Women and Healthcare: Nursing in 19th Century Post Civil War America

Kirtimay Pendse is a first year student at Grinnell College, where he’s studying Economics and Global Development Studies. He’s interested in studying the relationship between medicine and economics.

Various historians agree that nursing as a profession has provided new perspectives on the larger issues present in women’s history and in American medical history. However, not many view nursing as the product of women healthcare workers’ and volunteers’ desire and efforts to define their societal role and control their field of work. Since the post-Civil War 19th century, the development of nursing has greatly challenged and overcome the cultural expectation that a woman’s place is within the home. Moreover, the professionalization of nursing played a great role in transforming the main objective of healthcare to be more humanitarian, and help us understand what the ‘care’ in ‘healthcare’ really stands for. During this time, there was thought to be a causal relationship between disease and its eradication; however, the rise of nursing as a profession was accompanied with the rise of an idealistic humanitarian vision of healthcare, which focused more on taking care of a patient throughout the phase of disease. I argue that the medical professionalization of nursing provided women with the chance to seize control of their work, be viewed as legitimate working members with active roles in society, and ultimately, transform their social identity by having a purpose.

Over the course of the 19th century, the contextual and cultural meaning of ‘nursing’ has altered considerably with the increase in medical knowledge. Before the Civil War, nursing in the United States was a self-declared vocation practiced as a domestic service rather than a skilled craft.[1] Nursing was viewed as the duty of female relatives or neighbors, and developed from the “cultural expectation that caring would be a part of a woman’s duty to family and community.”[2] During the 19th century, care was provided by the women of the house, and sometimes neighbors, but the image of a caregiver was always female. Interestingly, some historians argue that the demand for female nurses increased due to a shortage of male attendants.[3] It was here, that the insipient distinction of ‘nurse’ being a female and ‘physician’ being a male started. Scholars agree that the ideology behind nursing was based more on a woman’s duty rather than her desire to care for others, which lent nursing a purpose, but severely lessened women’s ability to control or define their professional existence and social identity, especially before the Civil War.[4]

The post-Civil War economic social reform played a key role in forging the identity of nursing as a profession. The very ideology behind nursing- women preparing food and supplies, medicating and administering treatments to soldiers started to gain momentum during the Civil War. However, despite various women volunteers working in military based camps and hospitals, very few had training within nursing. The large number of untrained volunteers has surprised many historians; many claim that women became tired of the constrictive and passive roles they held in society, and wanted to actively contribute to the workforce.[5] On the other hand, various women looked at healthcare and taking care of the wounded as a way of fulfilling a patriotic duty, and adding a sense of purpose to their lives. The professionalization of nursing stemmed from the constraints and opportunities women confronted in their lives, and later on, their work. Increasing numbers of women wanted to be able to contribute to a society which was majorly patriarchal in it’s approach towards healthcare.

To analyze the changing societal role of women and its relationship with medicine, I directed my focus towards a key figure: Clara Barton. Clara Barton is a key figure in medical history and social history for various reasons: she founded the American Red Cross, was one of the very few women who held a full time paying government job, and was the first woman nurse to be present on the Civil War battlefield.[6] However, despite this list of incredible achievements, Barton always felt as if she was falling short of her expectations, and not fulfilling the role she was supposed to in society. Barton’s life was almost wholly defined by her achievements; her work was the only thing that gave her a purpose, something she could use to justify her existence. She was depressed, and utterly self-reliant, which she could counter only by immersing herself in excessive work or frantic activity.[7] When the Civil War stated in 1861, Barton arrived at the battlefield to nurse the injured soldiers; Barton discovered her “true calling in life” as she asked for donations and volunteer support, and received tremendous support.[8] A detailed account of Barton’s life can be found here. Barton’s life was truly a life of paradoxes: she was terrified by her life, but fearless on the battlefield, and she transcended expectations of a society whose acceptance she treasured dearly. She sought “the love and adoration missing from her home life” and found it through her nursing.[9] However, Barton could not have been the only woman who felt this way.

Barton’s life can easily be generalized to thousands of other women’s lives. When the Congress approved the use of female nurses in military hospitals in August 1861, thousands of women “volunteered their services to help the sick and wounded soldiers.”[10] Women felt patriotic as well, and since that couldn’t translate into expressing that patriotism into fighting for their country, they decided to nurse those who did; after all, “being a nurse was the next best thing to being a soldier.”[11] Thus, the image of a nurse as a female grew started to become more and more popular, which in turn led to the institutionalization of training for nursing. As the 19th century progressed, various hospitals had adjunct training schools which not only increased the numbers of the hospital workforce, but also increased the productivity of the labor present. A timeline of these events, along with a timeline of the history of nursing globally, can be found here. By the 1890s, there was excess supply of nurses, and nursing was still a disordered and an unstandardized profession. Despite, by now, nursing had started to be recognized as a respectable profession.

