Letters of Civil War Nurses are Windows into the Past

First-hand accounts

It’s difficult to comprehend the terrible hardship and suffering endured during the American Civil War. Historians’ writings help us visualize that era. Eyewitness accounts offer readers an intimate glimpse into the horror and chaos. Among those who provide invaluable perspectives about that time are the many women who served as Civil War nurses. Civil War nurses tirelessly worked in overcrowded hospitals and makeshift facilities across Washington, Baltimore, Richmond, and Nashville, aboard hospital ships along the Atlantic coast, and sometimes in dangerous field hospitals that sprang up just behind the battle lines.

Civil war nurses’ work was spontaneous and improvised, exhausting, and nearly always unrecognized. Despite these challenges, their letters, diaries, and later memoirs stand as some of the most vivid windows into the war’s devastating human cost.

Washington, DC. 1861: Picnicking at the Battle of Bull Run 

The carefree afternoon of entertainment for the city’s affluent and ignorant elite turned into a panicked and hysterical retreat of carriages. The Battle of Bull Run in July 1861 was not the anticipated social event they had expected. Once the cannon roared and the smoke and screams became deafening, the mood shifted dramatically. 

There had been lots of laughter and lively banter coming from the fine suits and fancy dresses, but that stopped abruptly. Suddenly, the opera glasses, plates of chicken, and champagne spilled everywhere as mad chaos ensued. Carriages violently rushed forward, wildly throwing riders out, and others being run over by the carriage wheels, and yells of “those damn Johnny Rebs.” Consequently, the nation’s capital was unprepared for the Southerners’ response. 

Hospitals Overwhelmed

When the wounded started arriving, doctors and city officials immediately recognized that the hospitals would soon be overwhelmed. Within hours, the number of casualties forced them to use every available church, government building, and even private home. Volunteers and residents threw together makeshift shelters to offer the injured some measure of comfort. The blistering heat pushed temperatures above 100 degrees Fahrenheit, worsening the suffering.

Harriet Patience Dame

Harriet Dame was a volunteer nurse from New Hampshire and was training in the city. She wrote an entry in her diary that night: “We can hear the cannon very plainly, and it makes my heart ache to think how many of our poor boys may be suffering. I shall go over tomorrow if I can be of any help to them.”

Clearly upset by the battle, Harriet is deeply worried for the soldiers’ safety and stunned that the war has come so close to the nation’s capital. 

Lincoln’s Generals Had Underestimated the Confederate Army

At the time of the battle, Clara Barton was working as a clerk at the U.S. Patent Office. In a letter to a friend, she described the terrible heat, the dust, and the cries of anguish from the soldiers. She wrote to her friend that most of the city’s people agreed that Lincoln’s generals had underestimated the Confederate Army. 

Confederate Victory at Bull Run 

The Confederate victory at Bull Run solidified the legitimacy of the Southern cause and its formidable army. Southern women, like Judith Brockenbrough McGuire, a volunteer nurse in Richmond, excitedly expressed pride upon hearing the news. In her diary, she wrote, “The whole city is wild with joy.… yet even in the rejoicing there is a trembling of the heart.”  

Southern Cause 

Women decorated streets, rang church bells, and wrote letters celebrating what they believed might be a short war. However, this celebratory mood soon shifted as the wounded began to arrive. 

Civil War nurses came from all walks of life, united in their mission to alleviate suffering during one of the most tumultuous periods in American history.

Judith McGuire – Richmond, Va. 

By nightfall, Judith McGuire was caring for the injured, much like the Union nurses in Washington, DC. Amidst the chaos, the horrors of war became an undeniable reality. Late that night, she penned,  “The wounded are coming in every hour… We women must do what we can; the times will not allow us to be weak.”

Through their bravery and dedication, Civil War nurses became integral to the war effort, often facing the same dangers as soldiers on the battlefield.

Sally Tompkins

Sally Tompkins, also of Richmond, reached the same conclusion as she opened her hospital, called Robertson. “If the men must suffer, then let me be where I may do them the most good.” Their words show how quickly joy gave way to duty, and how the war pushed women into roles they had never imagined for themselves.

Brutal Early Months of War 

The brutal early months of the war revealed the nation’s undeniable need for nurses. Consequently, both sides had underestimated much; they had not factored in the horror of disease and infection, plus the horrendous shock of battle itself. 

