Before the Civil War, nursing was not considered a reputable career. Women were already considered the natural choice for nurses because they were caretakers (Weatherford par 1) for their children and families. Nursing could be considered one of the oldest professions because some people were paid for their services well before it was organized. Women would accept positions as wet nurses and live in their employers homes (Weatherford par 1).
Many hospitals were built after the Civil War, and it aided in helping nursing become a credentialed profession (Weatherford par 3). At the beginning of the war, the volunteers included mistresses and wives who followed their soldiers. These volunteers were considered camp followers (Weatherford par 3), and most had no formal or informal nursing training. These women were not considered respectable (Weatherford par 3). This was an era of distinct class separations, and a higher-class woman would not have been allowed in military camps. Fortunately, many women rebelled against the proper standards of the time, and many of them had extremely important roles in changing the way nursing was viewed. More than 20,000 northern and southern women engaged in relief work during the Civil War. A great amount of this was the delivery of nursing care (Nursing, History, and Health Care par 11). They also assisted in implementing new procedures and standards that would help prevent death and disease from overrunning the camps.
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Clara Barton was one of these women. She was affiliated with the US Sanitary Commission. The US Sanitary Commission was the organization that promoted the Red Cross into existence. Clara assisted in the development of systems for the missing and dead (Weatherford par 4). Emma Edmonds wrote about an experience she had with a missing patient in her book Nurse and Spy in the Union Army. Edmonds writes, We had just commenced to pack our saddle-bags, when we heard an unusual noise, as of some one crying piteously, and going out to learn the cause of the excitement, whom should we find but the mother of our handsome blue-eyed patient. She had called at the surgeons tent to inquire for her son, and he had told her that all the sick had been sent to Washington, he having forgotten for the moment, the exception with regard to her son. The first words I heard were spoken in the most touching manner Oh, why did you send away my boy? I wrote you I was coming; Oh, why did you send him away! (31).
Because there was not any type of system set in place before the war many wounded, dead and missing were not accounted for. When camps moved, and soldiers were relocated their whereabouts were not accurately documented. It was not uncommon for families to come in search of deceased and not be able to find them. Barton acknowledged that she did not do actual nursing; however, she was instrumental in developing the systems to make processes much easier. These systems improved accountability and helped many soldiers bodies find their way home.
Mary Ann Bickerdyke was a better-known nurse of the time. Bickerdyke was a middle-aged widow who started in the nursing profession by accident. The union built make shift hospitals at the junction of the Mississippi and Ohio rivers, and her career began when she was delivering money and donations there. She would later be the only woman that General Sherman would allow with his army and was the only nurse for about 2,000 men at the battle of Lookout Mountain (Weatherford par 5).
Captain Sally Tompkins was another well know of these women. She was commissioned as an officer so that she could commandeer supplies. She also converted her home into the famous Robertson Hospital. She developed a reputation for having the least amount of deaths out of any northern or southern facility. Wall stated, Robertson Hospital in Richmond was famous for its low mortality rates (par 2). Mortality rates from actual battle was less than that of disease. Diseases such as dysentery, malaria, typhoid fever, smallpox, and tuberculosis were known as camp fevers (Miller 195). These diseases caused about 57,000 deaths for the Union army (Miller 195). These women were crucial in developing ways to treat as well as prevent some of these diseases. The involvement of these and other women during the Civil War helped improve the view of the nursing profession.
After the Civil War, nursing schools were started, and nursing progressed from being an in-home occupation into facilities. Typically, nursing schools were linked with hospitals. All the nurses would be women and they would reside and work at the hospital where they were attending school (Weatherford par 8). Samuel Gross who was president of the American Medical Association gave a report promoting the training of nurses.
