Heroines of Mercy Street

by Pamela D. Toler PhD

  Dysentery and related diseases were less deadly than typhoid. Today we use the word “dysentery” to describe two specific diseases caused by the bacteria Shigella or the amoebic parasite Entamoeba histolytica. Both forms of dysentery cause fever, abdominal pain, vomiting, headaches, delirium, and diarrhea with stools containing blood or mucus. Like typhoid, both types are transmitted by ingesting food or water contaminated by someone who carries the disease. During the Civil War, the word was used in a more generic sense to describe any condition that resulted in a loose or watery stool containing blood or mucus.

  John Snow’s groundbreaking work in tracing the source of a virulent outbreak of cholera in London in 1854 identified contaminated water as the source for cholera, and by the 1860s much of the European medical community had accepted his discovery and extended it to include dysentery and typhoid. A bacterial theory of disease was still some decades in the future.

  American medicine was slower to accept Snow’s work. The most progressive American doctors recognized the relationship between bad latrines, human waste, and diseases like dysentery. But because the mechanism of contagion remained unclear, they could do little more than attempt to keep regimental latrines and hospital wards “sanitary” within the contemporary understanding of the word. The prevailing theory of the period focused on clean air rather than clean water. Instead of disease being transmitted in some way from person to person, miasmatic medical theory held that diseases were spread through the poisoned atmosphere of “miasmas,” including “crowd poisoning,” caused by soldiers sleeping packed together in unventilated tents. While proponents of this theory also advocated sanitary camps and hospitals, their concern was eradicating the source of foul smells, especially those caused by rotting vegetables or meat. Other popular explanations for outbreaks of the “flux”—an old-fashioned term for all manner of gastrointestinal diseases—included eating unripe fruit or raw vegetables, wearing wet clothes, and sleeping on damp ground. No one understood that both typhoid and dysentery could be carried by an individual displaying no symptoms of the disease, making the use of convalescent soldiers as cooks and ward attendants an active danger to patients whose immune systems were already compromised. Think Typhoid Mary, the infamous asymptomatic carrier whose career as a domestic cook twenty years later resulted in multiple outbreaks of typhoid.

  The sanitary arrangements in Civil War hospitals also made it easy for both typhoid and dysentery to spread. Many latrines and indoor water closets had to be flushed with buckets of water, carried some distance by hand, which meant they were not flushed out as frequently as required to keep them sanitary. In some hospitals, latrines were located too close to kitchens. Even when there was an adequate distance between the two, flies carried bacteria on their feet as they flew between latrines, kitchens, and patients’ dinner trays.

  Disease was the greatest danger for nurses as well as for wounded solders. Few who had regular contact with soldiers escaped infection. Nurses, worn down from the physical and emotional strain of their work, were often hit harder than the men they took care of.

  Mary Phinney von Olnhausen lasted eleven months at Mansion House Hospital before succumbing to dysentery.

  A High-Risk Environment

  Civil War hospitals were battlefields in their own rights, where nurses fought to save lives and sometimes became casualties of war. In 1863, Hannah Ropes and Louisa May Alcott fell ill at Union House Hospital.

  Ropes found the atmosphere in Union House Hospital difficult in the days following her confrontations with the steward and Dr. Clark’s arrest and release: “The matter of food is bad enough,” she wrote in her diary on November 6, 1862. “But I believe the depressing sphere of the house tells quite as much upon the men as anything else. Generally I have been able to bring a smile from the invalids, but now they curl their heads under the sheet and think it is of no use to try any longer to get well.”3 Dr. Clark, now back at the hospital, refused to visit the wards. Ropes thought it was just as well: “I fear the men would hiss at him if he did.”4 Holed up in his office like a wounded fox, he lashed out in irrational ways against his staff, countermanding other surgeons’ orders for invalids’ food and refusing Ropes access to either the room where surgeries were performed or the storeroom.

  The tempest inside the hospital was matched by the weather outside when a severe snowstorm hit Washington. Icicles hung from the hospital’s window sashes, and snow stood a foot deep on the roof. There was no coal on hand, thanks to the steward’s depredations, and the men suffered needlessly in the unheated building. Ropes worried about the men in the camps, fearing that the next patients who came to the hospital would suffer from fever rather than wounds. Soon, though, the hospital would be overwhelmed with the wounded from the Battle of Fredericksburg, at which the Union forces suffered a bloody and spectacular military failure.

  On November 9, 1862, President Lincoln replaced McClellan as the commander of the Army of the Potomac with General Ambrose Burnside, a West Point graduate who proved to be as impulsive in the field as McClellan was cautious. In mid-November, Burnside began the Union’s next “drive to Richmond.” He planned a massive direct attack on the Confederate capital. The first step was a rapid advance that would allow the Union troops to move across the Rappahannock River, seize the heights to the west and southwest of Fredericksburg, and march on Richmond before Lee could shift his troops north and prevent the Union’s forces from crossing the river. Burnside’s troops arrived at the river according to schedule, but a mix-up about the pontoon bridges they needed for the river crossing left Burnside, then General-in-Chief Henry “Old Brains” Halleck, and Quartermaster General Montgomery Meigs pointing fingers at each other while Lee entrenched his troops along the heights behind Fredericksburg. Burnside’s troops outnumbered Lee’s 100,000 to 75,000, but Lee held the stronger position, an eight-mile-long front anchored on the east end by a twelve-hundred-foot stone wall at the foot of Marye’s Heights. If Burnside continued the attack as planned, his troops would have to cross the river, move through the town, and cross a wide plain under Lee’s guns. Burnside decided to do just that.

