Modern nursing began in northern Europe in the early 19th century with the Protestant Deaconess Movement. The deaconesses, housed in motherhouses, cared for the sick and infirm. The first secular effort to train nurses began in 1836, when the Reverend Theodore and Friederike Fliedner established a school in Kaiserwerth, Germany, offering three-year courses in nursing. Graduates could dispense medicines and nurse ill and convalescing patients, and by 1864 the school had trained 1600 nurses and had motherhouses as far away as Milwaukee, Wisconsin.

In 1851, Florence Nightingale visited the Kaiserwerth school. Nightingale, who came from a well-to-do British family, decided to devote her life to the care of the sick. In 1854 she volunteered to serve during the Crimean War, and was appalled by the lack of trained nurses and orderlies. Upon her arrival, Nightingale transformed the poorly ventilated, vermin-infested Barrack Hospital in Scutari into a clean, well-managed facility, and within six months the death rate fell from 40 to 2 percent. After the war Nightingale returned to London and founded her own nursing school. In 1859, Nightingale published Notes on Nursing,which became required reading for all nursing students.

The cover of the 1860 edition of Notes on Nursing.

Despite these European advances, American nursing was still in its infancy at the outbreak of the Civil War. There had been no effort at organized nurse training. As in Europe, it required a war to bring about reform.

When the war began, the only nurses were in the religious orders, namely the Catholic Sisters of Mercy and the Sisters of Charity. These nurses soon were overwhelmed by the large number of casualties the war produced, forcing the U.S. Government to establish the Army Nursing Service in 1861. The Service, headed by Dorothea Dix, faced many obstacles, including the prejudice of male surgeons. Dix herself refused to accept any woman who was not "plain of appearance" and at least thirty years old.

Women nurses usually worked in base hospitals well away from the front lines. However some, like Clara Barton, served in battlefield hospitals, earning Barton the nickname "Angel of the Battlefield." Other notable nurses during the Civil War included author Louisa May Alcott, whose book Hospital Sketches describes the touching and dramatic life as a Civil War nurse. Runaway slave Harriet Tubman also served as a nurse during the war, and for her work on the Sea Islands of South Carolina, Tubman received a government pension in 1892.

Title page of Alcott’s Hospital Sketches.

The work of these and thousands of other women advanced the professional status of nursing in the United States. In 1861 a professional nursing school was organized in New York City, and others followed during and after the war in many locations throughout the country. The Civil War proved to be a watershed in the quest toward professional nursing in the United States.

Alcott, Louisa May. Hospital Sketches. Boston: James Redpath, 1863.

Edmonds, S. Emma. Nurse and Spy in the Union Army: Comprising the Adventures and Experiences of a Woman in Hospitals, Camps, and Battle-Fields. Hartford: W. S. Williams & Co., 1865.

Livermore, Mary A. My Story of the War: A Woman's Narrative of Four Years Personal Experience as a Nurse in the Union Army. Hartford: A. D. Worthington and Company, 1890.

“The Last Letter Home,” an illustration from Livermore’s book.

Nightingale, Florence. Notes on Nursing: What It Is, and What It Is Not. New York: D. Appleton and Company, 1860.

Barbara Floyd, University Archivist, University of Toledo

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Last Updated: 6/27/22