Poster that has a picture of a woman knitting with the caption "You can help American Red Cross".
Poster encouraging civilian women to enroll with the American Red Cross as a nurse. Found on Europeana through Creative Commons:

The objective of healthcare was challenged as the societal view of healthcare workers changed. Healthcare was no longer about finding causes of infections and illnesses and removing them; healthcare became more focused on looking after the ill during their time of illness, maintaining their diet and their sanitation. During wars, treating the soldier’s wounds and keeping him alive became the utmost priority, and so, the provision of healthcare became more humanitarian in its approach. The prime example of healthcare’s objective becoming more humanitarian is the American Red Cross. Founded by Clara Barton in 1881, the Red Cross alongside the International Red Cross Foundation, were the chief architects in constructing a humanitarian vision for healthcare.[12] They not only provided relief and aid during wars and natural disasters, but also helped in professionalizing and standardizing the process of assembling and organizing various volunteers and healthcare workers. The American Red Cross had established protocols to follow during wars after the Civil War, such as the Spanish-American War of 1898 and World War I (1914-1918). More information on the Red Cross and their efforts can be found here.

Furthermore, the American Red Cross is also a symbol of Clara Barton going against the cultural and societal expectation of caring being her duty rather than being her right. Scholars have also noticed various parallels between the role of women in her home and her role as a nurse; they have also pointed out how failing to fulfill a domestic expectation, such as bearing children, resulted in compensation in the form of caring for someone else. Some have pointed out the nurse’s role being watching “over a stranger of whom she was thoughtfully tender as any mother.”[13] Interestingly, after the rise in the number of female healthcare workers, the image of the nurse or caregiver as a female started to be promoted even more. Nurses were started to be advertised as the equivalent of mothers and sisters when it came to taking care. Women were actually now being encouraged to join the healthcare industry because the image of a woman as the face of healthcare workers helped the ill and the wounded feel more comfortable. Nurses were slowly transforming the way healthcare was being viewed, and were becoming the face of the new humanitarian side of healthcare.

Nursing is a great example of the experience and meaning of women’s work in society, and how the development of nursing ultimately changed the crux of the relationship between healthcare and society. Evolving from a domesticated womanly duty to a worthy vocation for women, nursing has provided various women active roles in medicine and society, and helped immensely in shifting the focus of healthcare to become more humanitarian. We must note the importance of professionalized nursing and how it helped healthcare become more humanitarian. In a time where women struggled to define their social identity other than by what society expected of them, nursing gave them the opportunity to seize control of how they wanted to define their work and their lives. Nursing evolved greatly throughout the 20th century as well, and alongside developed greater issues within its inner workings; there were problems of authority between nurses and physicians, and the stigma of male nurses brought with it an entirely different debate about gender roles in medicine.Nursing has had and will continue to have new developments, but understanding the beginnings and the subsequent development is important in order to understand how the relationship between nursing and healthcare has evolved.


[1] Barbara Melosh, “The Physician’s Hand”: Work Culture and Conflict in American Nursing. (Philadelphia: Temple University Press, 1982), 3.

[2] Susan M. Reverby, Ordered to Care: The Dilemma of American Nursing, 1850-1945 (Cambridge [Cambridgeshire]: Cambridge University Press, 1987), 2.

[3] Larry G Eggleston, Women in the Civil War: Extraordinary Stories of Soldiers, Spies, Nurses, Doctors, Crusaders, and Others (Jefferson, N.C.: McFarland, 2003), 169.

[4] Reverby, Ordered to Care, 5.

[5] Eggleston, Women in the Civil War, 169.

[6] David H. Burton, Clara Barton: In the Service of Humanity (Westport, Conn.: Greenwood Press, 1995).

[7] Elizabeth B. Pryor, Clara Barton: Professional Angel (Philadelphia: University of Pennsylvania, 1988).

[8] Eggleston, Women in the Civil War, 168.

[9] Pryor, Clara Barton.

[10] Eggleston, Women in the Civil War, 173.

[11] Reverby, Ordered to Care, 4.

[12] Burton, Clara Barton, 99.

[13] Eggleston, Women in the Civil War, 174.

Further Reading

Barton, Clara. The Story of My Childhood (Meriden, Conn.: Journal Publishing Company, 1907).

Dulles, Foster R.  The American Red Cross: A History (New York: Harper and Brothers, 1950).

D’Antonio, Patricia. Nurses’ Work: Issues Across Time and Place (New York: Springer Pub., 2007).