  On December 11, Union troops fired on the city while engineers put three pontoon bridges in place, and the battle began in earnest on December 13. Over the course of the day, Burnside flung his infantry in fourteen suicidal charges against the stone wall at Marye’s Heights; none of them reached the wall, and few got within fifty yards of it. When the two sides declared a truce on December 15, so that the wounded of both armies could be removed from the field, the Union army had suffered 12,700 casualties, with 6,000 of them dead.

  Dr. John Letterman, known as the “father of battlefield medicine” and then medical director of the Army of the Potomac, took advantage of the delayed arrival of the pontoon bridges to be sure his arrangements for treating and evacuating battlefield casualties were in order. With a storehouse of supplies at the nearby railroad depot at Aquia Creek, five hundred hospital tents, and almost a thousand ambulances, Letterman and his staff crossed the pontoon bridges with Burnside’s troops on December 12, to identify undamaged buildings that could be used as temporary field hospitals and stock them for use. For the first time since the war began, the Medical Bureau was prepared for battle. Problems began when it was time to move the men from field hospitals to facilities more suited for long-term care.

  In Washington, fifty-some miles away from the battlefield, the staff at Union House Hospital anticipated the arrival of the wounded. “All the week we have been getting ready for the expected battle,” Ropes wrote in her diary on December 13, the same day Burnside’s troops battered themselves against Lee’s defenses. Every morning they sent those patients who were in the best condition to hospitals farther north in order to make room for the expected flood of patients; every evening their beds were full again with sick men from the camps around Washington.5 The only bright point in the day was the arrival of “Miss Alcott from Concord,” who showed the potential to be a really good n
urse, something the hospital desperately needed as some of the current nurses seemed to consider keeping a patient from falling out of bed the full extent of their job.6

  The transfer of some six thousand wounded soldiers from Fredericksburg to the hospitals in and around Washington began on December 16. In order to give them time to stabilize, Letterman had kept the wounded on site as long as possible, housed in canvas tents outside Fredericksburg even though they were less than a day’s travel from Washington, and he intended to keep them longer. Burnside, however, insisted that it was necessary to transfer the men to permanent hospitals. The disorder of an unplanned evacuation replaced Letterman’s careful planning for battlefield care. Those in the best condition were moved first. Soldiers walked or were taken by ambulance to the Falmouth railroad station, where they were loaded onto railroad cars. Many of the cars were open platforms with nothing to protect the men from the weather, not well designed for transporting wounded men at any time, but especially bad in midwinter. There was only a single railroad track between Falmouth and Aquia Landing, which served as the embarkation point for the river steamboats that carried the wounded to Washington. No one coordinated the arrivals and departures of the trains and steamers, so wounded soldiers were left on the landing in the winter cold without shelter for hours at a time, dependent on an improvised Sanitary Commission relief depot for food, medicine, blankets, and care. Only two of the steamers were equipped for the purpose; others had been pressed into service with no provisions made for the soldiers’ comfort. Soldiers, already cold and worn, rested on the hard boards of the deck, without even food or drink.

  Seventeen hours after they finally left Fredericksburg, the wounded soldiers arrived in Washington, where ambulances transported them to hospitals throughout the city. It was Christmas before the evacuation was complete.

  The first seventy-one casualties from Fredericksburg reached Union Hotel Hospital on the evening of December 17. As soon as the nurses got them settled in, they received an order to send forty men, the least wounded, to a hospital farther north to make room for the next shipment of casualties. On December 21, Ropes told her daughter Alice that they were waiting for “a fresh supply of worse wounded from the Fredericksburg battles, or murder ground I might say.”7 Eight days later, the hospital was filled with seriously wounded men, including twenty who had suffered amputations, and the nurses had their “hearts and hands full.”8

  In addition to washing men, dressing wounds, and carrying trays, Ropes and Alcott worked together over the next ten days to take care of four dying men, who proved to be highly contagious. Alcott developed a cough almost immediately. Since many of the patients suffered from a similar cough, Ropes initially dismissed it as “purely sympathetic,”9 the nineteenth century’s equivalent of the medical student who diagnoses herself as suffering from each ailment she studies. By January 11, Alcott was sick enough that Ropes ordered her to stay in her room with a mustard plaster on her chest. The doctors visited her room daily to tap on her chest. After several days they began to raise their eyebrows ominously. Finally they told her to go home, but Alcott was determined to serve out her three-month commitment to the nursing corps. Her severe chills and the violent cough of typhoid-related pneumonia developed into delirium: “Hours began to get confused; people looked odd; queer faces haunted the room, and the nights were one long fight with weariness and pain.”10 In the third week of January, Alcott’s father arrived in Washington, where he found her near death. “At the sight of him, my resolution melted away,” Alcott admitted. “My heart turned traitor to my boys, and when he said ‘Come home,’ I answered ‘Yes father.’ And so ended my career as an army nurse.”11

