THE BIRTH OF OUR PROFESSION IN AMERICA Caroline Rogers, RN

It is deplorable but true that too often, nurses have paid little attention to their heritage. As a professional organization, nursing has compiled only a limited amount of historical background for the world and future genera- tions. Written accounts of nursing date back to the Bible and yet, through the years, nursing has been recorded sparsely in past history.

While nursing itself is as old as man himself, it is also true that as a profession, nursing is comparatively new. Accounts of nursing endeavors have been grouped with and made a part of the evolution of modern medicine. The basis for this assumption has been that without the development of medi- cine, nursing could, not have developed. However, it could also be said that without the development of nursing, modern medicine probably would not be where it is today.

The radical emergence of nursing as a profession in America took place during the Civil War years. At that time in almost every large city, there were almshouses and infirma- ries for the poor and sick. A few voluntary

Immediate past vice-president, AORN, Mrs. Caroline Rogers, RN, is a graduate of Mary Immaculate Hos- pital School of Nursing, Jamaica, NY. A born New Yorker, and resident there until December 1969, Mrs. Rogers has experience as head nurse of specialty operating rooms, assistant supervisor of the OR, and in inservice OR education at Mercy Hospital, Rock- ville Centre. She served as scrub nurse in a urologist’s office in Garden City, and is now employed in Engle- wood, Colo by the AORN National Headquarters as membership coordinator, and as a staff OR nurse at Swedish Medical Center.

hospitals were in existence, but in almost all of these the quality of care was poor. No special training was needed and indeed most nursing in these institutions was done by inmates themselves.

At this time hospitals for the most part were dirty and overcrowded. Most of the women who nursed in these places were rarely more qualified than their patients. Drunken- ness and slovenly appearance along with pri- son records were inevitably found to be char- acteristic of women doing hospital work.

The only semblence of nursing care helpful for the sick was to be found in several religious orders devoted to this work. In 1809, Mother Seton founded the St. Joseph‘s Sisterhood at Emmitsburgh, Md. This order later joined the Sisters of Charity and in 1850 adopted their rule. Soon after reaching the United States in 1843, the Sisters of Mercy administered patient care in several hospitals. In 1845 an Episcopal sisterhood was founded in this country. Just 13 years later, St. Luke’s Hospital in New York was established and staffed by these sisters. In 1849 a Lutheran minister introduced the Kaiserwerth deacon- ess order, and in a short time several hospitals were the recipients of their charitable work.

Religious reforms had played a predomi- nant role up to this time but soon, fevered interest in women’s rights came on the scene. Historically, the campaign for women’s rights is dated from the Seneca Falls, NY convention in 1848. The American Women’s Rights Movement included in their platform a

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statement about women’s rights to enter into various professions-they very definitely had in mind the entrance of women into the medical field.

Elizabeth Blackwell’s acceptance into Gene- va College Medical School first broke the barrier to the medical profession for women. Dr. Blackwell’s ceaseless fight for women in medicine met with opposition and many heartbreaks and set-backs. Finally, in 1857, she was able to offer a nurses’ training course at the New York Hospital. At the beginning, the course was free and lasted four months. Suitability of the ,applicants was a problem because nursing was such an undesirable type of work that it attracted mostly women of unsavory character. However, Dr. Blackwell’s work was soon taken up in Philadelphia and Boston by groups of interested women, and it was through Dr. Blackwell that the name of Florence Nightingale was brought to the American scene.

Florence and Elizabeth had been friends before the Crimean War. In the United States at this time there was a beginning merger of nursing reform movements and women’s rights movements. In Europe however, Miss Nightingale attempted to keep separate the two reforms. This perhaps explains why the history of nursing in Europe rightfulIy claims first place for Miss Nightingale.

The day the Civil War broke out, and President Lincoln called for the first volun- teers, Soldiers Aid Societies also came into being. These societies sprang up all over the country. Their purpose was to sew for the soldiers, assemble necessary food and clothing supplies and provide means of communication between soldiers and relatives.