Gross called for women with some education, a gentle disposition, good powers of observation, and great powers of endurance. Gross saw nursing as a carefully honed medical intervention. While he did not think the nurse was more valuable than the physician, he did claim that she was often incomparably more valuable than his most skillful medication. Gross also believed that carefully trained nurses were a critical part of medicines own reform agenda. The nurse, Gross reminded his American Medical Association audience. can do much to correct the errors of ignorant, careless, or unscrupulous physician. (Nursing, History, and Health Care par 14)
Initially the nursing students were not paid. The facilities where they were receiving their training viewed the students as free labor. They would be made to do tasks such as scrub floors and do laundry. Curricula improved, however, in part because of the development of a tradition with caps: each nursing school had a distinctive cat that women wore after graduation (Weatherford par 9). The visibility of these caps caused schools to raise their standards. Nursing still was not an organized profession. Nursing as a trade operated fairly independently of medicine, and most nurses, although unskilled, were self-employed (Miller 197). There remained no regulations and standardizations for medical education and practices. There were medical boards organized during the war that assisted with instilling organization for practices and schools.
From the beginning all nursing was done in the home (Weatherford par 2). The Civil War was a vital influence on institutionalized healthcare (Miller 194). Miller states, The Civil War brought to the attention of the American public not only the dangers of disorganized hospital and sanitary systems, but also models for their reform (194).
Wall states, At the beginning of the war both Union and Confederate medical departments entered the conflict unprepared. Initially, care was provided in existing buildings such as schools, churches, almshouses, hotels, and homes: but as the war progresses, the armies constructed new hospitals. (par 1)
The first hospital began in Philadelphia in 1751 and was viewed as an asylum or poorhouse (Weatherford par 2). The facility that would become Philadelphia General Hospital was established as an almshouse. Almshouse were designed to provide shelter and care for people who were unable to care for themselves, however, these people were often considered inmates. Local governments would establish these places to ensure sick people stayed away from healthy people. Because of the war, hospitals grew, and people began to accept them as more than poorhouses (Miller 194).
Many factors promoted the development of official nursing schools including the need for recognition and official training. The need for better sanitation in camps prompted nurses to learn new medical techniques and better preventative care methods. Miller says, Although sanitarian and reform movements had initially started the movement toward nurse training, the growth of the modern hospital and the advent of scientific medicine would prove to be a stronger source of influence (197).
Official nursing schools that viewed the students as more than just labor and provided a nursing education with credentials soon began. Dr. Marie Zakrewska founded a medical school in Boston that was affiliated with her New England Hospital for Women and Children in 1862 (Weatherford par 10). She started the nations first associated nursing school in 1872. The schools first graduate was Linda Richards. She is known as Americas first professionally trained nurse (Weatherford par 10). Richards became superintendent of nursing at New Yorks Bellevue Hospital and began Japans first nursing school. The first three nursing schools to say they were based on the principal of Florence Nightingale were the New York Training School at Bellevue Hospital in New York City, the Connecticut Training School at the State Hospital in New Haven, and the Boston Training School at Massachusetts General hospital in Boston.
Nightingales principles included an endowment ensuring the independence of the training school, a superintendent of nurses reporting only to the head if the hospital, a strong emphasis on sanitary knowledge clearly defined lecture and ward time for students and an insistence on the importance of technical skill and a disciplined character in nurses. Few training schools even Nightingales own school at St. Thomas in London met all these criteria, and most reported to medical doctors. Nevertheless, the idea of shaping a school around Nightingales principles became an animating sprint for the experimental ideal of formal nurses training in hospitals and accounted in large measure for its success (Nursing, History, and Health Care par 2).
Most of these establishments did not admit African Americans, and even though they nursed during the Civil War, they could not get credentials. The New England Hospital and Training School for Women and Children allowed one African American and one Jewish student to attend per year. Mary Eliza Mahoney was the first black nurse to get credentials. She graduated from Dr. Zakrewskas Boston school in 1879. She led the National Association of Colored Graduate Nurses that began in 1908 (Weatherford par 12). In 1986 Spelman Seminary in Atlanta, Georgia began a nursing program for African American Women. The Schools were set up in traditionally black hospitals and educational institutions (Nursing, History, and Health Care par 6).
Weatherford concludes that During the four decades of between the Civil War and the beginning of the twentieth century, the image of nurses moved from being viewed as somewhat less than honorable to a respected profession (par 13).
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