Many of the fatalities were not caused by battle but rather by the widespread illnesses contracted from close quarters among thousands of troops. These illnesses were fueled by rampant bacterial, parasitic, and viral infections. It was further exacerbated by poor sanitation and contaminated water sources, all culminating in medical disasters such as dysentery, diarrhea, typhoid fever, malaria, wound infections, and gangrene. 

Women Nurses Rejected by the Surgeon General 

Despite the dangers, women overwhelmingly responded to the call to serve as wartime nurses.  The idea, however, was initially flatly rejected by the Army Medical Bureau. Led by Surgeon General Clement Finley, he argued that women were “unfit for hospital service,” believing they lacked the “physical strength and emotional steadiness” necessary for medical work. Despite Finley’s objections, common sense prevailed. Civil War nurses proved Finley’s beliefs wrong, and the urgent need for women nurses became undeniable.

Caring for the Wounded took Many Shapes 

As the war progressed, so did the shape of Civil War nursing. A small number served as official, paid army nurses, working in hospitals under military authority. The larger number of women were volunteer nurses, recruited by aid societies or simply coming forward to offer help. They were found in hospitals, church halls, barns, and any improvised shelters wherever the wounded gathered. 

Camp Nurses

Camp nurses were wives, mothers, and daughters, or just family members who followed their regiments and helped the wounded after battles.  Sarah “Mother” Bickerdyke was a camp nurse and helped the wounded at the Battle of Shiloh in April 1862. Despite the heavy rain, she moved fearlessly through the crowded barns and fields to attend the fallen soldiers. Because of the intense fighting, some of the men had been unattended for more than a day. She wrote in her diary, “My place is wherever the men fall.” Later, it was said that “Mother” had worked with such certainty that it was felt as if “the whole army trusted her more than any officer.” 

 Local Woman

It was common, moreover, especially in the South, where most of the battles took place, for local women to rush onto the fields once the firing stopped. Like volunteer nurses, they, too, used makeshift structures for field hospitals, for whichever wounded men lay closest, blue or gray. The face of nursing changed, and was driven by both circumstance and necessity.

Woman Volunteer Nurses 

Many women were very enthusiastic about becoming war nurses.  Clara Jones, a young woman training at Christian Street Hospital in Philadelphia, was bursting with impatience when she wrote: 

“If I were in the midst of the distress… lending a helping hand to the poor fellows, I would feel really happy in comparison — but here I am, tied to School.”

Therefore, women volunteered because the war offered a rare opportunity for independence outside the home. The overwhelming suffering of soldiers made them feel they had no right to stand back. Many wrote that they wanted “to be useful,” and nursing gave them a chance to serve. 

The Virginia Peninsula Campaign, Spring 1862

In the spring of 1862, the Union Army came into Virginia and began the Peninsula Campaign, and with it a new wave of casualties. The weather along the Old Dominion’s coastline was wet, sometimes cold, and unpredictable. Rain turned roads into rivers of mud, slowing the evacuation of the wounded. 

Hannah Ropes, a Civil War nurse who served near the front lines, wrote of the “clammy fogs” that engulfed the camps and the “reek of damp wool and unwashed bodies.” She described men lying on straw pallets that quickly became soaked through, their blankets heavy with wet. Supplies were limited, and surgeons washed their instruments in cold water from the nearby creeks and streams. When on the front lines, surgeries were performed in the open, just off the battlefield. 

The conditions faced by Civil War nurses were often dire, yet they persevered and still embodied the spirit of compassion.

Savage Station

In June 1862, in a place called Savage Station located near Richmond, the Union field hospital held more than 2500 wounded. The day was intensely hot, and flies swarmed over the men, drawn by the smell of blood. The nurses were steadily trying to comfort the men by bringing them water, changing dressings, and offering words of encouragement.

The Southern army was closing in, and the wounded were very aware that if their army retreated, they would be left behind. On June 29, the Union army retreated and abandoned hundreds of its men, and Confederate troops captured the hospital. 

One nurse later recalled the “terrible quiet” that fell over the camp as the sound of Union wagons faded into the distance. The men understood what it meant. Some wept. Others stared at the sky, resigned. Nevertheless, when the army left their wounded, they also left the field nurses. Civil War nurses were bound by duty to stay and continue providing care, without regard for their own safety. 