Women’s rights movements had acquired considerable strength by this time and Northern women were more insistent in their demands on key officials. The women of the South, however, had a much harder time achieving their goals because of a lack of central authority. Instead of a thorough national unifying body as in the North,

Southern women did their good works through many local societies. The united societies in the North brought pressure to hear on Washington, DC, and as a result the US Sanitation Commission was formed June 9, 1861. One of the objectives of the commission was to coordinate a nursing program to function in the Army.

Miss Dorothea Dix was commissioned June 10, 1861 as “Superintendent of the United States Army Nurses.’’ The prevalent condi- tions which faced Miss Dix at the time of her appointment were deplorable. In the first few months of the war, dozens of letters from soldiers to their relatives and friends back home told of the horrors of war. Men in camps and field hospitals were dying daily of pneumonia, dysentery or other camp diseases caused by cold, exposure and lack of proper food. One of Miss Dix’s biggest problems after being put in charge of Army nurses was the overwhelming number of women who were already on the scene and the hundreds more who wanted to serve. No one really knew what a nurse’s duty should include-the work varied from army post to army post. Romantic dreams of being another Florence Nightingale had catapulted many women to army hospitals, or to the front lines. Careful consideration of the needed qualifications of a good army nurse prompted Miss Dix to issue this bulletin: “NO woman under thirty need apply to serve in the government hospitals. All nurses are required to be plain-looking women. Their dresses must be brown or black with no bows, no curls, no jewelry and no hoop skirts.”

The Civil War is historically recorded as a war of gross incompetence and disorganiza- tion, both politically and militarily. The medical preparation for the war was just as miserably incompetent. Because of disorgani- zation, women of doubtful age and reputation were employed as nurses. There were also many women who managed to infiltrate the ranks even though they were not commis- sioned by the Army. Thomas T. Ellis, MD, a

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post surgeon in New York, wrote in his diary about the depredations some women inflicted on the wounded soldiers, and of their embezzlement of needed supplies. The forma- tion of an efficient training program for the nurses and a workable course of procedure was virtually impossible. The establishment of a good program was further hampered because Miss Dix was never given the power to enforce discipline; and a $13 a month pay was certainly not an alluring factor for attracting good nurses. To further complicate the situation, she was unable to develop a good rapport with the army surgeons.

Finally in October, 1863, nurses were placed exclusively under the direction of medical officers. Strange that while many women earned the name of Sister, Lady or Angel in the minds of those treated and those back home, they were generally regarded by many of the army surgeons as fussy, meddlesome busybodies. Surgeons’ opposition to female notoriety seekers was weakened in time, as more and more women of good intention gave long hard hours of devoted service. Many of these women were left with their own health permanently impaired. Countless numbers of women who gave of themselves have been forgotten. But among those to be remembered are Clara Barton, Mary Ann Bickerdyke and Kate Cumming.

Kate Cumming immortalized herself by tending troops below the Mason-Dixon line, and her actions demanded more courage of her than was needed by her counterparts in the North. The strongest opposition to nursing came from the soldiers themselves. They felt it would be accepting defeat in the very cause for which they were fighting to allow their women to enter military hospitals. Southern gentlemen could not bear the thought of having their women perform the tasks of caring for the wounded. They felt it was quite permissible to have the ladies select the wounded and care for them in their homes, but service should not extend beyond there.

Women did slowly succeed, however, in getting themselves to the front lines and into the camps to do what they could for the soldiers. The determined courage of this southern belle, Kate, did more than anything else to put down forever the arguments to keep women of good character out of hospitals. Kate Cumming proved that a woman could nurse in a hospital still remaining refined and modest.

After twenty years of teaching, Clara Barton went to Washington, DC, where she obtained a position in the Patent Office. I t was while she was working in Washington that the Civil War started, with firing on Fort Sumter. She immediately took herself to the hospital to volunteer her services, and found that at this ti,me there were more than enough women anxious to do hospital work. Through talking to the soldiers, she realized that the battlefield was the place of greatest need. Far too many men were dying because they lacked proper care before they could reach a hospital. She decided not to gamble that supplies would get to the front lines in time, but to deliver them there herself. She made many a bumpy wagon trip over muddy, rutted roads, all the while being dangerously close to getting shot or being captured.

