problem and kept Washington authorities informed of the victims’ needs. She remained on the battle scene, visited each field hospi­tal and undoubtedly helped coordinate the final move to Letterman Hospital, a tent facility located near Gettys­burg. At the end of July, when sufficient personnel and sup­plies were available, she passed that information on to the Washington offices.

By working with the federal authorities in the nation’s capital, rather than at the local level, Dix suffered unending criticism. Her unpopularity with the officers and field workers took its toll. In Octo­ber 1863, an order by the as­sistant general stated that only she could appoint members to the Army Nurse Corps, with the exception of the surgeon general, who also gained the right to discharge a member. This certainly weakened Dix’s authority, for her decisions could be overruled. Despite this blow to her authority, she persisted. At her own request she went unpaid, continuing to serve until eighteen months after the war ended.

Little is recorded concern­ing the forty nurses who ar­rived on the third day after the battle of Gettysburg, but it is assumed they assisted with surgery, transported patients, changed dressings and distributed the meager supply of medications.

From the time this nation was formed, women defined themselves in male terms, but the Civil War prompted the realization that the world was not perfect and the special skills of women were needed. They also became aware of human needs, exploitation, and their own ability to help make a better world. Women volunteers in military hospitals were at odds with the doctors, many of whom entered the Medical Corps for the learning experience. Women felt noble about the work they per­formed, for they saw it as a response to a higher calling. Women saw patients as per­sons, whereas physicians treated them as cases.

Once women became aware of the contrived effort to ex­clude them from participation in life, a rebellion arose. The value of their efforts as care­takers of the sick was undeni­able. Clara Barton, Dorothea Dix and countless others shat­tered forever the belief that in a crisis women lacked a role. The determination of some women to “outsoldier” the soldier by bearing inconven­ience, inadequate housing, poor transportation, distasteful food and long hours of work brought them to the recogni­tion that they belonged to a new social order.

The social system had moved too far away from its ideals to continue functioning, as first evidenced at Gettys­burg. It had taken until this time for the Sanitary Commis­sion, Christian Commission, Ambulance Corps and other agencies to bring their efforts to highest efficiency. Although the problem of massive num­bers of wounded was monu­mental, the work moved purposefully. The acceptance of women as Army Nurse Corps members, in the Sani­tary Commission and as indi­vidual volunteers yielded many rewards. The care ren­dered at Gettysburg, for exam­ple, was considered the best organized and most efficient of any project of the war. When women were finally accepted, working alongside the sur­geons at Gettysburg, nursing was forged.

Excerpt from Hospital Scenes

Providence decided the point for us, for the only rooms we could obtain were directly opposite Christ Church, the College Church, which had been occupied since the first day’s battle, by the 1st Corps, 2d Division, (Gen. Reynolds’s men,) designated by the white lozenge on a red flag.

After a good night’s rest, we felt prepared to enter upon our duties. Mr. Heinitsh kindly secured our rooms, procured us a stove, assisted in our moving, and then took us over and in­troduced us to the surgeon in charge. We did not think he gave us a warm reception; per­haps having a prejudice against lady nurses, and afterwards (when by his courtesy and kindness he atoned for whatever coolness he might have shown at first,) we used laughingly to tell him that he looked at us as though we were a set of adventurers. All of which he earnestly disclaimed.

The suit of rooms which we now occupied were very convenient, but the entrance was by no means imposing; a long, narrow alley led to them, as they were in the back building of the house, the front being used as a store. Our accommodations embraced three rooms, a store-room, a dining-room, and kitchen; as soon as we were settled, we had a board placed over the entrance, on which was written in large letters, in chalk: “Patriot Daughters of Lan­caster,” and our work commenced. We had, by tacit agreement, arranged that some of us should cook, and prepare delicacies for the sick, while the rest should undertake the nurs­ing. I was one of those upon whom the latter duty devolved. With what trepidation I crossed the street, for the first time, to enter the scene of so much sorrow and anguish, may be more easily imagined than described. Had I stopped one moment to think, my courage would have failed, I would have turned back; but I did not. I walked up to the Hospital steward, and told him that it was probable that we should be associated together in our duties for some weeks, and asked him what his patients most needed; his reply was, “Everything. These men are now lying, with the exception of having their wounds dressed, as they were brought in from the battle-field.” Some were on a little straw, while most of them had no­thing between them and the hard boards but their old thin, war-worn blankets; the more …

For Further Reading

Alleman, Tillie Pierce. At Get­tysburg. Bozland, New York: W Lake, 1889.

Castiglioni, Arturo. A History of Medicine. New York: Alfred A. Knopf, 1941.

Dietz, Lena Dixon and Aurelia R. Lehozky. History and Modern Nursing. Philadelphia: F. A. Davis, 1967.

Doian, Josephine A. Goodnow’s History of Nursing. Philadel­phia: W. B. Saunders Company, 1958.

Garrison, Fielding H. An Intro­duction to the History of Medi­cine. Philadelphia: W. B. Saunders Co., 1929.

Goodnow, Minnie. Nursing History in Brief. Philadelphia: W. B. Saunders Company, 1943.

Massey, Mary Elizabeth. Bonnet Brigades. New York: J. B. Lip­pincott Co., 1965.

Robinson, Victor, M. D. White Caps. Philadelphia: J. B. Lippin­cott, 1946.

Rowbotham, Sheila. Women, Resistance and Revolution. New York: Pantheon Books, Div. of Random House, 1972.

Wilson, Dorothy Clarke. Stranger and Traveler, the Story of Dorothea Dix, American Re­former. Boston: Little Brown and Company, 1976.

Ruth W. Davis, a nurse for more than three decades, is president of the Nursing Archives Foundation of York County. Site earned her nursing degree from Conemaugh Valley Memorial Hospital, Johns­town, and later worked as a surgi­cal nurse. Her articles have appeared in professional journals and magazines, such as Ameri­can Journal of Nursing, Associ­ation of Operating Room Nurses Journal, Clinical Nurse, Nursing Digest, TV Guide and Outdoors Magazine. Self­ employed as a photojournalist, her ultimate goal is to establish a nurse museum and library in York so that the original history of nursing will be preserved.