Antietam- September 1862

The weather that week was warm and dry, and the cornfields around Sharpsburg, Maryland, were full and green and yet to be harvested. A few stores, a church, and a small school, were located in Sharpsburg, or as many called it, Antietam, the name of its well-known creek. Such a lovely and quiet place, it was an unlikely spot for such a horrendous loss of life and limb. Consequently, the Battle of Antietam  fought on September 17, was to be known as the bloodiest single day in American history, producing more than 23,000 casualties. 

Clara Barton – “Angel of the Battlefield.”

The battle was brutal from the moment it began, and the wounded and dead began to pile up quickly. In the midst of the mad chaos of deadly fire, Clara Barton arrived on the live battlefield with wagons of much-needed medical supplies. The wagons had traveled all night, and Clara was in the lead wagon.

Self-taught nurse

Clara was a self-taught nurse and was affectionately known as the “Angel of the Battlefield.” Her courage and kindness were legendary, and she was remembered for her unwavering determination in the face of death. Many stories recount her solitary journeys across the bloodiest and deadliest battlefields, carrying supplies and medicines to the wounded. 

Once the wagons were unloaded, Barton assisted the surgeons who were performing amputations in open areas near the battlefield. She held lanterns, fetched water, and tore strips of cloth for bandages. At one point, a bullet passed through her sleeve and killed the man she was tending. She wrote of the moment with characteristic restraint: “A strange thing happened — a sudden jar, a quick cry — and the poor fellow at my feet was gone.”

Battle of Fredericksburg – December 1862 

Snow fell on the wounded as they lay on the frozen ground. Nurses who arrived after the battle found men stiff with cold, their breath visible in the frigid air. One wrote that the “wind cut like a knife” as she tried to light a lantern to guide the surgeons’ hands.

By the end of 1862, the Union Army had suffered another devastating defeat at Fredericksburg, Virginia. The result was a staggering loss of nearly 15,000 Union soldiers, while the Confederates sustained fewer than 4,000 casualties. 

Surgeons tents

The surgeons’ tents were scenes of relentless activity. Amputations were performed in assembly-line fashion. Nurses learned to steady men during operations, to speak softly into their ears, to hold their hands as the saws worked. Many later wrote that the screams were the hardest part — not the volume, but the “rawness”.

Louisa May Alcott 

Many of the Union wounded were treated in Washington hospitals. Louisa May Alcott described the sounds of the “ceaseless tramp of feet” echoing through the corridors and the “sickening odor” of the hospital wards. 

Louisa wrote that the overwhelming number of patients meant they had to be packed tightly together, and nurses had to turn sideways to pass between them. The war left her with memories she never shook: the fevers, the amputations, and the quiet courage of the men she tended. She later wrote that the work taught her “the patience, the pity, and the pain that make up a nurse’s life.”

Chimborazo Confederate Hospital, Richmond, Va. 

The Confederate wounded were temporarily cared for in makeshift hospitals, homes, churches, and vacant buildings in and around Fredericksburg. Large numbers were transported back to Richmond to the Chimborazo Hospital; moreover, by 1865, it had expanded so much that it was considered the largest hospital in the world. 

Phoebe Yates Pember, age 39, the Head Nurse at Chimborazo Hospital, had pondered her decision to leave the comforts of home in Tennessee to help, and wrote: “I could not stand idle while our poor fellows lay in want of the simplest care.”  

Hospital Ships: The Floating Wards

Mary Phinney von Olnhausen was widowed and considerably older than most of the other nurses. She left her home in Massachusetts and served aboard the hospital ship Daniel Webster. She noted the “constant motion” of the vessel and the struggle to keep dressings dry, describing the mix of “salt air, damp wood, and antiseptic” that clung to everything below deck. When the ship finally reached New York or Philadelphia, she felt deep relief, knowing that steadier ground, fresh supplies, and better chances for her patients awaited at the dock.

By 1863, the Union was sending its wounded north on hospital ships, many of them converted steamers with cramped wards. Nurses wrote of calm days when the decks smelled of salt and sunlight, followed by nights when storms tossed the ship so violently that lanterns swung and the wounded groaned in their hammocks.

As the war progressed, the contributions of Civil War nurses became increasingly recognized, shaping the future of nursing.

Gettysburg, 1863

When nurses arrived in the days after the fighting, they found the fields littered with bodies and the wounded lying in barns, churches, and private homes. Cornelia Hancock, a 23‑year‑old volunteer nurse, reached Gettysburg on July 6. She wrote that the “stench of death was overpowering” and that the sight of the wounded “beggared all description.” She described men lying in rows, their wounds crawling with maggots — a detail she noted not with horror but with clinical observation, as maggots often prevented infection.