After the second battle of Bull Run, Aug 31, 1862, she travelled less and settled down to nursing on the battlefield. There were three thousand suffering ,men within acres of where she set up a hasty first-aid station. The men were lying close together on the ground on a thin bed of rotting hay. Surgeons and nurses would scurry around with lanterns and candles. A misstep could and often did start a fire in the dried hay, and space between the men was so limited that often a man had to be jostled out of the way for enough room to attend to another.

The men at the hospitals were dying from infections which could have been avoided had they had better attention at the front. The surgical techniques of the day unfortunately

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imperiled life and many times caused death. Not wishing to soil his good clothes the surgeon would don an old waistcoat, at the beginning of the operating day, and later he would hang it on a peg in the hall to be worn again the next day, with layers of accumulated crust, blood, debris and rotting tissue. Rats, lice and bugs thrived on such surroundings.

Before the firing on Fort Sumter there was not a general army hospital in the country. Each post had its own hospital, and the largest of these was a forty-bed hospital at Leaven- worth. The army medical department had no unified staff, no diet charts, no provisions for bedding or clothing. No one really believed this war would last, so improvised hospitals came into existence-farmhouses, barns, schools, churches, deserted warehouses, damp cellars or any empty structure was used to shelter the wounded. There were hastily set up amputating rooms and all too many times nurses had to assist in the common practice of amputation, often when anesthesia was un- available.

The Civil War marked an end to an era in nursing. It seems amazing though that these great women who gave so much of themselves in the stress of war, wanted no part of nursing as a disciplined profession after the war ended.

Dorothea Dix returned from the war to plunge herself into the work nearest her heart, the task of improving the care and treatment of the insane. I t consumed the balance of her life. Clara Barton became wholly engrossed in the guidance and development of the Ameri- can Red Cross. The names of Mary Ann Bickerdyke and Kate Cumming were pressed in the minds of those they had treated, but

after the war their names seemed to disappear from history’s pages.

Progress, however, was making new and urgent demands. The approximately 6,000 women who nursed during the Civil War had completely changed the image of a nurse. The way was now made clear for other women to develop this newly formed image.

The final recognition of nursing as a profession came about in 1868 through a statement by S. D. Cross, MD, president of the American Medical Association. His statement urged all major cities to establish institutions for the education of those whose duty it is to care for the sick. Nurses’ training schools sprang up all over the country to insure that disciplined nursing skills would be taught in the future. In May, 1873 Bellevue Hospital opened its nursing school. In October of the same year a training school opened in New Haven, Conn. One month later the Boston Training School of Massachusetts General Hospital was officially started.

The blood-soaked battlefields of the tragic years from 1861 to 1865 gave birth to our well established and constant advancing pro- fession.

Our courage and determination must match that of the great women who were our professional and spiritual ancestors. AS they worked and perservered in the beginnings of nursing, we must continue the small beginning made in research and historical documenta- tion, and it is our job to keep the records clear. We are, after all, the ones who are at the scene of action-we are what and where it is happening in nursing.

Who better than ourselves will be able to tell the story of the second hundred years?

REFERENCES

1. Brooks, Gladys: Three Wise Virgins, New York: 3. Dodge, Bertha S.: The Story of Nursing, Boston:

4. Lowe, Corinne: The Gentle Warrior, New York:

5. Williams, Blanche Colton: Claru Barton, New

E.P. Dutton & Co., 1957. Little, Brown and Company, 1954.

H ~ ~ ~ ~ ~ ~ ~ , B~~~~ and comDany, 1948.

York: J.B. Lippincott Company, 1941.

2. Rullough, Bonnie, BS, MS, RN, and B u l l o ~ h , L.9 RA, MA, PhD: The Emergence of Modern

Nursing, New York: The Macmillan Co., 1964.

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