  Ropes became sick with typhoid pneumonia at the same time as Alcott. She developed the characteristic rose-colored rash on her chest and suffered from sharp pains in her ribs, severe coughing, and uncontrollable diarrhea. On December 29, the new head surgeon placed Ropes “under arrest” in her room. He visited her twice a day. The entire hospital staff worked together to care for her. The surgeons swore the place would fall apart without her.12 It wasn’t enough. With two nurses seriously ill and the hospital full of the wounded from Fredericksburg, Ropes’s Washington friends sent for Alice to help care for her. Ropes died the evening of January 20, the same day Bronson Alcott was preparing to take his daughter home.

  Ropes worked at the Union Hotel Hospital as a nurse for six months; Alcott for less than forty days. Nursing was hazardous work.

  On the Front Lines at Mansion House Hospital

  In the six months from December 1862 through May 1863, the nurses at Mansion House were stretched trying to keep up with the flow of wounded in and out of the hospital.

  Mansion House Hospital received an overwhelming number of wounded men after the Battle of Fredericksburg. Like their counterparts at Union Hotel Hospital, the nurses at Mansion House received orders to clear space in anticipation of the arriving wounded from the great battle. Anne Reading noted that they needed to do the best they could for the seventy-five patients who had just arrived from the convalescent camp because they would soon have to send them, as well as their own convalescent patients, to one of the hospitals farther north to make room for as many new patients as possible. When the time arrived, she made sure that her ward was ready. Beds made up. Sponges, soap, clean linen and towels ready. It was a good thing they were prepared: on December 21, seven hundred wounded men, rebel and Union alike, were brought into Alexandria, filling every bed in every ward at hospitals throughout the city.13

  Reading looked back on her performance with satisfaction at a job well done. By contrast, von Olnhausen, worn out with excitement and fatigue, described the arrival of the wounded after the Battle of Fredericksburg with righteous indignation about the handling of the evacuation:

  To-day has been such an awful day… The whole street was full of ambulances, and the sick lay outside on the sidewalks from nine in the morning till five in the evening. Of course, places were found for some; but already the house was full; so the most had to be packed back again and taken off to Fairfax Seminary, two miles out. I have been so indignant all day,—not a thing done for them, not a wound dressed. To be sure, they got dinner; but no supper. They reached town last evening, lay in the cars all day without blankets or food, were chucked into ambulances, lay about here all day, and tonight were put back into ambulances and carted off again. I think every man who comes a-soldiering is a fool!14

  In the weeks and months that followed Fredericksburg, the hospital received wave after wave of wounded, beginning with the Confederate raid on the Union supply depot at Dumfries on December 28 and ending with the great battle between Generals Hooker and Lee at Chancellorsville, which dragged on from April 30 to May 6 and left more than 30,000 dead on the field. For von Olnhausen and the other nurses, the days ran together in a patchwork of boredom, frantic activity, and exhaustion. Sometimes they were barely aware of what day it was or the place from which the men were evacuated.

  Over and over nurses sent convalescent patients to hospitals farther north in anticipation of more wounded coming in: “We have been sending off this week everyone who could be moved,” von Olnhausen wrote.

  And you may believe it’s been a pretty blue time with me, I have had so many of them so long under my care.15

  On Friday last, we sent over fifty men from this hospital to Providence Rhode Island. As we are in daily expectation of another battle, we are clearing out as many as are convalescent in order that we may be ready for reception of the wounded.16

  Tuesday night came another dispatch from headquarters that every man who could be moved must leave next morning for Philadelphia; so before I had got interested or could distinguish one man from another I lost them all… wasn’t it too bad when had got them all cleaned up and straightened out to have them go again? They left me only six of the new cases. I have eleven in all. It was harder to have them go than come, I think; they did not want to leave, either.17

  Repeat
edly, the nurses received the news that patients were on the way, hurried to prepare the wards to receive them, and resigned themselves to the strain of waiting:

  We have just heard that by the last of the week every bed in the house will be full; the sick and the wounded are all to be sent from the front.18

  We have been expecting some wounded all day from Fairfax Station… but they have not come yet; probably, as usual, they will come in the night.19

  I hope before I write you again we have have our house filled up once more; I am so tired of this idleness. Those wounded expected yesterday did not come, and we almost despair.20

  On Monday morning news came that a boatload of wounded men were on the way for us. They arrived about five o’clock,—such a sick, neglected set as one could ever see.21

  As each fresh lot of wounded arrived, Reading found it heart-sickening to see them. They were so dreadfully mutilated and suffered so badly. The head wounds were particularly bad. The ball went in the back of one young man’s head and came out the front, carrying hair and brains with it; he lived just long enough to make it to the hospital and then died. In another case, the ball missed the man’s brain, but tore out his left eye as it exited. She found such wounds more shocking than anything she had seen before.22