Civil war nurses played a pivotal role in providing care during the aftermath of battles, serving as a vital support system for soldiers.

Hancock worked in a barn where the heat was stifling. The smell of manure mixed with the odors of blood and infection was nearly unbearable. She wrote of wiping sweat from her face with a sleeve already stiff with dried blood. Yet she also noted moments of grace: a soldier who asked her to sing a hymn; another who pressed a small Bible into her hand as thanks.

Lee’s Retreat 

Although medical staff, such as surgeons and doctors, came, the  Confederate army did not bring its own nurses with them to Pennsylvania. When Robert E. Lee’s army retreated on July 4, 1863, its medical staff did so as well, although some were captured. 

At a Richmond hospital, Fannie Beers  described the arrival of Gettysburg wounded: “The Gettysburg men came to us exhausted, many scarcely able to speak of what they had endured.” 

Nonetheless, the nurses at Gettysburg faced shortages of everything — water, bandages, food. They improvised constantly. One wrote of tearing her own petticoats into strips for dressings. Another described boiling water over a fire built from fence rails scavenged from nearby fields.

Shortages, Disease, and Southern Hospitals

In Nashville’s sprawling hospital complex, winter winds blew through cracks in the walls. Nurses wrapped themselves in shawls as they moved from bed to bed. Pneumonia and dysentery were also constant threats. One nurse wrote of “the endless coughing” that echoed through the wards at night.

In Richmond, Confederate nurses faced even greater shortages. The city was under strain from the Union blockade, and supplies were scarce. Sally Tompkins, who ran the Robertson Hospital, kept meticulous records and maintained strict standards of cleanliness. Furthermore, her hospital had one of the lowest mortality rates in the Confederacy, a fact recognized when Jefferson Davis commissioned her as a captain — the only woman to hold that rank.

Final Years 

Most women had entered service with determination, but by 1864, they were working in hospitals stripped of bandages, medicines, blankets, and even soap. Their words capture the bleakness of the Confederacy’s final years and the burden that fell on the women who tried to keep its wounded alive.

Kate Cumming, who served with the Army of Tennessee, was exhausted, angry, and surrounded by deprivation. Her diary gives one of the sharpest surviving descriptions of how bad things had become:

“We are nearly worn out for want of the commonest necessities… everything is scarce, and the suffering is dreadful.”

The War’s End 

When the war ended in April 1865, the majority of Civil War nurses returned home, taking memories that would profoundly influence the rest of their lives. Some, however, chose to write memoirs; others opted for silence. However, their diaries and letters collectively paint a vivid picture of a shared emotional landscape. It was characterized by exhaustion, grief, pride, and an enduring sense of unreality.

Their stories also remind us that Civil War nurses were not only caregivers but also pioneers who forged new paths in healthcare.

Louisa May Alcott

Louisa May Alcott wrote that the war had “burned itself into my mind.” While serving as a Union nurse, she contracted severe typhoid fever, and it left her with debilitating lifelong health issues. After the war, she became widely popular for her novels, including Little Women (1868), Good Wives (1869), and Little Men (1871).

Clara Barton

After the war, Clara Barton spent years helping families to find their missing soldiers. She founded the American Red Cross and served as its driving force.

Cornelia Hancock

Cornelia Hancock continued humanitarian work for the remainder of her life. She opened a school for African Americans in Mount Pleasant, South Carolina, and founded several charity organizations. She was a founding member of the Children’s Aid Society and helped children orphaned after the Johnstown Flood of 1889.

Final Thoughts

Their accounts are not heroic in the traditional sense. They are part of the fabric in the daily realities of caring for the wounded; the weight of a man’s head as he drinks from a cup, the foul smell of antiseptics and the stench of hospital wards, the sound of boots on a hospital floor at midnight, and remembering the small encouragements given to dying men. Also, they remind us that the Civil War was not just a clash of armies, but also a profound human crisis. Additionally, the crisis demanded compassion as much as military planning and, of course, bravery. 

A poignant and fitting final sentiment was left by Phoebe Pember: “I have witnessed such immense suffering that I often wonder how the heart can endure it and continue to function.”  Phoebe Y. Pember, Richmond, 1865

Related Reading

• Antietam and the 1862 Midterm Elections
• Confusion and Anxiety: Lincoln and the Days Before the War
• Civil War Surgeons: The Other Nightmare

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