My Scope of Practice: A Retrospective: The Civil War Nurse

Bearing the bandages, water and sponge, 
Straight and swift to my wounded I go, 
Where they lie on the ground after the battle brought in,  
Where their priceless blood reddens the grass, the ground, 
Or to the rows of the hospital tent, or under the roof’d hospital, 
To the long rows of cots up and down each side I return, 
To each and all one after another I draw near, not one do I miss, 
An attendant follows holding a tray, he carries a refuse pail, 
Soon to be fill’d with clotted rags and blood, emptied, and fill’d again. 

—  Walt Whitman, The Wound Dresser (1896)

Before the American Civil War (fought 1861–1865), nurses were 5 times more likely to be male and they were expected to provide not only health care and medical care, but also do cooking, laundry, and perform other maid/matron-like services. The war changed attitudes and responsibilities. With millions of soldiers fighting on the 2 sides, more than 620,000 soldiers killed, and more than 450,000 wounded, health care volunteers were in high demand. Volunteer nurses ranged from upper-class Caucasian females to “contraband” (escaped slaves); some nurses even were soldiers unfit for duty. Male nurses were believed to be more capable of handling the mass casualties and carnage of the war, but by 1862 female volunteer nurses (and some paid females) were integrated into every hospital. Although these women entered the war with little-to-no experience, their passion and dedication to helping their boys and causes put to rest most if not all of society’s reservations. 

One of the main reasons women were introduced as nurses was their perceived penchant for cleanliness, which was also their first responsibility as a wartime nurse. Cleaning wasn’t something the male nurses liked to do, so hospitals were a mess. Using Florence Nightingale’s nursing plan from the Crimean War as a guide, the women cleaned up the hospitals, instituted good air flow, managed dietary needs for the soldiers, changed soldiers’ bloody and muddy clothing, and wrote and read letters on the soldiers’ behalf. These actions not only improved the mortality rate, but they also boosted morale and consoled the soldiers. Some female nurses believed they were the only ones who knew how to perform certain daily tasks in the hospitals, which ignited conflict between the nurses and the physicians. Yet despite the increasing number of women serving as nurses, most were restricted to the hospitals and, usually, were not permitted to tend to the wounded on the battlefields.

While white female civilians were praised for their patriotism and eagerness to help the sick and injured, the contributions of African Americans who served as nurses were overlooked. More common within Confederate forces, African Americans served as nurses in convalescent homes and government hospitals; 5 served on the first U.S. Navy hospital ship, the USS Red Rover. These volunteers and contraband individuals performed the same work as their white counterparts. However, earning the title “volunteer nurse” was differentiated based on social class; African Americans, in most cases, were referred to as “laundry help.” 

Some of the resources available to Union and Confederate medical professionals were the foundation for some products used today. Agents used in the treatment of wounds during the war included honey, chloroform or ether, ointments or grease, morphine powder, suture materials (horse hair and silk), and the hypodermic needle. Used for centuries, honey was applied to the wound along with a dressing. The lack of chloroform use during the war is a long-held misconception; some form of anesthesia was utilized in 95% of operations. Morphine powder applied directly to the wound by the physician or nurse proved to be the quickest and most efficient method for relieving a soldier’s pain.

Medical personnel also used moist dressings on wounds during the war, partly out of necessity. When performing amputations, physicians were unable to utilize primary closure because of infection risks, so they inserted drains that allowed fluids and pus to leave the wound through a tube. Physicians covered these partially open wounds with moist dressings, which included the use of lint or cotton. Lint also was used as a sponge and in compressive dressings; it was folded and pressed into or onto the wound and covered with a bandage to help control bleeding. Maggots also were utilized; Dr. John Forney Zacharias is arguably the first physician to intentionally expose his patients’ wounds to larvae. 

Great medical advances were made during and after the Civil War. In particular, nurses and clinicians advocated for professional nursing training. In 1873, Bellevue Hospital School of Nursing in New York City became the first nursing program in the US in response to the need for protocols, programs, and parameters to provide and improve health care. The determination and dedication of medical professionals and volunteers, especially the Civil War nurses, ensured these attributes were woven into their scope of practice.