Union Secretary of State Stewart Cameron accepted Dorothea Dix‘s offer to organize an army of nurses without taking the time to define what her position would entail or how she would fit into a military medical bureaucracy, which was itself in a state of transformation. As a result, Dix was in constant conflict with the Medical Bureau and chief surgeons.*
The Confederate Congress did a better job of outlining the role of women in military hospitals. In response to the statistical evidence that patients fared better in hospitals run by women, the act which created general hospitals for the Confederate Army included clearly defined positions for women. Each hospital would have two matrons and two assistant matrons who would be in charge of the “domestic economy” of the hospital. Responsible for the housekeeping, cooking, and nursing staffs, these women were hospital administrators rather than what we think of as nurses today. (Kate Cumming, perhaps the best known of the Southern nurses, admitted that she was a nurse for more than two years before she ever changed a bandage or dressed a wound.) In addition, each ward would have two ward matrons, who were responsible for preparing beds for incoming soldiers, administering medicine, and supervising the nursing and cleaning staffs.
The duties outlined in the 1862 legislation included little of what many Union volunteers considered “real nursing.” In fact, the act did not deal with hospital personnel below the level of ward matron, ignoring the people who actually took care of the patients. At the beginning of the war, convalescent soldiers provided most of the actual nursing,** a practice that Cumming railed against on the grounds that nursing was a skill that had to be learned,*** and that since the soldiers were rotated through the job the same way they rotated through guard duty it was a skill they had no time to learn.
As the war continued, the South suffered a manpower crisis that made the continued use of convalescent soldiers as nurses increasingly difficult. The Confederacy desperately needed to fill noncombatant jobs with individuals ineligible for military service, of which women were the largest and most underutilized group. As early as June 1861, individual hospitals ran newspaper ads looking for nurses, but women did not volunteer for hospital work in the numbers needed in the face of mounting casualties.
Hospitals soon turned to a group of noncombatants who did not have the choice of saying no: slaves. Brigadier General John Bankhead Magruder argued for the employment of female slaves as nurses on functional grounds, claiming that they combined the qualities needed for the perfect nurse: female tenderness, no aversion to menial labor, and the habit of subservience. (And may I say, !!!!!) The largest number of women who performed front-line nursing and other hospital work in Confederate general hospitals were slaves, either impressed into service or hired out by their owners. So much for volunteer nurses.
*This situation was made worse by Dix’s prickly personality and lack of administrative skills. Her detractors nicknamed her “Dragon Dix” for a reason.
**Before the Civil War, convalescent enlisted men who were not yet able to return to their military duties performed any nursing required by ill or wounded soldiers, a system that would continue side by side with female nurses in both American armies throughout the war.
***A radical idea at the time.